[Reliability of optokinetic nystagmus test].
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Humans↗
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Results for “VESTIBULAR FUNCTION TESTS”
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[The electro-optico-rotatory vestibular test].
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Humans↗
Vestibular evoked myogenic potentials in young children: test parameters and normative data.
OBJECTIVE: The vestibular evoked myogenic potential (VEMP) is a test of the vestibulocollic reflex that has been extensively studied in adults. Much is known about the normal values in adults as well as their changes with age. In children, the expected test values and their possible changes in development have not yet been described nor has the feasibility of reliable testing in this group. The aim of this prospective study is to accumulate normative data and to verify the viability of testing in young children. The study focused on optimal test parameters, reproducibility, and subject compliance in a pediatric population. METHODS: Thirty normal-hearing children (60 ears) ages 3 to 11 completed VEMP testing and audiograms for analysis. VEMP testing was performed with alternating clicks at three intensities (80-, 85-, and 90-dB normalized hearing level) using averaged, unrectified electromyograms recorded by surface electrode on the sternocleidomastoid muscle ipsilateral to the stimulus. VEMP latencies, amplitude, compliance, and length of testing were recorded for each patient, as well as their feedback on the testing session. The subjects were divided into four age groups for analysis. RESULTS: All but one of the subjects attempting VEMP testing was able to finish. Of 30 children completing VEMP tests, bilateral reflexes were recorded for all subjects with symmetric responses in 28 of 30 subjects (93%). The mean peak latencies (+/- standard deviation [SD]) of pI and nII were 11.3 msec (1.3 ms) and 17.6 msec (1.4 ms), respectively. The mean pI-nII amplitude (+/- SD) was 122 muV (68 muV). There was a significantly shorter nII mean peak latency of group I (ages 3-5) left ear in comparison to other groups, with an absolute shorter mean latency nII in the right ear of group I (not significant). Average test time was 15 minutes with two researchers testing, and subjects were highly compliant. CONCLUSIONS: VEMP is a well-tolerated test for screening vestibular function in young children, performed with minimal test time and reproducible results. Mean latencies in this study suggested a shorter initial negative peak (nII) than in adult studies, consistent with prolongation seen in previous research on the effects of age. Ninety-decibel normalized hearing level clicks were adequate for uniform response rates. Expected latency and amplitude values in single-channel VEMP-unrectified electromyograms were established. This is the first study describing expected latencies and optimal testing parameters in children.
Child↗
[Clinical application of the visual suppression test].
200 cases of peripheral and central vestibular disorder patients were examined by caloric test and visual suppression test (VS) simultaneously. The results with ENG recording showed: (1) VS score > 50% indicates normal function. (2) VS score 50%-10% is function decreased. (3) VS score < 10% shows function failure. (4) Patients with negative VS score accompanies nystagmus strengthen with eye open when in the light also, the clinical application of the VS test for diagnosis of several kinds of vestibular disorder were discussed.
Acoustic Stimulation↗
[Ganglion block and vestibular test].
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Autonomic Agents↗
Pseudocaloric nystagmus.
Pseudocaloric nystagmus (PCN) is an appropriately beating nystagmus induced by cold caloric irrigation of an ear with abolished vestibular function. The nystagmus is not the result of endolymph flow but probably represents unmasking a latent nystagmus by altering the patient in this case, through tactile (caloric) stimulation. Pseudocaloric nystagmus has the following characteristics: (1) mild intensity (eyes closed-slow phase velocity usually less than 8 degrees/sec), it has not been observed with the eyes open, (2) always beats away from the diseased ear; therefore, any nystagmus induced by cold irrigation will be appropriately (contralateral) beating while that induced by warm irrigation will be inappropriately (contralateral beating; 3) the induced nystagmus will not reverse direction after inverting the ampulla. Establishing bidirectional sensitivity of the cupula by demonstrating appropriately beating nystagmus to ampullopetal and ampullofugal flow of endolymph not only assures that the lateral semicircular canal (SCC) is functionally intact to caloric stimulation but will avoid errors in electronystagmorgraphic (ENG) interpretation.
Caloric Tests↗
[Vestibular function in severely retarded children in relation to their motor disabilities].
We examined vestibular functions of thirty-one severely retarded children with caloric test and rotation nystagmus test, in combination with auditory brainstem response (ABR) recordings and measurement of brainstem width on cranial CT scans. The laterality of vestibular response was over 20% in most of the bedridden cases and was under 20% who could move. Abnormal findings in ABR had no relationship with the degree of motor disabilities, but decreased width of brainstem on CT scan showed some relationship with the degree of motor disabilities. We conclude that vestibular function tests are useful to predict future motor development in severely retarded children.
