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PubMed1998

A head autorotation test for patients with Menière's disease.

OBJECTIVE: We compared the vestibulo-ocular reflex (VOR) of healthy volunteers and of two groups (group A, conservatively treated; and group B, with gentamicin or surgically treated) of Menière's disease (MD) patients to determine whether the head autorotation test (HART) can reveal abnormality of the VOR and whether the HART can be applied in evaluation of MD. METHODS: The gain, phase, asymmetry, and the highest frequency band reached was evaluated with the HART in the frequency range of 1-5 Hz. The caloric responses and posturography results were also determined. RESULTS: The mean gain was lower for the both groups of MD patients than for the controls. In the MD patients the phase difference was shorter and the asymmetry was greater than in the controls. Only 58% (group A) and 36% (group B) of the MD patients reached the frequency band of 4 Hz, and 33% (group A) and 19% (group B) reached 5 Hz. The respective percentages for the controls were 97 and 77%. Of the 25 MD patients (group B) 72% had abnormal HART results. Among the group A of MD patients the HART (50%) was more sensitive to VOR abnormality than the caloric test (10%) was. For aggressively treated MD patients a decrease in gain at 2 and 3 Hz in the HART correlated with abnormal caloric test results. Increased body sway in posturography correlated with the pathological results in the HART. CONCLUSION: The HART is a complementary method for evaluating the natural frequency range of the VOR, and evaluation of MD patients may benefit from combined results of the caloric test and HART.

Adult↗
PubMed2003

[Video-nystagmography and vibration test in the diagnosis of vestibular schwannoma. Review of 100 cases].

OBJECTIVE: To evaluate informations given by the combination of videonystagmography (VNG) including vibratory tests and auditory brainstem responses (ABR) in patients suffering vestibular schwannoma (VS) and try to find the most conclusive test(s). Combination of different functional tests is supposed to improve diagnosis and preoperative evaluation and precise indication for magnetic resonance imaging (MRI) facing audiological and vestibular symptoms. MATERIAL AND METHOD: A prospective study of 100 patients with VS. All patients underwent a preoperative work-up including complete audiometry, auditory brainstem response (ABR) and videonystagmography (VNG). VNG protocol included caloric testing, rotatory tests, oculometry tests (saccade testing, optokinetic testing) and spontaneous and gaze-evoked nystagmus. From these six tests a score of positivity could be set, from 0 to 6. RESULTS: The vibratory test is non invasive and easy to realize. Were observed: 1/ a good sensitivity in vibratory test to elicit nystagmus in this context. 2/ a good correlation between subliminal rotatory chair tests and vibratory tests 3/ a better control of caloric testing using vibratory test. 4/ a good but deficient sensitivity of ABR alone with regard to VS (95%) 5/ an increase of sensitivity of VNG when coupling it with ABR and using as a criterion the score of positivity: no patient had all tests negative. CONCLUSION: The vibratory test is a non-invasive, fast examination with an easy execution. It reinforces VNG-ABR association screening power to diagnose VS. It constitutes, combined to caloric testing a good tool to diagnose and evaluate unilateral vestibular weakness.

Adult↗
PubMed2004

Vestibular evoked myogenic potentials in basilar artery migraine.

