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1.
Arq. neuropsiquiatr ; 77(1): 25-32, Jan. 2019. tab, graf
Article in English | LILACS | ID: biblio-983874

ABSTRACT

ABSTRACT Changes in postural balance and visual complaints are frequent consequences of stroke. We aimed to investigate the symptoms and the vestibular and oculomotor functions of patients with dizziness post ischemic and hemorrhagic stroke and compare the results among them. Methods: Fifty patients with dizziness after stroke were evaluated through a clinical anamnesis and computerized vector electronystagmography: calibration of ocular movements, spontaneous nystagmus, semi-spontaneous nystagmus, pendular tracking, optokinetic nystagmus, rotary chair testing, and the caloric test. Results: All patients complained of dizziness, especially imbalance. Ischemic stroke in the carotid territory was the prevalent type. Visual complaints were reported by 56% of the sample and were related to abnormalities in oculomotor and caloric tests. Conclusion: The occurrence of visual symptoms was related to some abnormalities in the vector electronystagmography tests, being more frequent in cases of stroke in the vertebrobasilar system, and with oscillopsia and reduced visual acuity as symptoms.


RESUMO Alterações no equilíbrio postural são consequências frequentes no acidente vascular cerebral (AVC). O objetivo deste estudo foi investigar os sintomas e as funções vestibular e oculomotora de sujeitos com tontura após AVC isquêmico e hemorrágico, comparando seus resultados. Métodos: Foram avaliados 50 sujeitos com tontura após AVC, por meio de anamnese clínica e vectoeletronistagmografia computadorizada (VENG): calibração dos movimentos oculares; nistagmo espontâneo e semi-espontâneo; rastreio pendular; nistagmo optocinético; prova rotatória pendular decrescente e prova calórica com estímulo a ar. Resultados: Todos relataram tontura, principalmente do tipo desequilíbrio. O AVC isquêmico e no sistema carotídeo foi o mais frequente. Sintomas visuais pós-AVC foram referidos por 56% da amostra, os quais tiveram relação com alterações nas provas oculomotoras e calórica da VENG. Conclusão: A ocorrência de sintomas visuais relacionou-se a alterações em alguns testes. Essas alterações foram mais frequentes nos casos de AVC da circulação posterior, naqueles com oscilopsia e diminuição da acuidade visual.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Vestibular Function Tests , Stroke/complications , Stroke/physiopathology , Dizziness/etiology , Dizziness/physiopathology , Oculomotor Nerve/physiopathology , Vision Disorders/etiology , Vision Disorders/physiopathology , Caloric Tests , Visual Acuity/physiology , Nystagmus, Pathologic/etiology , Nystagmus, Pathologic/physiopathology , Vestibule, Labyrinth/physiopathology , Cross-Sectional Studies , Statistics, Nonparametric , Electronystagmography/methods
2.
Clinics ; 74: e786, 2019. tab, graf
Article in English | LILACS | ID: biblio-989641

ABSTRACT

OBJECTIVES: Currently, cochlear implant procedures are becoming increasingly broad and have greatly expanded. Bilateral cochlear implants and cochlear implants are more frequently applied in children. Our hypothesis is that the video head impulse test may be more sensitive than the caloric test in detecting abnormal vestibular function before cochlear implant surgery. The objective of this study was to compare the video head impulse test and caloric test results of patients selected for cochlear implant procedures before surgery. METHODS: The patients selected for cochlear implant surgery were submitted to a bithermal caloric test and video head impulse test. RESULTS: By comparing angular slow phase velocity values below 5° in the bithermal caloric test (hypofunction) and video head impulse test with a gain lower than 0.8, we identified 37 (64.9%) patients with vestibular hypofunction or canal paresis and 21 (36.8%) patients with abnormal video head impulse test gain before the cochlear implant procedure. Of the 37 patients with caloric test vestibular hypofunction, 20 (54%) patients exhibited an abnormal gain in the video head impulse test. CONCLUSION: The caloric test is more sensitive than the video head impulse test (Fisher's exact test, p=0.0002) in detecting the impaired ear before cochlear implant delivery. The proportion of caloric test/video head impulse test positive identification of abnormal vestibular function or caloric test/video head impulse test sensitivity was 1.8:1.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Caloric Tests/methods , Vestibular Diseases/diagnosis , Sensitivity and Specificity , Cochlear Implants , Head Impulse Test/methods , Paresis/diagnosis , Video Recording , Preoperative Care/methods , Cross-Sectional Studies , Predictive Value of Tests
3.
Article in English | WPRIM | ID: wpr-764339

