Videonystagmography Research Articles

Effects of Covid-19 on the audio-vestibular system

PurposeIt was aimed to investigate the effects of COVID-19 infection on hearing and the vestibular system. MethodsTwenty-six patients whose treatment had been completed and who had no previous hearing or balance complaints were included in the study. Patients diagnosed with the disease by PCR were included in the study. Patients with at least one month of illness were included in the study. The hearing of patients was evaluated with transient evoked otoacoustic emissions (TEOAE) and pure-tone audiometry. Bedside tests, the European Evaluation of Vertigo scale (EEV), Video Head Impulse Test (vHIT), Ocular Vestibular Myogenic Evoked Potential (oVEMP), Cervical Vestibular Myogenic Evoked Potential (cVEMP) and Videonystagmography (VNG) tests were applied to evaluate the vestibular system. ResultsA statistically significant difference was found between the COVID-19 positive and control groups according to the mean values of the 4000 Hz and 8000 Hz in both the right and left ears (p < 0.05). No statistically significant difference was found in the other frequencies and TEOAE. No statistically significant difference was found between the COVID-19 positive and control groups in terms of their normal or pathological VNG saccade, optokinetic and spontaneous nystagmus values (p > 0.05). The normal and pathological VNG head shake values were found to be significantly different between the COVID-19 positive and control groups (p < 0.05). ConclusıonThe high frequencies in audiometry in the COVID-19 positive group were worse than those in the control group. In the vestibular system, especially in oVEMP and cVEMP, asymmetric findings were obtained in comparison to the control group, and a low gain in vHIT was shown. This study shows that the audiovestibular system of people with COVID-19 infection may be affected.

Vestibular dysfunction in cochlear implant candidates: Prevalence and outcomes

PurposeCochlear implantation (CI) has been shown to reduce vestibular function postoperatively in the implanted ear. The objective of this study was to identify the prevalence of preoperative vestibular weakness in CI candidates and identify any risk factors for postoperative dizziness. Study designRetrospective cohort study. Materials and methodsPatients who underwent CI and had preoperative videonystagmography (VNG) at the Silverstein Institute from January 1, 2017 to May 31, 2020 were evaluated. The primary endpoint was dizziness lasting more than one month postoperatively. ResultsOne hundred and forty nine patients were evaluated. Preoperative VNG revealed that 46 (30.9%) had reduced vestibular response (RVR) on one side and 32 (21.5%) had bilateral vestibular hypofunction (BVH). Postoperative dizziness occurred in 14 (9.4%) patients. Patients with postoperative dizziness were more likely to have abnormal preoperative VNG (RVR or BVH), compared to patients without postoperative dizziness (78.6% versus 49.6%, p = 0.0497). In cases of RVR, implantation of the weaker or stronger vestibular ear did not affect the postoperative dizziness (16.1% versus 6.7%, p = 0.38). Postoperative VNG in patients with dizziness showed decreased caloric responses in the implanted ear (28.4 to 6.4 degrees/s, p = 0.02). ConclusionPreoperative caloric weakness is prevalent in CI candidates and abnormal preoperative vestibular testing may be a predictor of postoperative dizziness. CI has the potential to cause vestibular injury and preoperative testing may aid in both counseling and decision-making.

Sensitivity and specificity of the modified tandem walking test for vestibular hypofunction with chronic dizziness in young adults

Background/Aim: Patient comfort is greatly affected during videonystagmography (VNG), and more comfortable tests are needed for diagnosis. This study aims to evaluate the modified tandem walking test (MTWT) as an alternative pre-assessment method to the VNG test. Methods: A total of 3348 patients were recruited in this retrospective cohort study between 2015-2019 based on the inclusion criteria of having chronic dizziness (>3 months), being aged between 18-65 years, and having an interpretable VNG test result. All patients were examined by an otolaryngologist, and the examination phase consisted of three parts: Physical examination, VNG test, and performing MTWT. The sensitivity, specificity, and likelihood ratio of the MTWT were calculated with the relevant formulas. Results: The female/male ratio was 2.19, and there was no significant difference between the groups in terms of age (P=0.334). The number of patients who were VNG positive (regardless of MTWT), both VNG and MTWT positive, both VNG and MTWT negative, and VNG negative (regardless of MTWT) were 2519, 2000, 699, and 2519, respectively. The sensitivity and specificity of MTWT were 79.37%, and 84.31%, respectively. Conclusion: MTWT has good sensitivity and specificity, and we think that it can be a safe, simple, and accessible pre-diagnostic tool when VNG is not available or cannot be tolerated by the patients.

