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PubMed2006

Caloric and vestibular evoked myogenic potential tests in evaluating children with benign paroxysmal vertigo.

OBJECTIVE: This study applied caloric and vestibular evoked myogenic potential (VEMP) tests to evaluate whether children with benign paroxysmal vertigo (BPV) shares similar vestibular features with basilar type migraine. METHODS: Twenty subjects of each group including healthy and BPV children were enrolled in this study. Each subject underwent audiometry, caloric and VEMP tests. Diagnosis of BPV was based on the International Classification of Headache Disorder, second edition. RESULTS: All BPV children had normal hearing, bilaterally. Caloric test revealed normal responses in 13 patients and abnormal responses in 7 patients (35%). VEMP test showed 50% abnormality in BPV children, including absent and delayed responses. However, when results of caloric and VEMP testing were considered together, 70% of BPV children had abnormality, exhibiting non-significant difference compared with 75% abnormality in basilar type migraine. CONCLUSIONS: A combination of caloric and VEMP results reveals higher abnormality (70%) in BPV children, sharing similar features with basilar type migraine in adults, given the similarity of the two disorders. Thus, caloric and VEMP tests may serve as supplementary diagnostic tools in evaluating children with BPV.

Adolescent↗
PubMed1979

Neurotological diagnosis of vestibular disorders in children.

The most marked findings in a group of 66 children were a spontaneous nystagmus presenting in 29% of the cases, and an abnormal caloric reaction in 40%. For qualitative and quantitative assessments of the positional test and caloric stimulation, at our University ENT department at Erlangen we use the positiogram and frequency calorigram described here, which are particularly suitable for follow-up observations and for the purpose of providing an expert medical opinion.

Adolescent↗
PubMed2001

Perspectives for the comprehensive examination of semicircular canal and otolith function.

A review is presented on the three-dimensional aspects of the vestibulo-oculomotor system and the current functional tests for unilateral examination of the individual receptors in the vestibular labyrinth. In the presentation, attention is directed towards the recently developed vestibular tests, which promise a more comprehensive examination of labyrinth function. More explicitly, unilateral tests for the utricle, saccule and the individual semicircular canals are discussed. Caloric irrigation and rotatory testing are widely used as tests for the integrity of the (horizontal) semicircular canals. Little useful diagnosis is made however on the vertical canals, not to mention the otolith organs. A promising approach to the examination of individual semicircular canal function has been described. This involves the perception of self-rotation in each of the planes of the semicircular canals. The patient/subject is rotated by an arbitrary amount on a standard Barany chair and then required to return the chair to its original position, by joystick control of the chair velocity. In order to test the vertical canals, the head of the subject/patient is positioned so that the plane of each canal lies in the plane of rotation. A promising unilateral test of saccular function involves the use of vestibular evoked myogenic potentials. Here it has been demonstrated that the saccules can be activated using brief, high-intensity acoustic clicks. The myogenic potential is measured using surface electrodes over the sternocleidomastoid muscles. Initial data from patients has indicated that the test is specific for unilateral saccule disorders. The unilateral test of utricle function is based on the eccentric displacement profile. Thus, eccentric displacement of the head to 3.5 cm during constant velocity rotation about the earth-vertical axis generates an adequate unilateral stimulation of the otolith organ, without involving the semicircular canals. This paradigm has also proved efficient in localizing peripheral otolith dysfunction by means of SVV estimation. This represents a novel test of otolith function that can be easily integrated into routine clinical testing. In contrast to the otolith-ocular response, the subjective visual vertical also reflects the processing of otolithic information in the higher brain centres (thalamus, vestibular cortex). Exploitation of the two complementary approaches therefore provides useful information for both experimental and clinical scientists. Of direct interest is the finding that testing with the subject rotating on-centre is sufficient to localize peripheral otolith dysfunction by means of SVV estimation. This represents a novel test of otolith function that can be easily integrated into routine clinical testing. In addition to caloric testing, which has remained the classical unilateral test of vestibular function, the newly developed tests should improve the differential diagnosis of vestibular disorders.

Caloric Tests↗
PubMed2006

Vestibular impairment and cochlear implantation.

