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

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.

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Clinical Study to Determine Occult Vestibular Dysfunction in Patients of Chronic Otitis Media using Computerized Static Posturography

Bengal Journal of Otolaryngology and Head Neck Surgery ◽

10.47210/bjohns.2019.v27i1.223 ◽

2019 ◽

Vol 27 (1) ◽

pp. 36-43

Author(s):

D K Singh ◽

Salil Kumar Gupta ◽

Vijay Bhalla ◽

Sheetal Raina ◽

Abha Kumari

Keyword(s):

Otitis Media ◽

Vestibular Function ◽

Chronic Otitis Media ◽

Vestibular Dysfunction ◽

Healthy Controls ◽

Comprehensive Management ◽

Static Posturography ◽

Objective Evidence ◽

Significant Difference ◽

Age Range

Introduction Various studies have shown high incidence of subjective vestibular dysfunction in cases of chronic otitis media (COM). Evaluation of vestibular dysfunction in chronic otitis media patients is becoming an integral part of comprehensive management of COM. In our study, we have evaluated vestibular dysfunction in patients with COM, using computerized static posturography, an objective technique in contrast to other subjective tests of vestibular dysfunction. Materials and Methods In this prospective case control study done over a period of 1.5 years, 50 cases of COM and 50 healthy controls were included and they underwent Computerized Static Posturography. Parameters taken were Somaesthetic, visual and vestibular scores in both antero-posterior (AP) and medio-lateral (ML) axis; and in combined axis (Antero-posterior +Medio-lateral) and these scores were compared with those of healthy controls. Results Total 50 cases of COM (average disease period - 5.7 years), of both sexes, with age range of 15-60 years and mean age of 31.58 years were taken. On analyzing above mentioned parameters using SPSS software, we found no significant difference in vestibular function in cases of COM as compared with healthy individuals. Discussion The outcome of computerized static posturography can be quantified with respect to changes in center-of-force sway amplitude, distance, or velocity, which, by virtue of not being burdened by subjective interpretation, its results can be, documented both graphically and numerically. Conclusion This study, further solidified with objective evidence, raises a question on COM without complications being directly responsible for vestibular dysfunction.

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

Communications Medicine ◽

10.1038/s43856-021-00036-w ◽

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.

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084 Separating stroke from vestibular neuritis by vestibular function test parameters

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2019-anzan.72 ◽

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.

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Investigating short latency subcortical vestibular projections in humans: what have we learned?

Journal of Neurophysiology ◽

10.1152/jn.00157.2019 ◽

2019 ◽

Vol 122 (5) ◽

pp. 2000-2015 ◽

Cited By ~ 2

Author(s):

James G. Colebatch ◽

Sally M. Rosengren

Keyword(s):

Brain Stem ◽

Physiological Role ◽

Vestibular Function ◽

Short Latency ◽

Vestibular Evoked Myogenic Potentials ◽

Ocular Vemp ◽

Motor Unit Firing ◽

Cervical Vemp ◽

Noninvasive Assessment

Vestibular evoked myogenic potentials (VEMPs) are now widely used for the noninvasive assessment of vestibular function and diagnosis in humans. This review focuses on the origin, properties, and mechanisms of cervical VEMPs and ocular VEMPs; how these reflexes relate to reports of vestibular projections to brain stem and cervical targets; and the physiological role of (otolithic) cervical and ocular reflexes. The evidence suggests that both VEMPs are likely to represent the effects of excitation of irregularly firing otolith afferents. While the air-conducted cervical VEMP appears to mainly arise from excitation of saccular receptors, the ocular VEMP evoked by bone-conducted stimulation, including impulsive bone-conducted stimuli, mainly arises from utricular afferents. The surface responses are generated by brief changes in motor unit firing. The effects that have been demonstrated are likely to represent otolith-dependent vestibulocollic and vestibulo-ocular reflexes, both linear and torsional. These observations add to previous reports of short latency otolith projections to the target muscles in the neck (sternocleidomastoid and splenius) and extraocular muscles (the inferior oblique). New insights have been provided by the investigation and application of these techniques.

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Efficacy of microsurgical tumor removal for treatment of patients with intracanalicular vestibular schwannoma presenting with disabling vestibular symptoms

Journal of Neurosurgery ◽

10.3171/2016.4.jns153020 ◽

2017 ◽

Vol 126 (5) ◽

pp. 1514-1519 ◽

Cited By ~ 14

Author(s):

Madjid Samii ◽

Hussam Metwali ◽

Venelin Gerganov

Keyword(s):