ABSTRACT

BACKGROUND AND PURPOSE: Conflicting results about vestibular function in progressive supranuclear palsy (PSP) prompted a systematic examination of the semicircular canal function, otolith function, and postural stability. METHODS: Sixteen patients with probable PSP [9 females, age=72±6 years (mean±SD), mean disease duration=3.6 years, and mean PSP Rating Scale score=31] and 17 age-matched controls were examined using the video head impulse test, caloric testing, ocular and cervical vestibular evoked myogenic potentials (o- and cVEMPs), video-oculography, and posturography. RESULTS: There was no evidence of impaired function of the angular vestibulo-ocular reflex (gain=1.0±0.1), and caloric testing also produced normal findings. In terms of otolith function, there was no significant difference between PSP patients and controls in the absolute peakto-peak amplitude of the oVEMP (13.5±7.2 µV and 12.5±5.6 µV, respectively; p=0.8) or the corrected peak-to-peak amplitude of the cVEMP (0.6±0.3 µV and 0.5±0.2 µV, p=0.3). The total root-mean-square body sway was significantly increased in patients with PSP compared to controls (eyes open/head straight/hard platform: 9.3±3.7 m/min and 6.9±2.1 m/min, respectively; p=0.032). As expected, the saccade velocities were significantly lower in PSP patients than in controls: horizontal, 234±92°/sec and 442±66°/sec, respectively; downward, 109±105°/sec and 344±72°/sec; and upward, 121±110°/sec and 348±78°/sec (all p<0.01). CONCLUSIONS: We found no evidence of impairment of either high- or low-frequency semicircular function or otolith organ function in the examined PSP patients. It therefore appears that other causes such as degeneration of supratentorial pathways lead to postural imbalance and falls in patients with PSP.


Subject(s)
Accidental Falls , Caloric Tests , Female , Head Impulse Test , Humans , Movement Disorders , Otolithic Membrane , Reflex, Vestibulo-Ocular , Saccades , Semicircular Canals , Supranuclear Palsy, Progressive , Tauopathies , Vestibular Evoked Myogenic Potentials
4.
Article in Korean | WPRIM | ID: wpr-761295

ABSTRACT

OBJECTIVES: The purpose of this study is to investigate characteristics of nystagmus during attacks of vestibular migraine (VM), and to find a distinct clinical feature compared to other migraine and peripheral vestibular disorders. METHODS: This study is a retrospective chart review of 82 patients satisfied with VM criteria, which is formulated by the new Bárány Society. Spontaneous and positional nystagmus provoked by various head positions were examined with video-nystagmography in all patients. Bithermal caloric test and cervical vestibular evoked myogenic potential test (cVEMP) were also performed. The direction and peak slow-phase velocity (SPV) of nystagmus, unilateral caloric weakness and interaural difference of cVEMP were analyzed. Control groups were lesion side in acute VN for nystagmus results and healthy side in the patients with benign paroxysmal positional vertigo of posterior semicircular canal for caloric and cVEMP results. Chi-square test and Mann-Whitney U-test were used for statistical analysis. RESULTS: During the acute attack, nystagmus was seen in 71.9% (59 of 82) of patients. Horizontal nystagmus was the predominant type. Peak SPV in VM patients was much slower than in the control group (2.37±1.73 °/sec vs. 17.05±12.69 °/sec, p<0.0001). There was no significant difference on the result of both caloric and cVEMP test, compared to those of control groups. CONCLUSION: Nystagmus with horizontal directions and low SPV was dominant form in the attack of VM. Close observation of nystagmus can be helpful to make a correct diagnosis and to understand the pathomechanism of vertigo in VM.


Subject(s)
Benign Paroxysmal Positional Vertigo , Caloric Tests , Diagnosis , Head , Humans , Migraine Disorders , Nystagmus, Pathologic , Nystagmus, Physiologic , Retrospective Studies , Semicircular Canals , Vertigo
5.
Article in Korean | WPRIM | ID: wpr-761288

ABSTRACT

Acute vestibular neuritis (VN) is characterized by acute/subacute vertigo with spontaneous nystagmus and unilateral loss of semicircular canal function. Vestibular system in human is represented in the brain bilaterally with functional asymmetries of the right hemispheric dominance in the right handers. Spatial working memory entails the ability to keep spatial information active in working memory over a short period of time which is also known as the right hemispheric dominance. Three patients (patient 1, 32-year-old female; patient 2, 18-year-old male; patient 3, 63-year-old male) suffered from acute onset of severe vertigo, nausea and vomiting. Patients 1 and 2's examination revealed VN on the right side showing spontaneous left beating nystagmus and impaired vestibular ocular reflex on the right side in video head-impulse and caloric tests. Patient 3's finding was fit for VN on the left side. We also evaluated visuospatial memory function with the block design test in these 3 VN patients which discovered lower scores in patients 1 and 2 and the average level in patient 3 compare to those of healthy controls. Follow-up block design test after resolved symptoms showed within normal range in both patients. Our cases suggest that the patients with unilateral peripheral vestibulopathy may have an asymmetrical effect on the higher vestibular cognitive function. The right VN can be associated with transient visuospatial memory dysfunction. These findings add the evidence of significant right hemispheric dominance for vestibular and visuospatial structures in the right-handed subjects, and of predominant dysfunction in the hemisphere ipsilateral to the peripheral lesion side.


