Vestibular symptoms and relations with postural balance, inner ear function, and long term survival

Bakgrunn: Svimmelhet og balanseproblemer er vanlige symptomer som i befolkningsstudier har vært assosiert med økt dødelighet, men det er ikke kjent om det er sykdommer i balanseapparatet som forårsaker denne økte dødeligheten. Kunnskapsgrunnlaget for å vurdere og behandle pasienter med svimmelhet har vært vurdert som dårlig og ofte er det kun pasientens beskrivelse av symptomer som danner grunnlaget for å diagnostikken. Mål: Å evaluere hvilke symptomer som gir nyttig informasjon, og undersøke sammenhenger mellom balanse, funksjonen av det indre øre og langtidsoverlevelse. Materialer og metode: En gruppe pasienter henvist for vurdering med tanke på vestibulær sykdom i perioden mellom 1992 og 2004. Resultater: De fleste pasienter (72,1%) valgte kun en tids-kategori for å beskrive sine symptomer, mens mindre enn halvparten (47,1%) valgte kun en type svimmelhet. Oppkast var assosiert med økt risiko for asymmetri på kalorisk prøve (odds ratio 1,50. 95% konfidensintervall 1,24-2,06). 10-dB økning i hørselstap på det best hørende øret var assosiert med 6,0% økning i kurvelengde. Standardisert mortalitetsrate var 1,03 (0,94-1,12). Periodiske eller korte anfall av svimmelhet var assosiert med redusert dødelighet med hasard rate på henholdsvis 0,62 (0,50-0,77) og 0,76 (0,63-0,93). Pasient-rapportert ustøhet og ustøhet målt ved posturografi var assosiert med økt dødelighet med hasard rate på 1,30 (1,08-1,47) og 1,44 (1,14 – 1,82). Konklusjon: Det bør fokuseres på tidsaspektet av vestibulære symptomer og det bør skilles mellom oppkast og kvalme. Hvilken type svimmelhet pasienten opplever gir noe tilleggsinformasjon, men virker ikke å være nyttig for å kunne gruppere pasienter. Vestibulær sykdom kunne ikke forklare sammenhengen mellom hørsel og balanse i denne studien og vestibulær sykdom ser ikke ut til å være hovedårsaken til den økte dødeligheten blant personer med svimmelhet og balanseplager i den generelle befolkningen. For å finne årsakssammenhenger er det behov for ytterligere studier på dødsårsaker blant pasienter med vestibulære symptomer, vestibulær sykdom, dårlig balanse og nedsatt hørsel.Background: Dizziness and unsteadiness are common symptoms that can be caused by pathologies in various organ-systems. In the general population such symptoms are associated with increased mortality, but it is not known if this increased mortality is caused by vestibular pathology. Today, many of the common vestibular diagnoses depend on patient-reported symptoms alone, and the evidence base for evaluating and treating patients with dizziness has been described as low. Aim: To critically evaluate which symptoms reported by dizzy patients provide useful information, and further to evaluate the interrelations between posturography, inner ear function, and long-term survival. Material and methods: A cohort of patients examined from 1992 to 2004 at an otolaryngology department for suspected vestibular disorder. Results: While most patients (72.1%) chose only one timing category, fewer than half the patients (47.1%) describe their complaints with only one type of dizziness. Vomiting was associated with increased risk for caloric asymmetry (Odds ratio 1.60, 95 % CI 1.24–2.06). A 10-dB increase in hearing loss in the best-hearing ear was associated with a 6.0% increase in path length measured on a balance platform. The standardized mortality ratio was 1.03 (0.94–1.12). Periodic or short attacks of dizziness were associated with reduced mortality with a hazard ratio of 0.62 (0.50–0.77) and 0.76 (0.63–0.93), respectively. Both self-reported and unsteadiness on posturography were associated with increased mortality with a hazard ratio of 1.30 (1.08–1.47) and 1.44 (1.14–1.82). Conclusions: The timing of vestibular symptoms and a differentiation between nausea and vomiting should be targeted when interviewing patients. The type of dizziness provides additional information but does not appear useful for categorization. The association between hearing and postural balance was not explained by unilateral vestibular disorders. Vestibular pathology is probably not the main cause of the increased mortality seen among patients with vestibular symptoms and balance problems in the general population. Further studies exploring cause of death related to vestibular symptoms, hearing, and postural balance are advocated.Doktorgradsavhandlin

NEMO: Internet of Things based Real-time Noise and Emissions MOnitoring System for Smart Cities

