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The applicability and reliability of SHIMP, a new vestibular test, in adolescents

The video head impulse (now called the head impulse paradigm – HIMP) is now a routine test battery in neuro-otological practice. Few will be familiar with the new suppression head impulse paradigm (SHIMP) test. The key difference is that, in...

Extrapolating lessons from vestibular schwannoma management

This paper presents a delightfully simple and sensible hypothesis for the management of benign schwannomas in the head and neck region. They have taken the approach used for the management of vestibular schwannomas and used the same principles to assess...

Vestibular migraine – the story so far and the work still to do

This interesting discussion paper begins with an overview of the background to the development of vestibular migraine as a separate diagnostic category. It discusses in some depth the diagnostic uncertainties in the context of an entity without a biomarker and...

How can we improve outcomes for patients with acute vestibular neuritis?

Vestibular neuritis is a common disorder that can leave up to 50% of patients with persistent vertigo symptoms for months to years following the acute insult. Often their first contact with ENT or balance specialists is many months after the...

Using cVEMPs to distinguish between vestibular migraine and from Ménière’s

Vestibular migraine (VM) and Ménière’s disease (MD) could overlap or mimic each other. Since the use of cVEMPs became routine, attempts have been made by researchers to explore its clinical utility in these two conditions. In this prospective study, the...

Outcomes after facial nerve preservation surgery for large vestibular schwannomas

Large vestibular schwannomas (Koos grade three or four) are traditionally treated by surgical resection. Gross total resection of such large tumours often results in facial nerve dysfunction. Hence facial nerve preservation surgery was introduced in which maximal surgical resection is...

Hearing outcomes after retrosigmoid resection of smaller vestibular schwannomas are better

The authors reviewed published literature reporting hearing outcomes in patients after retrosigmoid (RS) resection of vestibular schwannoma (VS). Aggregate hearing preservation of 31% and 35% under fixed and random models respectively was observed in the 2034 patients meeting eligibility criteria...

A raised neutrophil / lymphocyte ratio predicts vestibular schwannoma growth

It has long been known that the neutrophil to lymphocyte count ratio (NLR) is a marker of inflammation and that a higher ratio relates to poorer outcomes in some malignant tumours including some head and neck cancers. Neutrophilia (and therefore...

Salvage surgery vs. repeat stereotactic radiosurgery for progressing vestibular schwannomas

This large multicentre case series of patients treated twice with stereotactic radiosurgery (SRS) for progressing vestibular schwannomas (VS) is reported by the International Gamma Knife Radiosurgery consortium. Progression of tumour growth after primary SRS is rare but does occur. Complications...

Vestibular functions of hereditary hearing loss patients with GJB2 mutations

Mutations of the GJB2 gene are a common cause of deafness, being found in 15-25% of cases of congenital deafness. Over 100 mutations are now recognised and may be associated with a hearing loss ranging from mild to profound. This...

Do we need contrast MRI when screening for vestibular schwannoma?

Gadolinium contrast enhanced T1-weighted (gT1w) MRI images of the internal acoustic meati have long been considered the gold standard in the diagnosis of vestibular schwannoma (VS). However, the addition of contrast to the MRI examination increases the cost and time...

Is there a need for magnetic resonance imaging six-month post-radiosurgery for vestibular schwannoma?

With advances in imaging and radiation technologies, small, slowly growing vestibular schwannomas (VS) are treated primarily with either observation or stereotactic radiosurgery (SRS). Routine magnetic resonance (MRI) scans with gadolinium are obtained six months and one year after SRS in...