Subject(s)
Adolescent , Adult , Brain , Caloric Tests , Cognition , Female , Follow-Up Studies , Humans , Male , Memory , Memory, Short-Term , Middle Aged , Nausea , Reference Values , Reflex , Semicircular Canals , Vertigo , Vestibular Neuronitis , Vomiting
6.
Article in English | WPRIM | ID: wpr-719326

ABSTRACT

BACKGROUND AND OBJECTIVES: Video head impulse tests (vHITs) and caloric tests are widely used to assess the loss of vestibular function in acute vestibular neuritis. Although previous studies have reported on the results of each test, longitudinal comparison of these tests is rare. In the present study, vHITs and caloric tests were performed in patients with unilateral vestibular neuritis during the acute phase and after a long follow-up period (>6 months). The goal of this study was to evaluate the changes in vHIT and caloric test results and to analyze the relationships between them. SUBJECTS AND METHOD: Between September 2013 and December 2015, charts from 13 patients with unilateral vestibular neuritis were retrospectively reviewed. Among the 13 patients, caloric tests and vHITs were performed in 9 and 10 patients, respectively. Results of the vHITs and caloric tests were analyzed and the changes were compared. RESULTS: During the acute phase of vestibular neuritis, the results of the caloric test showed an increase in canal paresis (CP), and the results of the vHIT showed a decrease in horizontal gain. Although subjective symptoms improved in all patients after a long follow-up period (mean: 13.9 months), the occurrence of CP determined from the caloric test was not significantly changed (p=0.889). On the other hand, the mean horizontal gain of the vHIT had improved significantly (p < 0.05). CONCLUSION: While CP determined from the caloric test did not change after a long follow-up period, the decreased horizontal gain in the vHIT was significantly recovered in patients with unilateral vestibular neuritis.


Subject(s)
Caloric Tests , Follow-Up Studies , Hand , Head Impulse Test , Head , Humans , Methods , Paresis , Retrospective Studies , Vestibular Neuronitis
7.
Braz. j. otorhinolaryngol. (Impr.) ; 84(5): 608-613, Sept.-Oct. 2018. tab, graf
Article in English | LILACS | ID: biblio-974365

ABSTRACT

Abstract Introduction: Canal wall down tympanomastoidectomy is commonly used to treat advanced chronic otitis media or cholesteatoma. The advantages of canal wall down mastoidectomy are excellent exposure for disease eradication and postoperative control of residual disease; its disadvantages include the accumulation of debris requiring life-long otological maintenance and cleaning, continuous ear drainage, fungal cavity infections, and the occurrence of dizziness and vertigo by changing temperature or pressure. Objective: To evaluate whether cavity-induced problems can be eliminated and patient comfort can be increased with mastoid cavity reconstruction. Methods: In total, 11 patients who underwent mastoid cavity reconstruction between March 2013 and June 2013 comprised the study group, and 11 patients who had dry, epithelialized CWD cavities were recruited as the control group. The study examined three parameters: epithelial migration, air caloric testing, and the Glasgow Benefit Inventory. Epithelial migration, air caloric testing, and the Glasgow Benefit Inventory were evaluated in the study and control groups. Results: The epithelial migration rate was significantly faster in study group (1.63 ± 0.5 mm/week) than control group (0.94 ± 0.37 mm/week) (p = 0.003, p < 0.05). The mean slow component velocity of nystagmus of the study group (13.33 ± 5.36°/s) was significantly lower when compared to control group (32.11 ± 9.12°/s) (p = 0.018). The overall the Glasgow Benefit Inventory score was −7.21, and the general subscale, physical and social health scores were −9.71, −21.09, and +20.35, respectively in the control group. These were +33.93, +35.59, +33.31, and +29.61, respectively in the study group. All but the social health score improved significantly (0.007, 0.008, 0.018, and 0.181, respectively). Conclusions: Cavity reconstruction improves epithelial migration, normalizes caloric responses and increases the quality of life. Thus, cavity rehabilitation eliminates open-cavity-induced problems by restoring the functional anatomy of the ear.


