Asymmetric Optokinetic Afterresponse in Patients with Vestibular Neuritis

1991 ◽  
Vol 1 (3) ◽  
pp. 279-289
Author(s):  
Krister Brantberg ◽  
Måns Magnusson
Keyword(s):  
Vestibular Function ◽  
Vestibular Compensation ◽  
Vestibular Neuritis ◽  
Spontaneous Nystagmus ◽  
Positional Nystagmus ◽  
Optokinetic Afternystagmus ◽  
Vestibular Lesion ◽  
Caloric Response

The symmetry of primary and secondary optokinetic afternystagmus (OKAN I and OKAN II, respectively) was studied in 14 patients with vestibular neuritis, as well as in 50 normals. The patients were examined at onset of symptoms and at follow-up 3 and 12 months later. At onset, OKAN was found mainly to reflect the spontaneous nystagmus. Although the spontaneous nystagmus disappeared in all patients within 3 months, both OKAN I and OKAN II was asymmetric at the 3- and 12-month check-ups. OKAN beating toward the lesioned ear was weaker than the OKAN beating toward the healthy ear. Thus, the asymmetric vestibular function was reflected not only in the OKAN I, but also by an asymmetry in OKAN II. Between the 3- and 12-month check-ups, asymmetry in OKAN declined, even among those patients who showed no improvement in caloric response during that time. The decreasing asymmetry in OKAN with time after lesion was, however, related to the disappearance of a positional nystagmus. Hence, the results may be interpreted as suggesting OKAN not only to be affected by vestibular side-difference, but also to be modified by the process responsible for vestibular compensation following a peripheral vestibular lesion.

Vestibular Pathophysiologic Changes in Experimental Perilymphatic Fistula

1992 ◽  
Vol 101 (7) ◽  
pp. 612-616 ◽  
Author(s):  
Yasuya Nomura ◽  
Yi-Ho Young ◽  
Makoto Hara
Keyword(s):  
Round Window ◽  
Vestibular Function ◽  
Acute Stage ◽  
Spontaneous Nystagmus ◽  
Round Window Membrane ◽  
Caloric Test ◽  
Positional Nystagmus ◽  
Perilymphatic Fistula ◽  
Membrane Changes ◽  
Ice Water

An animal model of experimental perilymphatic fistula (EPLF) was developed in the guinea pig in order to study vestibular pathophysiology. In experimental animals, 4 μL of perilymph was suctioned from one cochlea via the round window membrane. Changes in vestibular function were as follows. 1) During the acute stage (5 hours postoperatively), spontaneous nystagmus directed toward the normal side was noted in 57.4% of the EPLF animals. This lasted less than 24 hours. 2) One week postoperatively, direction-fixed positional nystagmus toward the lesioned ear was present in 22.7% of the EPLF animals, especially when the lesioned ear was positioned inferiorly. 3) With the ice water caloric test, no response was present in 58.1% of the EPLF animals and an irregular response was found in 22.6% of them, 1 week postoperatively. These results tend to indicate that tests of vestibular function may differentiate between patients with Meniere's disease and those with perilymphatic fistula. Histologic findings indicate that a floating labyrinth is the cause of positional nystagmus and caloric irregularity. The absence of caloric responses was associated with collapse of the vestibular labyrinth.

scholarly journals Specific vestibular exercises in the treatment of vestibular neuritis

2004 ◽  
Vol 57 (5-6) ◽  
pp. 269-274 ◽  
Author(s):  
Zoran Komazec ◽  
Slobodanka Lemajic
Keyword(s):  
Treatment Time ◽  
Vestibular Rehabilitation ◽  
Vestibular Compensation ◽  
Vestibular Neuritis ◽  
Spontaneous Nystagmus ◽  
Compensation Mechanism ◽  
Hyperventilation Syndrome ◽  
Balance Disorders ◽  
Group I ◽  
Group Ii

Introduction Vestibular neuritis rapidly damages unilateral vestibular periphery, inducing severe balance disorders. In most cases, such vestibular imbalance is gradually restored to within the normal level after clinical therapies. This successive clinical recovery occurs due to regeneration of vestibular periphery and/or accomplishment of central vestibular compensation. Rehabilitation The program of vestibular rehabilitation presents a major achievement in the field of treatment of balance disorders. Vestibular compensation is associated with central sensory reintegration and bilaterally equalizes the vestibular tonus over a period of time. Material and methods In this retrospective study of a series of cases authors present their results in 58 patients undergoing a program of vestibular rehabilitation. Patients were divided into two groups. Thirty patients were in group I, and 28 in group II. Specific vestibular exercises were conducted in group I, and non-specific exercises in group II. Analysis of effects of vestibular compensation was made due electronystagmography. Results Results were satisfactory in both groups of patients. Absence of spontaneous nystagmus was detected in 83.3% of patients in group I (specific vestibular exercises) and in 53.5% of patients in group II (non-specific exercises), with an average treatment time of up to 2 months. Harmonization of pendular stimulation was detected in 83.3% and 60.7% of patients in groups I and II, respectively. Conclusion Early physiotherapeutic vestibular rehabilitation supports the vestibular compensation mechanism. At the same time vestibular rehabilitation may prevent panic disorder caused by hyperventilation syndrome.

