Proposal on the Diagnostic Criteria of Definite Isolated Otolith Dysfunction

Chua, Kenneth Wei De; Yuen, Heng-Wai; Low, David A.; Kamath, Savitha

doi:10.7874/jao.2020.00535

Cited by 4 publications

(5 citation statements)

References 5 publications

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“…However, diagnosing (isolated) otolith dysfunction is still challenging. The clinical presentation of otolith dysfunction is not yet well understood and no consensus has been reached on this possible clinical entity ( 37–39 ). After all, absent VEMP responses are not necessarily causally related to vestibular symptoms, and do not rule out involvement of other structures ( 37 ).…”

Section: Discussionmentioning

confidence: 99%

“…The clinical presentation of otolith dysfunction is not yet well understood and no consensus has been reached on this possible clinical entity ( 37–39 ). After all, absent VEMP responses are not necessarily causally related to vestibular symptoms, and do not rule out involvement of other structures ( 37 ). It would therefore be advised to further investigate the possible clinical entity of otolith dysfunction ( 38 ).…”

Section: Discussionmentioning

confidence: 99%

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Multi-frequency VEMPs improve detection of present otolith responses in bilateral vestibulopathy

Lucieer,

van der Lubbe,

van Stiphout

et al. 2024

Front. Neurol.

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ObjectiveTo investigate whether multi-frequency Vestibular Evoked Myogenic Potential (VEMP) testing at 500, 750, 1,000, and 2,000 Hz, would improve the detection of present dynamic otolith responses in patients with bilateral vestibulopathy (BV).MethodsProspective study in a tertiary referral center. BV patients underwent multi-frequency VEMP testing. Cervical VEMPs and ocular VEMPs were recorded with the Neuro-Audio system (v2010, Neurosoft, Ivanovo, Russia). The stimuli included air-conducted tone bursts of 500, 750, 1,000, and 2,000 Hz, at a stimulation rate of 13 Hz. Outcome measures included the percentage of present and absent VEMP responses, and VEMP thresholds. Outcomes were compared between frequencies and type of VEMPs (cVEMPs, oVEMPs). VEMP outcomes obtained with the 500 Hz stimulus, were also compared to normative values obtained in healthy subjects.ResultsForty-nine BV patients completed VEMP testing: 47 patients completed cVEMP testing and 48 patients completed oVEMP testing. Six to 15 % more present VEMP responses were obtained with multifrequency testing, compared to only testing at 500 Hz. The 2,000 Hz stimulus elicited significantly fewer present cVEMP responses (right and left ears) and oVEMP responses (right ears) compared to the other frequencies (p ≤ 0.044). Using multi-frequency testing, 78% of BV patients demonstrated at least one present VEMP response in at least one ear. In 46% a present VEMP response was found bilaterally. BV patients demonstrated a significantly higher percentage of absent VEMP responses and significantly higher VEMP thresholds than healthy subjects, when corrected for age (p ≤ 0.002). Based on these results, a pragmatic VEMP testing paradigm is proposed, taking into account multi-frequency VEMP testing.ConclusionMulti-frequency VEMP testing improves the detection rate of present otolith responses in BV patients. Therefore, multi-frequency VEMPs should be considered when evaluation of (residual) otolith function is indicated.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Multi-frequency VEMPs improve detection of present otolith responses in bilateral vestibulopathy

Lucieer,

van der Lubbe,

van Stiphout

et al. 2024

Front. Neurol.

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“…Moreover, the relevance of performing a single test that addresses the otoliths, such as the cVEMP, is debatable, as the clinical presentation of isolated otolith dysfunction is not yet clearly understood. Furthermore, preserved otolith responses do not exempt other vestibular structures of being affected ( 44–46 ). Regarding hearing status and VH, no correlation was found between the side (s) of SNHL, the degree of SNHL and the side(s) of VH.…”

Section: Discussionmentioning

confidence: 99%

Vestibular assessment in children with sensorineural hearing loss: diagnostic accuracy and proposal for a diagnostic algorithm

Gerdsen,

Hundscheid,

Boudewyns

et al. 2024

Front. Neurol.

