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Vibration-Induced Nystagmus – A Sign of Unilateral Vestibular Deficit
Abstract
Vibrations of 60 Hz and 100 Hz were applied on the mastoid of healthy subjects, patients with unilateral peripheral vestibular lesions, with central lesions of different localizations, and patients with benign paroxysmal positioning vertigo (BPPV). In patients with unilateral peripheral deficit a horizontal nystagmus with a small torsional component beating generally to the not affected side could be observed. This nystagmus did not show adaptation during 40 s. The occurrence was more frequent using 60-Hz stimulations. This vibration-induced nystagmus did never occur in healthy subjects, seldom in patients with central vertigo, and only exceptionally in patients with BPPV. It is concluded that the finding of a vibration-induced nystagmus reflects a side difference of peripheral vestibular excitability.
... Skull vibration-induced nystagmus (SVIN) is the result of noninvasive 100 Hz cranial vibrations [1], which stimulate both otoliths and semicircular canals (SCC). Otolaryngologists use it to screen for vestibular asymmetry and uncover vestibular dysfunction [5,8]. The first mention of the effects of vibrations applied to the skull is attributed to Von-Bekesy in 1935 [9]. ...
... A VIN was incidentally described for the first time by Lücke in 1973 [10]. A more systematic clinical utility was suggested in 1999 by Hamann [8] and Dumas [5,11]. It was the consensus meeting of the International Society of Otoneurology (SIO) in Briançon, France, in 2006, SVINT (in French: TVO-Test de vibration osseux), which officially presented this test as an independent new vestibular test, which needed to be validated. ...
... A SVIN occurs when there is an asymmetry between peripheral vestibular receptors and the nystagmus is beating toward the side of higher excitability in partial unilateral vestibular loss (PUVL) [15]. The usefulness of the test has been confirmed by numerous authors for Vestibular neuritis (VN), Menière's disease (MD), Labyrinthine commotion, and follow-up after intratympanic gentamicin or vestibular neurectomy or in superior semicircular canal dehiscence (SSCD) and rare central neurological diseases, [3,4,6,8,15,16]. In patients with central lesions, a VIN is usually not observed, except in the case of a unilateral lesion in the brainstem [12,17] located on the VOR pathway [6]. ...
This review enumerates most of the studies on the Skull Vibration-Induced Nystagmus Test (SVINT) in the past 50 years from different research groups around the world. It is an attempt to demonstrate the evolution of this test and its increased interest around the globe. It explores clinical studies and animal studies, both permitting a better understanding of the importance of SVINT and its pathophysiology.
... Four studies employed a custom-made ABC vibration stimulator (ABC Inc., Germany) (12,16,20,21). Two studies (12,16) specify it was an electromagnetic vibrator oscillating at 100 Hz, and with an amplitude of 0.8 mm. ...
... Two studies (12,16) specify it was an electromagnetic vibrator oscillating at 100 Hz, and with an amplitude of 0.8 mm. The other two older studies also used 100 Hz but they mention an amplitude of 0.2 mm (20) and of 0.5 mm (21). ...
... In UVL (Table 6), the vibration induced nystagmus beats away from the side of the lesion (4,14,16,17,21,22,24), and is mainly horizontal/horizontal-torsional (4,20,24). Exceptions were seen for cases of MD (4,12,21,24) and Ramsay-Hunt syndrome (14). ...
Objective:
To determine the specificity and sensitivity of the skull vibration-induced nystagmus test (SVINT) for detecting vestibular hypofunction.
Databases reviewed:
The Cochrane Library, MEDLINE, PubMed, EMBASE, and SciELO.
Methods:
A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Databases were searched using a comprehensive search strategy including the terms "Vibration-induced nystagmus" or "SVINT" or "skull vibration-induced nystagmus test" or "skull vibration-induced nystagmus" from inception to May 2020.
Results:
A total of 79 articles were identified, and 16 studies met the inclusion criteria. The methodology for performing the SVINT and determining positivity is varied. Most authors refer to reproducibility, sustained response, ending with withdrawal of stimulus, nondirection changing, and response in more than one point of stimulation, as necessary for a positive test. Only seven studies included a slow phase velocity of 2 degrees/s or 2.5 degrees/s as a criterion. Most studies employed 100 Hz stimulus for 10 seconds, while longer duration is suggested for pediatric patients. For partial and total unilateral vestibular loss, positivity varied from 58 to 60%, and 93 to 100%, respectively. Sensitivity ranged from 50 to 100%, and specificity from 62 to 100%. Importantly, the SVINT may decrease with time but does not usually disappear, hence, can provide information of past/compensated vestibular events.
Conclusions:
The SVINT can be used in pediatric and adult patients. It provides information regarding unilateral vestibular loss, acute, or compensated. It is a quick, safe, and noninvasive test, and is complementary to the dynamic vestibular and positional tests.
... Application of a short ($10 s) suprathreshold 100 Hz (but not 500 Hz!) BCV stimulus to either mastoid results in a tightly stimulus-locked, predominantly horizontal nystagmus with the quick phase beating toward the unaffected side in patients with unilateral vestibular loss (12,13). SVIN typically shows little to no habituation during stimulus application, no poststimulus reversal of the nystagmus and is present even years after central compensation of unilateral vestibular loss (11,14,15). The nystagmus is predominantly horizontal, but has also torsional and vertical components, indicating that 100 Hz vibration can activate all vestibular endorgans (11,13). ...
... 1B, C and 4) suggests that stereocilia deflection (and thus neuronal activation) is caused by direct endolymph displacement and not canal-cupula mechanics, which would account for the fact that SVIN shows no habituation during application of the stimulus and no poststimulus reversal (see above and (31)). Fourth, SVIN is persistent in subjects with asymmetric peripheral vestibular function despite central vestibular compensation (11), indicating that 100 Hz BCV activates the vestibular periphery (14), as shown in the present study. Thus, SVIN is a very sensitive and robust marker for unilateral peripheral vestibular loss even years after the acute event, just like a positive head impulse test (36). ...
... Finally, the results of the present study explain why 100 Hz BCV is the optimal stimulus for SVIN in unilateral vestibular loss, while no nystagmus is present at 500 Hz BCV (11,13): at 100 Hz, irregularly discharging SCC afferents respond vigorously to BCV, while the response is less intense at 200 Hz (Fig. 1D) and virtually absent at 500 Hz ( Fig. 3 and references (4,5)). This frequency-dependency of SVIN in unilateral vestibular loss fits with the notion that SVIN reflects primarily SCC activation (14). ...
Hypothesis:
Bone-conducted vibration (BCV) at 100 Hz causes endolymph displacement at hair cell stereocilia in semicircular canal (SCC) ducts of the intact bony labyrinth resulting in activation of irregularly discharging afferent neurons.
Background:
Suprathreshold 100 Hz BCV is employed in the clinic to evoke skull vibration-induced nystagmus, an indicator for peripheral vestibular asymmetry. Recently, this stimulus has also been used in vestibular-evoked myogenic potentials, a selective test for otolithic function.
Methods:
We performed extracellular recordings from utricular and SCC afferents in guinea pigs during application of suprathreshold BCV stimuli (100-500 Hz) to the animal's skull. Vibration was administered in a way that the animal, the vibrator, and the recording electrode moved as one.
Results:
In summary, 19 of 43 recorded SCC afferents displayed a stimulus- and phase-locked increase in firing during stimulation at 100 Hz BCV with no perstimulatory adaptation and no poststimulatory silencing. All of the 19 activated SCC afferents had an irregular resting discharge. Neuronal activation of SCC afferents was less pronounced at 200 Hz and largely absent at 500 Hz. On the contrary, a stimulus- and phase-locked increase in firing was observed for irregularly discharging utricular neurons at all frequencies tested.
Conclusions:
At intensities usually applied in the clinic, 500 Hz BCV is a largely selective otolithic stimulus, while 100 Hz BCV can activate both otolith and SCC afferents. Therefore, while 100 Hz BCV is ideally suited for evoking skull vibration-induced nystagmus in peripheral vestibular asymmetry, it is not recommended for vestibular-evoked myogenic potentials, as it lacks otolithic specificity.
... The clinician who was behind the participant rotated the head abruptly and unpredictably. To assess the horizontal SCCs, the head was rotated within the horizontal plane to the left and right direction with a small angle (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). To assess the left anterior right posterior (LARP) and right anterior left posterior (RALP) SCCs, the head was positioned 40 relative to the trunk and rotated either downward or upward to impulse. ...
... There are many mechanical sensors in the skin, muscles, tendons, joint capsules, and inner ear to sense vibration [14]. In a study with squirrel monkeys, it was shown that vestibular end organs can be activated by vibration [15]. ...
... A study showed that nystagmus can be activated by vibration at 100 Hz in 80% of patients with unilateral peripheral vestibular dysfunction. In addition, it was suggested that the stimulus of vibration can induce depolarization at the semicircular canals [14]. ...
Background: Chronic exposure to whole body vibration can affect the gastrointestinal system, the lumbar spine, the peripheral veins and the vestibulocochlear system.
Aims/Objectives: The aim of this study was to evaluate the effects of vibration on the vestibular system in noisy and noise-free environments using the video head impulse test (vHIT).
Material and Methods: A total of 138 employees were included in this study. Group 1 were exposed to vibration and noise. Group 2 only exposed to vibration, with no exposure to noise. Group 3 were not exposed to noise or vibration.
Results: Canal deficit was observed in 41 of 84 participants in Group 1, 7 of 24 participants in Group 2, and 1 of 30 participants in Group 3. There were more canal deficits in Group 1 and Group 2, than in Group 3 (p < .05). There was no significant difference between Group 1 and Group 2 in terms of canal deficits (p > 0.05).
Conclusions and Significance: Semicircular canal deficit can be seen with the synergistic effect of noise and vibration.
... The average slow-phase velocity (SPV) of SVIN after tUVL is 10.83°/s (SD = 6.82; n = 45) (10,26). The simplest procedure is to use only mastoid stimulation as described above (3,12,23,24); one may use also vertex stimulation (4,26,29). The technical and practical conditions of the test are presented in Figure 1. ...
... In pUVL, SVIN was significantly more frequently observed (90% of cases) when caloric testing revealed a hypofunction higher than 50% (10,12,27). Hamann and Schuster suggested that SVIN stimulated the horizontal SCC since they observed a SVIN correlated with the caloric hypofunction but not with cVEMP or SVV results (3,10). ...
... In BPPV, SVINT is seldom observed (3) and is positive only in Lindsay-Hemenway syndrome (BPPV associated with a strong ipsilateral caloric hypofunction) (10). ...
