Evaluation of Vestibular Functions in Patients with Vogt-Koyanagi-Harada Disease

2017 ◽  
Vol 22 (3) ◽  
pp. 190-195 ◽  
Author(s):  
Keishi Fujiwara ◽  
Shinya Morita ◽  
Kimiko Hoshino ◽  
Atsushi Fukuda ◽  
Yuji Nakamaru ◽  
...  
Keyword(s):  
Autoimmune Disorder ◽  
University Hospital ◽  
Caloric Test ◽  
Subjective Symptoms ◽  
Vestibular Evoked Myogenic Potential ◽  
Caloric Testing ◽  
Ocular Vemp ◽  
Cervical Vemp ◽  
Vestibular Symptoms ◽  
Vkh Disease

Vogt-Koyanagi-Harada (VKH) disease is an idiopathic, multisystem autoimmune disorder characterized by bilateral, diffuse granulomatous uveitis associated with neurological, audiovestibular, and dermatological manifestations. The purpose of this study is to investigate vestibular functions in patients with VKH disease. A total of 43 patients with VKH disease in Hokkaido University Hospital were enrolled in this study. Subjective symptoms such as dizziness or vertigo and the results of various vestibular examinations including nystagmus testing, caloric testing, and vestibular-evoked myogenic potential (VEMP) testing were investigated. Eight of 42 patients (19.0%) complained of subjective vestibular symptoms. On the other hand, 12 of 28 patients (42.9%) showed nystagmus, and 7 of 15 patients (46.7%) showed unilateral or bilateral weakness in the caloric test. VEMP testing was performed for 16 patients. Seven (43.8%) and 8 (50.0%) patients were evaluated as abnormal in cervical VEMP and ocular VEMP testing, respectively. The rate of detection of nystagmus was significantly higher than that of subjective symptoms. As vestibular dysfunction in patients with VKH disease cannot be detected through history taking alone, nystagmus testing, caloric testing, and VEMP testing should be performed to evaluate vestibular functions associated with VKH disease. It is considered that abnormal VEMP findings are associated with otolith organ dysfunction.

Vestibular Functions of Hereditary Hearing Loss Patients with GJB2 Mutations

2015 ◽  
Vol 20 (3) ◽  
pp. 147-152 ◽  
Author(s):  
Keita Tsukada ◽  
Hisakuni Fukuoka ◽  
Shin-ichi Usami
Keyword(s):  
Gjb2 Gene ◽  
Caloric Test ◽  
Congenital Deafness ◽  
Lateral Semicircular Canal ◽  
Vestibular Evoked Myogenic Potential ◽  
Causative Gene ◽  
Myogenic Potential ◽  
Vestibular Testing ◽  
Vestibular Symptoms ◽  
Gjb2 Mutations

Objectives: Mutations in the GJB2 gene have been of particular interest as it is the most common causative gene for congenital deafness in all populations. Detailed audiological features, including genotype-phenotype correlations, have been well documented. However, in spite of abundant gene as well as protein expression in the vestibular end organs, neither vestibular symptoms nor vestibular functions have yet been elucidated. In the present study, vestibular functions were evaluated in patients diagnosed with GJB2-related deafness. Subjects and Methods: Vestibular functions were evaluated by caloric test and cervical vestibular evoked myogenic potential (cVEMP) testing in 24 patients with biallelic GJB2 mutations. Results and Discussion: Twenty-one of 23 patients (91.3%) had normal caloric responses and significantly lower cVEMP amplitudes than the control subjects. In the patients who were able to undergo vestibular testing, the mostly normal reactions to caloric testing indicated that the lateral semicircular canal was intact. However, the majority of GJB2 patients showed low cVEMP reactions, indicating a saccular defect.

scholarly journals Diagnostic capabilities of the vestibular evoked myogenic potential test in children with vestibular dysfunction

2020 ◽  
Vol 6 (4) ◽  
pp. 606 ◽  
Author(s):  
Kalina I. Madzharova ◽  
Ana P. Beshkova
Keyword(s):  
Vestibular Dysfunction ◽  
Otolith Organs ◽  
Vestibular Evoked Myogenic Potential ◽  
Additional Method ◽  
Analysis And Evaluation ◽  
Myogenic Potential ◽  
Ocular Vemp ◽  
Cervical Vemp ◽  
Diagnostic Capabilities