A novel diagnostic method for myasthenia gravis.

Videonystagmography (VNG) which directly records eye movements using infrared video goggles with mini-cameras, is used to measure nystagmus. Our aim is to explore whether VNG can be used to detect a decrement in the extraocular muscle (EOM) activity of patients with myasthenia gravis (MG). Thirty-four patients with MG, including 13 with ocular-predominant and 21 with generalized MG, and 23 healthy controls participated. Using VNG we recorded the velocity of the eye movements of the patients as they followed a moving target. We then calculated the gain by dividing the eye movement velocity (degrees/second) by the target velocity (degrees/second). In MG subjects, the mean initial gain (maximum gain) was 1.23 ± 0.31 (range: 0.63-2.15) for the right eye and 1.22 ± 0.37 (range; 0.60-2.28) for the left eye. The mean minimum gain was 0.11 ± 0.12 (0.01-0.58) for the right and 0.14 ± 0.5 (0.02-0.55) for the left. Due to fatigue, the movement gain was reduced by 91.7% in the right eye and 88.2% in the left eye. After reaching minimum velocity, gain remained at a minimum for a mean of 1.08 ± 0.52 (0.3-2.4) s for the right and 1.49 ± 0.85 (0.4-3.6) s for the left, before the velocity increased again. There was no fatigue-induced decrement in healthy subjects. Our study documents a decrement in EOM activity recorded by VNG in patients with MG which begins to improve within 1-2 s after reaching minimum velocity, analogous to traditional low-frequency repetitive nerve stimulation testing and its U-shaped pattern. Thus, VNG may be a promising diagnostic test for MG.

Vestibular Hypersensitivity in Patients with Chronic Noise Exposure.

It has been demonstrated that high-intensity noise exposure adversely affects the human balance function. The Tullio phenomenon (TP) refers to sound-induced imbalance which is resulted from hypersensitivity of vestibular end organs to normal acoustic stimuli. Although different etiologies have been attributed to TP, evidence on the role of excessive noise exposure in the development of this symptom is limited. The present study aims to assess the vestibular functions in patients manifesting TP symptom who were exposed to long-term excessive noise levels. This was an analytic cross-sectional study conducted on 17 males diagnosed with TP with a history of chronic noise-induced hearing loss (TP group) and 17 healthy individuals. All subjects in both groups underwent complete otological, videonystagmography (VNG), and cervical vestibular myogenic potential (cVEMP) assessments. The most common complaint in TP subjects was vertigo and imbalance. During the VNG assessment, we found abnormal positional nystagmus and caloric irrigation (vestibular hyperfunction) results in 4 (23.53%) and 9 (52.94%) patients, respectively. Seven (41.17%) patients indicated cVEMP thresholds which were abnormally lower than the normal values (≤70dB HL). However, when both VNG and cVEMP results were considered together, the abnormal rate reached 70.58% (12 of 17 cases). Our findings showed that both the semicircular canal as well as otolith stuctures could be affected in TP patients with a history of chronic noise exposure.

Superior Semicircular Canal Dehiscence Syndrome Following Head Trauma: A Multi-institutional Review.

