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Dlugaiczyk J. Rare Disorders of the Vestibular Labyrinth: of Zebras, Chameleons and Wolves in Sheep's Clothing. Laryngorhinootologie 2021; 100:S1-S40. [PMID: 34352900 PMCID: PMC8363216 DOI: 10.1055/a-1349-7475] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The differential diagnosis of vertigo syndromes is a challenging issue, as many - and in particular - rare disorders of the vestibular labyrinth can hide behind the very common symptoms of "vertigo" and "dizziness". The following article presents an overview of those rare disorders of the balance organ that are of special interest for the otorhinolaryngologist dealing with vertigo disorders. For a better orientation, these disorders are categorized as acute (AVS), episodic (EVS) and chronic vestibular syndromes (CVS) according to their clinical presentation. The main focus lies on EVS sorted by their duration and the presence/absence of triggering factors (seconds, no triggers: vestibular paroxysmia, Tumarkin attacks; seconds, sound and pressure induced: "third window" syndromes; seconds to minutes, positional: rare variants and differential diagnoses of benign paroxysmal positional vertigo; hours to days, spontaneous: intralabyrinthine schwannomas, endolymphatic sac tumors, autoimmune disorders of the inner ear). Furthermore, rare causes of AVS (inferior vestibular neuritis, otolith organ specific dysfunction, vascular labyrinthine disorders, acute bilateral vestibulopathy) and CVS (chronic bilateral vestibulopathy) are covered. In each case, special emphasis is laid on the decisive diagnostic test for the identification of the rare disease and "red flags" for potentially dangerous disorders (e. g. labyrinthine infarction/hemorrhage). Thus, this chapter may serve as a clinical companion for the otorhinolaryngologist aiding in the efficient diagnosis and treatment of rare disorders of the vestibular labyrinth.
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Affiliation(s)
- Julia Dlugaiczyk
- Klinik für Ohren-, Nasen-, Hals- und Gesichtschirurgie
& Interdisziplinäres Zentrum für Schwindel und
neurologische Sehstörungen, Universitätsspital Zürich
(USZ), Universität Zürich (UZH), Zürich,
Schweiz
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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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Fujimoto C, Egami N, Kawahara T, Uemura Y, Yamamoto Y, Yamasoba T, Iwasaki S. Noisy Galvanic Vestibular Stimulation Sustainably Improves Posture in Bilateral Vestibulopathy. Front Neurol 2018; 9:900. [PMID: 30405522 PMCID: PMC6204397 DOI: 10.3389/fneur.2018.00900] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/03/2018] [Indexed: 11/26/2022] Open
Abstract
Patients with bilateral vestibulopathy (BV) suffer from persistent postural imbalance, leading to a marked decrease in quality of life and a higher risk of falls. However, so far, the effective treatments for BV are very limited. We examined whether long-term noisy galvanic vestibular stimulation (nGVS) keeps improving body balance after the cessation of the stimulus in BV patients. Thirteen BV patients received nGVS for 30 min with a lower intensity than the intensity at which they feel any cutaneous sensations, and their postural movement was monitored for 6 h after the stimuli. The same session was repeated at 14-day intervals. Stance tasks on two legs were performed with eyes closed. The velocity of the center of pressure (COP) movement, the area enclosed by the COP movement, and the root mean square of the displacement of the COP were measured. The power spectrum of the COP movement was assessed. Subjective improvement of body balance was graded as worsened (−2), slightly worsened (−1), unchanged (0), slightly improved (+1) and improved (+2) in comparison with that without nGVS. In each session, the velocity of the COP movement was significantly improved for 6 h after the stimulus had ceased (P < 0.01). Concomitantly, the mean frequency of the COP power spectrum was significantly reduced in the anterior-posterior axis (P < 0.05). Subjective symptoms of imbalance were improved during the post-stimulation effect (P < 0.05). nGVS leads to an improvement in body balance that lasts for several hours after the end of the stimulus in BV patients with a reduction in the high-frequency components of their postural movement. This trial was registered with the University Hospital Medical Information Network (UMIN) Clinical Trials Registry (UMINCTR: UMIN000028054).
