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At least 523 records · Page 29Linked to original sources
PubMed2003

Three cases of cochleosaccular endolymphatic hydrops without vertigo revealed by furosemide-loading vestibular evoked myogenic potential test.

OBJECTIVE: To describe possible cases of cochleosaccular endolymphatic hydrops without vertigo. STUDY DESIGN: Retrospective case report. SETTING: University hospital. PATIENTS: Three patients with possible cochleosaccular hydrops without vertigo were studied. The basis of diagnosis was positive result of the furosemide-loading vestibular evoked myogenic potential test, no canal paresis in the caloric test, and recurrent cochlear symptoms or fluctuating low-tone hearing loss. CASE REPORT: In case 1, a 47-year-old woman had recurrent left aural fullness and tinnitus and a few weeks later complained of a floating sensation and could not stand up. The furosemide-loading vestibular evoked myogenic potential test showed a positive result in the left ear. In case 2, a 24-year-old woman complained of a backward falling sensation lasting several seconds; subsequently, a severe floating sensation persisted and she could not stand up for several days. Audiography showed fluctuating low-tone hearing loss in the left ear, and the furosemide-loading vestibular evoked myogenic potential test showed a positive result. In case 3, a 41-year-old woman had a floating sensation while walking and subsequently complained of tinnitus in the left ear. She could not stand up because of a severe floating sensation and, moreover, complained of a sudden falling sensation lasting for several seconds. The furosemide-loading vestibular evoked myogenic potential test indicated a positive result in the left ear. CONCLUSIONS: The patients in cases 2 and 3 complained of a short-lasting sensation of falling down. Severe disequilibrium that prohibited standing up was noted in all cases. It was suggested that these symptoms were caused by saccular hydrops.

Adult↗
PubMed2000

[The vestibular system and migraine in children].

Migraine in childhood is relatively common disease. Although clinical practice and scientific publications recognize frequent association of migraine and vestibular disorders, relationships have yet to be well defined. In present study the vestibular function was extensively tested in 20 children suffering from migraine. All the patients underwent complete neurootological examination including tonal threshold audiometry, testing of vestibulo-spinal reflexes--Romberg and Unterberger-Fukuda tests, Dix-Halpike test for BPPV, videonystagmography. On videonystagmography each patient was evaluated regarding: calibration, spontaneous nystagmus, gaze nystagmus, eye tracking test, optokinetic and positional nystagmus, and caloric testing. The same procedure have been performed regarding control group comprised of 15 healthy. All the patients with migraine presented abnormalities in vestibular testing. Analysis of the results showed that: functional state of structures forming both visuo-ocular and vestibulo-ocular structures was altered in all the migraine patients evaluated in the study, pathological findings suggest mainly central localisation of vestibular dysfunction in children suffering from migraine, the number of pathological VNG findings seems not to be correlated with the type of migraine.

Adolescent↗
PubMed1985

[Otoneurologic symptomatology in mild craniocerebral injuries in the acute period].

Vestibular disorders are observed in all cases of a mild craniocerebral injury and are often the only objective sign of the sustained trauma because loss of consciousness and neurological symptoms may not infrequently be absent. Vestibular disorders are manifested by a small clonic horizontal bilateral multiple nystagmus. The caloric test revealed bilateral elevation of the caloric nystagmus in terms of duration and nature, with a regular alteration of the nystagmic phases. From the 5th to the 10th day after the injury there was an increase in asymmetric caloric nystagmus. Mild craniocerebral injury was characterized by an increase in sensory and vegetative responses after calorization. Spontaneous nystagmus and bilateral hyperreflexia of the caloric nystagmus were most expressed in the first 4 days and an increase in sensory and vegetative reactions within the first 9 days. Two weeks after a mild craniocerebral injury the vestibular disturbances were completely or partially compensated for by all parameters, which was expressed in the disappearance of the spontaneous nystagmus and the predominance of the symmetrically inhibited caloric nystagmus in the absence of sensory-vegetative reactions. In patients with diseases involving the cerebral vessels, compensation of vestibular disorders following a mild injury tends to be slower.