A 100-Hz bone-conducted vibration applied to either mastoid induces instantaneously a predominantly horizontal nystagmus, with quick phases beating away from the affected side in patients with a unilateral vestibular loss (UVL). The same stimulus in healthy asymptomatic subjects has little or no effect. This is skull vibration-induced nystagmus (SVIN), and it is a useful, simple, non-invasive, robust indicator of asymmetry of vestibular function and the side of the vestibular loss. The nystagmus is precisely stimulus-locked: it starts with stimulation onset and stops at stimulation offset, with no post-stimulation reversal. It is sustained during long stimulus durations; it is reproducible; it beats in the same direction irrespective of which mastoid is stimulated; it shows little or no habituation; and it is permanent—even well-compensated UVL patients show SVIN. A SVIN is observed under Frenzel goggles or videonystagmoscopy and recorded under videonystagmography in absence of visual-fixation and strong sedative drugs. Stimulus frequency, location, and intensity modify the results, and a large variability in skull morphology between people can modify the stimulus. SVIN to 100 Hz mastoid stimulation is a robust response. We describe the optimum method of stimulation on the basis of the literature data and testing more than 18,500 patients. Recent neural evidence clarifies which vestibular receptors are stimulated, how they cause the nystagmus, and why the same vibration in patients with semicircular canal dehiscence (SCD) causes a nystagmus beating toward the affected ear. This review focuses not only on the optimal parameters of the stimulus and response of UVL and SCD patients but also shows how other vestibular dysfunctions affect SVIN. We conclude that the presence of SVIN is a useful indicator of the asymmetry of vestibular function between the two ears, but in order to identify which is the affected ear, other information and careful clinical judgment are needed.
... Pour le test de vibration [2,4], la stimulation est induite par le système VVSED 500 (Euroclinic, Italie) qui présente un contact cylindrique de 4 cm de diamètre avec la peau. Le vibrateur est appliqué perpendiculai rement à la peau de la région mastoïdienne à une fréquence de 100 Hz successivement sur chaque mastoïde pendant 10 s. ...
... Le nystagmus est observé soit sous lunettes de Frenzel soit sous vidéonystagmoscope (Biodigital-Amplifon : LIVN II, France). Pour être positif, le test doit engendrer un NIV toujours du même sens retrouvé aussi bien en stimulation mastoïdienne droite que gauche qui démarre avec la stimulation et s'arrête avec elle [2,3,5,7]. ...
... Le nystagmus induit par les vibrations (NIV) [1,2], développé ces dernières années sous la forme du test vibratoire osseux vestibulaire (TVOV) dans le centre tertiaire de Grenoble [3][4][5][6], a été initialement décrit en Allemagne [1,2] et peut être utilisé en clinique comme un test de dépistage d'une asymétrie vestibulaire au fauteuil de consultation [3,5,7]. L'origine du NIV a été considérablement éclaircie ces 5 dernières années par des travaux fondamentaux. ...
Background: Nystagmus induced by vibrations (NIV), has been optimized by the present authors this last decade. The skull vibration-induced nystagmus test (SVINT) can be designated as a high-frequency global «vestibular Weber test» and can be considered as an office-based examination to detect vestibular asymmetry. The aim of this study is to define the tolerance of the SVINT as well as its comparison to the simplified caloric test of Veits (CTV) in normal workers during the pre-employment visit at the occupational medicine center.
... Pour le test de vibration [2,4], la stimulation est induite par le système VVSED 500 (Euroclinic, Italie) qui présente un contact cylindrique de 4 cm de diamètre avec la peau. Le vibrateur est appliqué perpendiculai rement à la peau de la région mastoïdienne à une fréquence de 100 Hz successivement sur chaque mastoïde pendant 10 s. ...
... Le nystagmus est observé soit sous lunettes de Frenzel soit sous vidéonystagmoscope (Biodigital-Amplifon : LIVN II, France). Pour être positif, le test doit engendrer un NIV toujours du même sens retrouvé aussi bien en stimulation mastoïdienne droite que gauche qui démarre avec la stimulation et s'arrête avec elle [2,3,5,7]. ...
... Le nystagmus induit par les vibrations (NIV) [1,2], développé ces dernières années sous la forme du test vibratoire osseux vestibulaire (TVOV) dans le centre tertiaire de Grenoble [3][4][5][6], a été initialement décrit en Allemagne [1,2] et peut être utilisé en clinique comme un test de dépistage d'une asymétrie vestibulaire au fauteuil de consultation [3,5,7]. L'origine du NIV a été considérablement éclaircie ces 5 dernières années par des travaux fondamentaux. ...
... The mastoid vibration (MV) with the frequency of stimulation at 100Hz has been used for decades to test for different kinds of VDs, like unilateral vestibular loss [8][9][10][11][12], unilateral vestibular lesions [13], partial unilateral vestibular lesions [14], vestibular neuritis [11], and superior semicircular canal dehiscence [15]. The studies above have used vibration-induced nystagmus (VIN), a form of abnormal eye movement, to evaluate the effectiveness of MV in diagnosing various forms of VDs. ...
... The studies above have used vibration-induced nystagmus (VIN), a form of abnormal eye movement, to evaluate the effectiveness of MV in diagnosing various forms of VDs. For instance, in individuals with partial or total unilateral vestibular lesions, stimulation of both sides of the mastoid process causes VINs to shift away from the side of the lesion [8][9][10][11][12][13][14]. However, when the MV is applied to patients with superior semicircular canal dehiscence [15], VINs move toward the side of the lesion. ...
... Bone conducted vibrations stimulate both canal and otolith structures [9,10] but SVIN origin is not clearly determined: the only horizontal canal for its horizontal component, [11], other canals for its torsional and vertical components [12][13][14], otolith structures, both [15] or cervical proprioceptive stimulation [7,16] were proposed. ...
... We performed a 3D analysis of the SVIN components to establish with more accuracy possible correlations with vestibular structures. Bone conducted vibrations stimulate both canal and otolith structures [9,10] but SVIN origin is not clearly determined: the only horizontal canal for its horizontal component [11], other canals for its torsional and vertical components [12][13][14], otolith structures, both [15] or cervical proprioceptive stimulation [7,16] were proposed. ...
Background:
To establish in patients with peripheral vestibular disorders relations between skull vibration-induced nystagmus (SVIN) different components (horizontal, vertical, torsional) and the results of different structurally related vestibular tests.
Methods:
SVIN test, canal vestibular test (CVT: caloric test + video head impulse test: VHIT), otolithic vestibular test (OVT: ocular vestibular evoked myogenic potential oVEMP + cervical vestibular evoked myogenic potential cVEMP) performed on the same day in 52 patients with peripheral vestibular diseases (age < 65 years), and 11 control patients were analyzed. Mixed effects logistic regression analysis was performed to assert whether the presence of nystagmus in SVIN (3D analysis) have an association with the presence of peripheral vestibular dysfunction measured by vestibular explorations (CVT or OVT).
Results:
We obtained different groups: Group-Co (control group), Group-VNT (dizzy patients with no vestibular tests alterations), Group-O (OVT alterations only), Group-C (CVT alterations only), Group-M (mixed alterations). SVIN-SPV horizontal component was significantly higher in Group-M than in the other groups (p = 0.005) and correlated with alterations of lateral-VHIT (p < 0.001), caloric test (p = 0.002) and oVEMP (p = 0.006). SVIN-SPV vertical component was correlated with the anterior-VHIT and oVEMP alterations (p = 0.007; p = 0.017, respectively). SVIN-SPV torsional component was correlated with the anterior-VHIT positivity (p = 0.017). SVIN was the only positive test for 10% of patients (83% of Group-VNT).
Conclusion:
SVIN-SPV analysis in dizzy patients shows significant correlation to both CVT and OVT. SVIN horizontal component is mainly relevant to both vestibular tests exploring lateral canal and utricle responses. SVIN-SPV is significantly higher in patients with combined canal and otolith lesions. In some patients with dizziness, SVIN may be the only positive test.
... Vibration-induced nystagmus was first reported in1973 by Lücke [1], describing the effects of 100 Hz mastoid bone vibration in a patient with unilateral vestibular loss. In 1993, Hamann demonstrated that mastoid vibratory test elicited nystagmus in 75% of patients with unilateral vestibular deficit and 10% of patients with central vestibular disorders [2]. Despite these and more recent reports, bone vibration-induced nystagmus did not receive much attention from clinicians and it was not a commonly used test. ...
... However, if one labyrinth responds more strongly to the stimulus than the other, nystagmus develops. Thus, the SVINT enables unilateral vestibular hypofunction to be readily detected * Enrique García Zamora enrique.ga.zam@gmail.com 1 Otoneurology Unit, ENT Department, Hospital "La Fe", Valencia, Spain 2 Otoneurology Unit, ENT Department, Hospital "da Luz", Lisbon, Portugal 1 3 ...
HypothesisThe knowledge of vibration-induced nystagmus test (SVINT) values in the normal population is highly relevant to provide a rapid orientation on the diagnosis attitude in a patient with vertigo. Background
Although mastoid bone vibration should only induce nystagmus in the presence of vestibular asymmetry, it has also been reported in normal individuals raising doubts as to how to interpret the SVINT. To date, no population studies involving the use of the SVINT and that establish normative values have been published. Methods
This study was carried out at two tertiary healthcare centres on a total of 122 subjects. We stimulated at three frequencies (30, 60 and 100 Hz), in increasing order, first stimulating the right mastoid and then the left mastoid, and waiting for 30 s between each stimulus. The response was recorded with a videonystagmography system. The following variables were evaluated in each subject: the mean and maximum speed of the slow phase of nystagmus, the frequency of the nystagmatic response (NR) and the component and direction of the rapid phase of nystagmus. ResultsOnly 26 subjects (20.5%) of the subjects studied here (122 subjects) developed any kind of nystagmatic response and 96 subjects (79.5%) did not display any response. Stimulation at 100 Hz provoked the largest number of responses (p = 0.04), while there was no difference in the number of responses induced by 30 and 60 Hz stimulations (p = 0.85). The frequency of nystagmus was ≤ 0.7 n/s in 80.8% of the positive responses. The mean velocity of the horizontal component of the NR was 2.2°/s (SD 1.6) and that of the vertical component was 1.3°/s (SD 1.2). Conclusions
Healthy subjects do not generally develop to NR upon vibratory stimulation and only 20% of the subjects studied here developed any kind of NR, this being a slow and inconsistent response of low frequency. The establishment of normal values contributes to improve the orientation in clinical practice in the pathological population and this opens possibilities for tackling more reliable studies in this population.
... Es sostenido, reproducible y bate en la misma dirección, independientemente de la mastoides que se estimule. El nistagmo comienza con el inicio de la estimulación y se detiene cuando ésta cesa, sin reversión posterior [5,[25][26][27][28][29][30]. La vibración se transmite eficientemente a través de la cabeza [31]. ...
