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PubMed1979

Caloric pattern test with special reference to failure of fixation-suppression.

Fixation-suppression of caloric nystagmus was studied in 1230 consecutive cases. An analysis of caloric nystagmus with failure of fixation-suppression (FFS) made it possible to classify patterns of FFS into three types: Type I: FFS was observed bilaterally in caloric nystagmus; Type II: FFS was recognized unilaterally on either side; Type III: FFS was seen in either direction of nystagmus. On the basis of these three types, the underlying neuroanatomical substrate responsible for FFS is discussed.

Brain Diseases↗
PubMed1993

Vestibular nerve disorder in patients suffering from sudden deafness with vertigo and/or vestibular dysfunction.

Vestibular nerve disorder (VND) in cases suffering from sudden deafness with vertigo was studied. Between 1987 and 1991, we observed 46 patients suffering from sudden deafness with or without vertigo, who had undergone the caloric test and galvanic body sway test (GBST). Twenty-seven patients had vertigo and canal paresis (CP) upon the caloric test, 6 vertigo without CP and 13 CP without vertigo. VND was detected in 12 of the 46 patients. All those with VND had vertigo and CP upon the caloric test, 12/27 (44%). The degree of hearing loss in those with VND was significantly (p < 0.05) more severe and their recovery of hearing loss was poorer than in patients without VND. These results indicate that VND is a common finding in cases of sudden deafness with vertigo especially in those with severe hearing loss.

Caloric Tests↗
PubMed2006

[Head shaking test (HSN) using to diagnose vestibule damage].

INTRODUCTION: There is described a transient nystagmus provoked by shaking the head in the horizontal plane for a few seconds in both normal subjects and patients that is called Head Shaking Test (HSN) as a diagnostic tool for vestibular dysfunction. HSN is generally accepted that is generated by an asymmetrical peripheral vestibular input and a central velocity storage mechanism, which integrate and extend the peripheral vestibular signals. Purposes 1. Creation of own modification method of stimulation and registration HSN 2. Estimation of HSN test value to show asymmetrical function of vestibular system 3. Establish possibility of HSN test to localization of damage vestibular system 4. Verification this test to use it as screening test MATERIAL AND METHODS: Studied group was consisted of 111 subjects that consist of 68 women and 43 men with mean age 52,4 years. All patients and controls were submitted to audiological tests and vestibular examinations According to the results of the otoneurological tests, patients were divided into: 36 with peripheral vestibular disease, 37 with central vestibular disease, 6 with both peripheral and central vestibular disease and 32 control persons. Own modified HSN test was described. Frequency of movements was approximately 2 Hz determined by metronome. HSN was recorded using ENG apparatus produced by Hartmann. RESULTS: In the first study stage incidence of HSN-H and HSN-V related to localization of vestibular organ damage, symmetric and asymmetric reaction in tested. It was observed more incidence of HSN-H and HSN-V in patients with peripheral and central lesion of vestibular system than in control group. Estimation of HSN incidence related to kinetic test--acceleration-deceleration rotary test shows the same HSN frequency in compared groups, with symmetric or asymmetric reaction in rotary test. HSN frequency related to caloric test (canal paresis) showed statistic differences between normal and canal paresis reaction in caloric test. Analysis incidence of HSN-V revealed no significant differences between examined groups. In the second studied stage the sensitivity and specificity were examined. CONCLUSIONS: 1. It is possible to make HSN test using metronome and ENG recording 2. HSN test may be use to reveal asymmetry of vestibular function. 3. HSN is helpful to diagnose peripheral and central lesion to some extent. 4. HSN is not useful as screening test

Adolescent↗
PubMed1992

Utility of headshake versus whole-body VOR evaluation during routine electronystagmography.

Evaluation of the vestibulo-ocular reflex (VOR) by caloric testing yields important localizing information, but does not examine the entire frequency spectrum of vestibular function. With the addition of head rotation at 0.5 Hz (50 deg/s) and a velocity sensor to measure head movement, additional unique information regarding higher frequency VOR function can be readily obtained using standard electro-oculography (EOG). Over the past 4 years, active head-on-body and passive whole-body rotation testing with four-channel strip-chart recording and hand analysis have been routinely performed on every patient referred for caloric testing. In 95 percent of cases with normal symmetric caloric responses, headshake VOR gain with either stimulus was normal (greater than 0.51). Similarly, more than 95 percent of patients with unilateral deficits on caloric testing yielded normal rotational VOR gains. In contrast, roughly one third of patients with bilaterally reduced caloric responses demonstrated both abnormally low active headshake and passive whole-body rotational gain (less than 0.5). It appears, therefore, that both active head-on-body and passive whole-body rotation VOR testing at 0.5 Hz are possible using standard recording techniques, and yield valuable added information in cases with reduced bilateral caloric responses.

