Videonystagmography Testing Research Articles

Assessment of hearing and balance functions in patients with acromegaly by the use of an audiovestibular test battery: a cross-sectional study.

Patients with acromegaly may have abnormalities in their hearing and balance as a result of modifications in body composition and involvement of the temporal bone. The objective of this study is to examine if there are any changes in the auditory and vestibular systems in individuals with acromegaly by using audiogram and vestibular function tests. This prospective study included 33 healthy controls and 33 acromegaly patients who were matched for age and gender distribution. A pure-tone audiometry test was conducted, including frequencies ranging from 250Hz to 8000Hz. Videonystagmography (VNG) was employed to assess nystagmus, an essential parameter used for assessing vestibular functions. The Video Head Impulse Test (v-HIT) was used to assess the vestibulo-ocular reflex (VOR). The Dizziness Handicap Inventory (DHI) was applied to evaluate the subjective complaints of the participants. The acromegaly patients had significantly elevated hearing thresholds at all frequencies (250, 500, 1000, 2000, 4000, and 6000Hz) compared to the control group (p < 0.005). The VNG tests, including gaze horizontal, gaze vertical, saccade, spontaneous nystagmus, optokinetic, smooth pursuit, and positioning tests, did not show any statistically significant difference between the two groups (p values > 0.05). The patient group demonstrated reduced VOR gains compared to the control group in the anterior and posterior channels (p < 0.005). There was no statistically significant difference between the two groups for the occurrence of aberrant eye movements (p values > 0.05). The patient group had a total DHI score of 6.6 ± 3.2, while the control group had a score of 3.2 ± 2.6 (independent samples t-test; p < 0.001). Therefore, The patient group exhibited significantly greater subjective vestibular symptoms. Patients with acromegaly experience impaired auditory function. The central vestibular system remains unaffected, while the gains of the vestibulo-ocular reflex (VOR) in the posterior and anterior semicircular canals are decreased. Additionally, these patients report experiencing subjective dizziness. Screening for hearing and balance in patients with acromegaly may improve the quality of life of patients and prevent problems related to balance disorders at an early stage.

Investigation of Video Ocular Counter-Roll Findings According to Head and Body Tilt Positions in Healthy Subjects.

A vestibulo-ocular reflex called the ocular counter-roll can be used to assess how well the otolith organs are functioning. The video ocular counter-roll (vOCR) test is a recent addition to the videonystagmography test battery that allows for video recording and quantitative ocular counter-roll analysis. The purpose of this study is to investigate potential discrepancies in vOCR measurements obtained from a 30° lateral head tilt in the roll plane versus measurements obtained from a 30° tilt of the head and body. Thirty otologically, and neurologically healthy subjects aged 18 to 30 (M = 23.32 years, SD = 2.66 years; 8 men, 22 women) participated in this study. Pure-tone audiometry, oculomotor tests, and vOCR evaluation were performed for all participants. The vOCR assessment was performed in 2 positions, 30° lateral head tilt, and 30° body tilt position. The degree of static vOCR eye position and vOCR asymmetry in both positions were calculated and compared. There was no statistically significant difference between the vOCR findings obtained in the right and left 30° lateral head tilt (p = 0.546) and body tilt (p = 0.114). vOCR asymmetry was determined as median (interquartile range) 0.08 (0.07) in lateral head tilt position and 0.09 (0.06) in body tilt position. The degree of static vOCR (8.75° [1.91]) detected during body tilt was statistically greater than the static vOCR (6.62 [1.69]) detected during head tilt (p < 0.001). There was no statistically significant difference in terms of ocular counter-roll asymmetry detected between head tilt and body tilt (p = 0.918). Our study shows a significant difference in the vOCR responses during head tilt and body tilt, a finding that should be considered during clinical evaluation of vestibular function. There was no significant asymmetry between the responses with either head or body tilt.

