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PubMed2006

[Assessment of betahistine dihydrochloride effectiveness in the treatment of vertigo of a different aetiology based on videonystagmography test results].

UNLABELLED: Comprehensive medical history and videonystagmography (VNG) testing play very important role in balance assessment especially when dealing with balance disorders occurring occasionally. VNG in many clinical situations is performed as an initial test before complete otoneurological examination is carried out. Betahistine dihydrochloride (betahistine) a synthetic histamine analogue is one of many drugs used in the treatment of balance disorders of central or peripheral etiology. The aim of our work was to analyze, using the VNG test, effectiveness of betahistine treatment and to compare it with the control group treated with different drugs. MATERIAL AND METHODS: 42 patients suffering from vertigo were evaluated before and after the treatment with betahistine. Treatment results were compared with the results of 20 vertigo sufferers treated during the same period of time with different drugs. In effort to standardize asked questions, interviews with patients were completed with specially structured questionnaire. In 54% of patients, decreased intensity and severity of vegetative symptoms was observed after the treatment with betahistine, in 45.2% of patients (30% of the control group) decreased frequency of attacks was noted. RESULTS: In 69.1% of patients treated with betahistine and in 50% of the control group improved results of the VNG test were noted. In 9.5% of patients (4 patients) treated with betahistine and in 20% of patients from the control group, the VNG test results were worse. Quantitative and qualitative features of the VNG test were best improved in parts of the test showing features of its central origin. In 50% of patients improvement of the symmetry in Optokinetic testing, decrease or stop of vertical component of positional nystagmus was noted. In 38.1% of patients decrease of directional predominance of nystagmus in Caloric Testing was noted. None of all examined patients exhibited features of worsening of VNG test results and no new symptoms were noted. Radiological investigations showed no new pathologies. CONCLUSION: Betahistine dichloride is one of the basic drugs used in the treatment of vertigo of different etiology.

Betahistine↗
PubMed2005

[Evaluation of the equilibrium system in patients with multiple sclerosis based on qualitative assessment with videonystagmography].

Multiple sclerosis (SM) is the most frequent inflammatory-demyelinating disease of central nervous system. The character of SM disease provokes that its most frequent symptoms are vertigo, equilibrium disorders and ataxia. Objective method of vertigo estimation is evaluation of the nystagmus via videonystagmography registration (VNG). This examination allows to simultaneously assess the vertical and horizontal component of the nystagmus. It is considered that mainly the vertical nystagmus is characteristic to equilibrium system impairments of the central nervous system, caused also by SM. The study was carried out on 40 patients (28 women, 12 men) with SM diagnosed as a result of neurological examination. 7 patients (17.5%) suffered from sham - movement vertigo, while 33 patients (82.5%) suffered from instability of posture and walking deviation. The videonystagmography examination resulted in the following: deviation of the eye movement was recorded in 26 patients (65%) during either in saccadic test and in smooth pursuit test, optokinetic nystagmus recorded: dissymetric and variable amplitude result in 24 patients (60%), presence of vertical nystagmus component in 30 patients (75%), positional test: directional-changable nystagmus in 8 patients (20%), pendular nystagmus in 4 patients (10%), presence of vertical nystagmus component in 31 patients (77.5%), caloric test: impairments of one of the labyrinth recorded in 12 patients (30%). SM is still the diagnostic and therapeutic problem. During the mentioned tests we have found the quantitative and qualitative changes in VNG recordings. This may be helpful in SM diagnosis, mainly during its early stages.

Adult↗
PubMed1991

Preoperative findings and hearing preservation in acoustic neuroma surgery.

For the purpose of clarifying whether or not the possibility of hearing preservation can be predicted preoperatively, we compared clinical characteristics and preoperative test results between hearing preserved and hearing unpreserved patients. Based on an analysis of this study, we conclude that duration of symptoms, ABR findings and caloric test results, in addition to hearing level, speech discrimination score and tumor size should be considered as prognostic signs of hearing preservation. Although all factors do not suggest a definite possibility of hearing preservation, candidates for hearing preservation surgery should be selected according to these prognostic factors.

