Objective: To assess the prevalence of vestibular migraine (VM) in patients consulting to an otol... more Objective: To assess the prevalence of vestibular migraine (VM) in patients consulting to an otolaryngology clinic, the neurootological associated symptoms, and the effect of prophylactic antimigrainous medication on VM symptom improvement. Study Design: Retrospective chart review. Setting: Tertiary referral otolaryngology clinic. Subjects and Methods: We used the diagnostic criteria from the Bárány Society and the International Headache Society to allocate patients to a subgroup: VM, possible VM, and atypical VM. Main Outcome Measure: The prevalence of VM, percentages of associated neurotological symptoms, and percentages of effectiveness of prophylactic medication. Results: Sixty-five (16%) patients were selected from the total patient population (n = 407) from which 4.2% were assigned to the definite VM group, 5.7% to the probable VM group, and 6.1% to the atypical VM group. We found a significantly different distribution between the groups for photophobia (p = 0.035), ear pressure (p = 0.023), and scotoma (p = 0.015). Thirty patients were administered with flunarizine and 68% responded with an improvement in VM symptoms (p G 0.001). For propranolol, 31 patients were treated and there was an improvement of symptoms in 73% (p G 0.001). Remarkable was the fact that these percentages were not significantly different between the subgroups. Conclusion: VM is a common disorder presenting in a dizziness clinic, and detailed history taking is important to assess VMassociated symptoms and thus to prevent underdiagnosis. The latter is very important because our study shows that the majority of patients, regardless of VM subtype, can benefit from a prophylactic treatment, but further prospective studies are necessary.
... At present, the members of the commission are Professors Christian Desloovere, Naïma Deggouj,... more ... At present, the members of the commission are Professors Christian Desloovere, Naïma Deggouj, Floris Wuyts and Doctors Sarah Casteleyn, Stéphane Dejardin, Anne Englebert, Chantal Gilain, Catherine Hennaux, Christian Van Nechel. ...
The utricle plays an important role in orientation with respect to gravity. The unilateral centri... more The utricle plays an important role in orientation with respect to gravity. The unilateral centrifugation test allows a side-by-side investigation of both utricles. During this test, the subject is rotated about an earth-vertical axis at high rotation speeds (e.g. 400°/s) and translated along an interaural axis to consecutively align the axis of rotation with the left and the right utricle. A simple sinusoidal translation profile (0.013 Hz; amplitude = 4 cm) was chosen. The combined rotation and translation induces ocular counter rolling (OCR), which is measured using 3-D video-oculography. This OCR is the sum of the reflexes generated by both the semicircular canals and the utricles. In this paper, we present a new physiological model that decomposes this total OCR into a canal and a utricular contribution, modelled by a second-order transfer function and a combination of 2 sine functions, respectively. This model yields parameters such as canal gain, cupular and adaptation time co...
Background: Orbiter landing data show decrements in pilot performance following spacefl ight comp... more Background: Orbiter landing data show decrements in pilot performance following spacefl ight compared to prefl ight simulated landings. This study aimed to characterize pilot head-eye coordination during simulated orbiter landings, and relate fi ndings to microgravity-related spatial disorientation. Methods: Orbiter landings were simulated in an A340-300 simulator fl own by six pilots. Turns about the Heading Alignment Circle (HAC) to align the orbiter with the runway were simulated by 45° banking turns. Final approach was simulated with an 11° glide slope from an altitude of 4267 m, with prefl are at 610 m and touchdown at 200 kn. Orbiter landings were also performed in the Vertical Motion Simulator (VMS) at NASA Ames by a NASA test pilot. Results: A340: During the HAC maneuver the head and eyes rolled toward the visual horizon with a combined gain of 0.14 of bank angle. Pilots alternated fi xation between the instruments and the runway during fi nal approach, almost exclusively focusing on the runway after prefl are. Optokinetic nystagmus was observed during rollout. VMS: Head and eye roll tilt when rounding the HAC were of similar magnitude to that observed in the A340. During fi nal approach the Heads-Up Display (HUD) reduced pitch head and eye movement. Conclusions: Roll tilt of the head and eyes during the HAC tended to align the retina with the visual horizon. Overlaying critical fl ight information and the approaching runway with the HUD reduced pitch head and eye movement during orbiter fi nal approach in the VMS relative to the A340 (no HUD installed).