Acute Disease↗
PubMed1985

Vestibular responses to different caloric stimulus intensities.

Data are presented concerning stimulus response relationships to weak (44 degrees C) and strong (0 degrees C) caloric stimuli. In clinically hypoactive ears the response to the strong stimulus is not equivalent to the response to the weak stimulus for evaluating hypoactivity when using the usual percentage formula. The ratio of responses to strong and weak stimuli in the hypoactive ear is greater than in the better ear. The absolute differences in mean eye speed response to strong and weak stimuli are the same for hypoactive and better ears as for hypoactive and probably normal groups. A hypothetical schema is described to explain these relationships involving alteration of tonic balance between the two ears in the presence of central compensation. The effect of directional preponderance on stimulus response relationships is described. It is suggested that differences in absolute mean eye speed values in group analysis are the true measure of gain due to the stronger stimulus and are more valid for determining stimulus response relationships between stimuli of differing intensities than the ratio of these means. Using this criterion, no evidence of recruitment was found in the ears described. The concept of vestibular recruitment and decruitment in terms of caloric test characteristics is discussed and the appropriateness of these terms is questioned.

Caloric Tests↗
PubMed1986

The Torsion Swing Chair test: a ratio method for quantifying nystagmus.

In a Torsion Swing Chair (TSC) test for nystagmus, S is oscillated sinusoidally around the vertical axis with successive cycles diminishing in extent. Channel II of a standard recording ENG traces the chair's movement (differing among Ss according to their weight) while Channel I records S's ENG. A method was devised to quantify S's nystagmus by calculating, for each pair of succeeding cycles, the ratio of the decline in amplitude of the slow phase nystagmic velocity to the decline in amplitude of chair movement. This ratio, relatively constant across cycles, is greater with labyrinthine pathology. Ratios were established with 15 normal young adults as cut-offs for normalcy. The method was applied to 30 patients with peripheral hearing loss whose only complaint was slight vertigo following an acute stage of vertigo. The TSC test was validated by comparing it to the severity of vertigo and to the presence/absence of abnormal results on a standard clinical caloric test in ENG and on standard clinical ECoG. All but 1 of the 30 pts exhibited abnormal results on the TSC test, as compared with 18 for the caloric and 16 for the ECoG. Furthermore, abnormality on the TSC test was more likely to be associated with abnormal results on one or both of the other two tests than were either of the other two tests. It can be concluded that the TSC test is a valid and objective tool useful in ENG practice.

Caloric Tests↗
PubMed1989

Diagnostic vetting of individuals with asymmetric sensorineural hearing impairments.

Audiological and vestibular tests were administered conjointly in a neurological or general ORL clinic to exclude cerebellopontine angle (CPA) tumours. This study aimed to assess the efficiency of various tests in achieving that exclusion with the minimum of unnecessary investigations. All patients received the full battery of auditory brainstem responses, acoustic reflex thresholds and decay, alternate binaural loudness balance and ENG and caloric testing. All patients who did not have normal auditory brainstem responses proceeded to high resolution CT scanning. One hundred and fifteen patients were investigated and four acoustic neuromas were diagnosed. The efficiency of these tests in a general ORL clinic is very much poorer than often suggested, due largely to the number of occasions on which the tests cannot be done, and to the very small proportion of the test population who have CPA tumours.

Adolescent↗
PubMed2004

[Vibration-induced nystagmus: mechanism and clinical interest].

