BACKGROUND:Vestibular migraine (VM), and probable vestibular migraine (VPM), are frequent causes of vertigo. The objective of this study was to establish the prevalence of hearing loss and cochleovestibular paresis in patients with VM and PVM. METHODS:Retrospective cohort study of adult patients seen between 01/2024 and 12/2025, diagnosed with VM or PVM. Demographics, family history of migraine and results of audiometry, videonystagmography (VNG), and VHIT were evaluated. This study was approved by the local ethics committee. RESULTS:A total of 470 patients we included: 53% had VM, 47% PVM. Overall, most were women (79%), average age 51.1 ± 15.2 years. 61% had a hearing test, and 40% had hearing loss. Most were mild-moderate, 51% had unilateral hearing loss and 6.6% had an event of documented cochleovestibular paresis. There were no differences between prevalence or degree of hearing loss or cochleovestibular paresis between VM and PVM. VNG abnormal findings were seen in 88%, most commonly central positional nystagmus, and 56% had an abnormal VHIT. Family history of migraine was greater in the VM group (64% vs 49%). CONCLUSION:Both VM and PVM patients show a high prevalence of hearing loss and vestibular abnormalities, with no significant differences in severity or clinical presentation between groups. These findings support the concept that VM and PVM represent a single pathophysiology continuum, The family history of migraine remains the most reliable clinical differentiator in the diagnostic spectrum. There appears to be no significant differences between VM and PVM with regards to hearing loss or cochleovestibular paresis. The main differences between both groups is family history of migraine.
BACKGROUND:High-frequency bone-conducted vibration (BCV) and skull vibration-induced nystagmus (SVIN) are widely used to probe vestibular function, yet their physical nature and physiological targets remain incompletely defined. In particular, the relationship between vibration physics and jerk, the time derivative of acceleration, and their relevance to vestibular activation has not been systematically explored. OBJECTIVE:To develop an engineering-informed framework for high-frequency vestibular stimulation, linking jerk-rich transient stimuli to otolithic biomechanics and vestibular signal processing, and translating this framework into practical guidance for interpreting BCV-evoked vestibular-evoked myogenic potentials (VEMPs) and SVIN. METHODS:This narrative review integrates: (1) mechanical analysis of sinusoidal motion, quantifying how displacement, velocity, acceleration and jerk scale with frequency; (2) contemporary vestibular physiology on Type I and Type II hair cells, calyx synapses and irregular versus regular afferents; and (3) experimental and clinical data on BCV, high-frequency sound, oVEMPs, cVEMPs and SVIN in health and vestibular disease. RESULTS:For a sinusoid of fixed displacement amplitude, velocity scales with angular frequency (ω), acceleration with ω² and jerk with ω³. At 60-100 Hz, jerk becomes a prominent macroscopic descriptor of the stimulus, not a directly encoded neural variable, reflecting rapid temporal transients and the dynamic filtering of otolithic macular mechanics. In parallel, Type I hair cells, calyx endings and irregular afferents form a transient, high-bandwidth vestibular pathway characterized by high gain, phase leads at higher frequencies and strong phase locking to high-frequency BCV and sound. The Type I-calyx complex supports multiple transmission modes, including ultra-fast resistive coupling, capable of transmitting rapid receptor-potential changes generated by mechanical transients at the sensory epithelium. Animal and human data indicate that BCV and high-frequency sound preferentially activate irregular otolithic and canal afferents. Accordingly, BCV-evoked oVEMPs, cVEMPs and SVIN provide complementary readouts of this rapid-transient vestibular pathway. In unilateral vestibular loss, Ménière's disease and third-window syndromes, this framework helps explain why vibratory responses may remain abnormal, or even exaggerated, despite partially normal caloric or vHIT findings. CONCLUSIONS:High-frequency BCV should not be interpreted simply as "very high-frequency rotation", but as a rapid transient mechanical stimulus shaped by otolithic biomechanics and high-bandwidth afferent pathways. BCV-evoked oVEMPs and cVEMPs reflect rapid transient otolithic activation recorded in extraocular and neck muscles, while SVIN reflects the time-integrated imbalance of rapid transient vestibular signals across canal-otolith pathways. Incorporating this dual-channel, biomechanics-informed perspective may improve test selection, pattern recognition and disease-specific interpretation in vestibular clinics.
