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PubMed2000

Electronystagmographic study in chronic schizophrenia.

The authors reached the neurological and psychiatric diagnosis of chronic schizophrenia in 20 patients after examination of both vestibulooculomotor and visuooculomotor reflexes on electronystagmography. The type and intensity of the disease were established on adequate scales, and the entire group was tested in the remission stage, during the absence of psychotic signs. Electronystagmographic study, particularly the eye-tracking test with caloric modification, revealed the significant pathology of optokinetic nystagmus. The disturbances of the suppression effect of fixation on caloric nystagmus were observed in one-half the cases. Caloric stimulation demonstrated no case of canal paresis and a very small amount of directional preponderance.

Adult↗
PubMed1978

[The early diagnosis of cerebello-pontine angle tumors (author's transl)].

The early symptoms and findings of 25 patients with tumors of the internal auditory canal and cerebellopontine angle are described. Particular emphasis is placed on the diagnostic value of our methods for early tumor detection. Of the audiometric suprathreshold methods, the Carhart test, stapedius reflex audiometry, and the speech audiogram constituted the most reliable procedures for defining deafness due to involvement of the auditory nerve by tumor. All of the patients examined by electronystagmography showed a significant vestibular hypoexcitability on the side of tumor involvement. The methodology of the vestibular testing and its evaluation are detailed. Although these methods are complicated and time-consuming, they enable an early tumor diagnosis to be made so that surgical intervention will result in preservation of the facial nerve and markedly lessen surgical mortality.

Audiometry↗
PubMed1986

[Significance of the Bárány convection hypothesis for thermal nystagmus. Quantitative comparison of the intensity of thermal nystagmus in supine and prone position].

The hypothesis of Bárány explaining thermic nystagmus has been shaken. We must accept a non-convective triggering of nystagmus in extraterrestrial space. Under terrestrial conditions, however, the reversibility of the thermic nystagmus by changing from supine to prone position continues to support the convection hypothesis. We examined the nystagmus intensity in the supine and prone position with 22 healthy ears. The thermic stimulus was monitored via computer-controlled alternating irrigation system. The sequence of examinations was randomised and the evaluation of the nystagmus effected by automatic analysis. Our data allow to assess the importance of the non-convective nystagmus. With clinical test conditions about 85% of the maximal thermal reaction can be explained by the convection hypothesis of Bárány. However, interindividual variance is considerable, and one exceptional case with predominantly non-convectively released nystagmus is presented.

Adult↗
PubMed1983

Vestibular function testing: where are we in 1983?

Conceptual, technological, electronic and computer revolutions have transformed the methodology for evaluating the patient with dysequilibrium. What has been said and written for the past 25 years is not currently applicable. Present day, cost effective, clinical evaluation format is presented, including changes and deletions in the conventional ENG test battery. It also includes the addition of computer technology in the rotation and ocular tracking tests. These deletions and additions in technique provide the clinician with more useful practical data for diagnosis. There is also capability for patient follow-up and monitoring. These concepts are presented from the clinical vantage point and are supported with patient evaluation examples.

Caloric Tests↗
PubMed1999

Prognosis in bilateral vestibular hypofunction.

OBJECTIVES/HYPOTHESES: The outcomes of patients with bilateral vestibular hypofunction vary widely. Some resume relatively normal activity within months, whereas others have a more debilitated course. This study sought to identify factors that may affect outcome. STUDY DESIGN: A retrospective review of patients treated for bilateral vestibular hypofunction over a 2-year period at a neurotology clinic. METHODS: Patients' medical charts, electronystagmography data, rotatory chair testing, and posturography results were reviewed. Subjective and objective measures were used to evaluate outcome. RESULTS: Bilateral vestibular hypofunction was diagnosed in 35 patients. Improvement after vestibular rehabilitation therapy was noted in 18 patients (51%), whereas 12 (34%) showed little or no change and 5 (15%) were not available for follow-up. The patients without improvement were more likely to have a chronic disorder as a cause of the vestibulopathy and had more medical comorbidities, on average, when compared with those who improved. Lower gains and time constants on rotatory chair testing were also seen in the group that did not improve. CONCLUSIONS: Poor rehabilitation results may be attributable to increased severity of vestibular insult, progressive peripheral or central vestibular dysfunction, and multiple medical problems.

Adolescent↗
PubMed1977

[The diagnostic value of the Stepping Test of Unterberger (author's transl)].