With the advent of ubiquitous sensors and Internet of Things (IoT) applications, research and development initiatives on smart cities are ramping up worldwide. It enables remote monitoring, management, and control of devices and the generation of fresh and actionable insight from huge quantities of real-time data. Real-time noise and emissions monitoring of vehicles remain indispensable in a smart city context. Effective management and control of noise and emissions of vehicles on the road are necessary and possible through analyzing lots of sensor data in real-time to take an actionable insight. To contribute to this, as part of an ongoing effort of the European Union project called ''NEMO: Noise and Emissions Monitoring and Radical Mitigation'', in this paper, we present the design and development of an IoT-based real-time noise and emissions monitoring system for vehicles in a smart city context. Real-world sensor data of the vehicles in some European cities are collected during the pilot tests. We have developed a complete application for infrastructure managers and analysts to monitor the sensor data related to noise and emissions of vehicles in real-time. The data of the individual road vehicles and trains in selected EU cities and from trains on a track in the Netherlands are collected in the cloud and analyzed with artificial intelligence (AI) algorithms for classification such as high emitter, medium emitter, and normal emitters. We present the development of a complete software solution that can be integrated with existing intelligent transportation systems in smart cities. Finally, we report the initial vehicle classification results from the Rotterdam (Netherlands) pilot test as a representative example for the NEMO monitoring system.acceptedVersio

Hearing as an Independent Predictor of Postural Balance in 1075 Patients Evaluated for Dizziness

Objective To evaluate the association between hearing and postural balance. Study Design Retrospective cross-sectional study. Setting Tertiary care otolaryngology clinic. Subjects and Methods Patients examined for suspected vestibular disorder were included in this study. The outcome variable was postural sway measured by static posturography during quiet standing with eyes closed. The predictor variable was pure-tone average hearing threshold on the best hearing ear at 0.5, 1, 2, and 3 kHz. Covariates were age, sex, and vestibular disease or vestibular asymmetry assessed by bithermal caloric irrigation. Results In total, 1075 patients were included. Increased hearing threshold was a strong predictor of increased postural sway (path length) after correcting for age and sex. A 10-dB increase in hearing loss on the best hearing ear predicted a mean 6.0% increase in path length (confidence interval, 2.9%-9.3%, P < .001). Of the covariates, increasing age (P < .001) and male sex (P = .009) were significant predictors of increased postural sway. The effect of increased hearing threshold was also significant after adjusting for vestibular disease. Conclusion Increased hearing threshold was an independent predictor of increased postural instability, and this effect was strongest for the best hearing ear. Unilateral vestibular disease did not seem to explain this association between hearing and postural balance. Reduced hearing is associated with impaired balance, and interventions to prevent falls should be considered for patients at risk.acceptedVersio

Long-Term Survival in 1,931 Patients With Dizziness: Disease- and Symptom-Specific Mortality

Objective: To evaluate mortality among patients referred for suspected vestibular disorder and to examine whether specific symptoms or disorders predict long-term survival among patients with dizziness or vertigo. Study Design: Retrospective cohort study. Methods: This retrospective cohort study analyzed long-term survival data. Consecutive patients examined for suspected vestibular disease at an otolaryngology clinic completed a detailed questionnaire regarding symptoms and comorbidities. Results: The study included 1,931 patients. Their mean age (standard deviation) was 50.5 (16.5) years, and 60% were women. The mean follow-up period was 20.6 years (range, 15.3–27.5 years). The standardized mortality ratio for the entire cohort compared with the Norwegian age- and sex-matched population was 1.03 (95% confidence interval [CI]: 0.94–1.12), illustrating no difference in overall survival. Patients with a cerebrovascular cause of dizziness had higher mortality in adjusted Cox regression analyses (hazard ratio [HR] 1.56, 95% CI: 1.11–2.19), whereas patients reporting periodic or short attacks of dizziness had lower mortality (HR 0.62 [0.50–0.77] and 0.76 [0.63–0.93], respectively). Reported unsteadiness between dizziness attacks was associated with higher mortality with an HR of 1.30 (95% CI: 1.08–1.57). Conclusion: This long-term study found comparable mortality rates between patients evaluated for suspected vestibular disorder and that of the general population. However, subgroup analyses showed reduced mortality in patients with periodic or short attacks of dizziness and increased mortality in patients with unsteadiness between attacks or cerebrovascular causes of dizziness. The time course of vestibular symptoms should be determined, and thorough evaluation including fall risk and comorbidities must be considered in patients with nonepisodic symptoms.publishedVersio

NEMO: Real-Time Noise and Exhaust Emissions Monitoring for Sustainable and Intelligent Transportation Systems