INTRODUCTION:Given that today's cochlear implant (CI) candidates frequently present with substantial residual low-frequency hearing, the preservation of residual hearing is becoming an increasingly crucial but as yet inadequately resolved aspect of CI surgery. A recent study has shown that a 15-minute treatment with light in the red to near-infrared range (NIR) before the insertion of a CI array resulted in a significant reduction of hearing loss, especially in the frequency range of residual hearing, accompanied by significant conservation of outer hair cells. Given that the total number of rescued hair cells was insufficient to account for the substantial reduction in hearing loss observed, the present study aims to investigate the potential protective effect of NIR on spiral ganglion neurons and ribbon synapses in the context of CI surgery. METHODS:Guinea pigs underwent initial auditory brainstem response (ABR) recordings separately for each ear. Subsequently, unilateral NIR irradiation of the cochlea was performed, followed by bilateral insertion of guinea pig-sized electrode arrays. After 4 weeks, the ABR measurement was repeated and the cochleae were collected for histological analysis of spiral ganglion neurons and ribbon synapses. RESULTS:A significant reduction of hearing loss was found on the NIR treated side across the entire frequency range tested. The number of ribbon synapses was not affected by the insertion of an electrode array, and could therefore, not be influenced by NIR treatment. Spiral ganglion neurons were significantly reduced 4 weeks after implantation. This effect was rescued by NIR treatment, specifically in the basal portion of the cochlea. CONCLUSION:These findings show a neuroprotective effect of NIR on SGNs, which may be crucial not only for the protection of residual hearing but also for the electrical stimulation of SGNs via a CI.
Introduction Despite advances in soft surgery, intra-cochlear trauma during CI electrode insertion still occurs, potentially damaging cochlear micro-structures and affecting hearing outcomes or future treatments. While the round window membrane (RWM) approach is generally less traumatic, the hook region's complex anatomy can still cause mechanical injury, often due to limited visual guidance. Preoperative imaging and intraoperative Optical Coherence Tomography (OCT) could reduce trauma by offering high-resolution, real-time visualization of cochlear micro-structures. Methods Eight fresh-frozen human temporal bones (TB1-TB8) were included. The first six specimens (TB1-TB6) underwent micro-CT scanning with manual segmentation to establish detailed anatomical baselines and served for OCT-micro-CT co-registration. Following a standard cochlear implantation approach, intra-cochlear structures behind the round window membrane (RWM) were visualized using a microscope-integrated OCT system, with additional imaging performed via an anteroinferior cochleostomy to compare access routes. Electrode insertions were performed under OCT guidance in selected specimens, while feasibility of intraoperative workflow and insertion dynamics was assessed in TB7-TB8 under fluoroscopic control. Results OCT images were successfully obtained for each TB, with proper RWM exposure being crucial. The OCT microscope enabled scanning of the RWM and scala tympani (ST) from various axes, depths, and angles at a surgical working distance, improving assessment of proximal ST anatomy. OCT appears reliable for evaluating micro-anatomy through the RWM, guiding CI electrode selection, approach, and proximal array course modification during insertion. By visualizing critical structures and inferring deeper ones, it supports preoperative imagery-based planning and may reduce the risk of intracochlear damage. Conclusion Intra-operative OCT imaging enhances the precision of cochlear opening site and electrode insertion axis. By integrating OCT, CI surgery could shift from a largely blind procedure to one with significant visual guidance, reducing surgical trauma and improving postoperative hearing preservation.
BACKGROUND AND OBJECTIVE:Cisplatin exhibits a steep dose-response relationship, wherein its therapeutic efficacy increases significantly with higher doses. This dose escalation, however, is limited by severe adverse effects, notably ototoxicity, which can lead to permanent and disabling hearing loss. The objective of this review was to evaluate the potential efficacy of intratympanic steroid administration (ITD) in preventing cisplatin-induced hearing loss (CiHL). MATERIALS AND METHODS:A systematic literature search was conducted using PubMed, Cochrane Library, and Scopus databases for evidence-based research articles published between January 2004 and July 2023. The search strategy focused on intratympanic steroids for cisplatin-related ototoxicity. Two independent reviewers performed the search, screening, and study selection according to predefined PICOS (Population, Intervention, Comparison, Outcome, Study design) criteria. Only randomized controlled trials (RCTs) involving patients receiving cisplatin and treated with an intratympanic steroid regimen were included. The review process adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RESULTS:The initial database and manual searches identified 383 records. Following title and abstract screening, 42 articles underwent full-text review. After applying the eligibility criteria, 38 studies were excluded, resulting in four RCTs for qualitative synthesis. Risk of bias (RoB) assessment revealed a high-risk concerning allocation concealment in all four studies. Additionally, a substantial risk of detection bias was present in three RCTs. According to the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework, the overall quality of evidence was rated as high in one study, moderate in two, and low in one. CONCLUSION:This review did not confirm a consistent otoprotective benefit of intratympanic steroid administration against CiHL. None of the included studies demonstrated high-quality evidence for a significant protective effect. The available RCTs report inconsistent outcomes and collectively fail to establish a definitive therapeutic advantage for ITD in this context. These discrepancies may be attributable to methodological variations across studies, including differences in steroid dosage, concentration, timing of administration relative to cisplatin therapy, and patient populations. Further rigorously designed RCTs with standardized protocols are warranted to definitively assess the potential role of ITD in mitigating cisplatin ototoxicity.