Resumo Introdução: A timpanomastoidectomia com a técnica Canal Wall Down, ou técnica aberta, é comumente utilizada para tratar otite média crônica avançada ou colesteatoma. As vantagens da mastoidectomia pela técnica aberta são uma excelente exposição para a erradicação da doença e controle pós-operatório da doença residual; suas desvantagens incluem o acúmulo de detritos que requerem manutenção e limpeza otológica ao longo da vida, drenagem contínua da orelha, infecções fúngicas na cavidade e a ocorrência de tonturas e vertigem com alterações de temperatura ou pressão. Objetivo: Avaliar se os problemas induzidos pela cavidade podem ser eliminados e o conforto do paciente aumentado com a reconstrução da cavidade mastoide. Método: No total, 11 pacientes submetidos à reconstrução da cavidade mastoide entre março de 2013 e junho de 2013 constituíram o grupo de estudo, e 11 pacientes com cavidades secas e epitelizadas, operadas pela técnica aberta, foram recrutados como grupo controle. O estudo analisou três parâmetros: migração epitelial, prova calórica com estimulação a ar e o questionário Glasgow Benefit Inventory. A migração epitelial, a prova calórica e o Glasgow Benefit Inventory foram avaliados nos grupos de estudo e controle. Resultados: A taxa de migração epitelial foi significativamente mais rápida no grupo de estudo (1,63 ± 0,5 mm/semana) do que no grupo controle (0,94 ± 0,37 mm/semana) (p = 0,003, p < 0,05). A velocidade média do componente lento do nistagmo no grupo de estudo (13,33 ± 5,36°/s) foi significativamente menor se comparada ao grupo controle (32,11 ± 9,12°/s) (p = 0,018). O escore global do Glasgow Benefit Inventory foi de -7,21 e os escores da subescala geral, saúde física e social foram -9,71, -21,09 e +20,35, respectivamente, no grupo controle. Esses escores foram +33,93, +35,59, +33,31 e +29,61, respectivamente, no grupo de estudo. Todos, exceto o escore de saúde social, melhoraram significativamente (0,007, 0,008, 0,018 e 0,181, respectivamente). Conclusões: A reconstrução da cavidade melhora a migração epitelial, normaliza as respostas da prova calórica e aumenta a qualidade de vida. Assim, a reabilitação da cavidade elimina os problemas induzidos por cavidades abertas ao restaurar a anatomia funcional da orelha.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Young Adult , Otitis Media/surgery , Quality of Life , Caloric Tests/methods , Cholesteatoma, Middle Ear/surgery , Mastoidectomy/methods , Mastoid/surgery , Otitis Media/psychology , Tympanoplasty/methods , Case-Control Studies , Chronic Disease , Follow-Up Studies , Cholesteatoma, Middle Ear/psychology
8.
Article in Korean | WPRIM | ID: wpr-761277

ABSTRACT

Recently with the introduction of video head impulse test (vHIT), it can be easily performed quantitative and objective measurement of vestibulo-ocular reflex (VOR). vHIT has been used as a clinical vestibular function test that can individually evaluate the function of each semicircular canal. Loss of VOR gain and corrective catch-up saccades that occur during the vHIT usually indicate peripheral vestibular hypofunction, whereas in acute vestibular syndrome, normal vHIT should prompt a search for a central lesion. In this study, we will examine the principle of vHIT and its interpretation, and explain its clinical application in peripheral and central vestibulopathy. In addition, we will compare the caloric test and the differences, and review the most recently introduced suppression head impulse paradigm test.


Subject(s)
Caloric Tests , Head Impulse Test , Head , Reflex, Vestibulo-Ocular , Saccades , Semicircular Canals , Vestibular Function Tests
9.
Article in Korean | WPRIM | ID: wpr-761268

ABSTRACT

OBJECTIVES: Aim of this study is to investigate the clinical efficacy of the vestibular function tests (VFTs) and the predictability of lesion side of vestibular asymmetry parameters in acute unilateral peripheral vestibulopathy. METHODS: Medical records and results of VFTs (caloric, rotatory chair, and head impulse tests) of 57 patients with acute unilateral vestibulopathy were reviewed retrospectively. The VFTs were examined within 7 days after the clinical onset. RESULTS: For the caloric test, 74% showed significant canal paresis and the predictability of lesion side was 88%. For the sinusoidal harmonic acceleration test, 91% had low gain in at least 1 Hz, phase lead showed 70%, 89% showed phase asymmetry and the predictability of lesion side was 90%. For velocity step test, 67% had abnormal Tc asymmetry and the predictability of lesion side was 95%. In bedside head impulse test (HIT), abnormal catch up saccades were observed in 89% and the predictability of lesion side was 100%. For the video HIT, cover or overt catch-up saccades were observed in 95% and the predictability of lesion side was 100%. One hundred percent (100%) had low gain on the video HIT, but the lesion sides were uncertain because of bilateral involvements or artifacts. CONCLUSIONS: The most important things in the diagnosis of acute unilateral vestibulopathy are typical clinical symptoms and spontaneous nystagmus. A combination of rotatory, caloric, and HITs will result in a more complete examination of the vestibular system. Among them, HIT is recommended as the best tool in acute unilateral vestibulopathy.