The applicability of the VNG System for Diagnostics and Physiotherapy Planning in Vertigo and Dizziness Patients – a pilot study

&lt;b&gt;Introduction:&lt;/b&gt; Videonystagmography (VNG) using a rotating chair is a recent tool for examining the vestibular system with infrared-sensitive cameras for ocular movement registration. This method aids in the differential diagnosis and treatment of dizziness. In practice, it can also be used by skilled physiotherapists as a complement to the diagnostics of balance disorders.&lt;b&gt;Aim:&lt;/b&gt; The aim of the presented project is to evaluate whether VNG using a rotating chair in a physiotherapist’s practice is a useful tool to serve as an addition to clinical diagnostics in the assessment and planning of rehabilitation.&lt;b&gt;Materials and methods:&lt;/b&gt; During a three-month period of study at the neurology department, 12 out of 42 patients with vertigo or dizziness were included for further analysis. The group consisted of eight women and four men aged 27–79 years. The study included only patients with vertigo of unspecified aetiology. VNG testing involving BURST protocol was performed by a physiotherapist to confirm the origin of the dizziness. Furthermore, the patients completed the Dizziness Handicap Inventory (DHI) questionnaire. Following the tests, a tailored set of physiotherapeutic exercises was prescribed and performed by the patient for two days. Subsequently, the patients underwent re-examination using a rotatory chair with VNG.&lt;b&gt;Results:&lt;/b&gt; Among the 12 patients examined, the overall quality of life improved after therapy, as evaluated through the DHI questionnaire. This improvement was correlated with elevated fixation index scores post-therapy&lt;b&gt;Conclusions:&lt;/b&gt; The use of a rotating chair has enabled to apply the optimal physiotherapy treatment. However, further research is needed to develop patient-specific therapy using VNG testing.

Effect of digital screen usage on the visual-vestibular system interaction

Background/aimThis research aims to develop an original understanding of the subject by examining how digital screen usage correlates with visual-vestibular system interaction and the vestibuloocular reflex mechanism using vestibular test parameters.Materials and methodsThe study included 59 healthy participants. Participants were divided into two groups according to their screen usage time 3–6 h (Group 1) and over 6 h (Group 2). Participants were asked questions about complaints after screen use. After that, Video Head Impulse, Dynamic Visual Acuity, Videonystagmography test was applied to the participants.ResultsDVA was significantly poor in group 2. In vHIT and Videonystagmography test, a significant difference was not observed between the groups.ConclusionThere is no conclusive evidence that digital screen usage directly affects the peripheral or central vestibular systems. However, the decrease in DVA in individuals who use digital screens for more than 6 h may be related to the effects of digital screen exposure on the visual-vestibular system.

Investigation of the Relationship Between BPPV with Anxiety, Sleep Quality and Falls.

To investigate the effects of dizziness on sleep quality and psychological status in patients with benign paroxysmal positional vertigo (BPPV) and to evaluate its relationship with falls. A Demographic Data Form, a Visual Vertigo Analog Scale, the Falls Efficacy Scale - International (FES-I), the Hospital Anxiety and Depression Scale (HADS), and the Pittsburgh Sleep Quality Index (PSQI) were administered in 102 individuals diagnosed with BPPV by videonystagmography test. The same scales were applied to 75 healthy volunteers as the control group, and the two groups were compared. The BPPV group was divided into two groups as posterior canal and lateral canal BPPV. These two groups were compared among themselves and with the control group. A statistically significant difference was found between the BPPV and control groups, the lateral canal BPPV and posterior canal BPPV groups, the lateral canal BPPV and control groups, and the posterior canal BPPV and control groups in terms of total scores of the PSQI, the FES-I, and the HADS (p<0.001). In the regression model, the FES-I score was fully explained by the PSQI and HADS scores (p<0.001). BPPV significantly affects sleep quality, psychological state, and the risk of fall. The negative effects of BPPV restrict daily living activities, affect the prognosis of the disease, and increase the risk of falling. Considering that psychiatric issues and sleep problems increase the risk of falling in individuals with BPPV, counseling services on this issue would reduce the incidence of falls and related injuries.