Research and development efforts on sustainable and intelligent transportation systems are accelerating globally as the transportation sector contributes significantly to environmental pollution and produces a variety of noise and emissions that impact the climate. With the emergence of ubiquitous sensors and Internet of Things (IoT) applications, finding innovative transport solutions, including adequate climate change mitigation, will all be vital components of a sustainable transport future. Thus, it is essential to continuously monitor noise and exhaust emissions from road vehicles, trains, and ships. As a contribution to addressing this as part of an effort of the European Union project called “NEMO: Noise and Emissions Monitoring and Radical Mitigation", in this paper, we propose the design and development of a real-time noise and exhaust emissions monitoring for sustainable and intelligent transportation systems. We report real-world field testing in some European cities where vehicle noise and exhaust emissions data are gathered in the cloud-enabled Nautilus platform and evaluated using artificial intelligence (AI) algorithms to determine their categorization into different classes of emitters and thereby enabling the infrastructure managers to define logic and actions to be taken by high emitters in near real-time. We outline the creation of a complete NEMO solution to monitor and reduce noise and emissions in real time for sustainable and intelligent transportation systems.acceptedVersio

Vestibular Tests Related to Tumor Volume in 137 Patients With Small to Medium-Sized Vestibular Schwannoma

Objective: The video head impulse test (vHIT) and cervical and ocular vestibular evoked myogenic potentials (cVEMP and oVEMP) are new methods for measuring peripheral vestibular function. The objectives of this study were to compare these tests and the traditionally used caloric test in patients with small and medium-sized untreated vestibular schwannoma (VS) and to measure the correlation between the tests' results and tumor volume. Study Design: National cross-sectional study. Setting: Tertiary university clinic. Methods: Prevalence of abnormal cVEMP, oVEMP, caloric test, and 6-canal vHIT results on the tumor side and the nontumor side were compared and related to tumor volume with regression analyses in 137 consecutive VS patients assigned to a wait-and-scan protocol in the period 2017 to 2019. Results: The sensitivity of 6-canal vHIT, caloric test, cVEMP, and oVEMP to detect vestibulopathy in VS patients was 51%, 47%, 39%, and 25%, respectively. Normal tests were found in 21% of the patients. The results of vHIT and caloric test were related to tumor volume, but this was not found for cVEMP and oVEMP. Conclusion: The caloric test and 6-canal vHIT showed the highest sensitivity in detecting vestibulopathy in untreated VS patients. vHIT, and particularly the posterior canal, was limited with a high prevalence of abnormal results on the nontumor side. A combination of cVEMP and caloric test was favorable in terms of a relatively high sensitivity and low prevalence of abnormal results on the nontumor side. Larger tumors had a higher rate of pathology on caloric testing and vHIT.publishedVersio

Krill oil attenuates left ventricular dilatation after myocardial infarction in rats

Background: In the western world, heart failure (HF) is one of the most important causes of cardiovascular mortality. Supplement with n-3 polyunsaturated fatty acids (PUFA) has been shown to improve cardiac function in HF and to decrease mortality after myocardial infarction (MI). The molecular structure and composition of n-3 PUFA varies between different marine sources and this may be of importance for their biological effects. Krill oil, unlike fish oil supplements, contains the major part of the n-3 PUFA in the form of phospholipids. This study investigated effects of krill oil on cardiac remodeling after experimental MI. Rats were randomised to pre-treatment with krill oil or control feed 14 days before induction of MI. Seven days post-MI, the rats were examined with echocardiography and rats in the control group were further randomised to continued control feed or krill oil feed for 7 weeks before re-examination with echocardiography and euthanization. Results: The echocardiographic evaluation showed significant attenuation of LV dilatation in the group pretreated with krill oil compared to controls. Attenuated heart weight, lung weight, and levels of mRNA encoding classical markers of LV stress, matrix remodeling and inflammation reflected these findings. The total composition of fatty acids were examined in the left ventricular (LV) tissue and all rats treated with krill oil showed a significantly higher proportion of n-3 PUFA in the LV tissue, although no difference was seen between the two krill oil groups. Conclusions: Supplement with krill oil leads to a proportional increase of n-3 PUFA in myocardial tissue and supplement given before induction of MI attenuates LV remodeling

Tumor HPV status, level of regulatory T cells and macrophage infiltration predict up to 20-year non-disease-specific survival in oropharynx squamous cell carcinoma patients

Oropharynx squamous cell carcinoma (OPSCC) is of special interest because human papilloma virus (HPV) and/or smoking cause this disease. Influxes of inflammatory cells into such tumors are known to vary with prognoses. Aims: To study whether the density of tumor-infiltrating T lymphocytes and tumor-infiltrating macrophages predicted general 20-year overall survival (OS), as well as OS with only disease-specific survival (DSS) patients included. Methods: Biopsies from patients treated for OPSCC (n = 180) were stained by immunohistochemistry and the tumor cell macrophage (CD68), pan T lymphocytes (CD3), and regulatory T lymphocytes (Foxp3) densities were determined. The HE-determined percentage of matured tumor cells and the rate of invasion were calculated, and stromal desmoplasia were performed. Tumor HPV presence was studied by PCR. Twenty-year OS and five-year DSS patients were determined. Results: Tumor HPV status strongly predicted survival. High tumor infiltration of CD3, Foxp3 and CD68-positive cells predicted better twenty-year OS, with and without HPV stratification. Foxp3 and CD68 levels predicted OS, and 20-year among DSS patients, primarily among HPV(+) patients. Tumor HE-derived variables did not predict such survival. Conclusions: Tumor HPV status, level of Foxp3 tumor-infiltrating lymphocytes and CD68 tumor-infiltrating macrophages predicted up to 20-year OS of both all patients and disease-specific survived patients.publishedVersio