Subject(s)
Acceleration , Artifacts , Caloric Tests , Diagnosis , Exercise Test , Head , Head Impulse Test , Humans , Medical Records , Paresis , Retrospective Studies , Saccades , Treatment Outcome , Vestibular Function Tests
10.
Article in Korean | WPRIM | ID: wpr-761267

ABSTRACT

OBJECTIVES: Vestibular paroxysmia (VP) of the eighth cranial nerve is characterized by recurrent auditory and vestibular disturbances when a proximal part of the eighth cranial nerve is continuously pressed by a vessel. A detailed history and several ancillary diagnostic tools, such as tinnitogram, caloric test, auditory brainstem response (ABR) and magnetic resonance imaging, are used for diagnosis of VP. Among them, although Møller criteria using ABR is a simple method, the previous study is insufficient. Therefore, this study aimed to evaluate ABR's diagnostic value of VP. METHODS: ABR records of the 14 patients (patient group) who were diagnosed with VP and 45 patients (as control) who were diagnosed with only tinnitus were reviewed retrospectively. We analyzed the differences in Møller criteria between 2 groups. RESULTS: Mean age of the patient group was 52.9 years old and the control group was 55.4 years old. As compared with the control group, there were no significant differences of Møller 3 criteria contents (peak II wave amplitude < 33% [35.7% vs. 15.5%, p=0.133], interpeak latency I–III ≥2.3 msec [42.8% vs. 35.5%, p=0.622]), Contralateral interpeak latency III–V ≥2.2 msec (0% vs. 4.4%, p=1.000) in patient group. CONCLUSION: There was no significant difference of ABR parameters according to the Møller criteria between patient and control groups.


Subject(s)
Caloric Tests , Diagnosis , Evoked Potentials, Auditory, Brain Stem , Humans , Magnetic Resonance Imaging , Methods , Retrospective Studies , Tinnitus , Vestibulocochlear Nerve
11.
Article in Korean | WPRIM | ID: wpr-761261

ABSTRACT

OBJECTIVES: We aimed to assess the clinical significance of spontaneous nystagmus (SN) in horizontal semicircular canal benign paroxysmal positional vertigo (HC-BPPV). METHODS: Twenty-four patients who were diagnosed with HC-BPPV in Eulji University Hospital from January 2015 to December 2016 were recruited. Various bed-side examinations including SN in both sitting and supine position, head roll test, and bithermal caloric test were evaluated. The number of canalith repositioning maneuvers were counted in all patients. RESULTS: SN was observed in 18.2% of geotropic HC-BPPV and 38.5% of apogeotropic HC-BPPV, respectively. There was no significant difference between presence of SN and the direction of initial nystagmus (p=0.386, 2-tailed Fisher exact test). The mean number of otolith repositioning maneuvers in patients with SN was 3.29±1.799 and this was significantly higher than in patients without SN (1.76±0.831) (p=0.009). Although the mean number of repositioning maneuver in patients in apogeotropic HC-BPPV and SN (3.80±1.924) tended to be higher than those who were diagnosed with apogeotropic HC-BPPV without SN (1.88±1.991) (p=0.035), the post hoc analysis with Bonferroni correction revealed that it was not significant because it was higher than the adjusted p-value (p=0.017). The initial direction of nystagmus was changed into the opposite direction in 29.17% of patient. However, this change was not different according to presence of SN (p=0.374, 2-tailed Fisher exact test). CONCLUSIONS: The presence of SN in HC-BPPV may be associated with lower treatment response. In particular, cautions are needed in patients with apogeotropic HC-BPPV.