Adult↗
PubMed1999

[Diagnostic value of ENG in occupied lesions of cerbellopontine angle].

OBJECTIVE: To evaluate the diagnostic value of ENG in occupied lesions of cerebellopontine angle. METHOD: Twenty-four cases of pathological confirmed occupied lesions of cerebellopontine angle were examined with ENG before operation. The ENG examination included saccade test, gaze test, ocular pursuit test, optoknetic test, positional test and positioning test. RESULT: ENG tests were compared with the results of operation and pathology. The results showed that abnomal ENG-OKR suggested central lesions. Brun's nystagmus and unilateral canal paresis were of important value in locating the lesions of cerebellopontine angle. The ocular pursuit test and optokinetic test could point out which side the lesions were. CONCLUSION: Patients with cerebellopontine angle lesions smaller than 3 cm in diameter showed unilateral canal paresis in caloric test indicated acoustic neuroma. Patients with cerebellopontine angle lesions showed no canal paresis may be other lesions except acoustic neuroma.

Adult↗
PubMedDate not supplied

The clinical significance of head-shaking nystagmus in the dizzy patient.

The clinical significance of horizontal head-shaking nystagmus (HSN) was evaluated in 85 patients who complained of dizziness and vertigo. This was done by comparison of the horizontal head-shaking test with routine rotatory and caloric vestibular testing. We found that HSN evoked by horizontal head-shaking is a highly sensitive way to detect unilateral vestibular hypofunction. Except in patients with additional central vestibular imbalance or in patients with Meniere's disease, the direction of horizontal HSN is highly significant in indicating the side of the lesion, with the fast phase beating toward the intact side. However, horizontal HSN is not specific in distinguishing peripheral hypofunction from more central vestibular imbalances. Peripheral vestibular hypofunction as well as a central asymmetry of the vestibular velocity storage mechanism can each separately or in combination produce horizontal HSN. Thus, while the head-shaking manoeuvre is an excellent bedside-test to detect unilateral vestibular hypofunction, further rotatory and caloric testing is still necessary to clarify the patient's condition.

Adult↗
PubMed1975

Second ear stapedectomy--a continued controversy.

This paper presents the results of an investigation into the effects of stapedectomy on vestibular function. We detected a disturbingly high incidence of vestibular abnormality in the results of caloric tests at three months postoperatively. Surprisingly, this was not usually accompanied by concurrent vestibular symptoms and there was no evidence of cochlear dysfunction in most cases. Although the caloric response at 12 months postoperatively showed an improvement in most instances, the responses rarely became symmetrical. We believe that a long-term alteration in vestibular response is not uncommon following stapedectomy. Although most patients will compensate quite quickly after unilateral stapedectomy we suspect that this occurs much less readily after bilateral stapedectomy and not at all should bilateral impairment of vestibular function occur. On the basis of this evidence, we submit that bilateral stapedectomy is justified only when vestibular function can be shown to be normal prior to the second ear operation.

Cochlea↗
PubMedDate not supplied

[The vestibulospinal test in unilateral neurolabyrinthitis].

In this paper we wanted to assess clinical relevance of two vestibulospinal tests: standing test (derived from Romberg test) and past pointing test. In retrospective and prospective study 42 patients have been tested with standing test and 50 patients with past pointing test. All patients suffered from unilateral neurolabyrinthitis that had started from one day to two years prior to examination. All patients had unilateral areflexion, or hyporeflexion on caloric test using 10 degrees C water. Control group consisted of 32 healthy individuals for both tests. Results show that both tests correctly indicate side of the lesion but only during first week of illness. Moreover, even during that first week sensitivity of both tests was below 50%, which means that more then half results from patients fall within normal findings. We conclude that vestibulospinal tests do not deserve prominent place in assessing patients with vestibular syndrome. Conclusions must be made according to findings obtained from much more precise vestibuloocular tests.

Adolescent↗
PubMed1991

[Effect of inner ear immune response on vestibular function in guinea pigs].