UNLABELLED: In 1973 Lücke described nystagmus induced by application of a vibrator on the mastoid process. Since that time, several Authors have applied the vibrator test in normal subjects or patients suffering from various well-characterized conditions. OBJECTIVE: Recognizing that results obtained with the vibrator test are sometimes in contradiction with those of other vestibular tests, our aim was to formulate an assumption regarding the genesis of induced nystagmus in an attempt to explain such contradictions. MATERIAL AND METHODS: We considered seven very different clinical situations. Each patient underwent a standard protocol including pendular and caloric tests as well as the vibrator test. We sought an assumption allowing, i) an interpretation of the characteristic features of nystagmus induced by the vibrator in any situation, ii) an understanding of the reasons why some vibrator test results do not correlate with those of other vestibular tests. RESULTS AND CONCLUSION: We assume that the vibrator stimulates phasic cells of the cupula and the vestibular maculae preferentially, if not exclusively. This assumption allows us to retain a very simple protocol for the vibrator test useful for routine clinical practice.

Caloric Tests↗
PubMed2005

Bilateral vestibular loss after caloric irrigation: clinical application of vestibular rehabilitation.

UNLABELLED: Bilateral vestibular loss is a rare diagnosis among patients with dizziness and imbalance. Nevertheless, symptoms are often disabling and therapy has yet to be established. AIM: To evaluate and describe the clinical outcome of patients with imbalance due to bilateral vestibular loss after a caloric test treated with vestibular rehabilitation. STUDY DESIGN: Retrospective case report. METHOD: Pre- and post-treatment outcomes were evaluated in 8 individuals suffering from post-caloric bilateral vestibular paresis who were submitted to vestibular rehabilitation. RESULTS: Clinical improvement after vestibular rehabilitation was observed in 7 (87.5%) of the 8 patients. CONCLUSION: Although complete compensation for bilateral vestibular loss is not expected, vestibular rehabilitation may be used as a therapeutic method in these patients.

Adult↗
PubMed2006

Testing utricular function by means of on-axis rotation.

CONCLUSIONS: Subjective visual vertical (SVV) estimation during on-axis rotation provides an efficient screening test of utricle function. The survey demonstrates that isolated disorders of peripheral utricular function can occur while SCC function appears normal. OBJECTIVE: The present study aimed to investigate estimation of SVV during constant velocity yaw rotation (with the head held on-axis--to enhance any asymmetry between right and left utricular responses), as a useful screening test. MATERIALS AND METHODS: In all, 230 patients were recruited from the dizziness clinic. For each patient, the SVV was estimated (a) while held stationary, and (b) during constant angular velocity (240 degrees/s), with the head centred on-axis. Bithermal caloric testing was also performed in 201 of the patients. RESULTS: Of those patients with normal SVV results during stationary testing, 18.3% were pathological during rotation testing. In those cases with pathological SVV during stationary testing, a significantly greater deviation from the norm was observed during rotation (p<0.001). Of those patients with normal caloric responses, 44.4% showed pathological SVV estimates; this increased to 54.3% for cases with unilateral weakness, and 56.5% for unilateral loss. No clear correlation was found between reports of tilt illusion and pathological SVV, respectively, between rotatory vertigo and pathological caloric responses.

Adult↗
PubMed2001

Different forms of dizziness occurring after cochlear implant.

Dizziness after cochlear implant (CI) was studied in a series of 94 consecutive adult patients receiving a cochlear implant, 46 (49.0%) of whom experienced dizziness post-operatively. In 29 patients, post-operative dizziness occurred soon after surgery and subsided within one month. Dizziness of the continuous type, lasting more than 6 months, was a complaint in only two patients. In addition to these already known forms of dizziness, spells of vertigo occurring later than one month after cochlear implant were experienced by 15 patients (delayed-V). The spells of delayed-V occurred suddenly and persisted for several hours. Moreover, 85.7% of delayed-V patients complained of hearing and tinnitus abnormalities during these spells. The clinical features of delayed-V were similar to those in patients with Meniere's disease. The preoperative bithermal caloric test showed a significantly higher response for the delayed-V group than the other groups (ANOVA: P < 0.05) in terms of slow phase eye velocity of caloric nystagmus. These findings suggest that inner ear lesions due to cochlear implant surgery develop gradually. Similarities in clinical features between delayed-V and Ménière's disease indicate the presence of labyrinthine hydrops.