<p class="abstract"><strong>Background:</strong> Vestibular evoked myogenic potential (VEMP) testing is used in the diagnosis of vestibular disorders. It is an objective method for testing the the otolith organs of the vestibular system. VEMP test is an additional method for diagnosing vestibular neuritis (VN). The combination of cervical VEMP (cVEMP) and ocular VEMP (oVEMP) testing has an advantage in long-term monitoring of patients with VN. The VEMP test is well-studied for adults but studies involving children are insufficient. The aim of this study was to analysis and evaluation of the results from VEMP testing of children diagnosed with vestibular dysfunction. Analysis and evaluation of the results from VEMP testing of children diagnosed with vestibular dysfunction.</p><p class="abstract"><strong>Methods:</strong> History, examination of ENT organs, tone threshold audiometry, tympanometry, otoneurological examination, VEMP test.  </p><p class="abstract"><strong>Results:</strong> Children with vestibular dysfunction who were examined showed changes predominantly in the oVEMP test. The upper branch of the vestibular nerve is affected.   </p><p class="abstract"><strong>Conclusions:</strong> The VEMP test is an additional method for diagnosing patients with vestibular dysfunction. It is safe when used for children.</p>

scholarly journals Significance of continuing audiovestibular practice during Covid-19 pandemic

2021 ◽  
Vol 37 (1) ◽  
Author(s):  
Oğuz Yilmaz ◽  
Dilara Bayazit ◽  
Handan Yaman ◽  
Berna Özge Mutlu
Keyword(s):  
Risk Factors ◽  
Cochlear Implant ◽  
Auditory Brainstem ◽  
University Hospital ◽  
Head Impulse Test ◽  
Caloric Test ◽  
Vestibular Evoked Myogenic Potential ◽  
Test Procedures ◽  
Lip Reading ◽  
Brainstem Response

Abstract Background We aimed to evaluate the significance of continuing audiovestibular practice during the Covid-19 pandemic in the audiology clinic of the university hospital. Methods The precautions, test procedures, and risk factors associated with the practice of audiology were evaluated. The number and diagnoses of the cases between 23 March and 23 May 2020 were also compared with the results of the same 2 months in 2019 in an attempt to evaluate the alterations in the audiology practice. Results The audiology practice has continued during the pandemic, and numerous audiovestibular tests like newborn hearing screening, pure tone and speech audiometry, auditory brainstem response (ABR) test, bedside vestibular assessment, videomystagmography (VNG), caloric test, vestibular evoked myogenic potential (VEMP), computerized dynamic posturography (CDP), video head impulse test (vHIT), intraoperative cochlear implant measurement, and postop cochlear implant fittings were performed. The number of tests has decreased significantly in the course of the pandemic (p < 0.01). No evidence of Covid-19 disease was detected in the audiology staff and patients. In general, no major risk was seen during testing under protective measures except for vestibular testing which induced vomiting and taking out the mask for lip reading during cochlear implant fitting in the elderly. Conclusion It is possible to perform audiovestibular tests during the Covid-19 pandemic by wearing necessary protective equipment and disinfecting the potential surfaces. Vomiting during vestibular tests, uncovering the nose and mouth for lip reading, and small-sized test cabins are the main risk factors of contamination in the audiology clinics.

scholarly journals Quantitative Vestibular Function Testing in the Pediatric Population

2018 ◽  
Vol 39 (03) ◽  
pp. 257-274 ◽  
Author(s):  
Amanda Rodriguez ◽  
Kristen Janky
Keyword(s):  
Pediatric Population ◽  
Vestibular Function ◽  
Head Impulse Test ◽  
Caloric Test ◽  
Vestibular Loss ◽  
Head Impulse ◽  
Ocular Vemp ◽  
Cervical Vemp ◽  
Vestibular Function Testing ◽  
Function Testing

AbstractQuantitative tests of vestibular function include the caloric test, cervical and ocular vestibular evoked myogenic potential (VEMP), rotary chair, and head impulse test, either at the bedside or utilizing video head impulse test (vHIT). The purpose of this article is to provide an overview of how to perform these tests in children, including which tests are recommended based on the child's age and any modifications or considerations that can be made. A variety of clinical measures have been recommended as screening measures for vestibular loss, which will be reviewed. Symptom questionnaires designed to assess the functional impact of dizziness and vestibular loss in children will also be discussed. If a child complains of dizziness or if vestibular loss is suspected (either by case history or positive screening measure), vestibular function testing is warranted. For vestibular function testing, children aged 0 to 2 years typically receive rotary chair, cervical VEMP, and vHIT if a remote system is available. For children aged 3 to 7 years, vHIT, cervical VEMP, and ocular VEMP are completed, and for children aged 8+ years, vHIT, caloric testing if vHIT is normal, and cervical and ocular VEMP are completed. For all children, modifications to testing can be made, as needed.

scholarly journals Ocular vestibular evoked myogenic potential (VEMP) reveals subcortical HTLV-1-associated neurological disease