To evaluate patients who become symptomatic from superior semicircular canal dehiscence (SSCD) following head trauma. Case series assessing patients presenting with SSCD after a trauma. A case series was completed assessing patients presenting with SSCD after trauma. Data from three academic medical centers were evaluated, including the following: imaging, videonystagmography (VNG)/vestibular evoked myogenic potential (VEMP) testing, audiometric assessment, and surgical repair. Outcome measures included the following: 1) Description of audio-vestibular symptoms, 2) mean pre- and post-operative pure tone average (PTA), word recognition score (WRS), and air bone gap (ABG). A total of 14 patients were included; 86% were male. Approximately 43% were found to have bilateral SSCD on imaging, with 57% of patients pursuing surgical management. The most common presenting symptoms included pulsatile tinnitus (93%), autophony (79%), and hearing loss (64%). Approximately 36% of patients underwent VNG/VEMP testing, with 83.3% of those demonstrating abnormal results. The mean audiometric findings on the symptomatic side included an air-conduction PTA of 38.0 dB, bone-conduction PTA of 24.3 dB, WRS of 81%, and ABG of 17.9 dB. Among patients who underwent surgery (57%), there was no significant change in the air-conduction PTA, bone-conduction PTA, or WRS (P > .05). However, there was an improvement in the ABG (preoperative=22.8 dB versus postoperative=9.7 dB; P=.005). Head trauma may be a potentiating event for SSCD syndrome. This study advances the hypothesis that these patients likely have underlying radiographic SSCD prior to their trauma, and a traumatic event increases in intra-vestibular or intracranial pressures, unmasking SSCD syndrome. 4 Laryngoscope, 131:E2810-E2818, 2021.

VESTIBULAR TESTING IN CHILDREN WITH DIZZINESS AND BALANCE CONCERNS AFTER CONCUSSION: LABORATORY AND CLINICAL RESULTS

Background:Dizziness is the second most common symptom in people who sustain a concussion and there are few reports on vestibular laboratory findings in the concussed pediatric population. Studies to date have shown conflicting findings regarding incidence of peripheral vestibular disorders. Hypothesis/Purpose: The purpose of this study is to report vestibular laboratory and clinical examination findings in concussed youth referred to a multidisciplinary vestibular clinic.Methods:A retrospective chart review was performed for all patients (n=474) seen from August 2017 to March 2020 for a single comprehensive examination in a multidisciplinary pediatric vestibular specialty clinic. Data was extracted from the charts of patients (n=64) with a history of concussion referred because of chronic dizziness and/or imbalance. Each patient was examined by a neurotologist, physical therapist, and audiologist with specialized training in vestibular disorders. Vestibular laboratory testing performed by audiologists included video nystagmography (VNG) evaluation of oculomotor function and BPPV, rotational chair, video head impulse test (vHIT), vestibular evoked myogenic potentials (VEMPs), post-headshake nystagmus, and caloric irrigation. Physical therapy clinical examination included dynamic visual acuity testing (DVA), vestibular/oculomotor screening (VOMS), and sensory organization test (SOT). Not all tests were performed on every patient secondary to factors such as insurance coverage, patient tolerance, and young age.Results:1 or more components of VOMS was abnormal in 30 of 53 patients examined. DVA was completed on 40 patients, 23 of which were reported as abnormal. SOT was completed on 46 patients, 18 of which demonstrated below normal composite equilibrium scores. Laboratory findings were as follows: VEMPs (n=50) were normal in all but 1 patient, vHIT (n=59), caloric irrigation (n=26), post-headshake nystagmus (n=49), and positional testing (n=55) were normal on all patients tested. Rotational chair (n=60) was performed at 4 different frequencies and revealed low gain in 3 patients.Conclusion:Vestibular laboratory examination was normal in nearly all subjects tested. These results suggest that in concussed youth with chronic dizziness and/or imbalance, laboratory vestibular test outcomes indicative of peripheral dysfunction are rare, which contradicts previous research in this population. In contrast, clinical vestibular assessment was abnormal in more than 50% of subjects examined which suggests that clinicians should use caution interpreting clinical examination findings for diagnosing peripheral vestibular dysfunction. Abnormal clinical examination findings may be indicative of central vestibular conditions such as space and motion intolerance and PPPD in chronically dizzy pediatric patients after concussion.Tables/Figures:

Effects of cognitive tasks on eye movements.