OBJECTIVES/HYPOTHESIS: Because the sacculocollic reflex is a descending pathway passing through the territory of basilar artery, the aim of the study was to investigate whether hypoperfusion affects this pathway by applying vestibular evoked myogenic potential (VEMP) testing in patients with basilar artery migraine. STUDY DESIGN: A prospective study from May 2000 to April 2002. METHODS: Twenty patients were diagnosed as having basilar artery migraine according to the criteria of the International Headache Society and literature. Eight were male and 12 were female patients, and their ages ranged from 9 to 48 years (mean age, 40 y). Each patient underwent a battery of audio-vestibular tests. RESULTS: Electronystagmography disclosed abnormal eye tracking test in six patients (30%), and there were abnormal optokinetic nystagmus test results in nine patients (45%). Caloric test revealed canal paresis in seven patients, directional preponderance in four patients, and normal responses in nine patients (45%). Vestibular evoked myogenic potential testing disclosed absent vestibular evoked myogenic potentials in seven patients and delayed vestibular evoked myogenic potentials in two patients, with one patient showing absent vestibular evoked myogenic potentials on one side and delayed vestibular evoked myogenic potentials on the other side. The remaining 10 patients (50%) had bilateral normal vestibular evoked myogenic potentials. Five patients had preserved both caloric and VEMP test responses, six patients displayed absent caloric and VEMP test responses, and the remaining nine patients had either abnormal caloric test responses or abnormal vestibular evoked myogenic potentials, exhibiting a nonsignificant relationship between caloric test responses and vestibular evoked myogenic potentials. Relief of headache and vertigo was achieved after 3 months of medication. Ten asymptomatic patients with either absent or delayed vestibular evoked myogenic potentials before treatment underwent follow-up VEMP test, and nine patients (90%) displayed normal vestibular evoked myogenic potentials bilaterally. CONCLUSION: Vestibular evoked myogenic potential testing evaluates the sacculocollic reflex, which descends through the lower brainstem. Some patients with basilar artery migraine have absent or delayed vestibular evoked myogenic potentials, presumably because the descending pathway from the saccule through the brainstem to cranial nerve XI is interrupted, which is attributed to hypoperfusion in the territory of the basilar artery. After 3 months of medication, recovery of normal vestibular evoked myogenic potentials in an asymptomatic patient indicates reversible ischemia in the territory of the basilar artery.

Adolescent↗
PubMed2001

Toxic effects of potassium bromate and thioglycolate on vestibuloocular reflex systems of Guinea pigs and humans.

Potassium bromate (KBrO(3)) and thioglycolate are two components of hair curling solution. The neurotoxic effects of KBrO(3) and thioglycolate on the vestibuloocular reflex (VOR) system have not been elucidated. In this paper, we report the adverse effects of KBrO(3) and thioglycolate on the VOR system of Hartley-strain guinea pigs. The function of the VOR system was evaluated by caloric test coupled with the electronystagmographic recordings after subcutaneous injection of 20 or 50 mg/kg KBrO(3) or 15 mg/kg thioglycolate, either alone or in combination once daily for 14 consecutive days. The results showed that KBrO(3) produced abnormal caloric responses in a concentration-dependent manner and thioglycolate enhanced this abnormality. Our clinical patients, 10 female hairdressers exposed to the hair curling solution for 10-30 years revealed a similar dysfunction in the caloric test. The possible mechanism of this adverse effect was studied: the cerebellar-regulated functions such as motor equilibrium performance and spontaneous locomotor activity of guinea pigs were reduced, the enzymatic Na(+)/K(+)-ATPase and Ca(2+)-ATPase activities of cerebellar tissues were significantly decreased, and the loss of Purkinje cells as well as the derangement of the granular cell layer of the cerebellar cortex was revealed after treatment with KBrO(3) plus thioglycolate. These findings imply that KBrO(3) plus thioglycolate is toxic to the VOR system, mediated by, at least in part, the dysfunction of a higher cerebellar regulatory mechanism. We suggest that the caloric test is a noninvasive method for monitoring the consequences of hazardous exposure of hair curling solution in humans. Our clinical findings together with the animal study imply that clinicians should be alert to the risk of bromate exposure in hairdressers, especially those with vertigo, tinnitus, or hearing loss.

Adenosine Triphosphatases↗
PubMed1998

Neurotological auditory brain stem response findings in human immunodeficiency virus-positive patients without neurologic manifestations.

Neurologic manifestations of human immunodeficiency virus (HIV) infection, rather than being a late complication of the disease, are principally correlated with the early central nervous system (CNS) localization of HIV. The CNS may be infected in the early stages of acquired immunodeficiency syndrome (AIDS) without evidence of neurologic disorders. Evoked potentials (visual, auditory, and somatosensory) and electronystagmographic test batteries have proven to be very sensitive in showing subclinical CNS disorders due to HIV. In this study, auditory brain stem response (ABR) and electronystagmographic test battery findings (smooth pursuit, saccades, caloric test) were performed in 29 neurologically asymptomatic, HIV-positive subjects at different stages of the disease. Compared to results of a control group, the ABR latencies of waves V, I, and III and interpeaks I-V and III-V were significantly increased in HIV patients. The same parameters did not differ significantly among the stages of the disease. In HIV-positive subjects, the accuracy of saccades was significantly reduced, while latency was normal. The velocity and the gain of pursuit were significantly reduced in HIV-positive patients, and 15 of 29 patients showed corrective saccades. Caloric tests revealed qualitative nystagmus abnormalities in 82% of HIV patients, while quantitative parameters were normal. The present results confirm that CNS involvement by HIV occurs early in the course of the disease. In particular, HIV does not seem to affect the labyrinth or the eighth cranial nerve, as demonstrated by the normality of the I-III value of the ABR and of the quantitative parameters of the caloric responses, but it does appear to involve the brain stem acoustic pathways, pontocerebellar pathways, and supratentorial areas.

