- Original article
- Open Access
Auditory and vestibular dysfunction in patients with Parkinson’s disease
The Egyptian Journal of Otolaryngology volume 35, pages313–321(2019)
Motor dysfunction in patients with Parkinson disease (PD) is just the tip of the iceberg. Auditory and vestibular dysfunction in patients with PD gained much attention owing to them being one of the nonmotor symptoms.
To explore abnormalities of pure tone audiometry (PTA), brainstem auditory evoked potentials (BAEPs), vestibular evoked myogenic potential (VEMP), and videonystagmography (VNG) in patients with PD and their correlation with motor and cognitive dysfunction.
Patients and methods
The study was conducted on 20 patients with PD and 15 controls. Selected patients were subjected to evaluation of motor symptoms using Unified Parkinson’s Disease Rating Scale (UPDRS) and cognitive function using Parkinson disease-Cognitive Rating Scale (PD-CRS). PTA, BAEPs, cervical VEMPs, and VNG were carried out for all patients and controls.
Patients with PD show higher mean hearing thresholds at all PTA frequencies in both ears than controls. Analysis of BAEP demonstrated that patients with PD have significantly prolonged absolute latencies of wave III and wave V and interpeak latencies of I–III and I–V in both ears than controls. VEMP findings revealed that patients have significantly delayed P13 and N23 latencies and smaller P13–N23 amplitude in both ears than controls. VNG findings showed canal paresis in 60% of patients with PD and nystagmus in 60% of patients with PD. Correlative results revealed statistically significant correlations between VEMP parameters and UPDRS as well as PD-CRS, but there were no statistically significant correlations between PTA frequencies or BAEP latencies and UPDRS or PD-CRS.
Auditory and vestibular dysfunction is common in PD but cannot be totally correlated with the motor and cognitive symptoms.
Hirsch E, Jenner P, Przedborski S. Pathogenesis of Parkinson’s disease. Mov Disord 2013; 28:24–30.
Pringsheim T, Jette N, Frolkis A, Steeves TD. The prevalence of Parkinson’s disease: a systematic review and meta-analysis. Mov Disord 2014; 29:1583–1590.
Tolosa E, Gaig C, Santamaría J, Compta Y. Diagnosis and the premotor phase of Parkinson disease. Neurology 2009; 72 (Suppl):S12–S20.
Hughes A, Daniel S, Kilford L, Lees A. Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry 1992; 55:181–184.
Chaudhuri K, Odin P, Antonini A, Martinez-Martin P. Parkinson’s disease: the non-motor issues. Parkinsonism Relat Disord 2011; 17:717–723.
Grinberg L, Rueb U, Alho A, Heinsen H. Brainstem pathology and nonmotor symptoms in PD. J Neurol Sci 2010; 289:81–88.
Seidel K, Mahlke J, Siswanto S, Kruger R, Heinsen H, Auburger G, et al. The brainstem pathologies of Parkinson’s disease and dementia with Lewy bodies. Brain Pathol 2015; 25:121–135.
Dickson D, Braak H, Duda J, Duyckaerts C, Gasser T, Halliday G, et al. Neuropathological assessment of Parkinson’s disease: refining the diagnostic criteria. Lancet Neurol 2009; 8:1150–1157.
Jellinger K. A critical evaluation of current staging of alpha-synuclein pathology in Lewy body disorders. Biochim Biophys Acta 2009; 1792:730–740.
Jellinger KA. Neuropathobiology of non-motor symptoms in Parkinson disease. J Neural Transm 2015; 122:1429–1440.
Del Tredici K, Rub U, De Vos R, Bohl J, Braak H. Where does Parkinson disease pathology begin in the brain? J Neuropathol Exp Neurol 2002; 61:413–426.
Pollak L, Kushnir M, Stryjer R. Diagnostic value of vestibular evoked myogenic potentials in cerebellar and lower-brainstem strokes. Neurophysiol Clin 2006; 36:227–233.
Pötter-Nerger M, Govender S, Deuschl G, Volkmann J, Colebatch J. Selective changes of ocular vestibular myogenic potentials in Parkinson’s disease. Mov Disord 2015; 30:584–589.
Vitale C, Marcelli V, Allocca R, Santangelo G, Riccardi P, Erro R, et al. Hearing impairment in Parkinson’s disease: expanding the nonmotor phenotype. Mov Disord 2012; 27:1530–1535.
Lai S, Liao K, Lin C, Lin C, Sung F. Hearing loss may be a nonmotor feature of Parkinson’s disease in older people in Taiwan. Eur J Neurol 2014; 21:752–757.
