Vertigo and Imbalance

2016 ◽  
pp. 869-912
Author(s):  
David A. Zapala
Keyword(s):  
Semicircular Canal ◽  
Muscle Tone ◽  
Vestibular Evoked Myogenic Potentials ◽  
Caloric Test ◽  
Anatomy And Physiology ◽  
Ocular Reflex ◽  
Vestibular Tests ◽  
Otolith Function ◽  
Vestibular Ocular Reflex ◽  
Central Compensation

Electrophysiologic testsests can be used to evaluate the function of each of the five vestibular sensory receptors in the labyrinth, in patients with dizziness and imbalance. Tests of semicircular canal function concentrate on vestibular ocular reflex behavior and include the bilateral, bi-thermal caloric test, video head impulse tests (vHIT), and rotary chair tests. Otolith function tests focus on changes in muscle tone and include the cervical and ocular vestibular evoked myogenic potentials (cVEMP and oVEMP). Interpreting vestibular tests requires an understanding of the underlying anatomy and physiology, and an appreciation of central compensation processes and their effects on each test. This chapter reviews the techniques and interpretation of vestibular testing to assess semicircular canal and otolith function and postural control.

Effects of cochlear implants on otolith function as evaluated by vestibulo-ocular reflex and vestibular evoked myogenic potentials

2019 ◽  
Vol 46 (6) ◽  
pp. 836-843
Author(s):  
Takao Imai ◽  
Tomoko Okumura ◽  
Yumi Ohta ◽  
Kazuo Oshima ◽  
Takashi Sato ◽  
...  
Keyword(s):  
Cochlear Implants ◽  
Vestibular Evoked Myogenic Potentials ◽  
Ocular Reflex ◽  
Otolith Function ◽  
Vestibulo Ocular Reflex

scholarly journals Utilization of an Application in Dizziness Treatment: Pilot Study

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Maria da Glória Canto de Sousa
Keyword(s):  
Female Gender ◽  
Qualitative Approach ◽  
Therapy Process ◽  
Dizziness Handicap Inventory ◽  
Beneficial Effects ◽  
Ocular Reflex ◽  
Vestibular Ocular Reflex ◽  
Before And After ◽  
Central Compensation

Vestibular Rehabilitation (VR), a method of therapy for dizziness, aims at reestablishing body balance and also at facilitating central compensation by means of adaptation and substitution mechanisms. With technological advance, the feasibility of a device which aided in VR process took place, both for stimulating and monitoring patients. In that sense, an application called Dizziness APP was developed in order to simplify and automatize dizziness therapy process performed by the phonoaudiology professional. The aim of the present study was to report a Dizziness APP experience of usage as therapeutic strategic towards dizziness, besides comparing dizziness impact on quality of life before and after using that application. It is a descriptive, exploratory study with a qualitative approach. A subject, age 29, female gender, took participation in the present study being solely subjected to Vestibular-Ocular-Reflex (VOR) Exercises by means of vertical, horizontal and oblique optokinetic stimulation during a period of six months. The scores obtained on Dizziness Handicap Inventory (DHI), monthly, expressed by the utilization of an automatized and simplified digital process available on the Dizziness APP application, were used. Initial DHI score achieved 46 points and, upon treatment conclusion, 0 point. Using Dizziness APP as a therapeutic resource enabled the following up, monitoring and remission of dizziness symptom demonstrating the beneficial effects by means of optokinetic exercise during the Dizziness APP process of validation.

scholarly journals Clinical Characteristics of Patients With Dizziness/Vertigo Accompanied by Posterior Semicircular Canal Hypofunction

2021 ◽  
Vol 8 ◽  
Author(s):  
Zheyuan Li ◽  
Bo Liu ◽  
Hongli Si ◽  
Kangzhi Li ◽  
Bo Shen ◽  
...  
Keyword(s):  
Inner Ear ◽  
Semicircular Canal ◽  
Clinical Characteristics ◽  
Disease Onset ◽  
Vestibular Migraine ◽  
Vestibular Evoked Myogenic Potentials ◽  
Caloric Test ◽  
Horizontal Semicircular Canal ◽  
Inner Ear Disease ◽  
Autoimmune Inner Ear Disease

