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PubMed1980

Vertigo: a physiological approach.

An understanding of vestibular function and a careful history will quickly separate patients with disease of the vestibular system from others. Further history and physical examination, often coupled with audiometric and vestibular function tests, will aid in localizing the lesion to the central or peripheral portions of the system and in determining the affected side. Medical management, which is often nonspecific and involves considerable psychological support, usually suffices.

Diagnosis, Differential↗
PubMed1991

A clinical study of vestibular neuronitis.

By means of clinical and neurotological findings in 38 patients with vestibular Neuronitis, an analysis of the clinical-pathological manifestations, that may be included into this denomination, has been carried out. The probable etiology of this disease and the results of the tests performed have also been analyzed. In the light of these results the vestibular compensatory mechanisms, studied with later periodic tests, are discussed, and the conclusions on the prognosis and treatment of this entity derived.

Adolescent↗
PubMed1984

Vestibulo-oculomotor characteristics in surgically treated patients with cerebellar haemangioblastoma (Lindau tumor).

In a survey of 18 patients that were operated on because of a cerebellar haemangioblastoma (Lindau tumor) 94% showed characteristic cerebellar oculomotor deficits when DC EOG recordings were analyzed. Only 22.1% showed also clinically cerebellar deficits. We studied the vestibular ocular reflex (VOR) with and without visual interaction, and also saccades and pursuit eye movements in our patients with lesions involving one cerebellar hemisphere (n = 14) or the vestibulocerebellum (n = 4). Gain of dysmetric saccades ipsilateral to the side of the lesion was significantly increased; gain of pursuit eye movements, that were often saccadic, was decreased contralaterally. Our patients showed highly increased responses for all three conditions of visual-VOR-interaction (sinusoidal or steplike rotation in the dark, in the light with fixed surround, or in the dark with head fixed fixation point) ipsilateral to the lesion, together with a remarkable inability to modulate their VOR with vision on this side. With movements contralateral to the side of the lesion they showed a larger variability of test responses than normals, but only for fixation suppression of the VOR a significantly increased gain. The very similar time constants of slow phase decay after a step change in chair velocity indicated a similar poor modulation of visual-VOR-interaction under these 3 conditions for stimulations ipsilateral to the lesion. Contrariwise, optokinetic step stimulation demonstrated a generally impaired response that was significantly lowered towards the side contralateral to the lesion. Our results indicate the critical function of the cerebellum for voluntary fast and slow eye movements as well as for visual-vestibular interaction in humans.

Adult↗
PubMedDate not supplied

Otoneurological functioning in panic disorder patients with prominent dizziness.

Fifteen panic disorder patients with prominent dizziness underwent audiologic, caloric, and vestibuloocular reflex activity testing and were compared with normal controls. There were no abnormalities detected on audiologic and caloric tests. Compared with normal controls, panickers with dizziness showed a greater discrepancy between eye and head movements on vestibulo-ocular reflex activity in the dark. Panickers with prominent dizziness did not differ from a second control group of panickers with severe heart palpitations on a number of psychological tests. The results did not support the hypothesis that organic dizziness is etiologically important in the causation of panic or agoraphobia, but do suggest that vestibuloocular reflex activity should be further studied in panic disorder.

Adult↗
PubMed1986

Vestibular effects of intravenous lidocaine used in the treatment of tinnitus.

Intravenous lidocaine is known to have an effect on the auditory system in that it is useful for suppressing tinnitus, albeit temporarily. We have used intravenously administered lidocaine as one of the treatment modalities for refractory, disturbing, tinnitus. Its effects on the vestibulo-ocular system were determined by electronystagmography performed before and immediately after injecting lidocaine: smooth pendular stimulus tracking was unaffected; spontaneous and positional nystagmus tended to be suppressed; directional preponderance was reduced or reversed; and the difference between the nystagmus responses in the two directions during the pendular rotation chair test was also reduced or reversed. These changes in the caloric and rotation tests were statistically significant. Lidocaine also appeared to have altered the balance between the two sides in the vestibulo-spinal system as indicated by the results of the stepping test during craniocorpography. The results lend support to the hypothesis that intravenous lidocaine acts at the level of the central nervous system rather than at the periphery.

Electronystagmography↗
PubMed1982

Vestibular function assessment in patients with Meniere's disease: the vestibulospinal system.

