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PubMed1998

Diagnosis of vertebrobasilar insufficiency: time to rethink established dogma?

As isolated symptoms, vertigo, dizziness and imbalance are not regarded by neurologists as reflections of transient ischemia in the vertebrobasilar circulation. The purpose of this retrospective study was to demonstrate that these symptoms can and do occur in isolation. To this end, we analyzed the symptoms, stroke risk factors and diagnostic algorithms in 27 patients with a diagnosis of transient vertebrobasilar ischemia. None of the 27 patients included in the review complained of any associated neurologic symptoms. Against the reference standard of brain imaging, the site of the pathologic lesion was defined in the brainstem/cerebellum with the Torok monothermal caloric test, with a sensitivity greater than 86%. Vestibular decruitment and hyperactive caloric responses were of particular diagnostic value. Thus, we recommend that the neurologic dogma with regard to brainstem cerebellar ischemia be rethought.

Adolescent↗

PubMed1980

Netilmicin treatment followed by monitoring of vestibular and auditory function using highly sensitive methods.

Auditory and vestibular function was monitored in 30 patients treated with netilmicin for urinary tract infection. During and after the treatment, no signs or symptoms appeared that could be ascribed to an ototoxic effect of the drug. Routine acoustico-vestibular tests as well as advanced, objective acoustic tests revealed no signs of impairment of the labyrinth function. Results of highly sensitive vestibular tests in 15 patients including computerized analysis of the nystagmus responses to caloric tests were compared with results obtained from a sample of normal individuals. Some of the results varied significantly more in the netilmicin group than in the reference group. The most characteristic variation was a decreased reaction to hot water stimulation.

Adolescent↗

PubMedDate not supplied

The furosemid test for Menière's disease.

In a previous report it was suggested that intravenous administration of furosemid followed by a comparative caloric test (the furosemid test) could be utilized for detection of endolymphatic hydrops (Kitahara et al., 1973). As a result of the further application of the furosemid test upon 161 patients with vertigo, positive results were observed in 80% of patients with typical Menière's disease, 6% of atypical Menière's disease, 42% with labyrinthine syphilis and 27% with sudden deafness. In patients with labyrinthitis, results were negative. It is thus concluded that the furosemid test provides positive evidence for determining the etiology of vertigo.

Audiometry↗

PubMed1979

Inverted caloric nystagmus by warm air stimulation.

The rather frequent appearance of an inverted nystagmus, when stimulating with warm air for caloric testing, is emphasized. It is clearly demonstrated that this nystagmus is a real caloric one, but beating in the opposed direction. Its occurrence in many cases, especially when an active middle ear pathology is present, diminishes the reliability of this air stimulation technique, as it is especially indicated in these cases.

Air↗

PubMed1987

[Balloon method and water irrigation in thermal vestibular assessment. Electronystagmographic comparison of both methods].

In cases of large central perforation of the eardrum, caloric test of the vestibular organ cannot be carried out by irrigation of the external auditory canal with water but must be done with a balloon instilled in the external auditory canal perfused with water. Caloric responses were registered by using water irrigation and balloon irrigation in 40 healthy persons. Nystagmographic registrations were analysed. Frequency, slow phase velocity and amplitude of nystagmus were measured. Cumulative percentage curves of the four caloric responses are drawn to compare the distribution of data in balloon and water irrigation (Figures 2-5). In addition, mean values and standard deviations of data and of difference in excitability related to the total excitability are recorded in table 1. Statistics (Wilcoxon test for matched pairs) reveals no significant differences in nystagmographic pattern of caloric reactions between water and balloon stimulation. It is concluded that in the caloric test of the vestibular organ balloon irrigation is equivalent to water irrigation. Balloon irrigation is more comfortable for the patient and easier to handle.

Caloric Tests↗

PubMed1981

Galvanic vestibular tests in the assessment of coma and brain death.

Galvanic stimulation over the mastoid process elicits oculovestibular responses that provide a measure of brainstem function. The equipment is simple and is available in most neurodiagnostic laboratories. This type of test provides an advantage over caloric testing in the presence of external and middle ear disease and basal skull fracture and can be a useful adjunct in the evaluation of coma and brain death.

Adult↗

PubMed1977

The nystagmus and the therapeutic effects on early-diagnosed cases of sudden deafness.