Objective: To investigate the clinical characteristics of patients with dizziness/vertigo accompanied by loss of the posterior canal(s) (LPC).Methods: Clinical data of 23 patients with LPC were collected. We determined video-head-impulse test (vHIT) gains of all six semicircular canals and correlated vHIT findings with other vestibulo-cochlear tests, including caloric test, ocular and cervical vestibular-evoked myogenic potentials (oVEMP, cVEMP), pure tone audiometry (PTA), and analyzed the differences in clinical manifestations of patients with LPC with different etiologies.Results: LPC was identified in 23 patients. At the time of disease onset, most patients presented with dizziness (47.8%) and vertigo (30.4%) only, and some patients (21.7%) complained of unsteadiness. Among these 23 patients with LPC, there were 14 (60.9%) patients of isolated LPC (ILPC), 21 (91.3%) patients of unilateral LPC (ULPC), and 2 (8.7%) patients of bilateral LPC (BLPC). (1) Among 14 patients with ILPC, 13 (92.9%) patients had unilateral ILPC, the rate of ipsilesional impairment on caloric test, or oVEMP/cVEMP test or PTA ipsilesionally was 53.8% (7/13) in patients with unilateral ILPC. The causes of unilateral ILPC were vertigo/dizziness of unclear origin (38.5%), labyrinthine infarction (15.4%), vestibular migraine (15.4%), and other diseases (30.8%); (2) among 21 patients with ULPC, 7 patients (33.3%) were accompanied with horizontal semicircular canal hypofunction ipsilesionally, the abnormal rate of caloric test, or oVEMP/cVEMP tests or PTA ipsilesionally was 57.1%. The causes of ULPC were vertigo/dizziness of unclear origin (33.3%), autoimmune inner ear disease (14.3%), labyrinthine infarction (14.3%), vestibular neuritis (9.5%), vestibular migraine (9.5%), and other diseases (19.0%); (3) among two patients with BLPC, one patient presented with unsteadiness, the causes of BLPC were vestibular paroxysmia and autoimmune inner ear disease.Conclusion: vHIT is a fast and effective method for assessing LPC, which can be used to detect isolated PC dysfunction. The causes of ILPC were peripheral origin or central origin. Patients with ILPC and ULPC mostly presented with dizziness/vertigo, and ULPC was often accompanied by ipsilateral vestibulo-cochlear impairment.

scholarly journals Skull Vibration-Induced Nystagmus Test in a Human Model of Horizontal Canal Plugging

2021 ◽  
Vol 11 (3) ◽  
pp. 301-312
Author(s):  
Georges Dumas ◽  
Christol Fabre ◽  
Anne Charpiot ◽  
Lea Fath ◽  
Hella Chaney-Vuong ◽  
...  
Keyword(s):  
Semicircular Canal ◽  
Vestibular Function ◽  
Human Model ◽  
Vestibular Evoked Myogenic Potentials ◽  
Head Impulse Test ◽  
Slow Phase ◽  
Caloric Test ◽  
Horizontal Semicircular Canal ◽  
Horizontal Canal ◽  
Tertiary Referral Center

