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Author: admin | 01.10.2015 | Category: Homeopathic Treatment For Tinnitus

Shropshire Tinnitus Support Group hosted a coffee morning at Signal: The Hub in the Riverside shopping centre in Shrewsbury during Tinnitus Awareness Week 2015 this week. It was lovely to see a number of regular group members from both the Shropshire and the Telford support groups, many of whom had travelled from far flung parts of the county on a cold and chilly day!
The morning was also supported by Signal staff members and trustees who were able to introduce themselves to people and talk about their roles in the organisation. In conclusion, I thoroughly enjoyed the morning, both appreciating the support of existing group members and meeting some lovely new potential members, who I am hoping will come along to our regular meetings! How Pycnogenol® potently inhibits inflammation in arthritis and lowers inflammatory markers in osteoarthritis?
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This finding suggests that the anti-inflammatory activity of Pycnogenol® is effective in individuals suffering from arthritic joints. Horphag Research supplies Pycnogenol® as a raw material to companies that produce a variety of Pycnogenol®-containing products. The positive medical history of sonovestibular symptoms was confirmed objectively by CDP with sound stimulation with a high statistical significance. The phenomenon of sound-induced vestibular symptoms and signs, termed the Tullio phenomenon (TP), has been known for six decades.
The effect of inducing nystagmus and vestibular symptoms by acoustic stimulation depends on the functional integrity of the vestibular labyrinth alone and is reproduced in animals when the cochlea has been ablated. Subsequently, TP was studied in terms of its physiological mechanism [4-9], nystagmic eye movements produced in response to intense sound [6,10-12], and the performance on a force platform with an acoustically stimulated vestibular system [10,13-15]. The presence of the TP was noted also in normal subjects (guinea pigs, monkeys, and humans) [19,20] and later even was found to be ubiquitous in normal subjects [21]. Previous reports show that the TP is provoked by a wide range of acoustic stimuli in terms of modes of delivery, intensity, and frequency.
Most authors agree that the middle frequencies are the most effective in producing the TP in patients with inner ear pathology (Table 1) [6,12,14,15,24-26].
Vestibular dysfunction has been characterized in terms of deficits in the vestibuloocular reflex system and the vestibulospinal reflex system.
Posturography is an approach to the assessment of vestibular dysfunction that uses a force platform and provides various measures that reflect postural stability, such as the amount of body sway.
The TP has been studied only by nystagmographic methods and by static posturography, as mentioned. The changes in postural stability were monitored by CDP when subjects attempted to maintain balance on the platform under stimulation with sound. A pure-tone sound of 110 dB at 1,000 Hz generated by a portable audiometer was delivered by air conduction in continuous mode through earphones. The extent of otological disease was established and documented in every case by history, physical examination, and audiometry. In addition, most subjects with audiovestibular disorders (groups A and B) underwent ENG with sound stimulation for the detection of spontaneous nystagmus, as in the classic method for the detection of the TP. The three study groups were matched in terms of age; consequently, differences between ages were not significant when compared statistically, as shown in Table 3. The subjects in this study were not matched in terms of quantitative results of diagnostic tests; therefore, the gravity of their disorder did not constitute a prerequisite for their selection. The 40 patients investigated first were classified according to their clinical diagnosis (Table 4). Patients' medical history focused on two pertinent symptoms: tinnitus and dizziness (Table 5), with special stress on severity, duration, and precipitating factors. Table 6 exhibits the results of audiological tests: pure-tone audiometry, speech reception thresholds, and performance intensity function for phonetically balanced words (speech discrimination scores). For the statistical approach of the results obtained in CDP before, during, and after acoustic stimulation, we calculated the means of the composite equilibrium scores and the mean individual sensory ratio scores for each study group in each trial.
For purposes of simplicity and a better expression, we preferred to plot the mean composite score and mean vestibular ratio obtained by the three study groups, instead of the individual scores achieved by each subject.
