scholarly journals 084 Separating stroke from vestibular neuritis by vestibular function test parameters

2019 ◽  
Vol 90 (e7) ◽  
pp. A27.1-A27
Author(s):  
Zeljka Calic ◽  
Benjamin Nham ◽  
Rachel Taylor ◽  
Allison Young ◽  
Craig Anderson ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Vestibular Function ◽  
Vestibular Neuritis ◽  
Vestibular Evoked Myogenic Potentials ◽  
Head Impulse Test ◽  
Saccade Amplitude ◽  
Vestibular Tests ◽  
Acute Vestibular Syndrome ◽  
Significant Difference ◽  
Catch Up

IntroductionVestibular neuritis (VN) and posterior circulation stroke (PCS) are the commonest causes of acute vestibular syndrome (AVS). We aim to identify discriminators of VN from PCS by testing all five vestibular end-organs in patients presenting with AVS.MethodsThree-dimensional video-head impulse test (v-HIT), cervical and ocular-vestibular evoked myogenic potentials (c-and oVEMP) and subjective visual horizontal (SVH) tests were performed in 22 patients with VN and 22 with PCS. Ipsilesional horizontal, anterior and posterior canal (HC, AC, PC) v-HIT gain and first catch-up saccade characteristics, VEMP amplitude asymmetry-ratios were compared.ResultsAll VN and 6 PCS patients had positive clinical HIT. Mean time to testing was 4.7 days for VN, 7.0 days for PCS. VN mean ipsilesional HC and AC first saccade amplitude was larger, peak-velocities faster and onset latencies earlier compared to PCS (p<0.05). No significant difference between VN and PCS in first saccade characteristics was found in PC. Ipsilesional first saccade amplitude, peak-velocity and duration were significantly different between PCS and controls for all canals (p<0.05). A gain <0.68 and first saccade amplitudes >2.2°separated VN from PCS with sensitivities of 95.5% and 86.4% and specificities of 72.7% and 63.6%. First saccade amplitude of >0.91°identified PCS from controls with sensitivity of 68.2% and specificity of 70%. Abnormality rates for AC cVEMP, BC oVEMP and SVH were 42.9%, 50% and 91% for VN and 38.1%, 9% 72% for PCS.Conclusion v-HIT gain and catch-up saccade metrics are useful separators of VN from PCS. Detailed saccade analysis complements existing vestibular tests.

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.

Influence of vestibular rehabilitation on the recovery of all vestibular receptor organs in patients with unilateral vestibular hypofunction

2020 ◽  
Vol 47 (2) ◽  
pp. 227-235
Author(s):  
Anamarija Sestak ◽  
Sinisa Maslovara ◽  
Zeljko Zubcic ◽  
Andrijana Vceva
Keyword(s):  
Vestibular Function ◽  
Vestibular Rehabilitation ◽  
Vestibular Evoked Myogenic Potentials ◽  
Head Impulse Test ◽  
Caloric Test ◽  
Vestibular Hypofunction ◽  
Sf 36 ◽  
Significant Difference ◽  
Different Types ◽  
Vestibular Receptor

BACKGROUND: Only a few studies in the literature demonstrate the effect of vestibular rehabilitation (VR) on all vestibular receptor organs. Furthermore, very little evidence of the effect of VR on isolated otolith dysfunction (IOD) is available. OBJECTIVE: The study aimed to investigate the effect of VR on all vestibular receptor organs in patients with different types of unilateral vestibular hypofunction (UVH). METHODS: We enrolled 80 patients with three different types of UVH; combined and isolated loss of semicircular canal and otolith organ function. All patients performed a 12-week customized program of VR and received a full battery of vestibular function tests, before and after the VR. The DHI and SF-36 were performed before, after 6 weeks, and 12 weeks of the VR. RESULTS: Parameters of the caloric test, video head impulse test, ocular and cervical vestibular evoked myogenic potentials were significantly improved after VR. A total of 59 (74%) patients fully recovered, with no significant difference in recovery regarding the type (p = 0.13) and stage of UVH (p = 0.13). All patients reported significantly lower disability and a better quality of life after the VR based on the DHI and SF-36 score. CONCLUSIONS: Vestibular rehabilitation has a positive effect on the recovery of all vestibular receptor organs and it should be used in patients with IOD.