The state-of-the-art approach to clinical assessment of vestibular disturbances includes a number of procedures in which it is assumed that the status of major vestibular pathways is quantified independently from converging somatosensory and visual influences. Although it has been known for some time that this approach has limitations in a highly integrative system in which inputs from a number of sensory modalities interact, a practical remedy has been only recently forthcoming. Using an approach to assessment of the vestibulospinal system developed by Nashner, the application of moving platform techniques has been the first to systematically identify the interactions among vestibular, visual, and proprioceptive senses and determine the role of vestibular losses in the process of postural control. A group of Meniere's disease patients were studied in order to determine whether or not such tests could be used as an effective vestibular screening method for Meniere's disease patients in remission, and whether the ability of Meniere's disease patients to use vision and proprioception to compensate for their vestibular disorders, could be assessed. Results indicated that quantitative evaluation of the vestibulospinal system was a very effective vestibular screening test. Furthermore, the adaptive ability of the subject can be estimated by varying the amounts of visual and proprioceptive vestibular information available to the patient for the control of postural sway. Preliminary results indicate that such a technique would be of great value clinically for the initial and on-going evaluation of patients with Meniere's disease and for pre and post-therapeutic evaluation of the Meniere's disease patient.

Adult↗
PubMed1989

Effects of unilateral loss of vestibular function on the vestibulo-ocular reflex and postural control.

Long-term recovery from surgically induced unilateral loss of vestibular function was studied in 14 patients. Seven patients underwent surgical extirpation or section of the vestibular nerve, and seven patients underwent labyrinthectomy without vestibular nerve section. The vestibulo-ocular reflex (VOR) and postural control were evaluated preoperatively and monitored for up to 4 years postoperatively with use of pseudorandom rotation (combined sinusoidal frequencies from 0.009 to 1.5 Hz) and moving platform posturography. Immediately following surgery all patients showed minimal reductions in the VOR gain constant, but marked reduction in the time constant, and marked increase in slow eye velocity bias. Bias returned to normal values within about 10 days, but time constants never returned to normal values. Results of standard Romberg tests in these patients were normal throughout the preoperative and postoperative periods. However, all patients showed marked postural control abnormalities in tests of the ability to maintain balance in unusual sensory environments in the immediate postoperative period. Seventy-five percent of the patients eventually recovered normal postural control. Postural control returned to near baseline performance with a time course similar to that of the VOR bias. However, postural control also continued to improve after the recovery of VOR bias was complete.

Adolescent↗
PubMedDate not supplied

Implications of Ewald's second law for diagnosis of unilateral labyrinthine paralysis.

The feasibility of replacement of the caloric test with sinusoidal rotatory stimulations of differing frequencies was investigated in ten normal subjects and seven patients with unilateral labyrinthine paralysis. Testing was performed at frequencies ranging from 0.0125 to 0.2 Hz at 60 degrees/sec and at 0.05 Hz at peak velocities of 30 degrees/sec to 180 degrees/sec. Gain, phase, and asymmetry of the nystagmic responses were measured in these groups. Results indicated that the rotatory test was not reliable enough to be used as the sole measure for identifying patients with unilateral labyrinthine lesions.

Analog-Digital Conversion↗
PubMed2004

Vestibular evoked myogenic potentials versus vestibular test battery in patients with Meniere's disease.

OBJECTIVE: The present study was undertaken to assess the sensitivity of vestibular evoked myogenic potentials testing to side-of-disease in Meniere's disease patients and to test the hypothesis that information supplied by vestibular evoked myogenic potentials is complementary to that provided by a conventional vestibular test battery. STUDY DESIGN: Prospective cohort study. SETTING: Large specialty hospital, department of otolaryngology. SUBJECTS: Twenty consenting adults (9 men and 11 women) with unilateral Meniere's disease by American Academy of Otolaryngology-Head and Neck Surgery diagnostic criteria. INTERVENTIONS: All subjects underwent bilateral vestibular evoked myogenic potentials testing using ipsilateral broadband click and short-toneburst stimuli at 250, 500, and 1,000 Hz. All subjects also underwent electronystagmography and sinusoidal vertical axis rotation testing. MAIN OUTCOME MEASURES: Accuracy of side-of-disease assignment by vestibular evoked myogenic potentials, caloric asymmetry, and multivariate analysis. RESULTS: Side-of-disease assignment was most accurate using caloric asymmetry with a 5% interaural difference criterion, achieving 85% correct assignment. The next best method was vestibular evoked myogenic potentials using 250-Hz toneburst stimuli, achieving 80% correct assignment. The least accurate method was caloric asymmetry using a traditional 30% interaural difference limen, achieving 55% correct assignment. Comparison of 5% interaural difference criterion and vestibular evoked myogenic potentials using 250-Hz toneburst stimuli showed discordant results, but in no case did both 5% interaural difference criterion and vestibular evoked myogenic potentials using 250-Hz toneburst stimuli make an incorrect assignment. CONCLUSION: Vestibular evoked myogenic potentials threshold was shown to be highly sensitive to side-of-disease in unilateral Meniere's disease. We observed instances of discordance in side-of-disease assignment by caloric asymmetry and vestibular evoked myogenic potential methods but no case in which both methods were incorrect. This supports the hypothesis that vestibular evoked myogenic potentials supplies information complementary to that provided by other components of the vestibular test battery.

