Achados neurológicos e vestibulares em três casos de Esclerose Múltipla / Neurological and vestibular findings in three cases of Multiple Sclerosis

RESUMO A Esclerose Múltipla (EM) é uma doença autoimune crônica e inflamatória que afeta o sistema nervoso central (SNC). A disfunção do equilíbrio corporal também é um sintoma comum e pode estar relacionada às lesões neurológicas decorrentes desta doença. O objetivo deste estudo foi caracterizar os achados neurológicos e vestibulares de três casos clínicos com diagnóstico de EM. Dados sobre a avaliação neurológica e do exame de ressonância magnética de crânio foram coletados dos prontuários. Os pacientes responderam a uma entrevista inicial e foram submetidos à avaliação clínica do equilíbrio corporal e ao Video Head Impulse Test (vHIT). Observou-se presença de sintomas vestibulares e alterações em pelo menos uma das provas clínicas do equilíbrio corporal e função cerebelar. No vHIT, obteve-se alterações em testes oculomotores, como presença de nistagmo semi-espontâneo e em parâmetros do teste sacádico, e ganho reduzido em um ou mais canais verticais. Foram verificadas lesões, na ressonância magnética de crânio, em áreas centrais que processam as informações vestibulares, como cerebelo e tronco encefálico. A associação destes achados sugere a presença de disfunção vestibular central, compatível com as lesões detectadas nos exames de imagem.

ABSTRACT Multiple sclerosis (MS) is a chronic and inflammatory autoimmune disease that affects the central nervous system (CNS). Dysfunction of body balance is also a common symptom and may be related to neurological injuries resulting from this disease. The aim of this study was to characterize the neurological and vestibular findings of three clinical cases diagnosed with MS. Data on the neurological evaluation and the magnetic resonance imaging of the skull were collected from the medical records. The patients responded to an initial interview and underwent clinical assessment of body balance and Video Head Impulse Test (vHIT). Vestibular symptoms and alterations were observed in at least one of the clinical tests of body balance and cerebellar function. In vHIT, changes were obtained in oculomotor tests, such as the presence of semi-spontaneous nystagmus and in parameters of the saccade test, and reduced gain in one or more vertical channels. Lesions were found on MRI of the skull in central areas that process vestibular information, such as the cerebellum and brainstem. The association of these findings suggests the presence of central vestibular dysfunction, compatible with the lesions detected in imaging exams.

Caracterización de resultados de posturografía en adolescentes con pérdida auditiva severa a profunda / Characterization of posturography results in adolescents with severe to profound hearing loss

Contexto: Las pérdidas auditivas en adolescentes se acompañan de desórdenes vestibulares desapercibidos que impactan el desarrollo motor e influyen en el aprendizaje. La identificación temprana y el conocimiento sobre la neuromaduración vestibular arroja alternativas para mejorar el rendimiento académico. Objetivos: caracterizar los resultados de la posturografía en adolescentes con pérdida auditiva severa a profunda. Método: estudio cuantitativo, con técnica descriptiva, buscando relaciones entre variables estudiadas. Población: 38 adolescentes con pérdida auditiva neurosensorial severa a profunda, en grupos de 12 ­ 15 y 16 - 19 años. Resultados: los adolescentes mayores presentaron un menor movimiento oscilatorio. Con antecedentes del desarrollo evidenciaron desempeño inferior en la posturografía y mayores dificultades en pensamiento cuantitativo, lenguaje y comunicación. Discusión: Los antecedentes neuromadurativos son importantes para el desarrollo del balance y el equilibrio. No se registraron relaciones directas entre la posturografía con bajo rendimiento académico, sin embargo, fue de utilidad clínica aportando datos del desempeño sensorial, motor y vestibular, para la intervención. Conclusiones: Los resultados sugieren efecto indirecto sobre el rendimiento académico verbal. La integración de los sistemas sensoriomotor, visual, vestibular y cognitivo, es clave para el desarrollo de habilidades de aprendizaje. La maduración es un proceso activo en el paso de la adolescencia a la edad adulta. La relación entre el déficit vestibular y los antecedentes del desarrollo, como nacimiento prematuro o edad de inicio de marcha, amerita identificar factores de riesgo del sistema vestibular en la primera infancia. El entorno socioafectivo, la familia y la convivencia con compañeros son importantes para el desempeño académico.

