OBJECTIVE: The \"collapse,\" a highly flexed, dented, or caved membrane between the endo- and peri-lymph of the saccule and utricle in adults, is considered as a morphological aspect of Ménière\'s syndrome. Likewise, when mesh-like tissues in the perilymphatic space are damaged or lost, the endothelium loses mechanical support and causes nerve irritation. However, these morphologies were not examined in fetuses.
METHODS: By using histological sections from 25 human fetuses (crown-rump length[CRL] 82-372 mm; approximately 12-40 weeks), morphologies of the perilymphatic-endolymphatic border membrane and the mesh-like tissue around the endothelium were examined.
RESULTS: The highly flexed or caved membrane between the endo- and peri-lymphatic spaces was usually seen in the growing saccule and utricle of fetuses, especially at junctions between the utricle and ampulla at midterm. Likewise, the perilymphatic space around the saccule, utricle and semicircular ducts often lost the mesh-like tissues. The residual mesh-like tissue supported the veins, especially in the semicircular canal.
CONCLUSIONS: Within a cartilaginous or bony room showing a limited growth in size but containing increased perilymph, the growing endothelium appeared to become wavy. Owing to a difference in growth rates between the utricle and semicircular duct, the dentation tended to be more frequently seen at junctions than at free margins of the utricle. The difference in site and gestational age suggested that the deformity was not \"pathological\" but occurred due to unbalanced growth of the border membrane. Nevertheless, the possibility that the deformed membrane in fetuses was an artifact caused by delayed fixation is not deniable.

BACKGROUND: The aqeductus vestibuli (aqueduct) is believed to connect to the saccule in embryos and adults. However, in embryos, the saccule and utricle are known to communicate widely to provide a common endolymph space \"atrium\".
METHODS: Using sagittal histological sections from five embryos (crown-rump length or CRL, 14-21 mm), nine early fetuses (CRL 24-35 mm) and 12 midterm and near-term fetuses (CRL 82-272 mm), we revisited the development and growth of the human ear aqueduct.
RESULTS: The atrium took on a thick tube-like appearance as an antero-inferior continuation of the aqueduct, but soon divided into multiple gulfs. Most of the gulfs corresponded to the ampullae of semicircular ducts, while one gulf at the antero-medio-inferior corner corresponded to the future saccule. Notably, in eight of the 14 embryos and early fetuses, the aqueduct ended at the utricle near the primitive ampulla of the anterior (superior) or posterior semicircular duct. Conversely, an embryo of CRL 21 mm was the smallest specimen in which the aqueduct joined the gulf-like saccule. At midterm and near-term, the growing perilymph space separated the aqueduct from the utricle and appeared to push the aqueduct toward the saccule. A topographical change occurred between the embryonic superiorly located utricle and the inferiorly-located saccule to create the antero-posterior arrangement in adults.
CONCLUSIONS: Consequently, the vestibular end of the aqueduct was most likely to migrate anteriorly from the utricle to the saccule at 6-8 weeks possibly due to differential growth of the endothelium. Previous reconstructions of the embryonic aqueduct might be biased by the adult morphology.

We describe herein the case of a patient whose primary complaints were episodic vertigo and \"depersonalization,\" a sensation of detachment from his own body.
This case study aims to further clinical knowledge and insight into the clinical evaluation of vertiginous patients with complaints of depersonalization.
This is a case study.
A retrospective chart review of vestibular function testing done on a vertiginous patient with complaints of depersonalization was performed.
Vestibular function testing revealed absent cervical and ocular vestibular evoked myogenic potentials on the left side with normal vHIT or video Head Impulse Test, videonystagmography, and rotational chair results, suggesting peripheral vestibular impairment isolated to the left saccule and utricle.
The otolith end organ impairment explains the patient\'s postural deviation to the left side during attempts to ambulate. We recommend that clinicians should be attentive to patient complaints of depersonalization and perform vestibular evoked myogenic potential testing to determine whether evidence of at least a unilateral peripheral otolith end organ impairment exists.