... En la dehiscencia del canal semicircular superior (DCSS), el nistagmo bate hacia el oído afecto, lo que sugiere que la vibración activa las aferencias del canal y no se cancela en los núcleos vestibulares del lado sano. Aparecerá un VIN en un alto porcentaje de los casos, VERSIÓN PREPRINT Revista ORL (Ediciones Universidad de Salamanca) mientras que las pruebas calóricas suelen ser negativas [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]. En la otosclerosis el VIN se observa muy pocas veces y se dirige tanto hacia el lado sano como hacia el lado lesionado [17]. ...
Introducción y objetivo: El nistagmo inducido por vibración o vibration-induced nystagmus (VIN) es una prueba útil, simple, no invasiva y sólida que indica la asimetría de la función vestibular. Aplicando una vibración de 100Hz sobre una de las mastoides se induce un nistagmo predominantemente horizontal que bate hacia el lado sano en pacientes con déficit vestibular unilateral. . En el presente trabajo se presentan las bases fisiológicas, las condiciones prácticas y la interpretación de los resultados de la prueba. Método: Revisión narrativa. Discusión y conclusiones: El VIN comienza con el inicio del estímulo y se detiene cuando éste cesa, bate en la misma dirección, independientemente de qué mastoides se estimule; muestra poca o ninguna habituación; y es permanente incluso en pacientes bien compensados.
... Skull vibration stimulates whole vestibular end organs in both ears and horizontal torsional nystagmus may develop in the presence of vestibular asymmetry [Hamann and Schuster, 1999;Karlberg et al., 2003;Lackner and Graybiel, 1974;Michel et al., 2001]. The occurrence of nystagmus induced by skull vibration was reported to range from 72 to 100% in unilateral peripheral vestibulopathy [Hong et al., 2007;Koo et al., 2011;Ohki et al., 2003;Park et al., 2007]. ...
... Mastoid vibration provides valuable bedside information by lateralizing the lesion side in patients with unilateral peripheral vestibular loss [Hamann and Schuster, 1999;Karlberg et al., 2003;Koo et al., 2011;Lackner and Graybiel, 1974]. This was also true in SCD patients in our study and previous reports. ...
A sound- and pressure-induced vestibuloocular reflex (VOR) has been described as vertical and torsional in superior canal dehiscence (SCD), and the rotational axes of induced VOR have been assumed to fit with the axis of the affected superior semicircular canal (SC). However, it has been difficult to characterize the pattern of vibration-induced VOR (ViVOR). We aimed to characterize the pattern of ViVOR by comparing the intensity and the axis of ViVOR with several clinical parameters of SCD. Ten symptomatic SCD patients were recruited. SCD size and location were measured on a reformatted image in the plane of the SC. Unilateral vibratory stimulation (100 Hz) was applied to the mastoid surface. ViVOR were recorded using 3D videooculography. The median 3D velocity of ViVOR was measured and the 3D vector trajectory plotted for reference against the axes of the human semicircular canals. A correlation between the magnitude of ViVOR and the size of SCD was evaluated. We also compared the location of SCD with the vertical-to-torsional component ratio of the ViVOR. ViVOR were present in 7 patients; 6 patients showed a substantial horizontal component in the excitatory direction in addition to strong torsional and weak vertical components. The computed rotational axes of ViVOR were located mostly between the axes of the ipsilateral SC and horizontal canal (HC) with a variable deviation to the axis of the ipsilateral posterior canal (PC). The magnitude of ViVOR was not related to the size of the SCD. The vertical-to-torsional component ratio of ViVOR tended to decline as the dehiscence was closer to the common crus. In SCD, mastoid vibration may stimulate the affected-side HC and PC as well as the SC. SCD can be suspected when excitatory horizontal torsional ViVOR direct to the side of the auditory symptoms. © 2014 S. Karger AG, Basel.
... The aforementioned studies have employed vibration-induced nystagmus, an abnormal eye movement, to gauge the efficacy of MV in diagnosing these diverse forms of vestibular disorders. For example, in individuals with partial or total unilateral vestibular lesions, stimulating both sides of the mastoid process results in vibration-induced nystagmus shifting away from the affected side (Lucke, 1973;Yagi and Ohyama, 1996;Hamann and Schuster, 1999;Karlberg et al., 2003;Dumas et al., 2007). Conversely, in patients with superior semicircular canal dehiscence (Dumas et al., 2014), vibration-induced nystagmus shift toward the side of the lesion when MV is applied. ...
Background
The Sensory Organization Test condition 5 (SOT5) assesses an astronaut’s vestibular function pre-/post-spaceflight but has a ceiling effect and mainly evaluates standing balance, neglecting the challenges of walking during space missions. A Locomotor Sensory Organization Test (LSOT) has been developed, mirroring the SOT concept but tailored to assess vestibular function during walking. This study aims to advance current knowledge by examining changes in ground reaction force (GRF) during normal walking (LSOT1) and walking in LSOT5 (vision blocked and treadmill speed varied), both with and without mastoid vibrations.
Methods
Sixty healthy adults were recruited and divided into two groups: one with mastoid vibration and one without. GRF peaks and respective variabilities were analyzed in the vertical (V), anterior-posterior (AP), and medial-lateral (ML) directions during stance cycles. The effects of LSOTs and mastoid vibration on each dependent variable were assessed using Friedman’s two-way analysis of variance by ranks.
Results
The findings revealed that:1) Walking in LSOT5 increased the variabilities of GRFs regardless of the administration of mastoid vibration; 2) the application of mastoid vibration reduced the amplitude of GRF peaks; and 3) walking in LSOT5 while receiving mastoid vibration was the most challenging task compared to all other tasks in this study.
Conclusion
The results indicated that analyzing GRF can detect changes in the strategy of balance control across different sensory-conflicted conditions. The findings could be beneficial for assessing the vestibular function pre- and post-space missions and planning for future sensorimotor training programs aimed at enhancing astronauts’ abilities to navigate unpredictable sensory-conflicted conditions.
... In fact, under these conditions, a 100 Hz bone vibration applied to one of the mastoids immediately induces a predominantly horizontal nystagmus (skull vibration-induced nystagmus-SVIN), with the fast phase generally directed toward the healthy side. In fact, SVINT would act as a "vestibular Weber test" because, in the case of vestibular asymmetry, as in the case of auditory asymmetry, the bone vibration stimulation reaching the vestibular sensory apparatus of the dominant side produces a nystagmus response with a rapid phase that is directed towards that side [4][5][6][7]. ...
Objective: Cochlear receptors are sensitive to vibratory stimuli. Based on this sensibility, bone-anchored hearing aids have been introduced to correct unilateral or bilateral conductive or mixed hearing loss and unilateral deafness. The vestibular system is also sensitive to the vibratory stimulus and this type of response is used in clinics to test its functionality. Being aware of this double separated sensibility, we wondered whether bone vibration, which activates the acoustic receptors of patients with bone conduction aids, can also influence the functionality of the vestibular system. Methods: To this end, we recruited 12 patients with a bone-anchored hearing aid and evaluated their vestibular function with and without an activated vibratory acoustic device. Results: Our results show that the vibratory stimulus delivered by the bone conduction aid also reaches and stimulates the vestibular receptors; this stimulation is evidenced by the appearance or modification of some nystagmus findings during bedside vestibular testing. Despite this, none of these patients complained of dizziness or vertigo during prosthesis use. Nystagmus that appeared or changed during acoustic vibratory stimulation through the prosthesis was almost all predominantly horizontal, unidirectional with respect to gaze or body position, inhibited by fixation, and most often consistent with vestibular function tests indicating peripheral vestibular damage. Conclusions: The findings of sound-evoked nystagmus seem to indicate peripheral rather than central vestibular activation. The occurrence of some predominantly horizontal and high-frequency induced nystagmus seems to attribute the response mainly to the utricle and lateral semicircular canal.
... Vibration when applied to mastoid tip or vertex stimulates both labyrinths equally and may bring about nystagmus in unilateral loss of vestibular function and rarely in superior SCC dehiscence. [32,33] Head shaking-induced nystagmus (HSN) is a useful sign of imbalance of dynamic vestibular function. [34] Here, the head is shaken from side to side at a frequency of about 3 cycles/s for 10 s. ...
Vertigo is a symptom of the illusory movement of spinning. Vertigo is a challenging diagnostic condition in the emergency room as it is a
symptom‑complex of a large number of benign to life‑threatening conditions. Both peripheral vestibular and central nervous system can
cause vertigo and it is often impossible to pinpoint the underlying etiology in the acute settings. Historical features such as recurrent vertigo,
triggers, duration of vertigo, accompanying symptoms along with meticulous vestibular, and ocular and balance examination can be valuable
in delineating peripheral from central vertigo. Currently, the emergency physicians approach majority of vestibular disorders with a mind‑set of
preventing any errors of omission, so they rely on unwarranted neuroimaging. In most instances, the timing and triggers of vertigo are ignored
and characteristic maneuvers to diagnose benign peripheral vertigo are underused, thereby missing nonlife‑threatening diagnosis. An urgent
neuroimaging is usually indicated for patients with sustained vertigo and suspected central lesions associated with brainstem dysfunction
... In the past decades, vibration stimulation has been used to identify the various vestibular disorders, such as patients with unilateral acute vestibular loss (Koo et al., 2011), patients with Meniere's disease (Hong et al., 2007;Marques and Perez-Fernandez, 2012;Lee et al., 2015), patients with the unilateral vestibular or central vestibular deficit (Hamann and Schuster, 1999), and patients with vestibular neuritis (Nuti and Mandalà, 2005). This vibration test was first introduced in 1973 by Lucke to detect abnormality in peripheral vestibular functions (Lücke, 1973). ...
The vestibular system is critical for human locomotion. Any deteriorated vestibular system leads to gait instability. In the past decades, these alternations in gait patterns have been majorly measured by the spatial-temporal gait parameters and respective variabilities. However, measuring gait characteristics cannot capture the full aspect of motor controls. Thus, to further understand the effects of deteriorated vestibular system on gait performance, additional measurement needs to be taken into consideration. This study proposed using the margin of stability (MOS) to identify the patterns of dynamic control under different types of mastoid vibrations in walking. This study hypothesized that (1) using the MOS method could facilitate the understanding of another aspect of motor control induced by different types of mastoid vibrations, and (2) applying the mastoid vibrations could induce the asymmetric MOS. Twenty healthy young adults were recruited. Two electromechanical vibrotactile transducers were placed on the bilateral mastoid process to apply different types of vestibular vibrations (bilateral, unilateral, and no vibration). A motion capture system with eight cameras was used to measure the MOSap (margin of stability in the anterior-posterior direction), MOSml (margin of stability in the medial-lateral direction), and respective variabilities. The results were in line with the hypotheses that both bilateral and unilateral mastoid vibrations significantly increased MOSap (p = 0.036, p < 0.001), MOSml (p = 0.012, p < 0.001), and respective variabilities p = 0.001, p < 0.001; p = 0.001, p < 0.01 when compared to the no vibration condition. Also, significantly larger MOSml (p = 0.001), MOSml variability (p < 0.023), MOSap (p < 0.001), and MOSap variability (p = 0.002) were observed under the unilateral vibration condition than that observed under the bilateral vibration condition. The above-mentioned result found that different types of mastoid vibrations affected the MOS differently, suggesting different patterns of control mechanisms under different sensory-conflicted situations. Besides, a significant difference between the dominant and non-dominant legs was observed in MOSml. Moreover, applying the unilateral mastoid vibrations induced a greater symmetric index of MOSml, suggesting that more active control in balance was needed in the medial-lateral than in the anterior-posterior direction.
