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PubMedDate not supplied

Vestibular tests in the selection of cosmonauts.

Vestibulo-vegetative disorders in cosmonauts and astronauts occurring during space flight compel otolaryngologists to search for vestibular tests enabling a precise evaluation of the activity of the vestibular apparatus and showing disposition to motion sickness. Otoneurological investigation of Polish candidates for cosmonaut status consisted of the following vestibular tests: caloric, rotatory, optokinetic, swinging torsion, statokinesimetric and vestibulo-vegetative. The value of various vestibular tests for aviation and space medicine is presented in this paper, taking into account the results of investigations of the equilibrium system with the group of pilots selected for space flight as well as extensive experience with candidates for the air service and also trained pilots and patients. The relatively frequent lack of correlation between the results of the applied tests, which renders difficult the proper evaluation of the equilibrium system, is emphasized in the paper. Finally, the results of investigations of acute habituation of the vestibular apparatus are discussed.

Adult↗
PubMed1993

Pendred's syndrome.

Although 5% of all cases of congenital deafness are caused by Pendred's syndrome, there are few reports in the literature. Seven patients with Pendred's syndrome in three families living in the same village were detected. For that reason, the syndrome is reviewed in light of the literature. The sex distribution of the patients with Pendred's syndrome and their families was recorded. We tested for thyroxine, triiodothyronine, thyroid-stimulating hormone, triiodothyronine resin uptake, and perchlorate, and performed caloric testing. In one patient, subtotal thyroidectomy was performed. In the histopathologic study, a thyroid nodule filled with colloid was found. Chromosome studies showed no anomalies in any patient. Five of the patients were deaf-mutes. We observed that the parents were cousins in all three families. These families also had healthy children, and the existence of the syndrome in both sexes points to an autosomal recessive trait.

Adolescent↗
PubMed2006

Clinical presentation of posterior fossa epidermoid cysts.

The aim of this study was to investigate the audiovestibular deficits in those with posterior fossa epidermoid cyst including cerebellopontine angle in two patients and cerebellum in one patient. Prior to operation, all three patients showed bilateral gaze nystagmus. Audiometry revealed mild hearing loss in two patients, and caloric test displayed canal paresis in two patients. After operation, subsidence of gaze nystagmus and recovery of caloric responses were disclosed in all patients. Two patients had both hearing and vestibular evoked myogenic potential (VEMP) results recovered to normal. In contrast, the only one who underwent craniotomy twice displayed bilateral mild hearing loss and delayed VEMPs, possibly due to operation sequela. Hence, bilateral gaze nystagmus may present as an initial sign for posterior fossa epidermoid cyst. Audiovestibular deficits in cases of epidermoid cyst are attributable to compression neuropathy, which may resolve and return to normal responses after surgery.

Adult↗
PubMed1977

Comparison of caloric and sinusoidal tests in the vestibulotoxic cat.

In order to evaluate the relative sensitivity of caloric and sinusoidal angular acceleration tests, thermal and rotational stimuli were administered to cats rendered vestibulotoxic with streptomycin sulfate. Three groups of six cats each, receiving daily subcutaneous injections of saline, 100 mg/kg streptomycin or 200 mg/kg streptomycin, were administered optokinetic, caloric and sinusoidal stimuli. Vestibular responses were evaluated by changes in the total slow phase displacement of the eyes and frequency of nystagmic beats. The results demonstrated that the saline treated animals had a decrease in response consistent with habituation; whereas, experimental animals showed a marked, rapid abolition of eye movement. The decrease in response was greater for the larger dose of streptomycin. Caloric or sinusoidal acceleration tests were equally sensitive in monitoring the degree of nystagmic depression. The data suggested that sinusoidal acceleration tests could be easily applied to the clinical vestibular assessment of ototoxicity.

Animals↗
PubMed2003

Familial lateral semicircular canal malformation with external and middle ear abnormalities.

We report a family with inner ear lateral semicircular canal (LSC) malformation and external and middle ear abnormalities. The family had no history of known syndromes or toxic exposures. Distinct phenotypic manifestations were found in three family members. A young girl exhibited bilateral LSC malformation with a right-sided preauricular tag, a mildly deformed auricle, a stenotic external auditory canal, and a constricted middle ear cavity. She had moderate conductive hearing loss in the right ear but normal hearing in the left ear. Her younger brother exhibited right-sided LSC malformation, microtia, external auditory canal atresia, a malformed middle ear cavity, and abnormal auditory ossicles. He had severe mixed hearing loss in his right ear. Their mother exhibited left-sided LSC malformation without external and middle ear abnormalities, and the hearing was normal in her left ear. None of the three cases had vestibular symptoms, and their results of balance tests were appropriate for the corresponding ages. In contrast, significantly decreased LSC function was revealed by caloric tests in an ear with LSC malformation. Previously, LSC malformation may have been underdiagnosed in patients presenting with external and middle ear abnormalities and their relatives, since this malformation is frequently associated with normal hearing and balance or conductive hearing loss only. To our knowledge, this condition has not been described previously. This condition supports a genetic basis for the combination of LSC malformation and external and middle ear abnormalities and may represent an autosomal dominant condition with variable expressivity.