Of the vestibulo-spinal reactions, the "stepping test" is considered to be the most important, especially for unilateral peripheral vestibular disturbances. Electronystagmography was performed on seven patients after transtemporal neurectomy of the vestibular nerve, 17 patients with a nearly compensated vesitbular defect after vestibular neuronitis, and seven patients after suboccipital removal of acoustic neuromas. These results were then compared to the spontaneous stepping test. The test could not be performed on six of the seven patients with the operated acoustic neuroma, and on three other patients. The test was positive in only ten of the other 22 patients. It was incorrect in five patients and equivocal in seven. A reliable spontaneous vestibulo-spinal reaction with nearly compensated peripheral vestibular defects could not be determined during the present study.

Adult↗
PubMed2007

The dizziness handicap inventory and its relationship with functional balance performance.

OBJECTIVE: The purpose of this study was to describe the relation between the Dizziness Handicap Inventory (DHI) and balance performance measures. STUDY DESIGN: Retrospective case series. SETTING: Outpatient balance clinic in a tertiary referral center. PATIENTS: Patients referred with dizziness or imbalance of vestibular and nonvestibular origin. OUTCOME MEASURES: DHI, Romberg with Jendrassik maneuver, standing on foam, tandem Romberg, single-leg stance, the timed up and go test, the Dynamic Gait Index (DGI), tandem gait, and the 10-m walking test. RESULTS: The mean age of participants (n = 214) was 53.9 years. The mean DHI total score was 35.1, ranging from 0 to 96. Spearman rank correlation coefficients (rS) between DHI and the static balance tests were fair and ranged between -0.42 (p < 0.01) for single-leg stance with eyes closed and -0.51 (p < 0.01) for single-leg stance with eyes open. Only the Romberg test with Jendrassik maneuver correlated weakly (rS = -0.25; p < 0.01) with the DHI. Correlations with the walking tests were moderate, the connection with the DGI being the strongest one (rS = -0.69; p < 0.01). Forty-two percent of the variance in DHI scores in our patients was accounted for by the DGI score (r = 0.417). CONCLUSION: Functional balance tests involving locomotion correlate better with DHI scores when compared with static balance measures. The DGI explains a large component of handicap in dizzy and unsteady patients, which advocates its use in these patients.

Adult↗
PubMed2005

Comparing neurootological complaints in patients at the end of their professional lives (51-60 years) with those during the first phase of retirement (61-70 years).

Geriatrics defines the branch of medicine that treats all problems peculiar to old age and the aging, including the clinical problems of senescence and senility. In the full chain of years of the human life, a special period is humans' last decade of professional life (i.e., 51-60 years) and their first decade of retirement (i.e., 61-70 years). For this study aimed at comparing neurootological complaints of persons in this period of their lives, we examined large samples of European neurootological patients: Group A consisted of 1,965 persons aged 51-60 years, and group B consisted of 1,032 persons aged 61-70 years. Of the 11 vertigo and nausea symptoms evaluated, group A demonstrated 2.68 signs and group B 2.49 signs per individual. Acoustic subjective symptoms of tinnitus were exhibited in 55.42% of group A patients, and hearing loss was present in 63.92% of these patients. In group B, 52.62% of patients exhibited tinnitus, and 68.31% of patients had hearing loss. Our experimental neurootometric investigations exhibited the following rates of abnormal test findings in group A: butterfly calorigrams, 71.86%; stepping craniocorpography, 72.01%; and pure-tone audiometry of bone conduction, 37.66% in the right and 47.07% in the left ear. Among group B patients, abnormal test findings were noted as follows: butterfly calorigrams, 69.86%; stepping craniocorpography, 74.03%; and pure-tone audiometry of bone conduction, 44.57% in the right and 55.43% in the left ear.

Aged↗
PubMedDate not supplied

The anti-motion sickness mechanism of ginger. A comparative study with placebo and dimenhydrinate.

A controlled, double-blind study was carried out to determine whether nystagmus response to optokinetic or vestibular stimuli might be altered by some agent contained in powdered ginger root (Zingiber officinale). For comparative purposes, the test subjects were examined after medication with ginger root, placebo and with dimenhydrinate. Eye movements were recorded using standard ENG equipment and evaluation was performed by automatic nystagmus analysis. It could be demonstrated that the effect of ginger root did not differ from that found at baseline, or with placebo, i.e. it had no influence on the experimentally induced nystagmus. Dimenhydrinate, on the other hand, was found to cause a reduction in the nystagmus response to caloric, rotatory and optokinetic stimuli. From the present study it can be concluded that neither the vestibular nor the oculomotor system, both of which are of decisive importance in the occurrence of motion sickness, are influenced by ginger. A CNS mechanism, which is characteristic of the conventional anti-motion sickness drugs, can thus be excluded as regards ginger root. It is more likely that any reduction of motion-sickness symptoms derives from the influence of the ginger root agents on the gastric system.