Eye movements are guided by vestibular and visual information. The vestibulo-ocular knowledge of the vestibule includes eye movements in the opposite direction of head movements. This study investigated the effect of auditory "what" and "where" tasks on the visual "where" to evaluate the effects of cognitive tasks on eye movements. All subjects underwent testing with videonystagmography (VNG). The VNG battery of saccade and tracking oculomotor tests were performed. The study design was planned in three stages: (1) without any cognitive tasks, eye movements were recorded with VNG, (2) participants were asked to tell "what" sound they heard during VNG recording, and (3) the subject was asked to tell from what direction, or "where," the sound had come from during VNG recording. Providing individuals with a cognitive task changed the test results negatively in all parameters. Giving cognitive tasks to individuals spoils all VNG parameters. The VNG oculomotor tests are affected by the dual tasks. Daily tasks such as sound object localization and recognition have a significant effect on scanning the visual environment in daily life such as during driving or walking in a crowded environment.

Unusual presentation of an intracochlear schwannoma

In this report, the authors discuss the case of a 49-year-old male presenting with sudden onset moderately severe left-sided Sensorineural Hearing Loss (SNHL), tinnitus, left otalgia, and disequilibrium. Prior to referral to our facility, an MRI was obtained which demonstrated non-specific asymmetric enhancement of the left cochlea that was initially suspected to be labyrinthitis. Patient was treated with valacyclovir and a prednisone burst-taper prior to referral. Despite this treatment, his left SNHL worsened, and he was noted to have left-sided peripheral weakness on Videonystagmography (VNG). Upon referral to our facility, MRI demonstrated an Intra-Cochlear Schwannoma (ICS), with possible associated hemorrhage into the cochlea. After discussion of treatment options, repeat imaging in 6-month interval demonstrated stable persistence of the lesion with no growth. The patient is currently being followed with a “Wait-andScan” regimen. Sudden unilateral SNHL is a rare presenting symptom for ICS and this case highlights not only the rarity in presentation, but also the complexity in diagnosis due to the possibility of intracochlear hemorrhage complicating the imaging work-up. Keywords: Intra-labyrinthine schwannoma; vestibular schwannoma; sensorineural hearing loss; disequilibrium. Abbreviations: SNHL: Sensorineural Hearing Loss; VNG: Videonystagmography; ICS: Intracochlear Schwannoma; MRI: Magnetic Resonance Imaging; IAC: Internal Auditory Canal; ILS Intra-Labyrinthine Schwannomas; CT: Computed Tomography; SRT: Speech Reception Threshold.

Risk factors related balance disorder for patients with dizziness/vertigo

BackgroundWhen dizziness/vertigo patients presented with balance disorder, it will bring severe morbidity. There is currently lack of research to explore risk factor related balance disorder in dizziness patients, especially in those who walk independently.AimTo investigate risk factors related balance disorder in dizziness/vertigo patients who walk independently.MethodsMedical data of 1002 dizziness/vertigo patients registered in vertigo/balance disorder registration database were reviewed. The demographic data, medical history, and risk factors for atherosclerosis (AS) were collected. Enrolled dizziness/vertigo patients could walk independently, completed Romberg test, videonystagmography (VNG), and limits of stability (LOS). The subjective imbalance was patient complained of postural symptom when performing Romberg test. Multivariable logistic regression analyzed risk factors related balance disorder. The receiver operating characteristic (ROC) curve evaluated the utility of regression model.ResultsFive hundred fifty-three dizziness/vertigo patients who walk independently were included in the final analysis. According to LOS, patients were divided into 334 (60%) normal balance and 219 (40%) balance disorder. Compared with normal balance, patients with balance disorder were older (P = 0.045) and had more risk factors for AS (P<0.0001). The regression showed that risk factors for AS (OR 1.494, 95% CI 1.198–1.863), subjective imbalance (OR 4.835, 95% CI 3.047–7.673), and abnormality of optokinetic nystagmus (OR 8.308, 95% CI 1.576–43.789) were related to balance disorder. The sensitivity and specificity of model were 71 and 63% (P<0.0001). The area under the curve (AUC) was 0.721.ConclusionsRisk factors for AS, subjective imbalance, and abnormality of optokinetic nystagmus were predictors for balance disorder in patients with dizziness/vertigo who walk independently.