Background/Aim: the aim of this study was to assess the skull vibration-induced nystagmus test (SVINT) results and vestibular residual function after horizontal semicircular canal (HSCC) plugging. Methods: In this retrospective chart review performed in a tertiary referral center, 11 patients who underwent unilateral horizontal semicircular canal plugging (uHSCCP) for disabling Menière’s disease (MD) were included. The skull vibration-induced nystagmus (SVIN) slow-phase velocity (SPV) was compared with the results of the caloric test (CaT), video head impulse test (VHIT), and cervical vestibular-evoked myogenic potentials (cVEMP) performed on the same day. Results: Overall, 10 patients had a strong SVIN beating toward the intact side (Horizontal SVIN-SPV: 8.8°/s ± 5.6°/s), 10 had a significant or severe ipsilateral CaT hypofunction, 10 had an ipsilateral horizontal VHIT gain impairment, and 3 had altered cVEMP on the operated side. Five had sensorineural hearing worsening. SVIN-positive results were correlated with CaT and horizontal VHIT (HVHIT) results (p < 0.05) but not with cVEMP. SVIN-SPV was correlated with CaT hypofunction in % (p < 0.05). Comparison of pre- and postoperative CaT % hypofunction showed a significant worsening (p = 0.028). Conclusion: SVINT results in a human model of horizontal canal plugging are well correlated with vestibular tests exploring horizontal canal function, but not with cVEMP. SVINT always showed a strong lesional nystagmus beating away from the lesion side. SVIN acts as a good marker of HSCC function. This surgical technique showed invasiveness regarding horizontal canal vestibular function.

Agreement between the Skull Vibration-Induced Nystagmus Test and Semicircular Canal and Otolith Asymmetry

2021 ◽  
Author(s):  
Yue Zhang ◽  
Jamie Soper ◽  
Christine M. Lohse ◽  
Scott D.Z. Eggers ◽  
Kenton R. Kaufman ◽  
...  
Keyword(s):  
Semicircular Canal ◽  
Vestibular Function ◽  
Chief Complaint ◽  
Vestibular Evoked Myogenic Potentials ◽  
Caloric Test ◽  
Otolith Organ ◽  
Organ Function ◽  
Test Sensitivity ◽  
Data Collection And Analysis ◽  
Higher Sensitivity

Abstract Background How significant asymmetries in otolith organ function in the presence of symmetrical and asymmetrical semicircular canal function influence skull vibration-induced nystagmus testing (SVINT) has not been well described. Purpose The aim of the study is to examine the agreement between SVINT and caloric testing, ocular vestibular-evoked myogenic potentials (oVEMP), and cervical vestibular-evoked myogenic potentials (cVEMP) for detecting asymmetric vestibular function. Research Design This is a retrospective study of patients presenting with the chief complaint of vertigo, dizziness, or imbalance. Study Sample A total of 812 patients were studied with a median age at testing of 59 years (interquartile range 46–70; range 18–93) and included 475 (59%) women. Intervention Either the monothermal warm caloric test or alternate binaural bithermal caloric test, oVEMP, and cVEMP tests were administered to all patients. All patients underwent the SVINT prior to vestibular laboratory testing. Data Collection and Analysis Agreement between tests categorized as normal versus abnormal was summarized using percent concordance (PC). Sensitivity and specificity values were calculated for SVINT compared with other tests of vestibular function. Results There was higher agreement between ipsilateral and contralateral SVINT with the caloric test (PC = 80% and 81%, respectively) compared with oVEMP (PC = 63% and 64%, respectively) and cVEMP (PC = 76% and 78%, respectively). Ipsilateral and contralateral SVINT showed higher sensitivity for the caloric test (sensitivity = 47% and 36%, respectively) compared with oVEMP (sensitivity = 26% and 21%, respectively), or cVEMP (sensitivity = 33% vs. 27%, respectively). Specificity of SVINT was high (>80%) for all assessments of vestibular function. Conclusion The presence of SVIN is a useful indicator of the asymmetry of vestibular function between the two ears when making judgments about semicircular canal asymmetry but is less sensitive to asymmetries in otolith organ function.

Routine Vestibular Tests May Point Out Vestibular Subtype of Seasickness Only

2020 ◽  
Vol 91 (11) ◽  
pp. 852-860
Author(s):  
Bulent Satar ◽  
F. Ceyda Akin Ocal ◽  
Ceren Karacayli ◽  
Volkan Kenan Coban
Keyword(s):  
Pure Tone Audiometry ◽  
Vestibular Evoked Myogenic Potentials ◽  
Caloric Test ◽  
Severe Nausea ◽  
Canal Paresis ◽  
Vestibular Tests ◽  
And Gender ◽  
And Control ◽  
Nose And Throat ◽  
Caloric Tests