Adult↗
PubMed2001

A vestibular phenotype for Waardenburg syndrome?

OBJECTIVE: To investigate vestibular abnormalities in subjects with Waardenburg syndrome. STUDY DESIGN: Retrospective record review. SETTING: Tertiary referral neurotology clinic. SUBJECTS: Twenty-two adult white subjects with clinical diagnosis of Waardenburg syndrome (10 type I and 12 type II). INTERVENTIONS: Evaluation for Waardenburg phenotype, history of vestibular and auditory symptoms, tests of vestibular and auditory function. MAIN OUTCOME MEASURES: Results of phenotyping, results of vestibular and auditory symptom review (history), results of vestibular and auditory function testing. RESULTS: Seventeen subjects were women, and 5 were men. Their ages ranged from 21 to 58 years (mean, 38 years). Sixteen of the 22 subjects sought treatment for vertigo, dizziness, or imbalance. For subjects with vestibular symptoms, the results of vestibuloocular tests (calorics, vestibular autorotation, and/or pseudorandom rotation) were abnormal in 77%, and the results of vestibulospinal function tests (computerized dynamic posturography, EquiTest) were abnormal in 57%, but there were no specific patterns of abnormality. Six had objective sensorineural hearing loss. Thirteen had an elevated summating/action potential (>0.40) on electrocochleography. All subjects except those with severe hearing loss (n = 3) had normal auditory brainstem response results. CONCLUSION: Patients with Waardenburg syndrome may experience primarily vestibular symptoms without hearing loss. Electrocochleography and vestibular function tests appear to be the most sensitive measures of otologic abnormalities in such patients.

Adult↗
PubMed2002

How does cochlear implantation affect the contralateral vestibular system?

Cochlear implantation has been performed for 16 years by investigators at Semmelweis University. During this period, different types of cochlear implants have been used and, in 30% of cases, hearing was observed to be restored in the nonimplanted ear. In addition to contralateral hearing improvement, significant improvement was observed in the caloric responsiveness of the nonoperated labyrinth. The preoperative median value of the average slow-phase velocity of the caloric test increased, and the increase was statistically significant on the contralateral side. The reason for this caloric response improvement is unclear, although possible explanations are brain plasticity or presently obscure trophic influence on the vestibular system. Whereas the role of brainstem function in the improvement of the contralateral ear's caloric response remains unclear it is also possible that hearing impulses affect the labyrinth. Clearly, the influence of cochlear implants on vestibular function requires further investigation to explain the improvement of contralateral vestibular responsiveness.

Adolescent↗
PubMed1976

Clinically relevant physiology of the vestibulo-ocular reflex.

This review attempts to explain those aspects of the physiology of the vestibulo-ocular reflex (VOR) which could be of future clinical value. The literature cited has been selected for its didactic worth to readers with limited time, preferring concise reviews to detailed reports wherever possible. Physiological data provide the background for the following possible improvements in clinical diagnosis: 1) In gaze analysis, coordination of the VOR with other motor patterns can be analyzed. 2) Precision of vestibular tests can be improved by selecting stimuli within the range of natural movements.3) Resolution of the caloric test can be imporved when the change of temperature at the semicircular canal mimics endolymph pressure changes during natural movements. 4) A direct test of the three neuron VOR pathways is possible, but not practicable. 5) Integration of the input signal (transformation from head acceleration to eye position information) can be directly tested. 6) Plasticity (the adaptation to visual requirements) of the VOR can be examined. 7) It is possible to quantify vestibular damage and detect the side of lesion in one test analyzing gain and binocular symmetry of the vertical VOR.

Cerebellum↗
PubMed1997

Improvement of hemispatial neglect with cold-water calorics: an electrophysiological test of the arousal hypothesis of neglect.

