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Liu D, Wang J, Tian E, Guo ZQ, Chen JY, Kong WJ, Zhang SL. Diagnostic Value of the Vestibular Autorotation Test in Menière's Disease, Vestibular Migraine and Menière's Disease with Migraine. Brain Sci 2022; 12:1432. [PMID: 36358359 PMCID: PMC9688433 DOI: 10.3390/brainsci12111432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/18/2022] [Accepted: 10/24/2022] [Indexed: 10/29/2023] Open
Abstract
(1) Background: Vestibular migraine (VM) and Menière's disease (MD) share multiple features in terms of clinical presentations and auditory-vestibular functions, and, therefore, more accurate diagnostic tools to distinguish between the two disorders are needed. (2) Methods: The study was of retrospective design and examined the data of 69 MD patients, 79 VM patients and 72 MD with migraine patients. Five vestibular autorotation test (VAT) parameters, i.e., horizontal gain/phase, vertical gain/phase and asymmetry were subjected to logistic regression. The receiver operating characteristic (ROC) curves were generated to determine the accuracy of the different parameters in the differential diagnosis of MD and VM. (3) Results: Our results showed that the horizontal gain of VAT significantly outperformed other parameters in distinguishing MD and VM. In addition, the sensitivity, specificity and accuracy of the horizontal gain were 95.7%, 50.6% and 71.6%, respectively, for the differentiation between VM and MD. In most MD patients, the horizontal gain decreased in the range of 3-4 Hz, while in most VM patients, horizontal gain increased in the range between 2-3 Hz. More MD with migraine patients had an increased horizontal gain when the frequency was less than 5.0 Hz and had a decreased horizontal gain when the frequency was greater than 5.0 Hz. (4) Conclusion: Our study suggested the VAT, especially the horizontal gain, as an indicator, may serve as a sensitive and objective indicator that helps distinguish between MD and VM. Moreover, VAT, due to its non-invasive and all-frequency nature, might be an important part of a test battery.
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Affiliation(s)
- Dan Liu
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jun Wang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - E Tian
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Zhao-qi Guo
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jing-yu Chen
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Wei-jia Kong
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Key Laboratory of Neurological Disorders of Education Ministry, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Su-lin Zhang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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Yao Y, Zhao Z, Qi X, Jia H, Zhang L. cVEMP and VAT for the diagnosis of vestibular migraine. Eur J Clin Invest 2022; 52:e13657. [PMID: 34293195 DOI: 10.1111/eci.13657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 05/18/2021] [Accepted: 07/11/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although the diagnostic criteria of vestibular migraine (VM) have already been defined, various clinical manifestations of VM and the lack of pathognomonic biomarker result in high rate of misdiagnosis and mismanagement. A timely and accurate diagnosis tool for the evaluation of VM is highly needed. OBJECTIVE The current study aims to investigate the potential feasibility of cervical vestibular evoked myogenic potential (cVEMP) and vestibular autorotation test (VAT) as a diagnosis tool for VM. METHODS A total of 211 subjects were recruited into the current study with all subjects meeting the inclusion and exclusion criteria. The subjects were divided into 3 groups: healthy control group, general migraine group and VM group. Test of cVEMP and VAT was conducted in all the groups, and the generated data were statistically compared. RESULTS Compared with the other two groups, cVEMP P13-N23 amplitudes of VM patients showed a significant decline. Mean latency values of the VM group had no significant difference in comparison with other groups. Asymmetry ratios showed increased level in VM patients compared to the control groups, without significant difference. VAT results showed that all the horizontal gain, horizontal phase, vertical gain and vertical phase differ from the other two groups to varying degrees at higher frequency. CONCLUSION cVEMP and VAT have potential usage in the assessment of VM and can serve as powerful tool in diagnosis of VM.
