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Hashimoto M, Koizuka I, Yamashita H, Suzuki M, Omori K, Origasa H, Takeda N, Shojaku H. Diagnostic and therapeutic strategies for vestibular neuritis of the Japan Society for Equilibrium Research. Auris Nasus Larynx 2024; 51:31-37. [PMID: 36581537 DOI: 10.1016/j.anl.2022.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 12/15/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To provide diagnostic and therapeutic strategies for vestibular neuritis in accordance with the Japanese Clinical Practice Guidelines for Vestibular Neuritis 2021. METHODS The Committee for Clinical Practice Guidelines for Vestibular Neuritis was entrusted with a review of the relevant scientific literature on the above topic. Clinical Questions (CQs) concerning the treatment of vestibular neuritis were produced, and a search of the literature was conducted to identify studies related to the CQs. The recommendations were based on the literature review and the expert opinion of a subcommittee. RESULTS We proposed the diagnostic criteria for vestibular neuritis, as well as answers to CQs, recommendations, and evidence levels for the treatment of vestibular neuritis. CONCLUSION The diagnostic criteria for vestibular neuritis were based on clinical history and examination findings after completing the differential diagnosis process. The treatment of vestibular neuritis was divided into acute, subacute, and chronic stages. The Japanese Clinical Practice Guidelines for Vestibular Neuritis 2021 should be used as a reference in the diagnosis and treatment of vestibular neuritis.
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Affiliation(s)
- Makoto Hashimoto
- Department of Otolaryngology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Izumi Koizuka
- Department of Otolaryngology, St. Marianna University School of Medicine, Kawasaki, Japan.
| | - Hiroshi Yamashita
- Department of Otolaryngology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Mamoru Suzuki
- Department of Otolaryngology, Tokyo Medical University, Tokyo, Japan
| | - Koichi Omori
- Department of Otolaryngology-Head and Neck Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hideki Origasa
- Department of Biostatistics and Clinical Epidemiology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Noriaki Takeda
- Department of Otolaryngology, University of Tokushima School of Medicine, Tokushima, Japan
| | - Hideo Shojaku
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan
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Nakamichi N, Shiozaki T, Sakagami M, Kitahara T. Differences in semicircular canal function in the video head impulse test in patients in the chronic stage of sudden sensorineural hearing loss with vertigo and vestibular neuritis. Acta Otolaryngol 2024; 144:123-129. [PMID: 38546396 DOI: 10.1080/00016489.2024.2330680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/10/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Sudden sensorineural hearing loss with vertigo (SHLV) and vestibular neuritis (VN) can result in prolonged dizziness. OBJECTIVES This study aimed to compare the video head impulse test (vHIT) of patients with SHLV and VN. METHODS Fifteen patients with SHLV and 21 patients with VN who visited the Vertigo/Dizziness Center of our hospital between December 2016 and February 2023 were included. vHIT was performed at the time of admission, and the VOR gain and catch up saccade (CUS) in the three types of semicircular canals (SCCs) were analyzed. RESULTS Pathologic vHIT results were observed most frequently in the posterior SCC (73%), followed by lateral (53%) and anterior (13%) SCCs in the SHLV group. In contrast, pathologic vHIT results were observed most frequently in the lateral SCC (100%), followed by the anterior (43%) and posterior SCC (24%) SCCs in the VN group. Pathological vHIT results in the lateral and posterior SCC showed significant differences between the two groups, but for anterior SCC, no significant differences were found. CONCLUSIONS AND SIGNIFICANCE Comparison of the two vHIT results revealed differences in the SCC dysfunction patterns. This may be due to the different pathophysiological mechanisms of the two vestibular disorders, which may result in prolonged vertigo.
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Affiliation(s)
- Natsuko Nakamichi
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, Kashihara-city, Japan
| | - Tomoyuki Shiozaki
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, Kashihara-city, Japan
| | - Masaharu Sakagami
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, Kashihara-city, Japan
| | - Tadashi Kitahara
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, Kashihara-city, Japan
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Li Z, Miao L, Zhang T, Li X. Objective Neurological Testing Methods Used to Follow Up Vestibular Neuritis Depending on Different Factors. Int J Gen Med 2023; 16:4991-5002. [PMID: 37933252 PMCID: PMC10625780 DOI: 10.2147/ijgm.s436206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/20/2023] [Indexed: 11/08/2023] Open
Abstract
Purpose We analyze the impact of different factors on clinical performance and prognosis in vestibular neuritis (VN) and explore indicators that could accurately reflect changes in patients' symptoms at different stages. Methods We observed patients with VN during the acute and recovery phases. Clinical symptoms, vertigo-related scales, neurological examination, vestibular function tests (caloric test, video head impulse test (vHIT), vestibular evoked myogenic potential (VEMP)), and the history of disease (underlying diseases, glucocorticoid therapy) were recorded at onset and at 4 and 12 weeks after onset in VN patients. Multiple linear regression analysis was used to identify vestibular function tests that had a linear regression relationship with the subjective quantitative results. Results At 4 weeks after onset, the group without underlying disease had better improvement in EEV, gain, and UW than the group with underlying disease (P < 0.05). There was a significant difference in the change in DHI, EEV, gain of the affected horizontal semicircular canal in the vHIT and unilateral weakness (UW) between the glucocorticoid treatment group and the no glucocorticoid treatment group (P < 0.05), and glucocorticoid treatment group was better. The change value in the gain of horizontal canals in the vHIT was mainly positively and linearly correlated with the EEV scores (P<0.001). Possible dynamic correlation between vHIT results and vestibular symptoms. Conclusion The absence of underlying disease and the receipt of glucocorticoid therapy significantly contributed to the improvement of objective vestibular function tests in the short term, while the improvement of subjective vertigo may correlate with the different objective measures and questionnaire. We believe that the improvement of the affected horizontal semicircular canal gain value in the vHIT can be used as a reference indicator of the degree of improvement of vestibular symptoms with superior vestibular neuritis.
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Affiliation(s)
- Zidong Li
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, People’s Republic of China
| | - Lu Miao
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, People’s Republic of China
| | - Tianyi Zhang
- School of Basic Medical Sciences, Shandong University, Jinan, 250000, People’s Republic of China
| | - Xinyi Li
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, People’s Republic of China
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El Medany NM, Kolkaila EA, El Mehallawi TH, Lasheen RM. A study of otolith function in patients with orthostatic dizziness. Eur Arch Otorhinolaryngol 2023; 280:4803-4810. [PMID: 37106133 PMCID: PMC10562266 DOI: 10.1007/s00405-023-07985-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Orthostatic dizziness (OD) is the dizziness that occurs when moving from a sitting or a supine to a standing position. It is typically thought to be connected to orthostatic hypotension (OH). The otolithic control of respiratory and cardiovascular system through vestibulosympathetic reflex has been the focus of considerable recent interest. This study aimed to evaluate the relationship between the orthostatic dizziness and otolith organ function. METHODS This study was carried on 50 adults aged from 18 to 50 years with normal peripheral hearing. Subjects were divided into two groups: controls (GI): 20 healthy adults and study group (GII): 30 patients who were complaining of OD. Patients were submitted to; blood pressure measurement in sitting and standing positions, combined vestibular-evoked myogenic potentials (VEMPs) and subjective visual vertical and horizontal tests (SVV) and (SVH). RESULTS The study group showed abnormal absent cVEMP, oVEMP. There were also statistically significant differences of P13 and N23 latencies and (P13N23) amplitudes between the two groups in the left ears. Both groups differed significantly in SVH values deviated to the left side. Study group were further subdivided into ten patients with OH and 20 patients with OD without OH. The both study subgroups showed abnormal absent cVEMP, oVEMP and abnormal SVH. OH patients showed statistically significant differences of cVEMP waves P13, N23 latencies in the left ears when compared with the control. CONCLUSIONS Otolith malfunction may be the cause of orthostatic dizziness (OD) in patients with and without orthostatic hypotension.
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Affiliation(s)
- Nada Medhat El Medany
- Audio-Vestibular Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Enaas Ahmad Kolkaila
- Audio-Vestibular Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | - Reham Mamdouh Lasheen
- Audio-Vestibular Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt
- Audiovestibular Unit, Department of Otolaryngology/Head and Neck Surgery, Tanta University Hospital, El-Geish Street, Tanta, 31511 El-Gharbia Egypt
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Rosa MS, Campagnoli M, Masnaghetti D, Taranto F, Pisani G, Garzaro M, Aluffi Valletti P. Clinical and Prognostic Implications of Cervical and Ocular Vestibular Evoked Myogenic Potentials (cVEMP and oVEMP) in Benign Paroxysmal Positional Vertigo (BPPV): A Prospective Study. Audiol Res 2023; 13:700-709. [PMID: 37736942 PMCID: PMC10514798 DOI: 10.3390/audiolres13050061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVE Several studies have investigated the efficacy of VEMP (vestibular evoked myogenic potential) in patients with vestibular disorders and BPPV (benign paroxysmal positional vertigo). However, previous data were inconclusive. The aim of this study was to investigate the difference in latency, amplitude P1-N1, asymmetry ratio (AR), and cervical/ocular-VEMP values between BPPV patients and healthy controls. METHODS 125 healthy subjects and 42 BPPV patients were prospectively enrolled in the study. In both groups, c/oVEMP tests with 500 Hz tone-burst stimuli were performed. Latencies P1, N1 peaks, and corrected amplitudes (CA) were measured, and AR was calculated. RESULTS in the BPPV group, 14.29% of patients lacked oVEMPs that recovered after therapy. N1 latencies were significantly elongated, and 50% of patients had pathological AR; this value normalized at follow-up sessions. In addition, there was a reduction in CA in the pathologic ear compared to healthy ears (p = 0.04) and compared to healthy controls (p = 0.01). For cVEMP, a significant reduction in latency-P1 was observed in BPPV patients compared to controls; no significant differences were observed for P1, N1, and CA values between the two ears. The cVEMPs were absent in 14.29% of BPPV patients (AR > 35) that recovered after therapy. CONCLUSION We identified several abnormal c/oVemp values in BPPV patients compared with healthy controls, with most changes in values occurring in oVEMPs, suggesting that utricular dysfunction may be more common than saccular. In addition, patients with oVEMP alteration showed later clinical recovery, suggesting a possible prognostic role of the test.
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Evaluation of vestibular evoked myogenic potential values in elder patients with hip fractures: A prospective controlled study. JOURNAL OF SURGERY AND MEDICINE 2023. [DOI: 10.28982/josam.7703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
Background/Aim: Hip fractures among the elderly are a major public health problem that cause high rates of morbidity and mortality. There are many studies regarding prevention and defining the underlying causes of hip fractures. The purpose of this study was to evaluate the cervical vestibular evoked myogenic potential (cVEMP) test responses of elderly patients without vestibular symptoms hospitalized due to fall-related hip fractures in order to evaluate the subclinical vestibular dysfunction rates in patients with hip fractures.
Methods: Twenty-two patients aged 67-79 hospitalized due to fall-related hip fractures and 24 control patients presenting to the orthopedic clinic due to knee pain were included in the study. The participants underwent detailed otological examination and cVEMP tests. The two groups’ cVEMP records were then compared.
Results: The demographic characteristics of the participants in the patient and control groups including age, gender, and race were similar. There was no statistically significant difference between the groups’ absent VEMP response rates. No significant difference in terms of P1 and N1 latencies was determined between the right and left ears in either group. The hip fracture group (study group) had significantly increased P1 and N1 latencies in cVEMP which is associated with central vestibular dysfunction. (P=0.008 and P=0.007, respectively).
Conclusion: The rate of subclinical peripheral vestibular dysfunction, which can be identified by cVEMP evaluation, is increased in elderly patients with hip fractures caused by low energy trauma. Precautions like vestibular rehabilitation can be a preventive measure for hip fractures in the elderly.
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Kunelskaya NL, Manaenkova EA, Chugunova MA, Zaoeva ZO. [Method of registration of vestibular myogenic evoked potentials in the diagnosis of diseases of the inner ear]. Vestn Otorinolaringol 2023; 88:44-49. [PMID: 37450390 DOI: 10.17116/otorino20228803144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
The literature review is devoted to the practical application of the method of recording vestibular evoked myogenic potentials (VEMPs) in the diagnosis of the inner ear diseases: superior semicircular canal dehiscence syndrome, Meniere's disease, benign paroxysmal positional vertigo (BPPV), vestibular neuritis. Registration of VMEP is an electrophysiological research method that allows to assess objectively the functional state of the otolith receptors (sacculus and utriculus) and their pathways, which expands the diagnostic capabilities in diagnosis of the inner ear diseases.