Objectives. Teachers are at increased risk for developing voice disorders. Occupational risk fact... more Objectives. Teachers are at increased risk for developing voice disorders. Occupational risk factors have been extensively examined; however, little attention has been paid to the consequences of the vocal complaints. The objective of this study was to investigate the knowledge that teachers have about vocal care, treatment-seeking behavior, and voice-related absenteeism. Methods. The study group comprised 994 teachers and 290 controls whose jobs did not involve vocal effort. All participants completed a questionnaire inquiring about vocal complaints, treatment-seeking behavior, voice-related absenteeism, and knowledge about vocal care. Comparisons were made between teachers with and without vocal complaints and with the control group. Results. Teachers reported significantly more voice problems than the control population (51.2% vs 27.4%) (c 2 ¼ 50.45, df ¼ 1, P < 0.001). Female teachers reported significantly higher levels of voice disorders than their male colleagues (38% vs 13.2%, c 2 ¼ 22.34, df ¼ 1, P < 0.001). Teachers (25.4%) sought medical care and eventually 20.6% had missed at least 1 day of work because of voice problems. Female teachers were significantly more likely to seek medical help (c 2 ¼ 7.24, df ¼ 1, P ¼ 0.007) and to stay at home (c 2 ¼ 7.10, df ¼ 1, P ¼ 0.008) in comparison with their male colleagues. Only 13.5% of all teachers received information during their education. Conclusions. Voice disorders have an impact on teachers' personal and professional life and imply a major financial burden for society. A substantial number of teachers needed medical help and was obligated to stay at home because of voice problems. This study strongly recommends the implementation of vocal education during the training of teacher students to prepare the vocal professional user.
The purpose of this study was to provide age specific normative data of clinical gait and balance... more The purpose of this study was to provide age specific normative data of clinical gait and balance tests and to determine to what extent gender contributes to differences in postural control. Standing balance and walking performance was tested in 318 asymptomatic adults. The logistic regression, using both 10- and 30-second time limits as a dichotomization point, revealed a significant age effect for standing on foam with eyes closed, tandem Romberg with eyes closed (TR-EC), and one leg stance (eyes open and closed). The actual effect of decline was different for each test. Both tandem gait and dynamic gait index showed a ceiling effect up to 60 years of age, with a rapid decline of performance for subjects in their seventies. Linear regression equations indicated that for both men and women, timed up and go test (TUG) times increased with age, but even older subjects should perform the TUG in 10 seconds or less. Women performed significantly poorer on the TUG and TR-EC (30-second time limit).
Sixty-eight students of a school for audiovisual communication participated in this study. A part... more Sixty-eight students of a school for audiovisual communication participated in this study. A part of them, 49 students, received voice training for 9 months (the trained group); 19 subjects received no specific voice training (the untrained group). A multidimensional test battery containing the GRBAS scale, videolaryngostroboscopy, Maximum Phonation Time (MPT), jitter, lowest intensity (IL), highest frequency (FoH), Dysphonia Severity Index (DSI) and Voice Handicap Index (VHI) was applied before and after training to evaluate training outcome. The voice training is made up of technical workshops in small groups (five to eight subjects) and vocal coaching in the ateliers. In the technical workshops, basic skills are trained (posture, breathing technique, articulation and diction), and in the ateliers, the speech and language pathologist assists the subjects in the practice of their voice work. This study revealed a significant amelioration over time for the objective measurements [Dysphonia Severity Index: from 2.3 to 4.5 ( P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001)] and the self-evaluation [Voice Handicap Index, from 23 to 18.4 ( P=0.016)] for the trained group only. This outcome favors the systematic introduction of voice training during the schooling of professional voice users.