Adult↗
PubMed2004

Vestibular evoked myogenic potentials: history and overview.

Vestibular evoked myogenic potential (VEMP) testing is a relatively new diagnostic tool that is in the process of being investigated in patients with specific vestibular disorders. In this review, we will outline the history and provide a current review of VEMP research. Briefly, the VEMP is a biphasic response elicited by loud clicks or tone bursts recorded from the tonically contracted sternocleidomastoid muscle. Current data suggest that the VEMP is a vestibulo-collic reflex whose afferent limb arises from acoustically sensitive cells in the saccule, with signals conducted via the inferior vestibular nerve. We will review the history of the response and detail the anatomy and physiology associated with the test. We will discuss specific VEMP applications in the diagnosis of Meniere's disease, vestibular schwannoma, vestibular hypersensitivity disorders, vestibular neuritis, multiple sclerosis, and other brainstem lesions.

Afferent Pathways↗
PubMed1995

[Quantitative evaluation of the Romberg test].

Simple and economical measuring platforms are available to aid the ENT clinician in examining vestibulospinal disorders. The aim of our study was to quantitatively interpret Romberg test measurements. Calculating the area between the zero line and the curves in sagittal and lateral direction--for the Romberg test with closed and open eyes--enables a quantification of body sway. For the evaluation of data, we developed a triangular diagram which allows a graphic representation and quantifies vestibulospinal reaction at a glance. We assessed a group of 80 persons without any symptoms of peripheral or central vestibular system disturbance. Selected patients complaining of vestibular disorders are helpful in demonstrating the objective and quantitative interpretation of the Romberg test, which is often analysed in a more subjective way.

Adult↗
PubMedDate not supplied

[Significance of comparing the results of caloric and vestibulometric rotation tests].

The use of modified, less laborious, easier endured vestibulometric tests made it possible to facilitate diagnosing Menière's disease and neurinomas of the vestibular nerve. Comparison of nystagmometric findings recorded in the same patient during caloric and rotation tests using the diagnostic model of a bithermal test permitted some assumptions to be made in relation to the mechanisms for nystagmogenesis associated with pathologic states in ear labyrinth and vestibular portion craniocerebral (VIII) nerve. It is found that in the majority of Meniere's disease cases (61%) there is a decrease in an intensity of caloric nystagmus induced by Lasix dehydration effect. This phenomenon can be explained by a reduced difference in energy levels of two complexes of vestibular nuclei and, therefore, by an attenuated afferents to peripheral compartment of vestibular system. In neurinoma of aural nerve, the phenomenon of vestibular recruitment (20%) was noted. The diagnostic model of a bithermal test makes it possible to explain an effect of smoothing out the nystagmic responses induced by an intensive stimulus when used a sinusoidal stepwise test. The observed vestibular recruitment results from the severe disorder of one of the afferent inputs due to destruction of induced by tumor pressure.

Adult↗
PubMed1993

Vestibular neuronitis: epidemiological survey by questionnaire in Japan.

An epidemiological survey on vestibular neuronitis in Japan was conducted by means of a questionnaire filled in by major neuro-otology clinics (otolaryngologists) during 1988-1990 (3 years). The diagnostic criteria of vestibular neuronitis settled on in 1986 by the Standardization Committee of the Japan Society of Equilibrium Research were applied. Gross analysis of questionnaire answers showed that i) there was no sexual difference, ii) the peak of age distribution was between 40-50 years, iii) about 30% of all cases had had common colds prior to the disease, the rate being highest among children below 10 years, iv) disappearance of positional and positioning nystagmus appeared in about 60% of all cases within 3 months, and that v) caloric CP was observed in about half of the cases at the follow-up test. Progress was not as favorable when compared to previous studies.