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Affiliation(s)
- N L Kunelskaya
- L. I. Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - E A Manaenkova
- L. I. Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - M A Chugunova
- L. I. Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - Z O Zaoeva
- L. I. Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
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Strupp M, Bisdorff A, Furman J, Hornibrook J, Jahn K, Maire R, Newman-Toker D, Magnusson M. Acute unilateral vestibulopathy/vestibular neuritis: Diagnostic criteria. J Vestib Res 2022; 32:389-406. [PMID: 35723133 PMCID: PMC9661346 DOI: 10.3233/ves-220201] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This paper describes the diagnostic criteria for Acute Unilateral Vestibulopathy (AUVP), a synonym for vestibular neuritis, as defined by the Committee for the Classification of Vestibular Disorders of the Bárány Society. AUVP manifests as an acute vestibular syndrome due to an acute unilateral loss of peripheral vestibular function without evidence for acute central or acute audiological symptoms or signs. This implies that the diagnosis of AUVP is based on the patient history, bedside examination, and, if necessary, laboratory evaluation. The leading symptom is an acute or rarely subacute onset of spinning or non-spinning vertigo with unsteadiness, nausea/vomiting and/or oscillopsia. A leading clinical sign is a spontaneous peripheral vestibular nystagmus, which is direction-fixed and enhanced by removal of visual fixation with a trajectory appropriate to the semicircular canal afferents involved (generally horizontal-torsional). The diagnostic criteria were classified by the committee for four categories: 1. "Acute Unilateral Vestibulopathy", 2. "Acute Unilateral Vestibulopathy in Evolution", 3. "Probable Acute Unilateral Vestibulopathy" and 4. "History of Acute Unilateral Vestibulopathy". The specific diagnostic criteria for these are as follows:"Acute Unilateral Vestibulopathy": A) Acute or subacute onset of sustained spinning or non-spinning vertigo (i.e., an acute vestibular syndrome) of moderate to severe intensity with symptoms lasting for at least 24 hours. B) Spontaneous peripheral vestibular nystagmus with a trajectory appropriate to the semicircular canal afferents involved, generally horizontal-torsional, direction-fixed, and enhanced by removal of visual fixation. C) Unambiguous evidence of reduced VOR function on the side opposite the direction of the fast phase of the spontaneous nystagmus. D) No evidence for acute central neurological, otological or audiological symptoms. E) No acute central neurological signs, namely no central ocular motor or central vestibular signs, in particular no pronounced skew deviation, no gaze-evoked nystagmus, and no acute audiologic or otological signs. F) Not better accounted for by another disease or disorder."Acute Unilateral Vestibulopathy in Evolution": A) Acute or subacute onset of sustained spinning or non-spinning vertigo with continuous symptoms for more than 3 hours, but not yet lasting for at least 24 h hours, when patient is seen; B) - F) as above. This category is useful for diagnostic reasons to differentiate from acute central vestibular syndromes, to initiate specific treatments, and for research to include patients in clinical studies."Probable Acute Unilateral Vestibulopathy": Identical to AUVP except that the unilateral VOR deficit is not clearly observed or documented."History of acute unilateral vestibulopathy": A) History of acute or subacute onset of vertigo lasting at least 24 hours and slowly decreasing in intensity. B) No history of simultaneous acute audiological or central neurological symptoms. C) Unambiguous evidence of unilaterally reduced VOR function. D) No history of simultaneous acute central neurological signs, namely no central ocular motor or central vestibular signs and no acute audiological or otological signs. E) Not better accounted for by another disease or disorder. This category allows a diagnosis in patients presenting with a unilateral peripheral vestibular deficit and a history of an acute vestibular syndrome who are examined well after the acute phase.It is important to note that there is no definite test for AUVP. Therefore, its diagnosis requires the exclusion of central lesions as well as a variety of other peripheral vestibular disorders. Finally, this consensus paper will discuss other aspects of AUVP such as etiology, pathophysiology and laboratory examinations if they are directly relevant to the classification criteria.
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Affiliation(s)
- Michael Strupp
- Department of Neurology and German Center for Vertigo and Balance Disorders, Hospital of the Ludwig Maximilians University, Munich, Marchioninistrasse, Munich, Germany,Corresponding author: Michael Strupp, MD, FRCP, FAAN, FANA, FEAN, Dept. of Neurology and German Center for Vertigo and Balance Disorders, Hospital of the Ludwig Maximilians University, Munich, Marchioninistrasse 15, 81377 Munich, Germany. Tel.: +49 89 44007 3678; Fax: +49 89 44007 6673; E-mail:
| | - Alexandre Bisdorff
- Clinique du Vertige, Centre Hospitalier Emile Mayrisch, Esch-sur-Alzette, Luxembourg
| | - Joseph Furman
- Department of Otolaryngology, Neurology, Bioengineering and Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jeremy Hornibrook
- Departments of Otolaryngology - Head and Neck Surgery, Christchurch Hospital, University of Canterbury and University of Otago, Christchurch, New Zealand
| | - Klaus Jahn
- Department of Neurology, Schoen Clinic Bad Aibling, Bad Aibling, Germany and German Center for Vertigo and Balance Disorders, Ludwig-Maximilians University, Campus Grosshadern, Munich, Germany
| | - Raphael Maire
- Department of Otorhinolaryngology/Head & Neck Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - David Newman-Toker
- Ophthalmology, Otolaryngology and Emergency Medicine, The Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Måns Magnusson
- Department of Otorhinolaryngology, Lund University, Lund, Sweden
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Effects of Gaze Position on Ocular Vestibular Evoked Myogenic Potential (oVEMP). JOURNAL OF BASIC AND CLINICAL HEALTH SCIENCES 2022. [DOI: 10.30621/jbachs.1108971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective: To compare ocular vestibular evoked myogenic potential (oVEMP) responses obtained with superomedial and oblique gaze positions.
Methods: The oVEMP test was applied in 59 healthy subjects at superomedial, right oblique, and left oblique gaze positions. Stimuli were presented at 110 dB nHL with a frequency of 500 Hz. oVEMP responses were recorded via electrodes placed on the lower eyelids.
Results: Higher N1-P1 amplitudes were obtained in oblique gaze positions in the stimulated ear direction compared to the superomedial position (p<0.05). The asymmetry values obtained in the superomedial gaze position were lower than those obtained in oblique gaze positions (p<0.05). Superomedial and oblique gaze positions had no effect on the N1, P1, and N1-P1 latencies of the waves obtained from the right ear, left ear, and both ears (p>0.05).
Conclusion: Superomedial and oblique gaze positions affect oVEMP waves. In patients in whom vestibular hypofunction is suspected, it is recommended to control oVEMP responses in oblique gaze positions as well as in superomedial gaze positions in the evaluation of the residual vestibular functions.
Keywords: oVEMP, gaze, vertigo
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Cianfrone F, Cantore I, Roperto R, Tauro F, Bianco F, Mastronardi L, Ruscito P. Preoperative vestibular evoked myogenic potentials (VEMPs), caloric test, and pure tone audiometry to identify the vestibular nerve branch of schwannoma origin: preliminary results in a series of 26 cases. Neurosurg Rev 2022; 45:3231-3236. [PMID: 35819734 DOI: 10.1007/s10143-022-01834-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/04/2022] [Accepted: 06/06/2022] [Indexed: 10/17/2022]
Abstract
Vestibular schwannoma (VS) is a benign tumor which develops in the internal auditory canal and the cerebellopontine angle, potentially diminishing hearing or balance. Most VS tumors arise from one of two vestibular branches: the superior or inferior vestibular nerve. Determining the specific nerve of origin could improve patient management in terms of preoperative counseling, treatment selection, and surgical decision-making and planning. The aim of this study was to introduce a preoperative testing protocol with high accuracy to determine the nerve branch of origin. The nerve of origin was predicted on the basis of preoperative vestibular evoked myogenic potentials (VEMPs), caloric stimulation test, and pure tone audiometry on 26 recipients. The acquired data were entered into a statistic scoring system developed to allocate the tumor origin. Finally, the nerve of origin was definitively determined intraoperatively. Receiver operating characteristic (ROC) curves analysis of preoperative testing data showed the possibility of predicting the branch of origin. In particular, ROC curve of combined VEMPs absence, nystagmus detectable at caloric stimulation, and PTA < 75 dB HL allowed to obtain high accuracy for inferior vestibular nerve implant of the tumor (area under the curve-AUC = 0.8788, p = 0.012). In 24 of 26 cases, the preoperatively predicted tumor origin was the same as the origin determined during surgery. Preoperative audiological and vestibular evaluation can predict the vestibular tumor branch of origin with high accuracy. Despite the necessity of larger prospective cohort studies, these findings may change preoperative approach, possible functional aspects, and counseling with the patients.
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Affiliation(s)
- Francesca Cianfrone
- Otorhinolaryngology Department, ASL Roma 1 San Filippo Neri Hospital, Via G. Martinotti, 20, 00135, Rome, Italy
| | - Italo Cantore
- Otorhinolaryngology Department, ASL Roma 1 San Filippo Neri Hospital, Via G. Martinotti, 20, 00135, Rome, Italy.
| | - Raffaelino Roperto
- Neurosurgery Department, ASL Roma 1 San Filippo Neri Hospital, Rome, Italy
| | - Francesco Tauro
- Otorhinolaryngology Department, ASL Roma 1 San Filippo Neri Hospital, Via G. Martinotti, 20, 00135, Rome, Italy
| | - Francesco Bianco
- Otorhinolaryngology Department, ASL Roma 1 San Filippo Neri Hospital, Via G. Martinotti, 20, 00135, Rome, Italy
| | - Luciano Mastronardi
- Neurosurgery Department, ASL Roma 1 San Filippo Neri Hospital, Rome, Italy.,Neurosurgery Department, The State Education Institution of Higher Professional Training, The First Sechenov Moscow State Medical University Under Ministry of Health, Moscow, Russian Federation
| | - Paolo Ruscito
- Otorhinolaryngology Department, ASL Roma 1 San Filippo Neri Hospital, Via G. Martinotti, 20, 00135, Rome, Italy
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Kamogashira T, Funayama H, Asakura S, Ishimoto S. Vestibular Neuritis Following COVID-19 Vaccination: A Retrospective Study. Cureus 2022; 14:e24277. [PMID: 35602793 PMCID: PMC9119312 DOI: 10.7759/cureus.24277] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2022] [Indexed: 01/08/2023] Open
Abstract
Objective To determine if the COVID-19 vaccine can cause vestibular neuritis (VN). Design Retrospective study. Setting Vertigo outpatient clinic of the Department of Otolaryngology JR Tokyo General Hospital. Participants: 378 patients who presented at the Vertigo clinic between July 2018 and March 2022 Results 23 out of 378 cases were diagnosed with vestibular neuritis. There was a significant seasonal bias of the onset of VN in 2021-3Q compared to other seasons. All 7 patients diagnosed with VN whose onset was 2021-3Q and 2021-4Q had received the BNT162b2 (Pfizer-BioNTech) vaccine within the previous 3 months and one patient diagnosed with VN whose onset was 2022-1Q had a history of COVID-19 infection six months earlier. Conclusions VN should be recognized as one of the side-effects of the BNT162b2 COVID-19 vaccination.
