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Mavrodiev V, Strupp M, Vinck AS, van de Berg R, Lehner L. The dissociation between pathological caloric testing and a normal video head impulse test helps differentiate between Menière's disease, vestibular migraine, and other vestibular disorders: a confirmatory study in a large cohort of 2,101 patients. Front Neurol 2024; 15:1449261. [PMID: 39206283 PMCID: PMC11350975 DOI: 10.3389/fneur.2024.1449261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 07/29/2024] [Indexed: 09/04/2024] Open
Abstract
Vestibular migraine (VM) and Menière's disease (MD) are characterized by episodes of vertigo of similar duration. It is well known that differentiation between both diseases is not always possible based only on the patient history, physical examination, and audiological testing. In addition, the quantification of the vestibular function can also be helpful since, among patients with MD, there is often a dissociation between a normal/pseudo-normal video head impulse test (vHIT) and reduced caloric testing. The goal of this confirmatory study was to determine the sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of this dissociation to differentiate between MD and VM as well as between MD and other vestibular diseases. We performed a retrospective analysis of 2,101 patients. The examination group consisted of 1,100 patients; of these, 627 (57%) had MD according to the diagnostic criteria of the Bárány Society and 473 (43%) had VM. The comparison group consisted of 1,001 patients with other peripheral, central, or functional vestibular disorders. Statistical analysis revealed the following findings for the dissociation: MD vs. VM: specificity: 83.5%, sensitivity: 58.9%, PPV: 82.6%, and NPV: 60.5%, and MD vs. all other vestibular disorders (VM plus others): specificity: 83.5%, sensitivity: 58.9%, PPV: 60.3%, and NPV: 82.7%. The dissociation between a normal vHIT and a reduced caloric response is due to the high specificity and PPV suited for the differentiation between MD and VM. This part of the study confirms previous findings in a large cohort of patients. When it comes to differentiating between MD and all observed vestibular disorders, if there is no dissociation, the diagnosis of MD is unlikely.
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Affiliation(s)
- Vergil Mavrodiev
- Department of Neurology, LMU University Hospital, Munich, Germany
- German Center for Vertigo and Balance Disorders, LMU University Hospital, LMU Munich, Munich, Germany
| | - Michael Strupp
- Department of Neurology, LMU University Hospital, Munich, Germany
- German Center for Vertigo and Balance Disorders, LMU University Hospital, LMU Munich, Munich, Germany
| | | | - Raymond van de Berg
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Vestibular Disorders, Maastricht University Medical Center, Maastricht, Netherlands
| | - Louisa Lehner
- Department of Neurology, LMU University Hospital, Munich, Germany
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Noy R, Fridman E, Eran A, Keywan A, Vaisbuch Y, Ishai R, Cohen-Vaizer M. Predictive nomograms and an algorithm for managing patients with probable Meniere's disease. Am J Otolaryngol 2024; 45:104472. [PMID: 39106687 DOI: 10.1016/j.amjoto.2024.104472] [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: 02/02/2024] [Revised: 07/02/2024] [Accepted: 07/29/2024] [Indexed: 08/09/2024]
Abstract
PURPOSE To explore the efficacy of diagnostic tests in accurately reclassifying patients initially diagnosed with probable Meniere's disease (MD) into either definite or non-MD categories. MATERIALS AND METHODS A retrospective cohort study was conducted at a neurotology clinic between 1/2016 and 5/2022. Patients underwent a battery of tests, from which sensitivity, specificity, positive and negative predictive values, as well as positive and negative likelihood ratios, were calculated. Additionally, prediction nomograms were developed. RESULTS Of the 69 patients, 25 (36.2 %) were initially classified as definite MD, 21 (30.4 %), probable MD, and 23 (33.4 %) non-MD. The mean follow-up was 3.5 years. The sensitivity of electrocochleography (ECochG) was the highest (92 %), with a negative likelihood ratio of 15 %. Magnetic resonance imaging (MRI) with MD-protocol had the highest specificity (100 %), with a positive likelihood ratio of 100 %. Videonystagmography, video head impulse test, and cervical vestibular-evoked myogenic potentials, had lower sensitivity and specificity. We were able to reclassify 18 (86 %) patients with probable MD: 12 (57 %) were diagnosed with definite MD, and 6 (29 %) were diagnosed with non-MD, consistent with their clinical course. CONCLUSIONS The combination of ECochG and MRI with MD-protocol provides the most reliable approach to reclassify patients with Probable MD, ensuring a precise and accurate diagnosis. Vestibular tests express the functional status of the labyrinth and may not be reliable. Our findings provide valuable insights into clinical decision-making for patients with Probable MD and raise the consideration of additional diagnostic tests as supplementary to the existing clinical-only diagnosis criteria.