... The vibrational SPAV increased in elderly patients with UPVL and younger patients with BPPV. In BPPV, vibration nystagmus is a very rare sign [31], and it is positive if BPPV is associated with an ipsilateral caloric hypofunction (Lindsay-Hemenway syndrome) [2]. Our study recruited subjects with BPPV who presented a pseudo-spontaneous Ny as a positive control and diseased patients with confirmed UPVD. ...
Background:
Despite clinical practice utilizing the Dumas test (SVINT), some questions remain unanswered, including the age-related changes in frequency (FN) and slow-phase angular velocity (SPAV). This study aims to retrospectively evaluate their variations in subjects affected by unilateral peripheral vestibular loss (UPVL).
Methods:
We evaluated the selected samples based on the results of the SVINT, the results of the vestibular-evoked potentials (C-VEMP and O-VEMP), and the results of the head impulse test (HIT) and we compared the results against the age of the patients. We calculated the timing between the onset of UPVL and clinical evaluation in days. The presence or absence of VEMP indicated the UPVL severity. UPVL and BPPV patients with spontaneous or pseudo-spontaneous nystagmus were compared.
Results:
Statistical analysis showed changes in the FN and SPAV depending on age and the side of the application of the stimulus. We also observed that, in the UPVL, the severity of the disease modifies the SPAV, but not the frequency.
Conclusions:
The SVINT is a simple, reliable, and straightforward test that, if evaluated instrumentally, can show significant differences with aging. Further studies need to be performed to refine the clinical significance of the test and clarify its physiological background.
... In total, unilateral vestibular loss was reported to be positive in around 98%, in partial vestibular deficits in 75%, while it resulted positive in only 34% of subjects with central vestibular disorders [9,19]. Recent studies with three dimensional eye recording showed that elicited nystagmus present a torsional and sometimes vertical component, suggesting a global participation of inner ear in observed findings [9,20]. ...
Background:
Vestibular migraine (VM) and Menière's disease (MD) are the two most frequent episodic vertigo apart from Benign Paroxysmal Positional Vertigo (BPPV) differential diagnosis for them may be troublesome in the early stages. SVINT is a newly proposed vestibular test, which demonstrated to be fast and reliable in diagnoses above all of peripheral vestibular deficits.
Methods:
We retrieved clinical data from two groups of subjects (200 VM and 605 MD), enrolled between 2010 and 2020. Among others, these subjects were included when performing a SVINT. The purpose of the study is to assess if SVINT can be useful to differentiate the two episodic disorders.
Results:
59.2% of MD subjects presented as positive with SVINT while only 6% did so with VM; among other tests, only video HIT demonstrated a different frequency in the two groups (13.1% and 0.5%, respectively), but the low sensitivity in these subjects makes the test unaffordable for diagnostic purposes.
Conclusions:
Since SVINT demonstrated to be positive in a peripheral vestibular deficit in previous works, we think that our data are consistent with the hypothesis that, in the pathophysiology of VM attacks, the central vestibular pathways are mainly involved.
... Das Frequenzspektrum des VOR liegt dabei etwa zwischen 1 und 16 Hz. (Halmagyi et al., 2001;Halmagyi and Curthoys, 1988;Hamann and Schuster, 1999;Walther, 2013;Walther et al., 2012) Daher spielt der klinische Befund bei der Auswahl des geeigneten diagnostischen Verfahrens eine wichtige Rolle. ...
Die obstruktive Schlafapnoe ist eine häufige Schlafstörung, die mit rezidivierenden, nächtlichen Sauerstoffentsättigungen und Reoxygenierungen während des Schlafs einhergeht. Sie stellt einen Risikofaktor für verschiedene kardiovaskuläre und cerebrovaskuläre Erkrankungen, Diabetes sowie das auditorische System dar. Der Einfluss einer obstruktiven Schlafapnoe auf das vestibuläre System wurde bisher nicht ausreichend untersucht. Ziel der vorgestellten Studie war es daher, einen möglichen vestibulotoxischen Effekt der Sauerstoffschwankungen bei Patienten mit einer obstruktiven Schlafapnoe durch die Untersuchung eines möglichen Zusammenhangs zwischen vestibulären Funktionstests und Atmungsparametern einer Polysomnografie zu bewerten. Im Rahmen dieser prospektiven Studie wurde bei 56 Patienten eine Polysomnografie durchgeführt. Anschließend erfolgte die rezeptorspezifische Testung der Vestibularorgane bzw. ihrer Reflexstrecken, sodass durch einen Videokopfimpulstest die Funktion des horizontalen Bogengangs untersucht werden konnte. Die Funktion der Otolithen konnte hingegen durch die okulären und cervikalen vestibulären myogenen Potentiale beurteilt werden. Deskriptive Daten wurden beschrieben und zudem wurde eine Korrelationsanalyse anhand des Rangkorrelationskoeffizienten Kendall’s Tau zwischen Parametern der Polysomnografie (Apnoe-Hypopnoe-Index, Oxygen-Desaturation-Index, minimale Sauerstoffsättigung, durchschnittliche Sauerstoffsättigung, t90) und dem Gain des Videokopfimpulstest sowie Ergebnissen der Messung der vestibulären myogenen Potentiale durchgeführt. Anschließend erfolgte die Untersuchung auf signifikante Unterschiede (Wilcoxon Rangsummentest) zwischen Gruppen mit physiologischen und pathologischen Messergebnissen bezüglich ihrer Polysomnografie-Parameter. Eine signifikante Korrelation oder einen signifikanten Unterschied zwischen Polysomnografie- Parametern und dem Videokopfimpulstest bzw. den Messungen der vestibulären myogenen Potentiale konnte in der Studie nicht nachgewiesen werden (p > 0,05). Es konnte jedoch gezeigt werden, dass bei einer obstruktiven Schlafapnoe im Vergleich zu Patienten mit einem Apnoe- Hypopnoe-Index < 5 häufiger pathologische okuläre und cervikale vestibuläre myogene Potentiale vorliegen, insbesondere wenn gleichzeitig eine arterielle Hypertonie besteht. Dementsprechend könnten bei Patienten, welche an einer obstruktiven Schlafapnoe leiden, häufiger Funktionsstörung der Otolithen vorliegen. Die Funktion des horizontalen Bogengangs zeigte sich bei Patienten mit einer obstruktiven Schlafapnoe im Vergleich zu gesunden Probanden hingegen nicht vermindert. Somit konnte kein toxischer Effekt von Sauerstoffschwankungen auf das Vestibularorgan und die nachgeschalteten vestibulären Reflexkreise nachgewiesen werden. Um differenziertere Aussagen darüber treffen zu können, welche Strukturen des vestibulären Systems innerhalb der Reflexstrecke von den nächtlichen Hypoxien betroffen sind, könnten diese histopathologisch untersucht werden oder die Messung der vestibulären myogenen Potentiale mit weiteren Verfahren kombiniert werden. Eine größere Stichprobengröße würde die Möglichkeit bieten, komplexere statistische Analysen durchzuführen, sodass untersucht werden könnte, in wie weit die arterielle Hypertonie oder auch andere kardiovaskuläre Risikofaktoren wie zum Beispiel Diabetes und Hyperlipidämie, welche häufig mit einer obstruktiven Schlafapnoe einhergehen, an der Pathogenese von vestibulären Funktionsstörungen beteiligt sind.
... Confirmation of this phenomenon was later provided by Hamann and Schuster. 2 The search for this form of nystagmus during application of BCV is now commonly referred to in the literature as the skull vibration-induced nystagmus test (SVINT). ...
Background How significant asymmetries in otolith organ function in the presence of symmetrical and asymmetrical semicircular canal function influence skull vibration-induced nystagmus testing (SVINT) has not been well described.
Purpose The aim of the study is to examine the agreement between SVINT and caloric testing, ocular vestibular-evoked myogenic potentials (oVEMP), and cervical vestibular-evoked myogenic potentials (cVEMP) for detecting asymmetric vestibular function.
Research Design This is a retrospective study of patients presenting with the chief complaint of vertigo, dizziness, or imbalance.
Study Sample A total of 812 patients were studied with a median age at testing of 59 years (interquartile range 46–70; range 18–93) and included 475 (59%) women.
Intervention Either the monothermal warm caloric test or alternate binaural bithermal caloric test, oVEMP, and cVEMP tests were administered to all patients. All patients underwent the SVINT prior to vestibular laboratory testing.
Data Collection and Analysis Agreement between tests categorized as normal versus abnormal was summarized using percent concordance (PC). Sensitivity and specificity values were calculated for SVINT compared with other tests of vestibular function.
Results There was higher agreement between ipsilateral and contralateral SVINT with the caloric test (PC = 80% and 81%, respectively) compared with oVEMP (PC = 63% and 64%, respectively) and cVEMP (PC = 76% and 78%, respectively). Ipsilateral and contralateral SVINT showed higher sensitivity for the caloric test (sensitivity = 47% and 36%, respectively) compared with oVEMP (sensitivity = 26% and 21%, respectively), or cVEMP (sensitivity = 33% vs. 27%, respectively). Specificity of SVINT was high (>80%) for all assessments of vestibular function.
Conclusion The presence of SVIN is a useful indicator of the asymmetry of vestibular function between the two ears when making judgments about semicircular canal asymmetry but is less sensitive to asymmetries in otolith organ function.
... The skull vibration induced nystagmus test can predict the vestibular asymmetry in unilaterally vestibular lesioned patients [5,9,30] and is used as a vestibular Weber Test [10,21]. Neural evidence shows that the bone conducted vibration stimulates both canal and otolith afferents [13,14]. ...
Résumé
Objectif
Optimiser la fréquence et la topographie des stimulations utilisées par le test de vibration osseux vestibulaire (TVOV) dans les déhiscences du canal semi-circulaire antérieur.