Because the composite score is an average of all sensory conditions, it reflects the overall on-feet stability of the subject. The variation among the three study groups was examined by means of one-way ANOVA followed by Bonferroni multiple range test (Table 9). Because in the study of the TP we were interested in both the overall equilibrium and the vestibular system in particular, the vestibular ratio score given by the CDP software was investigated next. Once again the one-way ANOVA followed by the Bonferroni mUltiple range test (Table 11) analyzed the variation among the three study groups.
The vision preference is one of the sensory ratios provided by the sensory analysis of the CDP's software.
The sensory analysis revealed a variety of disequilibrium types or sensory organization patterns according to the specific sensory system responsible for imbalance (Table 13).
A more intriguing pattern-the combined vestibular and vision dysfunction-was observed in some group A patients on trials 2 and 3 (20% and 25%, respectively).
A last sensory organization pattern observed on sound delivery in two patients in group A was a vestibular dysfunction combined with vision preference. The current study focused on the postural stability of normal subjects and patients with otological impairments and on a third group of patients with similar otological disorders accompanied by a history of sonovestibular symptoms. Hadj-Djilani [14,15] studied the performance on the force-plate under sound stimulation with exactly the same sound stimulus that we delivered in our work (1,000 Hz, 110 dB SPL).
Our normal subjects and the patients with inner ear impairments without a medical history of Tullio symptoms showed no significant change in postural stability. The occurrence of vestibular disturbance complicated by vision dysfunction during exposure to strong acoustic stimuli in patients suffering from Tullio symptoms is not surprising, given the exposure of the hyperirritable "Tullio" ears to intense noise as a general excitation and discomfort.
The diagnosis of vestibular malfunction related to sound exposure may be of crucial clinical significance, beyond the obvious medicolegal implications. An additional goal of this study had been to evaluate and compare the sensitivities of CDP and ENG in detecting vestibular impairment in the study participants.
CDP and ENG were compared in a retrospective study of a mixed population of 375 patients with complaints of dizziness and imbalance [34]. Two additional retrospective studies [35,36] compared CDP and ENG results in patients with confirmed vestibular system deficits. Because of the nonoverlapping nature of the two tests, the foregoing three studies concluded that both vestibuloocular and vestibulospinal tests were essential components in the diagnostic workup. We have managed to learn since the inception of this study that many patients who experience attacks of vertigo when exposed to loud noise complain of these symptoms solely in circumstances of noisy environment.
A 43-year-old active ambulance driver was referred to the Otolaryngology Department of Bnai-Zion Medical Center 2 years before his admission to the current study. A constant, very disturbing tinnitus of alternately low and high pitch had been complicating his condition ever since. The pure-tone audiogram exhibited a bilateral hearing loss of notched configuration in the higher frequencies, typical of NIHL (Fig. Prior to his admission to this study, the patient underwent ENG that revealed neither spontaneous nor gaze nor positional nystagmus, with no evidence of any vestibular pathology. His temporary unsteadiness provoked by sound occurred because of an underlying vestibular dysfunction, as indicated by sensory analysis: The vestibular ratio is very low (Fig 6). This work constitutes the final wrap-up of the preliminary study presented at the Twenty-Fourth Neurootological and Equilibriometric Society Congress, 1997, and subsequently published in the International Tinnitus Journal 3:2, 1997.
We also welcomed a number of people who experience tinnitus but had not known about the support groups previously. The Links Cafe, based at The Hub, did a fabulous job in providing much needed warming drinks and, of course, cake!
This occasion was no exception with lots of conversation and sharing of thoughts about individual experiences of tinnitus and coping strategies.
Many of us concluded that we were of the opinion that our tinnitus did not result so much from any problems with our hearing, but was rather more to do with ‘brain function’. In addition Pycnogenol® has been found to lower inflammatory markers of joint soreness. In addition, the consumption of Pycnogenol® was found to naturally inhibit generation of COX-2 enzymes during inflammation in humans, thus providing a significant contribution for lowering joint pain.