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IntroductionVestibular assessment in children with sensorineural hearing loss (SNHL) is critical for early vestibular rehabilitation therapy to promote (motor) development or guide decision making towards cochlear implantation (timing of surgery and laterality). It can be challenging from a clinical viewpoint to decide which vestibular tests should be performed for a pediatric patient. The aim of this study was to evaluate the diagnostic accuracy of several clinically available vestibular tests in children with SNHL, and to provide recommendations for the implementation of vestibular testing of children in clinical practice, to screen for vestibular hypofunction (VH).MethodsA two-center retrospective chart review was conducted. Eighty-six patients between the age of 0 and 18 years were included in this study with SNHL. Vestibular tests included video headimpulse test (VHIT), caloric test (performed at the age of four or higher), rotatory chair and cervical vestibular evoked myogenic potential (cVEMP). A combination of the clinical assessment and (combinations of) vestibular test outcomes determined the diagnosis. The diagnostic quality of tests and combination of tests was assessed by diagnostic accuracy, sensitivity and specificity.ResultsVH was diagnosed in 44% of the patients. The VHIT and caloric test showed the highest diagnostic accuracy compared to the rotatory chair and cVEMP. All combinations of VHIT, caloric test and cVEMP showed improvement of the diagnostic accuracy compared to the respective tests when performed singularly. All combinations of tests showed a relatively similar diagnostic accuracy, with the VHIT combined with the caloric test scoring the highest. Adding a third test did not substantially improve the diagnostic accuracy.DiscussionVestibular testing is feasible and VH is highly prevalent in children with SNHL. A proposed diagnostic algorithm recommends starting with VHIT, followed by cVEMP for children under the age of four, and caloric testing for older children if VH is not confirmed with the first test. Performing a third test is redundant as the diagnostic accuracy does not improve substantially. However, challenges remain, including the lack of a gold standard and the subjective nature of the diagnosis, highlighting the need for standardized testing and increased understanding of VH in this population.

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“…However, when considering secondary iOD with known or suspected vestibular diagnosis, it may be more challenging especially for fluctuating conditions such as MD and VM. Central compensation may also result in “false negative” laboratory test results and further limit the diagnosis of a truly iOD ( Chua et al., 2021 ).…”

Section: Discussionmentioning

confidence: 99%

The prevalence of isolated otolith dysfunction in a local tertiary hospital

et al. 2022

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Objective Patients with dizziness may present with symptoms of tilting, swaying, rocking, floating or with disequilibrium. This may be suggestive of an isolated otolithic dysfunction yet, there is little emphasis on this emerging clinical entity. To characterize and describe the prevalence of isolated otolith dysfunction in a local tertiary hospital and correlate them with clinical diagnosis. Methodology Retrospective medical chart review of patients who presented with dizziness to the specialist outpatient Otolaryngology clinic, who required vestibular laboratory investigation. Results Of the 206 patients, more than half of them (52.4%) fulfilled the criteria for either probable or definite isolated otolith dysfunction. When there are clinical symptoms of otolith dysfunction reported, there is a 1.62 odds of a remarkable laboratory otolith finding. The most common clinical finding was “no clear diagnosis” (65.5%) followed by Vestibular Migraine (13.6%). Conclusion The prevalence of isolated otolith dysfunction is quite high. Laboratory tests of otolith function should be performed more routinely. This can be done in a sequential way to optimize cost effectiveness in countries with no insurance reimbursement. Prospective cohort studies on isolated otolith dysfunction, will lay the groundwork for achieving diagnostic consensus and formulating rehabilitation plans to aid this group of patients.

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Proposal on the Diagnostic Criteria of Definite Isolated Otolith Dysfunction

Cited by 4 publications

References 5 publications

Multi-frequency VEMPs improve detection of present otolith responses in bilateral vestibulopathy

Multi-frequency VEMPs improve detection of present otolith responses in bilateral vestibulopathy

Vestibular assessment in children with sensorineural hearing loss: diagnostic accuracy and proposal for a diagnostic algorithm

The prevalence of isolated otolith dysfunction in a local tertiary hospital

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