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At least 397 records · Page 22Linked to original sources
PubMed1987

A study of potential vestibulotoxic effects of once daily versus thrice daily administration of tobramycin.

Tobramycin 5.1 mg/kg/day was administered for 9 days to 20 healthy human volunteers to determine the potential vestibulotoxicity of once daily versus thrice daily treatment regimens. Vestibular function was tested carefully before, during, and following drug administration, using a battery of postural and caloric tests. Although subjects receiving the once daily regimen performed better on the postural tests, we feel this does not necessarily indicate an adverse effect in either group. The caloric test was the primary measure of vestibular function in this experiment, and this test appeared to demonstrate a slight adverse effect during drug administration of equal magnitude in both treatment groups. The results of this experiment indicate that there is no significant difference in the risk of adverse vestibular effects between once daily and thrice daily tobramycin administration.

Adult↗
PubMed2005

Abnormal vestibular evoked myogenic potentials in the presence of normal caloric responses.

OBJECTIVE: Combined use of vestibular evoked myogenic potential (VEMP) and caloric response testing has enabled us to examine the function of the inferior and superior vestibular nerves separately. Although results of VEMP testing and caloric response testing have been reported for many diseases, a clinical entity showing abnormal VEMP responses but normal caloric test responses has rarely been reported. The aim of the study was to investigate clinical features of diseases showing abnormal VEMP responses with normal caloric test responses. STUDY DESIGN: Retrospective. SETTING: University hospital. PATIENTS: Eight hundred eleven patients with balance problems who had undergone both caloric response and VEMP testing were included in the study. MAIN OUTCOME MEASURES: The amplitudes and latencies of the first positive-negative peak of the VEMP (p13-n23) were measured. RESULTS: Forty of the 811 patients (5%) were found to have abnormal VEMP responses with normal caloric test responses. Clinical diagnoses of these patients were Ménière's disease (n = 12), acoustic neuroma (n = 8), sudden deafness with vertigo (n = 6), and other diseases (n = 6). Eight patients could not be diagnosed as having a disease already recognized. Clinical manifestations of these eight patients were rotatory vertigo in six patients and non-rotatory dizziness in two. None of these patients showed abnormalities other than VEMP responses on neurologic or neurotologic examinations. CONCLUSION: Apart from Ménière's disease, acoustic neuroma, and sudden deafness with vertigo, which are already known as diseases with abnormal VEMP responses but normal caloric test responses, some patients might be diagnosed as having a disease that involves only the inferior vestibular nerve region.

Adult↗
PubMed1981

[The perverted nystagmus (author's transl)].

The perverted nystagmus is a modification of the horizontal beating nystagmus (in classical caloric stimulation) by a vertical or rotatory mainly component. Experimentally, this disorder can be shown after an unilateral destroy of the superior or median vestibular nucleus. We show 32 cases of subjects with a perverted nystagmus. 75% of these subjects have a pure central disease and 20% a vestibular neuronitis. The perverted nystagmus had an upbeat component with the cold stimulation and downbeat component with the hot stimulation. It was accompanied by a spontaneous nystagmus in 66% (and 30% with vertical nystagmus). Some abnormal responses with the simultaneous bilateral vestibular caloric testing, were found in 95%. The analysis of the results of the unilateral caloric testing shown the frequent association: hyporeflectia (canal paresis) of one side and hyper-reflects of the other side. This fact would have evoked a mixed disease, peripheric and central (i.e. the vestibular neuronitis). Beside some pathogenic hypothesis, we prefer the fall of the inhibiting control of the superior semi-circular canal firing activity. Although, the perverted nystagmus is a simple and precious examination sign (it is directly shown with Frenzel glasses after caloric vestibular stimulation. It ought to do the brain stem topography diagnosis.

Adult↗
PubMed1985

Vestibular neuronitis: neurotological findings and progress.