CONCLUSION: Cochlear implantation (CI) may induce vestibular impairment soon after surgery as well as after implant activation. This impairment seems to be independent from the cause of deafness and can be considered a possible complication from the intra-operative trauma and, to minor degree, from the ongoing electric stimulation. It would also seem that vestibular damage occurs independently from the likelihood of post-operative hearing deterioration. In unilateral selected CI cases, vestibular examination can be proposed as additional pre-operative exam for selection of the ear to be implanted. OBJECTIVES: This study has been planned in order to get evidence of eventual impairment of the vestibular apparatus after cochlear implantation as well as to verify whether the impairment could be related to different variables, such as cause of deafness, concomitant hearing deterioration, surgical trauma and duration of electrical stimulation. METHOD: Charts from two different populations of implantees have been reviewed, 21 from a prospective, 72 from a retrospective study, respectively. All the patients were implanted with Clarion(R) devices of different generation. Vestibular testing was based on rotatory, caloric (when possible) and stabilometric measurements, which were carried out pre-operatively and at the following different times: 5 weeks after CI surgery, and 30, 60 and 90 days after CI activation. Hearing thresholds were also assessed in those patients who showed signs of vestibular impairment as well as in a group of patients without vestibular disorders (control). Patients belonging to the retrospective group were all asked to fill a questionnaire regarding their balance condition. Results. In 14.3% of the prospective study group, a grade I and II spontaneous nystagmus was evidenced pre-operatively and remained unchanged during the whole assessment period. A grade II spontaneous nystagmus was present in 3 patients (21.4%) of the same group after surgery. In the immediate post-operative period, vestibular impairment was displayed as true rotational vertigo in 21.4% and unsteadiness in 42.8% of the study group. Severe unsteadiness was present during the first 2 days after activation in 14.3% of the subjects. In 21.4% of the patients a VPPB episode occured. In the retrospective study group, 26.4% of the subjects referred pre-operative dizziness and 25 patients (34.7%) referred immediate post-operative vertigo episodes, which remained in a milder form after CI activation in 12% of them. The hearing threshold showed to deteriorate in both vestibular-impaired and control CI population without significant difference.

Adolescent↗
PubMed1985

[Otoneurologic testing in multiple sclerosis].

The values of the individual audiological and vestibular examination methods in multiple sclerosis (MS) diagnosis are discussed. Our experience shows that the most accurate indications are provided by acoustic stapedius reflex, brainstem auditory evoked potentials (BAEPs) and vestibular investigation. Other testing processes play only a minor part. Using the three methods mentioned, brainstem injuries can be shown to be present at an early stage. Hence one should always include them in MS-diagnosis as a matter of routine. Of the 85 patients we examined, 72 had definite MS and 13 probable (sub-division according to Mc Alpine criteria): all of them underwent acoustic stapedius reflex test and vestibular investigation (nystagmogram, caloric vestibular test according to Hallpike-Frenzel. The stapedius reflex measurements showed pathological findings of 64/54% and the vestibular test findings of 53/61%.

Adult↗
PubMed1993

Is cis-platinum vestibulotoxic?

Serial vestibular testing was performed on 34 patients undergoing cis-platinum chemotherapy and 12 age-matched normal subjects. Vestibular testing comprised caloric and low-frequency, sinusoidal rotational testing (0.01 to 0.16 Hz). Test-retest variability in the caloric and rotational vestibular assessment of the normal subjects formed the basis for evaluation of subclinical loss of vestibular function within our patient population. In spite of high-dose cis-platinum chemotherapy (100 mg/m2) with cumulative dosages to 1600 mg, no clear evidence of vestibular toxicity was found.

Adult↗
PubMed1978

Forced downward ocular deviation. Occurrence during oculovestibular testing in sedative drug-induced coma.

A total of 32 consecutively encountered patients, comatose from sedative-hypnotic drug overdose, were studied by caloric (oculovestibular) testing with ice water. A variety of induced lateral eye movements was observed. The most striking finding was that the induced lateral eye movements were followed (in 24 of 32 cases) by delayed forced downward deviation of one or both eyes. The phenomenon of forced downward ocular deviation during oculovestibular testing of comatose patients should suggest the diagnosis of sedative-hypnotic drug overdose.

Caloric Tests↗
PubMed1981

Acoustic brain stem response in diagnosis of acoustic neuroma.