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Affiliation(s)
- Roee Noy
- Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
| | - Eran Fridman
- Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ayelet Eran
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; Department of Radiology, Rambam Health Care Campus, Haifa, Israel
| | - Aram Keywan
- Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Yona Vaisbuch
- Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Reuven Ishai
- Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Mauricio Cohen-Vaizer
- Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Fukushima M, Kadowaki S, Nakatani S, Waki S, Matsumoto K, Okamoto H. Impact of endolymphatic hydrops on the function of the horizontal canal during caloric stimulation in Ménière's disease. Eur Arch Otorhinolaryngol 2024; 281:1701-1708. [PMID: 37804352 DOI: 10.1007/s00405-023-08272-7] [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: 05/25/2023] [Accepted: 10/02/2023] [Indexed: 10/09/2023]
Abstract
PURPOSE When a dizzy patient with episodic vertigo has an abnormal caloric and a normal video head impulse test (vHIT), this caloric-vHIT dissociation provides vital information for a diagnosis of Ménière's disease (MD). Endolymphatic hydrops (EH), a histological marker of MD, is hypothesized to be involved in the caloric-vHIT dissociation in MD through hydropic duct distension of the horizontal semicircular canal (SC). This study was designed to determine the impact of EH on the function of horizontal SC during caloric stimulation. METHODS Caloric test and vHIT were used to evaluate the function of horizontal SC every six months, annual magnetic resonance imaging (MRI) was used to evaluate the degree of EH size in the vestibule, and monthly vertigo and hearing evaluation was done for 12 months. EH shrinkage was defined as the size change of vestibular EH from significant to none. RESULTS Among 133 MD patients evaluated for eligibility, 67 patients with caloric-vHIT dissociation entered the study. Fifteen participants had EH shrinkage (G-I), while 52 participants had no remarkable EH change (G-II). Average values (IQR) of the maximum slow phase velocity in G-I and G-II were 29.6 (13.0-34.0) and 25.9 (17.3-31.3), respectively, at baseline, 26.1 (9.0-38.0) and 23.6 (18.0-28.3) at 12 months. Two-factor repeated-measures ANOVA showed no significant differences between the groups (P = 0.486). The values of vestibulo-ocular reflex gain of the horizontal SC in G-I and G-II remained above 0.8 during the study period. CONCLUSIONS EH detected by MRI shows limited correlation with caloric stimulation results.
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Affiliation(s)
- Munehisa Fukushima
- Department of Otolaryngology, Adachi Medical Center, Tokyo Women's Medical University, 4-33-1 Kohoku, Adachi-Ku, Tokyo, 123-8558, Japan.
- Department of Otolaryngology and Head and Neck Surgery, Kansai Rosai Hospital, Hyogo, Japan.