We investigated the hearing prognoses of early diagnosed cases of sudden deafness. We tried to find the most reliable factor to determine the prognosis of hearing loss. Of various possibilities that affect the prognosis; the period of onset to first examination, therapeutic manner and vestibular test findings, the findings of caloric test and spontaneous nystagmus showed much better correlation with the hearing prognosis than others. Thus, we presume the vestibular dysfunction in cases of sudden deafness may reflect the extension and severity of inner ear involvement.

Adult↗

PubMed2002

Are there any disturbances in vestibular organ of children and young adults with Type I diabetes?

AIMS/HYPOTHESIS: The aim of the work was to evaluate the vestibular organ condition in children and young adults suffering from Type I (insulin-dependent) diabetes mellitus. METHODS: The group examined consisted of 95 children and young adults aged from 6 to 28 years with Type I diabetes diagnosed. The diabetic group was divided into subgroups according to duration of the disease, compensation of the disease, and presence and character of hypoglycaemic incidents, and presence of diabetic complications. The control group consisted of 44 healthy children and young adults aged 6 to 28 years. After collecting detailed medical history in each case an electronystagmographic test was performed using the computed two-canal electronystagmographer. RESULTS: Within the diabetic group 6 patients complained about vertigo and balance disorders. Spontaneous nystagmus occurred in 10 cases, positional one in 21 cases. Impaired optokinesis occurred in 36 cases and impaired eye tracking test in 33 cases. In caloric tests there was partial canal paresis in 4 cases and directional preponderance in 7 cases. CONCLUSION/INTERPRETATION: Metabolic disturbances present in Type I diabetes cause disturbances in different parts of vestibular organ but mostly in its central part. Comparing disturbances in the vestibular organ with clinical and biochemical parameters characterising diabetes, the range of vestibular organ impairment in diabetes mellitus type 1 seems to depend mainly on the presence and character of hypoglycaemic incidents and the duration of the disease and to some extent on the compensation of diabetes.

Adolescent↗

PubMed2003

Various causes and clinical characteristics in vertigo in children with normal eardrums.

OBJECTIVE: The differential diagnosis of vertigo in children is extensive. Otitis media and middle ear effusion could be the most common causes of vertigo in children, but there are some problems in detecting the other causes for vertigo because they are one of most frequent diseases of childhood. The purpose of this study is to review the clinical characteristics and both the audiological and vestibular findings of vertigo in children with normal eardrums, who do not show otitis media or middle ear effusion, and to assist in making a differential diagnosis of vertigo. METHODS: The fifty five children (< 16 years old) with vertigo, who visited the Department of Otolaryngology, Ajou University Hospital, Suwon, South Korea between January 1995 and December 2001 were selected for this study. These excluded the patients with abnormal eardrums/tympanograms or those that did not perform questionnaires, audiological, or vestibular evaluations. They were retrospectively analyzed for clinical symptoms, vestibular functions, and differential diagnosis. RESULTS: The most common causes for vertigo in children were migraine in 17 (30.9%) and benign paroxysmal vertigo of childhood (BPVC) in 14 (25.5%). Other less frequent causes included four cases of trauma, two cases each of Meniere's disease, delayed endolymphatic hydrops, benign positional vertigo, and one case only for cerebellopontine angle tumor, seizure, acute vestibular neuritis, juvenile rheumatoid arthritis, leaving ten cases (18.2%) as unclassified. Abnormal findings were noted in 13 (23.6%) in pure tone audiogram, 3 (5.5%) in positioning test, 6 (10.9%) in bithermal caloric test, and 36 (65.5%) in rotation chair test. CONCLUSIONS: The vertigo in children with normal eardrums, who did not show otitis media or middle ear effusion, was most commonly caused by migraine and BPVC. These findings have shown to be very different from those with adult vertigo. The evaluation of vertigo in children requires a questionnaire for extensive and complete history taking, audiograms and vestibular function tests. And in selected cases, electroencephalography, hematological evaluation, imaging of the brain or temporal bone should be performed.

Adolescent↗

PubMedDate not supplied

The clinical picture of Meniere's disease in the light of glycerin and urea tests.