Using actual diagnostic criteria, the diagnosis of certain Menière's disease remains impossible d... more Using actual diagnostic criteria, the diagnosis of certain Menière's disease remains impossible during life without histopathologic confirmation. Assessing the value of a diagnostic test is difficult due to the lack of a gold standard. Recent studies reported on the use of MRI after intratympanic gadolinium injection to demonstrate endolymphatic hydrops in vivo. We evaluate whether MRI after intratympanic gadolinium administration is useful for predicting the effect and outcome of intratympanic gentamicin therapy. The correlation between transtympanic electrocochleographic (TT-ECoG) results and hydrops grade on MRI images is also investigated. Twelve definite Menière's disease patients with incapacitating vertigo attacks, not responding to drug and behavioral treatment, were selected for partial chemolabyrinthectomy with intratympanic gentamicin. All patients underwent transtympanic electrocochleography followed by surgical middle ear inspection, partial chemolabyrinthectomy (gentamicin solution 40 mg/ ml applied during 60 min) and intratympanic gadolinium injection with clear exposure of the round window membrane. The MR images were reviewed and a hydrops grade was assigned. Correlation between the hydrops grade and the electrocochleographic data was assessed. Only 5 of 12 patients showed gadolinium enhancement in the inner ear. However, 6 of the 7 patients that did not show postoperative intracochlear or intralabyrinthine gadolinium distribution did report the clinical improvement after intratympanic gentamicin therapy. Hydrops grade correlated with the result of transtympanic electrocochleography in four of five cases that showed gadolinium enhancement. We conclude that the use of intratympanic gadolinium has no added value in predicting the clinical outcome of intratympanic gentamicin application. However, based on these data, a correlation between the result of TT-ECoG and hydrops grading on MRI images can be suggested.
The results of several studies have indicated that patients aged over 80 years were at greater ri... more The results of several studies have indicated that patients aged over 80 years were at greater risk if they needed cardiac surgery, including aortic valve replacement for aortic valve disease (1-4). Nevertheless, results were considered as rewarding if the operation was performed before damage to the cardiac muscle develops (1,2,5). Despite these reports, surgery was sometimes not recommended, solely on the basis of age of the patients. This could lead to the progression of valve disease requiring urgent surgical intervention, or to sudden death. Between December 1986 and January 2000, in this retrospective study, 500 patients received a Carpentier-Edwards pericardial prosthesis in the aortic position. Coronary artery bypass grafting (CABG) was also performed in 348 of the patients. The median age of the patients was 73 years (interquartile range: 71 to 77 years), and 60 were aged 80 years or more. The preoperative profile for all patients is included in Table . Need for medication included digitalis, usually in combination with diuretics and an angiotensin-con-Presented as a poster at the Second Biennial Meeting of the Society for Heart Valve Disease, 28th June-1st July, Palais des Congrès,
The purpose of this study was to provide age specific normative data of clinical gait and balance... more The purpose of this study was to provide age specific normative data of clinical gait and balance tests and to determine to what extent gender contributes to differences in postural control. Standing balance and walking performance was tested in 318 asymptomatic adults. The logistic regression, using both 10- and 30-second time limits as a dichotomization point, revealed a significant age effect for standing on foam with eyes closed, tandem Romberg with eyes closed (TR-EC), and one leg stance (eyes open and closed). The actual effect of decline was different for each test. Both tandem gait and dynamic gait index showed a ceiling effect up to 60 years of age, with a rapid decline of performance for subjects in their seventies. Linear regression equations indicated that for both men and women, timed up and go test (TUG) times increased with age, but even older subjects should perform the TUG in 10 seconds or less. Women performed significantly poorer on the TUG and TR-EC (30-second ti...
This review describes the practicalities of using both the inner Ear Profile to define hydrops la... more This review describes the practicalities of using both the inner Ear Profile to define hydrops labyrinthi, and the American Academy of Otolaryngology and Head and Neck Surgery (AAO-HNS) guidelines to define Meniere&amp;amp;#39;s disease. The requirement for standardisation is stressed since either system alone may be inadequate. It is suggested that the Inner Ear Profile could be adapted to the AAO-HNS criteria to create a unified method of evaluation.
