Dizziness, Vertigo, and Syndromes of the Medulla

2014 ◽  
pp. 292-332
Author(s):  
Shirley H. Wray
Keyword(s):  
Vestibular Function ◽  
Semicircular Canals ◽  
Clear Distinction ◽  
Head Impulse Test ◽  
History Taking ◽  
Clinical Detail ◽  
Full Discussion ◽  
Diagnostic Symptoms ◽  
Inferior Olivary ◽  
Intractable Hiccups

reviews the medulla’s vestibular components (the vestibular, perihypoglossal, and inferior olivary nuclei ), and the components of the vestibular labyrinth (the semicircular canals and the otolith receptors) preparatory to a full discussion of dizziness and vertigo as diagnostic symptoms. The model used for history-taking is extensive and allows for clear distinction to be made between the two symptoms and their implications for risk of stroke. Direction- changing nystagmus as a localizing sign is discussed in depth, and provocative tests to elicit nystagmus by suppression of fixation are presented in clinical detail. The head-thrust (head impulse) test is also described as a simple way to identify a complete unilateral or bilateral loss of vestibular function at the bedside. Medullary syndromes illustrated by case studies include oculopalatal tremor, benign paroxysmal positional vertigo, upbeat and apogeotropic nystagmus, Wallenberg’s syndrome due to infarction of the medulla, and a case of intractable hiccups.

scholarly journals A case series shows independent vestibular labyrinthine function after major surgical trauma to the human cochlea

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Stefan K. Plontke ◽  
Torsten Rahne ◽  
Ian S. Curthoys ◽  
Bo Håkansson ◽  
Laura Fröhlich
Keyword(s):  
Case Series ◽  
Vestibular Function ◽  
Semicircular Canals ◽  
Vestibular Evoked Myogenic Potentials ◽  
Head Impulse Test ◽  
Surgical Trauma ◽  
Cochlear Function ◽  
Receptor System ◽  
Tertiary Referral Center ◽  
Significant Difference

Abstract Background The receptors for hearing and balance are housed together in the labyrinth of the inner ear and share the same fluids. Surgical damage to either receptor system was widely believed to cause certain permanent loss of the receptor function of the other. That principle, however, has been called into question because there have been anecdotal reports in individual patients of at least partial preservation of cochlear function after major surgical damage to the vestibular division and vice versa. Methods We performed specific objective vestibular function tests before and after surgical trauma (partial or subtotal cochlear removal) for treatment of intracochlear tumors in 27 consecutive patients in a tertiary referral center. Vestibular function was assessed by calorics (low-frequency response of the lateral semicircular canal), vestibulo-ocular reflex by video head impulse test (vHIT) of the three semicircular canals, cervical and ocular vestibular evoked myogenic potentials (cVEMP, saccule and oVEMP, utricle). Preoperative and postoperative distributions were compared with paired t-tests. Results Here we show that there was no significant difference between pre- and post-operative measures for all tests of the five vestibular organs, and that after major surgical cochlear trauma, the vestibular receptors continue to function independently. Conclusions These surprising observations have important implications for our understanding of the function and the surgery of the peripheral auditory and vestibular system in general and open up new possibilities for the development, construction and evaluation of neural interfaces for electrical or optical stimulation of the peripheral auditory and vestibular nervous system.

scholarly journals Early Assessment of Vestibular Function after Unilateral Cochlear Implant Surgery

2019 ◽  
Vol 25 (Suppl. 1-2) ◽  
pp. 50-59 ◽  
Author(s):  
Maurizio Barbara ◽  
Rita Talamonti ◽  
Anna Teresa Benincasa ◽  
Silvia Tarentini ◽  
Chiara Filippi ◽  
...  
Keyword(s):  
Short Form ◽  
Statistical Significance ◽  
Round Window ◽  
Vestibular Function ◽  
Semicircular Canals ◽  
Vestibular Evoked Myogenic Potentials ◽  
Diagnostic Tools ◽  
Head Impulse Test ◽  
Early Assessment ◽  
Window Approach