| | - Seiichi Kadowaki
- Department of Otolaryngology, Adachi Medical Center, Tokyo Women's Medical University, 4-33-1 Kohoku, Adachi-Ku, Tokyo, 123-8558, Japan
- Department of Physiology, School of Medicine, International University of Health and Welfare, Chiba, Japan
| | - Saho Nakatani
- Department of Otolaryngology and Head and Neck Surgery, Kansai Rosai Hospital, Hyogo, Japan
| | - Sadanori Waki
- Department of Otolaryngology and Head and Neck Surgery, Kansai Rosai Hospital, Hyogo, Japan
| | - Ken Matsumoto
- Department of Otolaryngology and Head and Neck Surgery, Kansai Rosai Hospital, Hyogo, Japan
| | - Hidehiko Okamoto
- Department of Physiology, School of Medicine, International University of Health and Welfare, Chiba, Japan
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Lee SU, Park E, Kim HJ, Choi JY, Kim JS. Evolution of Vestibular Findings During and Between the Attacks of Meniere Disease: Update. Neurol Clin Pract 2024; 14:e200235. [PMID: 38223349 PMCID: PMC10783974 DOI: 10.1212/cpj.0000000000200235] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/13/2023] [Indexed: 01/16/2024]
Abstract
Purpose of Review The diagnosis of Meniere disease (MD) has based on characteristics of vertigo and findings of audiologic evaluation. This review focuses on the recent findings of the evolution of vestibular function and their underlying physiology during and between the attacks of MD and thus aims to help identify this common disorder with many faces according to the phase. Recent Findings During the attacks, the direction of spontaneous nystagmus changes over time, beating initially toward the affected ear (irritative nystagmus), then toward the healthy ear (paretic nystagmus), and finally back toward the affected ear again (recovery nystagmus). Apart from these direction changes, atypical forms of spontaneous nystagmus, such as downbeat, discordant horizontal-torsional, and aperiodic alternating nystagmus, can be observed. Head impulse tests (HITs) are mostly normal during the irritative/recovery phases, but positive in more than half of patients during the paretic phase. By contrast, caloric tests are usually abnormal irrespective of the phases, although paradoxical caloric hyper-responsiveness can be observed in 18% of patients during the irritative/recovery phases. Thus, dissociation in the findings of caloric tests-HITs can be observed during and between the attacks. Horizontal head shaking tends to augment spontaneous nystagmus during each phase, while skull vibration mostly induces nystagmus beating toward the healthy ear irrespective of the phases. During the attacks, ocular vestibular-evoked myogenic potentials (VEMPs) may be enhanced, whereas cervical VEMPs are usually decreased during stimulation of the involved ear. Summary Recognizing these evolutions of vestibular findings during and between the attacks of MD would provide insights into its pathophysiology and aid in treatments and diagnosis.
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Affiliation(s)
- Sun-Uk Lee
- Department of Neurology (S-UL), Korea University Medical Center; Neurotology and Neuro-ophthalmology Laboratory (S-UL, EP), Korea University Anam Hospital; Department of Otorhinolaryngology-Head and Neck Surgery (EP), Korea University College of Medicine, Seoul, South Korea; Biomedical Research Institute (H-JK), Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Neurology (J-YC, J-SK), Seoul National University College of Medicine, Seoul, South Korea; and Dizziness Center (J-YC, J-SK), Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Euyhyun Park
- Department of Neurology (S-UL), Korea University Medical Center; Neurotology and Neuro-ophthalmology Laboratory (S-UL, EP), Korea University Anam Hospital; Department of Otorhinolaryngology-Head and Neck Surgery (EP), Korea University College of Medicine, Seoul, South Korea; Biomedical Research Institute (H-JK), Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Neurology (J-YC, J-SK), Seoul National University College of Medicine, Seoul, South Korea; and Dizziness Center (J-YC, J-SK), Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hyo-Jung Kim
- Department of Neurology (S-UL), Korea University Medical Center; Neurotology and Neuro-ophthalmology Laboratory (S-UL, EP), Korea University Anam Hospital; Department of Otorhinolaryngology-Head and Neck Surgery (EP), Korea University College of Medicine, Seoul, South Korea; Biomedical Research Institute (H-JK), Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Neurology (J-YC, J-SK), Seoul National University College of Medicine, Seoul, South Korea; and Dizziness Center (J-YC, J-SK), Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jeong-Yoon Choi