Role of videonystagmography and cervical vestibular evoked myogenic potentials in the diagnosis of vestibular migraine

Background and objective: Vestibular migraine is widely accepted as a unique disease, although its pathophysiology remains uncertain. When the patient is asymptomatic, vestibular migraine is often challenging to diagnose as its many symptoms overlap with other conditions. This study aimed to assess the role of videonystagmography and cervical vestibular evoked myogenic potentials tests in diagnosing vestibular migraine. Methods: This study is a descriptive cross-sectional study conducted on 30 patients clinically diagnosed with vestibular migraine in the Audiology Center in Sulaimani City. The study duration was from December 1st, 2018, to June 30th, 2019. The author interpreted magnetic resonance imaging, videonystagmography, and cervical vestibular evoked myogenic potential results. Results: The patients' mean age was 34.9 years with a high predominance of the female gender. Vertigo was the main complaint of the patients (73.4%) with the recurrent course. A family history of migraine was present in 83.3% of the patients. Only two (6.7%) patients had abnormal findings on the brain magnetic resonance imaging. Videonystagmography examination showed that 40% of the patients had abnormal findings; 20% were abnormal on the left, 16.7% were abnormal on the right, and 3.3% were bilaterally abnormal. The cervical vestibular evoked myogenic potentials test was abnormal for 63.3% of the patients; 43.3% abnormality was on the left side, and 20% was on the right side. Conclusion: The cervical vestibular evoked myogenic potentials and videonystagmography tests are helpful in the diagnosis of vestibular migraine. Keywords: Vestibular migraine; Video nystagmography; Cervical vestibular-evoked myogenic potentials.

Vestibular findings in patients with white matter disease

BackgroundOlder people develop gait and balance dysfunction that is associated with the gradual onset of cerebral white matter disease. White matter disease is easily detected by neuroimaging, whereas small vessels are not; hence, the term small vessel disease is frequently used to describe the parenchyma lesions rather than the underlying small vessel alterations. This study was done to investigate the relationship between the presence and/or absence of white matter disease identified on magnetic resonance imaging with the vestibular findings in elderly patients with dizziness. The current study was conducted on a total number of 30 elderly patients complaining of dizziness and/or instability. The inclusion criteria are patients above 55 years old and a history of vertigo and/or instability. All the study groups were subjected to full neuro-otological history, hearing assessment, video-nystagmography test (VNG), assessment of the risk of fall by functional gait assessment test (FGA), and radiological assessment: magnetic resonance stroke protocol.ResultsFGA total scores were significantly lower in patients with white matter disease (0.047) specifically PVWM score 3 (0.04) and DWM score 3 (0.19). Abnormal VNG test results were significantly higher in patients with atherosclerotic changes (0.04). The most common VNG finding abnormality was positional nystagmus.ConclusionsNormal VNG findings in elderly dizzy patients should be complemented with FGA test to assess the risk of falls. The presence of risk factors for white matter disease (WMD) as hypertension, diabetes mellitus, ischemic heart disease, hyperlipidemia, and migraine is an indication for requesting a further radiological assessment. The most frequent VNG abnormality in elderly patients with white matter disease is positional and positioning nystagmus, and a significant number of patients had positional nystagmus of the non-localizing criteria. FGA test scores are significantly related to the severity of white matter disease. The presence of atherosclerotic changes is significantly related to the presence of VNG test abnormality. It is important to ask the patient about the past history of migraine as it has an effect on VNG, FGA, and radiological findings.

