Objectives During caloric irritation, the spinning/rotating sensation is predominant. However, there is no report on the temporal relationship between caloric nystagmus and perception.
Methods Consecutive 57 participants underwent bithermal caloric test in the dizziness clinic of Chungnam National University Hospital from February 2018 to September 2018. For vestibular perception, we asked the subject to report feelings of rotation and/or linear sensation during each warm and cold water irrigation period. Besides routine caloric parameters, the duration of nystagmus and vestibular sensation were analyzed.
Results In most participants, the caloric nystagmus preceded the vestibular sensation (79.6% in right warm, 83.3% in left warm, 88.5% in right cool, and 84.6% in left cool stimuli). The precedence of perception was observed in 5 normal persons and 15 patients with vestibular migraine (n=4), unilateral vestibulopathy (n=3), and Menière’s disease (n=2), multiple systemic atrophy (n=2), cerebellar ataxia (n=2), vertebrobasilar insufficiency (n=1), and post-earthquake dizziness (n=1). The mean latency between nystagmus and perception was 11.7 seconds. And the duration of nystagmus was longer than that of perception in all conditions. Non-spinning sensations during the caloric test were also observed in some participants (26.8% in right warm, 30.3% in left warm, 29.1% in right cool, and 24.1% in left cool stimuli).
Conclusions During the bithemal alternate caloric test, various vestibular perception and temporal relationship between perception and nystagmus suggest the bithermal caloric stimulation does not reflect only the signal originating from the horizontal canal pathway. A further validation study is needed.
Purpose
During caloric irritation, the spinning/rotating sensation is predominant. However, there is no report on temporal relationship between the caloric nystagmus and perception.
Method
Consecutive 57 participants underwent bithermal caloric test in dizziness clinic of Chungnam National University Hospital from Feb 2018 to Sep 2018. For vestibular perception, we asked the subject to report feelings of rotation and/or linear sensation during each warm and cold water irrigation period. Besides routine caloric parameters, the duration of nystagmus and vestibular sensation were analyzed.
Results
In most participants, the caloric nystagmus preceded the vestibular sensation (79.6 % in right warm, 83.3% in left warm, 88.5% in right cool, and 84.6% in left cool stimuli). The precedence of perception was observed in 5 normal persons and 15 patients with vestibular migraine (n=4), unilateral vestibulopathy (n=3), and Meniere’s disease (n=2), multiple systemic atrophy (n=2), cerebellar ataxia (n=2), vertebrobasilar insufficiency (n=1) and post-earthquake dizziness (n=1). The mean latency between nystagmus and perception was 11.7s. And the duration of nystagmus was longer than that of perception in all conditions. Non-spinning sensations during caloric test were also observed in some participants (26.8% in right warm, 30.3% in left warm, 29.1% in right cool, and 24.1% in left cool stimuli).
Conclusion
During bithemal alternate caloric test, various vestibular perception and temporal relationship between perception and nystagmus suggests the bithermal caloric stimulation does not reflect only the signal originating from horizontal canal pathway. Further validation study is needed.
The upward deviation could be explained by loss of inhibitory inputs from the cerebellum onto the brainstem anterior semicircular canal projections for upward vestibulo-ocular reflex, which would lead to an upward bias in static eye position. Therefore, upward gaze deviation has been reported in comatose patients after resuscitation and diffuse cerebrocerebellar damage sparing the brainstem. Herein, we report a patient with ingestion of glufosinate ammonium presented with cerebellar ataxia and ocular motor findings suggestive of cerebellum involvement such as upward gaze tendency, spontaneous downbeat, gaze-evoked nystagmus, perverted head impulse test, and impaired smooth pursuit.
Objectives This study was performed to assess the efficacy and feasibility of mobile application-based Frenzel tests in dizziness clinics.
Methods We performed an investigator-initiated, blinded-outcome assessor, parallel, randomized controlled crossover trial at Chungnam National University Hospital between August 2019 and October 2019. Certified medical staffs were randomly assigned to the intervention group (i.e., a mobile application-based Frenzel glass system, n=15) or the observation group (i.e., a conventional desktop-based Frenzel glass system, n=15); the groups applied the respective systems for the preparation of eye movement recording and switched systems. The primary outcome was the elapsed time in seconds it took the participants to prepare the system for eye recording simulation. The secondary outcomes were perceived stress and satisfaction scores after completion of the operation, as measured by a questionnaire using 10-point Likert scales.