Context: Hearing loss in adolescents is accompanied by unnoticed vestibular disorders that impact motor development and influence learning. Early identification and knowledge about vestibular neuromaturation provides alternatives to improve academic performance. Objectives: to characterize the results of posturography in adolescents with severe to profound hearing loss. Method: quantitative study, with descriptive technique, searching for relationships between studied variables. Population: 38 adolescents with severe to profound sensorineural hearing loss, in groups of 12 - 15 and 16 - 19 years old. Results: older adolescents presented less oscillatory movement. With a developmental history, they showed lower performance in posturography and greater difficulties in quantitative thinking, language and communication. Discussion: neuromadurative antecedents are important for the development of balance and equilibrium. No direct relationships were recorded between posturography with low academic performance, however, it was clinically useful providing sensory, motor and vestibular performance data, for intervention. Conclusions: The results suggest indirect effect on verbal academic performance. The integration of the sensorimotor, visual, vestibular and cognitive systems is key to the development of learning skills. Maturation is an active process in the transition from adolescence to adulthood. The relationship between vestibular deficit and developmental history, such as premature birth or age of onset of walking, merits identifying risk factors of the vestibular system in early childhood. The socio-affective environment, the family and living with peers are important for academic performance.

A supressão do (La supresión del) reflexo vestíbulo-ocular humano / The human supression vestibulo-ocular reflex

O objetivo do presente estudo foi revisar os conceitos relativos ao funcionamento e alterações da supressão do reflexo vestíbulo-ocular (SRVO) e as principais formas de avaliação atualmente. Trata-se de uma pesquisa descritivo-exploratória, baseada em uma revisão da (El trabajo es una investigación descriptiva-exploratoria, basada en una revisión de la) literatura, realizada no (en el) Portal de Periódicos da Capes, no período de abril de 2020. Os (Los) operadores booleanos utilizados foram vestibulo-ocular reflex (OR), semicircular canal (OR), vestibular (AND) suppression. Como estratégia de pesquisa, na (en la) etapa de triagem (selección) foram utilizados os filtros: descritores no (en) título, publicações dos (de los) últimos dez anos, tipo de material, idioma e artigos revisados por pares. Dos 30 artigos triados (seleccionados), 20 apresentaram resumo de acordo com o tema e 13 estudos atenderam aos critérios de incluso (presentaron resúmenes relacionados al tema y 13 estudios cumplieron los criterios de inclusión). Scopus, Medline/PubMed e Science Citation Index Expanded foram as bases mais abrangentes (fueron las bases más abarcativas). A maioria dos (La mayoría de los) estudos, sobretudo os mais recentes, utilizaram os testes de impulso cefálico com o paradigma ´suppression head impulse test´ (SHIMP) comparando-o ao ´head impulse test´ (HIMP). A cadeira rotatória (La silla rotatoria) com eletronistagmografia foi o segundo teste mais utilizado. Apenas um estudo utilizou a Scleral Search Coil. A partir dessa revisão constata-se que a SRVO é influenciada pela idade, pode ser alterada por disfunções vestibulares periféricas unilaterais ou bilaterais, mas também por alterações neurológicas, como as cerebelares (las cerebelosas). Além da via visual, a SRVO pode ser desencadeada por fontes auditivas, somestésicas e até mesmo imagéticas (e incluso imaginativas, fantasiosas)

The present study aimed to review the concepts related to the functioning and changes in vestibular-ocular reflex suppression (VORS) and the most used assessments today. This is descriptive-exploratory research, based on a literature review, carried out on the Capes Journals Portal, in April 2020. The Boolean operators used were Vestibulo-ocular reflex (OR) Semicircular canal (OR) Vestibular (AND) Suppression. As a research strategy, in the screening stage, with the filters: descriptors in the title, last ten years, type of material, language, and peer-reviewed articles. Thirty articles were screened, 20 presented a summary according to the theme and 13 studies met the inclusion criteria. Scopus, Medline/PubMed, and Science Citation Index Expanded were the most comprehensive databases. Most studies, especially the most recent ones, used cephalic impulse tests with the SHIMP paradigm (suppression head impulse test) comparing it to the HIMP (head impulse test, HIMP). The rotary chair with electronystagmography was the second most used test. Only one study used the Scleral Search Coil. From this review, it appears that the SRVO is influenced by age; it can be altered by unilateral or bilateral peripheral vestibular disorders, but also by neurological changes, such as the cerebellar ones. In addition to the visual pathway, other sources can trigger SVOR, such as auditory, somesthetic and even imagery sources