scholarly journals Assessment of cervical and ocular vestibular evoked myogenic potentials in migraine patients

2020 ◽  
Vol 36 (1) ◽  
Author(s):  
Doaa Elmoazen ◽  
Hesham Kozou ◽  
Jaidaa Mekky ◽  
Dalia Ghanem
Keyword(s):  
Vestibular Function ◽  
Vestibular Dysfunction ◽  
Peak Amplitude ◽  
Vestibular Evoked Myogenic Potentials ◽  
Healthy Controls ◽  
Latency Difference ◽  
Significant Difference ◽  
Cervical Vemp ◽  
Vestibular Symptoms ◽  
Function Assessment

Abstract Background Patients suffering from vestibular migraine (VM) are known to have various vestibular test abnormalities interictally and ictally. Recently, vestibular evoked myogenic potentials (VEMPs) have become accepted as a valid method for otolith function assessment. Many studies have identified various vestibular symptoms and laboratory abnormalities in migraineurs. Since migraineurs with no accompanying vestibular symptoms might exhibit subclinical vestibular dysfunction, we investigated vestibular function using ocular and cervical VEMPs in migraine patients. The aim was to study cervical VEMP and occular VEMP in migraineurs with and without vestibular symptoms interictally. Results Migraine and VM patients showed significantly longer P13 latency of cVEMP compared to controls. A statistically significant cVEMP interaural P13 latency difference was found in VM compared to healthy controls. Cervical VEMP N23 latency, peak-to-peak amplitude, interaural N23 latency, and amplitude asymmetric ratio did not show any significant difference in migraine and VM patients compared to healthy controls as well as no significant difference across the three groups regarding oVEMP parameters. Conclusions Abnormal interictal cVEMP results in migraineurs might indicate subclinical vestibulo-collic pathway dysfunction.

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.

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.

Video Head Impulse Testing (vHIT) and the Assessment of Horizontal Semicircular Canal Function

2015 ◽  
Vol 26 (05) ◽  
pp. 518-523 ◽  
Author(s):  
Kristal M. Riska ◽  
Owen Murnane ◽  
Faith W. Akin ◽  
Courtney Hall
Keyword(s):  
Semicircular Canal ◽  
Objective Assessment ◽  
Vestibular Function ◽  
Vestibular Evoked Myogenic Potentials ◽  
Head Impulse Test ◽  
Clinical Test ◽  
Horizontal Semicircular Canal ◽  
Head Impulse ◽  
New Instrument ◽  
Qualitative Test

Background: Vestibular function (specifically, horizontal semicircular canal function) can be assessed across a broad frequency range using several different techniques. The head impulse test is a qualitative test of horizontal semicircular canal function that can be completed at bedside. Recently, a new instrument (video head impulse test [vHIT]) has been developed to provide an objective assessment to the clinical test. Questions persist regarding how this test may be used in the overall vestibular test battery. Purpose: The purpose of this case report is to describe vestibular test results (vHIT, rotational testing, vestibular evoked myogenic potentials, and balance and gait performance) in an individual with a 100% unilateral caloric weakness who was asymptomatic for dizziness, vertigo or imbalance. Data Collection and/or Analysis: Comprehensive assessment was completed to evaluate vestibular function. Caloric irrigations, rotary chair testing, vHIT, and vestibular evoked myogenic potentials were completed. Results: A 100% left-sided unilateral caloric weakness was observed in an asymptomatic individual. vHIT produced normal gain with covert saccades. Conclusions: This case demonstrates the clinical usefulness of vHIT as a diagnostic tool and indicator of vestibular compensation and functional status.

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

2020 ◽  
pp. 1-7
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. 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, cervical vestibular-evoked myogenic potentials (cVEMPs), and the v-HIT. 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.