A mathematical-statistical analysis of the role of glycerin and urea tests in patients with Meniere's disease is presented. Using the quantification method for multidimensional qualitative data, 13 variables were analysed. The younger the patient the stronger was the correlation between age and positive glycerin and urea tests. At ages over 50 years, no correlation to positive test results was found. The longer the duration of disease, the stronger was the correlation between this duration and a positive urea test. The glycerin test showed no correlation to the duration of the disease. Hearing losses of 40-69 dB were correlated both to a positive glycerin test and to a positive urea test. Greater hearing losses were correlated only to a positive glycerin test. Hearing losses of less than 39 dB were not correlated to positive results of either the glycerin or the urea test. Directional preponderance in the caloric test showed a correlation to a positive urea test. On the basis of these results a hypothesis has been formulated to explain how glycerin and urea might affect the internal ear.

Adult↗

PubMedDate not supplied

Diagnosis and management of vertigo.

Vertigo is an illusion of rotation due to a disorder of the vestibular system, almost always peripheral. In the history it must be distinguished from pre-syncope, seizures and panic attacks. A single attack of acute, isolated spontaneous vertigo lasting a day or more is due either to vestibular neuritis or cerebellar infarction; distinguishing between the two requires mastery of the head impulse test. Recurrent vertigo is mostly due to benign paroxysmal positioning vertigo (BPPV), Meniere's disease or migraine. With a good history, a positional test, an audiogram and a caloric test, it is usually possible to distinguish between these. BPPV is the single most common cause of recurrent vertigo and can usually be cured immediately with a particle repositioning manoeuvre. Posterior circulation ischaemia very rarely causes isolated vertigo attacks and when it does the attacks are brief and frequent and the history is short.

Diagnosis, Differential↗

PubMed1999

Investigation of endolymphatic hydrops by electrocochleography in patients with Cogan's syndrome.

We compared auditory and vestibular function between a patient with typical Cogan's syndrome and a patient with atypical Cogan's syndrome. Repeat audiograms demonstrated fluctuating sensorineural hearing loss in the affected ear. Brainstem auditory evoked response testing revealed no abnormalities. Hallpike caloric testing showed a decreased response in the affected ear in the typical case and responses within normal limits in the atypical case. Sinusoidal harmonic acceleration was normal in the typical case, and there was an abnormal phase at 0.01 Hz in the atypical case. Endolymphatic hydrops was investigated by electrocochleography. In both patients, there was an enhancement of the summating potential, with an increased ratio of summating potential to action potential amplitude. This finding is consistent with endolymphatic hydrops.

Adult↗

PubMed1985

Unilateral Meniere's disease: is the contralateral ear normal?

Certain investigations in patients with unilateral Meniere's disease may on occasion show abnormalities in the completely symptomless contralateral ear. These tests include transtympanic electrocochleography, the acetazolamide cochlear hydration test, vestibular aqueduct tomography, and caloric testing. Eventually these ears may well become symptomatic. Previous studies have shown that otoadmittance changes are a sensitive indicator of glycerol-induced intracochlear pressure alterations in hydropic ears, but do not occur in patients without Meniere's disease. Otoadmittance parameters were evaluated in the asymptomatic ears of 73 consecutive patients with unilateral Meniere's disease. Satisfactory traces and adequate dehydration were achieved in fifty-nine. A significant change in the maximum conductance, similar to that often seen in symptomatic hydropic ears, was found in twenty-four cases (40.7%). The presence of functional abnormalities in well over one-third of asymptomatic ears means that they cannot be used as controls in clinical research studies. Furthermore, recognition of contralateral latent hydrops at the initial otologic assessment may modify the subsequent treatment strategy.

Acoustic Impedance Tests↗

PubMed1995

[The variation of the vestibular response vs. the variations of the auditory threshold after administration of glycerol in patients with Meniere's disease].

Vestibular and auditory functions after glycerol intake were assessed correlated in twenty-eight patients diagnosed as menieric according to AAOO criteria. All patients had unilateral Ménière's disease confirmed by monolateral hypoacusia and labyrinthine hypofunction. Hearing thresholds were tested by tone-audiometry, according to the standard glycerol test. Variation in vestibular response were assessed comparing the VOR during the rotatory sinusoidal test as well as the caloric test, before glycerol intake and 2 hours after drug administration. Slow phase angolar velocity, directional preponderance percentile and percentile variation between basic and control observation were calculated. The audiometric glycerol test was positive in 58% of the cases. The vestibular glycerol test was positive in 30% of the cases and no correlation between and individual results hearing threshold result was found. The findings reported by other Authors regarding auditory and vestibular responses to glycerol intake were verified. Possible reasons which may account for variation with regard to reaction patterns in the acoustic and non acoustic labyrinth after glycerin administration are discussed. In the Authors' view, incoherence between vestibular and cochlear response might be linked to differences in the physiology of the fluid in the two labyrinths. In the vestibular district, glycerol might induce an early depletive effect and a later paradoxal effects due to mechanical modification of the ampulla function.