Introducing ice-water into the left ear of right-brain-damaged patients attenuates unilateral neglect symptoms. By examining EEG changes over each hemisphere during this procedure, we were able to test a hypothesis concerning the mechanism of cold-water calorics and the attention-arousal hypothesis of hemispatial neglect. We present a case study of an 83-year-old woman with a massive right-hemisphere CVA exhibiting severe hemispatial neglect. Caloric stimulation produced a leftward eye deviation to central position, and a temporary partial remission of neglect symptoms. Significant changes in EEG activation indicated a central mechanism associated with the regularization of eye gaze. Caloric stimulation also produced a significant interaction between EEG frequency band and hemisphere, indicating that while both hemispheres increased in cortical activation, the right hemisphere increase was significantly greater. This supports the activation-arousal hypothesis of neglect over the mutual inhibition model.

Aged↗
PubMed2000

[Neurootologic study of acoustic neuroma].

OBJECTIVE: To summarize the outcome of neurootologic examination of acoustic neuroma and study of diagnostic significance of neurootologic examination on acoustic neuroma. METHOD: 13 patients were examined with pure tune test, acoustic immittance, electronystagmography, acoustic brainstem evoked response, electrocochleogram, otoacoustic emissions and facial electroneurography. RESULT: All patients had subjective hearing loss. One patient had normal pure tone audiogram, other 4 patients had normal pure tone test at the frequency < 2000 Hz. The outcome of acoustic immittance is various. 5 patients were normal in caloric test, but all were abnormal in visual-vestibular optokinetic response. ABR are positive in 90.9% of cases, but 2 patients had no response. 7 patients were abnormal in facial electroneurography, 3 (of 3) eletrocochleogram and 2 (of 2) otoacoustic emissions revealed retrocochlear pathology. CONCLUSION: Neurootologic examination played important role in filtering diagnosis of acoustic neuroma, results should be considered synthetically, acoustic neuroma should not be ruled out if any one test was negative.

Adult↗
PubMed1988

Otoneurological diagnostics in posterior fossa lesions.

When investigating patients with suspicion of a posterior fossa lesion, case history and clinical examination are important. Additional information is obtained by using an otoneurological test battery consisting of electronystagmography and audiology, primarily brain stem audiometry. In the electronystagmography one should look for spontaneous, positional and gaze nystagmus and asymmetry in the caloric test. In our material of 78 patients with acoustic neuromas, spontaneous nystagmus was present in 58%, positional nystagmus in 43% gaze nystagmus in 5% and caloric asymmetry in 88%. To reveal CNS disturbances in the posterior fossa, whether due to pressure from a pontine angle tumour or a vascular loop, or caused by cerebellobrainstem infarction, bleeding or tumour, certain special tests have proved valuable: computerized sinusoidal vs. randomized rotatory and smooth pursuit tests and ocular saccade test. A visual suppression test performed in the rotatory chair makes it possible to compare suppression and pursuit at identical stimulation patterns, which adds a new diagnostic tool.

Audiometry, Evoked Response↗
PubMed2005

[Signs and symptoms associated to otoneurologic alterations diagnosed on computerized vestibular exam of patients with multiple sclerosis].

OBJECTIVE: To identify main symptoms and signs on computerized vestibular testing in patients diagnosed with multiple sclerosis. METHOD: Thirty patients with the diagnosis of multiple sclerosis were studied. We analyzed data related to presented symptoms and the findings from a computerized vestibular testing realized in the otoneurological ambulatory in Santa Casa de Misericórdia de São Paulo in 2003. RESULTS: Reported symptoms consisted mainly of disequilibrium (60%), tingling of limbs (43.3%), vertigo (40%), headache and anxiety (36.7%), tinnitus (30%), depression (26.7%). In vestibular testing we found alterations in positional nystagmus (6.7%), spontaneous nystagmus with the eyes shut (30%), directional nystagmus (13.3%) and caloric testing (63.3%). In the final conclusion of the exam, the diagnosis of irritative type peripheral vestibular syndrome (60%) and central syndrome (13.4%) prevailed. CONCLUSION: We conclude that the realization of an otoneurological exam has become indispensable in patients with multiple sclerosis. This is due to high prevalence of alterations at computerized vestibular exam and of otoneurological symptoms.

Adult↗
PubMed1981

Diagnosis of acoustic neurinoma.