Objective: To assess the prevalence of vestibular migraine (VM) in patients consulting to an otol... more Objective: To assess the prevalence of vestibular migraine (VM) in patients consulting to an otolaryngology clinic, the neurootological associated symptoms, and the effect of prophylactic antimigrainous medication on VM symptom improvement. Study Design: Retrospective chart review. Setting: Tertiary referral otolaryngology clinic. Subjects and Methods: We used the diagnostic criteria from the Bárány Society and the International Headache Society to allocate patients to a subgroup: VM, possible VM, and atypical VM. Main Outcome Measure: The prevalence of VM, percentages of associated neurotological symptoms, and percentages of effectiveness of prophylactic medication. Results: Sixty-five (16%) patients were selected from the total patient population (n = 407) from which 4.2% were assigned to the definite VM group, 5.7% to the probable VM group, and 6.1% to the atypical VM group. We found a significantly different distribution between the groups for photophobia (p = 0.035), ear pressure (p = 0.023), and scotoma (p = 0.015). Thirty patients were administered with flunarizine and 68% responded with an improvement in VM symptoms (p G 0.001). For propranolol, 31 patients were treated and there was an improvement of symptoms in 73% (p G 0.001). Remarkable was the fact that these percentages were not significantly different between the subgroups. Conclusion: VM is a common disorder presenting in a dizziness clinic, and detailed history taking is important to assess VMassociated symptoms and thus to prevent underdiagnosis. The latter is very important because our study shows that the majority of patients, regardless of VM subtype, can benefit from a prophylactic treatment, but further prospective studies are necessary.
... At present, the members of the commission are Professors Christian Desloovere, Naïma Deggouj,... more ... At present, the members of the commission are Professors Christian Desloovere, Naïma Deggouj, Floris Wuyts and Doctors Sarah Casteleyn, Stéphane Dejardin, Anne Englebert, Chantal Gilain, Catherine Hennaux, Christian Van Nechel. ...
The utricle plays an important role in orientation with respect to gravity. The unilateral centri... more The utricle plays an important role in orientation with respect to gravity. The unilateral centrifugation test allows a side-by-side investigation of both utricles. During this test, the subject is rotated about an earth-vertical axis at high rotation speeds (e.g. 400°/s) and translated along an interaural axis to consecutively align the axis of rotation with the left and the right utricle. A simple sinusoidal translation profile (0.013 Hz; amplitude = 4 cm) was chosen. The combined rotation and translation induces ocular counter rolling (OCR), which is measured using 3-D video-oculography. This OCR is the sum of the reflexes generated by both the semicircular canals and the utricles. In this paper, we present a new physiological model that decomposes this total OCR into a canal and a utricular contribution, modelled by a second-order transfer function and a combination of 2 sine functions, respectively. This model yields parameters such as canal gain, cupular and adaptation time co...
Background: Orbiter landing data show decrements in pilot performance following spacefl ight comp... more Background: Orbiter landing data show decrements in pilot performance following spacefl ight compared to prefl ight simulated landings. This study aimed to characterize pilot head-eye coordination during simulated orbiter landings, and relate fi ndings to microgravity-related spatial disorientation. Methods: Orbiter landings were simulated in an A340-300 simulator fl own by six pilots. Turns about the Heading Alignment Circle (HAC) to align the orbiter with the runway were simulated by 45° banking turns. Final approach was simulated with an 11° glide slope from an altitude of 4267 m, with prefl are at 610 m and touchdown at 200 kn. Orbiter landings were also performed in the Vertical Motion Simulator (VMS) at NASA Ames by a NASA test pilot. Results: A340: During the HAC maneuver the head and eyes rolled toward the visual horizon with a combined gain of 0.14 of bank angle. Pilots alternated fi xation between the instruments and the runway during fi nal approach, almost exclusively focusing on the runway after prefl are. Optokinetic nystagmus was observed during rollout. VMS: Head and eye roll tilt when rounding the HAC were of similar magnitude to that observed in the A340. During fi nal approach the Heads-Up Display (HUD) reduced pitch head and eye movement. Conclusions: Roll tilt of the head and eyes during the HAC tended to align the retina with the visual horizon. Overlaying critical fl ight information and the approaching runway with the HUD reduced pitch head and eye movement during orbiter fi nal approach in the VMS relative to the A340 (no HUD installed).