Quality Of Life ◽

Vestibular Schwannoma ◽

Symptom Relief ◽

Vestibular Dysfunction ◽

Control Group ◽

Surgical Removal ◽

Asymptomatic Patients ◽

Significant Difference ◽

Vestibular Symptoms

OBJECTIVEThe aim of this study was to analyze the efficacy and risks of microsurgery via the hearing-preserving retrosigmoid approach in patients with intracanalicular vestibular schwannoma (VS) suffering from disabling vestibular symptoms, with special attention to vertigo.METHODSThis is a retrospective analysis of 19 patients with intracanalicular VS and disabling vestibular dysfunction as the main or only symptom (Group A). All of the patients reported having had disabling vertigo attacks. Subjective evaluation of the impairment of patients was performed before surgery, 3 weeks after surgery, 3 months after surgery, and 1 year after surgery, using the Dizziness Handicap Inventory (DHI). The main outcome measures were improvement in quality of life as measured using the DHI, and general and functional outcomes, in particular facial function and hearing. Patient age, preoperative tumor size, preoperative DHI score, and preservation of the nontumorous vestibular nerve were tested using a multivariate regression analysis to determine factors affecting the postoperative DHI score. The Mann-Whitney U-test was used to compare the postoperative DHI score at 3 weeks, 3 months, and 1 year after surgery with a control group of 19 randomly selected patients with intracanalicular VSs, who presented without vestibular symptoms (Group B). The occurrence of early postoperative discrete vertigo attacks was also compared between groups.RESULTSThe preoperative DHI score was ≥ 54 in all patients. All patients reported having had disabling rotational vertigo before surgery. The only significant factor to affect the DHI outcome 3 weeks and 3 months after surgery was the preoperative DHI score. The DHI outcome after 1 year was not affected by the preoperative DHI score. Compared with the control group, the DHI score at 3 weeks and 3 months after surgery was significantly worse. There was no significant difference between the groups after 1 year. Vertigo was improved in all patients and completely resolved after 1 year in 17 patients.CONCLUSIONSDisabling vestibular dysfunction that affects quality of life should be considered an indication for surgery, even in otherwise asymptomatic patients with intracanalicular VS. Surgical removal of the tumor is safe and very effective in regard to symptom relief. All patients had excellent facial nerve function within 1 year after surgery, with a very good chance of hearing preservation.

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Vestibular function in families with inherited autosomal dominant hearing loss

Journal of Vestibular Research ◽

10.3233/ves-2008-18105 ◽

2008 ◽

Vol 18 (1) ◽

pp. 51-58

Author(s):

Valerie A. Street ◽

Jeremy C. Kallman ◽

Paul D. Strombom ◽

Naomi F. Bramhall ◽

James O. Phillips

Keyword(s):

Hearing Loss ◽

Inner Ear ◽

Autosomal Dominant ◽

Vestibular Function ◽

Vestibular Dysfunction ◽

Self Report ◽

Vestibular Hypofunction ◽

Mount Kilimanjaro ◽

Vestibular Symptoms ◽

Balance Problems

The inner ear contains the developmentally related cochlea and peripheral vestibular labyrinth. Given the similar physiology between these two organs, hearing loss and vestibular dysfunction may be expected to occur simultaneously in individuals segregating mutations in inner ear genes. Twenty-two different genes have been discovered that when mutated lead to non-syndromic autosomal dominant hearing loss. A review of the literature indicates that families segregating mutations in 13 of these 22 genes have undergone formal clinical vestibular testing. Formal assessment revealed vestibular dysfunction in families with mutations in ten of these 13 genes. Remarkably, only families with mutations in the COCH and MYO7A genes self-report considerable vestibular challenges. Families segregating mutations in the other eight genes do not self-report significant balance problems and appear to compensate well in everyday life for vestibular deficits discovered during formal clinical vestibular assessment. An example of a family (referred to as the HL1 family) with progressive hearing loss and clinically-detected vestibular hypofunction that does not report vestibular symptoms is described in this review. Notably, one member of the HL1 family with clinically-detected vestibular hypofunction reached the summit of Mount Kilimanjaro.

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

Neurorehabilitation ◽

10.3233/nre-203113 ◽

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.

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Unilateral peripheral vestibular disorders in the emergency room of the ENT Department of Cluj-Napoca, Romania

Medicine and Pharmacy Reports ◽

10.15386/cjmed-412 ◽

2015 ◽

Vol 88 (2) ◽

pp. 181-187 ◽

Cited By ~ 2

Author(s):

Maria Petri ◽

Magdalena Chirila ◽

Sorana Bolboaca ◽

Marcel Cosgarea

Keyword(s):

Emergency Room ◽

Vestibular Function ◽

Clinical History ◽

Complete Recovery ◽

Vestibular Dysfunction ◽

Vestibular Disorders ◽

Co Morbidity ◽

Significant Difference ◽

Hearing Recovery ◽

Intratympanic Injection

Objective: To asses the management of unilateral peripheral vestibular disorders in the emergency room of the ENT Department of Cluj-Napoca, Romania.Material and method: The study was prospective, non-randomized and included the patients presented for dizziness or balance disorders at the emergency room of the ENT Department between March 2012 and March 2013. Demographic characteristics, specific clinical history, the onset of peripheral vestibular disorders, and co-morbidities were recorded. The patients charts included the type of onset and the treatment (medical, surgical, and rehabilitation) performed in the emergency room or in case of hospital admission, the relieving measures for the vestibular symptoms with or without hearing recovery.Results: One hundred and fifty-two subjects were included in our study, 97 with pure peripheral vestibular dysfunction (VD), 34 with cochlear-vestibular dysfunction (CVD), and 21 with Ménière’s disease (MD). No significant differences were identified when the proportion of patients with a certain onset (acute, subacute or chronic) were compared. Hypertension was the most frequent co-morbidity in all investigated groups. No significant difference was observed when the relief of vertigo or hearing recovery were compared between all groups.Conclusion: This first Romanian report on the management of unilateral peripheral vestibular disorders showed that early corticosteroids treatment associated with electrolytes, antiemetic, and vasodilation drugs led to produces recovery of the vestibular function without any differences between the types of peripheral vestibular dysfunction. In addition, we obtained the complete recovery of the vestibular and acoustic dysfunction in the cases treated with metylprednisolone intratympanic injection.