Subject(s)
Benign Paroxysmal Positional Vertigo , Caloric Tests , Head , Humans , Otolithic Membrane , Semicircular Canals , Supine Position
12.
Article in Chinese | WPRIM | ID: wpr-775947

ABSTRACT

To analyze the functional change of horizontal semicircular canals after cochlear implantation.Eighteen patients were enrolled in this study.Their vestibular function was evaluated by using the caloric test and video head impulse test before and one week,one month after CI surgery,respectively.The unilateral weakness(UW),slow phase velocity(SPV)in caloric test and gain in video head impulse test(vHIT-G)were observed.Caloric test was abnormal when UW>25% or SPV mean<6°/s,while vHIT was abnormal when vHIT-G<0.8.The SPV of the implanted ear were[(10.36±8.01)°/s;(14.77±14.24)°/s]pre-operatively,[(6.45±7.52)°/s;(5.14±4.67)°/s]1 week post-operatively and[(6.05±3.86)°/s;(6.27±4.17)°/s]1 month post-operatively.Statistically significant difference(<0.05)was found between pre-and post-operative period.The vHIT-G of the implanted ear were(0.73±0.33)pre-operatively,(0.65±0.32)1 week post-operatively and(0.71±0.36)1 month post-operatively.There was no statistically significant difference of vHIT-G between preand post-operative period((pre-operative/1 week post-operative)=0.084,(pre-operative/1 month post-operative)=0.679).Four patients presented with vertigo and one of them manifested slight unsteadiness post-operatively.All symptoms resolved within 7 days.These symptoms had no correlate with age,gender,implantedear and results of vestibular test.Cochlear implantation can affect the horizontal semicircular canal function,and the video head impulse test and caloric test should be used in a complementary fashion.


Subject(s)
Caloric Tests , Cochlear Implantation , Methods , Head Impulse Test , Humans , Semicircular Canals , Vertigo
13.
Article in English | WPRIM | ID: wpr-715301

ABSTRACT

OBJECTIVES: Growth of vestibular schwannomas (VS) causes progressive vestibular symptoms and postural instability. Since the tumor grows slowly, compensation of decaying vestibular input may decrease subjective symptoms of dizziness. This study aims to estimate the relationship of subjective vestibular symptoms and objective postural instability in patients with VS. METHODS: A retrospective review of 18 patients newly diagnosed with VS and with subjective vertigo symptoms was performed. The results of vestibular function tests including the sensory organization test (SOT) using computerized dynamic posturography, caloric test, and self-report measures of subjective dizziness handicap (Dizziness Handicap Inventory) and visual analogue scale were compared according to the onset of vertigo symptoms. RESULTS: In VS patients, SOT showed decreased equilibrium score for all vestibular function related conditions, condition (C) 5 and 6, and composite (COMP) score. COMP scores were not correlated with visual analogue scale or Dizziness Handicap Inventory scores. Acute onset group included six patients and insidious onset group, 12 patients. Equilibrium scores for C5 and C6, and COMP scores were lower for insidious onset group, but the difference was not statistically significant. CONCLUSION: Our findings confirmed postural instability is prevalent in VS patients. SOT parameters did not differ significantly between acute onset and insidious onset groups, but increased tumor size and canal weakness were noted in the insidious onset group. Clinicians should consider that postural instability is likely present even in patients who do not complain of acute vertigo, and appropriate counseling should be discussed with the patients.


Subject(s)
Caloric Tests , Compensation and Redress , Counseling , Dizziness , Humans , Neuroma, Acoustic , Postural Balance , Retrospective Studies , Vertigo , Vestibular Function Tests
14.
Article in Korean | WPRIM | ID: wpr-718230

ABSTRACT

BACKGROUND AND OBJECTIVES: We evaluated the clinical characteristics and vestibular function of patients with direction changing vibration induced nystagmus (DC VIN) and unilateral vestibular hypofunction and suggest clinical implication and a proposed mechanism of DC VIN. SUBJECTS AND METHOD: The records of 315 patients who underwent the VIN test were reviewed retrospectively. Among these, 18 patients (5.7%) showed DC VIN, and out of whom, 15 patients (4.8%) were diagnosed as unilateral vestibular hypofunction by caloric, rotation chair (RCT), and video head impulse test (vHIT). We analyzed the relationship between DC VIN and the dizziness characteristics, duration of disease, and the outcome of the vestibular function test. RESULTS: The mean age of 15 patients was 67.4±10.7 years and the mean duration of dizziness was 13.6±29.7 months. The caloric test revealed 25% of the patients to have significant canal paresis [Caloric vestibular neuritis (VN)], while 75% showed normal caloric response. However, unilateral vestibular hypofunction was observed by abnormal results in RCT or vHIT (Non-caloric VN). Seven patients showed ipsilateral DC VIN (nystagmus to vibrated side) and eight patients contralateral DC VIN (nystagmus to opposite side of vibration). Patients with ipsilateral DC VIN were shown to have a significant longer duration of dizziness than those with contralateral DC VIN. CONCLUSION: Although rare, DC VIN can also be found in patients with unilateral vestibular hypofunction. Patients with DC VIN had a mild vestibular asymmetry with Non-caloric VN or Caloric VN in the process of compensation. The mechanism of ipsilateral DC VIN seems to be due to the small amount of vestibular asymmetry, which is smaller than the interaural attenuation of vibration.