Objectives. Teachers are at increased risk for developing voice disorders. Occupational risk fact... more Objectives. Teachers are at increased risk for developing voice disorders. Occupational risk factors have been extensively examined; however, little attention has been paid to the consequences of the vocal complaints. The objective of this study was to investigate the knowledge that teachers have about vocal care, treatment-seeking behavior, and voice-related absenteeism. Methods. The study group comprised 994 teachers and 290 controls whose jobs did not involve vocal effort. All participants completed a questionnaire inquiring about vocal complaints, treatment-seeking behavior, voice-related absenteeism, and knowledge about vocal care. Comparisons were made between teachers with and without vocal complaints and with the control group. Results. Teachers reported significantly more voice problems than the control population (51.2% vs 27.4%) (c 2 ¼ 50.45, df ¼ 1, P < 0.001). Female teachers reported significantly higher levels of voice disorders than their male colleagues (38% vs 13.2%, c 2 ¼ 22.34, df ¼ 1, P < 0.001). Teachers (25.4%) sought medical care and eventually 20.6% had missed at least 1 day of work because of voice problems. Female teachers were significantly more likely to seek medical help (c 2 ¼ 7.24, df ¼ 1, P ¼ 0.007) and to stay at home (c 2 ¼ 7.10, df ¼ 1, P ¼ 0.008) in comparison with their male colleagues. Only 13.5% of all teachers received information during their education. Conclusions. Voice disorders have an impact on teachers' personal and professional life and imply a major financial burden for society. A substantial number of teachers needed medical help and was obligated to stay at home because of voice problems. This study strongly recommends the implementation of vocal education during the training of teacher students to prepare the vocal professional user.
The purpose of this study was to provide age specific normative data of clinical gait and balance... more The purpose of this study was to provide age specific normative data of clinical gait and balance tests and to determine to what extent gender contributes to differences in postural control. Standing balance and walking performance was tested in 318 asymptomatic adults. The logistic regression, using both 10- and 30-second time limits as a dichotomization point, revealed a significant age effect for standing on foam with eyes closed, tandem Romberg with eyes closed (TR-EC), and one leg stance (eyes open and closed). The actual effect of decline was different for each test. Both tandem gait and dynamic gait index showed a ceiling effect up to 60 years of age, with a rapid decline of performance for subjects in their seventies. Linear regression equations indicated that for both men and women, timed up and go test (TUG) times increased with age, but even older subjects should perform the TUG in 10 seconds or less. Women performed significantly poorer on the TUG and TR-EC (30-second time limit).
Sixty-eight students of a school for audiovisual communication participated in this study. A part... more Sixty-eight students of a school for audiovisual communication participated in this study. A part of them, 49 students, received voice training for 9 months (the trained group); 19 subjects received no specific voice training (the untrained group). A multidimensional test battery containing the GRBAS scale, videolaryngostroboscopy, Maximum Phonation Time (MPT), jitter, lowest intensity (IL), highest frequency (FoH), Dysphonia Severity Index (DSI) and Voice Handicap Index (VHI) was applied before and after training to evaluate training outcome. The voice training is made up of technical workshops in small groups (five to eight subjects) and vocal coaching in the ateliers. In the technical workshops, basic skills are trained (posture, breathing technique, articulation and diction), and in the ateliers, the speech and language pathologist assists the subjects in the practice of their voice work. This study revealed a significant amelioration over time for the objective measurements [Dysphonia Severity Index: from 2.3 to 4.5 ( P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001)] and the self-evaluation [Voice Handicap Index, from 23 to 18.4 ( P=0.016)] for the trained group only. This outcome favors the systematic introduction of voice training during the schooling of professional voice users.