Horphag Research does not make any claims regarding the use of these finished products and each manufacturer is responsible for ensuring that the claims made for and use of its products comply with the regulatory requirement of the locations in which it markets its products. The Tullio phenomenon evaluated by computed dynamic posturography (CDP) under acoustic stimulation is reflected in postural unsteadiness, rather than in the classic nystagmus. This establishes the described method as a sensitive testing technique for validating the existence of the Tullio phenomenon in patients with a variety of disorders of the inner ear, especially chronic noise-induced hearing loss and acute acoustic trauma. In his early works on labyrinthine physiology, Pietro Tullio [1-3] described how sound stimuli caused pigeons to sway in the plane of the horizontal semicircular canals when minute holes were created in these canals. Blecker and deVries [4] showed that a microphonic, analogous to the cochlear microphonic, can be recorded from the cristae of the fenestrated semicircular canal of the pigeon and that the frequency response of this crystal microphonic parallels the frequency response curve for the TP.
No difference in body sway was observed according to whether sound was delivered with monaural or binaural stimulation [13]. Lowfrequency noise (50-400 Hz) was shown also to induce responses in the vestibular neurons [9] by direct influence on vestibular end organs [3,9], and its influence on vestibular function was studied with infrasound stimuli of 25, 50, and 63 Hz at 130-132 dB [13,17]. Tests of the vestibuloocular reflex system-caloric irrigation, vertical axis rotation of the entire body, and ENG evaluations of spontaneous and positional nystagmus -provide information about the symmetry of a vestibular lesion affecting the horizontal semicircular canals. One of the latest versions, computed dynamic posturography (CDP) (Equitest), attempts to ferret out the effects of various sensory inputs to the brain and to relate them to overall on-feet balance and stability [27-29].


We could not find any study of vestibular responsiveness to acoustic stimulation evaluated by CDP in the literature. Mean composite equilibrium scores in three consecutive sensory organization tests; the second trial was carried out with acoustic stimulation In conditions 5 and 6. From the wide range of acoustic stimuli used to provoke a sonovestibular response, we favored one of low intensity that efficiently, yet safely, elicits a Tullio response. Some patients were investigated by imaging studies (computed tomography or magnetic resonance imaging). Informed consent was obtained from the subjects, and the experimental protocol was approved by the local Ethics (Helsinki) Committee and the Israeli Ministry of Health.
The only criteria in our choice were the established diagnosis of an audiovestibular disease and an accurate medical history concerning the presence or absence of sonovestibular complaints.
The two dominating categories in this study, comprising a majority of 80% (70% in group A and 90% in group B), were patients demonstrating hearing loss caused by noise. By definition, all patients with sonovestibular complaints (clustered in group A) had to be suffering from either lightheadedness, true vertigo, or plain disequilibrium, with or without nausea and vomiting.
The binaural hearing loss percentage was based on the pure-tone thresholds at the speech frequencies of SOO, 1,000, 2,000, and 3,000 Hz and were calculated according to the formula used by the American Medical Association [32]. For a more accurate evaluation of hearing loss, basic statistical tests were run on several audiometric parameters. This was accomplished by the alternate binaural balance test administered to patients with a difference of 2S dB or more between the hearing thresholds of the two ears at the test frequency. As we have seen, this presumption about the nonsimilarity of the two sets of subjects with otological disorders eventually was proved partially correct. Vestibular ratios scores obtained in computed dynamic posturography in three consecutive sensory organization tests, the second under stimulation with sound. Switching to this representation is correct as long as the mean follows the trend of most individual values in the group.
The trend over repeated trials of SOT was studied by ANOVA for repeated measurements, followed by the Bonferroni test for repeated measurements, applied to the average composite score (Tables 7,8). The trend over repeated trials of SOT was again studied by making use of the ANOVA for repeated measurements, followed by the Bonferroni test for repeated measurements (Table 10; see also Table 8). It reflects the degree to which affected patients rely on visual information to maintain balance, even when the information is incorrect.