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Affiliation(s)
- Yufang Yao
- Department 7 of Neurology, Cangzhou Central Hospital, Cangzhou, China
| | - Zhiyue Zhao
- College of Mechanical and Electrical Engineering, Cangzhou Normal University, Cangzhou, China
| | - Xiaoyuan Qi
- Department 7 of Neurology, Cangzhou Central Hospital, Cangzhou, China
| | - Hongning Jia
- Department 7 of Neurology, Cangzhou Central Hospital, Cangzhou, China
| | - Lihua Zhang
- Department 4 of Neurology, Cangzhou Central Hospital, Cangzhou, China
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Gökgöz MC, Satar B, Hıdır Y, Ceyhan A, Çoban VK. Recognizing Decompensated Meniere's Disease Using High Frequency Rotational Test. J Int Adv Otol 2021; 16:165-170. [PMID: 32066549 DOI: 10.5152/iao.2019.6502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES The purpose of this study is to investigate the effectiveness of the high-frequency rotational test for discrimination of patients with decompensated from those with compensated Meniere's disease. MATERIALS AND METHODS Patients with unilateral Meniere's disease were divided into two groups (compensated and decompensated), based on the presence of clinically significant positional nystagmus as a determinant of the compensation status. All patients and subjects underwent pure tone audiometry, video nystagmography, and the vestibular autorotation test (VAT). The gain, phase, and asymmetry values of VAT were evaluated to range between 2 and 6 Hz. RESULTS Phase values of horizontal vestibulo-ocular reflex (VOR) at 2.0, 2.3, and 2.7 Hz were significantly higher in the decompensated group (p<0.05). There was no significant difference in gain values, phase values, of vertical VOR and horizontal asymmetry values. CONCLUSION Our study confirmed that horizontal phase values were determined as sensitive markers in VAT to discriminate decompensated from compensated Meniere's disease.
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Affiliation(s)
- Mert Cemal Gökgöz
- Department of Ear Nose and Throat, Gülhane School of Medicine, Ankara, Turkey
| | - Bülent Satar
- Department of Ear Nose and Throat, Gülhane School of Medicine, Ankara, Turkey
| | - Yusuf Hıdır
- Clinic of Ear Nose Throat, Private Egepol Hospital, İzmir, Turkey
| | - Aykut Ceyhan
- Department of Ear Nose and Throat, Dumlupınar University School of Medicine, Evliya Celebi Training and Research Hospital, Kütahya, Turkey
| | - Volkan Kenan Çoban
- Department of Ear Nose and Throat, Gülhane School of Medicine, Ankara, Turkey
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Yetiser S, Ince D. Active Head Auto-Rotations in Patients With Benign Paroxysmal Positional Vertigo. J Clin Med Res 2021; 13:107-112. [PMID: 33747325 PMCID: PMC7935628 DOI: 10.14740/jocmr4413] [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: 12/14/2020] [Accepted: 12/30/2020] [Indexed: 11/11/2022] Open
Abstract
Background Utricular degeneration is the source of traveling otoconia inside the semicircular canals in patients with benign paroxysmal positional vertigo (BPPV). The underlying pathology is not clear. The aim of this study was to analyze vestibulo-ocular reflex (VOR) during sudden head accelerations in those patients since clinical reports designating an association of BPPV with inner ear problems are increasing. Methods VOR reaction to impulsive head rotations were tested in 34 patients with BPPV (13 lateral, 21 posterior canal BPPV) and 15 healthy subjects in a prospective controlled study. Main outcome measure was the gain (the ratio of head and eye velocity) of vertical and horizontal head auto-rotations to the pathologic and normal sides. Results All patients with BPPV and control subjects had normal gain (≥ 0.9) at 1 and 2 Hz but the gain decreased at higher frequencies. No statistically significant difference was found when comparing the gain between the horizontal head rotations toward the pathologic and those toward the normal side (P = 0.89, P = 0.90, P = 0.78, P = 0.20 and P = 0.16, at 1, 2, 3, 4 and 5 Hz, respectively) and between upward and downward vertical head rotations (P = 0.28, P = 0.53 and P = 0.15, at 1, 2 and 3 Hz, respectively) in patients with lateral and posterior canal BPPV. Conclusion VOR gain was reduced in some patients. However, head auto-rotation test (HART) does not show any functional abnormality of VOR during head rotations toward the pathologic side. HART is not suitable as a screening test for BPPV.
