BACKGROUND AND OBJECTIVES: It has been reported that vibration applied either on the mastoid or the sternocleidomastoid (SCM) muscles induces nystagmus in patients after unilateral vestibular neuritis. The aims of the study were to characterize the vibration-induced nystagmus (VIN) in patients with various vestibular disorders and to compare the results of VIN to unilateral weakness in caloric test. MATERIALS AND METHODS:Fifthy-four patients with Meniere's disease, 58 patients with unilateral vestibular neuritis, 170 patients with migraine-associated dizziness, and 78 patients with chronic recurrent vestibulopathy were included. We recorded eye movements during unilateral 100-Hz vibration on the mastoids and SCM muscles. The bithermal caloric test was also performed. Abnormal criteria of VIN were slow-phase slow-phase velocity (SPV) at 4 all different conditions > or = 2degrees/s with the same directions or mean of SPV at vibration on both mastoids or both SCM muscles > or = 5degrees/s with the same directions. RESULTS: In Meniere's disease, 28 of 57 (49.1%) of patients show pathologic VIN, 21 of 57 (36.8%) show pathologic canal paresis. 14 of 57 (24.6%) show abnormalities in both tests, and 35 of 57 (61.4%) show any abnormalities in either test. In unilateral vestibular neuritis, 43 of 58 (77.6%) showed pathologic VIN, 58 of 58 (100%) show canal paresis. In migraine-associated dizziness, 48 of 170 (28.2%) showed pathologic VIN, 58 of 170 (18.8%) show canal paresis. 15 of 170 (8.8%) showed abnormalities in both tests, and 65 of 170 (38.2%) show any abnormalities in either test. In chronic recurrent vestibulopathy, 23 of 78 (29.5%) of patients show pathologic VIN and 17 of 78 (21.8%) show pathologic canal paresis. Seven of 78 (9.0%) showed abnormalities in both tests, and 33 of 78 (42.3%) show any abnormalities in either test. CONCLUSION: VIN test can increase the sensitivity in detecting vestibular imbalance in vestibular disorders when combined with caloric test.
Caloric Tests ; Dizziness ; Eye Movements ; Humans ; Mastoid ; Meniere Disease ; Muscles ; Paresis ; Vestibular Neuronitis ; Vibration

BACKGROUND AND OBJECTIVES: It has been reported that vibration applied either on the mastoid or on the sternocleidomastoid (SCM) muscles induces nystagmus in normal subjects. The aims of the study were to characterize the direction and velocity of slow-phase eye movement which is induced by vibration in normal subjects and to propose the mechanism of vibration-induced nystagmus (VIN) in normal subjects. MATERIALS AND METHOD: We recorded eye movements during unilateral 100-Hz vibration on the mastoid bone and SCM muscles in 56 normal subjects. The subjects were divided into 4 groups in ages (20s, 30s, 40s, 50~60s). The directions of VIN, the degree of maximal slow-phase eye velocities were analyzed according to age. Positive value means slow-phase velocity (SPV) to the right side. RESULTS: In 20s, vibration on right/left mastoids induced SPV of 1.2+/-2.0degrees/sec, 0+/-2.1degrees/sec and on right/left SCM muscles, 1.1+/-1.9degrees/sec, -1.2+/-2.5degrees/sec. In 30s, vibration on right/left mastoids induced SPV of 3.3+/-3.8degrees/sec, -0.3+/-1.4degrees/sec and on right/left SCM muscles, 2.8+/-4.2degrees/sec, -1.0+/-1.5degrees/sec. In 40s, vibration on right/left mastoids induced SPV of 0+/-1.7degrees/sec, -0.2+/-1.2degrees/sec and on right/left SCM muscles, 0+/-1.8degrees/sec, 0+/-1.0degrees/sec. In 50~60s, vibration on the right/left mastoids induced SPV of -1.3+/-1.3degrees/sec, 1.2+/-1.3degrees/sec and on right/left SCM muscles, -0.6+/-0.9degrees/sec, 0.9 +/-1.5degrees/sec. The directional preponderance of the slow-phase eye movement to the vibrated side was statistically significant in 20s and 30s, however, the preponderance of the slow-phase eye movement changed into the non-vibrated side in 50~60s. CONCLUSION: The proprioceptive input, changing major rotator from the inferior oblique muscle to the sternocleidomastoid muscles might explain the change of the directional preponderance of the slow-phase eye movements in normal subjects according to ages. Although this directional preponderance is not consistent in all age groups, it is still important in discriminating normal responses from abnormal responses which can be induced by vibration.
Eye Movements ; Humans ; Mastoid ; Muscles ; Vibration