Introduction: Cochlear implantation (CI) has been reported to negatively affect vestibular function. The study of vestibular function has variably been conducted using different types of diagnostic tools. The combined use of modern, rapidly performing diagnostic tools could prove useful for standardization of the evaluation protocol. Methods: In a group of 28 subjects undergoing CI, the video head impulse test (vHIT), the cervical vestibular evoked myogenic potentials (cVEMP) and the short form of the Dizziness Handicap Inventory (DHI) questionnaire were investigated preoperatively and postoperatively (implant on and off) in both the implanted and the contralateral, nonimplanted ear. All surgeries were performed with a round window approach (RWA), except for 3 otosclerosis cases in which the extended RWA (eRWA) was used. Results: The vHIT of the lateral semicircular canal showed preoperative vestibular involvement in nearly 50% of the cases, while the 3 canals were contemporarily affected in only 14% of the cases. In all the hypofunctional subjects, cVEMP were absent. A low VOR gain in all of the investigated superior semicircular canals was found in 4 subjects (14%). In those subjects (21.7%) in whom cVEMP were preoperatively present and normal on the operated side, the absence of a response was postoperatively recorded. Discussion/Conclusion: The vestibular protocol applied in this study was found to be appropriate for distinguishing between the CI-operated ear and the nonoperated ear. In this regard, cVEMP was found to be more sensitive than vHIT for revealing a vestibular sufferance after CI, though without statistical significance. Finally, the use of RWA surgery apparently did not reduce the occurrence of signs of vestibular impairment.

scholarly journals vHIT Testing of Vertical Semicircular Canals With Goggles Yield Different Results Depending on Which Canal Plane Being Tested

2021 ◽  
Vol 12 ◽  
Author(s):  
Louise Wittmeyer Cedervall ◽  
Måns Magnusson ◽  
Mikael Karlberg ◽  
Per-Anders Fransson ◽  
Anastasia Nyström ◽  
...  
Keyword(s):  
Semicircular Canal ◽  
Vestibular Function ◽  
Vertical Direction ◽  
Semicircular Canals ◽  
Vertical Movement ◽  
Head Impulse Test ◽  
Recording Device ◽  
Prospective Design ◽  
Vertical Semicircular Canal ◽  
Vertical Semicircular Canals

Objective: The use of goggles to assess vertical semicircular canal function has become a standard method in vestibular testing, both in clinic and in research, but there are different methods and apparatus in use. The aim of this study was to determine what the cause of the systematic differences is between gain values in testing of the vertical semicircular canals with two different video head impulse test (vHIT) equipment in subjects with normal vestibular function.Study Design: Retrospective analysis of gain values on patients with clinically deemed normal vestibular function (absence of a corrective eye saccade), tested with either Interacoustics or Otometrics system. Prospective testing of subjects with normal vestibular function with the camera records the eye movements of both eyes. Finally, 3D sensors were placed on different positions on the goggles measuring the actual vertical movement in the different semicircular planes.Results: In the clinical cohorts, the gain depended on which side and semicircular canal was tested (p < 0.001). In the prospective design, the combination between the stimulated side, semicircular canal, and position of the recording device (right/left eye) highly influenced the derived gain (p < 0.001). The different parts of the goggles also moved differently in a vertical direction during vertical semicircular canal testing.Conclusion: The gain values when testing the function of the vertical semicircular canals seem to depend upon which eye is recorded and which semicircular plane is tested and suggests caution when interpreting and comparing results when different systems are used both clinically as well as in research. The results also imply that further research and development are needed to obtain accurate vertical semicircular canal testing, in regard to both methodology and equipment design.

scholarly journals The resilience of the inner ear—vestibular and audiometric impact of transmastoid semicircular canal plugging

2021 ◽  
Author(s):  
Joost J. A. Stultiens ◽  
Nils Guinand ◽  
Vincent Van Rompaey ◽  
Angélica Pérez Fornos ◽  
Henricus P. M. Kunst ◽  
...  
Keyword(s):  
Semicircular Canal ◽  
Bone Conduction ◽  
Vestibular Function ◽  
Semicircular Canals ◽  
Vestibular Evoked Myogenic Potentials ◽  
Head Impulse Test ◽  
Superior Semicircular Canal Dehiscence ◽  
Caloric Response ◽  
The Impact