Using actual diagnostic criteria, the diagnosis of certain Menière's disease remains impossible d... more Using actual diagnostic criteria, the diagnosis of certain Menière's disease remains impossible during life without histopathologic confirmation. Assessing the value of a diagnostic test is difficult due to the lack of a gold standard. Recent studies reported on the use of MRI after intratympanic gadolinium injection to demonstrate endolymphatic hydrops in vivo. We evaluate whether MRI after intratympanic gadolinium administration is useful for predicting the effect and outcome of intratympanic gentamicin therapy. The correlation between transtympanic electrocochleographic (TT-ECoG) results and hydrops grade on MRI images is also investigated. Twelve definite Menière's disease patients with incapacitating vertigo attacks, not responding to drug and behavioral treatment, were selected for partial chemolabyrinthectomy with intratympanic gentamicin. All patients underwent transtympanic electrocochleography followed by surgical middle ear inspection, partial chemolabyrinthectomy (gentamicin solution 40 mg/ ml applied during 60 min) and intratympanic gadolinium injection with clear exposure of the round window membrane. The MR images were reviewed and a hydrops grade was assigned. Correlation between the hydrops grade and the electrocochleographic data was assessed. Only 5 of 12 patients showed gadolinium enhancement in the inner ear. However, 6 of the 7 patients that did not show postoperative intracochlear or intralabyrinthine gadolinium distribution did report the clinical improvement after intratympanic gentamicin therapy. Hydrops grade correlated with the result of transtympanic electrocochleography in four of five cases that showed gadolinium enhancement. We conclude that the use of intratympanic gadolinium has no added value in predicting the clinical outcome of intratympanic gentamicin application. However, based on these data, a correlation between the result of TT-ECoG and hydrops grading on MRI images can be suggested.
The results of several studies have indicated that patients aged over 80 years were at greater ri... more The results of several studies have indicated that patients aged over 80 years were at greater risk if they needed cardiac surgery, including aortic valve replacement for aortic valve disease (1-4). Nevertheless, results were considered as rewarding if the operation was performed before damage to the cardiac muscle develops (1,2,5). Despite these reports, surgery was sometimes not recommended, solely on the basis of age of the patients. This could lead to the progression of valve disease requiring urgent surgical intervention, or to sudden death. Between December 1986 and January 2000, in this retrospective study, 500 patients received a Carpentier-Edwards pericardial prosthesis in the aortic position. Coronary artery bypass grafting (CABG) was also performed in 348 of the patients. The median age of the patients was 73 years (interquartile range: 71 to 77 years), and 60 were aged 80 years or more. The preoperative profile for all patients is included in Table . Need for medication included digitalis, usually in combination with diuretics and an angiotensin-con-Presented as a poster at the Second Biennial Meeting of the Society for Heart Valve Disease, 28th June-1st July, Palais des Congrès,
The purpose of this study was to provide age specific normative data of clinical gait and balance... more The purpose of this study was to provide age specific normative data of clinical gait and balance tests and to determine to what extent gender contributes to differences in postural control. Standing balance and walking performance was tested in 318 asymptomatic adults. The logistic regression, using both 10- and 30-second time limits as a dichotomization point, revealed a significant age effect for standing on foam with eyes closed, tandem Romberg with eyes closed (TR-EC), and one leg stance (eyes open and closed). The actual effect of decline was different for each test. Both tandem gait and dynamic gait index showed a ceiling effect up to 60 years of age, with a rapid decline of performance for subjects in their seventies. Linear regression equations indicated that for both men and women, timed up and go test (TUG) times increased with age, but even older subjects should perform the TUG in 10 seconds or less. Women performed significantly poorer on the TUG and TR-EC (30-second ti...
This review describes the practicalities of using both the inner Ear Profile to define hydrops la... more This review describes the practicalities of using both the inner Ear Profile to define hydrops labyrinthi, and the American Academy of Otolaryngology and Head and Neck Surgery (AAO-HNS) guidelines to define Meniere&amp;amp;#39;s disease. The requirement for standardisation is stressed since either system alone may be inadequate. It is suggested that the Inner Ear Profile could be adapted to the AAO-HNS criteria to create a unified method of evaluation.
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