Carpenter M. Core text of neuroanatomy. Baltimore, MD: Williams & Wilkins 1985. pp. 137–149.
Shammah-Lagnado S, Alheid F, Heimer L. Efferent connections of the caudal part of the globus pallidus in the rat. J Comp Neurol 1996; 376:489–507.
Chan F, Armstrong I, Pari G, Riopelle R, Munoz D. Deficits in saccadic eye-movement control in Parkinson’s disease. Neuropsychologia 2005; 43:784–796.
Vidailhet M, Rivaud S, Gouider-Khouja N, Pillon B, Gaymard B, Agid Y, et al. Saccades and antisaccades in parkinsonian syndromes. Adv Neurol 1999; 80:377–382.
Nakamura T, Kanayama R, Sano R, Ohki M, Kimura Y, Aoyagi M, et al. Quantitative analysis of ocular movements in Parkinson’s disease. Acta Otolaryngol Suppl 1991; 481:559–562.
Lekwuwa G, Barnes G, Collins C, Limousin P. Progressive bradykinesia and hypokinesia of ocular pursuit in Parkinson’s disease. J Neurol Neurosurg Psychiatry 1999; 66:746–753.
Garbutt S, Riley D, Kumar A, Han Y, Harwood M, Leigh R. Abnormalities of optokinetic nystagmus in progressive supranuclear palsy. J Neurol Neurosurg Psychiatry 2004; 75:1386–1394.
Hughes A, Ben-Shlomo Y, Daniel S, Lees A. What features improve the accuracy of clinical diagnosis in Parkinson’s disease: a clinicopathologic study. Neurology 1992; 42:1142–1146.
Fahn S, Elton R, and Members of The UPDRS Development Committee. Unified Parkinson’s Disease Rating Scale. In: Fahn S, Marsden C, Calne D, Goldstein M, editors. Recent developments in Parkinson’s disease (153–63). Florham Park, NJ: Macmillan Health Care Information; 1987.
Pagonabarraga J, Kulisevsky J, Llebaria G, García-Sánchez C, Pascual-Sedano B, Gironell A. Parkinson’s disease-cognitive rating scale: a new cognitive scale specific for Parkinson’s disease. MovDisord 2008; 23:998–1005.
Soliman S, Fathalla A, Shehat M. Development of Arabic staggered spondee words. XXXX 1985; 2:1220–1246.
Soliman S. Speech discrimination audiometry using Arabic phonetically-balanced words. Ain Shams Med J 1976; 27:27–30.
Murofushi T, Shimizu K, Takegoshi H, Cheng P. Diagnostic value of prolonged latencies in the vestibular evoked myogenic potential. Arch Otolorngol Head Neck Surg 2001; 127:1069–1072.
Rigual N. Otolaryngologic manifestations of rheumatoid arthritis. Ear Nose Throat J 1987; 6:18–22.
Yýlmaz S, Karalý E, Tokmak A, Güçlü E, Koçer A, Oztürk O. Auditory evaluation in Parkinsonian patients. Eur Arch Otorhinolaryngol 2009; 266:669–671.
Fradis M, Samet A, Ben-David J, Podoshin L, Sharf B, Wajsbort J, et al. Brainstem auditory evoked potentials to different stimulus rates in parkinsonian patients. Eur Neurol 1988; 28:181–186.
Tachibana H, Takeda M, Sugita M. Short-latency somatosensory and brainstem auditory evoked potentials in patients with Parkinson’s disease. Int J Neurosci 1989; 44:321–326.
Gawel M, Das P, Vincent S, Rose F. Visual and auditory evoked responses in patients with Parkinson’s disease. J Neurol Neurosurg Psychiatry 1981; 44:227–232.
Tsuji S, Muraoka S, Kuroiwa Y, Chen K, Gadusek C. Auditory brainstem evoked response (ABSR) of Parkinson dementia complex and amyotrophic lateral sclerosis in Guam and Japan. Rinsho Shinkeigaku 1981; 21:37–41.
Chiappa K. Short-latency somatosensory evoked patentials: methodology. In: Chiappa KII, editor. Evoked potential in clinical medicine. New York, NY: Raven Press 1983. pp. 204–313.
Prasher D, Bannister R. Brainstem auditory evoked potentials in patients with multiple system atrophy with progressive autonomic failure (Shy Drager syndrome). J Neurol Neurosurg Psychiatry 1986; 49:278–289.