Abstract Background Certain cases of superior semicircular canal dehiscence or benign paroxysmal positional vertigo can be treated by plugging of the affected semicircular canal. However, the extent of the impact on vestibular function and hearing during postoperative follow-up is not known. Objective To evaluate the evolution of vestibular function and hearing after plugging of a semicircular canal. Methods Six patients underwent testing before and 1 week, 2 months, and 6 months after plugging of the superior or posterior semicircular canal. Testing included caloric irrigation test, video Head Impulse Test (vHIT), cervical and ocular Vestibular Evoked Myogenic Potentials (VEMPs) and audiometry. Results Initially, ipsilateral caloric response decreased in all patients and vHIT vestibulo-ocular reflex (VOR) gain of each ipsilateral semicircular canal decreased in 4/6 patients. In 4/6 patients, postoperative caloric response recovered to > 60% of the preoperative value. In 5/6 patients, vHIT VOR gain was restored to > 85% of the preoperative value for both ipsilateral non-plugged semicircular canals. In the plugged semicircular canal, this gain decreased in 4/5 patients and recovered to > 50% of the preoperative value. Four patients preserved cervical and ocular VEMP responses. Bone conduction hearing deteriorated in 3/6 patients, but recovered within 6 months postoperatively, although one patient had a persistent loss of 15 dB at 8 kHz. Conclusion Plugging of a semicircular canal can affect both vestibular function and hearing. After initial deterioration, most patients show recovery during follow-up. However, a vestibular function loss or high-frequency hearing loss can persist. This stresses the importance of adequate counseling of patients considering plugging of a semicircular canal.

Evaluation of Vertical Semicircular Canal Function in Patients With Vestibular Schwannoma

2018 ◽  
Vol 128 (2) ◽  
pp. 113-120 ◽  
Author(s):  
Keishi Fujiwara ◽  
Hiroko Yanagi ◽  
Shinya Morita ◽  
Kimiko Hoshino ◽  
Atsushi Fukuda ◽  
...  
Keyword(s):  
Vestibular Schwannoma ◽  
Semicircular Canal ◽  
Vestibular Function ◽  
Semicircular Canals ◽  
Vestibular Nerve ◽  
Head Impulse Test ◽  
Posterior Semicircular Canal ◽  
Vestibulo Ocular Reflex ◽  
Anterior Semicircular Canal ◽  
Vertical Semicircular Canal

Objectives: The aim of this study was to investigate vertical semicircular canal function in patients with vestibular schwannoma (VS) by video head impulse test (vHIT). Methods: Fifteen patients with VS who had not received any treatment, including surgery or stereotactic radiotherapy, before vHIT examination were enrolled. Vestibulo-ocular reflex gain and catch-up saccade in vHIT were evaluated. Results: Dysfunction of anterior and posterior semicircular canals was detected by vHIT in 26.7% and 60.0%, respectively. Six patients (40.0%) demonstrated abnormalities referable to both vestibular nerve divisions. Abnormalities referable to the superior vestibular nerve were identified in 3 patients (20.0%), while 3 patients (20.0%) demonstrated a pattern indicative of inferior vestibular nerve involvement. Anterior semicircular canal vHIT produced fewer abnormalities than did either horizontal or posterior semicircular canal vHIT. Conclusions: Dysfunction of the semicircular canals, including the vertical canals, in patients with VS was detected by vHIT. The anterior semicircular canal was less frequently involved than the horizontal or posterior semicircular canal. The examination of the vertical canals by vHIT is useful in the evaluation of vestibular function in patients with VS.

scholarly journals The Video Head Impulse Test in a Case of Suspected Bilateral Loss of Vestibular Function

2014 ◽  
Vol 20 (01) ◽  
pp. 084-086 ◽  
Author(s):  
Pedro Albernaz ◽  
Flavia Cusin
Keyword(s):  
Vestibular Function ◽  
Semicircular Canals ◽  
Head Impulse Test ◽  
Video Head Impulse Test ◽  
Head Impulse ◽  
Caloric Tests

Introduction A patient who had no symptoms suggestive of bilateral loss of vestibular function presented no responses in rotational and caloric tests. Objectives To demonstrate the importance of the video head impulse test in neuro-otologic diagnosis. Resumed Report This patient had a neuro-otologic evaluation and presented no responses in torsion swing tests, caloric tests, and rotational tests in a Bárány chair. The video head impulse test elicited responses in four of the six semicircular canals. Conclusion Absent responses in caloric and rotatory tests alone are not sufficient to diagnose bilateral loss of vestibular function.