Vestibular Function in Older Adults With Cognitive Impairment: A Systematic Review

Importance: Given the rising prevalence of patients with dementia and those at risk for it, early identification is prioritized. As vestibular dysfunction is associated with Alzheimer’s disease (AD) and may contribute to its onset, vestibular assessment may yield an opportunity in early dementia screening. Objective: This systematic review structures and compares the different raw outcome measures used to assess vestibular function while comparing older adults with preserved cognition to individuals with cognitive impairment, either suffering from mild cognitive impairment (MCI) or AD. Design: Two investigators independently and systematically searched publications performing objectively measured vestibular testing in a patient population consisting of either MCI or AD, compared with a control group of older adults with preserved cognition. No limitations regarding language or publication date were applied. References of the retrieved articles were hand searched for relevant articles. Results: Seven articles were included for analysis. A total of 235 older adults with impaired cognition (150 AD, 85 MCI) were compared with a control group of 481 older adults with preserved cognition. Evaluation of the peripheral vestibular function included video head impulse test (vHIT), videonystagmography (VNG), electronystagmography (ENG) including bithermal caloric irrigation and vestibular evoked myogenic potentials (VEMP). The VEMP test, assessing otolith function and the elicited vestibulocollic reflex (VCR), was able to differentiate subjects with AD and its prodromal stage from healthy controls, with p13 latency (p &lt; 0.05) and amplitude (p &lt; 0.05) having the most discriminating power. No correlation between cognitive decline and vestibulo-ocular reflex measurements in different frequency ranges of the semicircular canals (using vHIT, rotatory chair testing, and caloric irrigation) was found. Because of the limited number of available studies and the large heterogeneity in outcome measures, these results have to be interpreted with caution. Conclusions: Measurements of the VCR, as evoked by the VEMP test, discriminate between patients with cognitive impairment (MCI and AD) and older adults with preserved cognition, whereas measurements of the vestibulo-ocular reflex do not. More studies are needed to further elaborate on these findings.

Treatment Results of Definite and Probable Meniere's Disease

Objectives: To evaluate the treatment results of definite and probable Meniere's disease (MD). Methods: A total of 51 patients, who were diagnosed with Meniere's disease (MD) between January 2019 to January 2021 at EMJJ ENT hospital's vestibular laboratory in Mongolia, was included in our study. The diagnosis of Meniere's disease was according to the 2015 Diagnostic criteria of Meniere's disease of the Classification Committee of the Barany Society. The clinical dizziness handicap inventory (DHI) questionnaire was taken, and videonystagmography (VNG), caloric test, and PTA was done in all patients. Results: Of a total of 51 patients, 9 were diagnosed as probable MD, and 42 were diagnosed as definite MD. The mean age of the patients was 43.7, male to female ratio was 1:1.8, 37 (72.5%) patients were in treatment group I who all received medication only, and 14 (27.5%) patients were in treatment group II who were refractory to prior medical therapy underwent ITDL Comparing the two treatment groups, there were significant differences in all test results (p = 0.000). After ITDI hearing improved (p = 0.000). Conclusions: VNG, caloric test, and DHI questionnaire results show that both medical treatment and ITDI are successful in improving vestibular function.

Evaluation of vestibular function following endolymphatic sac surgery.

To evaluate objective vestibular function after endolymphatic sac surgery (ELSS) for Menière's disease (MD), using comparative vestibular function tests: videonystagmography (VNG), vestibular evoked myogenic potentials (VEMP) and video head-impulse test (VHIT) METHODS: Patients with definite MD using the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) of 1995 criteria modified in 2015 and treated with ELSS (sac decompression or sac opening) were included. The primary outcome was the preservation of vestibular function, comparing pre- and postoperative vestibular function tests: VNG, VEMP, VHIT. Secondary outcomes were control of episodes of vertigo, hearing outcome using AAO-HNS criteria, and QoL using the Menière's disease outcome questionnaire. 73 patients were included in the study. We found a significant preservation of vestibular function as measured by VNG and VHIT. There was no statistical difference in the presence or absence of cervical and ocular (P13/N23 and N1/P1) waves on VEMP pre- and postoperatively. 67% of patients had good control of episodes of vertigo post-operatively, with significantly better results in the sac opening group (75%). There was no significant change in hearing postoperatively, and QoL scores were significantly improved after surgery (p < 0.0001). Endolymphatic sac surgery (ELSS) is a conservative surgical treatment, which does not negatively impact vestibular function. It was associated with improved control of episodes of vertigo, preservation of hearing, and a clear improvement in QoL scores. Despite its pathophysiology not being fully understood, it remains a first-line procedure preserving vestibular function, for MD refractory to medical management.