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Affiliation(s)
- Teru Kamogashira
- Department of Otolaryngology, JR Tokyo General Hospital, Tokyo, JPN.,Department of Otolaryngology and Head and Neck Surgery, University of Tokyo, Tokyo, JPN
| | - Hideaki Funayama
- Department of Clinical Examination, JR Tokyo General Hospital, Tokyo, JPN
| | - Shinnosuke Asakura
- Department of Clinical Examination, JR Tokyo General Hospital, Tokyo, JPN
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12
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Chang C, Lo W, Young Y, Liao L, Wu P, Cheng P, Cheng P. Galvanic
vestibular‐evoked
myogenic potentials in evaluating damaged sites of vestibular neuritis. Laryngoscope Investig Otolaryngol 2022; 7:506-514. [PMID: 35434345 PMCID: PMC9008165 DOI: 10.1002/lio2.745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/14/2021] [Accepted: 01/11/2022] [Indexed: 11/28/2022] Open
Abstract
Objectives To test the possibility of pure otolithic organ deficits and validate the histopathological evidence of retrovestibular neural impairment in vestibular neuritis (VN), the authors adopted a topographic survey combining cervical vestibular‐evoked myogenic potential (cVEMP) and ocular vestibular‐evoked myogenic potential (oVEMP) using various stimulation modes and caloric tests. Methods Forty patients with VN were enrolled in this study. All patients underwent pure tone audiometry, acoustic cVEMP, galvanic cVEMP, vibratory oVEMP, galvanic oVEMP, and caloric tests. Different combinations of vestibular tests were further compared and analyzed. Results According to vestibular test results in affected VN ears, the proportion (10%) of pure saccular dysfunction was significantly less than that (52.5%) of saccular nerve deficit. The proportion (2.5%) of pure utricular dysfunction was significantly less than that (37.5%) of utricular nerve deficit. The percentage (82.5%) of VN involving the ampullar vestibulo‐ocular reflex (VOR) pathway was significantly higher than that (40%) involving the utriculo‐ocular reflex (UOR) pathway. The superior, inferior, and total VN percentages were 37.5%, 17.5%, and 45%, respectively. The proportion of inferior VN was significantly less than that of VN involving the superior vestibular nerve. Conclusion There were significantly fewer cases of pure otolithic organ dysfunction than vestibular nerve involvement in VN patients. The damage to the ampullar VOR pathway was more significant than that to the UOR pathway, and both pathways might be independent of each other. In addition, the incidence of isolated inferior VN was significantly less than that of VN involving the superior vestibular nerve. Level of Evidence Level 3.
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Affiliation(s)
- Chih‐Ming Chang
- Department of Biomedical Engineering National Yang Ming Chiao Tung University Taipei Taiwan
- Department of Otolaryngology Far Eastern Memorial Hospital Taipei Taiwan
- Department of Otolaryngology National Taiwan University Hospital Taipei Taiwan
| | - Wu‐Chia Lo
- Department of Otolaryngology Far Eastern Memorial Hospital Taipei Taiwan
- Department of Otolaryngology National Taiwan University Hospital Taipei Taiwan
- Graduate Institute of Medicine Yuan Ze University Taoyuan Taiwan
| | - Yi‐Ho Young
- Department of Otolaryngology National Taiwan University Hospital Taipei Taiwan
| | - Li‐Jen Liao
- Department of Otolaryngology Far Eastern Memorial Hospital Taipei Taiwan
- Department of Otolaryngology National Taiwan University Hospital Taipei Taiwan
- Department of Electrical Engineering Yuan Ze University Taoyuan Taiwan
- Medical Engineering Office Far Eastern Memorial Hospital Taipei Taiwan
| | - Po‐Hsuan Wu
- Department of Otolaryngology Far Eastern Memorial Hospital Taipei Taiwan
- Department of Communication Engineering Asia Eastern University of Science and Technology Taipei Taiwan
| | - Ping‐Chia Cheng
- Department of Otolaryngology Far Eastern Memorial Hospital Taipei Taiwan
| | - Po‐Wen Cheng
- Department of Otolaryngology Far Eastern Memorial Hospital Taipei Taiwan
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Saidha P, Chandran D, Sima N, D'souza O. A study of vestibular evoked myogenic potential and clinical features in benign paroxysmal positional vertigo: An institutional experience. INDIAN JOURNAL OF OTOLOGY 2022. [DOI: 10.4103/indianjotol.indianjotol_17_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Chen ZC, Zhang YZ, Zhao HD, Wei X, Murofushi T, Hu J, Cheng Y, Chen FY, Xu XD, Xu M, Zhang Q. Retro-labyrinthine Lesion Site Detected by Galvanic Vestibular Stimulation Elicited Vestibular-evoked Myogenic Potentials in Patients with Auditory Neuropathy. Curr Med Sci 2021; 41:695-704. [PMID: 34403094 DOI: 10.1007/s11596-021-2411-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 07/18/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Auditory neuropathy (AN) is a unique pattern of hearing loss with preservation of hair cell function. The condition is characterized by the presence of otoacoustic emissions (OAE) or cochlear microphonic (CM) responses with severe abnormalities of the auditory brainstem response (ABR). The vestibular branches of the VIII cranial nerve and the structures innervated by it can also be affected. However, the precise lesion sites in the vestibular system are not well characterized in patients with AN. METHODS The air-conducted sound (ACS) vestibular-evoked myogenic potentials (VEMPs) and galvanic vestibular stimuli (GVS)-VEMPs were examined in 14 patients with AN. RESULTS On examination of VEMPs (n=14, 28 ears), the absent rates of ACS-cervical VEMP (cVEMP), ACS-ocular VEMP (oVEMP), GVS-cVEMP, GVS-oVEMP and caloric test were 92.9% (26/28), 85.7% (24/28), 67.9% (19/28), 53.6% (15/28), and 61.5% (8/13), respectively. Impaired functions of the saccule, inferior vestibular nerve, utricle, superior vestibular nerve, and horizontal semicircular canal were found in 25.0% (7/28), 67.9% (19/28), 32.1% (9/28), 53.6% (15/28) and 61.5% (8/13) patients, respectively. On comparing the elicited VEMPs parameters of AN patients with those of normal controls, both ACS-VEMPs and GVS-VEMPs showed abnormal results in AN patients (such as, lower presence rates, elevated thresholds, prolonged latencies, and decreased amplitudes). CONCLUSION The study suggested that patients with AN often have concomitant vestibular disorders. Retro-labyrinthine lesions were more frequently observed in this study. GVS-VEMPs combined with ACS-VEMPs may help identify the lesion sites and facilitate detection of areas of vestibular dysfunction in these patients.
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Affiliation(s)
- Zi-Chen Chen
- Department of Otorhinolaryngology, Head, and Neck Surgery, Second Affiliated Hospital of Xi'an Jiaotong University School of Medicine, Xi'an, 710000, China.,Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200082, China.,Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, 200082, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, 200082, China
| | - Yu-Zhong Zhang
- Department of Otorhinolaryngology, Head, and Neck Surgery, Second Affiliated Hospital of Xi'an Jiaotong University School of Medicine, Xi'an, 710000, China.,Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200082, China.,Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, 200082, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, 200082, China
| | - Huan-di Zhao
- Department of Otorhinolaryngology, Head, and Neck Surgery, Second Affiliated Hospital of Xi'an Jiaotong University School of Medicine, Xi'an, 710000, China
| | - Xinyu Wei
- Department of Otorhinolaryngology, Head, and Neck Surgery, Second Affiliated Hospital of Xi'an Jiaotong University School of Medicine, Xi'an, 710000, China
| | - Toshihisa Murofushi
- Department of Otolaryngology, Teikyo University School of Medicine Mizonokuchi Hospital, Kawasaki, 213-0001, Japan
| | - Juan Hu
- Department of Otorhinolaryngology, Head, and Neck Surgery, Second Affiliated Hospital of Xi'an Jiaotong University School of Medicine, Xi'an, 710000, China
| | - Ying Cheng
- Department of Otorhinolaryngology, Head, and Neck Surgery, Second Affiliated Hospital of Xi'an Jiaotong University School of Medicine, Xi'an, 710000, China
| | - Fei-Yun Chen
- Department of Otorhinolaryngology, Head, and Neck Surgery, Second Affiliated Hospital of Xi'an Jiaotong University School of Medicine, Xi'an, 710000, China
| | - Xin-da Xu
- Department of Otorhinolaryngology, Affiliated Ophthalmology and Otolaryngology Hospital of Fudan University, Shanghai, 200082, China
| | - Min Xu
- Department of Otorhinolaryngology, Head, and Neck Surgery, Second Affiliated Hospital of Xi'an Jiaotong University School of Medicine, Xi'an, 710000, China.
| | - Qing Zhang
- Department of Otorhinolaryngology, Head, and Neck Surgery, Second Affiliated Hospital of Xi'an Jiaotong University School of Medicine, Xi'an, 710000, China. .,Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200082, China. .,Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, 200082, China. .,Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, 200082, China.
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Fujimoto C, Kawahara T, Yagi M, Murofushi T. Association between vestibular dysfunction and findings of horizontal head-shaking and vibration-induced nystagmus. J Vestib Res 2020; 30:319-327. [PMID: 33164966 DOI: 10.3233/ves-200721] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The association between vestibular function and findings of horizontal head-shaking nystagmus (HHSN) and vibration-induced nystagmus (VIN) tests is not well understood. OBJECTIVE To investigate the association between function in the five distinct vestibular end organs and findings of these nystagmus tests. METHODS We retrospectively reviewed the medical records of 50 patients with vestibular diseases who underwent HHSN testing, VIN testing, video head impulse testing (vHIT), cervical vestibular evoked myogenic potential testing to air-conducted sound (ACS cVEMP) and ocular VEMP testing to ACS (ACS oVEMP). We performed mixed-effects logistic regression analyses to see whether age, sex or the presence of nystagmus in HHSN or VIN have an association with the presence of peripheral vestibular dysfunction on the opposite side to the direction of nystagmus. RESULTS The presence of HHSN had a significant association with abnormal vHIT in the lateral semicircular canal (LSCC) on the opposite side to the direction of nystagmus. The presence of VIN had a significant association with abnormal vHIT in all the SCCs and abnormal ACS oVEMP on the opposite side to the direction of nystagmus. CONCLUSIONS HHSN had an association with LSCC dysfunction alone. VIN had an association with dysfunction in all the SCCs and the utricle.
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Affiliation(s)
- Chisato Fujimoto
- Department of Otolaryngology, Tokyo Teishin Hospital, Tokyo, Japan.,Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takuya Kawahara
- Biostatistics Division, Clinical Research Support Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Masato Yagi
- Department of Otolaryngology, Tokyo Teishin Hospital, Tokyo, Japan
| | - Toshihisa Murofushi
- Department of Otolaryngology, Tokyo Teishin Hospital, Tokyo, Japan.,Department of Otolaryngology, Teikyo University School of Medicine Mizonokuchi Hospital, Kawasaki, Japan
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Association of cervical vestibular-evoked myogenic potential tuning property test results with MRI findings of endolymphatic hydrops in Meniere's disease. Eur Arch Otorhinolaryngol 2020; 278:3267-3273. [PMID: 33037440 DOI: 10.1007/s00405-020-06410-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/28/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE To examine the concordance between cervical vestibular-evoked myogenic potential (cVEMP) tuning property test results and MRI findings of endolymphatic hydrops (EH). METHODS Fourteen subjects (age 24-76 years) that had been diagnosed with unilateral definite Meniere's disease (MD) (N = 8) or unilateral probable MD (N = 6) were enrolled. All of the subjects underwent cVEMP tests (using 500 Hz and 1000 Hz tone bursts), pure-tone audiometry, and gadolinium-enhanced 3 T-MRI. To examine tuning properties of cVEMP, the 500-1000 Hz amplitude ratio was calculated as the SLOPE. The results of the cVEMP tuning property test results were compared with EH-related MRI findings. RESULTS EH positivity in both the cochlea and vestibule on MRI was observed in 7 of the 8 affected ears of definite MD and 3 of the 6 affected ears of probable MD, although it was only in one of the 14 unaffected ears. EH(+) or no response (NR) in cVEMP tuning property test was significantly associated with EH positivity on MRI, while EH(-) in the cVEMP tuning property test was significantly associated with EH-negativity on MRI (p = 0.0016 Fisher's exact test test). CONCLUSION EH(+) or NR in the cVEMP tuning property test correspond well to EH positivity in the MRI findings. The cVEMP tuning property test is useful for screening and following up EH.