Adult↗
PubMed2006

The clinical characteristics of tinnitus in patients with vestibular schwannoma.

OBJECTIVES: To review the symptoms, signs, and clinical findings in a large series of patients diagnosed with unilateral sporadic vestibular schwannoma (VS) to describe the clinical characteristics of tinnitus in this population. Further, to ascertain which of the proposed mechanisms of tinnitus generation in VS was supported. DESIGN: Retrospective case note and database review. SETTING: Tertiary university teaching hospital departments of audiology and neuro-otology. PARTICIPANTS: Nine hundred forty-one patients with unilateral sporadic VS, diagnosed during the period 1986 to 2002. Twenty-three additional patients were excluded due to missing clinical data. MAIN OUTCOME MEASURES: The presence or absence of tinnitus, and its rated subjective severity were analyzed in conjunction with data regarding patient demographics, symptoms, signs, and diagnostic audiovestibular test findings. RESULTS: No statistical association at the 5% level was found between tinnitus presence/absence and patient age, gender, 2- to 4-kHz audiometric thresholds, ipsilateral auditory brainstem response abnormality, length of history, tumor side, nor caloric test abnormality. Statistically significant associations were found between tinnitus presence/absence and tumor size (p = 0.012) and type of hearing loss (progressive, sudden, fluctuant, nil) with a tendency for patients without hearing loss to be less likely to experience tinnitus. Statistically significant associations were identified between classification of tinnitus severity and age at diagnosis (p < 0.001) (greater age being associated with greater tinnitus severity), abnormal findings on caloric testing (p = 0.01) (abnormal calorics being associated with greater tinnitus severity), and tinnitus as a principal presenting symptom (p < 0.001) (this being associated with greater tinnitus severity). CONCLUSIONS: The analysis does not identify any single one of the proposed mechanisms for tinnitus as being the obvious culprit. In fact, even in a homogeneous group of patients such as this, there is evidence of multiple mechanisms that are not mutually exclusive. The association between increased tinnitus severity in older patients, patients with canal pareses on caloric testing, and with tinnitus as a principal presenting symptom should be borne in mind by the clinician.

Journal Article↗
PubMed1983

Comparative study of caloric responses induced by different stimulus intensities.

Bithermal caloric responses induced by 20, 50 and 240 ml water irrigations were compared in 111 healthy Japanese adults. Distribution mode of max. slow phase eye velocity (SPEV), duration and max. frequency showed normal pattern in the logarithmic scale but not in the regular scale. All three nystagmus parameters of 240 ml caloric test showed most linear distribution compared with two other caloric tests in the probit plots of logarithmic scale. When the mean, coefficient of variation and normal range (mean +/- 2 SD) were compared between two modes of distribution, the most consistent difference was found in the range which was biased to the side of large number with little difference in the width of the range. When one standard deviation of CP- and DP-indexes were compared, these values were smallest in max. frequency, however, the best negative correlation between variation (SD) of CP- and DP-indexes and stimulus intensity was found in SPEV.

Adolescent↗
PubMedDate not supplied

Reference values for serial vestibular testing.

This study defines the normal limits of day-to-day variation in vestibular function. A short-acting caloric test was used and nystagmus intensity was measured by means of an interactive computerized technique. Data were analyzed from 30 normal subjects tested on three successive days and from ten of these subjects who were also tested on 11 additional occasions. Individual caloric test scores generally remained between 55% and 170% of their initial value; narrower ranges resulted when scores were averaged together. There was very little habituation of caloric responses. The upper normal limits of test-retest variation in scores for right-left difference and directional preponderance of caloric responses were 24% and 22%, respectively.

Caloric Tests↗
PubMed1995

Caloric irrigators: air, open-loop water and closed-loop water.