Eye movements and visual perception in dyslexic children

Background Many research has demonstrated that reading problems, such as dyslexia, can coexist with visual abnormalities. While remediation for phonological impairments in dyslexics is widely acknowledged and practiced, the potential impact of visual deficits, particularly on eye movements and visual perception, is rarely explored. Objective This study looks at the performance of eye movements and visual perception abilities in dyslexic children. Methods A sample of 20 dyslexic children compared to 20 non-dyslexic age-matched children (aged 7–11). Both groups of the study underwent a video-nystagmography test and visual perception test. Results Our study revealed a statistically significant difference between dyslexic and non-dyslexic children in saccade and pursuit tracking tests. There was a statistically significant difference between case and control regarding the visual perception test. Among subgroups of dyslexic children with abnormal eye movements, they displayed visual perception weakness mainly in visual sequencing and discrimination tasks in comparison to dyslexic children with normal eye movements. Conclusion The poor oculomotor function affected dyslexic children in their proper control and leads to sluggish visual attention and poor visual perception. According to the major findings of this study, a routine eye examination should be part of the examination of any child with a learning disability.

Audio-vestibular evaluation in vitiligo patients

ObjectivesThe aim of the study was to evaluate the auditory and vestibular function in vitiligo patients.BackgroundVitiligo is a systemic disease affecting pigmented cells throughout the body. Some evidence suggests the involvement of melanocytes in the auditory system in the disease process.Patients and methodsA total of 63 patients with vitiligo and 63 age-matched and sex-matched healthy controls were enrolled in this study. Pure tone audiometry, cervical vestibular-evoked myogenic potential, and videonystagmography were carried out in all participants.ResultsSixteen cases (25.4%) of the vitiligo patients had vestibular symptoms. Vitiligo patients showed poorer hearing threshold at high frequencies. Cervical vestibular evoked myogenic potential showed a highly significant difference between cases and controls (P < 0.001). In videonystagmography test, smooth pursuit test did not show any significant difference between cases and controls (P > 0.05). Catch up saccades were detected only in 4 cases (6.3%), spontaneous nystagmus without fixation was detected in only 8 cases (12.7%) with a significant difference (P value = 0.006), and caloric test showed a significant difference between cases and controls (P = 0.004).ConclusionThis study highlights the involvement of the audio-vestibular system in vitiligo patients, suggesting that vitiligo is a systemic disease rather than a purely cutaneous problem.

The Relationship Between Sudden Sensorineural Hearing Loss, Vestibular Neuritis, and Infection With COVID-19

Introduction: This study aimed to investigate the relationship between sudden sensorineural hearing loss, vestibular neuritis, and infection with COVID-19. Materials and Methods: In this study, a total of 56 Iranians (32 females and 24 males) with a Mean±SD age of 45.12±14 years were studied in Tehran City, Iran. Individuals diagnosed with Sudden Sensorineural Hearing Loss (SSNHL) or vestibular neuritis based on definitive diagnostic criteria were included in the study. The methodology comprised four sections of underlying Sudden Hearing Loss,, auditory and vestibular inspection, SARS-CoV-2 Reverse Transcription-Polymerase Chain Reaction (RT-PCR) test, and statistical analysis. Also, the videonystagmography test was used in participants with vertigo to diagnose vestibular neuritis. Pure tone audiometry confirmed SSNHL in some patients with a complaint of hearing loss. Furthermore, tuning fork, Rinne and Weber tests were also performed. Results: The results of SARS-CoV-2 RT-PCR in 56 subjects showed that eight subjects (22.2%) with vestibular neuritis and two with SSNHL (10%) had a positive RT-PCR test. The Chi- square and Fisher exact-tests with a 95% confidence interval revealed no statistically significant (P&gt;0.05) relationship between COVID-19 infection and vestibular neuritis or SSNHL. Conclusion: The present study showed no statistically significant relationship between audiovestibular disorders and positive SARS-CoV-2 RT-PCR test. However, the possibility of this relationship cannot be ruled out, and there is a need for studies with larger sample sizes.

Videonystagmography (VNG) Findings in Patients with Vestibular Migraine: A Hospital-Based Study.