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.

scholarly journals Recovery Nystagmus in Vestibular Neuritis with Minimal Canal Paresis. Clinical Observation and Interpretation

2022 ◽  
Vol 12 (1) ◽  
pp. 110
Author(s):  
Eleni Zoe Gkoritsa
Keyword(s):  
Time Course ◽  
Brain Mri ◽  
Vestibular Neuritis ◽  
Spontaneous Nystagmus ◽  
Vestibular Evoked Myogenic Potentials ◽  
Head Impulse Test ◽  
Slow Phase ◽  
Canal Paresis ◽  
Directional Preponderance

Recovery nystagmus in vestibular neuritis patients is a reversal of spontaneous nystagmus direction, beating towards the affected ear, observed along the time course of central compensation. It is rarely registered due either to its rarity as a phenomenon per se, or to the fact that it is missed between follow-up appointments. The aim of the manuscript is to describe in detail a case of recovery nystagmus found in an atypical case of vestibular neuritis and discuss pathophysiology and clinical considerations regarding this rare finding. A 26-year-old man was referred to our Otorhinolaryngology practice reporting “dizziness” sensation and nausea in the last 48 h. Clinical examination revealed left beating spontaneous nystagmus (average slow phase velocity aSPV 8.1°/s) with absence of fixation. The head impulse test (H.I.T.) was negative. Cervical vestibular evoked myogenic potentials (cVEMP) and Playtone audiometry (PTA) were normal. Romberg and Unterberger tests were not severely affected. A strong directional preponderance to the left was found in caloric vestibular test with minimal canal paresis (CP 13%) on the right. The first follow-up consultation took place on the 9th day after the onset of symptoms. Right beating weak (aSPV 2.4°/s) spontaneous nystagmus was observed with absence of fixation, whereas a strong right directional preponderance (DP) was found in caloric vestibular test. A brain MRI scan was ordered to exclude central causes of vertigo, which was normal. The patient was seen again completely free of symptoms 45 days later. He reported feeling dizzy during dynamic movements of the head and trunk for another 15 days after his second consultation. The unexpected observation of nystagmus direction reversal seven days after the first consultation is a typical sign of recovery nystagmus. Recovery nystagmus (RN) is centrally mediated and when found, it should always be carefully assessed in combination with the particularities of vestibular neuritis.

scholarly journals Vestibular Preservation After Cochlear Implantation Using the Round Window Approach

2021 ◽  
Vol 12 ◽  
Author(s):  
Keita Tsukada ◽  
Shin-ichi Usami
Keyword(s):  
Cochlear Implantation ◽  
Round Window ◽  
Surgical Techniques ◽  
Vestibular Function ◽  
Vestibular Evoked Myogenic Potential ◽  
Flexible Electrodes ◽  
Caloric Testing ◽  
Before And After ◽  
Window Approach ◽  
Caloric Response

Background: The development of less traumatic surgical techniques, such as the round window approach (RWA), as well as the use of flexible electrodes and post-operative steroid administration have enabled the preservation of residual hearing after cochlear implantation (CI) surgery. However, consideration must still be given to the complications that can accompany CI. One such potential complication is the impairment of vestibular function with resulting vertigo symptoms. The aim of our current study was to examine the changes in vestibular function after implantation in patients who received CI using less traumatic surgery, particularly the RWA technique.Methods: Sixty-six patients who received CI in our center were examined by caloric testing, cervical vestibular evoked myogenic potential (cVEMP) and ocular VEMP (oVEMP) before or after implantation, or both, to obtain data on semicircular canal, saccular and utricular function, respectively. Less traumatic CI surgery was performed by the use of the RWA and insertion of flexible electrodes such as MED-EL FLEX soft, FLEX 28, and FLEX 24 (Innsbruck, Austria).Results: Caloric response and the asymmetry ratio of cVEMP and oVEMP were examined before and after implantation using less traumatic surgical techniques. Compared with before implantation, 93.9, 82.4, and 92.5% of the patients showed preserved vestibular function after implantation based on caloric testing, cVEMP and oVEMP results, respectively. We also examined the results for vestibular function by a comparison of the 66 patients using the RWA and flexible electrodes, and 17 patients who underwent cochleostomy and insertion of conventional or hard electrodes. We measured responses using caloric testing, cVEMP and oVEMP in patients after CI. There were no differences in the frequencies of abnormal caloric and oVEMP results in the implanted ears between the RWA and cochleostomy. On the other hand, the frequency of abnormal cVEMP responses in the implanted ears in the patients who received implantation by cochleostomy was significantly higher than that in the patients undergoing surgery using the RWA.Conclusion: Patients receiving CI using less traumatic surgical techniques such as RWA and flexible electrodes have reduced risk of damage to vestibular function.