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17
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Shupak A, Falah R, Kaminer M. Functional Integrity of the Inferior Vestibular Nerve and Posterior Canal BPPV. Front Neurol 2020; 11:894. [PMID: 32982924 PMCID: PMC7479309 DOI: 10.3389/fneur.2020.00894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 07/13/2020] [Indexed: 11/13/2022] Open
Abstract
The functional integrity of the inferior vestibular nerve (IVN) may be evaluated by the cervical vestibular evoked myogenic potential (cVEMP) response, which requires signal transmission via the nerve. As functional integrity of the IVN innervating the posterior semicircular canal is required to produce the typical positioning vertigo and nystagmus characterizing posterior canal benign paroxysmal positional vertigo (PCBPPV), we hypothesized that normal cVEMPs would be found in most PCBPPV patients. Twenty-four PCBPPV patients participated in a prospective cohort study. All were treated by canal repositioning maneuver and had air-conduction cVEMP and videonystagmography (VNG). Follow-up evaluations including history and otoneurological bedside examination were carried out 1, 3, 6, and 12 months after the initial treatment. At the last follow-up, the patients filled the Dizziness Handicap Inventory (DHI) questionnaire. Normal cVEMPs were recorded in 19 (79%) and were absent in 5 (21%) of the subjects. The average DHI in the patients with normal cVEMP was 16.42 ± 17.99 vs. 0.4 ± 0.89 among those with pathological cVEMP (p < 0.04, Mann-Whitney test). Thirteen (54%) patients experienced recurrent PCBPPV (rPCBPPV). The average DHI score was significantly higher among patients having recurrence (22.15 ± 18.61) when compared to those with complete cure (2.36 ± 5.98; p < 0.003, Mann-Whitney test). Ten (77%) of the subjects with rPCBPPV had normal and 3 (23%) had pathological cVEMP as compared to 9 (82%) and 2 (18%) subjects in the non-recurrent (nrPCBPPV) group (Fisher's exact test-not significant). cVEMP p13 and n23 wave latencies and amplitudes, inter-aural differences in p13-n23 peak-to-peak amplitudes, and response thresholds did not differ between the groups. No differences were found between the rPCBBPV and nrPCBBPV groups in VNG caloric lateralization and directional preponderance values. We have found that in most cases, PCBPPV symptoms and signs are associated with normal cVEMP response supporting the role of IVN functional integrity. The absent cVEMPs in the minority of patients, although having similar clinical presentation, raise the possibility that the ipsilateral saccule is affected by the same pathology causing degeneration of the utricle macula. Alternatively, lacking inhibitory stimuli from the involved ipsilateral utricle or partial degeneration of the IVN and ganglion could explain the diminished cVEMP response. Clinical Trial Registration: The study was registered in ClinicalTrials.gov Internet site (study ID-NCT01004913; https://clinicaltrials.gov/ct2/show/NCT01004913?cond=BPPV&cntry=IL&draw=2&rank=3).
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Affiliation(s)
- Avi Shupak
- Unit of Otoneurology, Lin Medical Center, Haifa, Israel.,Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel.,Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Rohi Falah
- Unit of Otoneurology, Lin Medical Center, Haifa, Israel.,Department of Otolaryngology Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
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Hu J, Chen Z, Zhang Y, Xu Y, Ma W, Zhang Y, Wang J, Chen Y, Xu M, Yang H, Zhang Q. Vestibular dysfunction in patients with auditory neuropathy detected by vestibular evoked myogenic potentials. Clin Neurophysiol 2020; 131:1664-1671. [PMID: 32089450 DOI: 10.1016/j.clinph.2020.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 01/15/2020] [Accepted: 02/05/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aimed to determine vestibular involvement in patients with auditory neuropathy (AN) using ocular vestibular evoked myogenic potential (oVEMP), cervical vestibular evoked myogenic potential (cVEMP), caloric tests, video Head Impulse Tests (vHIT), and Suppression Head Impulse Paradigm (SHIMP) tests. METHODS Twenty-two patients with AN (study group) and 50 age-and-gender-matched healthy subjects (control group) were enrolled. All patients underwent air-conducted sound oVEMP and cVEMP tests. In the study group, 20 patients underwent a caloric test, 10 patients underwent a video Head Impulse Test (vHIT), and nine patients underwent the Suppression Head Impulse Paradigm (SHIMP) test. RESULTS Significant differences in VEMP abnormalities were found between the two groups. Most AN patients showed no VEMP response, while only a few patients showed VEMP responses with normal parameters. Some AN patients presented abnormal VEMP parameters, including thresholds, latencies, and amplitudes. The abnormal rate (including no response and abnormal parameters) was 91% in the cVEMP test and 86% in the oVEMP test. No significant difference was found between oVEMP and cVEMP abnormalities. AN patients exhibited a 70% abnormal rate in the caloric test. Most AN patients showed normal VOR gains. Most patients showed no overt corrective saccades in vHIT, and exhibited normal anticompensatory saccades in the SHIMP test. CONCLUSION Many AN patients experience vestibular dysfunction, which may be detected by using a vestibular functional test battery. SIGNIFICANCE VEMP abnormalities might reflect the status and degree of vestibular involvement in AN.
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Affiliation(s)
- Juan Hu
- Department of Otorhinolaryngology, Head and Neck Surgery, The 2nd Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, PR China
| | - Zichen Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, The 2nd Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, PR China
| | - Yuzhong Zhang
- Department of Otorhinolaryngology, Head and Neck Surgery, The 2nd Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, PR China
| | - Yong Xu
- Department of Otorhinolaryngology, Head and Neck Surgery, The 2nd Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, PR China; Department of Otorhinolaryngology, Head and Neck Surgery, Yanliang 141 Hospital, Xi'an 710089, Shaanxi Province, PR China
| | - Weijun Ma
- Department of Otorhinolaryngology, Head and Neck Surgery, The 2nd Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, PR China
| | - Yan Zhang
- Department of Otorhinolaryngology, Head and Neck Surgery, The 2nd Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, PR China
| | - Junli Wang
- Department of Otorhinolaryngology, Head and Neck Surgery, The 2nd Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, PR China
| | - Yanfei Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, The 2nd Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, PR China
| | - Min Xu
- Department of Otorhinolaryngology, Head and Neck Surgery, The 2nd Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, PR China
| | - Hui Yang
- Department of Otorhinolaryngology, Head and Neck Surgery, The 2nd Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, PR China.
| | - Qing Zhang
- Department of Otorhinolaryngology, Head and Neck Surgery, The 2nd Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, PR China; Department of Otorhinolaryngology, Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, PR China.
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Li X, Gong S. The Effect of Cochlear Implantation on Vestibular Evoked Myogenic Potential in Children. Laryngoscope 2020; 130:E918-E925. [PMID: 32031698 PMCID: PMC7754474 DOI: 10.1002/lary.28520] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 12/18/2019] [Accepted: 12/30/2019] [Indexed: 11/17/2022]
Abstract
Objectives/Hypothesis We conducted this study to assess the effects of unilateral cochlear implantation (CI) on otolith function by observing the changes in ocular vestibular evoked myogenic potential (oVEMP) and cervical vestibular evoked myogenic potential (cVEMP) in children. Study Design: Prospective case series. Methods The oVEMP and cVEMP elicited by air‐conducted sound in 35 children were analyzed preoperatively and at 5 days, 1 month, and 2 months after surgery. Results Before CI, the response rates of oVEMPs and cVEMPs were 81.4% and 91.4%, respectively. In the implanted side, oVEMPs and cVEMPs were reduced by 37.1% and 68.6%, respectively, 5 days after CI. One month after CI, oVEMPs and cVEMPs were 34.6% and 72%, respectively, with the device switched off, and 50% and 73.1%, respectively, with the device switched on. Two months after CI, the oVEMPs and cVEMPs were 36% and 80%, respectively, when the implant was turned off, and 70.8% and 75%, respectively, when the implant was turned on. Conclusions The study confirmed the value of VEMP testing in the clinical setting and that absent VEMPs could indicate impairment of otolith function after CI. Level of Evidence 4 Laryngoscope, 2020
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Affiliation(s)
- Xin Li
- Department of Otorhinolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Department of Otorhinolaryngology-Head and Neck Surgery, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Shusheng Gong
- Department of Otorhinolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Preoperative Assessment of Cervical Vestibular Evoked Myogenic Potentials (cVEMPs) Help in Predicting Hearing Preservation After Removal of Vestibular Schwannomas Through a Middle Fossa Craniotomy. Otol Neurotol 2019; 39:e1143-e1149. [PMID: 30339649 DOI: 10.1097/mao.0000000000002017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether cervical vestibular evoked myogenic potentials (cVEMPs) are predictive of hearing preservation in patients undergoing vestibular schwannoma removal through middle fossa craniotomy approach. STUDY DESIGN Retrospective case study. SETTING Tertiary referral center. PATIENTS Eighteen patients who underwent a middle fossa craniotomy for vestibular schwannoma (stage I or II of Koos classification) with attempted hearing preservation from January 2008 to February 2016 were retrospectively reviewed. INTERVENTION Pre-surgical cVEMPs test, videonystagmography (caloric test), and magnetic resonance imaging (MRI) as well as a pre- and post-surgical audiometry test. MAIN OUTCOME MEASURES cVEMPs parameters including amplitude asymmetry ratio (AR), P13, and N23 latencies and peak-to-peak amplitude between P13 and N23 waves were calculated. Hearing data were classified according to the AAO-HNS hearing classes. The nerve of origin of the tumor was specified during surgery and the largest tumor diameter was measure on MRI axial plane on T2-CISS weighed images. RESULTS Preoperative amplitude asymmetry ratio was lower (n = 15, Mann-Whitney U test, p < 0.001) in the group with postoperative hearing preservation (n = 11) compared with the group with postoperative hearing preservation failure (n = 4). The positive predictive value of an AR less than 24% to assess postoperative hearing preservation is 91.6%. Tumor size and localization were not correlated with cVEMPs, nor with caloric testing in this group of small-sized intracanalicular vestibular schwannomas. CONCLUSIONS Our data suggest that cVEMPs may help predict hearing preservation outcome in vestibular schwannoma surgery via the middle fossa craniotomy approach.
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Oya R, Imai T, Takenaka Y, Sato T, Oshima K, Ohta Y, Inohara H. Clinical significance of cervical and ocular vestibular evoked myogenic potentials in benign paroxysmal positional vertigo: a meta-analysis. Eur Arch Otorhinolaryngol 2019; 276:3257-3265. [PMID: 31605189 DOI: 10.1007/s00405-019-05674-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 09/27/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE As the pathological cause of benign paroxysmal positional vertigo (BPPV), the dislocation or degeneration of otoconia in the utricle and saccule is suggested. Vestibular evoked myogenic potential (VEMP) could reflect otolithic dysfunction due to these etiologies of BPPV. The aim of this study was to validate the clinical significance of cervical (c) and ocular (o) VEMP in BPPV by a meta-analysis of previous articles. METHODS Articles related to BPPV with data on cVEMP and oVEMP were collected. The following keywords were used to search PubMed and Scopus for English language articles: benign paroxysmal positional vertigo or BPPV and vestibular evoked myogenic potential or VEMP. RESULTS The p13 latency in cVEMP and n1 latency in oVEMP were slightly but significantly prolonged in BPPV patients compared to control patients. AR in oVEMP of BPPV patients also showed higher value than that of control patients. However, the n23 latency and AR in cVEMP and p1 latency in oVEMP showed no significant difference between BPPV and control patients. Furthermore, latencies in VEMPs also showed no significant difference between an affected and a non-affected ear in BPPV patients. CONCLUSIONS Our results indicated that otolith dysfunction of BPPVs was detected by latencies in VEMPs, and AR in oVEMP more sensitively reflects the difference between affected and non-affected ears in BPPV patients. The otolith dysfunction of BPPV might be induced by the systemic condition. However, the differences of latencies between BPPV patients and control patients were too small to use VEMPs as a prognostic predictor.
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Affiliation(s)
- Ryohei Oya
- Department of Otorhinolaryngology Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, Japan.
| | - Takao Imai
- Department of Otorhinolaryngology Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, Japan
| | - Yukinori Takenaka
- Department of Otorhinolaryngology Head and Neck Surgery, Kansai Medical Hospital, 1-7-2 Shinsenrinishimachi, Toyonaka, Osaka, Japan
| | - Takashi Sato
- Department of Otorhinolaryngology Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, Japan
| | - Kazuo Oshima
- Department of Otorhinolaryngology Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, Japan
| | - Yumi Ohta
- Department of Otorhinolaryngology Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, Japan
| | - Hidenori Inohara
- Department of Otorhinolaryngology Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, Japan
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Fujimoto C, Yagi M, Murofushi T. Recent advances in idiopathic bilateral vestibulopathy: a literature review. Orphanet J Rare Dis 2019; 14:202. [PMID: 31426838 PMCID: PMC6701126 DOI: 10.1186/s13023-019-1180-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 08/14/2019] [Indexed: 11/10/2022] Open
Abstract
Background Idiopathic bilateral vestibulopathy (IBV) is an acquired bilateral peripheral vestibular dysfunction of unknown etiology, with persistent unsteadiness but without sensorineural hearing loss (SNHL) other than age-related hearing loss (ARHL). Main text The prevalence of IBV is unknown. The most common symptom is persistent unsteadiness, particularly in darkness and/or on uneven ground. The other main symptom is oscillopsia during head and body movements. IBV is neither associated with SNHL, except for ARHL, nor any other neurological dysfunction that causes balance disorders. The clinical time course of IBV can generally be divided into two main types: progressive type and sequential type. The progressive type involves gradually progressive persistent unsteadiness without episodes of vertigo. The sequential type involves recurrent vertigo attacks accompanied by persistent unsteadiness. Originally, IBV was found to exhibit bilateral dysfunction in the lateral semicircular canals (LSCCs) and the superior vestibular nerve (SVN) system. However, recently, with the development of more sophisticated vestibular function tests of the otolith organs and vertical semicircular canals, it has been revealed that IBV involves peripheral vestibular lesions other than those already identified in the LSCC and the SVN system. Furthermore, novel subtypes of IBV that do not involve bilateral dysfunction of the LSCC and/or the SVN system have been proposed. Therapeutically, exercise-based vestibular rehabilitation in adult bilateral vestibulopathy (BVP) patients has resulted in improved gaze and postural stability moderately. There are several technical approaches for the treatment of BVP such as vestibular implants, sensory substitution devices and noisy galvanic vestibular stimulation. Conclusions Combined use of various vestibular function tests, including recently developed tests, revealed the diversity of lesion sites in IBV. Further studies are required to determine the therapeutic effects of the technical approaches on IBV.
