Hasil untuk "Otorhinolaryngology"

Mohamed S. Kishta, Aya Khamis, Hafez AM et al.

Head and neck squamous cell carcinoma (HNSCC) remains a challenging malignancy due to its high rates of recurrence, metastasis, and resistance to conventional therapies. microRNA-200c (miRNA-200c) has emerged as a critical tumor suppressor in HNSCC, with the potential to inhibit epithelial-mesenchymal transition (EMT), which is considered as a key process in cancer metastasis and progression. Interestingly, there are also controversial findings in HNSCC characterizing miRNA-200c as oncogenic factor. This review article provides a comprehensive overview of the current understanding of miRNA-200c's general role in cancer, and particularly in HNSCC, highlighting its mechanisms of action, including the regulation of EMT and other oncogenic pathways.Additionally, the review explores the innovative approach of exosome-mediated delivery of miRNA-200c as a therapeutic strategy. Exosomes, as natural nanocarriers, offer a promising vehicle for the targeted delivery of miRNA-200c to tumor cells, potentially overcoming the limitations of traditional delivery methods and enhancing therapeutic efficacy. The review also discusses the challenges and future directions in the clinical application of miRNA-200c, particularly focusing on its potential to improve outcomes for HNSCC patients. This article seeks to provide valuable insights for researchers and clinicians working towards innovative treatments for this aggressive cancer type.

Zhuangzhuang Li, Jingwei Lai, Yini Li et al.

We aimed to investigate whether sleep deprivation (SD) affects vestibular compensation and explore the underlying mechanisms. After unilateral labyrinthectomy (UL), adult mice were subjected to 6 h of SD for 5 days. Behavioural tests were performed to evaluate the vestibular recovery. RNA sequencing and bioinformatic analyses were conducted on the deafferented vestibular nuclei (VN) of UL mice with or without SD. Immunofluorescence and western blotting were used to verify the inflammatory responses, neuroplasticity, and pathways in the VN of UL+SD mice. Minocycline and TAK-242 were used to inhibit microglial activation and TLR4, respectively. Our findings suggest that SD significantly impaired vestibular compensation in UL mice. RNA sequencing identified upregulated immune- and inflammation-related pathways in the deafferented VN after SD, which was verified by microglial overactivation. Moreover, neuroplasticity was impaired, and inhibition of microglial proliferation with minocycline partially improved the impaired vestibular compensation during the early stages. Mechanistically, TLR4/NF-κB/NLRP3 pathway activation was predominantly involved in this process, and pharmacological inhibition of TLR4 inhibited NLRP3 activation in microglia and improved SD-induced vestibular compensation delay. Overall, this study illustrates that SD alters neuroplasticity and aggravates microglia-mediated neuroinflammation in deafferented VN by activating TLR4/NF-κB/NLRP3 signalling, which contributes to impaired vestibular compensation.

Lauren Farquhar, Amr El Refaie

Background/Objectives: Children with congenital or early onset sensorineural hearing loss (SNHL) are at a greater risk of vestibular dysfunction (VD), hypothesized to occur from the close embryological relationship between the cochlear and vestibular systems. Even with increasing focus on early detection and rehabilitation through Universal Newborn Hearing Screening (UNHS) programmes in many countries, few studies have focused on the prevalence and feasibility of vestibular assessment in infant populations. The objectives of this review are to 1. identify the prevalence of VD infants with congenital or early onset (<12 months old) SNHL, 2. identify which vestibular assessment tests/protocols are conducted on this population, 3. report sensitivity and specificity values for identified vestibular assessment tests/protocols. Methods: Studies that included infants aged 0–12 months, with congenital or early onset SNHL of any laterality, degree, or configuration, and who underwent any method of vestibular assessment were included. The review adhered to the Joanna Briggs Institute (JBI) guidance and the PRISMA-ScR extension statement. Results: A total of 18 studies were included in the review. All articles reported that infants with congenital or early onset SNHL are at a greater risk of VD, particularly those with bilateral severe–profound SNHL. The cervical vestibular-evoked myogenic potentials (cVEMP) test was the most frequently identified vestibular assessment tool for this age demographic. Conclusions: Results from the included articles coincide with results from literature assessing older paediatric populations. cVEMPs have been reported to be a feasible, sensitive, and specific screening tool in infants with congenital or early onset SNHL. The prevalence of VD in infants with congenital or early onset SNHL justify further investigation on the feasibility of establishing a pathway for vestibular assessment for all infants referred by UNHS programmes.