Results The mean time of machine preparation for eye recording simulation was reduced by 50% in the mobile application group compared to the desktop group in both study periods (38.0±7.1 sec vs. 76.0±8.7 sec). We detected no carryover effect. Participants also reported lower stress while using application than while using the desktop system (2.3±1.3 vs. 4.6±2.4; p<0.001). The application obtained a mean overall satisfaction score of 9.2 out of 10.
Conclusions The implementation of an eye movement recording application in a dizziness examination was well adopted by users and decreased the time and stress related to machine operation.
Objectives The head impulse test paradigm (HIMP) assesses semicircular canal function by measuring compensatory saccades during head movements as an indication of an impaired vestibulo-ocular reflex (VOR). The recently introduced suppression head impulse test paradigm (SHIMP) examines anticompensatory saccades after head movements as a measure of intact VOR. Thus, HIMP measures a decrease in vestibular function, whereas SHIMP measures residual function. We evaluated the effectiveness of SHIMP, compared HIMP and SHIMP results in the same subjects, and examined the relationship between the 2 tests.
Methods HIMP and SHIMP protocols were performed in 73 patients. The patients were instructed to maintain their gaze on a fixed target for the HIMP, or a moving target for the SHIMP during head impulses. The VOR gain and saccade parameters were compared.
Results HIMP and SHIMP data were obtained for all ears except in 3 patients. The VOR gain with SHIMP was smaller than for HIMP, but showed significant correlation (r=0.8356, p<0.001) and substantial agreement (k=0.79). However, neither the percentage of saccades (appearance of HIMP compensatory saccades and reduction of SHIMP anticompensatory saccades) nor their amplitudes were correlated between the 2 tests.
Conclusions The HIMP and SHIMP protocols are valuable tools to evaluate VOR during high-velocity head movements. Our results confirm their agreement as measures of VOR gain during head impulses, but also show that the relationship between compensatory and anticompensatory saccades is not straightforward. Thus, care should be taken during clinical interpretation of either protocol.
Citations
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Objectives Despite patients with dizziness were reported of revealing gait problems, there is still lack of objective quantitative measurement of gait patterns of peripheral vestibular disorders. To demonstrate gait variability in acute unilateral peripheral vestibular deficit, we evaluated the differences in gait patterns between vestibular neuritis (VN) patients and healthy subjects by the use of shoe-type inertial measurement unit (IMU) with sensors mounted.
Methods Between April 2017 and January 2019, 30 patients diagnosed with unilateral peripheral vestibular deficit presumed to be caused by VN were enrolled in this study. The shoe-type IMU was used to analysis subjects. We assessed gait speed, cadence, stride length, stance phase, normalized stride length, normalized step length, phase coordination index and gait asymmetry of data from shoe-type IMU sensors with the walking protocol. We tested 30 healthy volunteers as control group.
Results We identified spatiotemporal parameters of human gait. The gait speed of patients with VN was decreased to 3.82±0.8 compared to 4.93±1.08 in control group. In addition, there were differences in normalized stride length, normalized gait speed and related gait parameters, when comparing VN group and control group.
Conclusion Gait analysis by the use of shoe-type IMU could provide important information regarding vestibular pathophysiology in patients with VN. Gait performance tests can examine gait variability quantitatively. It will be taken into consideration as a vestibular function test for patients with vertigo.
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Objectives Excitability o medial vestibular nucleus (MVN) in the brainstem can be affected by changes in the arterial blood pressure. Several animal studies have demonstrated that acute hypotension results in the alteration of multiunit activities and expression of cFos protein in the MVN. In the field of extracellular electrophysiological recording, tetrode technology and spike sorting algorithms can easily identify single unit activity from multiunit activities in the brain. However, detailed properties of electrophysiological changes in single unit of the MVN during acute hypotension have been unknown.
Methods Therefore, we applied tetrode techniques and electrophysiological characterization methods to know the effect of acute hypotension on single unit activities of the MVN of rats.
Results Twoor3typesofunitcouldbeclassifiedaccordingtothemorphologyofspikes and firing properties of neurons. Acute hypotension elicited 4 types of changes in spontaneous firing of single unit in the MVN. Most of these neurons showed excitatory responses for about within 1 minute after the induction of acute hypotension and then returned to the baseline activity 10 minutes after the injection of sodium nitroprusside. There was also gradual increase in spontaneous firing in some units. In contrast small proportion of units showed rapid reduction of firing rate just after acute hypotension. Conclusions: Therefore, application of tetrode technology and spike sorting algorithms is another method for the monitoring of electrical activity of vestibular nuclear during acute hypotension.