- Department of Neurology (S-UL), Korea University Medical Center; Neurotology and Neuro-ophthalmology Laboratory (S-UL, EP), Korea University Anam Hospital; Department of Otorhinolaryngology-Head and Neck Surgery (EP), Korea University College of Medicine, Seoul, South Korea; Biomedical Research Institute (H-JK), Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Neurology (J-YC, J-SK), Seoul National University College of Medicine, Seoul, South Korea; and Dizziness Center (J-YC, J-SK), Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ji-Soo Kim
- Department of Neurology (S-UL), Korea University Medical Center; Neurotology and Neuro-ophthalmology Laboratory (S-UL, EP), Korea University Anam Hospital; Department of Otorhinolaryngology-Head and Neck Surgery (EP), Korea University College of Medicine, Seoul, South Korea; Biomedical Research Institute (H-JK), Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Neurology (J-YC, J-SK), Seoul National University College of Medicine, Seoul, South Korea; and Dizziness Center (J-YC, J-SK), Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea
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Castellucci A, Dumas G, Abuzaid SM, Armato E, Martellucci S, Malara P, Alfarghal M, Ruberto RR, Brizzi P, Ghidini A, Comacchio F, Schmerber S. Posterior Semicircular Canal Dehiscence with Vestibulo-Ocular Reflex Reduction for the Affected Canal at the Video-Head Impulse Test: Considerations to Pathomechanisms. Audiol Res 2024; 14:317-332. [PMID: 38666899 PMCID: PMC11047701 DOI: 10.3390/audiolres14020028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/10/2024] [Accepted: 03/21/2024] [Indexed: 04/29/2024] Open
Abstract
Posterior semicircular canal dehiscence (PSCD) has been demonstrated to result in a third mobile window mechanism (TMWM) in the inner ear similar to superior semicircular canal dehiscence (SSCD). Typical clinical and instrumental features of TMWM, including low-frequency conductive hearing loss (CHL), autophony, pulsatile tinnitus, sound/pressure-induced vertigo and enhanced vestibular-evoked myogenic potentials, have been widely described in cases with PSCD. Nevertheless, video-head impulse test (vHIT) results have been poorly investigated. Here, we present six patients with PSCD presenting with a clinical scenario consistent with a TMWM and an impaired vestibulo-ocular reflex (VOR) for the affected canal on vHIT. In two cases, an additional dehiscence between the facial nerve and the horizontal semicircular canal (HSC) was detected, leading to a concurrent VOR impairment for the HSC. While in SSCD, a VOR gain reduction could be ascribed to a spontaneous "auto-plugging" process due to a dural prolapse into the canal, the same pathomechanism is difficult to conceive in PSCD due to a different anatomical position, making a dural herniation less likely. Alternative putative pathomechanisms are discussed, including an endolymphatic flow dissipation during head impulses as already hypothesized in SSCD. The association of symptoms/signs consistent with TMWM and a reduced VOR gain for the posterior canal might address the diagnosis toward PSCD.
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Affiliation(s)
- Andrea Castellucci
- ENT Unit, Department of Surgery, Azienda USL—IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Georges Dumas
- EA 3450 DevAH–Development, Adaptation and Handicap, Faculty of Medicine, University of Lorraine, 54500 Nancy, France;
| | - Sawsan M. Abuzaid
- Otorhinolaryngology Department, Royal Medical Services, Amman 11855, Jordan;
| | - Enrico Armato
- Ph.D. Program in Development, Adaptation and Handicap, Faculty of Medicine, University of Lorraine, 54500 Vandoeuvre-lès-Nancy, France;
| | | | - Pasquale Malara
- Audiology & Vestibology Service, Centromedico, 6500 Bellinzona, Switzerland;
| | - Mohamad Alfarghal
- Otorhinolaryngology—Head and Neck Section, Surgery Department, King Abdulaziz Medical City, Jeddah 21556, Saudi Arabia;
| | - Rosanna Rita Ruberto
- Audiology and Ear Surgery Unit, Azienda USL—IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (R.R.R.); (P.B.)
| | - Pasquale Brizzi
- Audiology and Ear Surgery Unit, Azienda USL—IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (R.R.R.); (P.B.)