Adolescent↗
PubMedDate not supplied

Vertigo as reflected by the nystagmogram. A clinical analysis.

Efforts to evaluate findings in the nystagmogram were made in a material of 338 vertiginous and dizzy patients. A spontaneous nystagmus, a positional nystagmus as well as a difference in caloric reactivity are as solitary findings of lettle value for revealing peripheral disorders. On the other hand, central disturbances are frequently revealed by inability to track a moving optic target, resulting in an irregular or a saccadic pattern, by persistence of vestibular nystagmus in light, by persistence of such nystagmus at eye-closure, by an increase in spontaneous nystgmus on eye-closure or by dysrhythmic nystagmus in caloric tests. Cases of functional vertigo seem to differ from cases of vertigo from other sources by their increase of spontaneous nystagmus (when present) or by persistence of caloric nystagmus on eye-closure.

Caloric Tests↗
PubMed1977

[Acute isolated vestibular paralysis. A clinical and electronystagmographic follow-up study in 28 patients].

Twenty-eight patients with unilateral acute vestibular paralysis (vestibular neuronitis) were examined after a period of 4-140 months. Seventeen of these patients were examined by electronystagmography with caloric stimuli at 44 degrees, 30 degrees, 17 degrees and 0 degrees C. Most were free of subjective symptoms only one-third had slight unsteadiness after sudden head movement. Subjective symptoms were independent of the presence of permanent canal paralysis or partial recovery of caloric excitability. Spontaneous nystagmus of 3-6,6% intensities was found in 11 of 17 patients. The normal limit for physiological spontaneous nystagmus should therefore be below 3 degrees/s. The most reliable parameter was the maximum velocity of the slow phase, as a mean value of the 4 caloric responses (values corrected for spontaneous nystagmus). The results were: 6 patients with persistent canal paralysis; 4 patients with considerable hypoexcitability; and 7 patients with moderate hypoexcitability. In no patient complete restoration of normal caloric response was found. This is attributed to the described method of caloric testing, which permits exact measurement of small side differences in excitability.

Acute Disease↗
PubMed1985

[Frequent errors in neuro-otologic diagnosis].

A number of characteristic sources of error during the testing of vestibular function, originating from anamnesis, equipment and examination, are described. It is stressed that false-positive findings are often due to the influence of alcohol and that false-negative findings may be the result of tiredness or sedative drugs. With regard to the caloric test, it is recommended that water provides a better stimulus than air, and that the warm caloric stimulus is more valid than the cold caloric stimulus. Attention should be paid to the ENG-recorders, particularly to an adequate writing breadth, and to time constants. Different parameters in use for quantitative analysis of the intensity of vestibular reactions are discussed. If the findings are vague, repeated examination will often help to clarify matters. The regular use of Frenzel glasses is of great importance, since otherwise examination of the vestibular organs must be considered incomplete.

Alcohol Drinking↗
PubMed2001

Influence of canal paresis and compensation on gain and time constant of nystagmus slow-phase velocity to yaw-axis rotation.

In order to assess the influence of canal paresis and compensation on the yaw-axis rotatory chair test parameters gain and time constant, a study was conducted in 435 patients diagnosed with unilateral peripheral vestibulopathy. Patients were grouped according to the amount of canal paresis found in the caloric test and by the result of a bedside examination of the vestibulo-ocular reflex (VOR). The time constant of the VOR diminishes as canal paresis increases and, when using a high-velocity sinusoidal test, there is a similar reduction in gain. Mean time constant was reduced when rotations were to the side of the lesion (ipsilesional) and to the normal (contralesional) and differences between both rotations were found for 21-80%, canal paresis. Ipsilesional gain was significantly less than contralesional gain, which had a normal result independent of the amount of canal paresis; differences between them were significant when canal paresis was > 41%. Spontaneous nystagmus significantly influenced the appearance of asymmetries in gain and time constant in the tests performed while, with high-velocity sinusoidal rotation, gain was found to be significantly different for ipsilesional and contralesional rotations in non-acute symptomatic patients.

