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PubMed1986

Acoustic tumor with hearing loss of sudden onset and recovery.

In many cases of acoustic tumor the hearing loss is gradually progressive, but some cases of acoustic tumor show a sudden onset of hearing loss. In this paper we report two interesting cases of acoustic tumors which were diagnosed as sudden deafness at the first examination. Being treated with steroid hormones, their hearing was partially recovered. But the hearing loss recurred in both cases. At the second examination, CT showed the cerebellopontine angle tumors. So it was emphasized that careful questioning as well as the caloric test and the auditory brainstem response (ABR) was important. If one of these tests shows abnormality, the patient should be examined by the CT scan. The same may be said of patients who show recovery due to steroid hormone therapy.

Adult↗
PubMed2005

Distal renal tubular acidosis associated with large vestibular aqueduct and sensorineural hearing loss.

CONCLUSIONS: Hearing loss and equilibrium dysfunction have different etiologies in patients with large vestibular aqueduct syndrome. We suggest that all children with distal renal tubular acidosis (dRTA) should be subjected to an equilibrium study and audiological evaluation, as well as to a CT or MRI scan. OBJECTIVE: dRTA has been described in association with sensorineural hearing loss, but there are no reported cases that have been examined in detail using audiological and equilibrium studies. We report here a case of progressive sensorineural hearing loss with a large vestibular aqueduct and dRTA, and the results of audiological and equilibrium studies. MATERIAL AND METHODS: A 31-year-old female presented with hearing loss, tinnitus and vertigo. She had been treated with oral sodium citrate, potassium citrate and potassium chloride supplementation because of dRTA since the age of 1 month. RESULTS: The pure-tone audiogram of the patient was off the scale for the right ear and showed progressive sensorineural hearing loss for the left ear. Ice-water caloric testing showed canal paresis on the left side. Temporal bone CT and inner ear MRI revealed a large vestibular aqueduct and a large endolymphatic sac on both sides.

Acidosis, Renal Tubular↗
PubMed1978

Absolute and relative reliability of several response parameters used in vestibular assessment.

This experiment investigated the reliability of five indices used to express the magnitude of induced vestibular nystagmus. The investigation was undertaken because information concerning the reliability of the various response parameters when caloric testing is repeated on the same subject is limited. Electronystagmographic assessments of the nystagmus response to the Fitzgerald-Hallpike test were obtained from 16 subjects on three occasions with equal intervals of time between occasions. The data were statistically treated with an analysis of variance technique that allows the generation of correlation coefficients. The findings showed that speed of the slow phase, total beats, culmination frequency, and total amplitude reliably express the magnitude of induced nystagmus on repeated tests. Duration of the induced reaction was not as reliable as the other indices on repeated testing. In addition, difference scores were more repeatable than absolute scores and the caution that must be maintained when using correlation coefficient analyses to estimate reliability is highlighted.

Adolescent↗
PubMed1988

Caloric stimulation during short episodes of microgravity.

Caloric testing was performed during parabolic flight at the NASA Reduced Gravity Facility in Houston, Texas. Six test subjects were stimulated with continuous unilateral air insufflation (25 degrees R), in a manner similar to the experiments performed in the extended weightlessness of orbital flight during the SL1 and D1 Spacelab missions. Nystagmus response was recorded by electro-oculography and eye video image. It was the purpose of the experiments to re-examine the apparent discrepancy between the disappearance of caloric nystagmus during short episodes of weightlessness and the finding that caloric responses can be elicited during periods of extended weightlessness. The present results agree with those of earlier experiments in that a prompt reduction of caloric nystagmus occurs on transition from hypergravity (1.8 G) to weightlessness. The time constant of nystagmus decay was estimated to be approximately 2-3s, a value which cannot be explained by cupular mechanics. A central gating mechanism involving the labyrinthine canal and otolithic afferents is proposed for the observed modulation of caloric nystagmus.