| | - Angelo Ghidini
- ENT Unit, Department of Surgery, Azienda USL—IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Francesco Comacchio
- ENT Unit, Regional Vertigo Specialized Center, University Hospital of Padova, Sant’Antonio Hospital, 35039 Padova, Italy;
| | - Sébastien Schmerber
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital, 38043 Grenoble, France;
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Balayeva F, Kirazlı G, Celebisoy N. Vestibular test results in patients with vestibular migraine and Meniere's Disease. Acta Otolaryngol 2023:1-5. [PMID: 37267063 DOI: 10.1080/00016489.2023.2213723] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/28/2023] [Accepted: 05/03/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND Vestibular migraine (VM) and Meniere's Disease (MD) are episodic vestibular disorders, sometimes difficult to differentiate from each other on clinical grounds. OBJECTIVE To evaluate vestibular test results of the two groups that may help in the differential diagnosis. METHODS Twenty-two patients with VM, 21 patients with definite MD and 21 healthy volunteers (HC) were studied. Pure tone hearing thresholds (PTHT), cervical vestibular evoked myogenic potentials (cVEMPs), video head impulse test (vHIT) and functional head impulse test (fHIT) were performed. RESULTS PTHT of the MD-affected ears were significantly higher than VM and HC groups (p < .001 for both) when cVEMP amplitudes were lower (p = .005 for HC), (p = .006 for VM). Lateral canal vHIT gain of the MD-affected ears were lower than VM patients (p = .003) and the HC (p < .001). The percentage of correctly identified optotypes (CA%) on fHIT was low for both patient groups when compared with the HC (p < .001). CONCLUSION In addition to hearing loss, low cVEMP amplitudes on the affected side with decreased gain on vHIT indicate disturbed saccular and lateral semicircular canal functions in MD patients differentiating them from VM. A functional deficit in gaze stabilization detected by fHIT is the only abnormality found in patients with VM.
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Affiliation(s)
- Fidan Balayeva
- Department of Neurology, Ege University Medical School, Bornova, Izmir, Turkey
| | - Gülce Kirazlı
- Department of Audiology, Ege University Faculty of Health Sciences, Izmir, Turkey
| | - Nese Celebisoy
- Department of Neurology, Ege University Medical School, Bornova, Izmir, Turkey
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Orimoto KY, Vartanyan M, O’Leary SJ. Systematic review of the diagnostic value of hydrops MRI in relation to audiovestibular function tests (electrocochleography, cervical vestibular evoked myogenic potential and caloric test). Eur Arch Otorhinolaryngol 2023; 280:947-962. [PMID: 36301356 PMCID: PMC9899732 DOI: 10.1007/s00405-022-07702-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/12/2022] [Indexed: 02/07/2023]
Abstract
The objective of this systematic review is to compare the diagnostic value of endolymphatic hydrops (EH) magnetic resonance imaging (MRI) with audiovestibular function tests, including electro cochleography (ECochG), cervical vestibular evoked myogenic potential (cVEMP) and caloric tests for the diagnosis of definite Meniere's disease (DMD). An electronic search was performed in the PubMed, Embase and Cochrane databases in August 2022. Original studies which reported the efficacy of gadolinium MRI for diagnosis of DMD were compared with ECochG, cVEMP and caloric tests from 2007 to 2022 published in English. Two reviewers extracted the methodology and results of MRI and functional tests, assessing them independently. A modified version of the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) was used for the assessment of the quality and the risk of bias of each study. The proportion of DMD cases diagnosed by MRI hydrops vs corresponding functional tests were calculated and the relationship between MRI and functional tests were evaluated using the Cohen's Kappa test. Concerning the MRI, the proportion diagnostic of DMD was 0.67 by cochlear EH and 0.80-0.82 by vestibular EH. Regarding the functional test, the propotiojn diagnostic of DMD was 0.48 by ECochG, 0.76 by cVEMP and 0.65 by caloric test. The findings of this systematic review were that the vestibular EH on imaging most effectively assisted in diagnosing DMD. Among the functional tests, cVEMP was the second most effective test. The agreement between imaging and cVEMP was moderate (0.44), indicating a gap between the patients identified by the imaging and functional tests based on the relatively small number of patients.