Adolescent↗
PubMed1992

Clinical and vestibulometric status following labyrinthectomy or vestibular nerve section for Menière's disease.

A clinical and vestibulometric comparison of 10 patients following labyrinthectomy, 5 following vestibular nerve section, and 10 control subjects was undertaken in order to evaluate the long-term effectiveness of these procedures. Testing was performed a mean of 8.5 years after surgery. Vestibulometry assessed time constants, gain, and phase advance of the vestibulo-ocular reflex (VOR) in both horizontal and vertical planes of head movement. Loss of the anticipated increase in phase advance in the vertical VOR of the labyrinthectomy group, significantly different from the vestibular nerve section group (P less than 0.05 and P less than 0.01 for each direction of rotation), suggests that posterior and superior semicircular canal function remains intact following per-meatal labyrinthectomy. Although stabilometry suggested that balance in the labyrinthectomy group was poorer than in the two other groups (P less than 0.025 without optic fixation), clinical assessment demonstrated excellent functional results. Per-meatal labyrinthectomy remains a safe and effective procedure for the relief of vestibular symptoms, although vestibular nerve section may provide more complete removal of contributory end-organ function.

Aged↗
PubMed1995

Posturography: head stabilisation compared with platform recording. Application in vestibular disorders.

Posturography with simultaneous recording of the head movements (H-recording) and of the pressure of the feet on the platform (P-recording) has been applied in patients with peripheral vestibular disorders. For the whole testing (four tests with visual and proprioceptive interaction) 40% showed an identical degree of abnormality for the measurements of surface in P- and H-recording. In a large majority of the patients, showing a difference between H- and P-recording, this difference indicated a lower degree for the H-recording. Concerning the four tests separately, the differences for eyes closed tests were more frequently positive (larger surface for head movements) than for eyes open tests. Also on foam rubber there was more difference than on stable platform. Especially the test with eyes closed on foam rubber showed more differences. These data show that in a minority of patients the comparison of H-recording and P-recording affords complementary information showing in these cases some independence of head stabilisation and foot-stabilisation. Head-recording can be used as a posturographic technique but one has to keep in mind the possible differences with platform-recording.

Functional Laterality↗
PubMedDate not supplied

Computerized screening of the human vestibulospinal system.

The vestibular nerve projects rostrally via the ascending medial longitudinal fasiculus (MLF) to eventually supply the ocular muscles and also projects caudally via the descending MLF to eventually supply the spinal and limb musculature. Electronystagmographic techniques are designed to evaluate only portions of the vestibulo-ocular and oculomotor systems. Vestibular lesions affecting only the caudal vestibular nerve distributions or lesions affecting both neural distributions, therefore, cannot be objectively assessed except for the vestibulo-ocular component. A promising recording technique for the evaluation of the vestibulospinal system has been developed and tested in the Raymond E. Jordan Human Vestibular Systems Laboratory. A comparison of two data analysis techniques in normal subjects, unilateral vestibular lesion patients and patients with unilateral lesions of the cerebellar hemispheres have provided pilot data which indicate that the vestibulospinal stability test technique holds considerable promise for both research and clinical evaluation of the human vestibulospinal system.

Adult↗
PubMed1981

Positional test in acute vestibular disorders.

With the aid of th positiogram, a quantitative recording of th positional test, it was possible to study the intensity of nystagmus in three acute vestibular diseases (vestibular neuronitis, Meniere's disease and sudden hearing loss with vestibular involvement). Patients with vestibular neuronitis in the acute stage showed a higher intensity of nystagmus during the positional test than patients passing through the irritation stage of Menière's disease. Especially patients suffering from vestibular neuronitis complained also subjectively about such an intense vertigo that they were seized by a feeling of annihilation at the onset of the disease. Quantification of the nystagmus during the positional test allows the progress, constancy or remission of the findings to be identified during the follow-up checks. Protracted constant pathological results obtained during the positional test, or when they become progressive, constitute in the light of our experience an indication for neuroradiological clarification in order to rule out an acoustic neurinoma as a cause (especially when a unilateral sensorineural hearing impairment exists).

Aged↗