Vestibular function testing. Curr Opin Neurol

Antwerp University Research Center for Equilibrium and Aerospace, Department of ENT, University of Antwerp, Antwerp, Belgium.
Current Opinion in Neurology (Impact Factor: 5.31). 03/2007; 20(1):19-24. DOI: 10.1097/WCO.0b013e3280140808
Source: PubMed


This review provides an overview of vestibular function testing and highlights the new techniques that have emerged during the past 5 years.
Since the introduction of video-oculography as an alternative to electro-oculography for the assessment of vestibular-induced eye movements, the investigation of the utricle has become a part of vestibular function testing, using unilateral centrifugation. Vestibular evoked myogenic potentials have become an important test for assessing saccular function, although further standardization and methodological issues remain to be clarified. Galvanic stimulation of the labyrinth also is an evolving test that may become useful diagnostically.
A basic vestibular function testing battery that includes ocular motor tests, caloric testing, positional testing, and earth-vertical axis rotational testing focuses on the horizontal semicircular canal. Newer methods to investigate the otolith organs are being developed. These new tests, when combined with standard testing, will provide a more comprehensive assessment of the complex vestibular organ.

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    • "P13 and N23 latencies (ms) are the time from the onset of the stimulus to the peak. The peak-to-peak amplitude (lV) is considered at the first positive–negative peak (P13–N23) [20]. Statistical methods: Data were coded and entered using the statistical package SPSS version 21. "
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    ABSTRACT: Introduction: Audiovestibular dysfunction has been reported in connective tissue disease patients. Evaluation of the otolith organ function as a part of the vestibular system of the inner ear in systemic sclerosis (SSc) patients is still greatly uncovered in the literature. Aim of work: To assess otolith function in SSc patients and to correlate the findings with the clinical characteristics and disease severity. Patients and methods: Thirty SSc patients and 30 matched controls were included in this work. All patients were subjected to full history taking, clinical examination, assessment disease severity by modified Rodnan skin score (mRss), relevant laboratory and radiological tests. All patients had otolith function assessment using Vestibular Evoked Myogenic Potentials (VEMP) and auditory assessment done using pure tone audiometry (PTA), speech audiometry and tympanometry. Results: Auditory assessment revealed bilateral sensorineural hearing loss (SNHL) in 11 (36.6%) patients an abnormal VEMP response was found in 24 (80%). The mean latencies of P13 and N23 were significantly prolonged than in the controls (p< 0.001). Sine scleroderma subtype was significantly more frequent in SSc patients with normal VEMP (p = 0.04). Skin thickening was significantly more frequent in those with abnormal VEMP (p = 0.04) and the mRss score was also significantly increased (p = 0.007). Those with hearing loss were significantly older in age (p = 0.03) and had a significantly longer disease duration (p = 0.01) and had a significantly increased frequency of digital pitting (p = 0.02) and ulcers (p = 0.03) compared to those with normal hearing. Conclusion: Our results showed an evidence of inner ear involvement in SSc causing audiovestibular abnormalities.
    Full-text · Article · Feb 2015 · Egyptian Rheumatologist
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    • "Electronystagmography (ENG) is a gold standard vestibular function test. The caloric test induces vertigo and assesses only the horizontal semicircular canal function [5]. Compared to the ENG, VEMP testing is easier to perform, less complicated for interpretation, induces less dizziness or nausea , and is more tolerable to patients [6]. "
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    ABSTRACT: Vestibular-evoked myogenic potential (VEMP) testing is a vestibular function test used for evaluating saccular and inferior vestibular nerve function. Parameters of VEMP testing include VEMP threshold, latencies of p1 and n1, and p1-n1 interamplitude. Less commonly used parameters were p1-n1 interlatency, interaural difference of p1 and n1 latency, and interaural amplitude difference (IAD) ratio. This paper recommends using air-conducted 500 Hz tone burst auditory stimulation presented monoaurally via an inserted ear phone while the subject is turning his head to the contralateral side in the sitting position and recording the responses from the ipsilateral sternocleidomastoid muscle. Normative values of VEMP responses in 50 normal audiovestibular volunteers were presented. VEMP testing protocols and normative values in other literature were reviewed and compared. The study is beneficial to clinicians as a reference guide to set up VEMP testing and interpretation of the VEMP responses.
    Full-text · Article · Apr 2012 · International Journal of Otolaryngology
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    • "However, they have not yet come up with an appropriate algorithm for the VOR, possibly due to the short length of data segments. Since no easy-to-use tool has been provided to researchers and clinicians to handle the complexities of this system, experts continue to use the existing oversimplifying methods (Tangorra et al. 2004; Peterka 2005; Juhola et al. 2006; Wuyts et al. 2007). "
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    ABSTRACT: The Vestibulo-Ocular Reflex (VOR) stabilizes images of the world on our retinae when our head moves. Basic daily activities are thus impaired if this reflex malfunctions. During the past few decades, scientists have modeled and identified this system mathematically to diagnose and treat VOR deficits. However, traditional methods do not analyze VOR data comprehensively because they disregard the switching nature of nystagmus; this can bias estimates of VOR dynamics. Here we propose, for the first time, an automated tool to analyze entire VOR responses (slow and fast phases), without a priori classification of nystagmus segments. We have developed GNL-HybELS (Generalized NonLinear Hybrid Extended Least Squares), an algorithmic tool to simultaneously classify and identify the responses of a multi-mode nonlinear system with delay, such as the horizontal VOR and its alternating slow and fast phases. This algorithm combines the procedures of Generalized Principle Component Analysis (GPCA) for classification, and Hybrid Extended Least Squares (HybELS) for identification, by minimizing a cost function in an optimization framework. It is validated here on clean and noisy VOR simulations and then applied to clinical VOR tests on controls and patients. Prediction errors were less than 1 deg for simulations and ranged from .69 deg to 2.1 deg for the clinical data. Nonlinearities, asymmetries, and dynamic parameters were detected in normal and patient data, in both fast and slow phases of the response. This objective approach to VOR analysis now allows the design of more complex protocols for the testing of oculomotor and other hybrid systems.
    Full-text · Article · Oct 2011 · Journal of Computational Neuroscience
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