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Clinical Comparison Between Ocular and Cervical Vestibular Evoked Myogenic Potentials
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Il Kwon Cho, Myung Whan Suh, Tae Hyun Moon, Chung Ku Rhee, Jae Yun Jung
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Res Vestib Sci. 2011;10(2):68-73.
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- Background and Objectives: The goal of this study was to compare the outcome between cervical vestibular-evoked myogenic potential (cVEMP) and ocular VEMP (oVEMP) in the patients with definite vestibular dysfunction. Also, the subjective discomfort level was compared between cVEMP, classic oVEMP and head positioned oVEMP (a new method designed by the authors). Materials and Methods: Eighteen patients with dizziness associated with unilateral vestibular hypofunction were included in this study. Vestibular neuritis, Ramsay-hunt syndrome and sudden sensorineural hearing loss with vertigo were included in unilateral vestibular hypofunction disease. cVEMP, classic oVEMP, and head positioned oVEMP were assessed and compared. To compare the subjective discomfort during the tests, visual analogue scale on discomfort was checked. Results: There was a discrepancy between the cVEMP and classic oVEMP in 31.3% of the cases. The classic oVEMP were associated with more discomfort than the cVEMP. But, there was no difference between the classic and head positioned oVEMP. Conclusion: Since a substantial discrepancy was identified between the cVEMP and oVEMP, the pathways involved in cVEMP and oVEMP are likely different even with the same air conduction tone stimuli. The head positioned oVEMP may be an alternative to the classic oVEMP which has similar results and subjective discomfort levels.
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Possibility of Misdiagnosing the Lesion Side in Unilateral Vestibular Weakness
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Il Kwon Cho, Jae Yun Jung, Chung Ku Rhee, Myung Whan Suh
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Res Vestib Sci. 2009;8(2):168-173.
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- Sudden sensorineural Hearing Loss with Vertigo (SHLV) is characteristic of sudden onset vertigo and unilateral hearing loss, due to acute and profound deterioration in a vestibular and cochlear system. It is relatively easy to determine the lesion side in SHLV, because the patient will complain of unilateral hearing loss. But, it might not beapplicable to vestibular neuritis case, and several vestibular function tests may be helpful in deciding the lesion side. We have recently encountered a patient with SHLV whose caloric and SHA did not match with the lesion side. We speculated that the uncompensated dynamic defect and imbalance of the cerebellar clamping has been implicated in this lab finding. Although the exact mechanism of this curious finding cannot be explained by this single case report, we should consider that one could make a mistake to determine the involved site just only by lab finding in vestibular neuritis.
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Clinical Implication of Dissociation between Subjective Visual Horizontal and Subjective Visual Vertical
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Tae Hyun Moon, Sung Hyen Bae, Il Kwon Cho, Myung Whan Suh, Chung Ku Rhee, Jae Yun Jung
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Res Vestib Sci. 2009;8(1):37-42.
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- Background and Objectives Subject visual vertical (SVV) and subject visual horizontal (SVH) is well known otolith function test. Patients with acute unilateral vestibular weakness fail to set the test bar within normal range in SVH/SVV showing abnormal deviation toward lesion side. In some cases, SVH and SVV are deviated towards different directions, and analysis of these findings is rarely reported. The authors analyzed correlation of SVH/SVV and other vestibular function tests in patients with various vestibular diseases.
Materials and Methods From April 2005 to July 2007, total 234 patients who had admitted for dizziness were enrolled. All patients were divided in two groups, non-dissociation group (n=215) and dissociation group (n=19). Correlation of SVH, SVV, Videonystagmography (VNG), the rotating chair test was compared.
Results 8.1% of patients showed dissociation between SVH and SVV. Clinical features did not showed significant difference between groups. In non-dissociation group, SVH/SVV showed correlation with VNG, rotating chair test. However in dissociation group, VNG and rotating chair test revealed high rate of consistency with deviation of SVH than that of SVV. Also direction of SVH and dizziness had higher consistency (88.9%) than that of SVV (11.1%).
Conclusion The SVH showed consistency with other vestibular function test and may be more reliable than SVV when the result is dissociated.
Key Words: Subjective visual vertical; Subjective visual horizontal; Dissociation
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