Vestibular migraine (VM) is a disorder where vestibular symptoms are causally related to migraine. It is one of the common causes of recurrent vertigo in the general population. It has often remained as an under-recognized condition with largely unknown pathophysiology. Accurate diagnosis is essential in vestibular pathologies as it determines the management in each case. The aim of this reasearch was to compare vestibular functions of patients with VM and healthy controls using VNG and to study the VNG patterns of patients diagnosed with VM. This study is a retrospective analysis of subjects who have undergone videonystagmography (VNG) testing from October 2018 to October 2020 done in a tertiary referral hospital. Those patients satisfying diagnostic criteria for vestibular migraine were subjected to VNG testing. Group 1 consisted of 35 vestibular migraine patients, and group 2 consisted of 35 age and sex-matched healthy controls. Statistical comparison of parameters of these groups were made.We found that the mean age of VM patients in the study was 40 ± 9.9, and the females were predominantly affected (Female: Male = 2.8:1). Statistically significant difference was obtained between VM patients and healthy controls in vertical smooth pursuit and in the positional tests using the Dix Hallpike test on the right side (p value < 0.05). We conclude that a careful study of VNG patterns can serve as a valuable tool in hard to diagnose cases of vestibular migraine.

Vibration-induced nystagmus in patients with chronic unilateral Meniere's disease

Background and Aim: Meniere's disease (MD) is one of the inner ear disorders associated with fluctuating hearing loss, vertigo, ear fullness, and tinnitus. Vestibular stimulation delas with the int­egrity of the peripheral vestibular system and may cause nystagmus due to the functional asy­mmetry between right and lef peripheral vesti­bular system. This study aimed to assess the vibration-induced nystagmus (VIN) in patients with chronic unilateral MD and investigate the effectiveness of this test in detecting the affected ear in these patients. Methods: This study was conducted on 29 pati­ents with chronic unilateral MD. For this pur­pose, spontaneous nystagmus (SN) and VIN at frequencies of 30 Hz and 100 Hz were recorded by videonystagmography test under five recor­ding conditions. The vibratory stimulation was presented to both healthy and affected ears. Coll­ected were analyzed in SPSS v.22 software. Results: Vibratory stimulation compared to the unstimulated condition, revealed a significant difference in eye movements for both healthy and affected ears. Moreover, the difference between VIN and SN in the affected ear was much greater than in the healthy ear. Conclusion: In patients with chronic unilateral MD, 100 Hz vibratory stimulation of the affected ear induces more reliable nystagmus than 30 Hz stimulation and unstimulated condition. The VIN test can be used for the evaluation of the vesti­bular system function and is a promising techni­que to detect the MD ear. Keywords: Meniere's disease; spontaneous nystagmus; vibration-induced nystagmus; chronic; definite; vestibular vibrator

Vestibular Function in Children with Type 1 Diabetes: Videonystagmography Testing

Background: Vestibular system is critical for maintaining balance and learning complex tasks. This study aimed to determine the frequencies, types, and predictors of vestibular dysfunctions (VDs) in children with type 1 diabetes (T1D) using videonystagmography (VNG). Patients and Methods: This study included 65 patients (children with T1D = 40; controls = 25). The patients underwent VNG. Results: Patients (boys = 15; girls = 25) had a mean age of 14.05 ± 1.82 years and duration of illness of 6.30 ± 2.84 years. The majority had frequent attacks of diabetic ketoacidosis (DKA) (65%) and hypoglycemia (40%). Dizziness was reported in 20%. VNG abnormalities were reported in 70% (n = 28), of them 71.43 and 28.57% had central and peripheral VDs, respectively. Dizziness was associated with peripheral VD. Compared to patients without VDs, those with VDs were older and had earlier age at onset and longer duration of diabetes (>5 years), higher levels of HbA1c (>7%), higher frequencies of DKA and hypoglycemic attacks, comorbid medical conditions, and diabetic complications. Multiple logistic regression analysis showed that presence of VNG abnormalities (VDs) was independently correlated with diabetes duration >5 years (odds ratio [OR] = 4.52 [95% confidence interval [CI] = 3.55–7.04], p = 0.001), HbA1c% levels >7% (OR = 3.42 [95% CI = 2.84–5.75], p = 0.001), and presence of hypoglycemic attacks (OR = 4.65 [95% CI = 2.85–7.55]). Conclusions: -VDs are prevalent in children with T1D and correlated with the duration and severity of diabetes and the occurrence of hypoglycemic attacks. Therefore, optimizing glycemic control and prevention and treatment of diabetic complications and comorbidities are important. Multidisciplinary follow-ups are required for early detection and management of diabetic VDs.