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Affiliation(s)
- Kumiko Yukawa Orimoto
- The University of Melbourne, The Royal Victorian Eye and Ear Hospital, 32 Gisborne St, East Melbourne, VIC 3002 Australia
| | - Maria Vartanyan
- The Royal Victorian Eye and Ear Hospital, East Melbourne, 3002 Australia
| | - Stephen J. O’Leary
- The University of Melbourne, The Royal Victorian Eye and Ear Hospital, 32 Gisborne St, East Melbourne, VIC 3002 Australia
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Functional and Molecular Markers for Hearing Loss and Vertigo Attacks in Meniere's Disease. Int J Mol Sci 2023; 24:ijms24032504. [PMID: 36768827 PMCID: PMC9916751 DOI: 10.3390/ijms24032504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/20/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
Meniere's disease (MD) is one of the most complicated diseases in the otologic clinic. The complexity of MD is partially due to the multifactorial etiological mechanisms and the heterogenous symptoms, including episodic vertigo, hearing loss, aural fullness and tinnitus. As a result, the diagnosis of MD and differentiating MD from other diseases with similar symptoms, such as vestibular migraine (VM), is challenging. In addition, it is difficult to predict the progression of hearing loss and the frequency of vertigo attacks. Detailed studies have revealed that functional markers, such as pure tone audiometry (PTA), electrocochleography (ECochG), vestibular evoked myogenic potential (VEMP), caloric test, video head impulse test (vHIT) and magnetic resonance imaging (MRI) could help to evaluate MD with different hearing levels and frequency of vertigo attacks. Investigations of molecular markers such as autoimmunity, inflammation, protein signatures, vasopressin and circadian clock genes in MD are still underway. This review will summarize these functional and molecular markers, address how these markers are associated with hearing loss and vertigo attacks in MD, and analyze the results of the markers between MD and VM.
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Mandegari M, Samiminia F, Baradaranfar M, Vaziribozorg S. The Efficacy of Combined VHIT and VNG in the Diagnosis of Vertigo Caused by Meniere's Disease. Indian J Otolaryngol Head Neck Surg 2022; 74:4298-4305. [PMID: 36742904 PMCID: PMC9895570 DOI: 10.1007/s12070-021-02955-5] [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: 08/07/2021] [Accepted: 10/19/2021] [Indexed: 02/07/2023] Open
Abstract
This study aimed to evaluate the efficacy of video head impulse test (VHIT) and Videonystagmography (VNG) diagnostic tests in the diagnosis of vertigo caused by Meniere's disease. In this cross-sectional study 20 patients (10 in Meniere's group and 10 in control group) with vertigo attacks were involved. Patients were diagnosed with Meniere's disease (according to clinical criteria) or acute vertigo due to other causes after taking a history, complete examination, audiometry screening, and recording patient information in a pre-prepared checklist. Patients were referred to an audiology clinic for performing ECOG, VHIT, and VNG. All variables and sensitivity, specificity, positive predictive value, and negative predictive value were recorded and analyzed. There was no statistical difference between two groups regarding the mean age and gender of the patients (p > 0.05). The results showed no statistically significant difference between the study groups regarding the frequency distribution of ECOG, VNG, VHIT results. Also the results showed no statistically significant difference between the study groups regarding the frequency distribution of combined VNG and VHIT results. Combined VNG and VHIT had a relatively low sensitivity but high specificity in diagnosing Meniere's disease compared with the ECOG test, which had a sensitivity of 70% and a specificity of 90%. At the time of attack in this study, combined VNG and VHIT had a sensitivity of 50% and a specificity of 90%. According to the results of the current study, it can be concluded that patients in whom the result of combined VNG and VHIT was positive for Meniere's were more likely to have Meniere's disease based on clinical criteria.
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Affiliation(s)
- Mohammad Mandegari
- Department of Otolaryngology-Head and Neck Surgery, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Fahime Samiminia
- Department of Otolaryngology-Head and Neck Surgery, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammadhossein Baradaranfar
- Department of Otolaryngology-Head and Neck Surgery, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Sedighe Vaziribozorg
- Department of Otolaryngology-Head and Neck Surgery, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Piker EG, Picou E, Jacobson GP, Coltisor A. Agreement Between Caloric and Horizontal Video Head Impulse Testing in School-Aged Children Presenting With Dizziness. Am J Audiol 2022; 31:299-304. [PMID: 35286154 DOI: 10.1044/2021_aja-21-00224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE The purpose of this investigation was to determine the relationship between the horizontal semicircular canal video head impulse test (hvHIT) and the caloric test in a sample of school-age children evaluated due to complaints of dizziness or imbalance. In adults, these two tests provide different but complementary information regarding vestibular function and/or pathology. However, the most common causes of vestibular loss in children are different than those in adults, and it is not clear how these two tests of horizontal semicircular canal function are related in a pediatric population. METHOD This is a retrospective study of electronic records of pediatric patients (< 18 years old) who were referred for vestibular function testing and completed both hvHIT and caloric testing. Agreement between both test results was evaluated by examining measures of sensitivity, specificity, and calculating Cohen's kappa. RESULTS Results from 117 patients (mean age = 13.7 years, age range: 8-17 years, 37 males) were analyzed. Most patients (97/115 [84.3%]) demonstrated both normal hvHIT and caloric test results. Compared to caloric testing, the hvHIT had poor sensitivity (38.9%) and excellent specificity (98.0%). Cohen's kappa analysis revealed moderate agreement between the methods (coefficient = 0.49 [0.24, 0.73]). Where disagreement between the two tests occurred, the final diagnosis was not contingent on either test result. CONCLUSIONS There is a moderate agreement between the hvHIT and the caloric test in pediatric patients presenting to a tertiary care medical center for a vestibular evaluation. Most patients in this cohort presented with normal findings. The specificity of hvHIT was excellent, although the sensitivity was low. This may be related to the low prevalence of peripheral vestibular system disease in this study cohort, and these results do not generalize to centers that serve populations of children where vestibular disorders are more prevalent (e.g., children with sensorineural hearing loss).