Neurotological follow-up observations were conducted on 38 of 43 cases of vestibular neuronitis treated between 1972 and 1983. The average observation period was 1 year and 3 months (range from 1 month to 9 years and 4 months) and 17 cases were followed for more than 1 year. The tests used for evaluation in this series were the following: spontaneous nystagmus, head positional nystagmus, a caloric test and a computed galvanic body sway test (GBST) conducted by Yamaguchi University. Changes in subjective symptoms are also noted. The main subjective complaint was vertigo (whirling; 93%). The remaining subjects noticed a floating sensation and unsteadiness of gait. In 50% of the cases, vertigo subsided by the end of the 3-month period, but 6 subjects suffered from an intractable dizzy sensation for over 1 year. Even after 3 years, 3 of these 6 cases were bothered by dizzy sensations. Especially in the central lesion, these 3 subjects had no other causative disease. Spontaneous nystagmus, which was usually horizontal and direction fixed, remained in 50% of the cases after the 1-year period. All of the cases tested showed reduced caloric responses. 21 of the 38 cases showed no response in cold caloric stimulation (including ice water) at the initial test. 13 of the 21 cases were followed satisfactorily and examined twice or more by caloric testing. 5 of these 13 cases did not recover in the caloric test even after more than 1 year.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2001

Heat radiation during caloric vestibular test: thermographic demonstration in temporal bone experiments.

Since Barany's descriptions in 1906, cold and warm irrigations of the external ear canal have been used for unilaterally testing vestibular excitability. The fluid kinetics within the endolymph have been studied thoroughly, whereas relatively few published articles deal with the mechanisms of heat transfer from the external to the internal ear. Even though heat conduction via the bone seemed to be well established in the textbooks, Feldmann and co-workers found heat radiation to be a very important factor. Using a rather uncommon method, we tried to make this heat radiation more apparent: in temporal bone experiments, temperature distribution was followed by thermography. Temporal bone specimens were prepared in such a way that heat distributions became visible after experimental caloric irrigations of the external ear canal. Temperature changes could well be verified by changes in coloration of the 2-dimensional thermograms. Conclusions were drawn from registrations performed in 2 projections, 90 degrees to each other, allowing cautious statements about 3-dimensional distribution. The velocity of heat transfer at the very onset of the reaction can only be explained by radiation, whereas later, other mechanisms, such as conduction via the bone or convection via the middle ear gas, may have some influence. Our results support Feldmann's findings and underline the significance of radiation in the heat transfer mechanism.

Body Temperature↗
PubMed2005

Sensitivity and specificity of mastoid vibration test in detection of effects of vestibular neuritis.

Aim of this study was to determine sensitivity and specificity of the mastoid vibration test in patients who had suffered an attack of vestibular neuritis. Results were compared with the caloric test and two bedside tests of vestibular function (head shaking test and head thrust test). Results are reported in 28 patients who had a residual vestibular deficit 6 months after acute neuritis and in 25 healthy subjects. Mastoid vibration nystagmus was evoked in 21 patients but not in controls. In these patients, mastoid vibration test had a sensitivity of 75% and specificity of 100%. Since one patient had inverted mastoid vibration nystagmus, specificity of identification on the pathological side was 95%. Sensitivity of the test increased with increasing severity of the vestibular lesion. Indeed, mastoid vibration nystagmus was induced in 93% of patients with caloric paralysis and in 58% of those with caloric paresis. Nystagmus could usually be modulated or elicited by stimulation of either mastoid. In the few patients in whom mastoid vibration nystagmus was elicited only from one side, or when there was a clear difference in intensity of the nystagmus induced on the two sides, the stimulated side was more often the affected side. Four patients still showed spontaneous nystagmus. The caloric test was abnormal in 26/28 patients (93%) with paralysis in 16 and paresis in 12; 71% of patients had a head shaking induced nystagmus: 64% had an asymmetrical response in head thrust test. In conclusion, mastoid vibration test was overall more sensitive than head thrust test. Mastoid vibration test was slightly less sensitive than head shaking test in patients with severe residual deficit and more sensitive in patients with partial deficit. Mastoid vibration test, a valid, low cost clinical screening test for rapid detection of asymmetrical vestibular function, does not cause patient discomfort. It is suggested that this test be included in the diagnostic workup of all patients with suspected vestibular dysfunction.