Adolescent↗
Determining the effectiveness of a vibrotactile balance prosthesis.
We present a quantitative method for characterizing the effectiveness of a balance prosthesis based on tactile vibrators. The balance prosthesis used an array of 12 tactile vibrators (tactors) placed on the anterior and posterior surfaces of the torso to provide body orientation feedback related to the angular position and velocity of anterior-posterior body sway. Body sway was evoked in subjects with normal sensory function and in vestibular loss subjects by rotating the support surface upon which a test subject stood with eyes closed. Tests were performed both with (tactor trials) and without (control trials) the prosthesis activated. Several amplitudes of support surface stimulation were presented with each stimulus following a pseudorandom motion profile. For each stimulus amplitude, a transfer function analysis characterized the amplitude (gain) and timing (phase) of body sway evoked by the support surface stimulus over a frequency range of 0.017 to 2.2 Hz. A comparison of transfer function results from the control trials of normal subjects with results from tactor trials of vestibular loss subjects provided a quantitative measure of the effectiveness of the balance prosthesis in substituting for missing vestibular information. Although this method was illustrated using a specific balance prosthesis, the method is general and could be applied to balance prostheses that utilize other technology.
Adult↗
Hearing, language, speech, vestibular, and dentofacial disorders in fetal alcohol syndrome.
Fetal alcohol syndrome (FAS) is characterized by congenital anomalies traditionally associated with hearing disorders. The present study sought to (a) evaluate possible central hearing loss; (b) verify and extend previous observations on sensorineural and conductive hearing losses; (c) evaluate possible vestibular disorders; (d) examine the relationships between hearing, speech, language, vestibular, and dentofacial disorders in FAS patients; and (e) evaluate the influence of patient age, race, and gender on the expression of these morbidities. A biracial group of 22 FAS patients (aged 3 to 26 years) were evaluated by standard hearing, speech, language, and vestibular tests. Dentofacial and other malformations were also assessed. Of the 22 FAS patients, 17 (77%) had intermittent conductive hearing loss due to recurrent serous otitis media that persisted from early childhood into adulthood, whereas 6 (27%) had sensorineural hearing loss in addition to the conductive hearing loss. Among the 12 patients tested for central hearing function, all (100%) were significantly impaired. Among the patients tested for speech and language ability, 18 of 20 (90%) had speech pathology, 16 of 21 (76%) had expressive language deficits, and 18 of 22 (82%) had receptive language deficits. Hearing, speech, and language deficits were not influenced by age, race, or gender. On the vestibular tests, all performed within normal limits with the possible exception of one child (n = 6). High incidences of dentofacial, temporomandibular joint, ocular, cardiac, and skeletal disorders were observed. Race and gender tended to influence dental malocclusion class. Two subjects exhibited autistic tendencies. In conclusion, new and important findings included a high prevalence of sensorineural, conductive, and central hearing deficits, the persistence of otitis proneness into adulthood, the existence of temporomandibular joint disorders, and the possible influence of gender or race on dental malocclusions. Such disorders can contribute to the learning, behavioral, and emotional difficulties seen in FAS patients and warrant early, aggressive intervention.
Adolescent↗
[Dynamics of cochleovestibular disorders in patients with early manifestations of cerebral circulation insufficiency].
Current diagnostic criteria of early manifestations of cerebral circulation disorders are entirely subjective. Most patients with this pathology are referred to the functional category and are consequently ignored by neurologists although their social adaptation is inadequate. On the basis of clinical data obtained from 150 patients with verified cerebral circulation pathologies the present author recommends to use otoneurological examinations to objectivize subjective diagnostic criteria and to monitor therapeutic efficiency. The author describes vestibular responses that can be used by a clinician in an outpatient clinic to identify patients who need a more detailed and often otoneurological examination as well as to control the efficiency of prescribed therapeutic agents.
Adult↗
Variability of air calorics vs water. Statistical implications.