Filipa Ferreira, Cátia Azevedo, Paula Campelo et al.

Objetivo: Elaboração de um protocolo de atuação no doente com disforia de género associada à voz. Desenho do Estudo: Revisão sistemática. Material e Métodos: Revisão bibliográfica nas bases de dados PubMed e Google Scholar de publicações em inglês, português e espanhol, que contemplem a avaliação clínica, tratamento médico e/ou cirúrgico da voz em doentes transgénero. A revisão sistemática foi elaborada segundo as normas PRISMA 2020. Resultados: Foram incluídas 10 publicações. A avaliação em consulta dos doentes transgénero deve incluir uma avaliação áudio-percetiva (GRBAS e CAPE-V), uma análise acústica da voz (frequência fundamental, frequência dos formantes, extensão vocal e tempo de fonação máxima), a realização de uma laringoestroboscopia a baixo, médio e alto pitch e a aplicação de questionários (Trans Woman Voice Questionnaire – TWVQ e 10-question Voice Handicap Index – VHI-10). Numa primeira fase da abordagem terapêutica, o indivíduo transgénero deve ser encaminhado a um terapeuta da fala habilitado. Quando esta ferramenta apresenta resultados insuficientes, devem ponderar-se opções cirúrgicas. Uma vez que a maioria dos homens transgénero fica satisfeito com a voz obtida com o tratamento hormonal, existem ainda poucos estudos acerca da abordagem cirúrgica nesta subpopulação. Em relação às mulheres transgénero, a glotoplastia de Wendler é o procedimento de eleição. Conclusões: Num tema que se encontra em franco crescimento, surge a necessidade de criação de um protocolo de abordagem que sintetize os melhores cuidados vocais da atualidade.

Simon Høj, BSc, Howraman Meteran, MD, PhD

Savine S. M. Martens, Jeroen J. Briaire, Johan H. M. Frijns

Devising a psychophysical test to assess spectral resolution has not been easy. Two tests that have been used previously are the spectral ripple test and the spectral-temporally modulated ripple test (SMRT). Over time, questions have been raised about the validity of these tests. We introduce a new computational electric hearing (with a cochlear implant, CI) model that can simulate how sound is transferred through a speech processor and is received by the cochlear nerve fibers. With this electric hearing model and a normal hearing model, we investigated whether the known limitations of these tests can be detected. For the spectral ripple test, we could show the limitations in the output of the CI, the information conveyed to the cochlear nerve, to estimate the threshold, and show the benefit of current steering. In addition, we reproduced the aliasing effect with normal hearing in the SMRT, as well as the reduced ripple resolution in CI users. Our computational modeling framework can serve as a first-step assessment of the validity of new psychophysical tests. Moreover, it could be used to test new speech coding strategies.

Yutian Li, Huiwen Yang, Xun Niu et al.

Objective: This systematic review investigates the long-term effect of cochlear implantation (CI) on clinical outcomes in tinnitus patients with sensorineural hearing loss (SNHL). Database Sources: PubMed, Embase, and the Cochrane Library were searched from inception to 30 April 2024. Manual searches of reference lists supplemented these searches when necessary. Review Methods: Original studies included in the meta-analysis had to contain comparative pre- and postoperative data for SNHL patients who underwent CI. Outcomes measured were the Tinnitus Handicap Inventory (THI), Visual Analog Scale (VAS), and Tinnitus Questionnaire (TQ). Results: A total of 28 studies comprising 853 patients showed significant tinnitus improvement after CI: THI mean difference (MD) −14.02 [95%CI −15.29 to −12.76, <i>p</i> < 0.001], TQ MD −15.85 [95%CI −18.97 to −12.74, <i>p</i> < 0.05], and VAS MD −3.12 [95%CI −3.49 to −2.76, <i>p</i> < 0.05]. Subgroup analysis indicated a significant difference between follow-up periods in THI (<i>p</i> < 0.0001) and VAS loudness (<i>p</i> = 0.02). Conclusions: Cochlear implantation substantially improves tinnitus in patients with hearing loss, though the effect may diminish over time. Further research is needed to confirm these findings.

Ole Jakob Jørgensen, Johan Edvard Steineger, Andreas Hillarp et al.

