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PubMedDate not supplied

The "marche-en-étoile" revised. The influence of after-images and prism-glasses on starwalks.

An analysis of the role that casual after-images play in starwalk (marche-en-étoile) tests, shows that these can be turned from unreliable into reliable tests. The vestibular function test described in this article is as follows: (a) the individual walks with open eyes to a point of reference 5 m distant. On arrival, he closes his eyes and walks backward and forward according to the marche-en-étoile procedure. (b) Same procedure as (a), but now the orientation point is replaced by a light source that is switched off when the patient reaches it. (c) Same procedure as (b), but now the patient is wearing prism-glasses. It turns out, the deviations in the starwalk are caused mainly by drifting of the after-image. This drift is based on an oculogyral illusion, and it appears that it can be influenced by wearing prism-glasses. These investigations reveal the existence of hitherto too little known interactions between the vestibular and the visual system.

Afterimage↗
PubMed1994

Relevance of function tests in the diagnosis of vestibular disorders.

The diagnostic value or relevance of a vestibular function test is dependent on the whole clinical and functional context of each particular case. It is not the ability to show 'abnormality' in a high number of patients complaining of whatever kind of vertigo, that indicates the relevance of a function test. Neither is relevance of a test based upon the possibility that this test can re-categorize some patients in the same way as has been done by other tests. Each test evaluates some particular functional aspect and this is very different from one test to another. A test is more relevant, i.e. indicates more abnormality when the type of vertigo caused by the dysfunction is also considered. These statements are confirmed by experience in peripheral vestibular disorders, especially benign paroxysmal positional vertigo (BPPV). A paroxysmal positional nystagmus (ppn) (nystagmus and vertigo elicited by movements and manoeuvres) is linked to the problem of provoked vertigo and gives a confirmation of this vertigo by reproducing it in some manoeuvres. Some inconstancy in the reproduction of this ppn may cause difficulties in diagnosis. Caloric tests are the clue for diagnosis of sudden unilateral loss (so-called neuronitis), whereas they give only complementary information for patients with BPPV. Posturography adds information in all categories concerning the standing position and can be interesting in the scope of rehabilitation treatment. The findings of a retrospective study in patients with BPPV (n = 95), compared with patients with Ménière's disease (n = 89) and others with sudden unilateral loss syndrome (n = 48), illustrate these concepts.

Audiometry↗
PubMed1987

The use of the logistic model in space motion sickness prediction.

The one-equation and the two-equation logistic models were used to predict tested subjects' susceptibility to motion sickness in KC-135 parabolic flights using data from other ground-based motion sickness tests. A data set containing data from 6 provocative tests, 2 vestibular function tests, and 1 motion sickness experience questionnaire from 162 subjects was used in this study. The prediction results from the logistic models were compared with those from the previously-used Bayes linear discriminant analysis procedures. The results based on this data set show that the logistic models correctly predicted substantially more cases (an average of 13%) in the data subset used for model building. In the data subset used for model cross-validation, the logistic models correctly predicted 4% and 5% more cases in the prediction of vomit or nonvomit, and of degree of susceptibility, respectively. Overall, the logistic models ranged from 53 to 65% predictions of the three endpoint parameters, whereas the Bayes linear discriminant procedure ranged from 48 to 65% correct for the cross validation sample.

Adult↗
PubMedDate not supplied

The reproducibility of caloric tests of vestibular function in young and old subjects.

The test-retest repeatability of the hot caloric response alone and of the hot and cold caloric responses combined, was evaluated in 29 subjects, over a 6-month period. The subjects were from two different age groups, 20-30 years (15 subjects) and 65-75 years (14 subjects). Intersubject variability was statistically significant in both age groups, though of greater magnitude in the older subjects. Once a vestibular caloric response baseline was established, for any given subject, there was reasonably reliable test-retest repeatability over time, in both age groups, with coefficients of reliability greater than 0.90.

Adult↗
PubMed1995

Visuo-vestibular interaction measurements: an alternative for rotation tests with better discriminatory power?

A vestibular function test is introduced for evaluating visuo-vestibular interaction (VVI), in which a visual target may move asynchronously with a pseudo-randomly oscillating rotatory chair. The results show better discrimination of patients (Meniere's disease, benign paroxysmal positioning vertigo (BPPV), uncompensated peripheral vestibular lesions. whiplash) than do standard tests (torsion swing, velocity step, calorization, smooth pursuit, optokinetics, saccade analysis). For the phase shift, the better performance is shown to stem from improved reproducibility. Signal analysis is done fully automatically, thereby precluding experimenter's bias.

Diagnosis, Differential↗
PubMed2000

Assessing vestibular function: which tests, when?