2019 ◽  
Author(s):  
Tatiana Rocha Silva ◽  
Marco Aurélio Rocha Santos ◽  
Luciana Macedo de Resende ◽  
Ludimila Labanca ◽  
Rafael Teixeira Scoralick Dias ◽  
...  
Keyword(s):  
Neurological Disease ◽  
Evoked Potential ◽  
Hearing Level ◽  
Vestibular Evoked Myogenic Potential ◽  
Asymptomatic Group ◽  
Cross Sectional ◽  
Recording Time ◽  
Ocular Vemp ◽  
Human T Cell ◽  
Cervical Vemp

AbstractIntroductionVestibular Myogenic Evoked Potential (VEMP) evaluates vestibulo-ocular and vestibulospinal reflexes associated with posture.PurposeTo compare cervical and ocular VEMP in individuals with HTLV-1 associated myelopathy (HAM) and with HTLV-1-asymptomatic infection.Materials and MethodsThis cross-sectional study included 52 HTLV-1-infected individuals (26 HAM and 26 asymptomatic carriers) and 26 negative controls. The groups were similar regarding age and gender. Participants underwent ocular and cervical VEMP that were performed simultaneously. The stimulus used to generate VEMP was a sound, low-frequency toneburst, intensity of 120 decibels normalized hearing level (dB nHL), bandpass filter from 10 to 1,500 Hz, with 100 stimuli at 500 Hertz (Hz) and 50 milliseconds (ms) recording time. An alteration in the electrophysiological waves P13 and N23 for cervical VEMP and N10 and P15 waves for ocular VEMP was compared between groups.ResultsCervical VEMP was different among the groups for P13 (p=0.001) and N23 (p=0.003). Ocular VEMP was similar for N10 (p=0.375) and different for P15 (p=0.000). In the HTLV-1-asymptomatic group, 1(3.8%) individual presented changes in both ocular and cervical VEMP, while in HAM group, 16(61.5%) presented changes in both tests.ConclusionNeurological impairment in HAM was not restricted to the spinal cord. The mesencephalic and thalamic connections, tested by ocular VEMP, were also altered. Damage of the oculomotor system, responsible for eye stabilization during head and body movements, may explain why dizziness is such a frequent complaint in HAM.Authors’ summaryHuman T-cell lymphotropic virus type 1 (HTLV-1) infection is endemic in Brazil and can cause HTLV-1-associated myelopathy (HAM). This neurological disease progresses slowly and, within ten years after its onset, can confine the patient to a wheelchair. Changes in HAM inflammatory characteristics can subsequently occur in the cortex, subcortical white matter, cerebellum, and brainstem. In the present study, we used the electrophysiological test Vestibular Myogenic Evoked Potential (VEMP) to evaluate the thalamic, brainstem, and spinal neural connections. This test evaluates the peripheral and the central vestibular pathway and has been used to test the postural reflexes involved in the control of one’s balance. The VEMP from the oculomotor muscles demonstrated that a subcortical impairment occurs in HAM and can also occur in the asymptomatic phase of HTLV-1 infection.

scholarly journals Assessment of cervical and ocular vestibular evoked myogenic potentials in migraine patients

2020 ◽  
Vol 36 (1) ◽  
Author(s):  
Doaa Elmoazen ◽  
Hesham Kozou ◽  
Jaidaa Mekky ◽  
Dalia Ghanem
Keyword(s):  
Vestibular Function ◽  
Vestibular Dysfunction ◽  
Peak Amplitude ◽  
Vestibular Evoked Myogenic Potentials ◽  
Healthy Controls ◽  
Latency Difference ◽  
Significant Difference ◽  
Cervical Vemp ◽  
Vestibular Symptoms ◽  
Function Assessment

Abstract Background Patients suffering from vestibular migraine (VM) are known to have various vestibular test abnormalities interictally and ictally. Recently, vestibular evoked myogenic potentials (VEMPs) have become accepted as a valid method for otolith function assessment. Many studies have identified various vestibular symptoms and laboratory abnormalities in migraineurs. Since migraineurs with no accompanying vestibular symptoms might exhibit subclinical vestibular dysfunction, we investigated vestibular function using ocular and cervical VEMPs in migraine patients. The aim was to study cervical VEMP and occular VEMP in migraineurs with and without vestibular symptoms interictally. Results Migraine and VM patients showed significantly longer P13 latency of cVEMP compared to controls. A statistically significant cVEMP interaural P13 latency difference was found in VM compared to healthy controls. Cervical VEMP N23 latency, peak-to-peak amplitude, interaural N23 latency, and amplitude asymmetric ratio did not show any significant difference in migraine and VM patients compared to healthy controls as well as no significant difference across the three groups regarding oVEMP parameters. Conclusions Abnormal interictal cVEMP results in migraineurs might indicate subclinical vestibulo-collic pathway dysfunction.