Abstract Objectives The objective of this study was twofold: to determine the prevalence of arterial and venous thromboembolic events in the Norwegian Hereditary Hemorrhagic Telangiectasia (HHT) population, and to explore potential factors linked to such events, with particular emphasis on FVIII. Methods Patients with an HHT diagnosis attending the Otorhinolaryngology Department at Oslo University Hospital—Rikshospitalet were included consecutively between April 2021 and November 2022. We recorded the participants' medical history with an emphasis on thromboembolic events. Measurements of blood constituents, including FVIII, FIX, vWF, hemoglobin, iron, ferritin, and CRP were performed. Results One hundred and thirty‐four patients were included in the study. The total prevalence of thromboembolic events among the participants was 23.1%. FVIII levels were high (>150 IU/dL) in the majority of HHT patients (n = 84) (68.3%) and were significantly associated with thromboembolic events (p < .001), as was age. Of the patients with high FVIII levels, 28 (33%) had experienced a thromboembolic event. Furthermore, FVIII levels were measured consecutively in 51 patients and were found to fluctuate above or below 150 IU/dL in 25% of these cases. Conclusion Thromboembolic events are highly prevalent in the Norwegian HHT population and are significantly associated with FVIII levels. FVIII levels can fluctuate, and measurements should be repeated in HHT patients to assess the risk of thromboembolic events. Level of Evidence 4.

Sara Yang, William Adams, Carol Bier‐Laning

Abstract Objective Unplanned 30‐day readmissions result in increased costs and decreased patient satisfaction. The objective of this study was to compare readmission rates before and after a multidisciplinary quality improvement initiative that focuses on patient and staff education, use of targeted skilled nursing facilities, and appropriate use of patient observation status. Methods This was a quality improvement study of all unplanned admissions to the Head and Neck Oncology service at a tertiary care facility during a 3‐year period between October 2015 and September 2018. In October 2016, when the Head and Neck Oncology service revised its discharge practices for patients undergoing extirpative and/or reconstructive surgery. These changes included enhancing patient education, increasing the use of a skilled nursing facility with directed staff education and patient handoffs by advanced practice nurses, and appropriate utilization of 23‐h observation status for returning patients. The readmission rate from the pre‐intervention era (October 2015 through September 2016) was compared to the readmission rate from the post‐intervention era (October 2016 through September 2018). Secondary outcomes were the rates of 23‐h observation within 30 days of the discharge as well as emergency room visits within 30 days of discharge. Results In this sample of 449 patients, 161 (35.9%) were observed before the change‐in‐practice (before October 2016), and 288 (64.1%) were observed following the change‐in‐practice (after September 2016). On univariable analysis, the risk of readmission declined by approximately 41.4% from the pre‐intervention era, though this conclusion was not statistically significant (P = 0.06). On multivariable analysis, patients at moderate or high risk of death were 2.31 times more likely than those at minor risk of death to readmit within 30 days (P = 0.03). Similarly, those with recurrent or persistent cancer were 3.33 times more likely than those undergoing initial curative surgical management of cancer to readmit within 30 days (P = 0.001). No patient characteristics were associated with a 23‐h observation following discharge (all P > 0.05). Conclusions were similar for emergency room visits following discharge. Conclusions A three‐part quality improvement strategy resulted in a clinically important decrease in 30‐day readmissions, though the decline was not statistically significant. There were no significant changes in 23‐h observation within 30 days of discharge or emergency room visits within 30 days of discharge.

Kai-Hung Cheng, Ning-Kuang Wu, Chao-Tung Chen et al.

BackgroundWorkplace health promotion (WHP) in the healthcare industry is an important yet challenging issue to address, given the high workload, heterogeneity of work activities, and long work hours of healthcare workers (HCWs). This study aimed to investigate the effectiveness and response differences of a multidisciplinary WHP program conducted in HCWs.MethodsThis retrospective cohort study included HCWs participating in a multidisciplinary WHP program in five healthcare facilities. The 20-week intervention included multiple easy-to-access 90-min exercise classes, one 15-min nutrition consultation, and behavioral education. Pre- and post-interventional anthropometrics, body composition, and physical fitness (PF) were compared with paired sample t-tests. Response differences across sex, age, weight status, and shiftwork status were analyzed with a generalized estimating equation.ResultsA total of 302 HCWs were analyzed. The intervention effectively improved all anthropometric (body mass index, waist circumference, waist-hip ratio, and waist-to-height ratio), body composition (body fat percentage, muscle weight, visceral fat area), and PF (grip strength, high jump, sit-up, sit-and-reach, step test) parameters in all participants (all p &lt; 0.05). Subgroup analyses revealed shift workers had a more significant mean reduction in body mass index than non-shift workers (adjusted p = 0.045). However, there was no significant response difference across sex, age, and weight subgroups.ConclusionThis study suggested that a multidisciplinary WHP program can improve anthropometric and PF profiles regardless of sex, age, and weight status for HCWs, and shifter workers might benefit more from the intervention.