Objective:The aim of this study is to explore the characteristics of ocular muscle vestibular evoked myogenic potential （oVEMP） in patients with Meniere\'s disease and benign paroxysmal positional vertigo （BPPV-MD）, and to explore the clinical characteristics of oVEMP frequency amplitude ratio （FAR）. Methods:Forty-one patients with unilateral MD diagnosed in the outpatient clinic from January 2016 to April 2019 were selected, of which 15 patients with BPPV-MD were set as BPPV-MD group, and 26 patients with unilateral MD were set as MD group. During the same period, 30 healthy volunteers matched in age and gender were selected as the control group. All the individuals underwent oVEMP and cVEMP recording for 500 Hz and 1000 Hz tone burst. The oVEMP and cVEMP response rate, N1 and P1 waves latency, N1-P1 wave amplitude and 1000/500 Hz FAR of the affected and contralateral ears of the three groups were compared and analyzed by SPSS 20.0 software. The receiver operating characteristics curves were obtained for finding out the criterion point, sensitivity, and specificity of 1000/500 Hz FAR for the diagnosis of BPPV-MD. Results:In response to 500 Hz tone burst, oVEMP response rates in the affected lateral ears of BPPV-MD group, MD group and right ears of control group were 46.67%, 46.15% and 76.67%, respectively; the rates for the 1000 Hz-oVEMP of the three groups were 53.33%, 46.15% and 63.33%, respectively. By the 500 Hz air-conducted tone-burst stimulus, the oVEMP N1 and P1 latency of the affected ears in the BPPV-MD group was longer than that in the MD group and the control group（P<0.05）. By the stimulus of 1000 Hz tone burst, the oVEMP N1 and P1 latency of the affected ears in BPPV-MD group and MD group was longer than that in control group（P<0.05）. At 500 Hz, the oVEMP amplitude of the affected ears in BPPV-MD group and MD group was lower than that in the right ears of the control group（P<0.05）. There was no statistically significant difference in the N1-P1 amplitudes of oVEMP in the three groups under the stimulation of 1000 Hz tone burst（P>0.05）. The FAR for 1000/500 Hz of the affected ears in BPPV-MD group and MD group was higher than that in control group（P<0.05）, but there was no significant difference between BPPV-MD group and MD group（P>0.05）. Conclusion:When FAR is greater than 0.84, which indicates that the pathophysiologic factor is accumulation of excessive amounts of endolymph; when FAR is greater than 1.79, which suggests that the otolitic membrane of the elliptic cyst is damaged by the hydrops of the labyrinthus. The FAR of BPPV-MD can be used as one of the indicators to evaluate the function of the utricle.
目的：通过分析梅尼埃病合并良性阵发性位置性眩晕（BPPV-MD）患者的眼肌前庭诱发肌源性电位（oVEMP）特征，探讨oVEMP频率振幅比（FAR）的临床特性。 方法：选取2016年1月-2019年4月期间门诊确诊的单侧MD患者41例，其中15例BPPV-MD患者设为BPPV-MD组，26例单侧MD患者设为MD组；同期选取30例（60耳）年龄和性别相匹配的健康志愿者作为对照组。分别以500、1000 Hz气导短纯音作为刺激声，对三组受试者进行oVEMP和cVEMP检测。应用SPSS 20.0软件对BPPV-MD组和MD组患耳与对照组右耳oVEMP和cVEMP的引出率，N1、P1波潜伏期、振幅以及1000/500 Hz FAR进行对比分析，并对FAR进行受试者工作特征曲线分析。 结果：500 Hz刺激下BPPV-MD组、MD组患耳与对照组右耳的oVEMP引出率分别为46.67%（7/15）、46.15%（12/26）及76.67%（23/30）；1000 Hz刺激下引出率分别为53.33%（8/15）、46.15%（12/26）及63.33%（19/30）。500 Hz下BPPV-MD组患耳oVEMP的N1、P1波潜伏期较MD组和对照组右耳延长（P<0.05）；1000 Hz下BPPV-MD组和MD组患耳oVEMP的N1、P1波潜伏期较对照组右耳延长（P<0.05）。500 Hz下BPPV-MD组和MD组患耳oVEMP振幅较对照组右耳降低（P<0.05）；1000 Hz下BPPV-MD组、MD组患耳与对照组右耳比较差异无统计学意义（P>0.05）。BPPV-MD组和MD组患耳oVEMP的FAR较对照组右耳高（P<0.05）；BPPV-MD组和MD组患耳之间FAR比较差异无统计学意义（P>0.05）。 结论：BPPV-MD的oVEMP具有频率调谐的特性，当FAR大于0.84时，表明患者内耳存在膜迷路积水的病理学改变；当FAR大于1.79时，表明膜迷路积水引起椭圆囊囊斑耳石膜受损，因此FAR可作为评价椭圆囊功能的指标之一。.