Caloric Tests↗
PubMed1996

[Furosemide test for diagnosis of endolymphatic hydrops: a clinical exploration].

Furosemide test (FT) is a clinical method for the diagnosis of endolymphatic hydrops (EH). Immediately preceding i.v. injection of 20 mg furosemide, a caloric test was performed with 50 micromilligrams of water at 30 degrees C. Nystagmography was employed to measure the maximum slow velocity of caloric nystagmus. The test was repeated one hour after the injection. The two sets of data were then compared. An increase beyond 22.97% was defined as positive. The first group was composed of 54 patients of EH as the experimental group, and the second group 54 patients with vertigo of non-EH as control. The positive rates of the two groups were 70.4% and 25.9% respectively. It showed that FT was useful for detecting EH. The percentage of directional preponderance (DP) was obviously descended in the two groups after i.v. furosemide. Descending rate was 77.8% (21/27) in the first group, which had reached the normal value in 9 cases. It was showed that DP was important also for criticizing FT. The hearing of all subjects was not damaged. When the renal function of the subject was normal and not combined with the use of aminoglycoside antibiotics, the dose of FT was not dangerous to the hearing and had few side reactions. The mechanism of dehydration in hydropic labyrinth was presumed to be acute systemic diuresis, but the effect in inner ear was unknown.

Diagnosis, Differential↗
PubMed1984

A double-blind clinical trial of hydroxyethylrutosides in Menière's disease.

A double-blind, placebo-controlled, cross-over trial was undertaken in 39 patients with well-defined Menière's disease. After a one-month placebo run-in period, the patients were assigned, on a randomized basis, to three months' treatment with O-(beta-hydroxyethyl)-rutosides (HR) (2 g./day) followed by three months on placebo, or vice-versa. In spite of a very pronounced placebo effect and a marked tendency to a 'carryover' effect from the first sequence with HR into the second placebo sequence, there appeared to be a clear trend to a greater symptomatic improvement with HR treatment than with placebo. The audiometric findings showed a very clear, uniform superiority under HR treatment, for both air and bone conduction and at all five frequencies studied (250, 500, 1,000, 2,000 and 5,000 Hz.) (p values between 0.002 and 0.05). Indeed, whereas there was a worsening of hearing-loss at each frequency under placebo during the first sequence, this was significantly diminished at each frequency under HR treatment. There were no significant changes in vestibulometry (caloric test) which showed wide variations already during the run-in period. Tolerance to HR treatment was excellent, the incidence of side-effects being similar to that in the placebo periods.

Adult↗
PubMed1995

Isolated acute vertigo in the elderly; vestibular or vascular disease?

INTRODUCTION: Elderly patients with isolated acute vertigo are commonly encountered in clinical practice, but little is known about the underlying cause of the symptoms. MATERIAL & METHODS: We prospectively studied 24 patients aged 50-75 years with the acute onset of isolated vertigo lasting > 48 h and no abnormality on neurological examination other than nystagmus. The study protocol included neuro-imaging (MRI 22 patients, CT 2 patients), Doppler sonography, and electro-oculography. RESULTS: MRI/CT showed the presence of an infarction of the caudal cerebellum in six patients (25%), 3 of whom had a potential cardioembolic source and normal Doppler sonography findings, whereas 3 patients had ipsilateral vertebral artery occlusion and normal cardiac findings. MRI of the posterior fossa was normal in 18 patients. On electro-oculography, ataxic pursuit eye movements was a characteristic finding in patients with cerebellar infarction, whereas caloric test findings were not discriminative. CONCLUSION: A caudal cerebellar infarction may easily be misdiagnosed clinically as a labyrinthine disorder, and was found to be the cause in one fourth of patients presenting with isolated acute vertigo.

Acute Disease↗
PubMedDate not supplied

[Errors in computerized electronystagmography].