Evaluation of Patients with Delayed Endolymphatic Hydrops by Videonystagmography, Vestibular-Evoked Myogenic Potentials, and Electrocochleography

Introduction: The categorization of delayed endolymphatic hydrops (DEH) based on the ear which produces vertigo may sometimes cause misdiagnosis. Objectives: The aim of this study was investigating the vestibular-evoked myogenic potentials (VEMPs), electrocochleography (ECoG), and videonystagmography (VNG) in cases with DEH to determine the ear that originates symptoms. Methods: In this cross-sectional study, 34 patients – 20 males and 14 females – with profound unilateral sensorineural deafness and vertigo attacks were recruited and evaluated by the ECoG, VNG, and VEMPs tests. Results: The average age was around 43; the summating potential/action potential was abnormal in 29.4% of patients in their normal auditive ear. In 32.4, 17.6, and 50% of cases with a deaf ear, absent, normal, and abnormal VEMPs results were sequentially observed, respectively. In normal-hearing ears, absent, normal, and abnormal VEMPs were observed in 23.5, 50, and 26.5%, respectively. In the normal-hearing ear, the distribution of abnormal VEMPs was 26.5%, and in the deaf ear, this parameter was abnormal in 50% of the opposite ear (p value = 0.00021). In the VNG test, among patients with a normal-hearing ear, results in 27 and 7 patients were sequentially normal and hypofunction. Conclusion and Significance: The probability of a hypofunction VNG test in a normal-hearing ear might be greater when the VEMPs results of the contralateral deaf ear are normal. In patients with a normal-hearing ear, the distribution of abnormal VEMPs in the contralateral deaf ear is greater, although the intact side may also manifest abnormality in VEMPs tests. The initial evaluation should begin in a deaf ear as well as for the normal-hearing ear ere utilizing ablation surgery.

Characteristics of Benign Paroxysmal Positional Vertigo Following an Earthquake.

Benign Paroxysmal Positional Vertigo (BPPV) is a commonly encountered peripheral vestibular disorder. People exposed to massive earthquakes experience intense and long-term problem associated with dizziness. The purpose of our study is to investigate this relationship and to demonstrate the efficacy of the treatment modalities used in the management of patients with post-earthquake dizziness. The study was carried out by examining the retrospective records of patients who presented with dizziness to the otorhinolaryngological outpatient unit before and after the Elazig earthquake that occurred on 24th Jan 2020. Parameters evaluated include patients' age and gender, onset of dizziness, accompanying symptoms and comorbidities, videonystagmography (VNG) findings, pre- and post-treatment Visual Analogue Scale (VAS), Dizziness Handicap Inventory (DHI), and Hospital Anxiety and Depression Scale (HADS). The number of patients who presented with dizziness to our outpatient clinic after the earthquake and were included in our study totaled 84. The number of patients who visited the outpatient clinic before the earthquake was identified to be 75. In the earthquake related group, while there was a statistically significant difference between residual symptoms (RS) and the need for repetitive repositioning maneuvers, there was no statistically significant difference detected for age, gender, and comorbidities. Also, no statistically significant difference was found in the pre- and post-treatment assessments of VAS, DHI, and HADS median values in the earthquake group. There was a remarkable increase in the number of patients presenting with dizziness in the early post-earthquake period. Management of these patients may differ from the classic BPPV. Residual symptoms appearing after performing repositioning maneuvers can be more commonly seen among these patients.