scholarly journals Vestibular Preservation After Cochlear Implantation Using the Round Window Approach

2021 ◽  
Vol 12 ◽  
Author(s):  
Keita Tsukada ◽  
Shin-ichi Usami
Keyword(s):  
Cochlear Implantation ◽  
Round Window ◽  
Surgical Techniques ◽  
Vestibular Function ◽  
Vestibular Evoked Myogenic Potential ◽  
Flexible Electrodes ◽  
Caloric Testing ◽  
Before And After ◽  
Window Approach ◽  
Caloric Response

Background: The development of less traumatic surgical techniques, such as the round window approach (RWA), as well as the use of flexible electrodes and post-operative steroid administration have enabled the preservation of residual hearing after cochlear implantation (CI) surgery. However, consideration must still be given to the complications that can accompany CI. One such potential complication is the impairment of vestibular function with resulting vertigo symptoms. The aim of our current study was to examine the changes in vestibular function after implantation in patients who received CI using less traumatic surgery, particularly the RWA technique.Methods: Sixty-six patients who received CI in our center were examined by caloric testing, cervical vestibular evoked myogenic potential (cVEMP) and ocular VEMP (oVEMP) before or after implantation, or both, to obtain data on semicircular canal, saccular and utricular function, respectively. Less traumatic CI surgery was performed by the use of the RWA and insertion of flexible electrodes such as MED-EL FLEX soft, FLEX 28, and FLEX 24 (Innsbruck, Austria).Results: Caloric response and the asymmetry ratio of cVEMP and oVEMP were examined before and after implantation using less traumatic surgical techniques. Compared with before implantation, 93.9, 82.4, and 92.5% of the patients showed preserved vestibular function after implantation based on caloric testing, cVEMP and oVEMP results, respectively. We also examined the results for vestibular function by a comparison of the 66 patients using the RWA and flexible electrodes, and 17 patients who underwent cochleostomy and insertion of conventional or hard electrodes. We measured responses using caloric testing, cVEMP and oVEMP in patients after CI. There were no differences in the frequencies of abnormal caloric and oVEMP results in the implanted ears between the RWA and cochleostomy. On the other hand, the frequency of abnormal cVEMP responses in the implanted ears in the patients who received implantation by cochleostomy was significantly higher than that in the patients undergoing surgery using the RWA.Conclusion: Patients receiving CI using less traumatic surgical techniques such as RWA and flexible electrodes have reduced risk of damage to vestibular function.

Association between vestibular dysfunction and findings of horizontal head-shaking and vibration-induced nystagmus

2020 ◽  
Vol 30 (5) ◽  
pp. 319-327
Author(s):  
Chisato Fujimoto ◽  
Takuya Kawahara ◽  
Masato Yagi ◽  
Toshihisa Murofushi
Keyword(s):  
Medical Records ◽  
Vestibular Function ◽  
Mixed Effects ◽  
Vestibular Dysfunction ◽  
Regression Analyses ◽  
Lateral Semicircular Canal ◽  
Vestibular Evoked Myogenic Potential ◽  
Vestibular Diseases ◽  
Ocular Vemp ◽  
Horizontal Head

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.

Investigating short latency subcortical vestibular projections in humans: what have we learned?

2019 ◽  
Vol 122 (5) ◽  
pp. 2000-2015 ◽  
Author(s):  
James G. Colebatch ◽  
Sally M. Rosengren
Keyword(s):  
Brain Stem ◽  
Physiological Role ◽  
Vestibular Function ◽  
Short Latency ◽  
Vestibular Evoked Myogenic Potentials ◽  
Ocular Vemp ◽  
Motor Unit Firing ◽  
Cervical Vemp ◽  
Noninvasive Assessment

Vestibular evoked myogenic potentials (VEMPs) are now widely used for the noninvasive assessment of vestibular function and diagnosis in humans. This review focuses on the origin, properties, and mechanisms of cervical VEMPs and ocular VEMPs; how these reflexes relate to reports of vestibular projections to brain stem and cervical targets; and the physiological role of (otolithic) cervical and ocular reflexes. The evidence suggests that both VEMPs are likely to represent the effects of excitation of irregularly firing otolith afferents. While the air-conducted cervical VEMP appears to mainly arise from excitation of saccular receptors, the ocular VEMP evoked by bone-conducted stimulation, including impulsive bone-conducted stimuli, mainly arises from utricular afferents. The surface responses are generated by brief changes in motor unit firing. The effects that have been demonstrated are likely to represent otolith-dependent vestibulocollic and vestibulo-ocular reflexes, both linear and torsional. These observations add to previous reports of short latency otolith projections to the target muscles in the neck (sternocleidomastoid and splenius) and extraocular muscles (the inferior oblique). New insights have been provided by the investigation and application of these techniques.

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