Adult↗
PubMed1995

[The examination of vestibular system in patients with degenerative changes of the cervical spine].

Degenerative changes of the cervical spine often cause the pains and vertigo as well as pathological results of otoneurological tests. The aim of the study was to estimate the frequency of the symptoms occurrence in the group of 146 patients, 63 male and 83 female, with degenerative changes of the cervical spine. Permanent or periodical headaches of various intensity occurred in 60% of the patients. Balance disturbances was observed in 74% of the patients, specially in women. In the cervical spine X-ray there were observed most frequently marginal degenerations with osteophytosis (16%), intervertebral disk narrowing (10%), and shallowing of the physiological lordosis (11%). In ENG examination, positional nystagmus (42-38%), gaze nystagmus (14-23%) were mainly recorded, with the eyes opened and closed. The eye-tracking pattern test was pathological in 57%. Optokinetic test results showed pathological records in 32% of the patients, unilateral weakness was observed in 22% and bilateral weakness in 17% of the patients. Observations mentioned above confirm frequent pathology and the necessity of early diagnosis and treatment of patients with degenerative changes of the cervical spine.

Adult↗
PubMed1995

Auditory air and bone conduction brainstem responses and damped rotation test for young children with bilateral congenital atresia of the ears.

This paper describes our assessment of auditory and vestibular functions at a very early age using the auditory air and bone conduction brainstem responses and the damped rotation test for infants and children with bilateral congenital atresia of the ear. Twelve infants and children with congenital microtia and occlusion of bilateral auditory canals were evaluated by this assessment to determine their function of hearing and balance and their suitability for fitting and surgical improvement.

Audiometry, Evoked Response↗
PubMed1984

The European vestibular experiments in Spacelab-1.

A series of experiments were performed in the Spacelab-1 mission on November/December, 1983, pre-, in-, and postflight. These experiments covered various aspects of the functions of the vestibular system, the inflight tests comprising threshold measurements for linear movements in three orthogonal axes, optokinetic stimulation, vestibulo-ocular reflexes under linear and angular accelerations, caloric stimulation with and without linear accelerations; pre- and postflight tests repeated the inflight protocol with the addition of subjective vertical and eye counter-rotation measurements using a tilt table. One of the most surprising and significant results was the caloric test: strong caloric nystagmus on the two subjects tested was recorded inflight; this was contrary to what was expected from Barany's convection hypothesis for caloric nystagmus.

Adaptation, Physiological↗
PubMed1990

[Vestibular disorders in Parkinson patients].

Patients suffering from Parkinson's disease frequently complain of dizziness, postural instability and falls. Vestibular tests have been performed in 30 parkinsonian patients and in 28 controls. The results suggest a central vestibular disturbance in Parkinson's disease which correlates with the clinical disability. This vestibular disturbance is assumed to be due to dysfunction of the nigro-striato-collicular tracts.

Aged↗
PubMed2006

What is the true incidence of horizontal semicircular canal benign paroxysmal positional vertigo?

OBJECTIVE: To assess the correct incidence of horizontal semicircular canal (H-SCC) benign paroxysmal positional vertigo (BPPV). STUDY DESIGN: Retrospective assessment of patients with BPPV. METHODS: All patients with BPPV were included and the rates of involvement of posterior, horizontal, and anterior SCCs were determined. RESULTS: One hundred sixty-nine patients with the diagnosis of BPPV were evaluated. One hundred forty-four patients (85.2%) were found to have posterior SCC (P-SCC) involvement, and there were 20 patients (11.8%) with horizontal SCC (H-SCC) and 2 patients (1.2%) with anterior SCC (A-SCC) involvement. Three patients (1.8%) had simultaneous H-SCC and P-SCC BPPV ipsilaterally. Geotropic nystagmus was seen in 17 out of 23 patients (73.9%) in roll test, and ageotropic nystagmus was seen in the remaining 6 patients (26.1%). CONCLUSION: H-SCC constitutes 13.6% of all BPPV cases. H-SCC BPPV with geotropic nystagmus is more common. H-SCC BPPV can coexist with ipsilateral P-SCC BPPV. However, in some cases of H-SCC BPPV, Dix-Hallpike maneuver can cause vertigo and horizontal nystagmus. This may be confused with P-SCC BPPV. Therefore, the roll test must be performed in all cases in addition to Dix-Hallpike maneuver and both ears must be evaluated with respect to all SCCs for BPPV. EBM RATING: C-4.