In this pattern, the sensory ratio of condition 4 to condition 1 is abnormal, whereas those of the remaining pairs are within the normal range (the equilibrium scores for condition 4 are abnormally low relative to the scores on condition 1). In this pattern, the sensory ratios on both SOT condition 5 to condition 1 and condition 4 to condition 1 are abnormal, with normal 2 to 1 and 3 and 6 to 2 and 5 ratios. Our two sets of pathological patients were picked by definition with regard to the medical history of inner ear disease and to the exclusion of neurological (somatosensory), orthopedic, and vision dysfunction.
Both the ratio for conditions 5 and 1 and the paired analysis of conditions 3 and 6 relative to conditions 2 and 5 were abnormal. Accomplishing that would have enabled a correct parallel and eventual contrast between the results and effectiveness of the two vestibular tests in evaluating the TP. The postural responses were monitored on the Equitest (the CDP) in three consecutive sensory organization tests, with the second performed partially under binaural delivery of sound (1 IO dB at 1,000 Hz). This establishes the described method as a sensitive testing technique for validating the existence of the TP in patients with a variety of disorders of the inner ear, especially chronic noise-induced hearing loss and phonal trauma, even when employing stimuli of harmless intensities (110 dB) and short durations (6 × 20 sec).
Three sensory systems are involved in the maintenance of balance: vestibular, visual, and somatosensory. As mentioned, ENG recordings were not made in some cases for a multitude of reasons, and the testing protocols were not identical in the remaining subjects.
CDP abnormalities were documented in 55% of the cases, whereas ENG revealed abnormality in only 26% of the patients.
In these more homogenous groups of 46 and 52 patients, ENG and CDP abnormalities were equally prevalent and occurred in approximately 50% of the cases.
The contrast between ENG findings and CDP findings in the particular case of patients with sonovestibular symptoms, however, is an interesting aspect and remains one of our objectives for the future. Others may suffer anyway, but their symptoms are significantly exacerbated during sound stimulation. He presented with a history of dizziness attacks triggered suddenly by noise, such as loud music or at weddings, or the whine of jet engines on aircraft flying at low altitude. He had been an otherwise healthy person, except for a peptic ulcer, silent at the time of our investigation, for which he had been administered antacids and H2-receptor blockers in the past.
ENG with acoustic stimulation included a 60-second continuous recording of ocular movements during binaural stimulation with the pure tone of 110 dB at 1,000 Hz. Individual and composite scores obtained from a patient with noise-induced hearing loss and the Tullio phenomenon in the sequence of three consecutive computed dynamic posturography sensory organization tests (SOTs). Sensory ratio scores obtained from the same patient as in Figure 5 (with noise-induced hearing loss and the Tullio phenomenon) in the sequence of three consecutive computed dynamic posturography sensory organization tests . The topic of anti-depressant use was discussed with many of the conversation participants observing that they had been prescribed medication to assist in the management of their tinnitus. With such a method, the dangerous effects of noise-induced instability can be assessed and prevented. This vestibular microphonic can be recorded from any of the vestibular end organs and has been observed in many species. A scan of the literature for the different stimuli used in different studies reveals that the sound pressure levels used to elicit a TP in healthy subjects were higher than those used in subjects with pathologies of the ear. These vestibular tests, however, do not characterize the vestibular deficit in terms of patients' functional status (the ability to stand and walk) because such patients are evaluated in "passive" positions in which balance is not required. CDP includes test conditions in which the platform and visual environment are moved to reduce subjects' ability to use visual and proprioceptive information for balance.
Static posturography falls short of revealing pure vestibular malfunction, manifested clinically as unsteadiness when standing or walking. This SPL is well within safety limits (Table 2) in accordance with the Illinois Occupational Diseases Act [30] and the Occupational Safety and Health Administration Regulation [31].