We examined vestibular dysfunction and histological damage caused by direct antigen challenge to the endolymphatic sac in guinea pigs. We observed spontaneous nystagmus every eight hours and performed caloric testing every week following endolymphatic sac secondary KLH challenge. Spontaneous nystagmus was seen in 12 of 18 animals, and nystagmus in all directed toward the unchallenged ear (paralytic). The caloric response time courses were classified into two types, which were irreversible type and reversible type after endolymphatic sac KLH challenge. The immune injury of animals with irreversible type was thought to be stronger than that of these with reversible type. The spontaneous nystagmus of irreversible type animals was longer than that of reversible type animals. The temporary vestibular dysfunction was thought to be similar to that observed in Meniere's disease.

Animals↗
PubMed1979

[Diagnosis of acoustic neurinoma (author's transl)].

In conjunction with a competent medical history, the early diagnosis of acoustic neurinomas is based on the following clinical investigations: pure tone and speech audiometry, caloric testing for nystagmus, and Stenvers radiological examination of the petrous bone. In abnormal studies, audiometry consistently indicates a unilateral hearing loss which is often accompanied by a severe speech discrimination impairment. The caloric response of the affected side is significantly reduced in 90% of the cases. In the same per cent of cases, the Stenvers projection shows significant pathological findings. These include enlargement of the internal auditory meatus, absence of the crista transversa and atrophy of the roof of the internal auditory meatus. As a result of these studies, the possibility of an acoustic neurinoma can be excluded in 50% of cases. Only when these tests yield enough positive findings should more sophisticated studies, such as computerized tomography and meatocysternography, be considered.

Audiometry, Pure-Tone↗
PubMed2001

Application of multivariate statistics to vestibular testing: discriminating between Menière's disease and migraine associated dizziness.

Menière's disease (MD) and migraine associated dizziness (MAD) are two disorders that can have similar symptomatologies, but differ vastly in treatment. Vestibular testing is sometimes used to help differentiate between these disorders, but the inefficiency of a human interpreter analyzing a multitude of variables independently decreases its utility. Our hypothesis was that we could objectively discriminate between patients with MD and those with MAD using select variables from the vestibular test battery. Sinusoidal harmonic acceleration test variables were reduced to three vestibulo-ocular reflex physiologic parameters: gain, time constant, and asymmetry. A combination of these parameters plus a measurement of reduced vestibular response from caloric testing allowed us to achieve a joint classification rate of 91%, independent quadratic classification algorithm. Data from posturography were not useful for this type of differentiation. Overall, our classification function can be used as an unbiased assistant to discriminate between MD and MAD and gave us insight into the pathophysiologic differences between the two disorders.

Adolescent↗
PubMed2006

[Benign paroxysmal positional vertigo of the horizontal semicircular canal].

OBJECTIVE: Assesment of 8 new cases of benign paroxysmal positional vertigo of the horizontal semicircular canal (BPPV-HC), since this variant of benign positional vertigo occurs rarely. An oculographic study of features in the positional response was carried out. Electrooculograpy (EOG) allows an exhaustive study of positional nystagmus. MATERIAL AND METHODS: We have studied retrospectively 8 patients with BPPV-HC and positive head rotation manoeuvre registered by EOG techniques. Possible alterations in other EOG tests in the group of patients were analyzed. RESULTS: Most of the patients (7/8) expressed bilateral horizontal geotropic changing-direction nystagmus. One patient exhibited apogeotropic horizontal nystagmus. 5/8 cases showed caloric hypofunction. CONCLUSIONS: We have proven that BPPV-HC is an uncommon disorder. In most of the cases, provocative manoeuver generates bilateral horizontal geotropic changing-direction nystagmus that probably is due to canalitiasis of the horizontal semicircular canal. The rest, a few cases, exhibit apogeotropic horizontal response that can be secondary to cupulolitiasis or location particles in the anterior portion of the horizontal canal. A caloric test showed abnormal in many and can help to locatize the affected ear.

Adult↗
PubMedDate not supplied

[Gilbert's syndrome: consideration of several diagnostic aspects].