Selective stimulation of the semicircular canal system of one ear by establishing a temperature gradient is still widely used in the clinic in the caloric test. The results obtained are noted for their imprecision and variability. This is, in part, due to a lack of uniformly applied standardized test protocols, as well as difficulties in applying a precise stimulus. The relative merit of the three types of irrigation are reviewed. Whilst some authors argue that both the closed-loop and air irrigators produce even more variability of response than open water systems, the present author believes that intratest replication studies indicate that the closed-loop irrigation stimulus is the least variable and best tolerated by the patient. In perhaps one-fifth of patients, response to the first irrigation is much stronger than subsequent stimulus applications. It is suggested that there may therefore be a case for routinely performing five irrigations in the bithermal caloric test, including a replication of the first irrigation. It is assumed that psychological factors, especially anxiety, may explain the phenomenon of enhanced initial response, and some of the variability of caloric test responses in general. Use of the closed-loop irrigator is advocated for ease of use, reduced routine maintenance and to minimize patient distress, thereby reducing anxiety and result variability.

Air↗
PubMed1999

Vestibular evoked myogenic potentials in acoustic tumor patients with normal auditory brainstem responses.

In order to clarify the utility of the vestibular evoked myogenic potential (VEMP) in detecting acoustic tumors, we report two patients who were found to have normal auditory brainstem responses (ABRs) and abnormal VEMPs. To record VEMPs, electromyographic responses to brief loud clicks (0.1 ms at 95 dBnHL) were amplified and averaged on the sternocleidomastoid muscle ipsilateral to the stimulated side. The stimulation rate was 5 Hz and the analysis time 50 ms. The first case was a 54-year-old woman in whom VEMPs were absent on the affected side while caloric tests and ABRs were normal. The second case was a 58-year-old woman whose VEMPs were absent on the affected side while caloric tests revealed a 22% canal paresis and normal ABRs. These results and previous studies suggested that the VEMP could reflect a function different from those evaluated by the ABR or the caloric test. We concluded that the VEMP can provide useful information in diagnosing acoustic tumors.

Acoustic Stimulation↗
PubMed2005

Prediction of the origin of intracanalicular neoplasms with high-resolution MR imaging.

Correct diagnosis of intracanalicular neoplasms is important to avoid unnecessary operations or an unsuitable surgical approach. We investigated the capability of high-resolution three-dimensional MR imaging in predicting the origin of intracanalicular neoplasms. Twenty cases underwent three-dimensional Fourier-transformation (3DFT) constructive interference in steady state and contrast-enhanced 3DFT-fast low angled shot MR imaging and surgery. Seventeen cases underwent caloric test. MR diagnosis on the origin of intracanalicular neoplasms was compared with surgical results. For MR diagnosis, the origin of intracanalicular neoplasms was predicted according to the location of the tumor in the internal auditory canal (IAC) in two ways, i.e., determining (1) a single specific nerve of origin and (2) whether the tumor originated from the superior or inferior aspect of the IAC. Surgery could determine the nerve of origin in 16 cases (14 inferior and 2 superior vestibular schwannomas), but it was indeterminate in 4. Comparison between MR prediction and surgical results on a single nerve origin revealed exact agreement in five, but inconsistent in three. Regarding whether the tumor was derived from superior or inferior aspect of the IAC, agreement was found in 10 of the 16 cases (62.5%). Caloric test was abnormal in all patients examined but one with superior vestibular schwannoma. 3DFT-MR imaging was not particularly useful in predicting a precise nerve of origin of intracanalicular neoplasms. The prediction on whether the tumor originated in the superior or inferior aspect of the IAC was superior to caloric test, which might have clinical significance in treatment planning especially for hearing preservation surgery.

Adult↗
PubMed2001

Neurotoxicity of mercury sulfide in the vestibular ocular reflex system of guinea pigs.