All patients with abnormal visual, orthopedic, and neurological function (other than audiovestibular disorders) were excluded from the study. Therefore, patients in group A were intrinsically a "dizzier" and (as demonstrated later) a more "unstable" set of subjects than were those in group B. Single-factor analysis of variance (ANOVA) revealed insignificant differences among hearing loss percentages, speech reception thresholds, and speech discrimination scores of the two pathological groups (see Table 6).
These study groups harbor a discrepancy with regard to symptomatology, whereas objective audiometry revealed a similar degree of hearing impairment.
In this way, excessive clutter in the illustration is avoided without generating any statistical error in this case. Thus, the severity of dizziness in these patients (as indicated by history) found a confirmation in terms of posturography by showing a worse balance even in the absence of sound. In group A, the vestibular component of the equilibrium again demonstrates a decrease on stimulation with sound (see Fig 3).
Thus, we got a confirmation of what theoretically was expected; the impaired on-feet stability is (at least in part) explained by a flawed vestibular system in patients with TP.
The vision preference scores did not show a large variation, either over consecutive trials or across study groups (Table 12).
The initial proportion of vestibular dysfunction increased on acoustic stimulation to 55% in group A but subsequently decreased in the third trial. As we know from the literature, this pattern is not observed commonly in patients with impairment limited to the vestibular system but rather are suggestive of central nervous system pathology, possibly in addition to that of the vestibular system.
CDP performances demonstrated that 90% of the 40 subjects (groups A and B) showed either normal balance or vestibular dysfunction solely. In these cases, the average equilibrium scores for conditions 3, 5, and 6 were not only below the normal limits but were abnormally low relative to the scores on conditions 1 and 2. Regrettably, not all 60 study subjects underwent ENG recording under stimulation with sound, and some of those who did were not evaluated identically in terms of duration of exposure to the acoustic stimulus for various reasons. In comparing our results to those found in previous works in which static posturography methods were used, we must take note of the controversy surrounding the subject in the literature. In these works, they studied the TP using low-frequency sound (25-63 Hz, 130 dB SPL) and observing the change in stability on a static posturograph.
This stimulus is well within the noise exposure standards and therefore is safe, with a temporary threshold shift the only unwanted effect it produces. When vestibular damage occurs and remains undiagnosed, the overall function of balance relies only on the other two systems.
Conclusions based on such a methodological incongruity of the two diagnostic tests could be erroneous.
Hence, CDP provided the only documented evidence of pathology in approximately 30% of the cases.
Both categories, especially the former, undergo extensive and protracted workup as the usual diagnostic tests fail to reveal the gravity of their otoneurological disease. He described these attacks as short (minutes), mainly lasting through the duration of the noise but sometimes beyond that, and always accompanied by nausea. As compared to relatively good overall equilibrium (composite score, 78) and competent sensory systems on the first trial (see Fig. The second trial was performed with acoustic stimulation during conditions 5 and 6, whereas the other two were quiet SOTs in the regular mode. Responses of squirrel monkey vestibular neurons to audiofrequency sound and head vibration. Influence of pressure loading to the external auditory canal on standing posture in normal and pathological subjects.


Tullio phenomenon and postural stability: experimental study in normal subjects and patients with vertigo.
Effects of increasing intensity levels of intermittent and continuous 1000 Hz tones on human equilibrium. Adaptation to alter support and visual conditions during stance: patients with vestibular deficits. Effect of visual support surface references upon postural control in vestibular deficit subjects.
Computerized dynamic posturography: its place in the evaluation of patients with dizziness and imbalance. Comparison between dynamic posturography and ENG recordings in patients with peripheral vestibular disorders. This is a useful additional source of income for the group and goes towards the costs of communicating with members through the post, venue hire and fees for guest speakers. This should be carried out preferably by means of CDP with acoustic stimulation for an objective corroboration of their complaint before continuing activity in a noisy environment, thus preventing dangerous loss of balance when exposed to noise. Tullio observed the currents created in the labyrinthine fluids in response to sound by watching the motion of dye particles introduced into the endolymph and perilymph. Furthermore, information gathered from these studies may indicate that the vestibular response-evoking threshold intensity varies with the frequency of the stimulus: Normal subjects evidence sonovestibular responses at midfrequency range (l,000 Hz) over 120 dB [23].