BACKGROUND: The vestibular system is important in the pathogenesis of seasickness. Our objective is to investigate whether routine vestibular tests detect seasickness.METHODS: Included were 17 professional naval personnel (mean age of 29.76 4.73 yr) diagnosed as having seasickness and 29 healthy age- and gender-matched controls. Cervical (c) vestibular evoked myogenic potentials (VEMP) and ocular (o) VEMP and bithermal caloric tests were performed after ear, nose, and throat examination, pure tone audiometry, and magnetic resonance imaging. Severity of seasickness was evaluated based on the Graybiel scale. P1 latency, N1 latency, P1N1 amplitude, and interaural asymmetry ratios (IAR) of cVEMP and oVEMP were compared between the patients and control groups. Abnormal findings in the caloric test were noted. Presence of an abnormality in any of the three vestibular tests (cVEMP, oVEMP, or caloric test) was accepted as a positive vestibular finding.RESULTS: According to the Graybiel Scale, severe malaise and frank sickness were observed in 3 patients (18.7%) and 13 patients (81.3%), respectively. Graybiel scoring could not be performed in one patient due to general discomfort and bad general condition. In the caloric test, each of three patients (17.65%) showed canal paresis, an incomplete test because of severe nausea, and vomiting and hyperactive response. There were no significant differences in P1 latency, N1 latency, P1N1 amplitude, or IAR of cVEMP and oVEMP (P > 0.05). There were three patients (17.65%) and two patients (11.76%) who had abnormal IAR for cVEMP and oVEMP, respectively.CONCLUSION: Routine vestibular tests may detect some findings in only a minority of patients with seasickness.Satar B, Akin Ocal FC, Karacayli C, Coban VK. Routine vestibular tests may point out vestibular subtype of seasickness only. Aerosp Med Hum Perform. 2020; 91(11):852860.

scholarly journals Contributions of ocular vestibular evoked myogenic potentials and the electrooculogram to periocular potentials produced by whole-body vibration

2012 ◽  
Vol 113 (10) ◽  
pp. 1613-1623 ◽  
Author(s):  
Neil P. M. Todd ◽  
Steven L. Bell ◽  
Aurore C. Paillard ◽  
Michael J. Griffin
Keyword(s):  
High Frequency ◽  
Whole Body Vibration ◽  
Low Frequency ◽  
Whole Body ◽  
Vestibular Evoked Myogenic Potentials ◽  
Visual Context ◽  
Body Vibration ◽  
Ocular Reflex ◽  
Head Displacement ◽  
Vestibular Ocular Reflex

In this paper we report the results of an experiment to investigate the emergence of ocular vestibular evoked myogenic potentials (OVEMPs) during the linear vestibular ocular reflex (LVOR) evoked by whole-body vibration (WBV). OVEMP and electrooculogram (EOG) montages were employed to record periocular potentials (POPs) from six subjects during WBV in the nasooccipital (NO) axis over a range of frequencies from 0.5 to 64 Hz with approximately constant peak head acceleration of 1.0 ms−2 (i.e., 0.1 g). Measurements were made in two context conditions: a fixation context to examine the effect of gaze eccentricity (0 vs. 20°), and a visual context, where a target was either head-fixed or earth-fixed. The principal results are that from 0.5 to 2 Hz POP magnitude in the earth-fixed condition is related to head displacement, so with constant acceleration at all frequencies it reduces with increasing frequency, but at frequencies greater than 2 Hz both POP magnitude and POP gain, defined as the ratio of POP magnitude at 20 and 0°, increase with increasing frequency. By exhibiting this high-pass characteristic, a property shared with the LVOR, the results are consistent with the hypothesis that the OVEMP, as commonly employed in the clinical setting, is a high-frequency manifestation of the LVOR. However, we also observed low-frequency acceleration following POPs in head-fixed conditions, consistent with a low-frequency OVEMP, and found evidence of a high-frequency visual context effect, which is also consistent with the OVEMP being a manifestation of the LVOR.