Adolescent↗
PubMed2002

Comparison between caloric and canal impulse rotatory test.

It has been suggested that the rotatory test using videosnystagmoscopy can also be applied for identification of vestibular canal paresis. In this study, we test this hypothesis by comparing the results of a canal impulse rotatory test with those of the caloric test using the method described by Freyss. Our study indicates that only in 38% of all tested patients, the same results between the two tests have been obtained. Furthermore, which the group with abnormal findings is observed separately, in 24% patients only these two test methods lead to the same results. Consequently, the canal impulse rotatory test cannot replace the caloric test.

Caloric Tests↗
PubMed2002

Comparison between caloric and canal impulse rotatory test.

It has been suggested that the rotatory test using videonystagmoscopy can also be applied for identification of vestibular canal paresis. In this study, we test this hypothesis by comparing the results of a canal impulse rotatory test with those of the caloric test using the method described by Freyss. Our study indicates that only in 38% of all tested patients, the same results between the two tests have been obtained. Furthermore, when the group with abnormal findings is observed separately, in 24% patients only these two test methods lead to the same results. Consequently, the canal impulse rotatory test cannot replace the caloric test.

Caloric Tests↗
PubMed1995

Vestibular evoked myogenic potentials.

A pilot study was undertaken in our Vestibular Disorders Clinic to re-evaluate the clinical benefits of vestibular evoked myogenic potentials (VEMP). In seven normal subjects and 20 documented unilateral peripheral vestibular disorder patients, electromyograms were recorded from surface electrodes over the sternomastoid muscles and averaged in response to 0.1-millisecond clicks played through headphones. Control patients demonstrated EMG positive-negative potentials (p14-n21) of equivalent latencies and amplitudes both ipsilateral and contralateral to the stimuli. In patients with documented unilateral peripheral vestibular disorders, the p14-n21 potentials were preserved in the presence of sensorineural hearing loss and absent in those patients with partial or total vestibular loss. A high directional correlation is noted between the p14-n21 potential and gold-standard caloric testing. We suspect the origin of the response may be in the saccule and suggest that VEMP testing may be useful in assessing intact vestibulocollic pathways in humans.

Adult↗
PubMed2003

Balance testing and Doppler monitoring during hyperbaric exposure.

BACKGROUND: The effects on the postural system of saturation diving to shallow and medium depths have not previously been adequately tested. The purpose of this study was to investigate whether postural function is affected by a moderate hyperbaric exposure, and whether any deterioration is correlated with the presence of intravascular bubbles. HYPOTHESIS: Postural control and the vestibulo-ocular reflex are not affected during heliox saturation diving to 5 meters of seawater (msw). At greater depths, an effect may occur. METHODS: Postural control was tested with the subjects standing on a static balance platform before, during, and after onshore experimental saturation chamber dives to 5 msw heliox, 20 msw air, and to 100 msw heliox. Standard caloric testing with electronystagmography was performed before and after the heliox dives. Cardiac ultrasound and Doppler monitoring were used to detect possible venous gas emboli (VGE) during decompression in the heliox dives. RESULTS: During the heliox exposure to 5 msw, no significant change in body sway was found. However, a significant change in body sway was found during an air dive to 20 msw and during the 100 msw heliox exposure. Caloric responses were unchanged immediately post-dive. After decompression from 5 msw, VGE were detected in two divers. During the 100 msw exposure, one case of VGE was observed. CONCLUSIONS: Exposure to hyperbaric heliox conditions corresponding to 5 msw, did not influence postural control significantly, while exposure to 100 msw heliox, and air diving to 20 msw, did. Although VGE were detected in the heliox dives, we could not find any correlation between this observation and postural instability.

Adult↗