Asymmetric Optokinetic Afterresponse in Patients with Small Acoustic Neurinomas1

1991 ◽  
Vol 1 (3) ◽  
pp. 299-307
Author(s):  
Krister Brantberg ◽  
Måns Magnusson
Keyword(s):  
Vestibular Function ◽  
Directional Asymmetry ◽  
Optokinetic Stimulation ◽  
Optokinetic Afternystagmus ◽  
Acoustic Neurinomas ◽  
Normal Controls

Directional asymmetry of primary and secondary optokinetic afternystagmus (OKAN I and OKAN II, respectively) was studied in 20 patients with small acoustic neurinomas (⩽20 mm), and results were compared to those for 24 normal controls. The optokinetic afterresponse was induced by 60 s of horizontal whole-field optokinetic stimulation in both directions. Among patients, the optokinetic afterresponse was asymmetric, OKAN I and OKAN II beating toward the lesioned ear being significantly weaker than the OKAN I and OKAN II beating toward the healthy ear. Hence, in these patients with gradual deterioration of vestibular function, the vestibular side-difference was reflected both in OKAN I and OKAN II. Although asymmetry in OKAN I was frequently observed among controls, it was significantly more pronounced among the patients. Moreover, patients could be distinguished by the occurrence of OKAN II, as it did not occur at all among controls exposed to the same stimulation.

scholarly journals 022 Patient-initiated event monitoring for acute vertigo

2019 ◽  
Vol 90 (e7) ◽  
pp. A8.2-A8
Author(s):  
Allison S Young ◽  
Corinna Lechner ◽  
Andrew P Bradshaw ◽  
Hamish G MacDougall ◽  
Deborah A Black ◽  
...  
Keyword(s):  
Spontaneous Nystagmus ◽  
Slow Phase ◽  
Vestibular Disorders ◽  
Positional Nystagmus ◽  
Low Velocity ◽  
Event Monitoring ◽  
Superior Semicircular Canal Dehiscence ◽  
Positional Vertigo ◽  
Horizontal Nystagmus ◽  
Vertical Nystagmus

IntroductionThe diagnosis of vestibular disorders may be facilitated by analysing patient-initiated capture of ictal nystagmus.MethodsAdults with a history of recurrent vertigo were taught to self-record spontaneous and positional-nystagmus at home while symptomatic, using video-goggles. Patients with final diagnoses of disorders presenting with recurrent vertigo were analysed: 121 patients with Ménière’s Disease (MD), Vestibular Migraine (VM), Benign Positional Vertigo (BPV), Episodic Ataxia Type II (EAII), Vestibular Paroxysmia (VP) or Superior Semicircular Canal Dehiscence (SSCD) were included.ResultsOf 43 MD patients, 40 showed high-velocity spontaneous horizontal-nystagmus (median slow-phase velocity (SPV) 39.7 degrees/second (°/s); Twenty-one showed horizontal-nystagmus reversing direction within 12-hours (24 on separate days). In 44 of 67 patients with VM, low velocity spontaneous horizontal (n=28, 4.9°/s), up-beating (n=6, 15.5°/s) or down-beating-nystagmus (n=10, 5.1°/s) was observed; Sixteen showed positional-nystagmus only, and seven had no nystagmus. Spontaneous horizontal-nystagmus with SPV >12.05°/s had a sensitivity and specificity of 95.3% and 82.1% for MD. Nystagmus direction-change within 12-hours was highly specific (95.7%) for MD. Spontaneous vertical-nystagmus was highly specific (93.0%) for VM. In the seven BPV patients, spontaneous-nystagmus was absent or <3°/s, and characteristic paroxysmal positional nystagmus was observed in all cases. Patients with central and MD-related positional vertigo demonstrated persistent nystagmus. Two patients with EAII showed spontaneous vertical nystagmus, one patient with VP showed short bursts of horizontal-torsional nystagmus lasting 5–10s, and one patient with SSCD demonstrated paroxysmal torsional down-beating nystagmus when supine.ConclusionsPatient-initiated vestibular event-monitoring is feasible and could facilitate rapid and accurate diagnosis of episodic vestibular disorders.

Sign in / Sign up

Export Citation Format

Share Document