Objective: To observe the ultrastructure of the ampulla, and analyze its physiological and pathological significance. Methods: In this study, 20 Kunming mice were used, and scanning electron microscopy was used to observe the ultrastructure of the ampulla of inner ear. Results: Otoconia was found among the cilia bundles of different haircell(intercilla otoconia of ampulla). The cupula was attached to the lateral wall of the ampulla, and easily to be separated; after separated, a kind of slender crystal(surface otoconia of ampulla) could be seen between the cupula and lateral wall of the ampulla, both sides of ampullary crest were covered with slender crystals too. On the canal side of the ampulla wall, there was more particulate matter attached to the wall near the bottom of ampullary crest, partially embedded in the wall, and less on the utricle side of the ampulla wall. Conclusions: The observation of the ultrastructure of the ampulla is helpful for better understanding the physiological functions of the semicircular canals and the ampulla, and better understanding the pathogenesis and solution of some vertigo diseases.
目的： 通过观察小鼠内耳壶腹超微结构，探讨其生理及病理意义。 方法： 20只昆明小鼠，采用扫描电镜观察其内耳壶腹超微结构。 结果： 扫描电镜下，壶腹嵴不同的毛细胞纤毛束之间可以观察到耳石结构的存在（壶腹嵴纤毛间耳石）；嵴帽与壶腹外侧壁相黏贴，二者容易分离，分离后在嵴帽和壶腹外侧壁之间可以观察到纤细的晶体样颗粒物，在壶腹嵴两侧壁上也可以观察到该纤细的晶体样颗粒物（壶腹嵴表面耳石）；在壶腹半规管侧壁近壶腹嵴底处有较多颗粒物黏附，部分埋于壁内，而壶腹椭圆囊侧壁则很少有这种颗粒物。 结论： 通过对小鼠壶腹超微结构的观察，我们能够更好地理解半规管和壶腹的生理功能，有助于对相关眩晕疾病发病机制和转归的理解。.

OBJECTIVE: Like other vestibular schwannomas developing in the internal auditory canal, intralabyrinthine schwannomas (ILS) may present with similar symptoms as in endolymphatic hydrops. Two different studies have described MR saccular hydrops in ~ 30% of internal auditory canal vestibular schwannomas, but this association has never been studied in ILS before. The aim of this work is to study the prevalence of a saccular dilation in ILS, on a T2-weigthed sequence at 3 T, compared to a control group.
METHODS: All patients presenting with typical ILS between January 2008 and October 2018 were included (n = 28, two patients with bilateral tumors) and compared to a control group (n = 53). All underwent a high-resolution T2-weighted 3D sequence (FIESTA-C). The height and width of the saccule were measured on a coronal plane by two radiologists.
RESULTS: The saccule was dilated on the side of the schwannoma in 47% of the cases (p = 0.0006 for the height, p = 0.0487 for the width). Bilateral saccular dilation was observed in 37% of the cases. There was a statistically significant correlation between the presence of a saccular hydrops and balance disorders (p = 0.02) as 50% of the patients with an intralabyrinthine schwannoma who presented with such symptoms had a saccular dilation.
CONCLUSIONS: Forty-seven percent of ILS are associated with homolateral saccular dilation, which is an MR sign of endolymphatic hydrops (bilateral in 37%) and it appears related to the presence of balance disorders. This opens new therapeutic potentialities with the possible use of anti-vertiginous drugs, which could have a beneficial effect on their clinical symptomatology.

OBJECTIVE: To evaluate the function of the utriculus and sacculus and their central connections by ocular and cervical vestibular-evoked myogenic potentials (oVEMPs and cVEMPs), and the function of high-frequency VOR of the semicircular canals by video head impulse test (vHIT) in patients with panic disorder (PD).
METHODS: Forty-eight patients with PD (21 with agoraphobia) and 20 sex- and age-matched healthy controls took part in the investigation. The vestibulo-ocular reflex (VOR) gains and latencies and peak-to-peak amplitudes of sound-induced VEMPs were measured and compared with those of healthy controls.
RESULTS: Any statistical differences in the parameters of cVEMP and oVEMP responses between both PD patients groups and between patients and healthy controls were not observed. Also, significant differences between VOR in patients and healthy controls were not found. The VOR gain, bilaterally in the three semicircular canals was within normal limits (0.8-1.2) for 67%, and higher for 33% of the patients with PD. Overt and covert saccades were not observed. The relationship between higher VOR gains and the increase of postural instability when a sensory conflict exists (standing on foam pad with eyes closed) for patients with PD was established.
CONCLUSIONS: The VEMPs and vHIT tests demonstrated that there is no evidence of hypofunction of the semicircular canals in the high-frequency spectrum of VOR functioning. Nor are there any indications of impairment of the otolith system in patients with PD, regardless of their subjective vestibular sensations. The findings of the current study confirm the proposed link between anxiety, panic symptoms and postural instability in PD patients.