Méthodes
La comparaison 3D des composantes du nystagmus induit par vibration (NIV) a été effectuée chez 40 patients porteurs d’une déhiscence du canal semi-circulaire antérieur (27 unilatérales et 13 bilatérales), 18 patients avec un déficit vestibulaire sévère et un groupe témoin de 11 volontaires.
Résultats
Dans les déhiscences unilatérales du canal semi-circulaire antérieur, les composantes torsionnelle et horizontale du NIV, obtenu au niveau du vertex dans 88 % des cas, battaient vers le côté lésé dans 95 % des cas, et pouvaient être observées jusqu’à la fréquence 800 Hz (la fréquence optimale se situant autour de 500 Hz). La vitesse de la phase lente du NIV était significativement plus importante après stimulation du vertex à 100 et 300 Hz (p = 0,04) qu’au niveau des mastoïdes. La composante verticale du NIV était le plus souvent supérieure qu’inférieure. Un NIV était significativement plus souvent observé dans les déhiscences unilatérales que bilatérales (p = 0,009) et avec une vitesse de phase lente (composante horizontale) plus importante (p = 0,008). Dans les déficits sévères unilatéraux vestibulaires la fréquence optimale était de 100 Hz et le NIV battait vers le côté intact. La stimulation mastoïdienne était significativement plus efficace que la stimulation du vertex à 60 et 100 Hz (p < 0,01).
Conclusion
Le TVOV révèle instantanément dans les déhiscences unilatérales du canal semi-circulaire antérieur un nystagmus caractéristique, principalement retrouvé au niveau du vertex, battant, pour les composantes torsionnelle et horizontale, vers le côté lésé et avec une sensibilité étendue vers les hautes fréquences. L’analyse des 3 composants du NIV suggère la stimulation conjointe du canal semi-circulaire antérieur et de l’utricule. Le TVOV agit comme un Weber vestibulaire, montre une asymétrie de la fonction vestibulaire et s’avère utile pour diagnostiquer la présence d’une déhiscence unilatérale du canal semi-circulaire antérieur.
... Skull Vibration-induced nystagmus (SVIN) is a nystagmus evoked by the application of vibration to the mastoid process, forehead, or sternocleidomastoid muscle. This condition is observed in patients with peripheral or central vestibulopathies [4,5]. It is thought to originate in peripheral vestibular receptors and/or proprioceptive receptors in the neck muscles [6]. ...
Background
As described by Dumas, an 80–100 Hz vibration applied to the mastoid produces a horizontal nystagmus, with quick phases beating away from the affected side in patients with unilateral vestibular loss (UVL).
Aim/objectives
To elucidate the characteristics of skull vibration-induced nystagmus (SVIN) in patients suffering from vestibular neuritis and how these characteristics are related to information provided by the video head impulse test (vHIT).
Material and methods
Sixty-three patients were enrolled to perform a vHIT to measure the gain in both ears. SVIN was induced with stimulation at 30 Hz, 60 Hz, and 100 Hz. The slow phase velocity (SPV) of the SVIN was measured.
Results
The SVIN test was positive in 25/63 patients at 30 Hz, 36/63 at 60 Hz and 46/63 at 100 Hz. Mean gain difference between both ears to obtain a positive SVIN at 30 Hz was observed to be 0.38 ± 0.25, decreasing to 0.35 ± 0.23 at 60 Hz, and 0.31 ± 0.24 at 100 Hz (p = .025). We found a significant positive linear correlation between the gain asymmetry measured using horizontal vHIT and SPV in SVIN at 100 Hz.
Conclusions and significance
There is a close relationship between the difference in the gains of both ears as measured using VHIT and the SPV of the nystagmus induced by SVIN at 100 Hz.
... Researchers have reported that vibratory stimuli of the head and neck could induce nystagmus in patients with vestibular disorders [4]. Lackner and Graybiel were the first to observe vestibular side effects from the regional vibration of the skull that caused an illusion of motion in normal subjects [5]. ...
Objective
To investigate whether mechanical vibrational energy from using an electric toothbrush may cause an increase in the incidence of benign paroxysmal positional vertigo (BPPV) and prevent successful treatment of BPPV with canalith repositioning procedure.
Methods
This was a retrospective study conducted at an otolaryngology private practice. A survey of 111 patients who were diagnosed with BPPV in an otolaryngology practice between May 2012 and January 2017 was conducted using a questionnaire that included questions regarding demographics, inner ear pathology, treatment method, and use of an electric toothbrush. The results were recorded and compared using a chi-square test of analysis or Fisher’s exact test.
Results
Overall, 47 (42.3%) of the 111 BPPV patients used an electric toothbrush, whereas 64 of the 111 (57.6%) patients did not. Six (12.7%) of the 47 patients experienced dizziness with electric toothbrush use. Of the 47 patients using an electric toothbrush, 33 (70.2%) had a resolution of symptoms after Epley treatment, whereas 14 (23.4%) of 47 patients did not. Of the 64 patients who did not use an electric toothbrush, 15 (23.4%) did not have resolution after Epley treatment. Of the 47 patients using an electric toothbrush, 6 (12.8%) had a recurrence of BPPV diagnosed in the office, whereas 41 (82.2%) did not. Seven (10.9%) of those who did not use an electric toothbrush had a recurrence of BPPV, whereas 57 (89.1%) of the 64 patients did not. These results were not statistically significant (p = 0.77).
Conclusions
This study suggests that the mechanical vibrations from electric toothbrush use do not have an association with recurrent BPPV. The results align with some publications demonstrating that vibrations in the head and neck area from the use of an electric toothbrush can initiate dizziness; however, it does not appear that this modality of vibration is significant for inducing recurrent BPPV.
... The skull vibration induced nystagmus test can predict the vestibular asymmetry in unilaterally vestibular lesioned patients [5,9,30] and is used as a vestibular Weber Test [10,21]. Neural evidence shows that the bone conducted vibration stimulates both canal and otolith afferents [13,14]. ...
Objective:
To establish optimum stimulus frequency and location of bone conducted vibration provoking a skull vibration induced nystagmus (SVIN) in superior semi-circular canal dehiscences.
Methods:
SVIN 3D components in 40 patients with semi-circular canal dehiscence (27 unilateral and 13 bilateral) were compared with a group of 18 patients with severe unilateral vestibular loss and a control group of 11 volunteers.
Results:
In unilateral semi-circular canal dehiscences, SVIN torsional and horizontal components observed on vertex location in 88% beat toward the lesion side in 95%, and can be obtained up to 800Hz (around 500Hz being optimal). SVIN slow-phase-velocity was significantly higher on vertex stimulation at 100 and 300Hz (P=0.04) than on mastoids. SVIN vertical component is more often upbeating than downbeating. A SVIN was significantly more often observed in unilateral than bilateral semi-circular-canal dehiscences (P=0.009) and with a higher slow phase velocity (P=0.008). In severe unilateral vestibular lesions the optimal frequency was 100Hz and SVIN beat toward the intact side. The mastoid stimulation was significantly more efficient than vertex stimulation at 60 and 100Hz (P<0.01).
Conclusion:
SVIN reveals instantaneously in unilateral semi-circular canal dehiscences a characteristic nystagmus beating, for the torsional and horizontal components, toward the lesion side and with a greater sensitivity toward high frequencies on vertex stimulation. SVIN three components analysis suggests a stimulation of both superior semi-circular canal and utricle. SVIN acts as a vestibular Weber test, assessing a vestibular asymmetrical function and is a useful indicator for unilateral semi-circular canal dehiscence.
... Mechanical vibration applied to the mastoid is known to stimulate the vestibular system. For example, a common clinical "vibration test" for unilateral vestibular hypofunction involves the application of mechanical vibration to the mastoid [42,46,92], with the elicitation of nystagmus in the presence of bilateral mastoid vibration (in the range of 60 Hz to 100 Hz) indicating unilateral peripheral dysfunction. Vibration applied on the mastoid has been shown to be an excitatory stimulus to the vestibular receptors [19,20,90,93], using both sinusoidal stimuli (i.e., "pure tones") ranging from 50 Hz to 4000 Hz and short impulsive stimuli (i.e., "clicks"). ...
Background:
Vibration applied on the mastoid has been shown to be an excitatory stimulus to the vestibular receptors, but its effect on vestibular perception is unknown.
Objective:
Determine whether mastoid vibration affects yaw rotation perception using a self-motion perceptual direction-recognition task.
Methods:
We used continuous, bilateral, mechanical mastoid vibration using a stimulus with frequency content between 1 and 500 Hz. Vestibular perception of 10 healthy adults (M±S.D. = 34.3±12 years old) was tested with and without vibration. Subjects repeatedly reported the perceived direction of threshold-level yaw rotations administered at 1 Hz by a motorized platform. A cumulative Gaussian distribution function was fit to subjects' responses, which was described by two parameters: bias and threshold. Bias was defined as the mean of the Gaussian distribution, and equal to the motion perceived on average when exposed to null stimuli. Threshold was defined as the standard deviation of the distribution and corresponded to the stimulus the subject could reliably perceive.
Results:
The results show that mastoid vibration may reduce bias, although two statistical tests yield different conclusions. There was no evidence that yaw rotation thresholds were affected.
Conclusions:
Bilateral mastoid vibration may reduce left-right asymmetry in motion perception.
... As such, Karlberg, et al. highlights the limitation of using vibration for testing for cervicogenic dizziness (Karlberg et al., 1996). Given that vibration testing may also be used to identify unilateral vestibular deficits, multiple other diagnoses are possible (Hamann and Schuster, 1999). ...
Study design
Narrative Review & Case Series.
Background
No “gold standard” test presently exists to confirm a diagnosis of cervicogenic dizziness, a condition whereby the neuromusculoskeletal tissues of the cervical spine are thought to contribute to imbalance and dizziness. Clusters of tests are presently recommended to provoke signs and symptoms of the condition. In this regard, dry needling may provide a valuable diagnostic tool. Targeting the musculoskeletal structures of the upper neck with dry needling may also provide a valuable treatment tool for patients that suffer from cervicogenic dizziness. While dry needling has been used to treat various musculoskeletal conditions, it has not been specifically reported in patients with cervicogenic dizziness.
Case description
Three patients were screened for signs and symptoms related to cervicogenic dizziness in an outpatient physical therapy clinic. These patients presented with signs and symptoms often associated with (though not always) cervicogenic dizziness, including a positive flexion-rotation test, altered cervical range of motion, and tenderness with manual assessment of the upper cervical extensors. In addition, dry needling targeting the obliquus capitis inferior muscle was used diagnostically to reproduce symptoms as well as to treat the patients.
Outcomes
Two of the patients reported full resolution of their dizziness and a significant improvement in their function per standardized outcome measures. While the third patient did not report full resolution of her cervicogenic dizziness, she noted significant improvement, and dry needling was helpful in guiding further treatment. Importantly, the effect of the treatment was maintained in all three patients for at least 6 months.