Computerized electronystagmography (ENG) is the analysis of the eye movement recordings using a computer program to identify nystagmus and quantitate response parameters. The results of 100 consecutive bithermal caloric tests of patients complaining of peripheral vertigo were analyzed by computer. All computer analyses were reviewed by authors and either were deemed accurate as made by the computer or were corrected manually. Final test interpretations with and without manual intervention were compared. In 48 tests the computer analysis was not modified. In 20 tests canal paresis and directional preponderance changed after manual review, but not the final diagnosis. In the remaining 20 tests, manual review yielded a different final diagnosis. Computerized ENG provides rapid and accurate vestibular studies, but recordings should be reviewed because system algorithms sometimes identify other ocular movements as nystagmus.

Adult↗
PubMed1999

Vestibular neuritis: a follow-up study.

Seven to eight years after a disease period of vestibular neuritis 19 patients previously examined at our department were given a questionnaire about whether they had experienced any audiovestibular symptoms since they first fell ill. All 19 patients responded and 18 consented to participate in the long-term follow-up study. The patients were subjected to a clinical evaluation, a bithermal caloric test and audiological examinations with stapedius reflex measurements with use of the same technique as at the first examinations. Ten of the 18 patients had experienced recurrent vestibular symptoms with sensation of dysequilibrium and vertigo. Six of these 10 patients also had periods of positional vertigo. The remaining nine patients were free of symptoms. None of the patients had noticed any change in their hearing ability. The mean caloric side difference at the 7- or 8-year follow-up was not significantly higher in the group of patients with symptoms than in the group without symptoms. Neither did the group of patients with pathologically elevated stapedius reflex thresholds at onset display a larger mean caloric side difference than the group of patients with normal thresholds. However, a small caloric side difference at onset of the disease served as a predictor for residual vestibular symptoms. It is speculated whether the group of patients with residual symptoms had a different pathophysiological localization of their disease within the vestibular system than the group of patients with no symptoms at follow-up.

Adult↗
PubMed2006

Audio-vestibular disturbance in patients with Behçet's disease.

OBJECTIVE: The present study prospectively investigated the frequencies and characteristics of audio-vestibular disturbance and the results of audiologic and vestibular function tests in patients with Behçet's disease. STUDY DESIGN: A prospective study. METHODS: Seventeen patients with Behçet's disease (mean age 41.2 [30-56] years, 5 males and 12 females), as well as age- and sex-matched healthy controls, were included in this study. All subjects satisfied the diagnostic criteria of the International Study Group for Behçet's Disease. Information on the subjects was obtained through questionnaires. Tests, including those for hearing impairment, tinnitus, ear fullness, and dizziness, pure-tone audiometry, and vestibular function, were performed. RESULTS: Auditory symptoms were reported by 7 (41.2%) and dizziness by 14 (82.4%) of the subjects. Sensorineural hearing loss was present in four (23.5%) subjects. One was treated with a cochlear implantation because of bilateral sudden deafness. Spontaneous nystagmus was detected in two (11.8%) subjects. Abnormal findings were noted in 1 (5.9%) in saccadic movement, 5 (29.4%) in the bithermal caloric tests, and 10 (58.9%) in the rotation chair tests. In total, audiologic or vestibular disturbance were noted in 16 (94.1%) of the subjects. However, audio-vestibular abnormalities were not noted in the healthy controls. CONCLUSION: Audio-vestibular disturbance is not rare in Behçet's disease patients compared with healthy controls. We believe that audio-vestibular assessment and management may be helpful for the diagnosis and treatment of patients with Behçet's disease.

Adult↗
PubMed1994

Relevance of function tests in the diagnosis of vestibular disorders.