YE Yuquan (叶玉泉)

Objective To observe the effect of external application with Traditional Chinese Medicine in prevention of postoperative fever (＞38 ℃) in patient undergoing surgery for obstructive sleep apnea-hypopnea syndrome. Methods Totally 118 patients undergoing bilateral tonsillectomy/adenoidectomy were randomly divided into the study group and the control group, with 59 cases in each group. All patients received routine care after surgery, and those in the study group were given external application with Traditional Chinese Medicine. The incidence of postoperative fever (＞38 ℃) was compared between two groups. Results The incidence of postoperative fever (＞38 ℃) in the study group was 28. 81%(17/59), lower than 35. 59%(21/59) in the control group, with no significant difference (P＞0. 05). Conclusion External application with Traditional Chinese Medicine is potentially effective to reduce the risk of postoperative fever in patient undergoing surgery for obstructive sleep apnea-hypopnea syndrome. (目的 观察中药敷贴预防阻塞性睡眠呼吸暂停低通气综合征(OSAHS)术后发热(术后体温＞38 ℃)的效果。方法 选取行双侧扁桃体切除术/腺样体切除治疗的OSAHS患者118例为研究对象, 术后将患者随机分为研究组和对照组, 各59例。对照组采用常规护理干预, 研究组在对照组基础上增加中药敷贴。对比2组患者临床发热(术后体温＞38 ℃)发生率。结果 研究组术后发热(体温＞38 ℃)的发生率为28. 81%(17/59), 低于对照组的35. 59%(21/59), 但差异无统计学意义(P＞0. 05)。结论 采用中药敷贴对降低OSAHS患者术后发热(体温＞38℃)发生风险具有积极意义, 有利于促进术后康复进程。)

Takuya Noda, Tomo Ishisaka, Keiichiro Okano et al.

Abstract Objectives Recurrent laryngeal nerve (RLN) injury is one of the severe complications in thyroid surgery. Therefore, intraoperative nerve monitoring (IONM) has been widely used to identify the RLN and confirm its integrity. Recently, the usefulness of continuous IONM (CIONM) with automatic, periodic stimulation to the vagus nerve during thyroid surgery was reported. This study aimed to report our experience with minimally invasive video‐assisted endoscopic endocrine neck surgery (VANS), during which, CIONM was successfully applied for the first time. Methods Consecutive patients who underwent thyroid surgery with CIONM, performed in our department using either external neck incision surgery or VANS between July 2017 and June 2019, were retrospectively analyzed. Results A total of 22 patients who underwent thyroid surgery with neck incision (14 cases; 7 men and 7 women; age, 21‐75 years [mean, 52 years]) or VANS (8 cases; 8 women, age, 20‐61 years [mean, 41 years]) were enrolled in this study. The addition of CIONM in VANS prolonged the operation's duration by approximately 30 minutes as the endoscopic surgery was technically more difficult. No intra‐ and postoperative incidence of transient or permanent RLN palsy was observed in any patient, except for three patients who underwent external neck incision surgery in whom combined resection was unavoidable due to tumor invasion of the RLN. Conclusion We reported the first successful application of CIONM during thyroidectomy using VANS. Future clinical trials should clarify the benefits of CIONM when compared to intermittent IONM in VANS. Level of Evidence 5.

Do Yoon Jeong, Jiwoong Cho, Jeonghyun Oh

Eagle's syndrome is a disease that can cause a variety of clinical symptoms, including pain in the head, neck, and face. The criteria for classifying the elongated styloid process and stylohyoid complex syndrome caused by ossification of the stylohyoid ligament were introduced. A 55-year-old male patient, without a history of trauma, visited the outpatient department with a history of intermittent ear pain and ear fullness while eating for the past 2 weeks. Computed tomography of the neck revealed that the right styloid process was pseudoarticulated with the hyoid bone, and round cystic changes were observed in the periphery. We performed operation using the transoral approach and the patient showed improvement in symptoms.