Objective vestibular function changes in children following cochlear implantation

2021 ◽  
pp. 1-9
Author(s):  
Ruijie Wang ◽  
Xiuhua Chao ◽  
Jianfen Luo ◽  
Daogong Zhang ◽  
Jiliang Xu ◽  
...  
Keyword(s):  
Semicircular Canal ◽  
Cochlear Implantation ◽  
Vestibular Function ◽  
Semicircular Canals ◽  
Vestibular Evoked Myogenic Potentials ◽  
Head Impulse Test ◽  
Caloric Test ◽  
Otolith Organs ◽  
Deterioration Rate ◽  
Vestibular Aqueduct

BACKGROUND: To date, systematically objective evaluations of vestibular function in children with cochlear implantation (CI) have been conducted sparsely, especiallyin children with large vestibular aqueduct syndrome (LVAS). OBJECTIVE: Our goal was to investigate the function of all five vestibular end-organs pre- and post-cochlear implantation in children with LVAS and normal CT. METHODS: In this retrospective cohort study, 34 children (age 4–17 years) with bilateral profound sensorineural hearing loss (SNHL) undergoing unilateral CI were included. Participants included 18 (52.9%) children with LVAS. Objective modalities to evaluate vestibular function included the caloric test, cervical vestibular-evoked myogenic potentials (cVEMP), ocular vestibular-evoked myogenic potentials (oVEMP), and video head impulse test (vHIT). All measurements were performed before surgery and 9 months after surgery. RESULTS: Mean age at CI was 8.1±3.7 years. Caloric testing showed hypofunction in 38.2%of cases before implantation and in 50%after (p >  0.05). We found a significant increase of overall abnormality rate in cVEMP and oVEMP from pre- to post-CI (p <  0.05). In all three semicircular canals tested by vHIT, there were no statistically significant mean gain changes (p >  0.05). Higher deterioration rates in cVEMP (53.3%) and oVEMP (52.0%) after surgery were observed (p <  0.05). In children with LVAS, cVEMP revealed a higher deterioration rate than superior semicircular canal (SSC) and posterior semicircular canal (PSC) (p <  0.05). In children with normal CT, the deterioration rates in VEMPs were both higher than those in vHIT (p <  0.05). CONCLUSIONS: In general, the otolith organs were the most affected peripheral vestibular sensors in children after cochlear implantation. The variations in otolith function influenced by CI were different between children with LVAS and normal CT. We recommend the use of this vestibular function test battery for children with cochlear implantation.

scholarly journals Vestibular Function Measured Using the Video Head Impulse Test in Congenital Nystagmus and Vertigo: A Case Report

2021 ◽  
Vol 12 ◽  
Author(s):  
Antonio Denia-Lafuente ◽  
Belén Lombardero
Keyword(s):  
Vestibular Function ◽  
Semicircular Canals ◽  
Head Impulse Test ◽  
Congenital Nystagmus ◽  
Video Head Impulse Test ◽  
Head Impulse ◽  
Ocular Reflex ◽  
Vestibulo Ocular Reflex ◽  
Vertical Semicircular Canals

In patients with congenital nystagmus (CN), the study of vestibular function is complicated by many factors related to the measurement of the vestibulo-ocular reflex (VOR) by means of caloric testing and the video head impulse test (vHIT), and to date no such studies have successfully employed the vHIT to evaluate vestibular function in these patients. We present a case with CN and vertigo in which peripheral vestibular function was evaluated using the vHIT system, including head impulse testing and the suppression head impulse protocol. We show that it is possible (a) to identify lateral VOR changes such as abnormalities resembling those produced by bilateral vestibular lesions, though not necessarily related to the same mechanism; (b) to identify peripheral VOR lesions of the vertical semicircular canals (SCC); and (c) to document compensation and recovery subsequent to these peripheral lesions during follow-up of patients with CN. vHIT is a useful tool that should be used to study vestibular function in patients with CN and vertigo, which could constitute a new clinical application of this technique.

