Air stimulation in tympanic perforation: inverted nystagmus study

Abstract

Response inversion during warm air stimulation is the most controversial finding seen in caloric tests of individuals with tympanic membrane perforation. In such cases, very few studies explore the possible interferences found in the caloric test, bringing about controversies in the interpretation of test results. Aim: This paper aimed at analyzing warm air stimulation effects in individuals with tympanic membrane perforation in comparison with normal healthy controls. Materials and Methods: Prospective, non-randomized study in which 48 individuals without vestibular complaints were assessed, 33 had one tympanic membrane perforated and 15 had no ear drum alteration. Results: 39.39% of the individuals had response inversion found during the warm air test. In the absence of this phenomenon, nystagmus responses were symmetrical. Conclusion: Nystagmus responses to the caloric test in individuals with tympanic membrane perforation were similar to those from healthy controls, with the exception of the fact that they had inverted responses in the warm caloric test.

Estimulação calórica a ar em mastoidectomias abertas unilaterais

“…Despite the proven efficacy of air stimulation, only a few papers have been published on the topic. In 2009, Nishino et al 9 carried out a study on air caloric stimulation in subjects with unilateral perforated eardrums and verified the viability of this test mode in this patient group.…”

“…Many are the reasons for air to be chosen over water. Among them are the possibility of testing individuals with middle and outer ear disorders, the fact that air is technically easier to handle than water, and increased comfort levels experienced by test subjects [1][2][3][4][5][6][7][8][9][10] . Dizziness is a symptom experienced by 10% of the world's population 11 , and otitis media is a highly prevalent condition worldwide 12,13 .…”

“…One should yet be reminded that middle ear disorders may hamper the interpretation of caloric test results and produce controversial readings 1,9,[18][19][20] . There is only one reference in the literature on the assessment of the vestibular system of ears submitted to unilateral canal wall down (CWD) mastoidectomy with the purpose of offering information on labyrinthine function during caloric stimulation in anatomically altered subjects.…”

“…Many are the reasons for air to be chosen over water. Among them are the possibility of testing individuals with middle and outer ear disorders, the fact that air is technically easier to handle than water, and increased comfort levels experienced by test subjects 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 .…”

“…Awareness levels over the possibility of performing caloric tests in individuals with middle ear disorders have increased, and so have the number or orders for this test. One should yet be reminded that middle ear disorders may hamper the interpretation of caloric test results and produce controversial readings 1 , 9 , 18 , 19 , 20 .…”