Clinical Characteristics of Patients With Abnormal Ocular/Cervical Vestibular Evoked Myogenic Potentials in the Presence of Normal Caloric Responses

Iwasaki, Shinichi; Fujimoto, Chisato; Kinoshita, Makoto; Kamogashira, Teru; Egami, Naoya; Yamasoba, Tatsuya

doi:10.1177/0003489414564997

Cited by 12 publications

(20 citation statements)

References 42 publications

(63 reference statements)

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“…The most common accompanying vestibular disorder was BPPV in this study, as also reported by other authors [1]. Utricular dysfunction has been suggested as a possible mechanism of BPPV [7]. For example, it has been reported that patients with BPPV have a tendency to show abnormal oVEMPs more frequently than cVEMPs [22].…”

Section: Discussionsupporting

confidence: 87%

“…The imperfect sensitivity and specificity of the caloric test can be a critical problem when defining iOD. The general definition of iOD is “abnormal function of the otolith organs despite the normal function of the semicircular canals.” In most studies reported to date, the caloric test was used as the gold standard to confirm normal function of the SCC [1-3,7,12,19]. The validity of this definition is dependent on the sensitivity and specificity of the caloric test [20].…”

Section: Discussionmentioning

confidence: 99%

“…Although the definitions are slightly different, terms such as IOV, OSVD, and iUD are all aimed at classifying a specific group of patients with abnormal otolith organ function and normal SCC function. In most of the studies mentioned above, a normal caloric response was a prerequisite to guarantee normal SCC function [1,5,7]. However, the false negative outcome of the caloric test in some patients may make this classification obscure.…”

Section: Introductionmentioning

confidence: 99%

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Proposal on the Diagnostic Criteria of Definite Isolated Otolith Dysfunction

Park

Lee

et al. 2019

J Audiol Otol

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Background and Objectives Dizzy patients with abnormal otolith function tests, despite a normal caloric response, are defined as having specific (isolated) otolith organ dysfunction. This study was performed to compare the differences in clinical presentation between isolated otolith dysfunction (iOD) patients with lab- and Sx-based iOD group and lab-based iOD symptoms. Subjects and Methods The medical records of 23 iOD patients with normal caloric response but abnormal cervical vestibular evoked myogenic potential (VEMP), ocular VEMP, or subjective visual vertical were reviewed. Non-spinning vertigo was considered as otolith-related symptoms. The patients’ age, onset of dizziness, Numeric Rating Scale on the severity of dizziness, and concomitant vestibular disorders were analyzed. Results Patients in the lab-based iOD group were significantly older than those in the lab- and Sx-based iOD group. Known vestibular disorders were significantly more common in the lab-based iOD group (83.3%) compared to the lab- and Sx-based iOD group (18.2%). Despite the normal caloric response, catch-up saccade was found in the video head impulse test in more than half (54.5%) of the lab-based iOD group patients. There was no catch-up saccade in the lab- and Sx-based iOD group. There were no significant differences in gender ratio, frequency of dizziness attacks, and duration of illness. Conclusions We propose new definitions of definite iOD (lab- and Sx-based iOD) and probable iOD (lab- or Sx-based iOD). These new definitions may help researchers to identify patients who are more likely to have true iOD, and facilitate comparisons of results between different studies.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Proposal on the Diagnostic Criteria of Definite Isolated Otolith Dysfunction

Park

Lee

et al. 2019

J Audiol Otol

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“…Caloric testing is considered as equivalent to only a low-frequency audiometric testing of the hearing [9] . Iwasaki et al [10] have reported abnormal vestibular-evoked myogenic potentials (VEMP) in some patients with BPPV having normal caloric responses. VEMP abnormality seems to be more correlated with the recurrence of symptoms in patients with BPPV [11] .…”