Acute Disease↗
PubMed1976

Construction of a practical and inexpensive air stimulator for caloric vestibular testing.

An inexpensive and practical method for delivering air into the aural canal at a selected stable temperature is described. A water-air heat exchanger utilizing the external circulation of a constant-temperature water bath brings the temperature of the air stream to a chosen value. Measurements indicate stable air outflow temperatures are maintained when proper nozzle design and air flow rates are employed. The apparatus is easy to construct and has proven convenient and effective when used in the clinical vestibular laboratory.

Air↗
PubMed1984

[Downbeat nystagmus during eye closure].

We studied eye movements and clinical findings in 1225 patients with complaints of dizziness. Downbeat nystagmus was demonstrated in 11 patients during eye closure. Simultaneous vertical and horizontal eye recordings were examined to demonstrate vertical eye position during eye closure. Downbeat nystagmus appeared on midline position even during eye closure in six patients. An electrooculography was demonstrated in three out of above six patients. A 24-year-old woman (Case 1) complained of a single spell of vertigo. There was no remarkable finding on neurological examination. An audiogram was an abrupt type sensorineural hearing loss in both ears. A caloric test was normal. Horizontal and vertical smooth pursuit was normal. Optokinetic nystagmus showed normal response in both horizontal and vertical planes. Both eyes were elevated on eye closure. They were depressed to the midline position with mental task and downbeat nystagmus appeared. A 68-year-old man (Case 2) had a history of dizziness on walking of three-year duration. On examination neurological findings were normal. A caloric test was normal in both ears. Optokinetic nystagmus and smooth pursuit were normal in both horizontal and vertical eye recordings. He had a transient eye elevation on eye closure. Both eyes immediately came downward to midline position and downbeat nystagmus was demonstrated. His nystagmus had persisted for four years. A 68-year-old woman (Case 3) complained of positional vertigo of seven-month duration. Neurological findings were normal. A caloric test was normal. There was a conductive hearing loss on the left ear. The right ear showed a normal audiogram.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Auditory and vestibular system findings in patients with vascular loops in the internal auditory canal.

Many anatomic studies have shown that a loop of the anterior inferior cerebellar artery is frequently found in the cerebellopontine angle and internal auditory canal. The concept of vascular cross-compression has been extended to the eighth cranial nerve, and patients with symptoms of hearing loss, tinnitus, and vertigo have been treated surgically by separating the vascular loop from the nerve. Previous reports have emphasized vascular anatomy, surgical approaches, and treatment results. Our study provides details of audiometric and vestibular system test results in a series of ten patients with prominent vascular loops in the internal auditory canal diagnosed by computerized tomography after subarachnoid space air injection (pneumo-CT). All patients had a unilateral (or asymmetric) hearing loss on the side of the lesion, and no vascular loops were detected on the contralateral sides. Hearing losses ranged from mild to profound. Audiometric findings were generally of a cochlear type, and most patients had excellent speech discrimination. Spontaneous nystagmus was detected in all patients during neurotologic testing, and half of the patients had normal caloric test results. The variability of audiometric and vestibular system test results is probably a reflection of anatomic variations of the vascular loop and its branches. Auditory and vestibular symptoms may be due to a complex interaction between the eighth cranial nerve and the vascular loop, in which the loop compresses the nerve and the nerve compromises circulation to the inner ear. Although symptoms from vascular loops and eighth nerve tumors are similar, the findings of a cochlear type of hearing loss, excellent speech discrimination, and normal caloric test results should raise the suspicion of a vascular loop.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Visual suppression of caloric nystagmus in cats.

A newly devised animal box with which caloric tests can be easily performed in the awake cat is presented. This device is also useful for position and optokinetic tests. Visual suppression of caloric nystagmus was investigated in such vertebrates as monkeys, cats and rabbits. There was a definite species difference in the rate of visual suppression of caloric nystagmus. It may be that the difference among species is due to a difference in fixation function among animal species.

Animals↗
PubMed1979

The accuracy of the simultaneous binaural bithermal test in the diagnosis of acoustic neuroma.