Case Study: Depersonalization and Vestibular Impairment

2021 ◽  
Author(s):  
Yini Sun ◽  
Allison Coltisor ◽  
Gary P. Jacobson ◽  
Richard A. Roberts
Keyword(s):  
Vestibular Function ◽  
Retrospective Chart Review ◽  
Vestibular Evoked Myogenic Potentials ◽  
Head Impulse Test ◽  
Vestibular Evoked Myogenic Potential ◽  
Episodic Vertigo ◽  
Data Collection And Analysis ◽  
Vestibular Function Testing ◽  
Function Testing

Abstract Background We describe herein the case of a patient whose primary complaints were episodic vertigo and “depersonalization,” a sensation of detachment from his own body. Purpose This case study aims to further clinical knowledge and insight into the clinical evaluation of vertiginous patients with complaints of depersonalization. Research Design This is a case study. Data Collection and Analysis A retrospective chart review of vestibular function testing done on a vertiginous patient with complaints of depersonalization was performed. Results Vestibular function testing revealed absent cervical and ocular vestibular evoked myogenic potentials on the left side with normal vHIT or video Head Impulse Test, videonystagmography, and rotational chair results, suggesting peripheral vestibular impairment isolated to the left saccule and utricle. Conclusion The otolith end organ impairment explains the patient's postural deviation to the left side during attempts to ambulate. We recommend that clinicians should be attentive to patient complaints of depersonalization and perform vestibular evoked myogenic potential testing to determine whether evidence of at least a unilateral peripheral otolith end organ impairment exists.

scholarly journals Worldwide survey on laboratory testing of vestibular function

2019 ◽  
Vol 10 (5) ◽  
pp. 379-387 ◽  
Author(s):  
Michael Strupp ◽  
Joy Grimberg ◽  
Julian Teufel ◽  
Göran Laurell ◽  
Herman Kingma ◽  
...  
Keyword(s):  
Reference Values ◽  
Vestibular Function ◽  
Vestibular Evoked Myogenic Potentials ◽  
Head Impulse Test ◽  
Slow Phase ◽  
Bilateral Vestibulopathy ◽  
Large Variability ◽  
Horizontal Canal ◽  
Caloric Irrigation ◽  
Cutoff Values

BackgroundThe function of the peripheral vestibular system can nowadays be quantified. The video head impulse test (vHIT) and caloric irrigation are used for the semicircular canals, cervical vestibular evoked myogenic potentials (cVEMP) for the sacculus, and ocular vestibular evoked myogenic potentials (oVEMP) for the utriculus. Because there is no agreement on normal and pathologic values, we performed a worldwide survey.MethodsA web-based standardized survey questionnaire was used to collect data on “reference values” and “cutoff” values. Thirty-eight centers from all continents (except Africa) replied.Results“Reference values”: vHIT: mean for the vestibulo-ocular reflex gain of the left horizontal canal 0.91 (range: 0.7–1.01) and of the left horizontal canal 0.92 (0.7–1.05); side difference 0.15 (0.25–0.3). Caloric irrigation: mean peak slow phase velocity of caloric-induced nystagmus for warm (44°C) water 18.65°/s (12–30°/s); cold (30°C) water 18.21°/s (10–25°/s). cVEMP: P13-N23 amplitude mean for the lower limit 28.67 μV (16–50 μV); upper limit 200 μV (50–350 μV). “Cutoff values”: vHIT: side difference 0.26 (0.1–0.4), bilateral vestibulopathy <0.61 (0.3–0.8); unilateral vestibulopathy (UVP) <0.68 (0.4–0.8). Caloric irrigation pathologic side difference mean 25.93% (17.7%–40%) or 12°/sec (5–30°/s); side difference UVP 26.73% (20%–40%) or 29.8°/s (5–100°/s). cVEMP: P13/N23 amplitude mean lower cutoff 32.5 μV (15–50 μV), mean upper cutoff 125 μV (50–200 μV), asymmetry 36.08 μV (20–50 μV).ConclusionThis worldwide survey showed a large variability in terms of reference and pathologic cutoff values in the 38 centers included. Therefore, standardization of how to achieve these values and agreement on which values should be used is highly warranted to guarantee a high quality of vestibular testing and interpretation of clinical and scientific results.

Sign in / Sign up

Export Citation Format

Share Document