Vestibular semicircular canal function as detected by video Head Impulse Test (vHIT) is essentially unchanged in people with Parkinson’s disease compared to healthy controls

2021 ◽  
pp. 1-9
Author(s):  
Kim E. Hawkins ◽  
Elodie Chiarovano ◽  
Serene S. Paul ◽  
Ann M Burgess ◽  
Hamish G. MacDougall ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Semicircular Canal ◽  
Neurodegenerative Disorder ◽  
Vestibular Function ◽  
Head Impulse Test ◽  
Healthy Controls ◽  
Video Head Impulse Test ◽  
Head Impulse ◽  
Vestibulo Ocular Reflex

BACKGROUND: Parkinson’s disease (PD) is a common multi-system neurodegenerative disorder with possible vestibular system dysfunction, but prior vestibular function test findings are equivocal. OBJECTIVE: To report and compare vestibulo-ocular reflex (VOR) gain as measured by the video head impulse test (vHIT) in participants with PD, including tremor dominant and postural instability/gait dysfunction phenotypes, with healthy controls (HC). METHODS: Forty participants with PD and 40 age- and gender-matched HC had their vestibular function assessed. Lateral and vertical semicircular canal VOR gains were measured with vHIT. VOR canal gains between PD participants and HC were compared with independent samples t-tests. Two distinct PD phenotypes were compared to HC using Tukey’s ANOVA. The relationship of VOR gain with PD duration, phenotype, severity and age were investigated using logistic regression. RESULTS: There were no significant differences between groups in vHIT VOR gain for lateral or vertical canals. There was no evidence of an effect of PD severity, phenotype or age on VOR gains in the PD group. CONCLUSION: The impulsive angular VOR pathways are not significantly affected by the pathophysiological changes associated with mild to moderate PD.

Vestibular function assessment of Susac syndrome patients by the video head impulse test and cervical vestibular-evoked myogenic potentials

2020 ◽  
Vol 30 (6) ◽  
pp. 393-399
Author(s):  
Yahav Oron ◽  
Ophir Handzel ◽  
Zohar Habot-Wilner ◽  
Keren Regev ◽  
Arnon Karni ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Vestibular Function ◽  
Pure Tone Audiometry ◽  
Sensorineural Hearing ◽  
Vestibular Evoked Myogenic Potentials ◽  
Head Impulse Test ◽  
Video Head Impulse Test ◽  
Head Impulse ◽  
Susac Syndrome

BACKGROUND: Susac syndrome (retino-cochleo-cerebral vasculopathy, SuS) is an autoimmune endotheliopathy characterized by the clinical triad of encephalopathy, branch retinal artery occlusions and sensorineural hearing loss. In contrast to data regarding auditory function, data measuring vestibular function is sparse and the cervical vestibular-evoked myogenic potentials (cVEMPs). OBJECTIVE: To determine whether the video head impulse test (vHIT) can serve as a confirmatory assessment of vestibulocochlear dysfunction in cases of suspected SuS. METHODS: Seven patients diagnosed with SuS underwent pure tone audiometry, a word recognition test, cVEMPs and the vHIT. RESULTS: Five patients were diagnosed with definite SuS, and two with probable SuS. Two patients were asymptomatic for hearing loss or tinnitus, and no sensorineural hearing loss was detected by audiograms. Four patients complained of tinnitus, and three patients reported experiencing vertigo. Three patients had abnormal cVEMPs results. All seven patients’ vHIT results were normal, except for patient #2, who was one of the three who complained of vertigo. The calculated gain of her left anterior semicircular canal was 0.5, without saccades. CONCLUSIONS: This is the first study to describe the results of the vHIT and cVEMPs among a group of patients with SuS. The results suggest that the vHIT should not be the only exam used to assess the function of the vestibular system of SuS patients.

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