Head impulses reveal loss of individual semicircular canal function

1999 ◽  
Vol 9 (3) ◽  
pp. 173-180
Author(s):  
S.T. Aw ◽  
G.M. Halmagyi ◽  
R.A. Black ◽  
I.S. Curthoys ◽  
R.A. Yavor ◽  
...  
Keyword(s):  
Semicircular Canal ◽  
Three Dimensional ◽  
Semicircular Canals ◽  
Normal Subjects ◽  
Three Dimensions ◽  
Posterior Canal ◽  
Head Velocity ◽  
Ocular Reflex ◽  
Vestibular Ocular Reflex ◽  
Head Impulses

We studied individual semicircular canal responses in three dimensions to high-acceleration head rotations (“head impulses”) in subjects with known surgical lesions of the semicircular canals, and compared their results to those of normal subjects. We found that vestibular-ocular reflex (VOR) gains at close to peak head velocity in response to yaw, pitch and roll impulses were reliable indicators of semicircular canal function. When compared to normals, lateral canal function showed a 70–80% gain at peak of yaw head velocity during ipsilesional yaw impulses. After the loss of one vertical canal function there was a 30–50% and torsional VOR gain in response to ipsilesional pitch and roll impulses respectively. Bilateral deficits in anterior or posterior canal function resulted in a 80–90% impulses, while the loss of ipsilateral anterior and posterior canal functions will result in a 80–90% ipsilesional roll impulses. Three-dimensional vector analysis and animation of the VOR responses in a unilateral vestibular deafferented subject to yaw, pitch and roll impulses further demonstrated the deficits in magnitude and direction of the VOR responses following the loss of unilateral lateral, anterior and posterior canal functions.

scholarly journals Vestibular cerebellar evoked potentials in humans and their modulation during optokinetic stimulation

2018 ◽  
Vol 120 (6) ◽  
pp. 3099-3109 ◽  
Author(s):  
Neil P. M. Todd ◽  
Sendhil Govender ◽  
James G. Colebatch
Keyword(s):  
Evoked Potentials ◽  
Posterior Fossa ◽  
Subjective Experience ◽  
Visual Stimulation ◽  
Climbing Fiber ◽  
Vestibular Evoked Myogenic Potentials ◽  
Negative Wave ◽  
Ocular Reflex ◽  
Vestibular Ocular Reflex ◽  
Reflex Gain

We recorded evoked potentials (EPs) from over the posterior fossa and in parallel ocular vestibular evoked myogenic potentials (OVEMPs) during visuo-vestibular stimulation in a sample of 7 male and 11 female human subjects. In 9 of the 18 subjects we were able to record EPs reliably in the form of an early biphasic positive-negative wave with latencies ~12 and 17 ms ipsilateral to head acceleration direction (P12-N17) and a slightly later, contralateral, biphasic positive-negative wave with latencies ~19 and 23 ms (P19-N23). The amplitudes of the responses varied widely between subjects. Both P12 and N23 EPs were modulated by the mode of visual stimulation, larger for vection (sense of movement) compared with optokinetic nystagmus and for congruent movement. We suggest that the EPs measured over the posterior fossa are a manifestation of climbing fiber responses of cerebellar cortical Purkinje cells, i.e., a form of vestibular cerebellar EP (VsCEP). The two subject groups with and without VsCEPs were distinguished by the magnitude of their OVEMPs and their subjective experience of vection. The modulation of VsCEPs by visual context may be a manifestation of cerebellar control of linear vestibular ocular reflex gain. NEW & NOTEWORTHY We report likely vestibular cerebellar evoked potentials (VsCEPs) produced by lateral head impulses recorded in intact humans over the posterior fossa. VsCEPs occurred as short-latency P12-N17 waves ipsilateral to the direction of head motion and as P19-N23 contralaterally and were present in half our subjects. Their properties suggest that the VsCEPs may be of a climbing-fiber origin. VsCEPs are related to the perception of motion and, possibly, control of linear vestibular ocular reflex gain.

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