Forty-three patients with a surgically confirmed unilateral acoustic neuroma were studied preoperatively with both alternate and simultaneous binaural bithermal caloric tests using horizontal lead electronystagmography. Twenty-four patients had a significant reduced vestibular response on the side of the tumor utilizing the alternate binaural bithermal calorization of Fitzgerald-Hallpike. The addition of the simultaneous binaural bithermal stimulus improved the diagnostic accuracy of caloric testing from 56% to 86%. The simultaneous test was of particular accuracy in diagnosing the inferior vestibular nerve neuroma. The simultaneous stimulus, which adds only six and one-half minutes to overall testing time, is felt to be a valuable adjunct to the alternate test of Fitzgerald-Hallpike.

Adult↗
PubMed1998

Caloric response and postural control in patients with nasopharyngeal carcinoma after radiotherapy.

Since radiotherapy is the treatment of choice for nasopharyngeal carcinoma, the influence of irradiation on the temporal bone is of great concern for these patients. In this study, the caloric test and posturography were used to investigate vestibular function in 41 irradiated patients with nasopharyngeal carcinoma. Caloric testing showed a high incidence of canal paresis; five unilateral and 10 bilateral. Factors such as middle ear effusion had no significant effect on the occurrence of canal paresis. Posturography showed no difference from the control group. The authors conclude that the influence of irradiation on the vestibular apparatus of patients with nasopharyngeal carcinoma might result in a canal paresis, while postural control is preserved. Central compensation may play an important role in the postural control of these patients.

Adult↗
PubMed1995

Recovery of caloric function in experimental perilymph fistula.

Twenty of 46 guinea pigs with experimental perilymph fistula that showed canal paresis on an ice water caloric test during the first week after operation were studied on the following days to observe the progression and final outcome of the caloric test. Two weeks after operation, 12 animals showed persistent canal paresis, whereas 8 animals developed a normal caloric response. Resolution of the caloric response progressed from canal paresis, via caloric irregularity, to a final return of normal caloric response. Morphological study of animals with recovery of caloric function shows healing of the previously ruptured membrane, with preservation of the contour of the membranous labyrinth in the lateral semicircular duct, and intact sensorineural elements. Recovery of caloric function may serve not only as an important diagnostic sign in patients with healed perilymph fistula, even without surgical proof, but also as an expectation for the recovery of hearing loss.

Animals↗
PubMed2003

Vestibular evoked myogenic potentials in brainstem stroke.

OBJECTIVES/HYPOTHESIS: Despite its widespread application in the posterior fossa tumor, the study of vestibular evoked myogenic potential (VEMP) in cases of posterior fossa stroke remains scarce. The purpose of the study was to establish the role of VEMP in patients with brainstem stroke. STUDY DESIGN: Retrospective study. METHODS: Patients with acute vertigo were admitted and underwent a battery of auditory vestibular tests including caloric and VEMP tests; then they were surveyed by magnetic resonance imaging scan. Seven patients (two men and five women) were demonstrated as having brainstem stroke, including infarction in five patients and hemorrhage in two. RESULTS: Clinical manifestations consisted of dizziness/vertigo in all patients, spontaneous nystagmus in five (71%), and ataxia in three. No patients had experienced conscious change or conventional neurological deficits (eg, long tract signs). Electronystagmography revealed abnormal findings on eye tracking test in 100% of patients, on optokinetic nystagmus test in 71% of the patients, and on caloric testing in 10 ears (71%), including absent ice-water caloric test response in 7 ears and canal paresis in 3 ears. Vestibular evoked myogenic potential testing displayed normal response in 3 ears and abnormal response in 11 ears (79%), including absent vestibular evoked myogenic potentials in 8 ears and delayed vestibular evoked myogenic potentials in 3 ears. When results of both caloric testing and VEMP test were combined, the abnormal rate increased to 93% (13 of 14 patients). CONCLUSIONS: Caloric testing assesses the vestibulo-ocular reflex, which passes upward through the upper brainstem, whereas VEMP testing evaluates the sacculocollic reflex, which travels downward through the lower brainstem. Hence, in evaluating the extension of brainstem stroke, both caloric and VEMP testing should be performed.