Gilbert's syndrome is a frequent clinical condition with indirect hyperbilirubinemia, with controversial pathogenesis, nosography, and diagnostic criteria. Reliability of diagnostic test (caloric intake restriction and phenobarbital induction), as well as bilirubin modifications after physical exercise, were assessed in 7 patients with the disease. Phenobarbital induction appears to be the most suitable and reliable test for clinical non-invasive diagnosis of Gilbert's syndrome.

Adolescent↗
PubMed1988

Recovery from unilateral labyrinthectomy in rhesus monkey.

1. We recorded eye movements in six rhesus monkeys before and after unilateral labyrinthectomy and quantified the compensation for both the static and the dynamic disturbances of the vestibuloocular reflex (VOR). 2. When first recorded after labyrinthectomy (18-20 h postlesion), all animals had a spontaneous nystagmus with mean slow-phase velocities ranging from 24 to 54 degrees/s measured in darkness and 0-4 degrees/s measured in the light. The level of nystagmus diminished quickly, and by postoperative day 25 mean values ranged from 4 to 22 degrees/s, measured in darkness. The waveform of individual slow phases was variable, but in the first postoperative week its trajectory usually showed an increasing, or an increasing then decreasing, velocity. This finding indicates that peripheral vestibular lesions can alter the function of the ocular motor eye-position integrator. 3. The VOR gain (eye velocity/head velocity, corrected for spontaneous nystagmus) during rotations (30-300 degrees/s) in the dark was diminished from nearly 1.0 preoperatively to approximately 0.5 when first measured after labyrinthectomy, except for rotations toward the lesioned side at high speeds for which the gain was even lower. Within the first few postoperative days, for rotations toward the intact side, the VOR gain increased rapidly, to approximately 0.8. For rotations toward the lesioned side similar behavior was noted for stimuli of 30-60 degrees/s, but at higher velocities compensation proceeded more slowly. By 3 mo postoperatively gains had reached values ranging from 0.77 to 1.03 for rotations toward the intact side and from 0.61 to 0.98 for rotations toward the lesioned side. Values were higher for lower-velocity stimuli. 4. Caloric testing with ice water in the unoperated ear elicited nystagmus with a mean value of maximum slow-phase velocity of 129 degrees/s preoperatively and 195 degrees/s 3 mo postoperatively. There was no caloric response on the lesioned side. From the increase in caloric responses from the intact ear we infer considerable restoration of spontaneous activity of vestibular neurons on the deafferented side. 5. The time constant of the VOR was a function of stimulus speed preoperatively with a maximum mean value of 35 s for a 60 degrees/s stimulus. After labyrinthectomy the VOR time constant was low (6.0-9.1 s) at all speeds. Subsequently, in three animals only, there was a small increase (2-3 s) in VOR time constant during the 3-mo period following labyrinthectomy. These results indicate that labyrinthectomy profoundly and persistently impairs the action of the vestibular velocity-storage mechanism.(ABSTRACT TRUNCATED AT 400 WORDS)

Adaptation, Physiological↗
PubMed2000

The phenotype of DFNA13/COL11A2: nonsyndromic autosomal dominant mid-frequency and high-frequency sensorineural hearing impairment.