The diagnostic value or relevance of a vestibular function test is dependent on the whole clinical and functional context of each particular case. It is not the ability to show 'abnormality' in a high number of patients complaining of whatever kind of vertigo, that indicates the relevance of a function test. Neither is relevance of a test based upon the possibility that this test can re-categorize some patients in the same way as has been done by other tests. Each test evaluates some particular functional aspect and this is very different from one test to another. A test is more relevant, i.e. indicates more abnormality when the type of vertigo caused by the dysfunction is also considered. These statements are confirmed by experience in peripheral vestibular disorders, especially benign paroxysmal positional vertigo (BPPV). A paroxysmal positional nystagmus (ppn) (nystagmus and vertigo elicited by movements and manoeuvres) is linked to the problem of provoked vertigo and gives a confirmation of this vertigo by reproducing it in some manoeuvres. Some inconstancy in the reproduction of this ppn may cause difficulties in diagnosis. Caloric tests are the clue for diagnosis of sudden unilateral loss (so-called neuronitis), whereas they give only complementary information for patients with BPPV. Posturography adds information in all categories concerning the standing position and can be interesting in the scope of rehabilitation treatment. The findings of a retrospective study in patients with BPPV (n = 95), compared with patients with Ménière's disease (n = 89) and others with sudden unilateral loss syndrome (n = 48), illustrate these concepts.

Audiometry↗
PubMed1993

Chaos theory applied to the caloric response of the vestibular system.

Developments in the field of nonlinear dynamics has given us a new conceptual framework for understanding the mechanisms involved in the regulation of complex nonlinear systems. This concept, called "chaos" or "deterministic chaos," has been applied to EKG, EEG, and other physiological signals, but not yet to the ENG signal. The underlying geometrical structure in chaotic dynamics is fractal (noninteger dimension), and calculating the fractal dimension of the electronystagmographic recording from caloric testing gave a dimension ranging from 3.3 to 7.7. This result demonstrates that the multidimensional vestibular system, with its numerous neurological pathways, can somehow reduce the degrees of freedom and give rise to an irregular dynamic low-dimensional behavior, which is associated with deterministic chaos.

Caloric Tests↗
PubMed1998

Influence of hyperlipidemia and smoking on age-related changes in caloric response and pure-tone hearing.

To examine the influence of hyperlipidemia and smoking on age-related changes in caloric response and pure-tone hearing, a caloric test and pure-tone audiometry were performed in 14 healthy volunteers and in 78 tinnitus patients without subjective hearing loss. The patients were from 24 to 84 years of age, and were divided into 4 groups: the no-risk group (N group), the smoking alone group (S group), the hyperlipidemia alone group (L group), and the smoking plus hyperlipidemia group (S-L group). Slow phase eye velocity of the caloric nystagmus (SPEV) and average hearing level at high frequencies were compared between the N groups and the other groups. There was a significant difference in SPEV only between the N and S-L groups, but not in the hearing level. This suggests that age-related changes in the caloric response be promoted by atherosclerosis, unlike presbycusis.

Adult↗
PubMedDate not supplied

Neurotological evaluation of vertical semicircular canal function in inner ear malformation. A case report.

A 9-year-old boy with inner ear malformation complained of slight deafness and unsteadiness. CT revealed a normal cochlea despite enlargement of the lateral semicircular canals. The vertical semicircular canals developed more or less normally. The caloric test showed complete canal paresis bilaterally; however, a horizontal rotational stimulus elicited a vestibulo-ocular response, which showed only rightward and downward nystagmus, and their maximal slow-phase velocities were low. In addition, the examination of the vertical semicircular canal function using the head-tilted rotation test revealed a more active response, and the maximal slow-phase velocities were higher than those of a standard horizontal rotational test. These results suggest that the function of the vertical semicircular canal was well preserved and that it may have perceived the horizontal acceleration instead of the lateral semicircular canal.

Audiometry, Pure-Tone↗
PubMedDate not supplied

[The prognostic values and correlations between Hockaday's (EEG) and Nathanson-Bergman's (ENG) scales in the context of new definition of death].