Discussion
This case series with narrative review covers various testing procedures for cervicogenic dizziness and explores the use of dry needling targeting the suboccipital muscles to evaluate and treat this patient population. The physiologic changes that occur in the periphery, the spine and the brain secondary to dry needling and their potential relevance to the mechanisms driving cervicogenic dizziness are discussed in detail.
... Hamann and Schuster revealed that the vibration-induced nystagmus (VIN) goes into the direction of the non-af- fected side of patients with peripheral vestibulopathies [232]. Koo et al. concluded based on their investigations that the VIN can be compared to caloric tests and leads to better results than orienting examination by means of provocation (head shaking) [233]. ...
Vertigo is a multisensory syndrome that otolaryngologists are confronted
with every day. With regard to the complex functions of the sense of
Leif Erik Walther1
orientation, vertigo is considered today as a disorder of the sense of
1 HNO-Gemeinschaftspraxis,
Main-Taunus-Zentrum,
Sulzbach, Germany
direction, a disturbed spatial perception of the body. Beside the frequent
classical syndromes for which vertigo is the leading symptom (e.g. positional
vertigo, vestibular neuritis, Menière’s disease), vertigo may occur
as main or accompanying symptom of a multitude of ENT-related diseases
involving the inner ear. It also concerns for example acute and
chronic viral or bacterial infections of the ear with serous or bacterial
labyrinthitis, disorders due to injury (e.g. barotrauma, fracture of the
oto-base, contusion of the labyrinth), chronic-inflammatory bone processes
as well as inner ear affections in the perioperative course. In
the last years, diagnostics of vertigo have experienced a paradigm shift
due to new diagnostic possibilities. In the diagnostics of emergency
cases, peripheral and central disorders of vertigo (acute vestibular
syndrome) may be differentiated with simple algorithms. The introduction
of modern vestibular test procedures (video head impulse test, vestibular
evoked myogenic potentials) in the clinical practice led to new diagnostic
options that for the first time allow a complex objective assessment of
all components of the vestibular organ with relatively low effort. Combined
with established methods, a frequency-specific assessment of
the function of vestibular reflexes is possible. New classifications allow
a clinically better differentiation of vertigo syndromes. Modern radiological
procedures such as for example intratympanic gadolinium application
for Menière’s disease with visualization of an endolymphatic
hydrops also influence current medical standards. Recent methodical
developments significantly contributed to the possibilities that nowadays
vertigo can be better and more quickly clarified in particular in
otolaryngology.
... Hamann and Schuster revealed that the vibration-induced nystagmus (VIN) goes into the direction of the non-af- fected side of patients with peripheral vestibulopathies [232]. Koo et al. concluded based on their investigations that the VIN can be compared to caloric tests and leads to better results than orienting examination by means of provocation (head shaking) [233]. ...
Modern diagnostic methods such as video head impulse test and cervical and ocular vestibular evoked myogenic potentials allow to measure canal and otolith function quantitatively and objectively. These methods contribute to a complex assessment of the functional integrity of all 5 sensory elements of the vestibular organ for the first time. Moreover, in combination with additional vestibular tests frequency specific and time depended changes of impairments of vestibular sensors and their pathways can be assessed. Over the past few years, new test methods have been established step by step in daily clinical diagnostic of vertigo and dizziness in acute vestibular syndrome and chronic complaints. Modern tests and concepts caused a paradigm shift in vestibular diagnostic. New classifications of vestibular disorders and algorithms provide a high diagnostic certainity and reliability although evidence-based investigations of diagnostic procedures are still missing.
... They are, therefore, ideal models for investigating the efficacies of various vestibular function tests, including the VIN test. Although several studies have investigated VIN in patients with vestibular schwannomas (Hamann and Schuster, 1999;Dumas et al., 2008Dumas et al., , 2011, no study till date has investigated the relationship of VIN with tumor characteristics and degree of vestibular loss. Furthermore, few reports have documented the changes in VIN during the compensatory period in patients with partial vestibular loss (vestibular neuritis). ...
Objective:
To investigate the clinical significance of vibration-induced nystagmus (VIN) in unilateral vestibular asymmetry and vestibular schwannoma.
Methods:
Thirteen patients with vestibular schwannoma underwent the VIN test, in which stimulation was applied to the mastoid processes and sternocleidomastoid (SCM) muscles on the ipsilateral and contralateral sides of lesions. Preoperative VIN was measured, and changes in VIN were followed up for 6months after tumor removal. Significance of VIN was determined by evaluation of its sensitivity, correlation with vestibular function tests and tumor volume, and postoperative changes.
Results:
The overall pre and postoperative sensitivities of VIN were 92.3% and 100%, respectively, considering stimulation at all four sites. Maximum slow-phase velocity (MSPV) of VIN was linearly correlated with caloric weakness and tumor volume, especially when stimulation was applied to the SCM muscle. Postoperative MSPV of VIN exhibited stronger linear correlation with postoperative changes in canal paresis value and inverse correlation with tumor size upon stimulation of the ipsilateral SCM muscle than upon stimulation of other sites. During the 6-month follow-up period, persistence of VIN without changes in MSPV was observed even after vestibular compensation.
Conclusions:
Evoking VIN by stimulation of the mastoid processes and SCM muscles is effective for detecting vestibular asymmetry. It could also help determine the degree of vestibular asymmetry and volume of vestibular schwannoma if stimulation is applied to the SCM muscle.
Significance:
The results of this study could provide clues for the basic application of VIN in patients with vestibular loss and vestibular schwannoma.
... While altered proprioceptive inputs from neck muscles might be important in the mechanism of vibration-induced ocular torsion and nystagmus after unilateral vestibular deafferentation, vibratory stimula-Introduction Vibration is an excitatory stimulus not only for cochlear afferents (Robles and Ruggero, 2001) but also for semicircular canal (SCC) and otolith afferents (Young et al., 1977;Wit et al., 1984;Hudspeth, 1989;Christensen-Dalsgaard and Narins, 1993). Vibration applied to the mastoid bone induces nystagmus in~80% of subjects with chronic unilateral peripheral vestibular lesions (Hamann and Schuster, 1999). Recently we reported that vibration applied to the mastoid bones of subjects with chronic unilateral vestibular deafferentation (uVD) induces a tonic shift of the subjective visual horizontal (Karlberg et al., 2002), similar to that seen acutely after uVD, in the absence of vibration (Curthoys et al., 1991). ...
Summary Vibration is an excitatory stimulus for both vestibular and proprioceptive afferents. Vibration applied either to the skull or to the neck muscles of subjects after unilateral vestibular deafferentation induces nystagmus and a shift of the subjective visual horizontal. Previous studies have ascribed these effects to vibratory stimulation of neck muscle proprioceptors. Using scleral search coils, we recorded three-dimensional eye movements during unilateral 92 Hz vibration of the mastoid bone or of the sternocleidomastoid (SCM) muscle in 18 subjects with chronic unilateral vestibular deficits after vestibular neurectomy or neuro-labyrinthitis. Nine subjects had lost function of all three semicircular canals (SSCs) on one side, and the other nine had lost function of only the anterior and lateral SSCs. Vibration of the mastoid bone or of the SCM muscle on either side induced an ipsilesional tonic shift of torsional eye position of up to 6.5∞ during visual fixation, as well as a nystagmus with horizontal, vertical and torsional components in darkness. Subjects who had lost function of all three SSCs on one side showed a larger shift in ocular torsion in response to SCM vibration than did subjects who had lost function of only two SSCs. The difference between ocular torsion produced by ipsilesional muscle or bone vibration was not significantly different from that produced by contralesional bone or muscle vibration. The vibration-induced nystagmus rotation axis tended to align with the pitch (y) axis of the head in subjects who had lost only anterior and lateral SSC function, and with the roll (x) axis of the head in subjects who had lost function of all three SSCs. We propose that the previously described vibration-induced shift of the subjective visual horizontal can be explained by the vibrationinduced ocular torsion, and that the magnitude of ocular torsion is related to the extent of the unilateral vestibular deficit. While altered proprioceptive inputs from neck muscles might be important in the mechanism of vibration-induced ocular torsion and nystagmus after unilateral vestibular deafferentation, vibratory stimulation of vestibular receptors in the intact labyrinth also appears to have an important role.
... Even though the changes in direction of SN in MD have been well established in the literature, the patterns of provoked nystagmus during the various phases of an acute vertigo episode are still unknown (9Y13). Various maneuvers have been applied to assess the static or dynamic vestibular imbalances in MD, including headshaking (13), vibration stimuli (12,14), hyperventilation (15,16), and mastication (17). However, those studies were mostly limited by evaluation only during the interictal periods, and no study has attempted to define the evolution patterns of spontaneous and induced nystagmus in patients with MD. ...
To aid in defining each phase of Ménière's disease (MD) and underlying vestibular pathophysiology by analyzing the evolving patterns of spontaneous, head-shaking (HSN), and vibration-induced nystagmus (VIN) during and between the attacks of MD.
Retrospective case series review.
We analyzed the patterns of HSN and VIN during 123 attacks from 87 patients who had definite unilateral MD and underwent recording of eye movements both during and between the attacks using video-oculography.
HSN tended to beat toward the lesion side during the irritative phase (80.0%) and toward the healthy side during the paretic phase (82.9%). In contrast, VIN was more commonly induced during the irritative phase (63.7%) and more likely beat toward the healthy side irrespective of the phases evaluated (84.3%). Directional dissociation may occur between HSN and VIN, especially during the irritative phase when HSN mostly beat to the lesion side, but VIN is toward the healthy side.
The characteristic patterns of HSN and VIN during each phase of MD would aid in defining the acute phases of MD and understanding the underlying vestibular pathophysiology.
Vestibular neuritis is one of the most common reasons that someone may experience an episode of acute spontaneous vertigo, with the majority cases impacting only one ear. Cases of bilateral vestibular neuritis are rare and are thought to account for less than 10% of all cases of vestibular neuritis. 18,1,9,15,12 Skull vibration testing is an efficient means to screen for asymmetry in vestibular function but is still in its infancy in clinical use. The ideal assessment methods and the typical patterns of skull vibration induced nystagmus are relatively well understood, however, the presentation of skull vibration induced nystagmus in atypical labyrinthine pathology is less clear. Skull vibration induces a horizontal nystagmus that beats toward the healthy labyrinth in most instances of significant labyrinthine asymmetry. We pose a case report of a patient that’s symptomology and clinical test findings are most consistent with bilateral sequential superior branch vestibular neuritis with an up beating skull vibration induced nystagmus.