OBJECTIVE: To study nonsyndromic progressive sensorineural hearing impairment in patients with a COL11A2 mutation (DFNA13) in a Dutch kindred. STUDY DESIGN: Survey. SETTING: Department of otorhinolaryngology of a university hospital. PATIENTS: Twenty-one living members of a Dutch family (150 relatives in 5 generations; 49 were studied) with autosomal dominant nonsyndromic sensorineural hearing impairment showed linkage to the DFNA13 locus. Mutation analysis revealed a missense mutation in the COL11A2 gene. METHODS: History was taken, hearing threshold levels were measured in all affected persons, and penetrance was evaluated. Longitudinal analysis (using linear regression analysis of threshold-on-age data) was possible in only 1 case. Cross-sectional analysis comprised the comparison of threshold levels between different generations of the family. Also, hearing thresholds were corrected for median presbyacusis to find out whether the hearing impairment characteristic of this trait is stationary or progressive. Vestibular functions were evaluated with electronystagmography, by use of rotatory and caloric tests. RESULTS: Most of the affected persons dated their first hearing impairment symptoms to the second to third decade of life. A possibly reduced penetrance was found. Anamnestically, 4 affected persons had hearing impairment symptoms from early childhood onward. Longitudinal analysis in the proband (IV26) revealed the exceptional combination of congenital offset and substantial early progression. Most of the threshold levels differed significantly between the frequencies within each age group and, at the high frequencies (2-8 kHz), between the two age groups covered by generations IV and III (ages 30-38 years and 58-74 years, respectively); the latter could be attributed to presbyacusis. Various caloric abnormalities, including areflexia, were found in about half (8/17) of the tested subjects with sensorineural hearing impairment. CONCLUSIONS: Correction for age, hearing impairment-presumably present and stationary from an early age onward-showed the worst or second-worst threshold usually at 1, 2, and 6 kHz (3540 dB) or 8 kHz (50 dB), whereas the best or second-best threshold was found at 0.25 to 0.5 and 4 kHz (25 dB). Presbyacusis, presumably from the fourth decade of life onward, caused a change of the typically shaped audiogram described as midfrequency hearing impairment with additional high-frequency impairment.

Adult↗
PubMed1998

Temperature Order Effects in the Caloric Reaction.

Does it matter in what order the four irrigations are conducted in the caloric test? It has been suggested that warm water (44 degrees C) elicits stronger reactions than does cold water (30 degrees C), which might be explained simply by slight differences in water temperatures. However, if it can be shown that starting with cold water diminishes the difference between the warm and cold irrigations, it might be worthwhile to apply the cold irrigations first. Binaural, bithermal caloric irrigation was conducted in darkness using electrooculography. Maximum slow-phase velocity was measured. One hundred and eighteen consecutive patients from our laboratory were tested with warm water first and then with cold irrigations. In a second run, 108 subjects were irrigated with cold water before the warm. Employing cold irrigations first produces a smaller difference between the warm and the cold irrigations than does the opposite order. However, the lateral and directional preponderances, according to the formulas of Jongkees, are not affected by this change of irrigation order. The fact that initial warm-water irrigations cause the temperature effect differences to be larger than do initial cold-water irrigations is a phenomenon having only marginal clinical implications.

Journal Article↗
PubMed1997

[Correlation between the age-dependent changes in caloric response and in pure tone hearing].

Previous reports have examined the age-dependent changes of the auditory system or the caloric response, but results have been inconsistent. No study to date has correlated the age-dependent changes in caloric response with those in pure tone hearing in the same subjects. In this study a caloric test and a pure tone audiometry test were performed in 86 subjects (172 ears), age range 24 to 84 years of age, including 12 otoneurologically healthy volunteers (24 ears), and 74 tinnitus patients without subjective hearing loss (148 ears). The maximal slow phase eye velocity (SPEV) of caloric nystagmus response and the mean hearing level at high frequencies were measured and the age-dependent changes in these scores were compared. The following results were obtained. 1) The SPEV of caloric nystagmus, which remained unchanged until markedly advanced age, decreased significantly from 65 years of age in men and from 75 years in women; the change occurring earlier in men than in women. 2) The hearing level at high frequencies decreased abruptly from 50 years of age with a more gradual change from 75 years was significantly lower in men than in women over 65 years of age. 3) There was a weak but significant correlation between the age-dependent changes in SPEV and those in hearing level at high frequencies.

Adult↗
PubMed1985

Otoneurological examination in panic disorder and agoraphobia with panic attacks: a pilot study.

A battery of vestibular and audiological tests was administered to eight patients with panic disorder and 13 patients with agoraphobia and panic attacks, all of whom experienced dizziness during their panic attacks. Positional or spontaneous nystagmus was present in 67% of the subjects. Abnormal responses were found in caloric testing (56%), rotational testing (35%), and posturography (32%). Pure tone audiograms were abnormal in 26% of the subjects and acoustic reflexes were abnormal in 44% of the subjects. Six of eight patients tested had an abnormal brainstem auditory evoked potential. The possible importance of the findings and their implications for further research are discussed.

Adult↗