title: Characterization of Vestibulopathy in Individuals with Type 2 Diabetes Mellitus.
abstract: OBJECTIVE
  Previous observational studies suggest higher rates of vestibular dysfunction among patients with type 2 diabetes mellitus (DM) compared with those without diabetes. This study aims to functionally localize vestibular dysfunction in adults with type 2 DM.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Tertiary academic medical center.
  
  
  METHODS
  Adults 50 years of age and older with ≥10-year history of type 2 DM were recruited (December 2011-February 2013, n = 25). Vestibular function was assessed by cervical and ocular vestibular-evoked myogenic potentials (VEMPs), testing the saccule and utricle, respectively. Head thrust dynamic visual acuity testing assessed semicircular canal (SCC) function in all canal planes. Results were compared with nondiabetic age-matched controls (n = 25).
  
  
  RESULTS
  Subjects were 64.7 ± 7.6 years old, were 40% female, and had a mean hemoglobin A1c of 8.3% ± 1.7%. SCC dysfunction was more common than otoconial organ dysfunction, with 70% of subjects with DM demonstrating impaired performance of at least 1 SCC (ΔlogMAR ≥0.18) and 50% demonstrating otoconial organ impairment (absent ocular VEMP and/or cervical VEMP). Adults with type 2 DM had poorer lateral and superior SCC performance (P < .05) but similar posterior SCC performance compared with controls (P = .16). Both cervical VEMP peak-to-peak amplitude and ocular VEMP n1 amplitude were also decreased with diabetes (P < .01).
  
  
  CONCLUSIONS
  Adults with type 2 DM have poorer performance on tests of vestibular function related to both SCC and otoconial organ function compared with nondiabetic age-matched adults. Future studies are needed to better understand the relationship between vestibular function and functional disability in persons with diabetes.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA bward15@jhmi.edu.
authors.forename: Bryan K
authors.initials: BK
authors.lastname: Ward
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: Angela
authors.initials: A
authors.lastname: Wenzel
authors.affiliation: Department of Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: Rita R
authors.initials: RR
authors.lastname: Kalyani
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: Yuri
authors.initials: Y
authors.lastname: Agrawal
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: Allen L
authors.initials: AL
authors.lastname: Feng
authors.affiliation: Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Polydefkis
authors.affiliation: Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: Howard S
authors.initials: HS
authors.lastname: Ying
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Schubert
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: M Geraldine
authors.initials: MG
authors.lastname: Zuniga
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: Charles C
authors.initials: CC
authors.lastname: Della Santina
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Carey
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012444:Saccule and Utricle / Q000503:physiopathology; D012665:Semicircular Canals / Q000503:physiopathology; D015837:Vestibular Diseases / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D058585:Vestibular Evoked Myogenic Potentials / Q000502:physiology; D014724:Vestibular Function Tests
keywords: diabetes; inner ear; vestibular