Laboratory Management Status of Vestibular Function Test in Korea / 대한평형의학회지

OBJECTIVES: This study was conducted to assess the current management status of the vestibular function test laboratories in Korea. METHODS: Questionnaire about the management status of the vestibular function test laboratories was sent by email to the entire members of the Korean Balance Society. The contents of questionnaire included situation of employees who perform the tests, the types of vestibular function tests and equipment, frequency of the test and types of dizziness related questionnaires. RESULTS: Forty-nine hospitals and clinics responded. All the 49 respondents answered that they have videonystagmography. Spontaneous nystagmus analysis by videonystagmogrphy was the most frequently tests for patients with dizziness. Questionnaires for dizziness were used by 27 respondents (55.1%) for initial evaluation of the dizziness patients. The Korean version of dizziness handicap inventory was the most frequently used dizziness related questionnaire. CONCLUSIONS: We analyzed the current management status of vestibular function test laboratories to comprehend the present condition of the vestibular function test. We think that these results will help to provide a standard for laboratory operations and prepare for the education, focusing on high-demand tests.

Etiology and Clinical Characteristics of Pediatric Dizziness / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Dizziness is not uncommon in children. The etiology of dizziness varies according to different studies due to different methods of examination or characteristics of the dizziness center. To assess meaningful causes of dizziness in children, a multidisciplinary approach would be needed. The purpose of this study was to analyze the main pathologies associated with vertigo and dizziness in children, paying particular attention to recent diagnostic advances with a multidisciplinary approach. SUBJECTS AND METHOD: A total of 73 children, aged between 4-18 years, who visited the Pediatric Dizziness Clinic of the University Hospital from January 2016 to June 2016 were included in this study. Medical records were reviewed retrospectively. All of the subjects were examined by history, questionnaires, physical examinations, electrocardiogram, hematologic tests, brain MRI scan, audiogram and vestibular function tests. Patients who had orthostatic symptoms additionally underwent a tilt table test, and in selective cases, a caloric and vestibular evoked myogenic potential tests as well. RESULTS: Vestibular migraine (VM) and benign paroxysmal vertigo of childhood (BPVC) were found in 35.6% and 27.4% of the children with dizziness, respectively. The incidence of orthostatic hypotension and postural orthostatic tachycardia syndrome were 12.3% each, both of which are higher than other previous reports. Other causes were Meniere's disease, benign paroxysmal positional vertigo, vestibular neuritis and so on. CONCLUSION: VM and BPVC were the most common causes of pediatric dizziness. Also, the incidence of orthostatic dizziness was rather high in pediatric population. The evaluation of dizziness in children should include a thorough check of history (questionnaire), neurotological examination, vestibular function tests and a tilt table test.

Clinical Significance of Perverted Head-Shaking Nystagmus / 대한평형의학회지

OBJECTIVES: We investigated clinical significance of head shaking nystagmus (HSN) and perverted HSN (pHSN) in patients with peripheral and central vestibular disorders. METHODS: We reviewed medical records of 822 consecutive subjects who were referred to a dizziness clinic. We performed neurologic examination including video-oculography in darkness for 60 seconds before, during and for 100 seconds after head-shaking. HSN was considered to develop when post-head-shaking nystagmus last at least 5 beats with latency from end of head-shaking of no more than 5 seconds, and a velocity at least 3°/sec. RESULTS: In control group (n=45), there were observed spontaneous nystagmus (SN) in 2.2%, HSN in 17.8%, pHSN in 6.7%. In patients with peripheral vestibular disorder group (n=397), there were observed SN in 14.1%, HSN in 40.6%, pHSN in 9.8%. In patients with central vestibular disorder group (n=217), there were observed SN in 17.5%, HSN in 24.0%, pHSN in 13.4%. In unspecified dizziness group (n=208), there were observed SN in 1.9%, HSN in 13.0%, pHSN in 1.9%. pHSN was frequently observed in central vestibular disorders such as stroke, vestibular migraine, cerebellar ataxia, and vertebro-basilar insufficiency. However, pHSN was also observed at higher rate than expected in peripheral vestibular disorders including benign paroxysmal positional vertigo especially involving vertical canals, Meniere disease and even in unilateral vestibulopathy. CONCLUSIONS: Our results show that perverted HSN in dizzy populations was frequently observed not only in cases of central vestibular disorders but also in peripheral disorders. Perverted HSN can develop by any conditions that cause difference in vestibular velocity storage in vertical component of vestibular-ocular reflex.