CDP constitutes a comprehensive sensorial function test of the equilibrium by virtue of its inherent feature of isolating the vestibular, visual, and somatosensory contribution to overall balance, unlike older posturography techniques that served as mere systemic balance tests. We deem CDP a very appropriate technique for investigating the interaction between balance and sound within the labyrinth.
According to these noise exposure safety standards, subjects can be exposed safely to 110 dB for a half-hour daily before any otological damage would occur. Subsequently, we summarized all the relevant medical information supplied by history and the battery of audiological tests. The findings were not suggestive of any correlation between recruitment and the presence or absence of sonovestibular symptoms. This is not surprising, considering that abnormal sensory preference is, in essence, the effect of a central pathology (arising from the vestibular nuclei or their higher connections), whereas all the subjects in this study were patients suffering from peripheral disease exclusively (arising from the labyrinth or vestibular nerve). The vestibular dysfunction percentages remained constant in the other two groups on repeated trials. The significance of this disclosure of a disturbance in the central connections responsible for equilibrium, triggered by acoustic stimulation in the patients with sonovestibular symptoms, has yet to be interpreted. Only 10% (two subjects in group A on trial 1 and two in group B on trial 3) revealed an inability to use input from the visual system to maintain balance.
In general, patients with this kind of pattern are unable to use vestibular system inputs and are abnormally destabilized by orientationally inaccurate visual stimuli.
Not only did the intense sound have no deleterious effect on the balance of normal subjects but they improved their postural stability during sound stimulation, probably through the alerting response. Thus, it can be used routinely for detecting this disturbing and potentially dangerous phenomenon in patients who complain of sudden dizziness or report protean descriptions of feeling bad when they happen to be exposed to intense noise at a concert hall, discotheque, airfield, or work.
Even though the functional impact of vestibular and vision dysfunction is limited to noise exposure in such patients, they require a stable support surface reference to maintain balance (somatosensory-dependent) in those instances. When, in addition, other sudden sensory deprivation occurs or if new relationships develop between the sensory systems involved in balance, spatial disorientation may transpire under these circumstances.
Among the cases with history of head injury, 100% had CDP abnormalities, whereas ENG results were normal in all of them.
Among patients with abnormal ENG and normal SOT results, the majority had compensated unilateral lesions. Such patients' symptoms seldom improve, because the underlying damage is by and large permanent regardless of etiology.
Additionally, he mentioned occasional vertiginous attacks caused by bending forward, always quite suddenly relieved by straightening out.
Speech audiometry found binaural speech reception thresholds and speech discrimination scores of 20 dB and 100% at 55 dB, respectively. 5A), our patient demonstrated a sharp decrease in his overall balance when exposed to the pure tone of 110 dB at 1,000 Hz (composite score, 52) (see Fig. Cited by Erlich MA, Lawson W, The incidence and significance of the Tullio phenomenon in man. He noted that these currents were in perfect correspondence with the frequency of the applied tone.
At low frequencies (25-63 Hz), the minimal intensity would be 145 dB [13], whereas at frequencies up to 2,500 Hz, the vestibular responses occur only at a sound pressure level (SPL) exceeding 120-160 dB [19]. This was followed 20 minutes later by a test carried out in quiet stance in SOTs I through 4 and with acoustic stimulation in SOT 5 and SOT 6 (Fig. This duration is more than an order of magnitude larger than the total of 120 seconds for which our subjects were exposed during the sequence of two SOTs (5 and 6) repeated three times each.
In vestibular dysfunction, the sensory ratio of condition 5 to condition 1 is abnormal, whereas those of the remaining pairs are within the normal range. This pattern was observed neither in those in group B nor in normal controls, whether stimulated acoustically or not.