Alexa D, Alexa L, Popa L, Paduraru D, Ignat B, Constantinescu A, et al. Brainstem auditory evoked potentials in Parkinson’s disease. Rom J Neurol Psychiatry 2013; XII4:XX.
Pollak L, Prohorov T, Kushnir M, Rabey M. Vestibulocervical reflexes in idiopathic Parkinson disease. Neurophysiol Clin 2009; 39:235–240.
Halberstadt A, Balaban C. Selective anterograde tracing of the individual serotonergic and nonserotonergic components of the dorsal raphe nucleus projection to the vestibular nuclei. Neuroscience 2007; 147:207–223.
De Natale E, Ginatempo F, Paulus K, Manca A, Mercante B, Pes G, et al. Paired neurophysiological and clinical study of the brainstem at different stages of Parkinson’s disease. Clin Neurophysiol 2015a;126:1871–1878.
De Natale E, Ginatempo F, Paulus K, Pes G, Manca A, Tolu E, et al. Abnormalities of vestibularevoked myogenic potentials in idiopathic Parkinson’s disease are associated with clinical evidence of brainstem involvement. Neurol Sci 2015b;36:995–1001.
Venhovens J, Meulstee J, Bloem B, Verhagen W. Neurovestibular analysis and falls in Parkinson’s disease and atypical parkinsonism. Eur J Neurosci 2016; 43:1636–1646.
Van der Marck M, Klok M, Okun M, Giladi N, Munneke M, Bloem B, et al. Consensus-based clinical practice recommendations for the examination and management of falls in patients with Parkinson’s disease. Parkinsonism Relat Disord 2014; 20:360–369.
Hassan D, Shalash A. Auditory brainstem evoked responses and vestibular evoked myogenic potentials: potential biomarkers in Parkinson’s disease. Egypt J Otolaryngol 2017; 33:508–517.
Braak H, Ghebremedhin E, Rub U, Bratzke H, Del Tredici K. Stages in the development of Parkinson’s disease-related pathology. Cell Tissue Res 2004; 318:121–134.
Braak H, Del Tredici K, Rüb U, de vos R, Jansen Steur E, Braak E. Staging of brain pathology related to sporadic Parkinson’s disease. Neurobiol Aging 2003; 24:197–211.
Grant M, Leigh R, Seidman S, Riley D, Hanna J. Comparison of predictable smooth ocular and combined eye-head tracking behaviour in patients with lesions affecting the brainstem and cerebellum. Brain 1992; 115:1323–1342.
Vidailhet M, Rivaud S, Gouider-Khouja N, Pillon B, Bonnet A, Gaymard B. Eye movements in parkinsonian syndromes. Ann Neurol 1994; 35:420–426.
Bassetto J, Zeigelboim B, Jurkiewicz A, Klagenberg K. Neurotological findings in patients with Parkinson’s disease. Braz J Otorhinolaryngol 2008; 74:350–355.
Reichert W, Doolittle J, Mcdowell F. Vestibular dysfunction in Parkinson disease. Neurology 1982; 32:1133–1138.
Gushikem P. Avaliação otoneurológica em idosos com tontura. 2001.84f. Tese. (Mestrado em Distúrbios da Comunicação Humana) –Universidade Federal de São Paulo- Escola Paulista de Medicina, São Paulo.
Dolowitz D. Diagnosis of early Parkinson’s disease. Laryngoscope 1969; 79:1275–1280.
Silveira S, Taguchi C, Ganança F. Comparative analysis of two lines treatment for patients with vestibular syndromes peripheral groups over the age of sixty. Acta Awho 2002; 21:14–31.
Whitney S. Treatment of the elderly with vestibular dysfunction. In: Herdman SJ, editor. Vestibular rehabilitation. 2nd ed. São Paulo: Manole; 2002. pp. 505–528.
Hain T, Ramaswamy T, Hillman M. Anatomy and Physiology of the System normal vestibular. In: Herdman SJ, editor. Vestibular rehabilitation. 2nd ed. São Paulo: Manole; 2002. pp. 3–24.
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Hussein, M., Koura, R. Auditory and vestibular dysfunction in patients with Parkinson’s disease. Egypt J Otolaryngol 35, 313–321 (2019). https://doi.org/10.4103/ejo.ejo_18_18
- brainstem auditory evoked potentials
- Parkinson disease-Cognitive Rating Scale
- pure tone audiometry
- Unified Parkinson’s Disease Rating Scale
- vestibular evoked myogenic potentials