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Affiliation(s)
- Erin G. Piker
- Department of Communication Sciences and Disorders, James Madison University, Harrisonburg, VA
| | - Erin Picou
- Division of Vestibular Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Gary P. Jacobson
- Division of Vestibular Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Allison Coltisor
- Division of Vestibular Sciences, Vanderbilt University Medical Center, Nashville, TN
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Relationship between spontaneous nystagmus and video Head Impulse Test findings among patients with chronic neurotologic conditions. J Clin Neurosci 2022; 99:244-247. [PMID: 35304316 DOI: 10.1016/j.jocn.2022.03.018] [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: 01/03/2022] [Revised: 02/16/2022] [Accepted: 03/10/2022] [Indexed: 11/22/2022]
Abstract
The vestibulo-ocular reflex (VOR) in neurotologic patients can be evaluated most quickly by spontaneous nystagmus examinations, and the video Head Impulse Test (vHIT) quantitatively evaluates the VOR of the semicircular canals. We aimed to clarify the concordance and discrepancies between spontaneous nystagmus and vHIT findings, to provide guidance on screening vestibular functions by initial spontaneous nystagmus examination then vHIT. We evaluated 169 outpatients by spontaneous nystagmus examination in the dark using a charge-coupled device camera, then by horizontal vHIT the same day. Vestibular loss on vHIT was defined if both reduced VOR gain (<0.8) and corrective saccade were observed. Adjusted logistic regression modelling revealed that differences in right and left VOR gain positively impacted the presence of nystagmus, which suggests lateralised vestibular dysfunction (P<0.05; odds ratio 1.39 [95% confidence interval, 1.1-1.8] per 0.1 increment). When vHIT is regarded as the standard clinical test, the positive predictive value of nystagmus for vestibular loss on vHIT was 44.4%, and the negative predictive value was 93.5%. The adjusted odds ratio of adults ≥65 years old compared to younger patients associated with a discrepancy of nystagmus and vHIT was significant (2.4 [1.1-5.3]). In conclusion, if spontaneous nystagmus is initially observed in patients, further assessment by vHIT could confirm vestibular dysfunction in 40-50% of cases. If no nystagmus is observed, vHIT might also result in a negative finding in >90% of cases. Older adults appear more likely to show discrepancies between nystagmus and vHIT.
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Milkov M. Recent advances in the diagnosis of some common vestibular disorders. SCRIPTA SCIENTIFICA MEDICA 2021; 53:21. [DOI: 10.14748/ssm.v0i0.7999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Abstract
While the majority of vestibular disorders may be diagnosed solely on clinical grounds, a variety of clinical scenarios exist in which objective functional assessment of the vestibular system provides data that facilitate diagnosis and treatment decisions. There exists a veritable armamentarium of sophisticated vestibular test modalities, including videonystagmography, rotary chair testing, video head impulse testing, and vestibular-evoked myogenic potentials. This article aims to help clinicians apply an accessible decision-making rubric to identify the clinical scenarios that may and may not benefit from data derived from specific vestibular function tests.
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Affiliation(s)
- Steven A Zuniga
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, 420 Delaware Street, MMC 396, Minneapolis, MN 55455, USA.
| | - Meredith E Adams
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, 420 Delaware Street, MMC 396, Minneapolis, MN 55455, USA
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