Subject(s)
Caloric Tests , Compensation and Redress , Dizziness , Head Impulse Test , Humans , Methods , Paresis , Retrospective Studies , Vestibular Function Tests , Vestibular Neuronitis , Vibration
15.
Article in Korean | WPRIM | ID: wpr-717348

ABSTRACT

BACKGROUND AND OBJECTIVES: Dizziness has been known as a prognostic factor in sudden sensorineural hearing loss (SSHL), but it is difficult to describe and quantify its subjective symptoms. Also, dizziness itself cannot imply vestibular dysfunction in SSHL. Comprehensive evaluation of vestibular function may help us understand the extent of lesions in sudden deafness. The purpose of this study is to determine whether an impaired caloric response is associated with disease severity and hearing outcome. SUBJECTS AND METHOD: A retrospective chart review was conducted of 488 patients diagnosed as unilateral SSHL. The patients were divided into two, an abnormal caloric group (canal paresis >20%) and normal caloric group (canal paresis ≤20%). Initial demographic and audiologic findings and final hearing outcomes were compared between the two groups. RESULTS: The initial pure tone averages of SSHL patients of abnormal caloric group and normal caloric group were 75.4±28.4 dB HL and 68.2±25.4 dB HL (p=0.004), respectively. Patients of abnormal caloric test group showed worse hearing outcome across all frequencies compared to those of the normal caloric group. Also, a significant correlation was noted between the magnitude of hearing recovery and canal paresis (r=-0.223, p < 0.001). CONCLUSION: SSHL patients of abnormal caloric test showed worse initial hearing level and poorer hearing outcome. Evaluation of vestibular function in SSHL patients is important because subjective symptoms alone cannot account for vestibular hypofunction patients, and the caloric test can help in the counseling of patients and prediction of hearing outcome in SSHL patients.


Subject(s)
Caloric Tests , Counseling , Dizziness , Hearing , Hearing Loss, Sensorineural , Hearing Loss, Sudden , Humans , Methods , Paresis , Retrospective Studies
16.
Article in Korean | WPRIM | ID: wpr-716563

ABSTRACT

BACKGROUND AND OBJECTIVES: Video head impulse test system (vHIT) is an easy-to-use test and there are numerous studies showing its efficacy. The aim of the study was to evaluate the clinical usefulness of vHIT as an initial test in determining vestibular hypofunction in patients with dizziness. SUBJECTS AND METHOD: The study recruited 103 outpatients who visited our ear clinic with dizziness. We performed both bedside head impulse test (bHIT), vHIT and bithermal caloric tests for 103 patients. Both bHIT and vHIT were consecutively performed in each subject on the same day by the same examiner. RESULTS: The sensitivity of bHIT and vHIT was determined based on the bithermal caloric test results, which showed that vHIT was more sensitive than bHIT. There was a significant negative correlation between vHIT gain and canal paresis (p < 0.05). Results of some patients indicated dissociation between vHIT and caloric test. CONCLUSION: T here is a significant correlation between the results of vHIT and caloric test. Although vHIT does not replace the caloric test, it would be useful to evaluate the initial vestibular loss in patients with dizziness.


Subject(s)
Caloric Tests , Dizziness , Ear , Head Impulse Test , Head , Humans , Methods , Outpatients , Paresis
17.
Clinics ; 72(8): 469-473, Aug. 2017. tab, graf
Article in English | LILACS | ID: biblio-890725

ABSTRACT

OBJECTIVE: This study compared the results of the caloric test with those of the video head impulse test obtained during the same session and evaluated whether the former can be used to screen for non-acute vestibular dysfunction. METHODS: A total of 157 participants complaining of dizziness with vestibular characteristics of varying durations and clinical courses completed the caloric test and video head impulse test. RESULTS: Significantly more caloric test results than video head impulse test results were abnormal. CONCLUSIONS: The results of the caloric test and video head impulse test are distinct but complement each other. Within our sample, the caloric test was more sensitive for vestibular dysfunction. Therefore, the video head impulse test is not a suitable screening tool of the vestibular system in patients with chronic complaints.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Caloric Tests/methods , Dizziness/diagnosis , Dizziness/physiopathology , Head Impulse Test/methods , Vestibular Diseases/diagnosis , Vestibular Diseases/physiopathology , Chronic Disease , Cross-Sectional Studies , Mass Screening , Reference Values , Reproducibility of Results , Semicircular Canals/physiopathology , Video Recording
18.
Article in Korean | WPRIM | ID: wpr-761253