Arthur Bister, Tabea Ibach, Corinna Haist et al.

Immunotherapy including chimeric antigen receptor (CAR) T cell therapy has revolutionized modern cancer therapy and has achieved remarkable remission and survival rates for several malignancies with historically dismal outcomes. The hinge of the CAR connects the antigen binding to the transmembrane domain and can be exploited to confer features to CAR T cells including additional stimulation, targeted elimination or detection and enrichment of the genetically modified cells. For establishing a novel hinge derived from human CD34, we systematically tested CD34 fragments of different lengths, all containing the binding site of the QBend-10 monoclonal antibody, in a FMC63-based CD19 CAR lentiviral construct. A final construct of 99 amino acids called C6 proved to be the best candidate for flow cytometry-based detection of CAR T cells and >95% enrichment of genetically modified T cells on MACS columns. The C6 hinge was functionally indistinguishable from the commonly used CD8α hinge in vitro as well as in in vivo experiments in NSG mice. We also showed that the C6 hinge can be used for a variety of different CARs and mediates high killing efficacy without unspecific activation by target antigen-negative cells, thus making C6 ideally suited as a universal hinge for CARs for clinical applications.

Jie Ren, Xilin Yang, Zhen Xu et al.

Coronavirus disease 2019 (COVID-19) has rapidly evolved into a pandemic, causing a global public health crisis. Many frontline healthcare workers providing ear, nose and throat services have been reported to contract COVID-19 at work. Early during the COVID-19 outbreak, several medical professionals in Otolaryngology-Head and Neck Surgery were infected in Wuhan, China. A series of measures were then taken immediately, which successfully halted the spread of the disease. Here we would like to share the lessons we have learned, and our experience to protect our health care workers during the COVID-19 pandemic.

A. Al-Qahtani, A. Qobty, Abdullah Al-shahrani et al.

Objectives: To analyze the data of patients with otorhinolaryngological foreign bodies and to evaluate the management and outcomes of foreign bodies to prevent complications. Methods: A retrospective study was conducted over 8 years at Aseer Central Hospital to examine all admitted cases with foreign bodies in the ear, nose, throat, esophagus and bronchus during the period from January 2011 to January 2019. Patient demographic data, type of foreign body, and most common site were analyzed. Results: A total of 184 patients were admitted, including 72 (39.1%) males and 112 (60.9%) females. The age range was from one year old to 70 years old; the mean±standard deviation of age was 10.6±12.55 years. Foreign bodies were most commonly located in the esophagus (n=97, 52.7%), followed by the bronchus (n=55, 29.9%). A statistically significant difference was found, with a p-value of 0.00001. The most common site in children was the bronchus (n=39, 21%); the most common site in adults was the esophagus (n=18, 72%). Conclusion: Otorhinolaryngological foreign bodies are found most frequently in preschool-aged children. The most common site in children was the bronchus, and the most common site in adults was the esophagus. Prevention measures are essential to reduce the risk of ingestion and admission, which can be challenging.

Daniella Parilli-Troconis, P. Baptista, M. Marcano-Lozada et al.

Abstract Introduction The novel coronavirus disease 2019 pandemic has rapidly spread worldwide, challenging healthcare resources and communities to an unprecedent degree. Simultaneously, the amount of clinical and scientific information released has overwhelmed journal platforms. Objectives This review aims to summarize the available diagnostic tools and current guidelines to safely assist patients while limiting the exposure of otolaryngologists during this pandemic. Data Synthesis Key articles were retrieved from the following databases: PubMed, Lancet, Springer Nature, BioMed Central, JAMA network and MEDLINE, as well as updated documents from the Spanish Ministry of Health, World Health Organization, Centers for Disease Control and Prevention, Spanish Association of Surgeons, ENT-UK, American College of Surgeons, and American Academy of Otolaryngology-Head and Neck Surgery. The terms used for the search were: COVID-19, Test COVID, Surgery in COVID, 2019-nCoV, ‘coronavirus’, and SARS-CoV-2. A total of 10,245 papers were retrieved. The inclusion criteria for the review included: COVID-19 testing (n = 531), society guidelines for otolaryngology-head and neck surgery patient care in the outpatient clinic (n = 10) and surgical (n = 18) settings. Studies not related to COVID-19 diagnosis were excluded. Conclusion Healthcare institutions around the world are outlining their own protocols regarding laboratory testing and personnel protective equipment usage based upon medical societies recommendations during the COVID-19 pandemic. We have summarized the available laboratory tests and their respective sensitivity and specificity. Moreover, clinical guidelines from different societies were reviewed and summarized to facilitate guidance for otolaryngologists in the operating room and in the clinical settings.