BACKGROUND AND OBJECTIVES: A possible link between Meniere's disease (MD) and headache was originally suggested by Prosper Meniere. We aimed to analyze the clinical manifestation of headache in definite MD compared with benign paroxysmal positional vertigo (BPPV) as a control group. MATERIALS AND METHODS:We examined headache in 67 patients with definite MD according to the criteria of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS). Sex- and age-matched 67 patients with BPPV served as a control group. Information was obtained concerning the prevalence, localization, severity, character, sequence of headache and response to therapy. RESULTS: Altogether 60 MD patients (90%) and 47 BPPV patients (70%) was reply the questionnaire. 46 MD patients (69%) and 15 BPPV patients (22%) reported headache. Headache was moderate to severe in 39 MD patients (85%) and as a whole more severe than that of the BPPV patients (P<0.05). Temporal area was the most frequently involved region in MD group, whereas posterior neck area was most frequent in BPPV group. The sequence of headache and vertigo attack was pre-(23%), intra-(33%), after-(44%). The 39 patients (89%) of headache in MD was response to the vestibular suppressants, diuretics, calcium channel blocker. CONCLUSION: It is concluded that high incidence of headache and migraine in combination with MD seems to common pathophysiology with migraine. Therefore, our results could provide predictive value in the treatment and follow up of MD patients with headache.
Calcium Channels ; Diuretics ; Follow-Up Studies ; Headache* ; Humans ; Incidence ; Meniere Disease* ; Migraine Disorders ; Neck ; Prevalence ; Surveys and Questionnaires ; Vertigo

BACKGROUND AND OBJECTIVES: Vestibular evoked myogenic potential (VEMP) is a relatively new diagnostic tool that is in the process of being investigated in patients with specific vestibular disorders. In this study, we examed the responses of VEMP in patients who complained of dizzines. MATERIALS AND METHOD: Eighty-six patients with complaint of dizziness and ten normal volunteers are included in this study. Among these patients, forty-six patients were diagnosed as unilateral vestibulopathy (A), five patients were bilateral vestibulopathy (B), nine patients were sudden sensorineural hearing loss with vertigo (C), fifteen patients were benign paroxysmal positional vertigo (D) and eleven patients were Meniere's disease (E). We compared VEMP parameters in each group. RESULTS: In each group, abnormal response in VEMP was 33%(A), 0%(B), 11%(C), 12%(D) and 36%(E) respectively. and there was no absent VEMP formation, and there was no abscent VEMP formation. CONCLUSION: VEMP is a promising method for diagnosing and following patients with many vestibular disorders.
Dizziness ; Healthy Volunteers ; Hearing Loss, Sensorineural ; Humans ; Meniere Disease ; Vertigo

BACKGROUND AND OBJECTIVES: The aim of this study was to verify if vibration-induced nystagmus in patients with vestibular neuritis changed over time and to compare the results of vibration-induced nystagmus (VIN) test to those of caloric test. MATERIALS AND METHOD: We compared VIN results with those of caloric testing in 23 patients (M:F = 11:12, 15~67 years old) with unilateral vestibular neuritis seen at onset and in follow-up for around 2 months. The eye movement recordings were made and the maximum slow-phase eye velocities (SPV) were calculated during vibration. If spontaneous nystagmus was present, it was subtracted from the slow-phase eye velocities of VIN. RESULTS: In acute stage, VIN of which SPV was directed towards the lesioned side was observed in 21 (91%). In follow-up, VIN of which SPV was directed towards the lesioned side was observed in 19 (83%). There was a significant decrease of the SPV of VIN over time. Significant correlations were observed in between canal paresis & SPV of VIN in both acute and follow-up stages. CONCLUSION: Our findings show that VIN test can predict the severity of vestibular asymmetry not only in acute stage but also in follow-up stage. Our results suggest that vibration-induced nystagmus might represent the peripheral vestibular asymmetry in patients with vestibular neuritis.
Caloric Tests ; Eye Movements ; Follow-Up Studies* ; Humans ; Paresis ; Vertigo ; Vestibular Function Tests ; Vestibular Neuronitis* ; Vibration

BACKGROUND AND OBJECTIVES: The aims of the study were to characterize the vibration-induced nystagmus (VIN) and air caloric test in patients with unilateral chronic otitis media, and to clarify the clinical availability of VIN by comparing the results of VIN test with those of air caloric test. MATERIALS AND METHODS: Nineteen patients with unilateral chronic otitis media who had had no vestibular symptoms in past history were investigated. Pure tone audiometry (PTA), air caloric, VIN and subjective visual vertical (SVV) tests were done and the results were analyzed to estimate the utility for investigating vestibular imbalance. RESULTS: If we consider a patient with abnormal results from two or more tests as a patient with latent vestibular imbalance, because they had no previous vestibular symptoms, 3 patients was considered to have latent asymmetric vestibular function. False positive rate were 32% in air caloric test, 5% in VIN test and 0% in SVV test. CONCLUSION: Our findings show that vestibular imbalance in patients with chronic otitis media should be determined through various tests and vibration-induced nystagmus test can be more useful than air caloric test in estimating the vestibular imbalance.
Audiometry ; Caloric Tests* ; Humans ; Otitis Media* ; Otitis* ; Vertigo*