Maintaining balance involves a complex interplay of the vestibular system, visual system (eyes and related anatomy), and proprioceptive system. Indeed, the etiology of “dizziness” can often be multifactorial and a challenging diagnosis. The thorough evaluation of a dizzy patient should always begin with a thorough history and physical exam, which are often sufficient to obtain a reasonable diagnosis explaining the patient’s symptoms [1]. However, although the majority of vestibular disorders may be elucidated from a thorough history and physical exam, appropriate vestibular tests can help refine the diagnosis and inform management decisions in specific situations. This chapter will focus on clinical and vestibular laboratory tests for the evaluation of the dizzy patient.
Introduction : La perte auditive neurosensorielle chez l'enfant est souvent accompagnée d'un dysfonctionnement vestibulaire. L'évaluation du système vestibulaire dans la population pédiatrique nécessite d'adapter les techniques utilisées chez l'adulte. Le test du nystagmus induit par les vibrations osseuses du crâne (TVO) ou test de Dumas, test d’examen de première intention non invasif, stimule à la fois les structures otolithiques et canalaires et montre instantanément une asymétrie vestibulaire chez l’adulte. Cette étude a visé à évaluer l'utilisation de ce test chez des enfants sains et à explorer plus sa valeur clinique chez les enfants malentendants bénéficiant d’une amplification par prothèses auditives (PA) ou par implant cochléaire (IC). Matériel et méthodes : Une étude cas-témoins a comparé les résultats du TVO, des tests oculomoteurs (saccade et poursuite oculaires), du test calorique (TC), du test de Halmagyi (VHIT) et de la posturographie (TOS) chez 120 enfants sains (groupe témoin) à ceux de 30 enfants avec PA et à ceux de 30 enfants avec IC, âgés de 5 à 17 ans. Le TVO a été enregistré par vidéonystagmographie après stimulation à très haute fréquence (THF= 100 Hz) des mastoïdes et du vertex. Résultats : Le TVO s’est révélé facile à réaliser chez les enfants et son résultat n’était pas affecté par leur âge dans le protocole d’utilisation employé. Cependant, avec l’âge, la latence des saccades a diminué et les gains de poursuite oculaire ont augmenté. De même, les données du TOS ont montré une amélioration significative de la posture liée à l'âge et une différence entre les sexes. Le TVO s’est également révélé facile à réaliser pour l’examinateur, avec une sensibilité de 86 % et une spécificité de 96 % pour la détection des lésions vestibulaires unilatérales (LVU). En cas de déficit bilatéral, le TVO est inopérant. Chez les participants bénéficiant d’une amplification, une LVU a été également détectée, que ce soit avec TVO, TC ou VHIT. Les comparaisons entre les tests permettent de suggérer que le TVO stimule les cellules phasiques (type I), qui occupent les sommets des crêtes ampullaires et le voisinage de la striola des macules utriculaires et sacculaires. Conclusion : le TVO est un test bien toléré et utile pour le dépistage d’une asymétrie vestibulaire chez l’enfant avec des troubles d’audition associés à d’autres tests vestibulaires. Il montre sa complémentarité à très haute fréquence. Il confirme son rôle comme un "Weber vestibulaire".
Background:
The association between vestibular function and findings of horizontal head-shaking nystagmus (HHSN) and vibration-induced nystagmus (VIN) tests is not well understood.
Objective:
To investigate the association between function in the five distinct vestibular end organs and findings of these nystagmus tests.
Methods:
We retrospectively reviewed the medical records of 50 patients with vestibular diseases who underwent HHSN testing, VIN testing, video head impulse testing (vHIT), cervical vestibular evoked myogenic potential testing to air-conducted sound (ACS cVEMP) and ocular VEMP testing to ACS (ACS oVEMP). We performed mixed-effects logistic regression analyses to see whether age, sex or the presence of nystagmus in HHSN or VIN have an association with the presence of peripheral vestibular dysfunction on the opposite side to the direction of nystagmus.
Results:
The presence of HHSN had a significant association with abnormal vHIT in the lateral semicircular canal (LSCC) on the opposite side to the direction of nystagmus. The presence of VIN had a significant association with abnormal vHIT in all the SCCs and abnormal ACS oVEMP on the opposite side to the direction of nystagmus.
Conclusions:
HHSN had an association with LSCC dysfunction alone. VIN had an association with dysfunction in all the SCCs and the utricle.
Background: Generally, vertical component of the skull vibratory nystagmus (VCN) is ignored in the clinical practise. Thus, the relative contribution of the vestibular organs in the presence of VCN remains unknown.
Objectives: To determine the association between vertical semicircular canal (vSCC) function and the presence of VCN.
Material and methods: Comparisons were made between Video Head Impulse Test and SVINT (100 Hz) results at the time of the acute peripheral vestibular lesion (PVL) and at the post-acute phase in patients diagnosed PVL. Later on, a paired analysis was performed restricting the assessments to patients with vestibular explorations in both the acute and post-acute phases.
Results: In an univariable analysis, larger mean total gain differences (TGD) between vSCC VOR gains, significantly related with the appearance of VCN in nystagmography in the acute phase (p = .001), unlike the post-acute phase (p = .46). After a multivariate analysis, mean TGD was the only predictive factor of the VCN (p = .013). In the paired analysis, we found an increase in the post-acute phase mean TGD, approaching zero value.
Conclusions and significance: Global relation between all vertical canals has at least a contributory role in the presence of the vertical component of nystagmus in SVINT.
L'exercice permet l'acquisition et l'intégration de nouvelles habiletés motrices propres à la nature de l'activité considérée. L'exercice est également un facteur de risque de lésions et semble altérer temporairement la fonction d'équilibration. Cependant, les mécanismes physiologiques et physiopathologiques et leurs conséquences sur la fonction d'équilibration sont encore mal connus. Ce travail, pour lequel le cyclisme a été utilisé comme modèle neurosensoriel, visait à évaluer les éventuelles modifications des stratégies sensori-motrices physiologiques et compensatoires de la fonction d'équilibration en fonction du type d'exercice et de perturbations de l'homéostasie.Les stratégies sensori-motrices de routiers et de vététistes et celles des effets d'une déshydratation induite par un exercice ont été évaluées par posturographie. De plus, la prévalence de vertiges après compétitions ou entraînements a été évaluée par questionnaire chez des routiers et des descendeurs (spécialistes du vélo tout terrain descente). Pour assurer la fonction d'équilibration, les vététistes, qui pratiquaient le plus de VTT, utilisaient principalement les informations proprioceptives. Les routiers et les vététistes, qui pratiquaient le plus le cyclisme sur route, utilisaient davantage les informations visuelles. La déshydratation induite par l'exercice altérait temporairement le contrôle postural. Plus la déshydratation était importante, moins les informations vestibulaires étaient requises. Les vertiges survenaient couramment après la pratique du cyclisme et, en particulier, en VTT descente. L'épuisement a été rapporté comme un déterminant important des vertiges en cyclisme sur route alors que les accélérations-décélérations brusques et les chutes ont été rapportées comme déterminants des vertiges en VTT descente.La différence d'organisation sensorielle entre les vététistes et les routiers peut être expliquée par des processus adaptatifs élaborés à partir des stimulations environnementales et des spécificités techniques de ces disciplines. Bien que la fatigue musculaire puisse expliquer les altérations posturales à la suite d'un exercice, les modifications de l'homéostasie des liquides vestibulaires peuvent également diminuer le poids de l'information vestibulaire dans la régulation de l'équilibration. Les mécanismes physiopathologiques générant des vertiges peuvent être liés à des modifications homéostatiques induites par l'effort en cyclisme sur route. En VTT descente, les accélérations-décélérations (incluant les chutes), auxquelles la tête est soumise, peuvent générer des dysfonctionnements des structures vestibulaires, en particulier des organes otolithiques
Le test de vibration osseux vestibulaire se pratique sur un sujet assis en stimulant par un vibreur chaque mastoïde puis le vertex à 100 Hz. Il s’agit d’un test rapide, non invasif, d'exploitation récente de premier niveau utile pour dépister une asymétrie vestibulaire au fauteuil de consultation chez un patient vertigineux qui oriente vers une latéralité lésionnelle. Nous avons pu établir en clinique dans des lésions vestibulaires totales (LUVT), partielles (LUVP), des lésions du tronc cérébral et des malformations labyrinthiques et avec l'aide des découvertes fondamentales chez l'animal (Curthoys) que des stimulations vibratoires osseuses appliquées au crâne ou sur les mastoïdes stimulaient l’ensemble des structures vestibulaires des 2 côtés ; le nystagmus induit (NIV) était la résultante d'une asymétrie des réponses (Weber vestibulaire). Dans les LUVT et les LUVP le NIV bat habituellement du côté sain. Inversement, dans les déhiscences du canal antérieur (DCA) il bat du côté lésé du fait d’une facilitation de la conduction osseuse secondaire à l’existence d’une 3ème fenêtre. Les stimulations des mastoïdes sont habituellement plus efficaces que celles du vertex sauf dans les DCA. Le NIV n'est pas influencé par la compensation vestibulaire et persiste telle une "cicatrice vestibulaire". Ainsi il présente un intérêt médicolégal par exemple en médecine du travail. Ce test utile en cas de test calorique (TC) impossible intéresse les hautes fréquences vestibulaires et complète le HST, le HIT, le TC qui n'intéressent que les moyennes et basses fréquences. Il est plus sensible pour dépister une lésion périphérique que centrale.
This book provides a multidisciplinary approach to vestibular migraine and related syndromes in which dizziness is the most predominant feature. Starting from the neurological point of view, the pathophysiology, classification, neurophysiology, and therapy of migraine are discussed. Readers will learn how to recognize and properly treat vestibular migraine, which is often undiagnosed or misdiagnosed as Ménière’s syndrome (a form of vertigo characterized by vertigo spells and hearing loss that presents comorbidity with migraine) or benign paroxysmal positional vertigo (in which patients experience brief episodes of vertigo, lasting from seconds to 1 minute, when they move their heads in a certain way). The described diagnostic and therapeutic strategies include the newest, state of the art approaches. Further aspects of migraine that are considered include hyperexcitability in the brain and the triad of migraine, dizziness, and anxiety. In addition, the imaging of migraine, and of vestibular migraine in particular, is discussed and clinical records are reported.
Vestibular Migraine and Related Syndromes is based on the practical and clinical experiences of an authoritative group of well-known neurologists, ENT specialists, and neuro-otologists. It provides neurologists with a complete overview of relevant clinical features, otolaryngologists with clear descriptions of clinical aspects and the pathophysiology of migraine, and radiologists with guidance on the role of imaging techniques.
Objective:
To analyze the frequency in which vibration-induced nystagmus (VIN) with ipsilesional direction appears in subjects with Ménière's disease (MD) or vestibular schwannoma (VS).
Study design:
Cross-sectional study.
Setting:
Tertiary referral center.