A traditional Chinese mineral medicine, cinnabar, naturally occurring mercuric sulfide (HgS), is still occasionally prescribed, but the neurotoxic effects of HgS have not been elucidated. In this paper, an animal model of the purified HgS intoxication was established in guinea pigs in order to study neurotoxicity and pathophysiology of the vestibular ocular reflex system (VOR). Guinea pigs were dosed with HgS by gastric gavage (0.01, 0.1 and 1.0 g/kg per day) for 7 consecutive days. By means of caloric testing coupled with the electronystagmographic (ENG) recording in guinea pigs, we have found that HgS at a dose of 0.1 g/kg induced reversible caloric hypofunction pattern and at a higher dose of 1.0 g/kg induced irreversible hypofunction of caloric test. Monitoring the mercury contents of various tissues (blood, kidney, liver and cerebellum) by continuous flow and cold vapor atomic absorption spectrometry (AAS) revealed that a certain amount of HgS could be absorbed from the gastrointestinal tract and was detectable in these tissues. In addition to the induced dysfunction of VOR system, HgS also caused disturbance of motor performance in guinea pigs. In enzyme assay, Na+/K+-ATPase activity of cerebellum was also significantly inhibited by HgS. Morphological studies showed partial cell loss only in the cerebellar Purkinje cell layer, but not in the granule cell layer, nor in the vestibular labyrinth. All of these findings suggest that cerebellar Purkinje cells are the sensitive target site responsible for HgS-inducing dysfunctions of both VOR system and the motor performance in guinea pigs. Thus, it is concluded that caloric test coupled with ENG recording in VOR system is certainly a sensitive biomarker for monitoring the neurotoxicity of HgS.

Analysis of Variance↗
PubMed1997

[A case report of Bickerstaff brainstem encephalitis with attention to electronystagmographic findings].

We evaluated brainstem function by using electronystagmography in a 43-year-old woman with typical Bickerstaff brainstem encephalitis. She developed fever, drowsiness, total opthalmoplegia, swallowing disturbance, areflexia, and muscle weakness. On electronystagmography, eye-tracking test showed ataxic pattern with impaired smooth pursuit eye movement. The horizontal optokinetic nystagmus test showed diminished pattern. Caloric test revealed the vestibular hypofunction and the increase of caloric nystagmus on eye fixation. We considered these findings were attributed to the disturbance of pontine tegmentum, especially reticular formation. These findings were similar to those observed in patients with Fisher syndrome.

Adult↗
PubMed1983

Acoustic neuromas. Progression of hearing impairment and function of the eighth cranial nerve.

The results obtained by conventional otologic evaluation are reported for fifty-nine patients with acoustic neuromas, sixty-one patients primarily suspected of an acoustic neuroma but in whom Pantopaque cisternography had invalidated the diagnosis, and in seventy-one patients with Meniere's disease. The audiologic tests were confined to the following: pure-tone audiometry, speech audiometry, recruitment examination by ABLB and Metz recruitment tests, and examination for reflex decay a.m. Anderson. Nineteen patients had an audiogram taken at their initial visit with the otologist, and already at this examination--4.2 years before the diagnosis was made--a high-tone hearing impairment was present. Fourteen patients had anacusis in the tumor ear and one patient had an impairment of 90 dB. The audiologic evaluations are based only on patients with hearing equal to or better than 80 dB. There was no connection between preoperative hearing impairment and the age at operation, and anacusis was found in all age groups. Four patients had recruitment by the ABLB test and six patients by the Metz recruitment test. When these two tests were combined, two patients had recruitment by both tests. Twenty percent had pathologic stapedial reflex decay. Only one patient had a normal differential caloric test. It is concluded that the typical patient with an acoustic neuroma has a gradually increasing unilateral hearing impairment of eight years' duration. A pronounced high-tone impairment with PTA of 55 dB and a poor discrimination score are to be expected. The patient is uncertain at pure-tone threshold determination and displays a lack of recruitment at both ABLB and Metz recruitment tests. The patient has a decreased or nonexistent differential caloric reaction in the ear in question. A normal differential caloric test does in all probability exclude an acoustic neuroma; however, all possible audiometric and anamnestic configurations may be encountered, and deviation from the "typical" picture should not lure the investigator into excluding the presence of a neuroma.

Adult↗
PubMed2002

Vestibular evoked myogenic potentials in delayed endolymphatic hydrops.

