Assessment of Vestibular and Oculomotor Function in Patients with Vestibular Migraine: A Preliminary Study

Background: The purpose of the study is to assess the vestibular and oculomotor function in patients with vestibular migraine(VM).And we also investigate the relationship between test resultsandeffectiveness of prophylactic medication.Methods: We recruited 41 patientswith VM. They were examinedwith vestibular-evoked myogenic potentials(VEMP), video head impulse test(vHIT) and videonystagmography(VNG), including spontaneous or positional nystagmus, gaze-evoked nystagmus, smooth pursuit and caloric irrigation testing.All VM patients were treated withprophylactic medications. Theintensity of vertigo were evaluated with dizziness handicap inventory(DHI) before and after treatment. After 6 months, we evaluate the effectiveness of prophylactic medication. We analyzed the relationship between test resultsandeffectiveness of prophylactic medication.Results:In vestibular function test,71% of VM patients showed abnormal result. 20% showed abnormal air-conducted cVEMP and 42% showed abnormal air-conducted oVEMP. 32% showed abnormal vHIT and 56% showed abnormal caloric irrigation test.The abnormal rate of oVEMP was significantly higher than cVEMP (p<0.05). And the abnormal rate of caloric irrigation test was significantly higher than vHIT(p<0.05). In oculomotor function test, 42% showed pathological result. The abnormal rate of oculomotor function test was significantly lower than vestibular function test (p<0.05). After 6 months follow-up, rate of good effectiveness was significantly higher in normal vestibular function test group compared with the abnormal vestibular function test group (p<0.05). Rate of good effectiveness was no statistically significant difference between normal oculomotor function test group and abnormal oculomotor function test group (p>0.05).Conclusions: Abnormal vestibular and oculomotor function are commonly observed in VM patients. And VM patients with abnormal vestibular function have a weak effectiveness of prophylaxis medications.

Peran Tes Dynamic Visual Acuity dan Tes Kalori dalam Menilai Gangguan Keseimbangan pada Pasien Tuberkulosis yang Mendapat Terapi Streptomisin

Latar belakang: Gangguan keseimbangan merupakan efek samping pemberian streptomisin yang dapat menurunkan kualitas hidup. Saat ini belum didapatkan penelitian gangguan keseimbangan pada pasien tuberkulosis yang mendapat terapi streptomisin diperiksa menggunakan tes dynamic visual acuity (DVA) dan tes kalori. Tujuan: Penelitian ini bertujuan untuk melihat akurasi pemeriksaan keseimbangan dengan DVA pada pasien TB yang mendapatkan streptomisin dibandingkan dengan elektronistagmografi (ENG). Metode: Penelitian ini merupakan penelitian pra-eksperimental untuk mengetahui perubahan hasil pemeriksaan fungsi keseimbangan vestibuler pada suatu kelompok pasien TB sebelum dan setelah 56 kali pemberian streptomisin, atau bila timbul keluhan gangguan keseimbangan dengan tes DVA dan tes kalori selama April-Oktober 2014. Digunakan rancangan uji diagnostik untuk membandingkan kedua cara pengukuran setelah pengobatan. Hasil: Setelah pemberian terapi didapatkan 31 (77,5%) dari 40 subjek dengan pemeriksaan kalori dan 30 (75%) dengan pemeriksaan DVA. Rerata nilai kalori sebelum terapi sebesar 93,5±32,07°/detik dan setelah terapi sebesar 82,30±38,43°/detik, terjadi perubahan sebesar -11,25±50,55°/detik. Median nilai kenaikan DVA sebelum terapi adalah 0 (minimal 0-maksimal 2) baris dan setelah terapi adalah 3 (minimal 0-maksimal 6) baris, terjadi perubahan sebesar 3 (minimal 0-maksimal 5) baris. Sensitivitas pemeriksaan DVA 83%, spesifisitas 27%, nilai duga positif 17%, nilai duga negatif 90%, rasio kemungkinan positif 1,13, dan rasio kemungkinan negatif 0,63 dengan pemeriksaan kalori sebagai baku emas. Kesimpulan: Pemeriksaan DVA dapat digunakan sebagai skrining pemeriksaan kelemahan vestibuler perifer bilateral pada pasien tuberkulosis yang mendapat terapi streptomisin.Background: Impaired balance is the side effect of Streptomycin administration which can decrease the quality of life Up till now, there is no research yet on dynamic visual acuity (DVA) and caloric test in tuberculosis (TB) patients receiving streptomycin therapy. Objective: This study aims to look at the accuracy of the examination using DVA in TB patients receiving Streptomycin, compared to using electronistagmography (ENG). Methods: A pre-experimental study was used to determine changes in the vestibular function test results in a group of TB patients before and after56times administrationof Streptomycin, or when subjects complained of balance disorders, with DVA test and caloric test during April-October 2014. Designed diagnostic test was used after treatment to compare the two methods of measurement. Result: After therapy there was 31 (77.5%) out of 40 subjects with caloric examination and in 30 (75%) with DVA examination. The mean value of caloric examination before therapy was 93.5±32.07°/sec and after therapy was 82.30±38.43°/sec, the change was -11.25±50.55°/sec. The median value of increased DVA line before therapy was 0 line and after therapy was 3 line, there was a change of 3 (minimum 0-maximum 5) line. DVA examination has a sensitivity of 83%, a specificity of 27%, positive predictive value 17%, negative predictive value 90%, a positive likelihood ratio 1.13 and a negative likelihood ratio 0.63 with caloric examination as the gold standard. Conclusion: DVA examination can be used as a screening tool in bilateral peripheral vestibular weakness in TB patients who received Streptomycin therapy.