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Affiliation(s)
- Sertac Yetiser
- Anadolu Medical Center, Dept of ORL & HNS, Gebze, Kocaeli 41400, Turkey
| | - Dilay Ince
- Anadolu Medical Center, Dept of ORL & HNS, Gebze, Kocaeli 41400, Turkey
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Naples JG, Henry L, Brant JA, Eliades SJ, Ruckenstein MJ. Intratympanic Therapies in Ménière Disease: Evaluation of Outcomes and Early Vertigo Control. Laryngoscope 2018; 129:216-221. [PMID: 30284276 DOI: 10.1002/lary.27392] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate outcomes of intratympanic (IT) dexamethasone and gentamicin in Ménière Disease (MD). METHODS Charts of adult patients with unilateral definite MD receiving IT gentamicin or dexamethasone from 2005 to 2017 were retrospectively reviewed. All patients had at least 6 months follow-up. Failure in each group was defined as the need for more aggressive therapy. Prior to 2011, all patient received IT gentamicin, administered as primary therapy after failure of conservative treatment measures. Gentamicin was administered every 2 weeks, up to three injections, until vertigo control was achieved. Beginning in 2011, the treatment protocol shifted to IT dexamethasone as initial treatment, with gentamicin used for dexamethasone failures. Dexamethasone was administered weekly for up to three injections. Treatments could be repeated if symptoms recurred. RESULTS Thirty-three patients received IT dexamethasone, and 70 patients received IT gentamicin. Dexamethasone patients received a mean of 3.3 injections compared to 2.7 in the gentamicin group (P = 0.011). There were 12 (38%) failures in the dexamethasone group and only seven (10%) gentamicin failures (P = 0.025). No patients failed both treatments. The mean time to failure in the dexamethasone group was 5 months, whereas in the gentamicin group it was 27 months. Change in pure tone audiometry from baseline was not different between treatment groups (P = 0.30). CONCLUSION Subjects receiving IT gentamicin required fewer injections and had a significantly longer time to failure than IT dexamethasone. Audiometric outcomes were similar between the groups. The use of IT gentamicin as initial therapy for early and long-term control of MD is safe and effective. LEVEL OF EVIDENCE 3 Laryngoscope, 129:216-221, 2019.
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Affiliation(s)
- James G Naples
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, U.S.A
| | - Laura Henry
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Jason A Brant
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, U.S.A
| | - Steven J Eliades
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, U.S.A
| | - Michael J Ruckenstein
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, U.S.A
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Thungavelu Y, Wang W, Lin P, Chen T, Xu K. The clinical utility of vestibular autorotation test in patients with vestibular migraine. Acta Otolaryngol 2017; 137:1046-1050. [PMID: 28541766 DOI: 10.1080/00016489.2017.1331375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To investigate the characteristics and clinical utility of vestibular autorotation test (VAT) in patients with vestibular migraine. METHODS This study included two groups, an experimental group (441 patients) and a control group (65 healthy subjects). Both groups undertook VAT; the parameters evaluated were horizontal gain/phase, vertical gain/phase and asymmetry. The differences in VAT results between the two groups were investigated. RESULTS There were no statistical differences between the VAT data of the control group when compared to the reference value from the manufacturer (p > .05). There were statistically significant differences in VAT results between the experimental and control group, namely elevated horizontal gain at frequency 2, 3, 4 and 5 Hz, horizontal phase delay at frequency 2, 4, 5 and 6 Hz, elevated vertical gain at frequency 2 6Hz and vertical phase delay at frequency 4 6Hz. CONCLUSION The results of this study using VAT in VM patients demonstrate elevated horizontal gain, vertical gain and delay in horizontal phase, vertical phase. We suggest the application of VAT as a diagnostic tool which may provide objective evidence that can contribute to the diagnosis of VM and also in differential diagnosis.