The Romberg sign, unilateral vestibulopathy, cerebrovascular risk factors, and long-term mortality in dizzy patients

Objectives: Describe the relationship between unsteadiness, canal paresis, cerebrovascular risk factors, and long-term mortality in patients examined for dizziness of suspected vestibular origin. Study design: Observational cohort with prospective collection of survival data. Setting: University clinic neurotological unit. Patients: Consecutive patients aged 18–75 years examined in the period 1992–2004 for dizziness of suspected vestibular origin. Outcome measures: Overall survival. Standardized mortality ratio (SMR). Factors: Unsteadiness, canal paresis, age, sex, patient-reported diabetes, hypertension, heart disease, stroke, or TIA/minor stroke. Patients were classified as steady or unsteady based on static posturography at baseline compared to normative values. Results: The study included 1,561 patients with mean age 48 years and 60 % females. Mean follow-up was 22 years. Unsteadiness was associated with higher age, heart disease, diabetes, hypertension, and cerebrovascular dizziness. There were 336 deaths over 31,335 person-years (SMR 0.96; 95 % confidence interval: 0.86–1.07). Canal paresis was not related to unsteadiness (chi square: p = 0.46) or to mortality (unadjusted Cox hazard ratio: 1.04, 95% CI: 0.80–1.34). Unsteadiness was an independent predictor of mortality (adjusted Cox hazard ratio: 1.44, 95% CI: 1.14–1.82). Conclusions: Unsteadiness measured by static posturography is associated with higher age, known cerebrovascular risk factors, and with increased long-term mortality, but not with canal paresis in patients evaluated for dizziness. The study highlights the importance of evaluating patients with conspicuous postural instability for non-vestibular causes.publishedVersio

Krill oil reduces plasma triacylglycerol level and improves related lipoprotein particle concentration, fatty acid composition and redox status in healthy young adults - a pilot study

Background: Lipid abnormalities, enhanced inflammation and oxidative stress seem to represent a vicious circle in atherogenesis, and therapeutic options directed against these processes seems like a reasonable approach in the management of atherosclerotic disorders. Krill oil (RIMFROST Sublime®) is a phospholipid-rich oil with eicosapentaenoic acid (EPA): docosahexaenoic acid (DHA) ratio of 1.8:1. In this pilot study we determined if krill oil could favourable affect plasma lipid parameters and parameters involved in the initiation and progression of atherosclerosis. Methods: The study was conducted as a 28 days intervention study examining effect-parameters of dietary supplementation with krill oil (832.5 mg EPA and DHA per day). 17 healthy volunteers in the age group 18–36 (mean age 23 ± 4 years) participated. Plasma lipids, lipoprotein particle sizes, fatty acid composition in plasma and red blood cells (RBCs), plasma cytokines, antioxidant capacity, acylcarntines, carnitine, choline, betaine, and trimethylamine-N-oxide (TMAO) were measured before and after supplementation. Results: Plasma triacylglycerol (TAG) and large very-low density lipoprotein (VLDL) & chylomicron particle concentrations decreased after 28 days of krill oil intake. A significant reduction in the TAG/HDL cholesterol resulted. Krill oil supplementation decreased n-6/n-3 polyunsaturated fatty acids (PUFA) ratio both in plasma and RBCs. This was due to increased EPA, DHA and docosapentaenoic acid (DPA) and reduced amount of arachidonic acid (AA). The increase of n-3 fatty acids and wt % of EPA and DHA in RBC was of smaller magnitude than found in plasma. Krill oil intake increased the antioxidant capacity, double bond index (DBI) and the fatty acid anti-inflammatory index. The plasma atherogenicity index remained constant whereas the thrombogenicity index decreased. Plasma choline, betaine and the carnitine precursor, γ-butyrobetaine were increased after krill oil supplementation whereas the TMAO and carnitine concentrations remained unchanged. Conclusion: Krill oil consumption is considered health beneficial as it decreases cardiovascular disease risk parameters through effects on plasma TAGs, lipoprotein particles, fatty acid profile, redox status and possible inflammation. Noteworthy, no adverse effects on plasma levels of TMAO and carnitine were found.publishedVersio