Objectives & Methods: Excitability o medial vestibular nucleus (MVN) in the brainstem can be affected by changes in the arterial blood pressure. Several animal studies have demonstrated that acute hypotension results in the alteration of multi-unit activities and expression of cFos protein in the MVN. In the field of extracellular electrophysiological recording, tetrode technology and spike sorting algorithms can easily identify single unit activity from multi-unit activities in the brain. However, detailed properties of electrophysiological changes in single unit of the MVN during acute hypotension have been unknown. Therefore, we applied tetrode techniques and electrophysiological characterization methods to know the effect of acute hypotension on single unit activities of the MVN of rats.
Results Two or three types of unit could be classified according to the morphology of spikes and firing properties of neurons. Acute hypotension elicited 4 types of changes in spontaneous firing of single unit in the MVN. Most of these neurons showed excitatory responses for about within 1 minutes after the induction of acute hypotension and then returned to the baseline activity 10min after the injection of sodium nitroprusside. There was also gradual increase in spontaneous firing in some units. In contrast small proportion of units showed rapid reduction of firing rate just after acute hypotension.
Conclusion Therefore, application of tetrode technology and spike sorting algorithms is another method for the monitoring of electrical activity of vestibular nuclear during acute hypotension.
Objective: There were few recent study concern about usefulness of cochlear hydrops analysis masking procedure (CHAMP) in progression of Ménièreʼs disease. The purpose of this study is to analyze changes in the CHAMP as advancement of Ménièreʼs disease.
Methods We studied 19 cases of ‘Definite’ group of Ménièreʼs disease. We assumed progression of Ménièreʼs disease would be checked by pure tone threshold by four tone average (4PTA), low tone average (LPTA). We also compared electrocochleography (ECoG), dizziness handicap inventory (DHI), tinnitus handicap inventory (THI) as parameters for progression of Ménièreʼs disease to CHAMP latency delay and amplitude ratio. Chi-square test was used as a statistical method.
Results In the group of patients had abnormal amplitude ratio, ECoG value were not improved, but there was not statistically significant (odds ratio [OR]=5.727, p>0.05). Better DHI and THI score were not necessarily construed as the improvement value in the CHAMP (p>0.05). In amplitude ratio abnormal group, 4PTA was aggravated, but not statistically significant (OR=1.5, p>0.05). In the group of patient had abnormality in both latency delay and amplitude ratio, LPTA was relatively aggravated (OR in latency delay: 2, OR in amplitude ratio: 10); however, reveals no statistically significance between them (p>0.05). Change of ECoG, hearing threshold including 4PTA and LPTA with progression of Ménièreʼs disease were not correlated significantly with latency delay or amplitude ratio of CHAMP.
Conclusion We conclude that CHAMP does not reflect clinical features with progression of Ménièreʼs disease.
Objectives
There were few recent study concern about usefulness of CHAMP in progression of Meniere’s disease. The purpose of this study is to analyze changes in the CHAMP as advancement of Meniere's disease.
Methods
We studied 19 cases of ‘Definite’ group of Meniere’s disease. We assumed progression of Meniere’s disease would be checked by pure tone threshold by four tone average(4PTA), low tone average(LPTA). We also compared electrocochleography(ECoG), dizziness handicap inventory(DHI), tinnitus handicap inventory(THI) as parameters for progression of Meniere’s disease to CHAMP latency delay and amplitude ratio. Chi-square test, Linear by linear association test were used as a statistical method.
Results
In the group of patients had abnormal amplitude ratio, ECoG value were not improved, but there was not statistically significant.(odds ratio(OR)=5.727,P>0.05) Better DHI and THI score were not necessarily construed as the improvement value in the CHAMP.(P>0.05) In amplitude ratio abnormal group, 4PTA was aggravated, but not statistically significant.(OR=1.5, P>0.05). In the group of patient had abnormality in both latency delay and amplitude ratio, LPTA was relatively aggravated.(OR in latency delay:2, OR in amplitude ratio:10), however, reveals no statistically significance between them.(P>0.05) Change of ECoG, hearing threshold including 4PTA and LPTA with progression of Meniere’s disease were not correlated significantly with latency delay or amplitude ratio of CHAMP.
Conclusions
We conclude that CHAMP does not reflect clinical features with progression of Meniere’s disease.
