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Contralateral hyperactive caloric response in unilateral labyrinthine weakness.

P L Huygen·M G Nicolasen·W I Verhagen·E J Theunissen
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Abstract

In a series of 600 patients, 10 showed unilateral hyperactive caloric responses without a trivial explanation such as spontaneous nystagmus or directional preponderance. All 10 had unilateral weakness on the contralateral side, which was accompanied in 9 by cochlear hearing loss. It is assumed that the phenomenon of unilateral hyperreactivity in these cases can be explained by release from commissural inhibition on the basis of temporary vestibular decompensation.

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Caloric TestsFunctional LateralityHumansLabyrinth DiseasesRetrospective StudiesVestibule, LabyrinthJournal Article

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P L Huygen, M G Nicolasen, W I Verhagen, E J Theunissen. Contralateral hyperactive caloric response in unilateral labyrinthine weakness.. https://doi.org/10.3109/00016488909127472

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PubMed2006

Functional evaluation of the vestibular organ in infants with risk factors for hearing loss occurring in the perinatal period.

BACKGROUND: Asphyxia at birth, low birth weight and low birth age constitute risk factors for inner ear damage in the perinatal period. Caloric stimulation is one of the most reliable diagnostic tools for vestibular testing in infants. Recording of vestibular-evoked myogenic potentials (VEMPs) evaluates the otolith organ and its pathways. Potentials reflecting the integrity of sacculo-collic reflex pathways are recorded on the surface of the neck muscles. The purpose of our study was to evaluate vestibular function in the discussed group of infants. MATERIAL/METHODS: 72 infants aged 3 months were examined: 40 healthy controls and 32 infants (17 girls, 15 boys) with risk factors for hearing loss occurring in the perinatal period. RESULTS: No reaction to caloric stimulation was elicited from 6 examined ears, no VEMPs were recorded from 6 ears, profound sensorineural hearing loss was diagnosed in 4 ears. The VEMP measurements did not differ between the groups. Profound sensorineural hearing loss occurred most frequently in infants with very low Apgar scores, responses to caloric stimulation were weakened in subjects with low Apgar scores. The response of the horizontal semicircular canals was more frequently abnormal than that of the otolith organs. CONCLUSIONS: The vestibular organ functions were frequently impaired in this group of infants, but the damage was rarely complete. Infants' vestibular organs should be routinely diagnosed.

Caloric Tests↗
PubMed2006

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CONCLUSIONS: Our results suggest that the sacculi of most children with cochlear implants can easily be damaged, as shown by the absence of vestibular-evoked myogenic potentials (VEMPs) in response to click stimuli. Also, in most of the children, the vestibular nerve was seemingly not stimulated by the cochlear implant. These results suggest that electrical stimulation at the C level can stimulate the cochlear nerve; however, this stimulation did not spread to the vestibular nerve in our children. In some children with Mondini dysplasia or vestibulocochlear nerve abnormality, the vestibular nerve was stimulated when the cochlear implant device was on, because of a VEMP response to electrical stimulation. OBJECTIVE: To clarify the diagnostic value of VEMPs in cochlear implant patients. MATERIAL AND METHODS: The click-evoked myogenic potentials of 12 children who underwent cochlear implantation surgery were investigated. The latency and amplitude of the VEMP responses were measured. RESULTS: Before surgery, 6 of the 12 children showed normal VEMPs, 1 showed a decrease in the amplitude of VEMPs and five showed no VEMP response. After surgery, with the cochlear implant device off, 1 child showed a decreased VEMP and 11 showed no VEMPs. With the cochlear implant device on, four children showed VEMPs and eight did not.

Caloric Tests↗
PubMed2006

Analysis of the vestibulo-ocular reflex time constant in patients with benign recurrent vertigo associated with head-shaking nystagmus.

CONCLUSIONS: When considering benign recurrent vertigo and a similar peripheral vestibular deficiency, the asymmetry of the vestibulo-ocular reflex (VOR) time constant (Tc) is lower in those patients with paretic head-shaking nystagmus (HSN) than in those with reversed HSN or without HSN. OBJECTIVE: To determine whether the existence of HSN is related to the time constant of the VOR in patients with benign recurrent vertigo (BRV). PATIENTS AND METHODS: This was a prospective study conducted at a tertiary care center in which patients were subjected to the head-shaking test, the caloric test and rotatory chair impulsive test on the same day. The clinical features of the disease analyzed were the disease duration, frequency of vertigo spells, time since the last vertigo spell and the existence of migraine. The results of the head-shaking test were considered positive when nystagmus appeared after head-shaking had ended. Two groups of patients were established on the basis of these results and the group that displayed HSN was divided according to the direction of nystagmus. In the impulsive test, the time constant of the VOR after ipsilesional and contralesional acceleration was analyzed, as was the symmetry of the response. The differences in the means were calculated. RESULTS: BRV was diagnosed in 25% of patients suffering recurrent spells of vertigo, of which 33 patients were HSN- and 29 were HSN+. In the latter group, vestibular migraine was frequently observed (83% of the patients), the spells of vertigo were more frequent and the patients were seen closer to the previous spell of vertigo. No differences were observed in the Tc of the VOR between HSN+ and HSN- patients, although the asymmetry of this Tc was higher in HSN- patients than in HSN+ patients. Nevertheless, the differences observed were only significant between paretic and reversed HSN patients and paretic HSN patients and HSN- patients.

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