Influence of Diazepam on Video Head Impulse Test in Patients with Acute Vestibular Neuritis: Preliminary Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although video head impulse test (V-HIT) has emerged as a popular test for vestibular function, there have been no reports about the influence of benzodiazepine on the test. The aim of this study is to investigate the influence of diazepam on the V-HIT in patients with acute vestibular neuritis. SUBJECTS AND METHOD: We retrospectively analyzed charts and medical records of 10 patients diagnosed with acute vestibular neuritis. The patients repeated V-HIT before and after intravenous (IV) injection of diazepam. Gain and presence of catch-up saccade (CUS) were compared. RESULTS: Gain in the affected ear was decreased compared to that in the unaffected ear. After the injection of IV diazepam, the presence of CUS was not changed significantly. Gain of CUS in V-HIT was also unchanged both in the affected and unaffected ear after the injection of IV diazepam. CONCLUSION: The influence of IV diazepam on the gain and presence of CUS in V-HIT were insignificant, indicating that it could be considered as a useful test to evaluate vestibular function in patients treated with diazepam.

A Case of Bilateral Vestibular Hypofunction Following Oseltamivir Medication / 대한평형의학회지

The threat of pandemic influenza has focused attention and resources on virus surveillance, prevention, and containment. The World Health Organization has strongly recommended the use of the antiviral drug, Oseltamivir (Tamiflu(R)), to treat and prevent pandemic influenza infection. In recent years, there have been case reports of vestibulocochlear events during or after oseltamivir treatment, other countries. Oseltamivir is generally well-tolerated and its most frequent adverse effects include nausea and vomiting, diarrhea, and abdominal pain. Up to now, bilateral vestibular hypofunction after oseltamivir medication has not been reported. Herein, we report a very rare case of a 36-year-old female with bilateral vestibular hypofunction following oseltamivir medication.

Clinical Manifestation and Prognosis of Vestibular Migraine According to the Vestibular Function Test Results

BACKGROUND AND OBJECTIVES: According to previous reports, patients with vestibular migraine (VM) display variable results from vestibular function tests (VFT): central, peripheral, or normal. The aim of this study was to classify the VM patients into the three groups according to interictal VFT findings (central, peripheral or normal) and to clarify the relationship between VFT results and the clinical manifestations and prognosis in each group. SUBJECTS AND METHODS: We reviewed the medical records of 81 patients diagnosed as VM using the criteria of Neuhauser, et al. between December 2004 and June 2009. Patients were divided into three groups according to the results of VFT. We compared the clinical manifestations and prognosis between groups. Characteristics including dizziness, the nature of headache, associated otologic symptoms, hearing threshold, duration of illness, and recovery time were analyzed. RESULTS: The number of patients with central, peripheral vestibular dysfunction and normal finding in VFT were 15, 28, and 38 respectively. There were no significant differences in the nature of headache, associated otologic symptoms, hearing threshold, duration of illness, and recovery time. A small difference was observed in the mean age and characteristics of dizziness, but these were not significant. CONCLUSIONS: In patients with VM, classification according to the type of vestibular dysfunction was not helpful in the prediction of prognosis and clinical manifestations.