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Affiliation(s)
- Chisato Fujimoto
- Department of Otolaryngology, Tokyo Teishin Hospital, 2-14-23, Fujimi, Chiyoda-ku, Tokyo, 102-8798, Japan. .,Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Masato Yagi
- Department of Otolaryngology, Tokyo Teishin Hospital, 2-14-23, Fujimi, Chiyoda-ku, Tokyo, 102-8798, Japan
| | - Toshihisa Murofushi
- Department of Otolaryngology, Tokyo Teishin Hospital, 2-14-23, Fujimi, Chiyoda-ku, Tokyo, 102-8798, Japan.,Department of Otolaryngology, Teikyo University School of Medicine Mizonokuchi Hospital 5-1-1, Futako, Takatsu-ku, Kawasaki, Kanagawa, 213-8507, Japan
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23
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Rosengren SM, Weber KP, Govender S, Welgampola MS, Dennis DL, Colebatch JG. Sound-evoked vestibular projections to the splenius capitis in humans: comparison with the sternocleidomastoid muscle. J Appl Physiol (1985) 2019; 126:1619-1629. [DOI: 10.1152/japplphysiol.00711.2018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The short-latency vestibulo-collic reflex in humans is well defined for only the sternocleidomastoid (SCM) neck muscle. However, other neck muscles also receive input from the balance organs and participate in neck stabilization. We therefore investigated the sound-evoked vestibular projection to the splenius capitis (SC) muscles by comparing surface and single motor unit responses in the SC and SCM muscles in 10 normal volunteers. We also recorded surface responses in patients with unilateral vestibular loss but preserved hearing and hearing loss but preserved vestibular function. The single motor unit responses were predominantly inhibitory, and the strongest responses were recorded in the contralateral SC and ipsilateral SCM. In both cases there was a significant decrease or gap in single motor unit activity, in SC at 11.7 ms for 46/66 units and in SCM at 12.7 ms for 51/58 motor units. There were fewer significant responses in the ipsilateral SC and contralateral SCM muscles, and they consisted primarily of weak increases in activity. Surface responses recorded over the contralateral SC were positive-negative during neck rotation, similar to the ipsilateral cervical vestibular evoked myogenic potential in SCM. Responses in SC were present in the patients with hearing loss and absent in the patient with vestibular loss, confirming their vestibular origin. The results describe a pattern of inhibition consistent with the synergistic relationship between these muscles for axial head rotation, with the crossed vestibular projection to the contralateral SC being weaker than the ipsilateral projection to the SCM. NEW & NOTEWORTHY We used acoustic vestibular stimulation to investigate the saccular projections to the splenius capitis (SC) and sternocleidomastoid (SCM) muscles in humans. Single motor unit recordings from within the muscles demonstrated strong inhibitory projections to the contralateral SC and ipsilateral SCM muscles and weak excitatory projections to the opposite muscle pair. This synergistic pattern of activation is consistent with a role for the reflex in axial rotation of the head.
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Affiliation(s)
- Sally M. Rosengren
- Neurology Department, Royal Prince Alfred Hospital, Camperdown, Australia
- Central Clinical School, University of Sydney, Sydney, Australia
| | - Konrad P. Weber
- Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Switzerland
| | - Sendhil Govender
- Prince of Wales Clinical School and Neuroscience Research Australia, University of New South Wales, Sydney, Australia
| | | | - Danielle L. Dennis
- Prince of Wales Clinical School and Neuroscience Research Australia, University of New South Wales, Sydney, Australia
| | - James G. Colebatch
- Prince of Wales Clinical School and Neuroscience Research Australia, University of New South Wales, Sydney, Australia
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24
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Imai T, Okumura T, Ohta Y, Oshima K, Sato T, Kamakura T, Inohara H. Effects of cochlear implants on otolith function as evaluated by vestibulo-ocular reflex and vestibular evoked myogenic potentials. Auris Nasus Larynx 2019; 46:836-843. [PMID: 31010711 DOI: 10.1016/j.anl.2019.03.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 03/13/2019] [Accepted: 03/28/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of this study was to investigate whether the insertion of an implant into the cochlea is accompanied by a deterioration in otolith function. Cervical and ocular vestibular evoked myogenic potentials (cVEMP and oVEMP) and linear vestibulo-ocular reflex (lVOR) during eccentric rotation were assessed before and after cochlear implantation (CI) to evaluate otolith function. METHODS Twelve patients with bilateral severe sensorineural hearing loss who had undergone CI surgery in our hospital between May 2016 and November 2017 were included in this study. cVEMP and oVEMP were assessed using the asymmetry ratio (AR), calculated with the following formula: [(peak-to-peak amplitude calculated as the sum of the p13 and n23 amplitudes in the non-operated side) - (that in the operated side)]/[(that in the non-operated side) + (that in the operated side)]. The ratio of VOR gain during eccentric rotation against VOR gain during center rotation was used to assess lVOR. For eccentric rotation, patients were rotated while displaced from the axis of rotation. At the same time, linear acceleration stimulated the utricle and induced lVOR. All patients underwent cVEMP and oVEMP tests and center and eccentric rotation tests before and about 30days after CI surgery. RESULTS Three patients with absent cVEMP responses before surgery were excluded, leaving pre-surgery cVEMP results for 9/12 patients. In five of these patients, the AR of cVEMP increased after CI, indicating that saccular function, as evaluated by cVEMP, did not deteriorate significantly postoperatively. One patient with an absent oVEMP response before CI was excluded, leaving pre-surgery oVEMP results for 11/12 patients. In 10 of these patients, the AR of oVEMP increased after CI surgery, indicating that utricular function, as evaluated by oVEMP, deteriorated significantly postoperatively. However, because the ratio of VOR gain during eccentric rotation against VOR gain during center rotation did not become worse after CI, utricular function, as evaluated by lVOR, did not deteriorate significantly postoperatively. Symptoms of vertigo became worse after CI in two of the 12 patients. CONCLUSION CI does not cause a deterioration in saccular function, as evaluated by cVEMP. Although CI does cause a deterioration in utricular function in oVEMP tests, this is not consistent in lVOR tests. These results indicate that CI causes a slight deterioration in utricular function that is insufficient to cause vertigo or deterioration of lVOR.
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Affiliation(s)
- Takao Imai
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita-shi, Osaka 565-0871, Japan.
| | - Tomoko Okumura
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita-shi, Osaka 565-0871, Japan
| | - Yumi Ohta
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita-shi, Osaka 565-0871, Japan
| | - Kazuo Oshima
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita-shi, Osaka 565-0871, Japan
| | - Takashi Sato
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita-shi, Osaka 565-0871, Japan
| | - Takefumi Kamakura
- Department of Otorhinolaryngology, Otemae Hospital, 1-5-34 Otemae, Chuo-ku, Osaka-shi, Osaka 540-0008, Japan
| | - Hidenori Inohara
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita-shi, Osaka 565-0871, Japan
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25
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Fujimoto C, Kawahara T, Kinoshita M, Kikkawa YS, Sugasawa K, Yagi M, Yamasoba T, Iwasaki S, Murofushi T. Aging Is a Risk Factor for Utricular Dysfunction in Idiopathic Benign Paroxysmal Positional Vertigo. Front Neurol 2018; 9:1049. [PMID: 30559714 PMCID: PMC6287371 DOI: 10.3389/fneur.2018.01049] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 11/19/2018] [Indexed: 11/13/2022] Open
Abstract
Benign paroxysmal positional vertigo (BPPV) is the most common cause of balance disorders in the elderly. Dislodgement of the otoconia in BPPV might have an association with damage to the otolith organs. The aim of this study was to investigate whether aging is a risk factor for otolith organ dysfunction in idiopathic BPPV. We retrospectively reviewed the medical records of 112 consecutive idiopathic BPPV patients who underwent cervical VEMP testing to air-conducted sound (ACS cVEMP), ocular VEMP testing to bone-conducted vibration (BCV oVEMP), and caloric testing. We performed binomial logistic regression analyses to see whether age, the side affected by BPPV or the canal affected by BPPV have an association with the presence of peripheral vestibular dysfunction in idiopathic BPPV patients. The elderly group (aged ≥65 years) had a significantly positive association with abnormalities in BCV oVEMPs (p = 0.0109), while the side affected by BPPV (p = 0.598) and the canal affected by BPPV (p = 0.576) did not. The odds ratio of the abnormal BCV oVEMPs for the elderly group compared with the non-elderly group (aged < 65 years) was 2.676 (95% confidence interval, 1.254–5.079). The elderly group had no significant association with the abnormalities in ACS cVEMPs (p = 0.0955) or caloric testing (p = 0.488). Dysfunction of the utricle, where the dislodgement of the otoconia mainly occurs, is affected by aging in idiopathic BPPV.
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Affiliation(s)
- Chisato Fujimoto
- Department of Otolaryngology, Tokyo Teishin Hospital, Tokyo, Japan.,Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Takuya Kawahara
- Biostatistics Division, Clinical Research Support Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Makoto Kinoshita
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yayoi S Kikkawa
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Keiko Sugasawa
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Masato Yagi
- Department of Otolaryngology, Tokyo Teishin Hospital, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Shinichi Iwasaki
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Toshihisa Murofushi
- Department of Otolaryngology, Tokyo Teishin Hospital, Tokyo, Japan.,Department of Otolaryngology, School of Medicine, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan
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26
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Ibraheem OA, Hassaan MR. Cervical Vestibular-Evoked Myogenic Potentials in Sedated Toddlers. Int Arch Otorhinolaryngol 2018; 22:197-202. [PMID: 29983754 PMCID: PMC6033596 DOI: 10.1055/s-0037-1599151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 01/02/2017] [Indexed: 11/04/2022] Open
Abstract
Introduction
Cervical vestibular-evoked myogenic potentials (cVEMPs) are difficult to test in toddlers who cannot follow instructions or stay calm.
Objective
Due to the growing need for vestibular testing in very young children as a part of a delayed walking assessment battery, this study aimed to provide a solution to this problem by recording the cVEMPs in toddlers during sedation.
Method
The cVEMPs measures were assessed in 30 toddlers aged 12 to 36 months with normal motor milestones. They were sedated with chloral hydrate. Then, the head was retracted ∼ 30° backward with a pillow under the shoulders, and turned 45° contralateral to the side of stimulation to put the sternocleidomastoid (SCM) muscle in a state of tension.
Results
The P13 and N23 waves of the cVEMPs were recordable in all sedated toddlers. The cVEMPs measures resulted in the following: P13 latency of 17.5 ± 1.41 milliseconds, N23 latency of 25.58 ± 2.02 milliseconds, and peak-to-peak amplitude of 15.39 ± 3.45 µV. One-sample
t
-test revealed statistically significant longer latencies and smaller amplitude of the toddlers' cVEMPs relative to the normative data for adults.
Conclusions
The difficulty of cVEMPs testing in toddlers can be overcome by sedating them and attaining a position that contracts the SCM muscle. However, the toddlers' recordings revealed delayed latencies and smaller amplitudes than those of adults.