Cervical Vestibular-Evoked Myogenic Potentials: Norms and Protocols

Vestibular-evoked myogenic potential (VEMP) testing is a vestibular function test used for evaluating saccular and inferior vestibular nerve function. Parameters of VEMP testing include VEMP threshold, latencies of p1 and n1, and p1-n1 interamplitude. Less commonly used parameters were p1-n1 interlatency, interaural difference of p1 and n1 latency, and interaural amplitude difference (IAD) ratio. This paper recommends using air-conducted 500 Hz tone burst auditory stimulation presented monoaurally via an inserted ear phone while the subject is turning his head to the contralateral side in the sitting position and recording the responses from the ipsilateral sternocleidomastoid muscle. Normative values of VEMP responses in 50 normal audiovestibular volunteers were presented. VEMP testing protocols and normative values in other literature were reviewed and compared. The study is beneficial to clinicians as a reference guide to set up VEMP testing and interpretation of the VEMP responses.

Prevalence and Characteristics of Preoperative Balance Disorders in Cochlear Implant Candidates

Objectives: The aim of this study was to elucidate the frequency and characteristics of preoperative vertigo symptoms in patients who undergo cochlear implantation (CI), in order to differentiate them from CI-related symptoms. Methods: In a prospective observational study, 47 adult CI candidates were asked about vertigo problems on a questionnaire. A subdivision into 3 groups was done: Group A (probable otogenic vertigo), group B (possible otogenic vertigo), and group C (not otogenic vertigo). Horizontal semicircular canal function was measured. Patients with vertigo complaints were compared to patients without vertigo with regard to the presence of abnormal vestibular function findings. Results: Twenty-five patients (53%) reported preoperative vertigo problems. In 21 (84%), the patient's history suggested a probable (group A) or possible (group B) otogenic origin. Patients with vertigo more often had abnormal findings on vestibular function testing than did patients without vertigo. This difference, however, was not statistically significant. Conclusions: A considerable number of CI candidates have preoperative vertigo symptoms. These cannot be explained by horizontal semicircular canal function alone. In order to understand why CI patients develop postoperative vertigo, analysis of prospective preoperative vestibular function test findings and vertigo symptoms is necessary.