Section: Discussionmentioning

confidence: 99%

Caloric Analysis of Patients with Benign Paroxysmal Positional Vertigo

Yetışer

İnce

2017

Int Adv Otol

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Original Article INTRODUCTIONPositional vertigo following sudden head motion in patients with benign paroxysmal positional vertigo (BPPV) is assumed to be due to freely floating otoconia inside the semicircular canals or those adhering to the cupula which make labyrinth sensitive to gravitational forces [1] . The majority of patients have quick relief of symptoms after repositioning maneuvers, although underlying pathology is obscure. Origin of these deposits is claimed to be due to degeneration of utricular neuroepithelium. Functional studies are needed to exclusively detect possible organic pathology of the utricule. Innervation of utricule is provided by superior vestibular nerve which also collects impulses from lateral and superior semicircular canals. The inferior vestibular nerve is connected to the posterior semicircular canal and the saccule.Caloric testing was first studied by the Nobel Prize winner Robert Barany in 1906, and later it was introduced to the otologic practice by Fitzgerald and Hallpike [2] in 1942. Videonystagmograpy (VNG) with caloric stimulation has been widely used in the analysis of severity of vestibular disorders. It reflects the degree to which the vestibular system is responsive and how symmetric the responses are between left and right. Caloric irrigation through the ear canal selectively stimulates the lateral canal [3] . However, studies indicate the contribution of other semicircular canals to the final response. Gacek et al. [4] have found severe dysfunction after caloric stimulation in seven patients who had singular neurectomy. Sensitivity of caloric stimulation to detect the vestibular pathology is subject to discussion [5] . Some problems may remain undiagnosed unless they cause severe vestibular dysfunction. The aim of this study is to analyze the incidence of caloric hypo-excitability, to investigate the role of symptom duration, and to compare the caloric responses in patients with lateral canal (LC-BPPV) and posterior canal (PC-BPPV). MATERIALS and METHODS MATERIALS and METHODS:A prospective study was conducted in 65 patients with BPPV (20 LC and 45 PC) who were subjected to caloric testing. Average slow-phase velocity and nystagmus duration were analyzed. RESULTS:Caloric hypo-excitability was 20.4%. It was more evident in patients with apogeotropic-type LC-BPPV. The comparison of average slowphase velocity of the nystagmus and nystagmus duration between selected types of BPPV for pathologic, non-pathologic, and the control ears after warm and cold stimulation was not statistically significant (p>0.05). No correlation was found between caloric results and symptom duration (p>0.05). CONCLUSION:Some patients presented caloric hypo-excitability. Reliability of caloric testing to differentiate the ear with normal and abnormal vestibular function in different types of BPPV was low. No difference was found in the analysis of the impact of symptom duration. Caloric testing is not an ideal tool to study BPPV.

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“…OTRAS CONDICIONES En aquellos pacientes con síntomas de vestibulopatía uni o bilateral (vértigo y ataxia) donde la exploración calórica e impulsiva es normal (15%), los VEMPs pueden resultar inequívocamente anómalos [60]. Hay sínto-mas vestibulares característicos de afectación macular, como el «drop attacks», o las sensaciones de inclinación o translación, pero en general, cuando exista desequilibrio postural, se debe pensar en afectación otolítica [61].…”

Section: Evaluación De La Función Otolítica En Niñosunclassified

Utilidad clínica de los potenciales evocados miogénicos vestibulares (VEMPs)

Orejas

2016

Rev. ORL

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Clinical Characteristics of Patients With Abnormal Ocular/Cervical Vestibular Evoked Myogenic Potentials in the Presence of Normal Caloric Responses

Cited by 12 publications

References 42 publications

Proposal on the Diagnostic Criteria of Definite Isolated Otolith Dysfunction

Proposal on the Diagnostic Criteria of Definite Isolated Otolith Dysfunction

Caloric Analysis of Patients with Benign Paroxysmal Positional Vertigo

Utilidad clínica de los potenciales evocados miogénicos vestibulares (VEMPs)

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