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27
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Hwang K, Kim BG, Lee JD, Lee ES, Lee TK, Sung KB. The extent of vestibular impairment is important in recovery of canal paresis of patients with vestibular neuritis. Auris Nasus Larynx 2018; 46:24-26. [PMID: 29866420 DOI: 10.1016/j.anl.2018.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 04/25/2018] [Accepted: 05/21/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We questioned whether the extent of vestibular impairment affected the recovery of vestibular function in acute vestibular neuritis (VN). The objective of this study was to identify how the extent of vestibular impairment influenced the recovery from canal paresis (CP) in patients with VN. METHODS We retrospectively reviewed the medical records of 46 patients diagnosed with acute vestibulopathy between January 2012 and December 2015. Pure-tone audiometry, a caloric test, and cervical vestibular evoked myogenic potential (cVEMP) testing were performed in all patients. Patients were divided into two groups, superior VN and total VN, according to the results of the cervical vestibular evoked myogenic potential (cVEMP) testing. The caloric test was rechecked 6-12months after diagnosis and the CP values were compared at 6 and 12months. The degree of recovery was evaluated by comparing the CP values. We defined good recovery as CP<25% at follow-up. RESULTS We found no significant difference in age, sex ratio, lesional site, or follow-up period between patients with superior VN and total VN. The follow-up CP in patients with superior VN was significantly lower than that in those with total VN. Twenty patients (65%) in the superior VN group exhibited good recovery as did three (20%) in the total VN group; the between-group difference was significant. CONCLUSIONS We found that CP values recovered well in patients with superior VN. We suggest that the extent of vestibular impairment is important in the recovery of CP in acute vestibulopathy.
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Affiliation(s)
- Kyurin Hwang
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Bo Gyung Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Jong Dae Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea.
| | - Eek-Sung Lee
- Department of Neuroloy, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Tae Kyeong Lee
- Department of Neuroloy, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Ki-Bum Sung
- Department of Neuroloy, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
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28
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Hain TC, Cherchi M, Yacovino DA. Bilateral Vestibular Weakness. Front Neurol 2018; 9:344. [PMID: 29904366 PMCID: PMC5990606 DOI: 10.3389/fneur.2018.00344] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 04/30/2018] [Indexed: 02/02/2023] Open
Abstract
Bilateral vestibular weakness (BVW) is a rare cause of imbalance. Patients with BVW complain of oscillopsia. In approximately half of the patients with BVW, the cause remains undetermined; in the remainder, the most common etiology by far is gentamicin ototoxicity, followed by much rarer entities such as autoimmune inner ear disease, meningitis, bilateral Ménière’s disease, bilateral vestibular neuritis, and bilateral vestibular schwannomas. While a number of bedside tests may raise the suspicion of BVW, the diagnosis should be confirmed by rotatory chair testing. Treatment of BVW is largely supportive. Medications with the unintended effect of vestibular suppression should be avoided.
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Affiliation(s)
- Timothy C Hain
- Department of Otolaryngology, Northwestern University, Chicago, IL, United States.,Department of Physical Therapy and Human Movement Science, Northwestern University, Chicago, IL, United States
| | - Marcello Cherchi
- Department of Neurology, Northwestern University, Chicago, IL, United States
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29
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Fife TD, Satya-Murti S, Burkard RF, Carey JP. Vestibular evoked myogenic potential testing: Payment policy review for clinicians and payers. Neurol Clin Pract 2018; 8:129-134. [PMID: 29708189 DOI: 10.1212/cpj.0000000000000430] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 11/28/2017] [Indexed: 11/15/2022]
Abstract
Purpose of review A recent American Academy of Neurology Evidence-Based Practice Guideline on vestibular myogenic evoked potential (VEMP) testing has described superior canal dehiscence syndrome (SCDS) and evaluated the merits of VEMP in its diagnosis. SCDS is an uncommon but now well-recognized cause of dizziness and auditory symptoms. This article familiarizes health care providers with this syndrome and the utility and shortcomings of VEMP as a diagnostic test and also explores payment policies for VEMP. Recent findings In carefully selected patients with documented history compatible with the SCDS, both high-resolution temporal bone CT scan and VEMP are valuable aids for diagnosis. Payers might be unfamiliar with both this syndrome and VEMP testing. Summary It is important to raise awareness of VEMP and its possible indications and the rationale for coverage of VEMP testing. Payers may not be readily receptive to VEMP coverage if this test is used in an undifferentiated manner for all common vestibular and auditory symptoms.
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Affiliation(s)
- Terry D Fife
- Department of Neurology (TDF), Barrow Neurological Institute and University of Arizona College of Medicine, Phoenix; Health Policy Consultant (SS-M), Santa Maria, CA; Department of Rehabilitation Science (RFB), University of Buffalo, NY; and Department of Otolaryngology-Head and Neck Surgery (JPC), Johns Hopkins School of Medicine, Baltimore, MD
| | - Saty Satya-Murti
- Department of Neurology (TDF), Barrow Neurological Institute and University of Arizona College of Medicine, Phoenix; Health Policy Consultant (SS-M), Santa Maria, CA; Department of Rehabilitation Science (RFB), University of Buffalo, NY; and Department of Otolaryngology-Head and Neck Surgery (JPC), Johns Hopkins School of Medicine, Baltimore, MD
| | - Robert F Burkard
- Department of Neurology (TDF), Barrow Neurological Institute and University of Arizona College of Medicine, Phoenix; Health Policy Consultant (SS-M), Santa Maria, CA; Department of Rehabilitation Science (RFB), University of Buffalo, NY; and Department of Otolaryngology-Head and Neck Surgery (JPC), Johns Hopkins School of Medicine, Baltimore, MD
| | - John P Carey
- Department of Neurology (TDF), Barrow Neurological Institute and University of Arizona College of Medicine, Phoenix; Health Policy Consultant (SS-M), Santa Maria, CA; Department of Rehabilitation Science (RFB), University of Buffalo, NY; and Department of Otolaryngology-Head and Neck Surgery (JPC), Johns Hopkins School of Medicine, Baltimore, MD
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30
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Casani AP, Cerchiai N, Navari E. Paroxysmal positional vertigo despite complete vestibular impairment: the role of instrumental assessment. ACTA ACUST UNITED AC 2018; 38:563-568. [PMID: 29498717 PMCID: PMC6325650 DOI: 10.14639/0392-100x-1549] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 03/21/2017] [Indexed: 11/23/2022]
Abstract
Lindsay-Hemenway syndrome is characterised by a posterior canal benign paroxysmal positional vertigo following a partial unilateral vestibular loss affecting the same side. The syndrome is caused by damage of structures innervated by the superior division of the vestibular nerve and perfused by the anterior vestibular artery; the detached otoconia can cause vertigo in the still intact posterior semicircular canal. The most recent vestibular instrumental techniques allow reaching an accurate topodiagnosis in case of peripheral vestibular failure. We report on two cases of Lindsay-Hemenway syndrome despite complete vestibular failure demonstrated by vestibular instrumental assessment. After making some critical considerations on these findings, we underline the importance of not disregarding the diagnosis of paroxysmal positional vertigo in an established complete labyrinthine loss of function.
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Affiliation(s)
- A P Casani
- Department of Medical and Surgical Pathology, Otorhinolaryngology Section, Pisa University Hospital, Pisa, Italy
| | - N Cerchiai
- Department of Medical and Surgical Pathology, Otorhinolaryngology Section, Pisa University Hospital, Pisa, Italy
| | - E Navari
- Department of Medical and Surgical Pathology, Otorhinolaryngology Section, Pisa University Hospital, Pisa, Italy
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31
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Clinical features of otolith organ-specific vestibular dysfunction. Clin Neurophysiol 2018; 129:238-245. [DOI: 10.1016/j.clinph.2017.11.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 10/30/2017] [Accepted: 11/04/2017] [Indexed: 01/20/2023]
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32
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Cheng Y, Kimura Y, Kaga K. A study on vestibular-evoked myogenic potentials via galvanic vestibular stimulation in normal people. J Otol 2017; 13:16-19. [PMID: 29937861 PMCID: PMC6002623 DOI: 10.1016/j.joto.2017.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 09/15/2017] [Accepted: 09/27/2017] [Indexed: 11/04/2022] Open
Abstract
Objectives The aim of our study is to examine vestibular-evoked myogenic potentials (VEMPs) elicited by the galvanic vestibular stimulation in the sternocleidomastoid muscle (SCM) in healthy subjects for clinical applications of auditory neuropathy or vestibular neuropathy in the future. Methods We enrolled sixteen healthy subjects to record the average responses of SCM to galvanic vestibular stimulation (GVS) [current 3 mA; duration 1 ms] by electromyography (EMG). SPSS18.0 software was used to analyze the obtained data for mean and standard deviation. Results In all healthy subjects mastoid-forehead galvanic vestibular stimulation produced a positive-negative biphasic EMG responses on SCM ipsilateral to the cathodal electrode. The latency of p13 was 11.7 ± 3.0 ms. The latency of n23 was 17.8 ± 3.4 ms. The amplitude of p13-n23 was 147.0 ± 69.0 μV. The interaural asymmetry ratio (AR) of p13, n23 latency and the amplitude was respectively 0.12 ± 0.09, 0.08 ± 0.08 and 0.16 ± 0.10. Discussions Galvanic vestibular stimulation could elicit biphasic EMG responses from SCM via the vestibular nerve but not from the otolith organs. Galvanic stimulation together with air conducted sound (ACS) or bone conducted vibration (BCV) can elicit VEMPs and may enable the differentiation of retrolabyrinthine lesions from labyrinthine lesions in vestibular system.
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Affiliation(s)
- Ying Cheng
- National Institute of Sensory Organs, Tokyo Medical Center, Japan.,The Department of Otolaryngology Head and Neck Surgery in the Second Affiliated Hospital of Xi 'an Jiaotong University, Shaanxi Province, PR China
| | - Yusuke Kimura
- National Institute of Sensory Organs, Tokyo Medical Center, Japan
| | - Kimitaka Kaga
- National Institute of Sensory Organs, Tokyo Medical Center, Japan
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33
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The vestibulocochlear bases for wartime posttraumatic stress disorder manifestations. Med Hypotheses 2017; 106:44-56. [DOI: 10.1016/j.mehy.2017.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 06/28/2017] [Indexed: 11/23/2022]
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34
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Lamounier P, de Souza TSA, Gobbo DA, Bahmad F. Evaluation of vestibular evoked myogenic potentials (VEMP) and electrocochleography for the diagnosis of Ménière's disease. Braz J Otorhinolaryngol 2017; 83:394-403. [PMID: 27397722 PMCID: PMC9442737 DOI: 10.1016/j.bjorl.2016.04.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 02/03/2016] [Accepted: 04/14/2016] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Ménière's disease (MD) is an inner ear disorder characterized by episodic vertigo, tinnitus, ear fullness, and fluctuating hearing. Its diagnosis can be especially difficult in cases where vestibular symptoms are present in isolation (vestibular MD). The definitive diagnosis is made histologically and can only be performed post-mortem, after analysis of the temporal bone. Endolymphatic hydrops is a histopathological finding of the disease and occurs more often in the cochlea and saccule, followed by the utricle and semicircular canals. Vestibular evoked myogenic potentials (VEMP) emerged as the method of assessment of vestibular function in 1994. Until then, there was no unique way of assessing saccular function and the inferior vestibular nerve. Given that the saccule is responsible for most cases of severe hydrops, VEMP appears as a new tool to assist in the diagnosis of MD. OBJECTIVE To evaluate the sensitivity and specificity of VEMP and electrocochleography (EcochG) in the diagnosis of definite MD compared with clinical diagnosis. METHODS The study includes 12 patients (24 ears) diagnosed with definite MD defined according to the clinical criteria proposed by the American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) in 1995, as well as 12 healthy volunteers allocated to the control group (24 ears). A clinical diagnosis by the AAO-HNS criteria was considered as the gold standard. All patients underwent an otoneurological examination, including pure tone and speech audiometry, VEMP, and extratympanic EcochG. The sensitivity and specificity to detect the presence or absence of disease were calculated, as well as their 95% confidence intervals. The reliability of VEMP and EcochG in both ears was assessed using the kappa index. RESULTS In both tests and in both ears, the ability to diagnose healthy cases was high, with specificity ranging from 84.6% to 100%. Moreover, the ability of the tests to diagnose the disease varied from low to moderate sensitivity, with values ranging from 37.5% to 63.6%. The agreement of both tests in the right ear, measured by the kappa coefficient, was equal to 0.54 (95% CI: 0.20-0.89), indicating a moderate agreement. In the left ear, that agreement was equal to 0.07 (95% CI: -0.33 to 0.46), indicating a weak correlation between the tests. The sensitivity of the VEMP for the right ear was 63.6% and for the left ear, 62.5%. The sensitivity of EcochG for the right ear was 63.6% and 37.5% for the left ear. CONCLUSION The specificity of both tests was high, and the sensitivity of VEMP was higher than that of EcochG.