Clinical Manifestations and Neuro-otological Findings of Migrainous Vertigo / 대한평형의학회지

BACKGROUND AND OBJECTIVES: Migrainous vertigo (MV) is one of the recurrent vestibular syndromes and may present episodic vestibular and concurrent migraine symptoms. The clinical manifestations and neuro-otological findings of MV have been delineated over the last couple of decades, however, there are still lots of uncertainties. MATERIALS AND METHODS: We performed a comprehensive literature search regarding the clinical manifestations and neuro-otological findings of MV compatible with the diagnostic criteria proposed by Neuhuaser. We found the published articles that addressed the clinical and neuro-otological findings and we performed a pooled analysis. RESULTS: Even though the duration of MV attack was variable from seconds to days, the most common durations investigated in this study was minutes (range, 5-60 minutes). During MV attack, most patients had a migraine headache, but instead the other migraine symptoms (i.e., photophobia, phonophobia) could be found. There were positional nystagmus which may not meet a stimulated canal plane and spontaneous nystagmus and, less commonly, gaze-evoked nystagmus. Regarding bithermal caloric test, unilateral canal paresis could be found in 15-20% of MV patients as well as hyperexcitability in some patients. Oculomotor tests might show impaired pursuits (mainly saccadic pursuit) and saccadic abnormalities such as delayed latency and hypometric saccade. CONCLUSION: From the result of the pooled analysis, we have found several clinical and neuro-otological findings. However, vital neuro-otological findings which can provide a clue for the diagnosis of MV are still lacking. So the diagnosis of MV should depend on the clinical manifestations and a process of differential diagnosis.

Efficacy of Takushato on Patients with Dizziness and Vertigo in Relation to Signs and Symptoms of Fluid Retention / 日本東洋医学雑誌

Takushato is a Kampo formula used for the treatment of dizziness and vertigo. Signs and symptoms suggestive of fluid retention have been regarded as clinical indications for takushato administration, but it is not clear if improvement of these signs and symptoms is related to the clinical efficacy of takushato, so we analyzed the correlation among these factors. Twenty patients who suffered from dizziness and vertigo were treated with takushato for 4 weeks. Before and after treatment, subjective symptoms and objective data including vestibular function tests were assessed, and correlation among the factors was analyzed. Improvement of patients' total symptoms was significantly correlated with improvement of fluid retention scores. Furthermore, improvement in vestibular function tests showed a trend toward correlation with that of fluid retention scores.These results suggest that improvement in the signs and symptoms of fluid retention is related to the clinical efficacy of takushato. We conclude that the presence of fluid retention is a reasonable clinical indication for takushato administration.

Inferior Vestibular Neuritis: Absence of Vestibular Evoked Myogenic Potentials in the Presence of Normal Caloric Responses / 대한평형의학회지

BACKGROUND AND OBJECTIVES: To report the clinical features of six patients diagnosed with cases of inferior vestibular neuritis based on abnormal vestibular evoked myogenic potential (VEMP) responses with normal caloric test results. MATERIALS AND METHODS: We retrospectively reviewed 62 patients presenting with dizziness. All patients underwent a battery of audiovestibular testing, including hearing tests, caloric test and VEMP test. RESULTS: Six patients were diagnosed as inferior vestibular neuritis. All patients presented with acute onset of prolonged vertigo. The pure tone audiograms and caloric test results were normal. VEMP response was absent unilaterally, and normal in the contralateral ear. CONCLUSION: Inferior vestibular neuritis should be considered in patients presenting with acute vertigo, but normal caloric responses. Comprehensive vestibular testing including VEMP is necessary.

Clinical Analysis of 42 Patients with Bilateral Vestibulopathy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To find out the causative factors and clinical features of bilateral vestibulopathy in the Korean population. SUBJECTS AND METHOD: The data of 42 patients (mean age: 55.04+/-18.87 years) with bilateral vestibulopathy were reviewed retrospectively between 1997 and 2009. We carried out a full neurotological examination, electronystagmography, a bithermal caloric test, a rotatory chair test, cranial imaging and laboratory studies. RESULTS: Nineteen patients (45.24%) were diagnosed as having secondary bilateral vestibulopathy with causative factors. The most common cause was ototoxic drug (14.29%). Other etiologic causes were labyrinthitis, temporal bone fracture, Meniere's disease, peripheral neuropathy and meningitis/encephalitis. Forty-five percent of all patients had symptoms that lasted less than 1 month, and about 43% of the patients presented with chronic progressive symptoms of over 1 year. CONCLUSION: In about 54% of all patients, we couldn't find any causative factors leading to bilateral vestibulopathy. Because a large subgroup of patients had a history of dizziness over one year, an adequate number of studies on vestibular and cerebellar function are recommended for patients of chronic dizziness to exclude bilateral vestibulopathy.