Seventy-six patients underwent the primary removal of an acoustic neurinoma at the Mayo Clinic from 1978 through 1980. Hearing loss was present in 97% of the patients, and tinnitus and dysequilibrium occurred in 70% of the patients. The most common signs were a decreased corneal reflex, nystagmus, and facial hypesthesia. In these patients, pure tone and speech audiometry are used to define the hearing loss. When hearing is still present, the speech discrimination is often disproportionately low. Acoustic reflex testing and brain stem evoked response are used to determine whether the hearing loss is cochlear or retrocochlear. When these tests could be performed in this series of patients, they were accurate in 85 to 95%. The vestibular response to caloric testing is expected to be decreased or absent in about 90% of patients, and this was so in 86% of our patients. Radiographic studies are the most important tests currently used for the diagnosis of acoustic neurinoma. Tomography of the internal auditory canal shows abnormalities in 80% of patients. Computed tomography with contrast enhancement demonstrates abnormalities in 90% of patients. The computed tomographic (CT) scan may reveal the location, the size, and often the consistency of the tumor. In cases still questionable after CT scanning, positive contrast rhombencephalography is used for clarification. In this series, no single symptom, sign, abnormal audiometric test result, or abnormal radiographic finding was present in all patients; therefore, the most important factor in diagnosis is an alert physician.

Adolescent↗
PubMed1991

Otoneurological findings in inner ear syphilis.

Eighty-one ears in 48 patients who had had ear syphilis for the past ten years were studied and otoneurological examinations reviewed. Twenty-five of 48 cases complained of vertigo, 13 of giddiness and/or unsteadiness, and 10 cases denied dizziness. Approximately one half of the patients had abnormal findings on primary equilibrium examinations, such as Mann's test and stepping test. Spontaneous nystagmus and positional nystagmus were frequently seen on electronystagmographic examinations. Many patients showed abnormal responses to the bithermal caloric test and pendular rotation (VOR) test. Moreover, 5 of 8 patients had positive furosemide VOR tests. On transtympanic electrocochleography, 13 of 22 ears demonstrated a dominant -SP response. Eleven of 26 ears had positive findings on an intravenously administered glycerol test. In conclusion, some cases of inner ear syphilis show the characteristic findings of endolymphatic hydrops.

Adult↗
PubMed1991

Classification of peripheral and central (pontine infarction) vestibular deficits. Selection of a neuro-otological test battery using discriminant analysis.

The results obtained from a complete neuro-otological test battery were examined statistically in order to select measurement variables which would optimally indicate significant differences between four groups: normal patients, patients with partially compensated unilateral peripheral vestibular deficit, patients with an acoustic neurinoma and patients with central (brainstem) vestibular deficit. A stepwise-discriminant analysis was performed on measurements of slow-phase velocity obtained from each test. The primary measurements selected to assign a subject optimally to one population were the canal paresis (CP) of the caloric test, the eye-tracking gain contralateral to the deficit for a 15 deg/s stimulus, the gain asymmetry for optokinetic nystagmus with a 30 deg/s stimulus, and the level of spontaneous nystagmus. The resulting classifications were 100% correct for normal and central deficit patients. However, the division between peripheral deficit and acoustic neurinoma patients overlapped causing about 30% false classifications of neurinoma patients: some 20% of the peripheral deficit patients were classified as normal. If the CP was not available the discriminant analysis substituted the rotating chair response for 5 deg/s2, in place of CP. This substitution caused a 10 to 20% decrease in classification accuracy.

Diagnosis, Differential↗
PubMed1998

[Otoneurologic state estimation 2 years after tick-borne encephalitis].

In this paper an attempt is described to estimate the incidence and frequency of neurologic and otologic symptoms among patients two years after TBE. We examined 43 persons of both sexes aged 17-58. The most frequent complaints were: headache--34.9%, equilibrium problems--37.2%, buzzing in the ears--27.9%, hearing problems--23.3%, memory problems--25.6%. Decrease of throat reflexes was stated in 3 (7%) and pseudobulbaris symptoms in 2 (4.6%), weakness of muscles in 4 (9.3%). In audiometric examination decrease of hearing was stated in 8 persons (18.5%). We registered nystagmus: spontaneous--4.6-7%, gaze--13.9-18.6%, positional-T, mainly Nylen I and III type-18.6-25.6%. Pathologic recording in the eye-tracking pattern test was shown in 7 (16.3%) persons. Asymmetry of optokinetic nystagmus was stated in 6 (13.9%) examined persons. Asymmetry in caloric test was proved in 25.5% of examined persons.

Adolescent↗
PubMedDate not supplied

The plasticity of compensatory eye movements in bilateral vestibular loss. A study with low and high frequency rotatory tests.