Video-nystagmography test findings in post COVID-19 patients

Objectives There is growing evidence of neurological involvement of SARS-CoV-2 in some otoneurological subjective symptoms such as balance disorders. The aim of this work was to investigate the prevalence of equilibrium disorders such as dizziness and vertigo in a sample of COVID-19 patients after recovery. The effect of COVID-19 on the vestibular system and the correlation between the severity of the infection and the effect on the vestibular system was investigated. Methods Twenty Post COVID-19 subjects after complete cure who complain of dizziness were subjected to full history taking, Otological examination, Pure tone audiometry, and Videonystagmography test. Results Half of the patients have a history of the sense of imbalance attacks and most patients showed positional nystagmus followed by caloric weakness. Half of the patients that had a history of severe COVID-19 disease have a symmetrical caloric response. However, two-thirds with a history of either mild or moderate degree COVID-19 had asymmetrical caloric response with a significant difference between the incidence in severe versus mild and moderate degrees reflecting a significant association between the severity of the disease and the caloric asymmetry. Conclusion The SARS-CoV-2 virus can affect different parts of the vestibular system.

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.

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.

VNG FINDINGS IN PATIENTS WITH AGE RELATED ISCHEMIC CHANGES.

Background: Older people develop gait and balance dysfunction that is associated with gradual onset of cerebral white matter disease. The term cerebral small vessel disease refers to a group of pathological processes with various etiologies that affect the small arteries, arterioles, venules, and capillaries of the brain. White matter disease is easily detected by neuroimaging, whereas small vessels are not, hence the term small vessel disease is frequently used to describe the parenchyma lesions rather than the underlying small vessel alterations.Aim of the work: To investigate the relationship between presence and/or absence of white matter disease identified on magnetic resonance imaging with the vestibular findings in elderly patients with dizziness.Patients and Method: Study population: 30 elderly patients complaining of dizziness & / or instability. Inclusion criteria: Patients above 55 years old with history of vertigo & / or instability. Exclusion criteria: 1- Meniere’s disease. 2- Bilateral vestibulopathy. 3- Recent vestibular neuritis or labyrinthitis. 4- History of head trauma or surgery. 5- Neurological diseases as (Intracranial space occupying lesions, Multiple Sclerosis, Parkinsonism, Paresis). 6- Patients with otologic history of otorrhea or Ear surgery. Study Procedure: 1- Full history taking. 2- Otological examination. 3- Hearing assessment. 4- Immittancemetry. 5- Video-nystagmography test (VNG). 6- Magnetic resonance imaging (MRI) & Magnetic resonance angiography (MRA) “Stroke protocol”.Results: Abnormal VNG test results were significantly higher in patients with atherosclerotic changes (0.04). The most common VNG finding was positional nystagmus.Conclusion: Presence of risk factors for white matter disease (WMD) in elderly patients as hypertension, diabetes mellitus, ischemic heart disease, hyperlipidemia and migraine is an indication for requesting further radiological assessment. The most frequent VNG abnormality in elderly patients with WMD is positional & positioning nystagmus. Presence of atherosclerotic changes is significantly related to presence of VNG test abnormality.

Impact and Cost Effectiveness of Videonystagmography.