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789 Obstructive Sleep Apnea (OSA) and Vestibular Dysfunction in Patients with Traumatic Brain Injury (TBI)

SLEEP ◽

10.1093/sleep/zsab072.786 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A307-A308

Author(s):

Karen Skop ◽

Laura Bajor ◽

Chad Swank ◽

Mitch Sevigny ◽

Sudha Tallavajhula ◽

...

Keyword(s):

Nutrition Education ◽

Vestibular Dysfunction ◽

Adverse Outcomes ◽

Model Systems ◽

Future Research ◽

Obstructive Sleep ◽

Significant Difference ◽

Vestibular Symptoms ◽

Relationship Of ◽

The Relationship

Abstract Introduction Recent work has highlighted prevalent OSA after TBI. Vestibular dysfunction is also common and associated with adverse outcomes particularly in military personnel. Vestibular dysfunction has been identified in patients with moderate to severe OSA, yet the relationship remains unexplored in those with TBI. This study examined the relationship of vestibular dysfunction with OSA in a large cohort of Veterans and Military Service Members (V/SM) with documented TBI. Methods Data are secondary analyses from a five-center prospective observational cohort study of V/SM admitted for inpatient rehabilitation for TBI and enrolled in the VA TBI Model Systems. Participants completing study measures from 2015 to March of 2020 were included in analyses. Study measures includes the Centers for Disease and Control’s National Health and Nutrition Education Survey (NHANES, OSA item embedded) epidemiologic survey and Neurobehavioral Symptom Inventory (NSI). T-tests and chi-square tests compared patients with OSA to those without OSA on the vestibular subscale on the NSI. Results The sample was mostly male (93%), a mean of 38 years of age, and predominantly with mild (52%) or severe (41%) TBI. OSA was reported in 30.6% on the NHANES. Vestibular symptoms were more common among those with OSA (24%) compared to those without (12%) with a significant difference on the NSI Vestibular Total Score (3.84 vs 2.88 respectively; p<0.001). Similar results were seen across all three NSI vestibular items (dizziness, balance difficulties, poor coordination). Conclusion Participants with TBI and comorbid OSA are more likely to endorse the presence and greater severity of vestibular symptoms compared to those without OSA. Future research is needed to improve understanding of the inter-relationship of OSA and vestibular dysfunction to inform clinical management. Support (if any) VA TBIMS & TBICoE (HT0014-19-C-0004), NIDILRR, North Texas TBI Model System (Grant #90DPTB0013), TIRR TBIMS (Grant #90DPTB0016)

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The lesion site of vestibular dysfunction in Ramsay Hunt syndrome: A study by click and galvanic VEMP

Journal of Vestibular Research ◽

10.3233/ves-2006-164-508 ◽

2007 ◽

Vol 16 (4-5) ◽

pp. 217-222

Author(s):

Hidenori Ozeki ◽

Shinichi Iwasaki ◽

Munetaka Ushio ◽

Naonobu Takeuchi ◽

Toshihisa Murofushi

Keyword(s):

Semicircular Canal ◽

Vestibular Dysfunction ◽

Vestibular Nerve ◽

Vestibular Evoked Myogenic Potentials ◽

Lesion Site ◽

Lateral Semicircular Canal ◽

Caloric Testing ◽

Ramsay Hunt Syndrome ◽

Hunt Syndrome ◽

Vestibular Symptoms

Ramsay Hunt syndrome (RHS) is characterized by vestibulocochlear dysfunction in addition to facial paralysis and auricular vesicles. The present study investigated the lesion site of vestibular dysfunction in a group of 10 RHS patients. Caloric testing, vestibular evoked myogenic potentials by click sound (cVEMP) and by galvanic stimulation (gVEMP) were used to assess the function of the lateral semicircular canal, saccule, and their afferents. The results of caloric testing (all 10 cases showed canal paresis) mean the existence of lesion sites in lateral semicircular canal and/or superior vestibular nerve (SVN). Abnormal cVEMPs in 7 patients mean the existence of lesions in saccule and/or inferior vestibular nerve (IVN). Four of the 6 patients with absent cVEMP also underwent gVEMP. The results of gVEMP (2 absent and 2 normal) mean that the former 2 have lesions of the vestibular nerve, and the latter 2 have only saccular lesions concerning the pathway of VEMPs. Thus, our study suggested that lesion sites of vestibular symptoms in RHS could be in the vestibular nerve and/or labyrinth, and in SVN and/or IVN. In other words, in the light of vestibular symptoms, there is the diversity of lesion sites.

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