None of the patients demonstrated somatosensory or central pathology, except for the "central" pattern exhibited by those in group A during and after exposure to sound, as discussed in the previous paragraph. As both the lack of visual and support surface inputs and conflicting visual inputs are destabilizing, these patients are more impaired functionally than are those with either vestibular dysfunction or vision preference alone. In the absence of a stable surface, they do not make effective use of either vestibular or visual inputs [33]. Exposure to intense noise in unusual environmental settings (during flying under changing gravitational forces, diving, physical activity in darkness, or night driving) might produce conditions that in certain circumstances could even be life-threatening.
In contrast, patients with normal ENG and abnormal SOT results had clear positive symptoms of vestibular system disorder.
By the nature of his trade, he had been constantly exposed to the wail of the ambulance siren for almost two decades, and this had turned his everyday life for the last 7 years into a desperate condition.
Capelli, 1929.) Cited by Erlich MA, Lawson W, The incidence and significance of the Tullio phenomenon in man. The second group (B) included 20 neurootological patients without a history of Tullio phenomenon. He also noted that at higher sound intensities, a nystagmus was produced, the frequency of which corresponded to the oscillations of the internal current. Bearing in mind that acoustic stimuli in unusual environmental conditions always affect both ears, we preferred to employ a binaural stimulation in the attempt to prove the hypothesized correlations in accordance to the hazards of quotidian reality.
Thus, the equilibrium scores for condition 5 only, or for conditions 5 and 6, are abnormally low relative to the scores on condition 1. This abnormal pattern is described as occurring in patients with balance disorders secondary to traumatic head injuries but also was reported in other patient populations. The balance functions during exposure to intense noise in such patients tend to be more impaired than in those with vestibular dysfunction, vision preference, or a combination of these pattems.
In these patients, disorders were either more central or were presumed to effect peripheral components other than the horizontal semicircular canals (vestibuloocular system). Consequently, these patients continue to seek medical assistance, and their complaints seem to be psychologically aggravated by frustration accumulated through continual visits, referrals, and failing therapy.
On the third (quiet) trial, 20 minutes later, his balance recovered completely (composite score, 80) (see Fig.
Sounds reaching the ear of the animal produced a current in the open canal, also affecting all three semicircular canals simultaneously.
In the latter two tests, subjects had only the vestibular system at their disposal (with inputs from other sensory systems canceled or inaccurate). The functional impact of this pattern dwells in the necessity of either a stable support surface or stable visual field to maintain balance. Indeed, one of our two patients with this disequilibrium pattern mentioned a head injury incurred several years prior to the current investigation (in addition to the NIHL from which he was suffering and for which he was selected). Preferably, this should be carried out by means of CDP with acoustical stimulation for an objective corroboration of their complaint before continuing activity in a noisy environment, thus preventing dangerous loss of balance when exposed to noise. We deem the description of a typical case of TP pedagogically rewarding and suggestive of the problem and therefore appropriate.
A pure-tone stimulus of I,000 Hz at 110 dB was delivered binaurally for 20 seconds during condition 5 and condition 6 of the CDP sensory organization test. However, the current was predominant and the cristae more easily displaced in the fenestrated canal, accounting for visible movements only in the plane of this canal.
The sensory analysis of the second patient showed mainly vestibular dysfunction and only a borderline visual preference abnormality.
The sequence of six sensory organization conditions was performed three times with two intermissions of 15-20 minutes between the trials. From the different reactions that Tullio observed by stimulating the ears of animals, he proposed that perhaps this was to become a potential diagnostic tool with which one could recognize the seat and nature of lesions in the different parts of the labyrinth. The latter is described in the literature as accountable to, among other causes, a declining performance caused by fatigue or by exacerbation of the patient's symptoms during repeated trials [29]. This was followed 20 minutes by a trial carried out in quiet stance in sensory organizations tests (SOTs) I through 4, and with acoustic stimulation in SOT 5 and SOT 6.



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