CSOM associated with dizziness, postural imbalance and vestibulo-ocular reflex reveals study

Egypt: A recent study published in the European Archives of Oto-Rhino-Laryngology has provided clinical evidence on the association of chronic suppurative otitis media (CSOM) with dizziness, poor postural control, and vestibulo-ocular reflex (VOR). The researchers also mentioned the positive association of sensory elements of hearing loss with vestibular dysfunction in CSOM patients.

CSOM is also tied to hearing loss and extra- and intracranial complications. CSOM is a chronic inflammation of the middle ear and mastoid cavity; the long-term consequences are tinnitus, psychological changes, poor life quality, and hearing loss.

Bacterial products and inflammatory mediators cause damage to the cochlea and vestibule. There are narrow data on the clinical effects of cochlear and vestibular damage related to CSOM. However, this damage results from sensorineural hearing loss (SNHL) and dizziness.

There is a lack of clinical correlation between dizziness and vestibular test findings. CSOM patients have vestibular dysfunction, the diagnosis of which is frustrating and has several limitations, like videonystagmography and vestibular evoked myogenic potentials (VEMP ). These findings are affected by the middle ear status.

Posturography assesses postural stability, illustrated graphically and numerically documented. It can be static or dynamic. Video head impulse test (vHIT) identifies and assesses postural stability and VOR. Considering this, the present study was conducted at Audio-Vestibular Medicine Unit from the Department of Otorhinolaryngology, Alexandria University, and was led by Dr. HebatAllah Abdelmotaleb. The study aimed to evaluate VSR and VOR in CSOM patients using posturography and vHIT.

The main points of the study are:

• 65 CSOM patients and 65 healthy participants (controls) were included in the study.

• Patients with CSOM completed the dizziness handicap inventory (DHI).

• Otoscopy, pure-tone audiometry, posturography sensory organization test (SOT), and vHIT were performed for all the participants.

• A higher rate of dizziness was recorded in CSOM patients.

• 52.3% of CSOM patients had dizziness and handicap as per DHI scores.

• SOT vestibular scores were lower in the CSOM group than in control.

• The anteroposterior and mediolateral planes had worse sways in CSOM patients.

• The CSOM group was subdivided into two groups based on hearing loss type.

• The mixed hearing loss group has poor SOT vestibular scores than the conductive hearing loss group.

• CSOM patients had conductive hearing loss (CHL) 36.9% had mixed hearing loss (MHL).

• Forty-four patients had unilateral CSOM, while 21 had bilateral CSOM.

• In the unilateral group, the left and right sides were affected in 31 (70.5%) patients and 13 (29.5%) patients.

• A positive correlation was recorded between disease duration and poor SOT vestibular scores.

• Poor SOT vestibular scores had a corelation with high DHI scores.

• In the CSOM group, abnormalities in the vHIT results were reported in the form of low VOR gain and corrective saccades.

• Abnormal AP and ML visual scores in CSOM patients were 10.7% and 9.2%.

This study highlighted that posturography and vHIT are diagnostic tools that could be used in CSOM patients to evaluate dizziness. These tests provide insight into preliminary and comprehensive ideas regarding vestibular function and provide information about VSR, VOR, and vestibule-colic reflex. But there is a need for further studies to find out about diagnostic protocol for dizziness in CSOM patients. This research could prove very useful for CSOM patients.

The researchers explained that in adults, DHI is a reliable and considered valid tool for assessing vestibular pathology. The study indicates that posturography is a good diagnostic tool for dizziness in CSOM patients. There are other tools like a caloric test, rotational chair, and VEMP, but these do not show a good correlation with clinical symptoms. We want to clarify that our study evidenced a correlation between the disease duration and poor vestibular scores, consistent with clinical and histopathological studies, which show an association between long disease duration and vestibular dysfunction severity, they added.

The researchers said, "In our study, dizziness was experienced by 52.3% of patients, and these findings are consistent with previous studies." They wrote, "We used the DHI scores to assess the severity of dizziness handicap."

Further reading:

Abdelmotaleb, H., Sobhy, O., Bassiouny, M. et al. Evaluation of postural stability and vestibulo-ocular reflex in adults with chronic suppurative otitis media. Eur Arch Otorhinolaryngol (2022). https://doi.org/10.1007/s00405-022-07687-y