A group of 92 patients being under treatment in Intensive Care Unit of Neurosurgery Clinic in Bydgoszcz were observed using EEG, ENG and neurological findings. The eeg patterns, classified by Hockaday's scale, were related to the clinical stage, described using Glasgow Coma Scale, and the ENG patterns (Nathanson-Bergman's scale). Unfavourable prognosis was indicated by appearance of IV and V stage on Hockaday's scale and the caloric test seemed to mark the moment of complete breakdown of all brain-stem functions. The present paper demonstrated the value of EEG- and ENG patterns in description and forecasting of patients in coma.

Adolescent↗
PubMed1987

Thermal stimulation of the vestibular labyrinth during orbital flight.

During the European Spacelab mission (SL1) in 1983, caloric testing was performed for the first time in long-term weightlessness. After 2 days into orbital flight an unequivocal caloric nystagmus was observed in both subjects tested which corresponded in both quality and intensity with that measured in one-g conditions on Earth. The subsequent D1 mission enabled the experiment to be repeated on further subjects and with improved measurement procedures. As with the SL1 findings, the observed caloric nystagmus response proved to be equivalent to that measured during baseline testing on Earth. Renewed consideration of peripheral and central mechanisms, which might be involved in the elicitation of the caloric response--both in one-g and zero-g environments--has led to the reopening of a number of associated issues. One important observation which has been addressed by various research groups concerns the influence of the labyrinth's orientation to the gravity vector on the caloric response. The present authors have examined a group of healthy subjects in various body positions in the sagittal plane. The interindividual variability in the response behavior was found to be high; indeed single cases were observed in which the nystagmus response did not invert from the supine to the prone positions. These findings are discussed together with earlier reports in the literature.

Caloric Tests↗
PubMed2006

'Bow and lean test' to determine the affected ear of horizontal canal benign paroxysmal positional vertigo.

OBJECTIVE: One of the problems in the management of horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV) is the difficulty in determining the affected ear using Ewald's second law. The purpose of this study is to develop the new "bow and lean test (BLT)" to easily determine the affected ear of HSC-BPPV and evaluate its efficiency. METHODS: We compared the efficiency between the classic method and BLT in 26 patients with HSC-BPPV. The classic method is based on Ewald's second law comparing the intensity of nystagmus or symptoms in the head roll test. BLT is based on the direction of both "bowing nystagmus" and "leaning nystagmus" at the head's bowing and leaning state in a sitting position. The affected ear is the same direction of bowing nystagmus in canalolithiasis and the same direction of leaning nystagmus in cupulolithiasis. RESULTS: In 26 patents (15 canalolithiasis, 11 cupulolithiasis), 3 (11.5%) patients did not show a prominent affected ear in the classic method, and 7 (26.9%) patients showed the different affected ear between the two methods. All 10 patients were successfully treated with just one trial of barbecue rotation based on the affected ear in BLT. Three patients did not show any bowing or leaning nystagmus. The side with canal paresis in all four patients, who showed significant canal paresis in bithermal caloric tests, was equal to the affected ear based on BLT. CONCLUSIONS: The "bow and lean test" (also called "Choung's test") is a new method that can easily determine the affected ear of HC-BPPV.

Adolescent↗
PubMed2004

A case of Cronkhite-Canada syndrome with vestibular disturbances.

A 66-year-old Japanese man with Cronkhite-Canada syndrome (CCS) presented with complaints of long-lasting dysequilibrium. On neuro-otological examination, he showed gaze-evoked nystagmus at the rightward and leftward gaze, and saccadic pursuit. On the caloric test, he showed no response in either side, and on the head-impulse test he showed bilateral loss of vestibule-ocular reflexes around the yaw axis, while he had bilateral normal responses on the vestibular-evoked myogenic potential testing. Neuro-otological findings suggested that he had lesions in the peripheral vestibular system as well as the central nervous system. Neurological disorders such as sensory neuropathy have been reported in patients with CCS. This patient's balance problems could be due to CCS itself.

Aged↗