The increasing use of air as a medium for inducing caloric nystagmus has produced a wide variety of comment, much of which may be ignored by opponents or proponents of air. What cannot be ignored by the latter is the report of increased response variability with air irrigation. The effect of increased single-measure variability on the variability of the resultant measures of unilateral weakness (UW) was explored by (1) development of a theoretical equation for the variance of UW and (2) examination of results from normal and clinical subjects. The theoretical equation indicates that variability is a function of both mean responses and the correlation between responses from opposite sides, as well as the variability of single measures. Increases in single-measure variability are attenuated by the formula to a degree such that clinically important increases in the variability of measures of UW are unlikely. This conclusion was supported by results from 22 normal and 12 clinical subjects and reexamination of previous reports.
Air↗
[Some aspects of otovestibular function in hyperbaric saturation].
Otovestibular performance was investigated in divers undergoing air and helium-oxygen hyperbaric saturation cycles. The subjects were all very experienced deep-sea divers. Before cycles, they presented various signs of altered otovestibular performance. These were not altered when controlled subsequently. No conclusions can be drawn from this small series, though its heterogeneity lends some significance to the results and it has been presented on account of the lack of other studies of this question.
Adult↗
Cis-platinum vestibular toxicity.
Cis-diamminedichloroplatinum has been proven to be an effective neoplastic agent. Nephrotoxicity and ototoxicity are two prominent side effects of this drug. Investigation of ototoxicity has been limited to auditory function. This report details the first known case of vestibular toxicity following platinum therapy. In addition, a prospective vestibular testing program is reported.
Aged↗
[Practical value of vestibular tests].
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Adult↗
General vestibular testing.
A dysfunction of the vestibular system is commonly characterized by a combination of phenomena involving perceptual, ocular motor, postural, and autonomic manifestations: vertigo/dizziness, nystagmus, ataxia, and nausea. These 4 manifestations correlate with different aspects of vestibular function and emanate from different sites within the central nervous system. The diagnosis of vestibular syndromes always requires interdisciplinary thinking. A detailed history allows early differentiation into 9 categories that serve as a practical guide for differential diagnosis: (1) dizziness and lightheadedness; (2) single or recurrent attacks of vertigo; (3) sustained vertigo; (4) positional/positioning vertigo; (5) oscillopsia; (6) vertigo associated with auditory dysfunction; (7) vertigo associated with brainstem or cerebellar symptoms; (8) vertigo associated with headache; and (9) dizziness or to-and-fro vertigo with postural imbalance. A careful and systematic neuro-ophthalmological and neuro-otological examination is also mandatory, especially to differentiate between central and peripheral vestibular disorders. Important signs are nystagmus, ocular tilt reaction, other central or peripheral ocular motor dysfunctions, or a unilateral or bilateral peripheral vestibular deficit. This deficit can be easily detected by the head-impulse test, the most relevant bedside test for the vestibulo-ocular reflex. Laboratory examinations are used to measure eye movements, to test semicircular canal, otolith, and spatial perceptional function and to determine postural control. It must, however, be kept in mind that all signs and ocular motor and vestibular findings have to be interpreted within the context of the patient's history and a complete neurological examination.
Humans↗
[Evaluation of VIIIth nerve disorders in learning-disabled children].
Recent research indicates that a subclinical VIIIth nerve defect can be a major contributing factor to, if not a cause of learning disabilities. A battery of tests developed for evaluation of VIIIth nerve function is presented. These tests include assessment of vestibular function and evaluation of auditory figure ground abilities. 70 primary school children diagnosed as learning-disabled by child study teams were tested using this battery. 94% had abnormal findings in the electronystagmographic test and 22% in the auditory figure ground test. This battery of tests can detect subclinical defects in learning-disabled children which can be alleviated by a combination of proper medical treatment and an appropriate educational plan.
Child↗
Vestibular diagnosis in Menière's disease.
Vestibular diagnosis of Menière's disease must be based on the results of an elaborate test battery. The latter should include a complete caloric test (stimulation with cold and warm water), carried out under nystagmographic control. Statistical analysis of caloric responses recorded in 100 normal test subjects by D.C. nystagmography show clearly that culmination frequency and culmination eye velocity are the most reliable parameters indicating an unilateral loss of function. With respect to the differential diagnosis - endorgan or neuronal lesion - only the galvanic test allows an unequivocal localisation of the site of the lesion. An analysis of 50 cases of Menière's disease reveals normal liminal and supraliminal galvanic responses without exception, thus indicating that the concomitant reduced caloric response is due to a lesion strictly confined to the vestibular endorgan. Hence the galvanic test may serve the same diagnostic purposes as supraliminal tests in pure tone audiometry.
Caloric Tests↗