OBJECTIVE/HYPOTHESIS: Vestibular evoked myogenic potential (VEMP) has become an established test to explore the sacculo-collic reflex. The study aims to investigate the VEMPs in cases of delayed endolymphatic hydrops because greatly dilated saccule was observed in histopathological specimens of delayed endolymphatic hydrops. STUDY DESIGN: Prospective study. METHODS: Twenty patients with delayed endolymphatic hydrops were subjected to pure-tone audiometry, caloric testing, and VEMP test. Delayed VEMP was defined as the latency of peak I exceeding 22.6 milliseconds or of peak II exceeding 33.1 milliseconds. Interaural amplitude difference over the sum of amplitudes of both ears was measured, and when the ratio exceeded 0.36, it was identified as augmented VEMP or depressed VEMP depending on whether the amplitude of the lesioned side was greater or less than the opposite side. RESULTS: The VEMP test revealed that 9 patients (45%) were normal, 6 (30%) exhibited absent VEMPs, and 5 (25%) displayed abnormal VEMPs, including delayed VEMPs in 2, depressed VEMPs in 2, and augmented VEMPs in 1. The caloric test indicated that 9 (47%) of the 19 ears exhibited normal caloric response, whereas 10 ears displayed abnormal caloric responses including canal paresis in 8 and absent caloric response in 2. Six ears had preserved both the caloric response and the VEMPs, whereas no ear demonstrated both absent caloric response and absent VEMPs. CONCLUSIONS: The residual caloric as well as saccular functions after ear insult may determine whether delayed endolymphatic hydrops will occur. These findings suggest that patients with sudden deafness or juvenile unilateral total deafness should undergo caloric testing and VEMP test to predict the occurrence of delayed endolymphatic hydrops in the future.

Adult↗
PubMed2006

Interaction of somatoform and vestibular disorders.

BACKGROUND: The high coincidence of organic vestibular and somatoform vertigo syndromes has appeared to support pathogenic models showing a strong linkage between them. It was hypothesised that a persisting vestibular dysfunction causes the development of anxiety disorders. OBJECTIVE: To determine the relation between vestibular deficits and somatoform vertigo disorders in an interdisciplinary prospective study. METHODS: Participants were divided into eight diagnostic groups: healthy volunteers (n=26) and patients with benign paroxysmal positioning vertigo (BPPV, n=11), vestibular neuritis (n=11), Menière's disease (n=7), vestibular migraine (n=15), anxiety (n=23), depression (n=12), or somatoform disorders (n=22). Neuro-otological diagnostic procedures included electro-oculography with rotatory and caloric testing, orthoptic examination with measurements of subjective visual vertical (SVV) and ocular torsion, and a neurological examination. Psychosomatic diagnostic procedures comprised interviews and psychometric instruments. RESULTS: Patients with BPPV (35.3%) and with vestibular neuritis (52.2%) had pathological test values on caloric irrigation (p<0.001). Otolith dysfunction with pathological tilts of SVV and ocular torsion was found only in patients with vestibular neuritis (p<0.001). Patients with Menière's disease, vestibular migraine, and psychiatric disorders showed normal parameters for vestibular testing but pathological values for psychometric measures. There was no correlation between pathological neurological and pathological psychometric parameters. CONCLUSIONS: High anxiety scores are not a result of vestibular deficits or dysfunction. Patients with Menière's disease and vestibular migraine but not vestibular deficits showed the highest psychiatric comorbidity. Thus the course of vertigo syndromes and the possibility of a pre-existing psychopathological personality should be considered pathogenic factors in any linkage between organic and psychometric vertigo syndromes.

Adult↗
PubMed2006

[Diagnosis of delayed endolymphatic hydrops].

OBJECTIVE: To investigate the diagnostic methods and significance of several tests for delayed endolymphatic hydrops (DEH). METHOD: Fifteen patients with delayed endolymphatic hydrops were tested with pure tone threshold, ECochG, bithermal caloric test and vestibular evoked myogenic potentials test to detect the lesioned side and the extent of hydrops. RESULT: All of the 15 patients had sensorineural hearing loss to the medium-severe extent at least. Ten were the ipsilateral type, four contralateral type and one bilateral type. Five cases had abnormal horizontal semicircular canal (HSCC) hydrops and saccular hydrops; six cases had abnormal HSCC function and normal saccular function; two cases had abnormal saccular function and normal HSCC function. The seven abnormal VEMP took the forms of loss of p13-n23, elongation of the latency of p13 or depressed amplitude cases with of p13-n23. CONCLUSION: ECochG, bithermal caloric test and VEMP may play a major role in the diagnosis of delayed endolymphatic hydrops and they should be utilized as the routine tests.

Adolescent↗