Twelve subjects with bilateral vestibular loss, with a mean age of 27 years (18-49) were studied. The loss was based on symptoms of oscillopsia and ice-water caloric tests. Nine subjects were evaluated by low-frequency sinusoidal harmonic acceleration (SHA) rotatory tests (0.01-0.32 Hz), and 3 subjects with high broad-frequency band rotatory tests (0.25-3.25 Hz). During alertness tests (darkness) all subjects had absent or very low gains. When tested with a stationary light in the middle of the swing, the SHA tests showed perfect compensatory eye movements with gains of 1 and phases of approximately 0 degrees. In the broad-frequency test, the gain was near 1 below 1 Hz, decreasing rapidly at higher frequencies. In imaginary stationary target tests (darkness), the gain was enhanced to 'normal' values (0.5) with a phase lead in the low-frequency range (SHA). This could not be replicated in the high-frequency tests. Testing with stationary acoustic guidance (darkness), further enhanced the gain in the SHA tests. A small increase of gain could also be found in the high-frequency tests. Compensatory eye movements, when tested in low-frequency rotatory tests (less than 1 Hz), are to a large extent influenced by non-vestibular mechanisms. By voluntary modifications, normal gains could be produced by patients with 'bilateral vestibular loss'. The phase lead found is proposed to be of central non-vestibular origin. Testing in higher frequency ranges (greater than 1 Hz) could not replicate these findings, thus the broad-frequency band rotatory test should be preferred for adequate vestibular quantification.

Adaptation, Physiological↗
PubMed2000

[Head shaking test and low-frequency rotation-acceleration test: comparison of sensitivity and specificity].

In studying the vestibular-oculomotor reflex (VOR) in patients with equilibrium disorders, both active and passive methods are used and at different stimulation frequencies, particularly to evaluate vestibular compensation. The present study compares the sensitivity and specificity of the low-frequency pendular test and the HST in normal subjects and in subjects suffering from various vestibular pathologies but showing no signs of spontaneous nystagmus, even under optimal evaluation conditions (infrared videonystagmoscopy). These spontaneous nystagmus-free subjects underwent a routine study including: case history, infrared videonystagmoscopy (HST with 2 Hz stimulation) and ENG recording (saccadic movement, smooth pursuit, OKN, VOR, VOR-fix during pendular stimulation at 0.05 Hz and VOR after Fitzgerald-Hallpike heat stimulation). On the basis of the results the subjects were classified as follows: normal (N): case history free of any equilibrium disorders and all tests negative (122 cases; 8.1%); peripheral vestibular pathology (P): case history of equilibrium disorders and labyrinthine predominance (LP) in excess of 20% upon caloric testing (716 cases; 47.6%); central pathology (C): case history of equilibrium disorders and at least 3 pathological results from among the following tests: saccadic movement, smooth pursuit, OKN, VOR-fix (226 cases; 15.0%); mixed pathology (M): with both signs of P and C (440 cases; 29.3%). The pendular test showed signs of directional dominance (DP) higher than 10% (normal limit) in 7 cases of N (5.7%), 308 P (43.0%), 33 C (14.6%) and 162 M (36.8%). DP was higher than 10% in 55.2% of the P and M cases with onset less than 1 month before, in 42.8% of those with onset within the year and in 37.2% of those with onset more than a year before. A pathological response to the HST was observed (characterized by a series of at least 3 nystagmus shakes after a maximum latency of 15 seconds) in 0 N (0.0%), 378 P (52.8%), 4 C (1.8%) and 247 M (56.1%). The nystagmus seen was nearly always monophasic (92.5%), biphasic nystagmus was only seen in only a few cases (7.5%); moreover it was predominantly horizontal in nature (94.9%) while it was vertical in only a few of the C cases (5.1%). The HST proved pathological in 46.5% of those pathologies with onset less than 1 month before, in 55.8% of those with onset within the year and in 54.4% of those with onset more than a year before. In 213 of the cases presenting pathological response to the HST there was agreement between VOR DP at the pendular test and the direction of the nystagmus evoked by the HST: 138 P (74.6%), 0 C (0.0%), 75 M (68.2%): moreover there was no agreement in 83 cases. When the DP was lower than 10% at the pendular test, the HST proved pathological in 213 P (52.2%), 3 C (1.6%), 150 M (53.9%). Both tests gave negative results in 112 N (91.8%), 163 P (22.8%), 186 C (82.3%), 123 M (27.9%). In cases of peripheral vestibular deficit (P and M) the sensitivity of the rotoacceleration test was 40.7%, specificity 88.5%. The sensitivity of the HST was 54.1%, specificity 98.8%. The sensitivity of the association using both tests was 75.2%, specificity 85.7%.

Biophysical Phenomena↗