The aim of the present investigation is to throw light upon the following question: Is recording of click-evoked brain stem responses (ABR) a more sensitive and reliable test than the oto-neurological and conventional audiological tests in selecting patients for computerized tomography (CT)? Thirty-three patients were examined. They all presented case histories and otoneurological findings indicating a tumor in te cerebellopontine angle. In all cases CT was carried out. A tumor was found in 16 patients, normal findings in 17. The results obtained by audiological and oto-neurological tests were compared to those obtained by ABR recording. It is concluded that recording of ABR and the caloric vestibular test are the most reliable examinations in selecting patients for CT. These examinations alone, are, however, not sufficient to secure a completely reliable selection, and should be supplemented by other audiological tests.

Adult↗
PubMed1991

Eye Coordination and Vestibular Testing in Electroconvulsive Therapy.

Nine depressive patients were examined before bilateral electroconvulsive therapy (ECT), immediately after ECT, and 2 days later with saccadic, pursuit tracking, and Hallpike caloric vestibular tests. Before ECT, all tests showed normal results. Immediately after ECT, the saccadic test displayed dysmetria of the fast eye movements in six of nine patients. The pursuit tracking test showed decreased gain of the slow eye movements with compensatory saccades in seven of nine patients. These findings were for both directions in the horizontal plane. In the caloric vestibular test, the changes were not significant. Two days after ECT, the eye coordination and vestibular testing showed normal function. We conclude that the eye coordination and vestibular function disturbances induced by ECT are transient.

Journal Article↗
PubMed1997

[Diagnosis of Gilbert's syndrome: current status of the fasting test. Review of the literature].

UNLABELLED: Gilbert's syndrome is a benign, often familial condition characterized by recurrent but asymptomatic jaundice. AIM: To describe the involvement of the reduced caloric intake test, used as a diagnostic test in Gilbert's syndrome. METHOD: 49 patients were diagnosed of Gilbert's syndrome for 6 years. 39 patients took 400 kcal/day for three days. The unconjugated bilirubinemia levels were measured at 0, 24, 48 and 72 hours. RESULTS: The 82.05% of test were diagnostics at 24 hours (p < 0.001), while it was necessary 48 hours to 100% of tests were diagnostics (p < 0.05). In any case was necessary to determinate the unconjugated bilirubinemia at 72 hours (p < 0.5). CONCLUSIONS: The best diagnostic efficiency of the reduced caloric intake test is at 48 hours, while the 24 hours determination could be considered diagnostic in a big percentage of the cases. It is not necessary the determination at 72 hours in any case.

Adolescent↗
PubMedDate not supplied

The relationship between caloric response, oculomotor dysfunction and size of cerebello-pontine angle tumours.

Seventy-nine consecutive patients, 70 patients with acoustic neurinomas (ACN) and 9 patients with cerebello-pontine angle tumours of other etiology (o-CPA) were analysed with respect to tumour size and the result of the caloric and oculomotor tests. The size of the tumour was judged by the largest diameter calculated from the computerized tomography. A highly significant linear relationship between tumour size and caloric side difference was found for the group of ACN patients who had normal oculomotor function. A unilateral loss of caloric response on the tumour side was found in 75% of the ACN patients with tumours larger than 20 mm, but not in any of the ACN patients with tumours smaller than 10 mm. Oculomotor dysfunction (OMD), defined as disturbed pursuit eye movements and/or gaze nystagmus was frequently found in the patients with ACN larger than 20 mm (77%), and was present in all but one of the o-CPA patients. However, the caloric response on the tumour side was significantly more impaired in the group of ACN patients with OMD than in the o-CPA group. A combined view of the oculomotor and caloric test results offers a possibility to obtain a rough estimate of tumour size as well as to distinguish ACNs from other types of tumours in the cerebello-pontine angle.

Adult↗
PubMed1989

Neurotological follow-up studies upon Minamata disease.

During 1986-87, 35 patients with organic mercury intoxication, who had been recognized as having Minamata disease by the Arbitration Committee in Niigata during 1968-78, were followed up neurotologically in Kido Hospital, Niigata, Japan. Characteristic follow-up features were served, as follows. 1. In 6 cases, spontaneous nystagmus had disappeared, but had newly appeared in 9 cases. However, positional nystagmus was markedly improved in 15 cases. 2. In OKN tests, especially in the vertical OKN test, relatively significant deterioration was observed at the follow-up examinations. 3. There was little significant change in the caloric nystagmus test and body-equilibrium tests. 4. In pure-tone audiometry, 16 out of 58 ears showed deterioration of hearing (28%), while 4 ears showed improvement (7%). In the neurotological findings there was much variation among the patients themselves. Therefore, these variable findings should be considered as being caused not by duration of the intoxication alone, but also by ageing factors in the patients.