Adolescent↗
PubMed1986

Present state of early neurotological diagnosis of acoustic neuroma.

The incidence of cases of acoustic neuroma that are manifested as sudden deafness or progressive sensorineural hearing loss was investigated. The findings of the stapedius reflex test, the auditory brain stem response test and the caloric test were analyzed, and the procedure for the diagnosis of acoustic neuroma was discussed.

Adult↗
PubMed1996

The oculocephalic response in the evaluation of the dizzy patient.

The oculocephalic response (OCR) is a simple office maneuver that assesses the vestibulo-ocular reflex (VOR). An abnormal response is manifested clinically as refixation saccades following a rapid horizontal head movement. Because little attention has been given to the OCR in the literature, a prospective study was undertaken with 112 consecutive patients who presented with dizziness and underwent OCR testing followed by caloric evaluation. Agreement was good between the OCR and caloric evaluation (kappa = 0.44). Specificity was quite high (97%); sensitivity was found to be less (39%). Positive (68%) and negative (90%) predictive values of the OCR illustrate that the clinician can often anticipate the results of caloric testing based on this response. This easily performed test of the VOR is a useful tool in the evaluation of the dizzy patient.

Adolescent↗
PubMed2006

Equilibrium test findings in patients with Bell's palsy.

OBJECTIVE: We analyzed equilibrium test findings in patients with Bell's palsy to confirm that such findings occur not only in patients with Hunt's syndrome but also in patients with Bell's palsy. METHODS: Subjects were 83 patients with Bell's palsy, 45 patients with Hunt's syndrome, and 82 patients with unilateral chronic otitis media without history of vertigo or ear surgery (for control). They were treated in our inpatient department and underwent equilibrium testing during the period 1983-2002. All subjects were at least 20 years of age. The following were analyzed: (1) presence of vertigo, (2) presence of abnormal equilibrium test findings, (3) relation between the degree of paralysis and abnormal equilibrium test findings, and (4) relation between the degree of recovery from paralysis and abnormal equilibrium test findings. Equilibrium testing consisted of a gaze nystagmus test, a spontaneous nystagmus test, positional and positioning nystagmus tests, and a caloric test. The incidence of abnormal findings in each test was compared between the three groups. RESULTS: Abnormal equilibrium test findings were observed in patients with Bell's palsy. No association was observed between the results of equilibrium tests and the degree of facial paralysis in patients with Bell's palsy. However, some of the equilibrium test results were significantly associated with the degree of facial nerve recovery. CONCLUSIONS: Although our study was limited in its lack of true control subjects, our data suggest that patients with Bell's palsy show a significantly high incidence of vestibular abnormalities.

Adult↗
PubMed1999

Saccular dysfunction in Meniere's disease.

OBJECTIVE: The aim of this study was to assess any dysfunction of the sacculus in patients with unilateral Meniere's disease by monitoring the vestibular evoked myogenic potentials (VEMPs) evoked by high level clicks on the Stemomastoid muscles (SCMs). STUDY DESIGN: The study was a retrospective analysis. SETTING: The study was performed in the E.N.T. department of the Lariboisière Hospital. PATIENTS: Fifty-nine patients aged 18 to 74 years with well-established unilateral Meniere's disease were included in the study. INTERVENTIONS: Loud monaural clicks were delivered unilaterally, and the VEMPs were recorded with skin electrodes on the ipsilateral SCM. All the patients were also subjected to a pure tone audiometric test and bithermal caloric testing. The postural performances of 39 patients were analyzed using the Equitest. MAIN OUTCOME MEASURE: VEMP results were the main outcome measure. RESULTS: The saccular response was absent on the affected side in 54% of the patients with Meniere's disease. This absence was correlated with the degree of low frequency hearing loss but not with canal paresis. Finally, nonfalling patients with saccular dysfunction had a significantly poorer postural performance than those without such dysfunction in the condition 5. CONCLUSION: Patients with Meniere's disease could have a saccular dysfunction (54% in this series). This saccular impairment correlated with low frequency hearing loss but not with canal paresis. Patients without VEMPs had poorer postural performances in condition 5 than those with normal VEMPs. Therefore, VEMP testing is useful for detecting patients at risk: in patients with saccular lesion, the dynamic postural performances should be assessed on a movable platform to detect visually dependent patients and to orient vestibular rehabilitation.