S. Hwang, Alan M. Gonzalez-Suarez, G. Stybayeva et al.

Microfluidic systems can be used to control picoliter to microliter volumes in ways not possible with other methods of fluid handling. In recent years, the field of microfluidics has grown rapidly, with microfluidic devices offering possibilities to impact biology and medicine. Microfluidic devices populated with human cells have the potential to mimic the physiological functions of tissues and organs in a three-dimensional microenvironment and enable the study of mechanisms of human diseases, drug discovery and the practice of personalized medicine. In the field of otorhinolaryngology, various types of microfluidic systems have already been introduced to study organ physiology, diagnose diseases, and evaluate therapeutic efficacy. Therefore, microfluidic technologies can be implemented at all levels of otorhinolaryngology. This review is intended to promote understanding of microfluidic properties and introduce the recent literature on application of microfluidic-related devices in the field of otorhinolaryngology.

Françoise Remangeon, Ghizlene Lahlou, Lauranne Alciato et al.

Abstract Objective To evaluate the surgical results and complications in a cohort of patients operated on to repair a tegmen bony defect using either transmastoid approach with obliteration using S53P4 bioactive glass granules (TMA‐O), or the classic middle cranial fossa approach (MCFA). Study design A retrospective monocentric study. Methods Twenty‐five cases (24 patients) were included. Data regarding patient demographics, etiology, intraoperative findings, complications, recurrences, audiometric data, and follow‐up were analyzed. Results Seven patients were operated with MCFA and 17 patients with TMA‐O. One patient was operated on using a combined approach (MCFA + TMA‐O). In the preoperative HRCT scan, the size of the defect was estimated to be 6 ± 3.8 mm in the TMA‐O group and 6 ± 3.5 mm in the MCFA group (P = .969). Intraoperatively, in the MCFA group, the location of the defect was mostly anterior (86%) with an intact ossicular chain (86%). A discontinuous chain was observed in 15 patients (88%) in the TMA‐O group. The mean follow‐up time was 22 ± 14 months in the TMA‐O group and 24 ± 15 months in the MCFA group (P = .762). In both groups, there were no early postoperative complications or recurrences during follow‐up. Conclusion Repair of a tegmen bony defect with S53P4 bioactive glass granules seems to be safe and effective, limiting the use of the middle cranial fossa approach to cases with epitympanic defects and with an intact ossicular chain, and it could be used whatever the size of the defect and/or the presence of meningoencephalocele. Level of evidence 4.

Claudia Lädrach, David S. Zee, Thomas Wyss et al.

Objective: Alexander's law (AL) states the intensity of nystagmus increases when gaze is toward the direction of the quick phase. What might be its cause? A gaze-holding neural integrator (NI) that becomes imperfect as the result of an adaptive process, or saturation in the discharge of neurons in the vestibular nuclei?Methods: We induced nystagmus in normal subjects using a rapid chair acceleration around the yaw (vertical) axis to a constant velocity of 200°/second [s] and then, 90 s later, a sudden stop to induce post-rotatory nystagmus (PRN). Subjects alternated gaze every 2 s between flashing LEDs (right/left or up/down). We calculated the change in slow-phase velocity (ΔSPV) between right and left gaze when the lateral semicircular canals (SCC) were primarily stimulated (head upright) or, with the head tilted to the side, stimulating the vertical and lateral SCC together.Results: During PRN AL occurred for horizontal eye movements with the head upright and for both horizontal and vertical components of eye movements with the head tilted. AL was apparent within just a few seconds of the chair stopping when peak SPV of PRN was reached. When slow-phase velocity of PRN faded into the range of 6–18°/s AL could no longer be demonstrated.Conclusions: Our results support the idea that AL is produced by asymmetrical responses within the vestibular nuclei impairing the NI, and not by an adaptive response that develops over time. AL was related to the predicted plane of eye rotations in the orbit based on the pattern of SCC activation.