Effects of vestibular spontaneous nystagmus on visual smooth pursuit function

Objective: The aim of the study is to analyze the effects of vestibular spontaneous nystagmus(SN) on the smooth pursuit function of visual ocularmotor system. Methods: A total of 46 patients with acute unilateral peripheral vestibular syndrome with SN (26 cases of vestibular neuritis, 6 cases of Ramsay Hunt Syndrome (RHS) with vertigo, 14 cases of sudden deafness with vertigo) were included in this work. In the study group, the results of SPT and SN test with videonystagmography(VNG) were also reviewed. Taking SPT parameters, the influence of SN intensity on SPT gain, asymmetry and waveform and their correlation were analyzed.SPSS19.0 software was used for statistical analysis. Results: Among the 46 patients, there were 36 cases of SN pointing to the healthy side(SN intensity range of 2.68°/s-32.53°/s), and 10 cases of SN pointing to the affected side (SN intensity range of 2.66°/s-16.54°/s). SN intensity was divided into 3 groups, including light(0.50°/s-5.00°/s), medium(5.01°/s-10.00°/s) and strong(>10.01°/s), accounting for 14 cases(30.4%), 18 cases(39.1%) and 14 cases(30.4%), respectively. The differences of the gain of SPT to the fast phase and slow phase direction in the overall groups and light, medium and strong groups of SN intensity respectively were statistically significant(ttotal=13.338, tlight=6.184, tmedium=8.436, tstrong=8.477, all of P<0.001). The difference of SPT gain in SN fast phase direction between groups with different SN intensity was statistically significant(F=9.639, P<0.001),there was no statistically significant difference in SPT gain between the groups on the SN slow phase direction(F=1.137, P=0.330).The SN intensity significantly negatively correlated with the SPT gain of the fast phase direction of SN (r=-0.433, P=0.003), that was, the SPT gain on the fast phase direction of SN decreased with the increase of SN intensity. There was no significant correlation between SN intensity and the gain of SPT on the slow phase direction of SN (r=-0.061, P=0.687). SPT waveform analysis showed that type I, type II and type III accounted for 8 cases(17.4%), 21 cases(45.6%) and 17 cases(37.0%), respectively. The corresponding mean values of SN intensity were (3.71±0.69)°/s, (7.44±1.88)°/s, (20.04±5.53)°/s, respectively, without type IV wave. The intensity of SN was positively correlated with the asymmetric value of the gain of SPT left and right(r=0.450,P=0.002). That was, with the increase of SN strength, the asymmetric value also increased, and the worse the asymmetry of the gain of SPT left and right pursuit was, the worse the SPT waveform was. Conclusion: SPT gain, asymmetry and SPT waveforms are all affected by SN, and the greater the intensity of SN, the greater the influence on the three. When SN is strong, type III waves may occur, suggesting that acute peripheral vestibular syndrome can also affect the visual ocularmotor systems.

A study of the effect of hot and cold gas perfusion sequence on caloric test results

Objective: To study whether the warm/cold air injection sequence affects the test results in the caloric test, and provide a basis for the specification and quality control of the caloric test. Methods:Video nystagmography and warm and cold air stimulation apparatus were applied for caloric test. Thirty healthy volunteers （60 ears） were divided into two groups of 15 （30 ears） each. The first group was given cold air stimulation followed by warm air stimulation, and the second group was given heat followed by cold. The differences in nystagmus maximal slow phase velocity （SPV）, semicircular canal paresis （CP） and dominant preponderance （DP） were compared between the two groups of subjects under different perfusion sequences of caloric test. Results:The intensity of nystagmus evoked by subjects in group 1 （cold first and then warm） and group 2 （warm first and then cold） were similar. Paired t-test showed that intra-group analysis of the SPV values of the two groups, comparison of the intensity of nystagmus evoked by different temperatures of the same ear or different sides of ear with the same temperature, the difference was not statistically significant （all P>0.05）. Independent samples t-test showed that between-group analysis of SPV values of two groups, the intensity of nystagmus induced by the same and different temperature stimuli in the ipsilateral ear, the difference was not statistically significant （all P>0.05）. Independent samples t-test showed that the CP values of the two groups were analyzed between groups, and the difference was not statistically significant （all P>0.05）. Independent samples t-test showed that DP values of both groups were in the normal range and the difference was not statistically significant （all P>0.05）. Conclusion:Different perfusion sequences of warm and cold air do not affect the results of caloric tests, and the order of warm and cold air stimulation is not the normative and quality control research direction of caloric test.