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Affiliation(s)
- Yogun Thungavelu
- Tianjin First Center Hospital, Tianjin Medical University, Tianjin, China
| | - Wei Wang
- Department of Otorhino-laryngology Head and Neck Surgery, Tianjin First Center Hospital, Otorhinolaryngology Institute of Tianjin, Tianjin, China
| | - Peng Lin
- Department of Otorhino-laryngology Head and Neck Surgery, Tianjin First Center Hospital, Otorhinolaryngology Institute of Tianjin, Tianjin, China
| | - Taisheng Chen
- Department of Otorhino-laryngology Head and Neck Surgery, Tianjin First Center Hospital, Otorhinolaryngology Institute of Tianjin, Tianjin, China
| | - Kaixu Xu
- Department of Otorhino-laryngology Head and Neck Surgery, Tianjin First Center Hospital, Otorhinolaryngology Institute of Tianjin, Tianjin, China
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Hsieh LC, Lin TM, Chang YM, Kuo TBJ, Lee GS. Clinical applications of correlational vestibular autorotation test. Acta Otolaryngol 2015; 135:549-56. [PMID: 25719606 DOI: 10.3109/00016489.2014.999874] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION The correlational vestibular autorotation test (VAT) system has the advantages of good test-retest reliability and calibrations of absolute degrees of eye movement are unnecessary when acquiring a cross correlation coefficient (CCC). The approach is able to efficiently detect peripheral vestibulopathies. OBJECTIVE A VAT has some drawbacks including poor test-retest reliability and slippage of sensor. This study aimed to develop a correlational VAT system and to evaluate the reliability and applicability of this system. METHODS Twenty healthy participants and 10 vertiginous patients were enrolled. Vertical and horizontal autorotations from 0 to 3 Hz with either closed or open eyes were performed. A small sensor and a wireless transmission technique were used to acquire the electro-ocular graph and head velocity signals. The two signals were analyzed using CCCs to assess the functioning of the vestibular ocular reflex (VOR). RESULTS The results showed a significantly greater CCC for open-eye versus closed-eye of head autorotations. The CCCs also increased significantly with head rotational frequencies. Moreover, the CCCs significantly correlated with the VOR gains at autorotation frequencies ≥1.0 Hz. The test-retest reliability was good (intraclass correlation coefficients ≥0.85). The vertiginous participants had significantly lower individual CCCs and overall average CCC than age- and-gender matched controls.
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Affiliation(s)
- Li-Chun Hsieh
- Institute of Brain Science, School of Medicine, National Yang-Ming University
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Abstract
OBJECTIVE To establish intrarater and interrater reliability of the Vestibular Autorotation Test (VAT) (Western Systems Research Inc., Pasadena, CA) in a clinical sample of individuals reporting dizziness. STUDY DESIGN Ninety-eight patients with reports of dizziness referred for vestibular function testing performed repeated trials of horizontal VAT. A subsample of 49 individuals repeated the test for a second rater. RESULTS Approximately 66% of subjects were unable to meet the performance criterion of six consecutive trials where data was displayed at frequencies > or =3.9 Hz with coherence values held constant trial to trial. There was a good level of intrarater reliability for gain independent of the effects of practice (intraclass correlation coefficient [ICC] = 0.78 [95% confidence interval [CI]: 0.69-0.87] to 0.95 [(95% CI: 0.93-0.97]). A significant difference in intrarater reliability was found when the first three trials were compared to the last three trials for phase (ICC ranged from 0.04 [95% CI: 0.00-0.31] to 0.96 [95% CI: 0.93-0.97]) and asymmetry (ICC ranged from 0.39 [95% CI: 0.17-0.56] to 0.73 [95% CI: 0.32-0.81]) particularly at frequencies > or =4.3 Hz. Interrater reliability was good to excellent across all variables at frequencies < or =3.9 Hz. CONCLUSIONS Many patients had difficulty performing the VAT. The reliability estimates for phase and asymmetry, but not gain, were significantly affected by practice. Careful attention to patient preparation, instruction, and test monitoring including sufficient patient practice before data collection are likely to be critical factors to ensure quality data.