Background and Objectives: Benign paroxysmal positional vertigo (BPPV) is one of the critical life events that can affect physical, emotional, and functional aspects of quality of life. Canalith repositioning procedure (CRP) provides rapid and long lasting relief of symptoms in most patients with BPPV. However, some patients express nonspecific symptoms such as anxiety or discomfort after treatment, The purpose of this study was to assess the residual symptoms after CRP in patients with BPPV using Dizziness Handicap Inventory (DHI) in a questionnaire format and to evaluate the therapeutic efficacy of CRP according to accompanying the DizzyFIX device. Materials and Methods: We performed a prospective investigation in 135 consecutive patients with confirmed posterior semicircular canal BPPV. CRP was performed until nystagmus and vertigo disappeared. Patients were divided into three group using the DizzyFIX (group A), not using the DizzyFIX (group B) and closed observation (group C) after treatment. Then patients were asked to complete the questionnaire for Korean form DHI before treatment, 1, 2, 3, 4, 8 week after treatment. Results: There was a significant improvement in DHI scores when comparing the pre CRP and post CRP three groups (p<0.05), although emotional items showed incomplete improvement at 1 week. But at 2 week after treatment, there were statistically significant differences between group A and other groups in DHI scores specially in emotional items. Conclusion: Even after successful CRP, DHI scores indicated incomplete recovery and residual subjective symptoms may remain. For these patients additional follow up and management are necessary and using of the DizzyFIX will be helpful to reduce the incidence of residual dizziness especially emotional aspect.
Background and Objectives: To report the clinical features of six patients diagnosed with cases of inferior vestibular neuritis based on abnormal vestibular evoked myogenic potential (VEMP) responses with normal caloric test results. Materials and Methods: We retrospectively reviewed 62 patients presenting with dizziness. All patients underwent a battery of audiovestibular testing, including hearing tests, caloric test and VEMP test. Results: Six patients were diagnosed as inferior vestibular neuritis. All patients presented with acute onset of prolonged vertigo. The pure tone audiograms and caloric test results were normal. VEMP response was absent unilaterally, and normal in the contralateral ear. Conclusion: Inferior vestibular neuritis should be considered in patients presenting with acute vertigo, but normal caloric responses. Comprehensive vestibular testing including VEMP is necessary.
Auditory neuropathy is a term used to describe abnormal auditory brain stem response (ABR) in the presence of preserved cochlear outer hair cell functions which can be measured by otoacoustic emissions (OAE). We report a case of auditory neuropathy accompanying unilateral vestibular hypofunction and benign paroxysmal positional vertigo. The patient was a 50-year-old man who had experienced hearing loss and tinnitus which started two weeks ago. He had taken several medicines for the last few months due to his lung cancer and tuberculosis. ABR and OAE were checked and the results were compatible with auditory neuropathy. To evaluate his vestibular function, video nystagmography, rotatory chair and oculomotor test were checked. The results were compatible with left unilateral vestibular loss and left lateral canal cupulolithiasis. But the patient experienced nearly no vertigo during his daily life. As presented in this case, most of the auditory neuropathy patients do not complain of vertigo. This is probably due to long term central compensation or maybe due to the decreased nerve conduction of the vertiginous sensation. Vestibular evaluation may be crucial in order to detect masked vestibular dysfunction and to protect these patients from imbalance accidents.
Key Words: Auditory neuropathy; Vestibular Neuronitis; Evoked Potentials, Auditory, Brain Stem; Otoacoustic Emissions
Background and Objectives: Many authors have suggested close relationship between benign paroxysmal vertigo of childhood (BPVC) and migraine. But the relationship between the two is not clearly determined. Therefore we investigate clinical features and the course in children with BPVC and the possibility of evolution of migraine in BPVC.
Materials and Methods: We interviewed 30 subjects having enough medical records and fitted to BPVC category who visited otorhinolaryngology for vertigo from 1995 to 2006 year.
Results: The BPVC was the most common diagnosis in our hospital and migraine associated vertigo was followed. The main features of the children with BPVC were in agreement with previous reports. The major differences were later age of onset, having trigger factor and non-spinning type of vertigo. During the follow up, 8 children developed migraine. Females were dominant duration of illness was longer in this group. Almost of them suffered from motion sickness and had more family history of migraine, which was maternal dominant.
Conclusions: The long term close follow-up may be needed in BPVC having possibility of evolution to migraine.
Acute hypotension induced excitation of electrical activities and expression of c-Fos protein and pERK in the vestibular nuclei. In this study, to investigate the excitatory signaling pathway in the vestibular nuclei following acute hypotension, expression of NR2A and NR2B subunits of glutamate NMDA receptor and GluR1 subunit of glutamate AMPA receptor was determined by RT-PCR and Western blotting in the medial vestibular nucleus 30 min after acute hypotension in rats. Acute hypotension increased expression of NR2A, NR2B, and pGluR1 in the medial vestibular nuclei. These results suggest that both of NMDA and AMPA glutamate receptors take part in transmission of excitatory afferent signals following acute hypotension.