Peripheral Vestibular Function in Patients with Fibromyalgia

Background: Fibromyalgia (FM) is a non-inflammatory musculoskeletal chronic syndrome, whose etiology is unknown, characterized by diffuse pain, many patients with FM were reported to have dizziness which is attributed to hypotension and the autonomic nervous system (ANS) dysfunction. Aim: To improve management of patients with fibromyalgia having dizziness. Objective: to assess peripheral vestibular functions in patients with fibromyalgia. Subjects and Methods: After obtaining approval from the Ethics Committee of the Suez Canal University Hospital (registration number:3646) and written informed patient consent, a Cross-sectional study was conducted at Suez Canal University hospital from June 2018 to December 2019 in the Audio-Vestibular Clinic of the E.N.T department, including 30 female subjects whose age ranged from 22 to 50 years and were divided into Study group that comprised patients diagnosed with fibromyalgia and Control group rather healthy individuals. The vestibular assessment was done using pure tone audiometry, Bedside tests, and video-nystagmography (VNG). Results: There was no statistically significant difference between both groups regarding results of bedside examinations and VNG results as a caloric test (p-value = 0.6) however, there was a trend towards positive results and an increase in vestibular weakness in the fibromyalgia group compared to the control group. Conclusion: Fibromyalgia is unlikely to be a cause of peripheral vestibular dysfunction, so vestibular testing is not routinely recommended for such patients.

Video-nystagmographic evidence in more than 700 consecutive cases of road traffic whiplash injury

PurposeWhiplash injury is a frequent traumatic lesion occurring mainly in road accidents, which may also cause dizziness severe enough to impact everyday life. Vestibular examination is routinely performed on these patients, although the role of the neuro-otologist is still not clearly defined. The main endpoint of this study was to describe the videonystagmography (VNG) evidence in a large cohort of patients who underwent road traffic whiplash injury. Methods717 consecutive patients who reported whiplash-associated disorders due to a road traffic accident underwent clinical examination and VNG. ResultsPatients with saccadic test latency anomalies more frequently complained of vertigo, nausea and cochlear symptoms after trauma (p = 0.031, 0.028 and 0.006), while patients with bilateral vestibular weakness at caloric stimulation more often displayed neck pain after trauma (p = 0.005). Patients complaining of positional or cochlear symptoms or with accuracy anomalies at the saccadic test were significantly older than those with no positional, no cochlear symptoms and without accuracy anomalies (p = 0.022, p = 0.034 and p = 0.001). Patients with bilateral vestibular hypofunction were significantly younger (p < 0.001). ConclusionsVNG evidence, particularly vestibular function and saccadic tests, may be related to damage in the cervical region due to whiplash trauma. These findings suggest that neuro-otologic examination may play a role in properly identifying those who suffer damage caused by whiplash trauma, and in characterizing the severity and prognosis of whiplash-associated disorders.

Postoperative audiovestibular assessment of obstructive sleep apnea patients

BackgroundIn obstructive sleep apnea syndrome, the impact of hypoxia on different body systems is of utmost importance. Brainstem is greatly sensitive to the effects of hypoxia including auditory and vestibular nuclei. Our aim in the current study is to evaluate hypoxic effect of OSAS on the audiovestibular system using auditory brainstem response, cervical vestibular evoked myogenic potential, and video nystagmography and to determine whether this effect is reversible postoperatively.ResultsIn OSAS patients, the mean absolute and interpeak latencies of ABR were significantly prolonged compared to controls and remained so postoperatively. No statistically significant difference between pre- and postoperative values was found. The differences in the mean latencies of P1 and N1 of the cVEMP responses between the two groups were insignificant. However, there was a significant difference in P1N1 amplitude. On the other hand, the difference in the mean amplitude of the P1N1 wave in the study group postoperatively was not significant. The VNG results included bilateral canal paresis in four, unilateral in two, and spontaneous nystagmus in two patients. Also, two patients showed pursuit abnormality and two had saccadic abnormality which did not improve postoperatively.ConclusionsPatients with moderate to severe OSAS experience both auditory and vestibular deficits which do not reverse 3 months after corrective surgery.