Clinical Characteristics of Dizziness after Motor Vehicle Accident / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Diagnosis and treatment of dizziness after motor vehicle accident (MVA) is not challenging. Psychological factors may be important and patient's quality of life can be underestimated due to nonspecific vague symptoms. The aim of this study is to reveal the clinical characteristics of dizziness after motor vehicle accident. SUBJECTS AND METHOD: Of the patients who have visited Dankook University hospital for traumatic dizziness from Jan. 1994 through Jan. 2008, we enrolled 51 patients who had history of motor vehicle accident and performed vestibular function test (VFT). Patients were divided into groups according to VFT findings. Patients who had unilateral hypo-function in VFT were classified as Group A. Patients who showed typical nystagmus for benign paroxismal positional vertigo (BPPV) were classified as Group B. And the others were classified as Group C who showed fair VFT results. RESULTS: Group C was found with unidentified dizziness, a tendency of late onset and long term recovery. Also they complained different distributions of their symptoms, that is, the rate of patients with headache and visual symptoms were higher in Group C. CONCLUSION: There were no remarkable characteristics in unidentified dizziness after MVA. Although the objective test results were non-specific, their clinical progress was not favorable. They complained of headache and visual symptoms more than other groups.

Benign Recurrent Vertigo: Clinical Manifestations And Vestibular Function Test

BACKGROUND AND OBJECTIVES: Benign recurrent vertigo has been defined as recurrent spells of vertigo lasting minutes to hours without cochlear and neurologic signs. The etiology is still unclear, but viral and vasospastic etiology as migraine equivalent has been suggested. We attempt to analyze the symptoms and vestibular function test of Benign recurrent vertigo that has clinically diagnosed. MATERIALS AND METHODS: We analyzed retrospectively the clinical characteristics and vestibular function test including ocular-motor test, rotation test and computerized dynamic posturography from 100 patients with a Benign recurrent vertigo diagnosis. RESULTS: Eight two percent of the patients were female, mean age was 52 years, and mean duration of prevalence was 47.3 months. In the characteristics of vertigo, 91% of patients have spinning sensation during attack. The vertigo attacks most commonly lasts several hours (57%), and frequency of attack is three to twelve time per year in 47%. A high incidence (40%) of headache was detected, but incidence of other associated symptoms including fluctuating hearing loss (3%), tinnitus (27%), aural fullness (9%) was relatively low. The incidence of spontaneous nystagmus and positional nystagmus was 18% and 10% each. Saccadic undershoot was observed in 21% of patients, but it was not associated with other ocular-motor test abnormalities. In rotation test, low gain, phase lead and asymmetry was observed in 18%, 3% and 9%, respectively. There were no abnormal findings in posturography. CONCLUSIONS: Although benign recurrent vertigo did not show any characteristic clinical findings or vestibular function test, it deserves to be considered for differential diagnosis of episodic vertigo.

Comparative Analysis of Vestibular Asymmetry Parameters in Acute Unilateral Peripheral Vestibulopathy

BACKGROUND AND OBJECTIVES: There are known parameters that indicate vestibular asymmetry, such as directional preponderance (DP) on caloric test, asymmetry on slow harmonic acceleration (SHA) test, asymmetry of time constant (Tc) and slow cumulative eye position (SCEP) on velocity step test. Aim of this study is investigate the sensitivity and predictability of the vestibular asymmetry parameters among them. MATERIALS & METHODS: Twenty six patients who were diagnosed as acute unilateral peripheral vestibulopathy were enrolled in this study. We compared each parameter with site of lesion based on the direction of spontaneous nystagmus and canal paresis (CP) which were totally correlated in this group of patients. RESULTS: Positive predictability of each parameter showed 58% in DP, 62% in SHA asymmetry, 62% in SCEP, 38% in Tc. In the cases that each parameter showed positive result, all of DP and SHA asymmetry indicated site of lesion, and showed high correlation coefficient(r=0.89). But in 27% of SCEP and 23% of Tc did not indicate site of lesion. CONCLUSION: All parameters showed low sensitivity for identifying laterality of lesion even the tests were performed within one week after vertigo attack. DP and VOR asymmetry showed high positive predictability for indicating lesion site.