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Abstract
CONCLUSIONS We recommend performing the test for nystagmus actively, both when the response is analyzed at bedside or with videonystagmography. If no nystagmus is observed with the active test, it should then be performed passively. OBJECTIVE Head-shaking nystagmus (HSN) is a sign of vestibular dysfunction that is elicited after actively (patient) or passively (examiner) shaking a patient's head. The objective of this study was to analyze the frequency of HSN when the test is performed actively (aHSN) or passively (pHSN), and to determine whether any differences in the results might be due to age or disease state, or whether they reflect the results of different vestibular tests. PATIENTS AND METHODS This was a prospective study conducted at a tertiary care center. The head-shaking test was carried out actively and passively on 100 patients. The caloric test, the rotatory chair tests and the measures of disability were performed on the same day and in the same setting. HSN was considered to be present when it was seen for a period longer than 5 s or if the maximum slow-phase velocity of HSN was higher than 3 degrees s(-1). Four groups were established according to the results of the two testing methods. RESULTS The frequency of aHSN was 47% and of pHSN was 46% when the presence of nystagmus was established as the criterion. Moreover, in patients who had experienced vestibular neuritis previously, the type of nystagmus was age-dependent. When the velocity of the nystagmus elicited was considered, the results coincided with the method of testing in 74% of the patients, while they differed in 26% of subjects; the aforementioned age dependency was no longer seen. Differences in the caloric and rotatory chair test results, as well as in disability, were observed in the groups generated on the basis of the types of nystagmus.
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Affiliation(s)
- Carlos Gimeno-Vilar
- Department of Otorhinolaryngology, Clínica Universitaria de Navarra, University Hospital and Medical School, University of Navarra, Pamplona, Spain
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López Escámez JA, Molina MI, Zapata C, Palma MJ, Gómez Fiñana M, Gámiz MJ, Fernández Pérez A. [Oculomotor response to the vertical cephalic autorotatory test in patients with benign paroxistic positional vertigo of the posterior canal]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2007; 57:210-6. [PMID: 16768198 DOI: 10.1016/s0001-6519(06)78695-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate the eye movement response to the head auto-rotation test (HART) in the vertical plane in patients with benign paroxysmal positional vertigo. PATIENTS AND METHODS DESIGN A transversal, descriptive study. SETTING UP: Outpatient clinic in a general Hospital. INDIVIDUALS 34 posterior canal BPPV cases with a video-oculographic diagnosis, older than 18 years old, 7 of them were not able to perform the HART. INTERVENTION HART was performed by a an electrooculographic system with simultaneous recording of head movement by an acelerometer in the vertical plane (Vorteq, Micromedical Instruments). The HART with eyes fixation was performed 3 times to determine its reliability. MAIN OUTCOME MEASURES Gain, asymmetry and phase for the vertical VOR respectively. A statistical analysis was carried out to determine the test reliability and the number of individuals with an abnormal result. RESULTS Gain is the only variable that showed a reproducible result in the HART for the active head movement at 1-2 Hz (test-retest reliability 0.83-0.89). The values of gain showed a moderate correlation at the frequencies 1-3 Hz (correlation 0.60-0.87). Asymmetry and phase were not reproducible variables (correlation < 0.55). Thirteen of 27 (48%) patients presented a decrease of the vertical gain, another 13 showed normal values and one case showed raised values. CONCLUSION Gain is the only useful variable in the vertical HART. Forty-eight percent of patients with posterior canal BPPV have a reduced vertical gain, suggesting an impairment of inferior vestibular nerve function.
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Affiliation(s)
- J A López Escámez
- Grupo de Otología y Otoneurología, CTS495, Unidad de Otorrinolaringología, Area de Cirugía, Hospital de Poniente de Almería, El Ejido.
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