Videonystagmography (VNG) is a commonly ordered test to evaluate patients with vestibular complaints. To date, there are no evidence-based guidelines for evaluating patients presenting with vestibular symptoms. This study evaluates the cost effectiveness of VNG and the impact of VNG findings on patient management. Patient charts were reviewed from 3 institutions to collect the pre- and post-VNG ICD-9/10 diagnosis and treatment plan. VNG findings were recorded to calculate the incidence of abnormal findings and the incidence of change in diagnosis and/or treatment plan. The cost effectiveness of VNG was estimated based on these calculations. A total of 120 patient charts were reviewed. 69/120 (57.5%; 95% CI: 48.2%-66.5%) patients had abnormal findings on their VNG. A change in diagnosis was noted in 24/120 (20.0%; 95% CI: 13.3%-28.3%) patients. A change in treatment plan was noted in 62/120 (51.7%; 95% CI: 42.4%-60.9%) patients, and 11/120 (9.2%; 95% CI: 4.7%-15.8%) had a change in diagnosis that led to change in treatment plan. Using the average Medicare reimbursement for VNG, the cost effectiveness analysis showed a cost of $869.57 per VNG with abnormal findings and a cost of $5454.55 per VNG that lead to a change in diagnosis and treatment plan. VNG findings may not result in changes in clinical diagnosis. However, VNG is impactful at influencing treatment plan changes. VNG results are beneficial for counseling patients, guiding treatment plans, and managing patient expectations. When there is a clear indication, VNG testing can be cost effective in managing patients presenting with vestibular symptoms.

Vestibular migraine and benign paroxysmal positional vertigo, close presentation dilemma

Background: Not only an association between benign paroxysmal positional vertigo (BPPV) and migraine have been recognized in the literature, but also, there are close similarities between BPPV and vestibular migraine (VM) presentations as both can be presented by very similar positional nystagmus.Aims/objectives: To prescribe relatively uncommon cases of positional nystagmus caused by VM that mimics positioning nystagmus of BPPV.Material and method: 12 patients were reviewed retrospectively in this study. All were subjected to full history taking, videonystagmography testing (VNG) and brain magnetic resonance imaging (MRI) with contrast. Provisionally, they were diagnosed with BPPV. After three attempts of repositioning sessions none of them improved. After exclusion of central insults using brain MRI, trial of anti-migraine medical treatment (50-100 Topiramate tablets once per day) for at least one month was prescribed to them.Results: 10 patients were completely cured on medical treatment and finally were diagnosed VM. Only 2 patients did not improve on medical treatment (for one month), were managed again by repeated repositioning maneuvers till finally improved and were diagnosed as resistant BPPV.Conclusions/significance: VM positional nystagmus can mimic BPPV nystagmus in some patients.

Vestibular Function and Motion Sickness Susceptibility: Videonystagmographic Evidence From Oculomotor and Caloric Tests.

Purpose Motion sickness (MS) is a common condition that affects millions of individuals. Although the condition is common and can be debilitating, little research has focused on the vestibular function associated with susceptibility to MS. One causal theory of MS is an asymmetry of vestibular function within or between ears. The purposes of this study, therefore, were (a) to determine if the vestibular system (oculomotor and caloric tests) in videonystagmography (VNG) is associated with susceptibility to MS and (b) to determine if these tests support the theory of an asymmetry between ears associated with MS susceptibility. Method VNG was used to measure oculomotor and caloric responses. Fifty young adults were recruited; 50 completed the oculomotor tests, and 31 completed the four caloric irrigations. MS susceptibility was evaluated with the Motion Sickness Susceptibility Questionnaire-Short Form; in this study, percent susceptibility ranged from 0% to 100% in the participants. Participants were divided into three susceptibility groups (Low, Mid, and High). Repeated-measures analyses of variance and pairwise comparisons determined significance among the groups on the VNG test results. Results Oculomotor test results revealed no significant differences among the MS susceptibility groups. Caloric stimuli elicited responses that were correlated positively with susceptibility to MS. Slow-phase velocity was slowest in the Low MS group compared to the Mid and High groups. There was no significant asymmetry between ears in any of the groups. Conclusions MS susceptibility was significantly and positively correlated with caloric slow-phase velocity. Although asymmetries between ears are purported to be associated with MS, asymmetries were not evident. Susceptibility to MS may contribute to interindividual variability of caloric responses within the normal range.