Patients:
Fifty-two subjects with MD and 21 subjects with vestibular schwannoma.
Intervention:
Videonystagmographic recordings of VIN at 30, 60, and 100 Hz.
Main outcome measures:
Direction and slow phase velocity of VIN at 30, 60, and 100 Hz.
Results:
Ipsilesional Nystagmus was observed in 8 of 52 subjects with MD (15.4%) and in 11 of 21 subjects affected of unilateral VS (52.4%). Ipsilesional nystagmus was significantly higher in patients with VS (p = 0.003). The frequency of appearance of ipsilesional nystagmus in the subjects with VS who has not been treated was significantly higher than those who underwent radiosurgery (84.6% vs 0%, p = 0.046).
Conclusion:
Ipsilesional vibration-induced Nystagmus can be present in subjects with vestibular deficits caused by MD and VS.
The pathophysiology of vestibular migraine (VM) is still a matter of speculation. Recently, clinical examination of patients with acute VM has clarified that the vast majority of patients with VM suffer from central vestibular dysfunction.
Neither in the acute episode nor in the interval is there any specific testing abnormality in vestibular migraine. However, laboratory testing can be useful to exclude other diseases and to reassure the patient. It is important to take note that minor signs of peripheral and central vestibular dysfunction are not uncommon in patients with vestibular migraine in the symptom-free interval. In this chapter, findings in the symptom-free interval and during the acute episode of VM are summarized.
During the last decades a new vestibular syndrome has emerged that is now termed vestibular migraine (VM). The main body of evidence for VM is provided by epidemiologic data demonstrating a strong association between migraine and vestibular symptoms. Today, VM is recognized as one of the most common causes of episodic vertigo. The clinical presentation of VM is heterogeneous in terms of vestibular symptoms, duration of episodes, and association with migrainous accompaniments. Similar to migraine, there is no clinical or laboratory confirmation for VM and the diagnosis relies on the history and the exclusion of other disorders. Recently, diagnostic criteria for VM have been elaborated jointly by the International Headache Society and the Bárány Society. Clinical examination of patients with acute VM has clarified that the vast majority of patients with VM suffer from central vestibular dysfunction. Findings in the interval may yield mild signs of damage to both the central vestibular and ocular motor system and to the inner ear. These interictal clinical signs are not specific to VM but can be also observed in migraineurs without a history of vestibular symptoms. How migraine affects the vestibular system is still a matter of speculation. In the absence of high-quality therapeutic trials, treatment is targeted at the underlying migraine.
Es folgen 43 Fragen zum Themengebiet HNO – allgemeine Aspekte. Beispiele sind:
- Besteht ein Zusammenhang zwischen der allergischen Rhinitis und der chronischen Rhinosinusitis?
- Wie funktioniert die akustische Rhinometrie?
- Warum schwindeln die Alten?
The aims of this study were to compare vibration-induced nystagmus (VIN) and hyperventilation-induced nystagmus (HVIN) findings in patients with Ramsay Hunt syndrome with vertigo (RHS-V), sudden sensorineural hearing loss with vertigo (SSNHL-V), and vestibular neuritis (VN) during the acute stage and to address the possible lesion sites of vestibular deficit in RHS-V.
Case series with chart review.
Tertiary referral center.
We conducted a retrospective case series study in 27 patients with SSNHL-V, 104 patients with VN, and 17 patients with RHS-V and evaluated the findings of VIN and HVIN tests.
An abnormal VIN was observed in 91% of the patients with VN, 89% of those with SSNHL-V, and 94% of those with RHS-V, and the prevalence of abnormal VIN was not significantly different (P = .436). An abnormal HVIN was observed in 51% of the patients with VN, 22% of those with SSNHL-V, and 59% of those with RHS-V. While the prevalence of an abnormal HVIN was significantly different between SSNHL-V and VN groups (P = .007) and between SSNHL-V and RHS-V groups (P = .014), that between VN and RHS-V groups did not show a significant difference (P = .547).
Since the results of HVIN in RHS-V patients were more similar to those in VN patients than those in SSNHL-V patients, a lesioned site may be more likely within the vestibular nerve than the inner ear as a cause for vestibular deficit in patients with RHS-V who show caloric canal paresis of 25% or greater.
© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.
Aufgrund der Entwicklung neuer Methoden, wie den vestibulär evozierten myogenen Potenzialen und dem Video-Kopfimpulstest, befindet sich die klinische Vestibularisdiagnostik gegenwärtig im Wandel. Mit dem Spektrum der zur Verfügung stehenden diagnostischen Methoden ist erstmals eine spezifische, quantitative und objektive Analyse vestibulärer Reflexe möglich. Die Kombination unterschiedlicher Verfahren erlaubt darüber hinaus eine Einschätzung unterschiedlicher Arbeitsbereiche. Das Konzept einer differenzierten Analyse der vestibulären Rezeptorfunktion beinhaltet neben einer topologischen Diagnostik die Beurteilung frequenzspezifischer Arbeitsbereiche (Frequenzdynamik) sowie die Erfassung von funktionellen Veränderungen im Zeitverlauf (zeitliche Dynamik). Damit ist eine neue Sichtweise auf das Resultat physiologischer Testergebnisse entstanden. Vestibuläre Störungen können so in der klinischen Praxis umfassend beurteilt und verstanden werden.
Afferent cervical somatosensory input may substitute for absent vestibular information as part of central vestibular compensation after unilateral peripheral vestibular deficit. In order to determine the particular contribution of neck muscle spindles to the perception of body orientation and to the oculomotor system, we measured (i) the subjective visual straight ahead (SVA) by psychophysical tests and (ii) the changes in eye position by video-nystagmography during unilateral stimulation of the posterior neck muscles by vibration (100 Hz). Twenty-five patients with subacute unilateral vestibular lesion (vestibular neuritis) and 25 controls participated in the study. Vibration elicited a horizontal displacement of SVA towards the side of stimulation in all subjects. Mean displacement (+/- SD) was 3.28 +/- 2.96 degrees for right-side and 3.45 +/- 2.93 degrees for left-side stimulation in controls. Muscle stimulation on the patients' lesion side induced a significantly higher displacement (11.51 +/- 6.63 degrees) than contralateral stimulation (3.04 +/- 2.95 degrees, P < 0.01, paired Student's t test). The mean difference during stimulation between the two sides in the patients was 8.02 +/- 5.52 degrees; in the controls, however, it was only 0.74 +/- 0.47 degree (P < 0.001, Student's t test). This asymmetry increased gradually in patients over a period of weeks, reaching a maximum at days 60-80 and declining thereafter. Videonystagmography revealed that ipsilateral stimulation in patients induced large horizontal eye deviations of up to 25 degrees towards the side of the lesion (9.1 +/- 7.6 degrees, n = 18). Contralateral stimulation induced only small shifts, which were within the range of controls. The correlation coefficient between displacement of the SVA and change in eye position was high (r = 0.94, P < 0.0001), indicating that the shift of SVA is the perceptual correlate of the directional change of gaze in space. This interpretation was supported by two control experiments in which the subject was required to (i) indicate the subjective straight ahead by finger-pointing with the eyes closed and (ii) adjust SVA when looking through horizontally reversing prisms. Vibration of neck muscles caused almost no displacement of the SVA when it was indicated by pointing with the eyes closed, but reversed the direction of the displacement if the subject wore reversing prisms. In summary, our data showed: (i) an increase in muscle spindle input following unilateral vestibular lesion; (ii) this increase is asymmetrical, restricted to the affected side, and gradually builds up over weeks; and (iii) the perceived effects during vibration are secondary to changes in eye position rather than changes in cortical representation of body orientation. This is the first study to demonstrate a unilateral increase in somatosensory weight, which substitutes for missing vestibular input.
In human subjects, vibration of amplitude 1.5 mm and frequency 20-220 Hz was applied to the tendons of muscles in the leg to examine the effects on the discharge of primary and secondary endings during manoeuvres designed to alter the level of fusimotor drive. The results suggest that the tonic vibration reflex, like the tendon jerk reflex, operates predominantly or exclusively on alpha motoneurones and that it does not utilize the same cortically originating efferent pathways as are used in the performance of voluntary contractions.
Post-headshake nystagmus (PHN) has recently been described as a clinically useful physical sign implying uncompensated asymmetric input from the vestibular end organs. A rapid 20-second headshake and sudden stop produces a jerk nystagmus of 5- to 20-second duration in certain individuals with symptoms suggestive of a peripheral vestibulopathy. This retrospective review of 214 patient evaluations was undertaken to study the associations between post-headshake nystagmus, caloric deficits after bithermal binaural irrigation, and the presence of vertigo. Both clinical observation of the nystagmus with eyes open (PHN-OBS) and routine EOG recording with eyes closed (PHN-EOG) were used. In patients with unilateral caloric deficits, 42% (18 of 43) had PHN-EOG, compared with 18% (3 of 17) in patients with bilateral dysfunction and 15% (23 of 154) in patients with normal calorics (p less than 0.001). In similar fashion, 26% (32 of 124) of patients with vertigo (recent or past) had PHN-EOG compared to 13% (12 of 90) of patients without vertigo (p less than 0.03). Finally, of 110 cases with both PHN-EOG and PHN-OBS performed, 45% (9 of 20) with PHN-EOG also had PHN-OBS, as opposed to only 4% (4 of 90) without PHN-EOG displaying PHN-OBS (p less than 0.0001). We conclude that the prevalence of post-headshake nystagmus is increased in patients with either a unilateral caloric deficit or a history of true vertigo, and is best detected in the absence of vision.
The retinal coordinates of an image are normally insufficient to define the direction of an object in body-centred visual space. Gaze direction, specified by information on the position of eye-in-head and on the position of head-on-torso, is also required. While the source of the eye-in-head signal is controversial, it is clear that proprioceptive signals from neck muscles are sufficient to provide head-on-torso information. Observations by Goodwin et al., beginning in 1972, that vibration of limb muscles modifies proprioception from them, and induces illusory motion and false perception of limb position, suggested this study of the effects of neck muscle vibration on the representation of visual space. Verbal reports, supported by objective measures, revealed that vibration of muscles on one side of the neck induces a visual illusion: contralateral displacement of a small visual target viewed in the dark. Pointing movements towards the target are similarly affected, confirming that the representation of directions in visual space is modified by neck muscle vibration. A second vibration-induced illusion was uncovered when apparent displacement ceased. This is an illusion of pure target motion in the same direction as the previously observed displacement. The magnitudes of both the displacement and pure motion illusions were dependent on vibration amplitude and were unrelated to real or apparent movements of eyes or head. Taken together these observations indicate that vibration of neck muscles can modify independently (1) the central representation of the instantaneous direction of gaze and (2) the signal of the velocity with which this direction is changing.