ABSTRACT

OBJECTIVES: In vestibular neuritis (VN), the lesion preferentially affects the superior vestibular nerve because of the anatomic arrangement. It is well known that VN patients have a higher score of metabolic syndrome or a higher incidence of vertebral artery hypoplasia than controls. However, it is unclear whether the frequency of cardiovascular risk factors can affect the selective involvement of the branch of the vestibular nerve. Thus, we investigated the influence of cardiovascular risk factors on the development of total- or divisional VN. METHODS: 61 patients with VN were enrolled. Video head impulse tests and caloric tests were performed to determine which vestibular divisionswere affected. The patients were divided into divisional-VN (superior or inferior) and total-VN groups. Statistical analysis of the frequency of cardiovascular risk factors was performed only in superior and total VN groups because the number of inferior VN patients was too small to be statistically analyzed. RESULTS: Nineteen (31.1%) patients were classified as the total-VN group. In the divisional-VN group (42 patients, 65.6%), 40 were superior VN. The frequency of cardiovascular risk factors are not significantly different in superior VN and total-VN groups (All patients 50/61 [82.0%], superior-VN 36/40 [90.0%], total-VN 13/19 [68.4%]). The frequency of having more than one cardiovascular risk factor was slightly higher in the superior VN group, (13 [68.4%] vs. 36 [90.0%], p=0.062) but did not show any significant difference. CONCLUSIONS: The number of cardiovascular risk factors did not differ in superior VN patients compared to total VN patients.


Subject(s)
Caloric Tests , Cardiovascular Diseases , Head Impulse Test , Humans , Incidence , Risk Factors , Vertebral Artery , Vestibular Nerve , Vestibular Neuronitis
19.
Article in Korean | WPRIM | ID: wpr-761248

ABSTRACT

It is known that about 30% of patients with sudden hearing loss present with vertigo or dizziness. In clinical practice, this is called sudden hearing loss with vertigo (SHLV) although definite diagnostic criteria have not been established. Dizziness in SHLV is known to be caused by the dysfunction of the vestibular end-organs as well as the superior vestibular nerve or both vestibular nerve divisions. Lesions of the inferior vestibular nerve or a single semicircular canal have also been reported in these patients. Herein we report a 71-year-old male patient with SHLV who demonstrated vestibular dysfunction involving only the posterior semicircular canal. The patient showed normal results in the bithermal caloric test and the cervical vestibular evoked myogenic potentials test as well as positional test. Video head impulse test showed decreased gain only in the posterior semicircular canal. This case is significant in showing that dizziness in SHLV patients can occur by an abnormality involving only a single semicircular canal.


Subject(s)
Aged , Caloric Tests , Dizziness , Head Impulse Test , Hearing Loss, Sudden , Humans , Male , Semicircular Canals , Vertigo , Vestibular Evoked Myogenic Potentials , Vestibular Nerve
20.
Article in English | WPRIM | ID: wpr-10592

ABSTRACT

OBJECTIVES: To analyze the clinical characteristics of vestibular neuritis patients with minimal canal paresis (canal paresis <25%). METHODS: Patients clinically diagnosed with vestibular neuritis and treated at our institute (n=201) underwent otoneurological examination and vestibular function tests. Patients were categorized in terms of the results of caloric testing (canal paresis<25%, n=58; canal paresis≥25%, n=143). Clinical characteristics and laboratory outcomes were compared between two groups. RESULTS: Existence of underlying diseases, preceding symptoms, and direction of spontaneous nystagmus were not different between the groups. The mean duration of spontaneous nystagmus was shortest in the minimal canal paresis group (P<0.001) and the direction of spontaneous nystagmus changed more frequently in this group (P<0.001) during recovery. Among the subgroup with minimal canal paresis, only 29.5% had an abnormal finding on the rotatory chair test, as compared to 81.5% of the canal paresis group. The minimal canal paresis group showed higher sensory organization test scores in computerized dynamic posturography. CONCLUSION: Patients with minimal canal paresis (canal paresis <25%) show similar clinical manifestations as conventional vestibular neuritis patients, but have faster recovery of symptoms and a higher incidence of recovery nystagmus. This finding support that the minimal canal paresis could be considered as a milder type of vestibular neuritis.


Subject(s)
Caloric Tests , Humans , Incidence , Paresis , Vertigo , Vestibular Function Tests , Vestibular Neuronitis
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