Audiometry, Pure-Tone↗

PubMed1993

Retro-labyrinthine disorder in cases with peripheral facial palsy.

In some previously reported cases, facial palsy, even in Bell's palsy, involved vestibular dysfunction. Vestibular dysfunction in facial palsy is considered to be due to a retro-labyrinthine disorder such as vestibular neuronitis or acoustic neuromas. For the past 9 years we have been using the galvanic body sway test (GBST) routinely for differential diagnosis of the vestibular system. This paper reports GBST detected, retro-labyrinthine disorders in facial palsy. From 1981 to 1989, equilibrium examinations were performed in 33 cases with Bell's palsy and in 12 cases with Hunt's syndrome within 2 weeks after the onset. GBST was tested in 10 out of the 17 cases showing canal paresis (CP) in the caloric test. Abnormal GBST responses were detected in 9 cases (90%), 4 (80%) with Bell's palsy and 5 (100%) with Hunt's syndrome. The incidence of abnormal GBST was very high not only in Hunt's syndrome but also in Bell's palsy. The results indicate that vestibular dysfunction combined with facial palsy is mainly due to a retro-labyrinthine disorder and suggest that what is called vestibular neuronitis might be caused by a pathogenesis similar to that of facial palsy.

Caloric Tests↗

PubMedDate not supplied

Sinusoidal harmonic acceleration.

The need for accurate and reliable diagnostic tests for the evaluation of vestibular function has stimulated investigation of rotational methods and more recently, an evaluation of harmonic angular acceleration. Initial studies, using these techniques in humans, demonstrated a linear input-output function from 0.24 to 0.04 cycles/s at 0.4 radians/s2, but a reduction in the increase of response with an increase of acceleration or a decrease of frequency from this range. Nystagmic responses were symmetrical in these same normal individuals. In patients with vestibular disease, input-output functions, as well as symmetry, were altered, and appeared related to the degree of pathology. Evaluation of the test system in animals, rendered ototoxic with streptomycin, showed a depression in response similar to caloric tests. All data suggested that harmonic angular acceleration provided a reliable and sensitive method for evaluation of vestibular function, and a useful and important confirmation to the other methods that are available for these evaluations.

Animals↗

PubMed1986

Unilateral sensorineural hearing loss: analysis of 200 consecutive cases.

The spectrum of diseases diagnosed and the protocol used in the investigation of 200 consecutive patients with unilateral sensorineural hearing loss (SNHL) is presented. The diagnostic tests found most useful in defining the site of the lesion were a combination of a well-masked pure tone audiogram, speech discrimination score (SDS), acoustic reflex test (ART), and a vestibular evaluation using photoelectric nystagmography (PENG) and the Torok Monothermal Differential Caloric Test. With this protocol, the site of the lesion was correctly defined in 94% of patients with unilateral progressive SNHL. Laboratory and radiological studies confirmed a variety of lesions other than acoustic tumors. It is, therefore, felt that the primary objective of investigations should be to define the site of the lesion rather than aim to diagnose a specific disease entity.

Adolescent↗

PubMed1994

Does intracochlear implantation jeopardize vestibular function?

We present the results of the vestibular function tests of 35 patients who were selected for cochlear implantation. Vestibular function was evaluated with a caloric test and a velocity step test. The preimplant data were compared to those in previously reported series. Intracochlear implantation was performed in 25 patients. The vestibular complications encountered in this group are presented and discussed. Six patients had normal or residual (but substantial) vestibular function in the ear eligible for implantation. Vestibular function was preserved in 3 patients and was lost in 3 patients, in 1 case through an iatrogenic cause. We estimate the risk of losing vestibular function as a result of intracochlear implantation as between 50% and 60% on the basis of the present and previously reported data.

Adult↗