BACKGROUND AND OBJECTIVES: Head tilt at the end of step rotation about a vertical axis decreases the time constant (TC) of the post-rotatory nystagmus, which is known as tilt-suppression of the vestibulo-ocular reflex (VOR). Tilt suppression of the VOR is mediated by the cerebellar nodulus and ventral uvula and is eliminated after surgical ablation of those structures. However, studies on the tilt suppression of the VOR have been sparse in humans with cerebellar lesions. MATERIALS AND METHODS:Five patients with circumscribed cerebellar lesions involving the nodulusor ventral uvula underwent recording of spontaneous and positional nystagmus, and the VOR. To evaluate tilt suppression of the VOR, the participants pitched their head forward at the end of step rotation about a vertical axis both in the clockwise and counter-clockwise directions. RESULTS: The VOR gain was increased in a patient with infarction in the territory of the medial posterior inferior cerebellar artery while the gain of visually enhanced VOR was normal in all the patients. The time constants of per- and post-rotatory nystagmus was increased in a patient with increased VOR gain and the tilt suppression of the post-rotatory nystagmus was impaired in two patients, either uni- or bilaterally. Spontaneous downbeat and central positional nystagmus were frequently accompanied. CONCLUSIONS: Nodular lesion may impair tilt suppression of the VOR. Measurement of tilt suppressive effect of the VOR may provide a valuable tool for evaluating the nodular dysfunction.
Arteries ; Axis, Cervical Vertebra ; Cerebellum ; Head ; Humans ; Infarction ; Nystagmus, Physiologic* ; Reflex, Vestibulo-Ocular ; Uvula

BACKGROUND AND OBJECTIVES: Congenital nystagmus (CN) is an ocular oscillation that usually manifests during early infancy. To report a novel mutation in FERM domain containing 7 (FRMD7) gene in a Korean family with CN. MATERIALS AND METHODS:Genomic DNA was prepared from peripheral blood leukocytes and direct sequencing of the entire coding and adjacent intronic regions was performed to detect sequence variation of FRMD7 gene, where mutations were found recently in patients with familial CN. The family showed an X-linked pattern of inheritance without father-to-son transmission. RESULTS: Three family members with CN exhibited two sequence variations which were a novel mutation (c. 875T>C; Leu292Pro) and a polymorphism (c. 1403G>A; Arg468His, dbSNP rs#6637934). The proband was hemizygous for both variations and his mother and maternal grandmother were heterozygous carriers. CONCLUSION: This study provides an additional evidence for mutations in FRMD7 as a common cause of X-linked CN and expands its mutation spectrum.
Clinical Coding ; DNA ; Humans ; Introns ; Leukocytes ; Mothers ; Nystagmus, Congenital* ; Wills

Lithium is recognized as a cause of reversible or permanent downbeat nystagmus. Many patients who were treated with lithium for psychiatric illness developed downbeat nystagmus and other neurological manifestations. Reversible splenial lesions of corpus callosum are commonly seen on diffusion-weighted imaging (DWI) in various neurological disorders including metabolic/toxic encephalopathy, encephalitis, patients with epilepsy receiving antiepileptic drugs. Herein, we report a patient with reversible downbeat nystagmus, disturbance of smooth pursuit, and gait ataxia who was treated with lithium. Also, we can observe reversible splenial lesion of corpus callosum on DWI in this patient.
Anticonvulsants ; Ataxia ; Corpus Callosum ; Encephalitis ; Epilepsy ; Gait Ataxia ; Humans ; Lithium ; Nervous System Diseases ; Neurologic Manifestations ; Pursuit, Smooth

BACKGROUND AND OBJECTIVES: Measurement of subjective visual vertical (SVV) in darkness with the head upright is one of the static function test of the otolithic system and is simple to perform in the patients. Changes of SVV were measured during the recovery period of vestibular neuritis to investigate the relation between SVV and the subjective improvements reported by the patients. MATERIAL AND METHODS:Sixty-two patients with unilateral vestibular neuritis were investigated. All the patients were diagnosed by physical examination with electronystagmography and the SVV were assessed during the acute period and sequentially followed during the recovery period. At the same time, the subjects were questioned in five scale of symptom improvement which were "Level 5: I am so dizzy to open my eyes", "Level 4: I am dizzy not moving my head", "Level 3: I am not dizzy if I don't move my head", "Level 2: I am not dizzy with head moving", "Level 1: I am not dizzy at all". RESULTS: The calibrated mean values were 5.72+/-4.77 degree in vertical deviated toward the lesion side. There was no relation between the canal paresis and the tilt of SVV. As the SVV reaches the normal value, the symptom scale improved to level 2 (p=0.018). The mean recovery time could be obtained by calculating the regression curve of the well compensated groups. CONCLUSION: These results show that SVV correlated with clinical improvement of dizziness symptoms in vestibular neuritis. Therefore, this method can be used to evaluate vestibular neuritis during the follow up.
Darkness ; Dizziness ; Electronystagmography ; Follow-Up Studies ; Head ; Humans ; Otolithic Membrane ; Paresis ; Physical Examination ; Reference Values ; Vestibular Neuronitis*