Adolescent↗
PubMed1992

On the capability of the vestibular apparatus to perceive sound stimuli.

This paper discusses the capacity of sound perception in 5 profoundly deaf subjects in whom a "fenestra" was previously formated on the lateral semicircular canal. The ability of sound and vibration perception after fenestra formation in profoundly deaf subjects with normal function of the vestibular apparatus has been described previously. The experiments for this procedure were done on pigeons by Wit & Bleeker. The subjects aged from 22 to 34 years. Causes of deafness varied. Their hearing threshold was bilaterally higher than 95 dB HL and their vestibular apparatus was of normal excitability bilaterally when tested with a caloric test. In all 5 patients the ear conduction hearing threshold remained the same, but the ability of vibration perception improved significantly, and ranged postoperatively between 30 and 45 dB HL. The frequency dynamic range was from 125 to 2,000 Hz in 4 subjects, and from 125 to 4,000 Hz in 1 subject. The patients claimed to have perceived higher intensities, but with a variable dynamic range from frequency to frequency. The intensity range amounted to between 15 and 40 dB. The obtained data of vibration perception ability are discussed.

Adult↗
PubMed1994

Multiple sclerosis presented acute hearing loss and vertigo.

A case of multiple sclerosis with acute deafness and dizziness as initial symptoms was reported. The pure-tone audiometry showed a high-frequency sensorineural hearing loss; in the auditory evoked brain stem response (ABR), the left side had a normal peak I with an absence of subsequent peaks. In the equilibrium test, Bruns' nystagmus was present, and the caloric test demonstrated CP on the left side. MRI disclosed a high-intensity lesion in the cerebellar peduncle (T2-weighted image). With steroid therapy, the deafness and dizziness improved within 10 days, although, after 20 days, the findings of the ABR and caloric test remained unchanged.

Adult↗
PubMedDate not supplied

Acute vestibular paralysis in herpes zoster oticus.

A case of herpes zoster oticus is presented in which the lateral and superior semicircular canals of the labyrinth were affected unilaterally. The results of several electronystagmographic examinations are described and correlated with the patient's description of symptoms. This case study indicates that disease affecting the lateral semicircular canal is reliably detected by the conventional caloric test. However, the fact that the posterior semicircular canal remained intact could not be inferred from the results of the caloric test in this case. Also the appearance of nystagmus upon eye closure appears to have been a more sensitive index of the state of the disease process than was the caloric test.

Adult↗
PubMed1989

Vestibulo-ocular and vestibulo-spinal reflexes in evaluation of vestibular lesions.

In order to evaluate to what extent different diseases causing vertigo can be detected by studying vestibulo-spinal and vestibulo-ocular reflexes, 146 patients were examined. The diagnosis classes were: periodical attacks, position induced attacks, vestibular neuronitis, brain concussion, cerebrovascular disorders and acoustic neurinoma. Dynamic posturography was performed on all the patients, standard bithermal caloric test on 129 and voluntary saccades on 127 patients. The proportion of pathological test results in posturography exceeded that in the caloric test in all but one diagnosis class. In vestibular neuronitis the amount of abnormal test results was low in posturography, probably due to vestibular compensation. Posturography tested with eyes open and with 80 Hz vibration revealed disturbances in equilibrium the most sensitively.

Caloric Tests↗
PubMedDate not supplied

Comparison of vestibulo-ocular and vestibulospinal screening tests.

A comparison of a newly developed vestibulospinal screening test and two vestibulo-ocular screening tests (caloric and rotation) was performed on two groups of patients, one with Meniere's disease (MD) the other with benign paroxysmal positional nystagmus (BPPN) and vertigo. Vestibulospinal screening tests were slightly more sensitive (not statistically significant) than caloric tests for detection of a peripheral vestibular disorder. Caloric, rotation, and vestibulospinal screening tests were specific neither for MD nor BPPN groups. The caloric test false-positive rate for the involved ear was unacceptably high for the BPPN group. The rotation test false-positive rate was the highest of the three tests for both groups. The vestibulospinal test combined with either the caloric or the rotational tests increased the sensitivity for detection of a peripheral vestibular disturbance, particularly for the MD patients.

False Positive Reactions↗