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Affiliation(s)
- Chisato Fujimoto
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Naoya Egami
- 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, University of Tokyo Hospital, Tokyo, Japan
| | - Yukari Uemura
- Biostatistics Division, Clinical Research Support Center, University of Tokyo Hospital, Tokyo, Japan
| | - Yoshiharu Yamamoto
- Educational Physiology Laboratory, Graduate School of Education, University of Tokyo, 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
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Rosengren SM, Welgampola MS, Taylor RL. Vestibular-Evoked Myogenic Potentials in Bilateral Vestibulopathy. Front Neurol 2018; 9:252. [PMID: 29719527 PMCID: PMC5913369 DOI: 10.3389/fneur.2018.00252] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 03/29/2018] [Indexed: 12/03/2022] Open
Abstract
Bilateral vestibulopathy (BVP) is a chronic condition in which patients have a reduction or absence of vestibular function in both ears. BVP is characterized by bilateral reduction of horizontal canal responses; however, there is increasing evidence that otolith function can also be affected. Cervical and ocular vestibular-evoked myogenic potentials (cVEMPs/oVEMPs) are relatively new tests of otolith function that can be used to test the saccule and utricle of both ears independently. Studies to date show that cVEMPs and oVEMPs are often small or absent in BVP but are in the normal range in a significant proportion of patients. The variability in otolith function is partly due to the heterogeneous nature of BVP but is also due to false negative and positive responses that occur because of the large range of normal VEMP amplitudes. Due to their variability, VEMPs are not part of the diagnosis of BVP; however, they are helpful complementary tests that can provide information about the extent of disease within the labyrinth. This article is a review of the use of VEMPs in BVP, summarizing the available data on VEMP abnormalities in patients and discussing the limitations of VEMPs in diagnosing bilateral loss of otolith function.
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Affiliation(s)
- Sally M Rosengren
- Neurology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Central Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Miriam S Welgampola
- Central Clinical School, University of Sydney, Sydney, NSW, Australia.,Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Rachael L Taylor
- Audiology Department, Whangarei Hospital, Whangarei, New Zealand.,New Zealand Dizziness and Balance Centre, Auckland, New Zealand
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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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Strupp M, Kim JS, Murofushi T, Straumann D, Jen JC, Rosengren SM, Della Santina CC, Kingma H. Bilateral vestibulopathy: Diagnostic criteria Consensus document of the Classification Committee of the Bárány Society. J Vestib Res 2017; 27:177-189. [PMID: 29081426 PMCID: PMC9249284 DOI: 10.3233/ves-170619] [Citation(s) in RCA: 299] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This paper describes the diagnostic criteria for bilateral vestibulopathy (BVP) by the Classification Committee of the Bárány Society. The diagnosis of BVP is based on the patient history, bedside examination and laboratory evaluation. Bilateral vestibulopathy is a chronic vestibular syndrome which is characterized by unsteadiness when walking or standing, which worsen in darkness and/or on uneven ground, or during head motion. Additionally, patients may describe head or body movement-induced blurred vision or oscillopsia. There are typically no symptoms while sitting or lying down under static conditions. The diagnosis of BVP requires bilaterally significantly impaired or absent function of the vestibulo-ocular reflex (VOR). This can be diagnosed for the high frequency range of the angular VOR by the head impulse test (HIT), the video-HIT (vHIT) and the scleral coil technique and for the low frequency range by caloric testing. The moderate range can be examined by the sinusoidal or step profile rotational chair test. For the diagnosis of BVP, the horizontal angular VOR gain on both sides should be <0.6 (angular velocity 150–300°/s) and/or the sum of the maximal peak velocities of the slow phase caloric-induced nystagmus for stimulation with warm and cold water on each side <6°/s and/or the horizontal angular VOR gain <0.1 upon sinusoidal stimulation on a rotatory chair (0.1 Hz, Vmax = 50°/sec) and/or a phase lead >68 degrees (time constant of <5 seconds). For the diagnosis of probable BVP the above mentioned symptoms and a bilaterally pathological bedside HIT are required. Complementary tests that may be used but are currently not included in the definition are: a) dynamic visual acuity (a decrease of ≥0.2 logMAR is considered pathological); b) Romberg (indicating a sensory deficit of the vestibular or somatosensory system and therefore not specific); and c) abnormal cervical and ocular vestibular-evoked myogenic potentials for otolith function. At present the scientific basis for further subdivisions into subtypes of BVP is not sufficient to put forward reliable or clinically meaningful definitions. Depending on the affected anatomical structure and frequency range, different subtypes may be better identified in the future: impaired canal function in the low- or high-frequency VOR range only and/or impaired otolith function only; the latter is evidently very rare. Bilateral vestibulopathy is a clinical syndrome and, if known, the etiology (e.g., due to ototoxicity, bilateral Menière’s disease, bilateral vestibular schwannoma) should be added to the diagnosis. Synonyms include bilateral vestibular failure, deficiency, areflexia, hypofunction and loss.
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Affiliation(s)
- Michael Strupp
- Department of Neurology and German Center for Vertigo, Hospital of the LMU Munich, Germany
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Toshihisa Murofushi
- Department of Otolaryngology, Teikyo University School of Medicine, Mizonokuchi Hospital Kawasaki, Japan
| | - Dominik Straumann
- Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland
| | - Joanna C. Jen
- Department of Neurology and Neurobiology, University of California, Los Angeles, USA
| | - Sally M. Rosengren
- Department of Neurology, Royal Prince Alfred Hospital and Central Clinical School, University of Sydney, Camperdown, Sydney, Australia
| | | | - Herman Kingma
- Department of Otolaryngology, Maastricht, The Netherlands/Department of Medical Physics, Tomsk Research State University, Russian Federation
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