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Affiliation(s)
- Pauliana Lamounier
- Universidade de Brasília (UNB), Ciências da Saúde, Brasília, DF, Brazil; Centro de Reabilitação e Readaptação Dr. Henrique Santillo (CRER-GO), Goiânia, GO, Brazil
| | | | - Debora Aparecida Gobbo
- Centro de Reabilitação e Readaptação Dr. Henrique Santillo (CRER-GO), Goiânia, GO, Brazil
| | - Fayez Bahmad
- Universidade de Brasília (UNB), Ciências da Saúde, Brasília, DF, Brazil; Instituto Brasiliense de Otorrinolaringologia, Brasília, DF, Brazil.
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Differential Involvement during Latent Herpes Simplex Virus 1 Infection of the Superior and Inferior Divisions of the Vestibular Ganglia: Implications for Vestibular Neuritis. J Virol 2017; 91:JVI.00331-17. [PMID: 28446678 DOI: 10.1128/jvi.00331-17] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 04/20/2017] [Indexed: 11/20/2022] Open
Abstract
Controversy still surrounds both the etiology and pathophysiology of vestibular neuritis (VN). Especially uncertain is why the superior vestibular nerve (SVN) is more frequently affected than the inferior vestibular nerve (IVN), which is partially or totally spared. To address this question, we developed an improved method for preparing human vestibular ganglia (VG) and nerve. Subsequently, macro- and microanatomical as well as PCR studies were performed on 38 human ganglia from 38 individuals. The SVN was 2.4 mm longer than the IVN, and in 65% of the cases, the IVN ran in two separate bony canals, which was not the case for the SVN. Anastomoses between the facial and cochlear nerves were more common for the SVN (14/38 and 9/38, respectively) than for the IVN (7/38 and 2/38, respectively). Using reverse transcription-quantitative PCR (RT-qPCR), we found only a few latently herpes simplex virus 1 (HSV-1)-infected VG (18.4%). In cases of two separate neuronal fields, infected neurons were located in the superior part only. In summary, these PCR and micro- and macroanatomical studies provide possible explanations for the high frequency of SVN infection in vestibular neuritis.IMPORTANCE Vestibular neuritis is known to affect the superior part of the vestibular nerve more frequently than the inferior part. The reason for this clinical phenomenon remains unclear. Anatomical differences may play a role, or if latent HSV-1 infection is assumed, the etiology may be due to the different distribution of the infection. To shed further light on this subject, we conducted different macro- and microanatomical studies. We also assessed the presence of HSV-1 in VG and in different sections of the VG. Our findings add new information on the macro- and microanatomy of the VG as well as the pathophysiology of vestibular neuritis. We also show that latent HSV-1 infection of VG neurons is less frequent than previously reported.
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He YB, Yu CJ, Ji HM, Qu YM, Chen N. Significance of Vestibular Testing on Distinguishing the Nerve of Origin for Vestibular Schwannoma and Predicting the Preservation of Hearing. Chin Med J (Engl) 2017; 129:799-803. [PMID: 26996474 PMCID: PMC4819299 DOI: 10.4103/0366-6999.178958] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Determining the nerve of origin for vestibular schwannoma (VS), as a method for predicting hearing prognosis, has not been systematically considered. The vestibular test can be used to investigate the function of the superior vestibular nerve (SVN) and the inferior vestibular nerve (IVN). This study aimed to preoperatively distinguish the nerve of origin for VS patients using the vestibular test, and determine if this correlated with hearing preservation. Methods: A total of 106 patients with unilateral VS were enrolled in this study prospectively. Each patient received a caloric test, vestibular-evoked myogenic potential (VEMP) test, and cochlear nerve function test (hearing) before the operation and 1 week, 3, and 6 months, postoperatively. All patients underwent surgical removal of the VS using the suboccipital approach. During the operation, the nerve of tumor origin (SVN or IVN) was identified by the surgeon. Tumor size was measured by preoperative magnetic resonance imaging. Results: The nerve of tumor origin could not be unequivocally identified in 38 patients (38/106, 35.80%). These patients were not subsequently evaluated. In 26 patients (nine females, seventeen males), tumors arose from the SVN and in 42 patients (18 females, 24 males), tumors arose from the IVN. Comparing with the nerve of origins (SVN and IVN) of tumors, the results of the caloric tests and VEMP tests were significantly different in tumors originating from the SVN and the IVN in our study. Hearing was preserved in 16 of 26 patients (61.54%) with SVN-originating tumors, whereas hearing was preserved in only seven of 42 patients (16.67%) with IVN-originating tumors. Conclusions: Our data suggest that caloric and VEMP tests might help to identify whether VS tumors originate from the SVN or IVN. These tests could also be used to evaluate the residual function of the nerves after surgery. Using this information, we might better predict the preservation of hearing for patients.
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Affiliation(s)
| | - Chun-Jiang Yu
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China
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Assessment of endolymphatic hydrops and otolith function in patients with Ménière's disease. Eur Arch Otorhinolaryngol 2016; 274:1413-1421. [PMID: 27942898 DOI: 10.1007/s00405-016-4418-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 11/30/2016] [Indexed: 02/01/2023]
Abstract
Ménière's disease is associated with hydrops of the inner ear endolymphatic space, and histopathologically, the cochlea and vestibule are usually involved. We used gadolinium-enhanced magnetic resonance imaging and measured cervical and ocular vestibular evoked myogenic potentials and the gain in the utricular induced linear vestibulo-ocular reflex to test the hypothesis that vestibular hydrops in Ménière's disease patients is associated with otolith organ dysfunction. We evaluated 21 patients diagnosed with unilateral definitive Ménière's disease using gadolinium magnetic resonance imaging to detect endolymphatic hydrops in the cochlea and vestibule. Cervical and ocular vestibular evoked myogenic potentials and the gain in utricular induced linear vestibulo-ocular reflex during eccentric rotation were measured to assess otolith organ function. For eccentric rotation, patients were rotated while displaced from the axis of rotation, while linear acceleration stimulated the utricle and induced the vestibulo-ocular reflex. Magnetic resonance imaging revealed vestibular hydrops in 14 of 20 patients (70%). Among the 14 patients, ten (71%) had abnormal cervical and three (21%) had abnormal ocular vestibular evoked myogenic potentials. Four patients (4/21, 19%) had abnormal linear vestibulo-ocular reflexes, three of whom also had abnormal ocular vestibular evoked myogenic potentials. Overall, 16 of 17 patients had normal linear vestibulo-ocular reflexes and normal ocular vestibular evoked myogenic potentials. Vestibular endolymphatic hydrops in Ménière's disease patients caused otolith organ dysfunction, mainly in the saccule. The number of Ménière's disease patients with abnormal ocular vestibular evoked myogenic potentials was low (19%), and they also had abnormal utricular induced linear vestibulo-ocular reflexes.
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von Kirschbaum C, Gürkov R. Audiovestibular Function Deficits in Vestibular Schwannoma. BIOMED RESEARCH INTERNATIONAL 2016; 2016:4980562. [PMID: 27747231 PMCID: PMC5055915 DOI: 10.1155/2016/4980562] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 08/12/2016] [Accepted: 08/24/2016] [Indexed: 11/28/2022]
Abstract
Introduction. Vestibular schwannomas (VS) are benign tumours of the vestibular nerve and can lead to hearing loss, tinnitus, vertigo, facial palsy, and brainstem compression. Audiovestibular diagnostic tests are essential for detection and treatment planning. Methods. Medline was used to perform a systematic literature review with regard to how audiovestibular test parameters correlate with symptoms, tumour size, and tumour location. Results. The auditory brainstem response can be used to diagnose retrocochlear lesions caused by VS. Since hearing loss correlates poorly with tumour size, a retrocochlear lesion is probably not the only cause for hearing loss. Also cochlear mechanisms seem to play a role. This can be revealed by abnormal otoacoustic emissions, despite normal ABR and new MRI techniques which have demonstrated endolymphatic hydrops of the inner ear. Caloric and head impulse tests show frequency specific dynamics and vestibular evoked myogenic potentials may help to identify the location of the tumour regarding the involved nerve parts. Conclusion. In order to preserve audiovestibular function in VS, it is important to stop the growth of the tumour and to avoid degenerative changes in the inner ear. A detailed neurotological workup helps to diagnose VS of all sizes and can also provide useful prognostic information.
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Affiliation(s)
- Constantin von Kirschbaum
- Department of Otorhinolaryngology and Head and Neck Surgery, Grosshadern Medical Center, University of Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Robert Gürkov
- Department of Otorhinolaryngology and Head and Neck Surgery, Grosshadern Medical Center, University of Munich, Marchioninistr. 15, 81377 Munich, Germany
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Murofushi T. Clinical application of vestibular evoked myogenic potential (VEMP). Auris Nasus Larynx 2016; 43:367-76. [DOI: 10.1016/j.anl.2015.12.006] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 11/12/2015] [Accepted: 12/07/2015] [Indexed: 01/31/2023]
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Iwasaki S, Ito K, Takai Y, Morita A, Murofushi T. Chondroid Chordoma at the Jugular Foramen Causing Retrolabyrinthine Lesions in Both the Cochlear and Vestibular Branches of the Eighth Cranial Nerve. Ann Otol Rhinol Laryngol 2016; 113:82-6. [PMID: 14763580 DOI: 10.1177/000348940411300118] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Shinichi Iwasaki
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
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Allena M, Magis D, De Pasqua V, Schoenen J, Bisdorff AR. The Vestibulo-Collic Reflex is Abnormal in Migraine. Cephalalgia 2016; 27:1150-5. [PMID: 17784856 DOI: 10.1111/j.1468-2982.2007.01414.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Interictal evoked central nervous system responses are characterized in migraineurs by a deficit of habituation, at both cortical and subcortical levels. The click-evoked vestibulo-collic reflex (VCR) allows the assessment of otolith function and an oligosynaptic pathway linking receptors in the saccular macula to motoneurons of neck muscles. Three blocks of 75 averaged responses to monaural 95-dB normal hearing level 3-Hz clicks were recorded over the contracted ipsilateral sternocleidomastoid muscle in 25 migraineurs between attacks and 20 healthy subjects, without vestibular symptoms. Amplitudes, raw and corrected for baseline electromyography, were significantly smaller in migraine patients. Whereas in healthy volunteers the VCR habituated during stimulus repetition (-4.96% ± 14.3), potentiation was found in migraineurs (4.34% ± 15.3; P = 0.04). The combination with a reduced mean amplitude does not favour vestibular hyperexcitability as an explanation for the habituation deficit in migraine, but rather an abnormal processing of repeated stimuli in the reflex circuit.
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Affiliation(s)
- M Allena
- Headache Research Unit, Department of Neurology, CHR Citadelle, University of Liège, Boulevard du 12ème de Ligne 1, 4000 Liège, Belgium
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Abstract
Normal vestibular end organs generate an equal resting-firing frequency of the axons, which is the same on both sides under static conditions. An acute unilateral vestibulopathy leads to a vestibular tone imbalance. Acute unilateral vestibulopathy is defined by the patient history and the clinical examination and, in unclear cases, laboratory examinations. Key signs and symptoms are an acute onset of spinning vertigo, postural imbalance and nausea as well as a horizontal rotatory nystagmus beating towards the non-affected side, a pathological head-impulse test and no evidence for central vestibular or ocular motor dysfunction. The so-called big five allow a differentiation between a peripheral and central lesion by the bedside examination. The differential diagnosis of peripheral labyrinthine and vestibular nerve disorders mimicking acute unilateral vestibulopathy includes central vestibular disorders, in particular "vestibular pseudoneuritis" and other peripheral vestibular disorders, such as beginning Menière's disease. The management of acute unilateral vestibulopathy involves (1) symptomatic treatment with antivertiginous drugs, (2) causal treatment with corticosteroids, and (3) physical therapy.