Adult↗
PubMed2003

Electronystagmographic and caloric investigation data about vascular-vestibular dysfunction among patients with vertebrobasilar insufficiency.

Audiovestibular symptoms are the first and often the only clinical signs of vertebrobasilar insufficiency. The aim of our investigation was to analyze the results of caloric and electronystagmographic investigation of vascular-vestibular disorders among patients with vertebrobasilar insufficiency. We examined a total of 55 men (mean age, 51.8 +/- 8.2 years)--a primary group of 35 men with proven vascular-vestibular dysfunction and vertebrobasilar insufficiency and a control group of 20 clinically healthy men. Standard and electronystagmographic ("Tönnies" type) caloric tests were used to evaluate the human vestibular analyzer. Our data from this investigation show that in both rotatory and caloric tests, the slow-phase speed is the most important index about function of the vestibular analyzer.

Caloric Tests↗
PubMed1995

Effects of anxiety arousal and mental stress on the vestibulo-ocular reflex.

Although the subjective reports of patients suggest that anxiety may aggravate vertigo and imbalance, there has been little research into how anxiety might directly affect balance system functioning. We conducted two studies to examine the effect of anxiety and arousal on the vestibulo-ocular reflex (VOR). In the first study, pre-lest fear ratings were obtained from 20 normal subjects and 36 anxious subjects immediately prior to rotation and caloric testing. Fear ratings were significantly correlated with the maximum slow-phase velocity (SPV) of nystagmus induced by caloric testing. In the second study, we assessed the VOR response to rotation of 36 normal subjects under 3 task conditions: a) minimal alerting (counting backwards during rotation), b) physical arousal (induced by exertion prior to rotation); c) mental arousal (induced by performance of stressful mental tasks during rotation). Both the physical and mental tasks induced a significant increase in heart rate compared with the alerting condition. The maximum SPV of the nystagmus induced by rotation was significantly greater during performance of the mental task than in the other two conditions. These combined results indicate that anxiety may influence the gain of the VOR.

Adolescent↗
PubMedDate not supplied

[Diagnostic value of head-shaking nystagmus in vestibular clinical evaluation].

OBJECTIVES: To determine the sensitivity and specificity of the head-shaking nystagmus test (HSN), the nystagmus elicited in response to a vigorous rotation of the head in the horizontal plane, in the study of patients with peripheral unilateral vestibular disease. PATIENTS AND METHODS: Retrospectively, we analyze the relationships between the HSN and the rest of the videonystagmographic tests on eighty-three patients with peripheral unilateral vestibular disease. RESULTS: Twenty-three patients showed a positive head-shaking nystagmus; twenty-one of them had unilateral caloric hypofunction and only two had a symmetric caloric test, but both of them showed some type of vestibular dysfunction on other videonystagmographic test. In our series, the HSN sensitivity for the existence of peripheral vestibular disease was 48.8%, while the specificity was 95% in relation to the caloric test, reaching 100% when the gold standard was the presence of any abnormal videonystagmographic test. CONCLUSION: HSN is a simple test that can be useful to identify patients having unilateral vestibular hypofunction.

Adolescent↗
PubMed1980

Effects of six conditions of ocular fixation on caloric nystagmus.

Caloric tests were performed on 20 normal volunteers under the following six conditions of ocular fixation: (1) eyes open with lighted +20-diopter lenses; (2) eyes open with lighted +20-diopter lenses plus strobe lighting; (3) eyes open in darkness; (4) eyes closed in darkness; (5) eyes closed in a dimly lighted room; and (6) eyes open with unlighted +20-diopter lenses plus strobe lighting. Latency, amplitude, frequency, duration, and speed of the slow component were measured from a permanent recording. Significant differences were found between the lighted +20-diopter lens conditions and all others for all variables except latency. Tests performed with lighted +20-diopter lenses should be cautiously interpreted due to the noticeable response suppression noted in these conditions. The present procedure of performing caloric tests with the eyes closed in a dimly lighted room was found to be unqeustionably preferable.

Adult↗