A New Method for Vestibulo-Collic Reflex

OBJECTIVE: Vestibulo-collic reflex (VCR) has been thought to be a simple and reliable test in evaluating the vestibular function. But it can only be examined by actively contracting the sternocleidomastoid muscle (SCM) and it would be impossible to conduct the examination without the cooperation of the subject. The aim of this study was to demonstrate a new method for VCR in the absence of the subject's cooperation. METHOD: Records were collected from 20 volunteers. Each subject was properly positioned on the bed with the head flexed, ipsilaterally bent and contralaterally rotated. An active electrode was placed over the belly of the SCM. 100 dB clicks were delivered through headphones. We compared the active contraction and passive positioning of the SCM in terms of the P1 latency and amplitude. RESULTS: Vestibular-evoked myogenic potentials (VEMPs) were recorded without actively contracting the SCMs for all the subjects by using our new method. There was no difference in P1 latency and amplitude between the active contraction and passive positioning of the SCM. CONCLUSION: With our new method, VEMPs can be recorded without actively contracting the SCM. It may be useful for evaluating the vestibular function of children and patients who cannot cooperate.

Auditory Neuropathy Accompanying Bilateral Vestibular Hypofunction / 대한이비인후과학회지

Auditory neuropathy is a term used to describe the auditory neural pathway abnormality in the presence of cochlear outer hair cell functions. It is reported that 9 of 14 auditory neuropathy patients had abnormal findings in the caloric test. The authors present a case of auditory neuropathy accompanying bilateral vestibular loss. The patient was a 33-year-old female who had a family history of her mother having bilateral hearing loss. Auditory brain stem response (ABR) and otoacoustic emission (OAE) were checked and the results were compatible with auditory neuropathy. To evaluate her vestibular function, bithermal caloric test, rotatory chair, fundus photograph, vestibular evoked myogenic potential (VEMP), oculomotor test were checked. Laboratory findings were compatible with bilateral vestibular loss involving both superior and inferior division of vestibular nerve territory. Though bilateral vestibular hypofunction was substantial, she did not report any subjective discomfort from bilateral vestibular loss. Considering the presence of OAE and the abnormal findings in ABR in this patient, the pathologic lesion seems to be in the vestibular neural pathway rather then in the vestibular end organs. Routine vestibular evaluation seems to be necessary for comprehensive evaluation of the auditory neuropathy patients.

Correlation between Spontaneous Nystagmus and Vestibular Function Test Parameters according to Gender and Age in Vestibular Neuritis

BACKGROUND AND OBJECTIVES: There are caloric test, SCEP, DP in Step velocity and VOR asymmetry in SHA test as parameters for evaluation in unilateral peripheral vestibulopathy in parameter of vestibular function test. The aim of this study is to assess the correlation between these parameters and intensity of spontaneous nystagmus in vestibular neuritis. MATERIALS AND METHOD: We evaluated 75 patients who were diagnosed as vestibular neuritis with 3 degree spontaneous nystagmus at vestibular function test lab from January 2000 to July 2005 in Dankook university hospital. The correlations between direction and intensity of spontaneous nystagmus and monothermal caloric test, SCEP and DP in step velocity, VOR asymmetry (0.01, 0.04, 0.16 Hz) in SHA test were analysed. And correlations according to sex, age were also analysed. RESULTS: The correlation coefficient between intensity of spontaneous nystagmus and monothermal caloric test was 0.60. The correlation coefficient between intensity of spontaneous nystagmus and SCEP was 0.35. The correlation coefficient between intensity of spontaneous nystagmus and Tc DP was 0.36 and it showed no significant correlation. The correlation coefficient between intensity of spontaneous nystagmus and VOR asymmetry (0.01, 0.04, 0.16) was 0.57, 0.46, 0.51, respectively and there was higher correlation in man, age under 60. CONCLUSION: Intensity of spontaneous nystagmus showed close relations to monothermal caloric test, VOR asymmetry of SHA, Tc DP, SCEP DP in sequence. In addition, young male patients tends to be closely related to intensity of spontaneous nystagmus.

The Application of Vestibular Functional Test in the Diagnosis and Evaluation of Flight Illusion in Pilots / 听力学及言语疾病杂志

0.05). ②Among 30 pilots with abnormal vestibular functions,19 were permanently grounded and 11 were permitted to return their flying station. 36 pilots returned to fly in 45 cases with normal vestibular functions. The permanently grounded rate had significant differences between the two groups with normal and abnormal vestibular functions. (P