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Affiliation(s)
- Michael Strupp
- Department of Neurology, German Center for Vertigo and Balance Disorders, University Hospital Munich, Campus Grosshadern, Munich 81377, Germany.
| | - Mans Magnusson
- Department of Otolaryngology, Lund University, Lund 22100, Sweden
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Singh NK, Sinha SK, Barman A. Assessment of otolith mediated neural reflexes through cervical and ocular vestibular evoked myogenic potentials in individuals with auditory neuropathy spectrum disorders. HEARING BALANCE AND COMMUNICATION 2016. [DOI: 10.3109/21695717.2016.1152047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Colebatch JG, Rosengren SM, Welgampola MS. Vestibular-evoked myogenic potentials. HANDBOOK OF CLINICAL NEUROLOGY 2016; 137:133-155. [PMID: 27638068 DOI: 10.1016/b978-0-444-63437-5.00010-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The vestibular-evoked myogenic potential (VEMP) is a short-latency potential evoked through activation of vestibular receptors using sound or vibration. It is generated by modulated electromyographic signals either from the sternocleidomastoid muscle for the cervical VEMP (cVEMP) or the inferior oblique muscle for the ocular VEMP (oVEMP). These reflexes appear to originate from the otolith organs and thus complement existing methods of vestibular assessment, which are mainly based upon canal function. This review considers the basis, methodology, and current applications of the cVEMP and oVEMP in the assessment and diagnosis of vestibular disorders, both peripheral and central.
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Affiliation(s)
- J G Colebatch
- Neuroscience Research Australia and Department of Neurology, Prince of Wales Hospital Clinical School, University of New South Wales, Sydney, Australia.
| | - S M Rosengren
- Neurology Department, Royal Prince Alfred Hospital and Central Clinical School, University of Sydney, Sydney, Australia
| | - M S Welgampola
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital and Central Clinical School, University of Sydney, Sydney Australia
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Singh NK, Apeksha K. Efficacy of cervical and ocular vestibular-evoked myogenic potentials in evaluation of benign paroxysmal positional vertigo of posterior semicircular canal. Eur Arch Otorhinolaryngol 2015; 273:2523-32. [DOI: 10.1007/s00405-015-3867-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 12/16/2015] [Indexed: 10/22/2022]
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Weber KP, Rosengren SM. Clinical utility of ocular vestibular-evoked myogenic potentials (oVEMPs). Curr Neurol Neurosci Rep 2015; 15:22. [PMID: 25773001 DOI: 10.1007/s11910-015-0548-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Over the last years, vestibular-evoked myogenic potentials (VEMPs) have been established as clinical tests of otolith function. Complementary to the cervical VEMPs, which assess mainly saccular function, ocular VEMPs (oVEMPs) test predominantly utricular otolith function. oVEMPs are elicited either with air-conducted (AC) sound or bone-conducted (BC) skull vibration and are recorded from beneath the eyes during up-gaze. They assess the vestibulo-ocular reflex and are a crossed excitatory response originating from the inferior oblique eye muscle. Enlarged oVEMPs have proven to be sensitive for screening of superior canal dehiscence, while absent oVEMPs indicate a loss of superior vestibular nerve otolith function, often seen in vestibular neuritis (VN) or vestibular Schwannoma.
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Affiliation(s)
- Konrad P Weber
- Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, CH-8091, Zurich, Switzerland,
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Xu XD, Ding CR, Yu J, Han Z, Gu J, Gao N, Jia XH, Luo X, Wang J, Chi FL. The hidden dysfunction of otolithic organs in patients with profound sensorineural hearing loss. Hear Res 2015; 331:41-6. [PMID: 26520583 DOI: 10.1016/j.heares.2015.10.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 10/12/2015] [Accepted: 10/15/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To define the profiles of ocular and cervical vestibular-evoked myogenic potentials (oVEMP and cVEMP, respectively) in patients with profound sensorineural hearing loss (PSHL). METHODS Twenty-nine patients with PSHL and 20 healthy volunteers were investigated. The patients' medical records were collected and analyzed. The ACS-evoked oVEMPs and cVEMPs and caloric test were tested and analyzed. RESULTS The oVEMP and cVEMP response rates in the patients with PSHL were 38.9% and 44.4%, respectively, and these values were significantly less than those in the healthy volunteers (both were 100%). Regarding the oVEMPs, significantly higher threshold (p < 0.001) and smaller amplitude (p = 0.022) were observed in the patients. Regarding the cVEMPs, a significant elevation in the threshold (p < 0.001) and a decrease in the amplitude (p = 0.024) were observed, and marked reductions in the P1 (p = 0.002) and N1 latencies (p = 0.001) were observed in the patients. Regarding the caloric test, the ratio of semicircular canal dysfunction in patients with PSHL was significantly higher than that in healthy volunteers (p < 0.001). However, neither the patients nor the doctors noticed balance problems or the loss of otolithic function in the summaries of the medical records of all 29 of the patients. CONCLUSION The utricular and saccular dysfunction that can be concealed in patients with PSHL can be observed in oVEMPs and cVEMPs. Otolithic function should receive attention in the diagnosis and treatment of PSHL. VEMPs have special value for the observation of hidden dysfunctions of the otolithic organs of patients with PSHL.
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Affiliation(s)
- Xin-Da Xu
- Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, 83 Fenyang Road, Shanghai 200031, China; Shanghai Auditory Medical Center, Shanghai, China; Key Laboratory of Hearing Science, Ministry of Health, Shanghai, China
| | - Chen-Ru Ding
- Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, 83 Fenyang Road, Shanghai 200031, China; Shanghai Auditory Medical Center, Shanghai, China; Key Laboratory of Hearing Science, Ministry of Health, Shanghai, China
| | - Jing Yu
- Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, 83 Fenyang Road, Shanghai 200031, China; Shanghai Auditory Medical Center, Shanghai, China; Key Laboratory of Hearing Science, Ministry of Health, Shanghai, China
| | - Zhao Han
- Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, 83 Fenyang Road, Shanghai 200031, China; Shanghai Auditory Medical Center, Shanghai, China; Key Laboratory of Hearing Science, Ministry of Health, Shanghai, China
| | - Jun Gu
- Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, 83 Fenyang Road, Shanghai 200031, China; Shanghai Auditory Medical Center, Shanghai, China; Key Laboratory of Hearing Science, Ministry of Health, Shanghai, China
| | - Na Gao
- Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, 83 Fenyang Road, Shanghai 200031, China; Shanghai Auditory Medical Center, Shanghai, China; Key Laboratory of Hearing Science, Ministry of Health, Shanghai, China
| | - Xian-Hao Jia
- Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, 83 Fenyang Road, Shanghai 200031, China; Shanghai Auditory Medical Center, Shanghai, China; Key Laboratory of Hearing Science, Ministry of Health, Shanghai, China
| | - Xu Luo
- Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, 83 Fenyang Road, Shanghai 200031, China; Shanghai Auditory Medical Center, Shanghai, China; Key Laboratory of Hearing Science, Ministry of Health, Shanghai, China
| | - Jing Wang
- Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, 83 Fenyang Road, Shanghai 200031, China; Shanghai Auditory Medical Center, Shanghai, China; Key Laboratory of Hearing Science, Ministry of Health, Shanghai, China.
| | - Fang-Lu Chi
- Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, 83 Fenyang Road, Shanghai 200031, China; Shanghai Auditory Medical Center, Shanghai, China; Key Laboratory of Hearing Science, Ministry of Health, Shanghai, China.
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Fujimoto C, Kinoshita M, Kamogashira T, Egami N, Sugasawa K, Yamasoba T, Iwasaki S. Characteristics of vertigo and the affected vestibular nerve systems in idiopathic bilateral vestibulopathy. Acta Otolaryngol 2015; 136:43-7. [PMID: 26381713 DOI: 10.3109/00016489.2015.1082193] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
CONCLUSION Vertigo attacks in IBV patients involving both the superior and inferior vestibular nerve systems were significantly more severe than vertigo attacks in patients with selective involvement of the inferior vestibular nerve system alone. OBJECTIVE To investigate the relationship between the frequency and duration of vertigo and the affected vestibular nerve system in idiopathic bilateral vestibulopathy (IBV). METHODS This study categorized 44 IBV patients into the following three sub-groups according to the affected vestibular nerve system: superior, inferior, and mixed type. These patients were also categorized into the following three sub-groups according to their clinical time course: progressive type showing no episodes of vertigo, sequential type showing recurrent vertigo attacks and single-attack type showing a single episode of vertigo. RESULTS Ten, 11 and 23 patients were classified as the superior, the inferior, and the mixed type, respectively. Seventeen, 23, and four patients were classified as the progressive, the sequential, and the single-attack type, respectively. For the patients having one or more vertigo attacks, the duration of the vertigo attack was longer than 24 h in 69% of the mixed type, and the duration of vertigo in the mixed type was significantly longer than that in the inferior type (p < 0.05).
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Affiliation(s)
- Chisato Fujimoto
- a Department of Otolaryngology, Faculty of Medicine , The University of Tokyo , Tokyo , Japan
| | - Makoto Kinoshita
- a Department of Otolaryngology, Faculty of Medicine , The University of Tokyo , Tokyo , Japan
| | - Teru Kamogashira
- a Department of Otolaryngology, Faculty of Medicine , The University of Tokyo , Tokyo , Japan
| | - Naoya Egami
- a Department of Otolaryngology, Faculty of Medicine , The University of Tokyo , Tokyo , Japan
| | - Keiko Sugasawa
- a Department of Otolaryngology, Faculty of Medicine , The University of Tokyo , Tokyo , Japan
| | - Tatsuya Yamasoba
- a Department of Otolaryngology, Faculty of Medicine , The University of Tokyo , Tokyo , Japan
| | - Shinichi Iwasaki
- a Department of Otolaryngology, Faculty of Medicine , The University of Tokyo , Tokyo , Japan
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Bogle JM, Zapala DA, Burkhardt B, Walker K, Lundy L, Shelfer J, Pratt T, Garry M, Walker D. The Effect of Repetition Rate on Air-Conducted Ocular Vestibular Evoked Myogenic Potentials (oVEMPs). Am J Audiol 2015; 24:411-8. [PMID: 25997090 DOI: 10.1044/2015_aja-15-0011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 05/17/2015] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Ocular vestibular evoked myogenic potentials (oVEMPs) are used to describe utricular/superior vestibular nerve function; however, optimal recording parameters have not been fully established. This study investigated the effect of repetition rate on air-conducted oVEMPs. METHOD Ten healthy adults were evaluated using 500-Hz tone bursts (4-ms duration, Blackman gating, 122 dB pSPL). Four repetition rates were used (1.6, 4.8, 8.3, and 26.6 Hz) and resulting oVEMP response presence, amplitude, amplitude asymmetry, and n1/p1 latency were assessed. RESULTS Response presence was significantly reduced for 26.6 Hz using monaural stimulation and for 8.3 Hz and 26.6 Hz for binaural stimulation. For monaural stimulation using 1.6, 4.8, and 8.3 Hz, no significant differences were noted for amplitude or latency. Responses obtained using binaural stimulation demonstrated a significant effect of rate on amplitude, with 8.3 Hz producing significantly reduced amplitude. Binaural amplitudes were significantly larger than monaural contralateral responses but with reduced response presence. No significant differences were noted for latency or amplitude asymmetry. CONCLUSION Using repetition rates of approximately 5 Hz or less may produce more consistent oVEMP response presence with minimal effects on amplitude for monaural or binaural recordings.
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Affiliation(s)
- Jamie M. Bogle
- Department of Otolaryngology, Mayo Clinic Arizona, Scottsdale
| | - David A. Zapala
- Department of Otolaryngology, Mayo Clinic Florida, Jacksonville
| | | | - Kurt Walker
- Department of Otolaryngology, Mayo Clinic Florida, Jacksonville
| | - Larry Lundy
- Department of Otolaryngology, Mayo Clinic Florida, Jacksonville
| | - Janet Shelfer
- Department of Otolaryngology, Mayo Clinic Florida, Jacksonville
| | - Terri Pratt
- Department of Otolaryngology, Mayo Clinic Florida, Jacksonville
| | - Millicent Garry
- Department of Otolaryngology, Mayo Clinic Florida, Jacksonville
| | - David Walker
- Department of Otolaryngology, Mayo Clinic Florida, Jacksonville
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Ocular and cervical vestibular-evoked myogenic potentials in children with cochlear implant. Clin Neurophysiol 2015; 126:1624-31. [DOI: 10.1016/j.clinph.2014.10.216] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Revised: 10/30/2014] [Accepted: 10/31/2014] [Indexed: 11/24/2022]
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