Adult↗
PubMed1988

Diagnostic strategies in search for acoustic neuromas. Findings in 300 acoustic neuroma patients.

The diagnostic findings in 300 patients with acoustic neuromas are reported. Because of a centralized treatment of acoustic neuromas, we have a uniform work-up of all the patients, which enables us to make a non-selected comparison of the diagnostic efficiency of the various tests. Diagnostic dilemmas in patients with normal hearing, anakusis, normal auditory brainstem recordings, normal vestibular function and normal tomography of the internal acoustic meatus are discussed. In patients with hearing better than 80 dB, a normal ABR, the presence of recruitment and a normal caloric reaction can exclude the presence of a tumour, making tomography superfluous. In patients with poor hearing, the need for tomography is imperative. We perform CT if two procedures among the following produce tumour-positive results: ABR, recruitment tests, caloric test, and tomography. Those who have only one tumour-positive finding at the screening are re-examined after one year. If, even with contrast enhancement, CT proves negative, we continue to perform air CT. Only then do we know for sure whether the patient has a tumour or not. An advantage with using many tests for the same physiological function is that they complement each other, though, on the other hand this often adds to the confusion. With fewer tests, the confusion is reduced, but the requirements regarding technical quality must be very stringent. ABR, the Metz recruitment test and tomography are purely objective, while the caloric test is subjective on the part of the investigator. The Hallpike procedure, however, has stood the test of time in separating pathologic from normal.

Adolescent↗
PubMed1991

Clinical and financial audit of diagnostic protocols for lesions of the cerebellopontine angle.

OBJECTIVE: To assess the diagnostic efficiency and costs of protocols used for investigating patients with suspected lesions of the cerebellopontine angle. DESIGN: Prospective evaluation of tests of auditory brain stem responses and acoustic reflex thresholds, electronystagmography, and calorics. Positive test results were confirmed or refuted by high resolution computed tomography with intravenous enhancement. SETTING: Single general otolaryngology clinic in a teaching hospital. PATIENTS: 270 consecutive patients with sensorineural hearing loss requiring investigation to exclude a lesion of the cerebellopontine angle. MAIN OUTCOME MEASURES: Estimated costs of various diagnostic protocols and performance in detecting tumours of the cerebellopontine angle. RESULTS: Protocols including tests of auditory brain stem responses and acoustic reflex thresholds as sifting tests before computed tomography were clinically acceptable and presented considerable savings over the use of computed tomography in all patients (74,000 pounds or 84,000 pounds v 122,000 pounds). The use of electronystagmography and calorics could not be justified on clinical or financial grounds. CONCLUSIONS: Audiological tests of auditory brain stem responses and acoustic reflex thresholds followed by computed tomography constitute the most cost effective protocol for determining suspected lesions of the cerebellopontine angle. IMPLICATIONS: The cost effectiveness of diagnostic protocols should be evaluated throughout the health service.

Caloric Tests↗
PubMedDate not supplied

Intratympanic gentamicin therapy for vertigo in nonserviceable ears.

PURPOSE: Intratympanic ototoxic agents have become a widely accepted means of managing vertigo in patients with Meniere's disease while preserving residual hearing. We investigated expanding the indications for intratympanic gentamicin to include control of vertigo in patients without serviceable hearing in the involved ear caused by a variety of end-organ pathologies. MATERIALS AND METHODS: We present a retrospective series of 6 patients suffering from vertigo caused by end-organ disease, in an ear without serviceable hearing. Two patients suffered from delayed endolymphatic hydrops, 3 from Meniere's disease, and 1 from poststapedectomy vertigo. These patients chose unilateral vestibular ablation with serial intratympanic gentamicin injection rather than labyrinthectomy for a variety of reasons. Conventional electronystagmography (ENG) testing and audiometry were completed on all patients. The ENG testing included bithermal calorics and rotational testing. All patients had a magnetic resonance image with gadolinium to exclude retrocochlear or central pathology. Rotational testing was repeated before each injection and at the conclusion of therapy to assess changes in the peripheral vestibular response. The patients' subjective response to therapy was followed. RESULTS: Follow-up has been 10 to 69 months with successful control of vertigo in all patients. CONCLUSIONS: Intratympanic gentamicin therapy offers a minimally invasive, ambulatory, low morbidity, cost-effective means of managing vertigo in patients with nonserviceable hearing.

Adult↗