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Vestibular function tests in children.

Vestibular function tests were performed on a series of 57 children between the ages of 1 and 16 years. Inattention and immaturity of eye movement control created difficulties in the analysis of the electronystagmography traces in some instances. With the eyes closed, spontaneous and positional nystagmus occurred in 20% of asymptomatic children and this was thought to be physiological. Changes in external ear pressure (fistula test) enhanced this spontaneous nystagmus. Smooth pursuit ataxia and optokinetic abnormalities were common in the children with reading disabilities and those with congenital deafness, and were thought to be soft neurological signs of brainstem dysfunction. The torsion swing chair test was acceptable and gave easily readable responses. Caloric abnormalities were very common in children with reading disabilities and provided useful information in those with congenital and acquired disorders of hearing and balance. It was concluded that normal data were required for children of all ages in order to improve our understanding of electronystagmography in children.

Adolescent↗

Modern vestibular function testing.

Current tests of vestibular function concentrate on the horizontal semicircular canal-ocular reflex because it is the easiest reflex to stimulate (calorically and rotationally) and record (using electro-oculography). Tests of the other vestibulo-ocular reflexes (vertical semicircular canal and otolith) and of the vestibulospinal reflexes have yet to be shown useful in the clinical setting. Digital video recording of eye movements and vestibular-evoked responses are promising new technologies that may affect clinical testing in the near future.

Electronystagmography↗

Vestibular function testing.

PURPOSE OF REVIEW: This review provides an overview of vestibular function testing and highlights the new techniques that have emerged during the past 5 years. RECENT FINDINGS: Since the introduction of video-oculography as an alternative to electro-oculography for the assessment of vestibular-induced eye movements, the investigation of the utricle has become a part of vestibular function testing, using unilateral centrifugation. Vestibular evoked myogenic potentials have become an important test for assessing saccular function, although further standardization and methodological issues remain to be clarified. Galvanic stimulation of the labyrinth also is an evolving test that may become useful diagnostically. SUMMARY: A basic vestibular function testing battery that includes ocular motor tests, caloric testing, positional testing, and earth-vertical axis rotational testing focuses on the horizontal semicircular canal. Newer methods to investigate the otolith organs are being developed. These new tests, when combined with standard testing, will provide a more comprehensive assessment of the complex vestibular organ.

Electrodiagnosis↗

Site of lesion vestibular function testing.

The results of conventional electronystagmography (ENG) sometimes are confusing. The Hallpike alternate binaural bithermal (ABB) caloric test is helpful diagnostically except for the group of "sick patients that have a normal test." Conventional ENG tests also fall short in the area of objective confirmation of patient progress. What does each test tell us regarding site of lesion? 1. Alternate binaural bithermal stimulation gives us information about the semicircular canals -- particularly the horizontal semicircular canal -- pickup head. 2. Simultaneous binaural bithermal stimulation gives information brain stem connections -- switching and relay. 3. Rotation testing gives information about the processing by the brain -- central control.

Adult↗

Audiological and vestibular function tests in hypothyroidism.

A battery of audiological and vestibular function tests have been performed in 72 cases of confirmed hypothyroidism. The severity of hypothyroidism was graded as mild, moderate or severe depending upon serum protein-bound iodine estimation. The incidence of hearing impairment, tinnitus and vertigo was correlated with the severity of the disease process. The site of lesion causing sensorineural hearing impairment in 25 cases was pinpointed audiologically.

Adolescent↗

Diagnostic value of vestibular function tests: an analysis of 200 consecutive cases.

The contribution that vestibular function tests can make in achieving a topographic and etiologic diagnosis is being increasingly questioned. A greater reliance is therefore being placed on audiometeric tests including auditory brain stem tests. Our experience with vestibular testing has been most favorable, using photoelectric nystagmography and the Torok monothermal differential caloric test. This analysis of 200 consecutive cases shows that patients with normal vestibular function can be differentiated with certainty from those with organic disorders. In the latter group the site of lesion could be confirmed with greater than 90% accuracy. The reasons why vestibular tests in general are non-productive are discussed.

Allied Health Personnel↗

Delayed motor function and results of vestibular function tests in children with inner ear anomalies.

The relation between the results of vestibular function tests and gross motor development was examined in 4 children with inner ear anomalies. CT scans demonstrated the absence of lateral semicircular canals in both ears in all 4 cases. None responded to caloric stimulation using 40 ml of icewater. In contrast, the damped rotation test elicited per-rotatory nystagmus in all cases. Per-rotatory nystagmus was provoked in only two cases by the Bárány rotation test. Development of gross motor function, especially independent walking, was more delayed in the two children in whom the Bárány rotation test failed to elicit per-rotatory nystagmus.

Child↗