Adult↗
PubMed1979

[Nystagmometry and biocybernetics (author's transl)].

Nystagmus can be predicted or simulated by means of mathematical models. If the simulation seems to be successful the parameters of the model may be used for an adequate description of the nystagmic response. Considering the biocybernetics of the vestibulo-oculomotor system a minimal extent of computer-nystagmometry is determined. The efficient application of this method requires the knowledge of standard values for the involved parameters. These values have been determined for tests with sinusoidal rotatory stimulation. Age dependent nominal values can be computed and are compared with actual results. The differences are divided by the standard deviation; values less than 2 are supposed to be normal. Thus a first step of automatic assessment of the vestibular system's function becomes possible.

Adolescent↗
PubMed1986

[Effect of the increase of the caloric load of a meal on gastric emptying of its solid and liquid phases].

Caloric regulation of gastric emptying was mainly assessed with artificial liquid meals. We thus studied the effects of glucidic and lipidic caloric loads on gastric emptying of a solid-liquid meal (400 ml; 480 kcal), measured by an isotopic technique. Sixteen healthy subjects were separated in 3 groups; solutions of identical volume (400 ml) were added to the meal: water in group I (N = 6), glucose polymers (Caloreen; 400 kcal) in group II (N = 5), and triglycerides (Intralipide; 400 kcal) in group III (N = 5). Gastric emptying was dramatically slower in groups II and III than in group I, whatever the parameter considered. The magnitude of this caloric brake was identical for the 2 caloric loads tested and concerned both phases of the meal. Therefore, 3 h after the end of the meal, intragastric percentages of ingested liquids were 50 +/- 4 in group II, 52 +/- 5 in group III, vs 14 +/- 1 p. 100 in group I (p less than 0.001); for solids these percentages were 56 +/- 6 and 68 +/- 2 vs 11 +/- 3 p. 100 (p less than 0.001). In all groups, emptying of solids was slower than that of liquids, but the kinetics of this discrimination was modified by the increase of caloric load. The pyloric output of calories, estimated for the 3 h of the study was close to 2 kcal/min for the 3 groups studied. Thus, the 2 fold increase of the caloric concentration in groups II and III as compared to group I, did not modify the delivery rate of energy to small bowel.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1997

Unilateral vestibular neuritis with otolithic signs and off-vertical axis rotation.

Off-vertical axis rotation (OVAR) at constant velocity is a dynamic otolith stimulus that induces horizontal and vertical eye movement responses. To determine the value of this examination as a test for unilateral otolithic hypofunction, we compared the OVAR responses of patients suffering from acute vestibular neuritis (VN) without any sign of otolith affection, with those of patients suffering from acute VN with otolithic signs. The horizontal eye movement bias component shows directional preponderance (DP) significantly higher in patients with otolithic signs than in patients not presenting them. However, as bias DP also reflects the imbalance between right and left horizontal canals activity, this greater bias DP could be explained by the more severe canals impairment-evaluated by caloric test-found in patients with otolithic signs. No significant difference can be shown on horizontal modulation. The DP of vertical modulation is significantly higher in patients presenting otolithic signs than in patients not presenting them: in the case of otolithic signs, the responses are smaller during rotations toward the affected side. Therefore, this variable could be used as an indication of unilateral otolithic hypofunction.

Adult↗
PubMed1993

Oscillopsia in patients with loss of vestibular function.

Contrary to standard teaching, many patients with bilateral vestibular loss clearly deny oscillopsia or imbalance in darkness. In an attempt to characterize these patients within the larger population of all patients with bilateral vestibular loss, the rotation and posturography test results of 22 patients with bilateral vestibular loss were reviewed. In addition, dynamic visual acuity was assessed with an eye chart test. There was a poor relationship between oscillopsia and dynamic visual acuity or rotation testing. There were three patterns of response on rotation testing, and loss of high-frequency gain was seen in as many patients who reported oscillopsia as did not. There were some patients with normal gain values at all frequencies tested who reported oscillopsia. It may be that the change in the VOR, rather than the absolute VOR loss, is responsible for the production of oscillopsia. On the basis of this and other studies, treatment strategies for patients with bilateral vestibular loss are suggested.

Adolescent↗