Vertigo and dizziness are common complaints encountered in clinical practice. The patient's history and a thorough otoneurological evaluation are essential for identifying the specific pathology behind the patient's complaints. If the patient reports an illusion of movement (vertigo), this most likely indicates an imbalance within the vestibular system. A sensation of rotatory movement together with a spontaneous nystagmus suggests a lesion involving the semicircular canals, while an illusion of linear movement indicates a disturbance of the otoliths. Nystagmus of central origin or caused by a peripheral vestibular lesion can usually be distinguished by other features in the history or on clinical examination. While peripheral vestibular lesions usually lead to a mixed horizontal-torsional or vertical-torsional nystagmus, a pure vertical or pure torsional nystagmus is always caused by a central lesion. With simple bedside tests such as head-shaking nystagmus and rapid head impulses deficits in labyrinthine function can clearly be detected. For a more thorough investigation of vestibular function at the level of individual semicircular canals and the otoliths, modern techniques are now available such as three-dimensional eye movement vector analysis for the evaluation of individual semicircular canal function, measurement of the subjective visual vertical for utricular, and click-evoked myogenic potentials for saccular testing.

Dizziness↗
PubMed1982

Unilateral cystic inner ear anomalies in siblings.

Unilateral cystic inner ear anomalies were diagnosed in two siblings, a 9 year old boy and a 6 year old girl. X-ray examination of the temporal bone was performed, together with audiological examinations and vestibular function tests. The common tomographic X-ray findings consisted of an enlarged solitary sac type deformity of the vestibule with narrowing of the internal auditory canal, severe hypoplasia of the anterior semicircular canal and no visualized cochlea. Pure-tone audiometry revealed severe mixed type of hearing loss in the right ear in both children. The test for vestibular function showed no response to caloric testing.

Child↗
PubMed1995

[Vestibular function in cochlear implants--prognostic factors and postoperative damage].

Eighteen patients with a 22-channel cochlear implant were evaluated both pre- and postoperatively with vestibular function tests; caloric test and body balance test using stabilometry. Preoperative promontory stimulation results and postoperative psychophysical factors of the cochlear implant showed no correlation with the preoperative vestibular function test results. The results of speech perception tests were not affected by the degree of residual vestibular function in any of the patients. However, for patients with deafness for a period of 10 to 20 years, the degree of the residual vestibular function estimated by the caloric test showed a correlation with the results of speech perception tests, significantly in the consonant recognition score. The results, not of length or the Rombberg ratio, but rather of the area of body sway, showed a correlation with the results of speech perception tests; consonant recognition, in patients with a short duration of deafness. Therefore preoperative vestibular function results may be useful as a predictive factor in postoperative speech perception; consonant recognition, for patients with a short duration of deafness. Reduced results of caloric testing after surgery were found in one of 11 patients (9%) with residual vestibular function. The occurrence of vertigo immediately after surgery was observed in 5 of 18 patients (28%), but this symptom was transient. No change in stabilometry results, pre-versus post-operatively, was observed. Thus, vestibular damage after surgery was considered to be minimal.

Adult↗
PubMed1993

Three-dimensional brain metabolic imaging in patients with toxic encephalopathy.

Thirty-three workers, ages 24 to 63, developed clinical toxic encephalopathy after exposure to neurotoxins and were studied by SPECT brain scans. Five were exposed to pesticides, 13 were acutely exposed to mixtures of solvents, 8 were chronically exposed to mixtures of hazardous wastes that contained organic solvents, 2 were acutely exposed to phosgene and other toxins, and 5 had exposures to hydrogen sulfide. Twenty-nine had neuropsychological testing and all had a medical history and physical. Of the workers who had a clinical diagnosis of toxic encephalopathy, 31 (93.9%) had abnormal SPECT brain scans with the most frequent areas of abnormality being temporal lobes (67.7%), frontal lobes (61.3%), basal ganglia (45.2%), thalamus (29.0%), parietal lobes (12.9%), motorstrip (9.68%), cerebral hemisphere (6.45%), occipital lobes (3.23%), and caudate nucleus (3.23%). Twenty-three out of 29 (79.3%) neuropsychological evaluations were abnormal. Other modalities when performed included the following percentages of abnormals: NCV, 33.3%; CPT sensory nerve testing, 91.3%; vestibular function testing, 71.4%; olfactory testing, 89.2%; sleep EEG analysis, 85.7%; EEG, 8.33%; CT, 7.14%; and MRI brain scans, 28.6%. The complex of symptoms seen in toxic encephalopathy implies dysfunction involving several CNS regions. This series of patients adds to the previous experience of brain metabolic imaging and demonstrates that certain areas of the brain are typically affected despite differences in toxin structure, that these lesions can be globally defined by SPECT/PET brain scans, that these lesion correlate well with clinical and neuropsychological testing, and that such testing is a useful adjunct to previous methods. EEG and structural brain imaging such as CT and MRI are observed to have poor sensitivity in this type of patient. Additional metabolic imaging studies need to be done to explore dose, time, and specific toxin effects as well as mechanisms of toxicity and olfactory migration.

Adolescent↗