OBJECTIVE: Vestibular schwannomas (VS) may present with similar symptoms endolymphatic hydrops. Association between hydrops and internal auditory canal VS has been described by Naganawa et al. (Neuroradiology 53:1009-1015, 2011), but has never been confirmed since. The aim of this work was to study the prevalence of a saccular dilation on a T2-weighted sequence at 3 T MRI in VS compared to a control group.
METHODS: All patients presenting with typical VS between May 2009 and July 2018 were included (n = 183) and compared to a control group (n = 53). All underwent a high-resolution T2-weighted 3D sequence (FIESTA-C). The height and width of the saccule were measured on a coronal plane by two radiologists.
RESULTS: The saccule was dilated on the side of the schwannoma in 28% of the cases (p = 2.81 × 10- 5), with 15.7% of bilateral dilation. Saccular dilation was correlated to sensorineural hearing loss (OR 3.26, p = 0.02). There was also a significant correlation between saccular hydrops on the normal contralateral side of patients with VS and vertigo (p = 0.049), and between saccular hydrops on the side of the tumour and tinnitus (p = 0.006).
CONCLUSIONS: A third (29%) of VS are associated with a saccular dilation on the side of the tumour, which is an MR sign of endolymphatic hydrops (bilateral in 15.7% of the cases) and it appears related to sensorineural hearing loss and tinnitus, as well as vertigo if a contralateral dilation is present. This opens new therapeutic potentialities with the use of anti-vertiginous drugs, which could have a beneficial effect on the clinical symptoms.

Vestibular neuritis (VN) can affect utricular afferents. Utricular function can be assessed by ocular vestibular evoked myogenic potentials (oVEMPs) whose abnormalities include weak or absent responses, and ocular cycloposition whose abnormalities include ocular torsion (OT). When studied independently in vestibular neuritis, oVEMPs are abnormal in 61-82% of cases, and OT is present in 72-80% of cases. The similar range of abnormalities suggests the hypothesis that these tests should be concordantly abnormal. We tested this hypothesis by identifying consecutive adult cases of VN in whom both oVEMPs and OT were performed. OT and oVEMP overlapped (both were abnormal) in only 47% of cases. In 40% of cases oVEMPs alone were abnormal, and in 13% of cases, OT alone was present. These results suggest that oVEMPs and OT assess different aspects of utricular function believed to arise from discrete zones of the utricular macula; the former are thought to reflect the activity of extra-striolar afferents (which detect constant acceleration), and the latter reflects the activity of striolar afferents (which detect change in acceleration).

OBJECTIVE: We aimed to describe vestibular/oculomotor function of 7-12-year-old children with CP, Gross Motor Function Classification System (GMFCS) levels (I-III), in comparison to an age-matched control group to understand the effect of the vestibular system on activities and participation of children with CP.
METHODS: Vestibular, oculomotor and balance function were tested in children with CP. Central and peripheral vestibular function was examined using an enclosed rotary chair and infrared video goggles (100 Hz) that measured eye movements. Oculomotor tests included smooth pursuit and optokinetic nystagmus (OKN). Vestibulo-Ocular Reflex (VOR) tests, done in complete darkness, included step rotation (STEP), sinusoidal harmonic acceleration (SHA) test, VOR cancellation and enhancement, and subjective visual vertical and horizontal (SVV/SVH). The integrity of the saccule was tested with the Cervical Vestibular Evoked Myogenic Potential. If able, the participants\' balance abilities were examined using the Sensory Organization Test (SOT) to determine ability to maintain standing balance during six conditions that challenged the visual, somatosensory and vestibular systems. Independent t-tests and Mann-Whitney U tests were used to compare results between groups.
RESULTS: Forty-one children with CP (mean age = 9.44 years, SD = 1.66; 23F/18M; Gross Motor Function Classification System levels: I (n = 19), II (n = 7), III (n = 15) and thirty-three typically developing (TD) children (mean age = 10.16 years, SD = 1.6; 13F/20M) were recruited from the Birmingham, AL community. There was no significant difference between children with CP and TD children in saccular function (i.e. C-VEMP test), and peripheral vestibular end organ (i.e. SHA test and STEP test), VOR enhancement, or OKN gain. Velocity gain for horizontal smooth pursuit was significantly worse in children with CP (p = 0.009), compared to TD children. Poor mediation of central vestibular function were that evident with significantly higher VOR cancellation gain in children with CP (p < 0.0001), compared to TD children and significantly higher SVV variance (p = 0.002), SVH mean (p = 0.001), and SVH variance (p < 0.0001) in children with CP compared to TD children. Compromised balance abilities in children with CP was evident with significantly lower composite scores (p < 0.0001), vestibular ratio (p < 0.0001), and visual ratio (p = 0.021). The somatosensory ratio (p = 0.798) of children with CP was similar to children with TD.
CONCLUSIONS: Although peripheral vestibular function was intact, children with CP had difficulty coupling eye and head movement (VOR cancellation), using the vestibular system for postural control (SOT), demonstrated poor perception of upright (SVV/SVH), and had difficulty following a slow moving target (smooth pursuit eye movement). These results implicate a central vestibular and oculomotor function impairment the severity of which corresponded with severity of the level of CP.