OBJECTIVETo discuss the characteristics of subjective visual gravity (subjective visual vertical/horizontal, SVV/SVH) and assess its clinical application for peripheral unilateral vestibular compensation.

METHODS69 cases of acute peripheral unilateral vestibular dysfunction patients (case group) accepted SVV/SVH, spontaneous nystagmus (SN), caloric test (CT) and other vestibular function tests. 49 healthy people (control group) accepted SVV/SVH only. SVV/SVH, SN and unilateral weakness (UW) were selected as for the observation indicators. The correlations between SVV/SVH, SN, UW and courses were investigated respectively, as well as the characteristic of SVV/SVH, SN in period of vestibular compensation.

RESULTSAmong case group SVV, SVH positive in 42 patients(60.9%) and 44 patients(63.8%), the absolute values of the skew angle were in the range between 2.1°-20.0°, 2.1°-22.2°. Skew angles of SVV/SVH in control were in the range between -1.5°-2.0° and -2.0°-1.6°, and had no statistical significance with case group(t=5.336 and 5.864, P<0.05). SN-positive 28 cases (40.6%), the range of intensities at 2.4°-17.1°; UW-positive 50 cases (72.5%). In case group, positive correlation between SVV and SVH(r=0.948, P=0.00), negatively correlated between SVV/SVH and SN respectively(r values were -0.720, -0.733, P values were 0.00), no correlation between the skew angle of SVV/SVH, strength of SN and UW value(r values were 0.191, 0.189, and 0.179, P>0.05), there was no correlation between the absolute value of SVV, SVH, SN, UW with the duration (rs values were -0.075, -0.065, -0.212, and 0.126, P>0.05).

CONCLUSIONSubjective visual gravity can be used not only to assess the range of unilateral peripheral vestibular dysfunction, but also help assess the static compensatory of otolithic, guidance and assessment of vestibular rehabilitation.

Caloric Tests ; Gravitation ; Humans ; Otolithic Membrane ; Pilot Projects ; Vestibular Diseases ; physiopathology ; Vestibular Function Tests ; Vestibule, Labyrinth ; physiopathology ; Visual Perception

OBJECTIVE: To investigate the application of modified clinical test of sensory interaction and balance (mCTSIB) in the patients with vertigo. METHOD: One hundred and six patients with vertigo (62 cases with peripheral and 44 cases with central vestibular disorder) were taken the mCTSIB of the firm surface and foam surface with eye open and eye closed for 30 seconds respectively. The standing foam surface was to interrupt the somatosensory and closing eyes was to interrupt the visual input in the postural stability. The falling during the test was recorded. The results between the mCTSIB and video nystagmography (VNG) were compared. RESULT: In vestibular peripheral disorder, the abnormal of mCTSIB was 45.16% (28/62) and agreement to VNG was 67.74% (42/62). In vestibular central disorder, the abnormal of mCTSIB was 27.27% (12/44) and agreement to VNG was 81.82% (36/44). For all these patients with vertigo in this study, the abnormal of mCTSIB was 37.74% (40/106) and agreement to VNG was 73.58% (78/106). Regarding the falling as abnormality, the mCTSIB was not significant different between the vestibular peripheral and central disorders (chi2 = 3.505, P > 0.05). CONCLUSION Although the mCTSIB, which was easy to carry out, can not be a method to differentiate the vestibular peripheral and central disorders, it was a suitable to assess the ability of sensory interaction to maintain balance in patients with vertigo.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Postural Balance ; Proprioception ; Vertigo ; physiopathology ; Vestibular Diseases ; physiopathology ; Vestibular Function Tests ; Young Adult

OBJECTIVE: The purposes of this study was to analyse the significant of low frequency air-bone gap in enlarged vestibular aqueduct (EVA) patients according to the pure tone audiogram and the benefit for clinic diagnosis of the EVA. METHOD: The audiology testing include (1) play audiometry or pure tone audiometry, tympanometry, middle ear muscle reflex thresholds and stapedius muscle reflex; (2) High-resolution computed tomography (CT) scan of the temporal bone and magnetic resonance imaging was used for diagnoses the EVA. RESULT: All the 78 patients (154 ears) were diagnosed as the typical EVA by CT or MRI. Inner ear malformations were found in 3 ears otherwise the structures of middle ear in all the patients were absolutely normal. The audiology analysis showed 154 ears were type A tympanogram including 126 ears with typical A, 25 ears with As, 3 ears with Ad type. In the 250 Hz pure-tone test:A-B gap were observed in 126 ears(126/154,81. 8%) with the different hearing loss degree: 1 ear mild, 11 ears moderate, 19 ears moderate severe, 40 ears severe and 53 ears profound. In the 500 Hz pure-tone test: A-B gap were found in 102 ears(102/154, 66. 2%) with the different hearing loss degree: 9. ears moderate, 17 ears moderate severe, 35 ears severe and 41 ears profound. CONCLUSION Our study suggested a 66. 2% -81. 8% possibilities to find the EVA through the pure-tone audiometry firstly in the basis of the normal tympanograms with the significant A-B gap.
Acoustic Impedance Tests ; Adolescent ; Audiometry, Pure-Tone ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Vestibular Aqueduct ; Vestibular Diseases ; physiopathology

OBJECTIVE: To observe the ocular vestibular evoked myogenic potential (oVEMP) and the cervical vestibular evoked myogenic potential (cVEMP) in patients with vestibular diseases. METHOD: From March, 2011 to March, 2012, 13 patients (14 ears) with peripheral vestibular diseases were recruited. Each patient underwent conventional oVEMP and cVEMP examinations elicited by intensive air conducted sound (short tone burst, 500 Hz) in bilateral ears. RESULT: Thirteen cases (14 ears) were included in this study. They were 3 cases (3 ears) with Ramsay Hunt syndrome, 3 cases (4 ears) with acoustic neuroma, 1 case (1 ear) with VII and VIII cranial nerve trauma after head injury, 2 cases (2 ears) with vestibular neuritis, 3 cases (3 ears) with Meniere's disease, and Icase (1 ear) with unilateral hypoplasia of the internal auditory canal. Altogether, oVEMP could be elicited in only 2 ears (14. 3%) and cVEMP were found abnormal in 11 ears (78. 6%). CONCLUSION The otolithic vestibular end organs and their input pathways could be examined by cVEMP and oVEMP examinations in patients with peripheral vestibular disorders.
Acoustic Stimulation ; Eye ; Humans ; Meniere Disease ; Neuroma, Acoustic ; Otolithic Membrane ; Vestibular Diseases ; physiopathology ; Vestibular Evoked Myogenic Potentials ; Vestibular Neuronitis ; Vestibule, Labyrinth

Kabuki syndrome is characterized by long palpebral fissures, large ears, a depressed nasal tip, and skeletal anomalies associated with postnatal dwarfism and mental retardation. There have been few prior detailed descriptions of strabismus or stereopsis in these patients. We report a patient with Kabuki syndrome who showed small-angle strabismus and poor stereopsis. This case illustrates the need for patients with a diagnosis of Kabuki syndrome to have an ophthalmologic evaluation. Strabismus associated with Kabuki syndrome may have a small angle that can be easily overlooked.
Abnormalities, Multiple/physiopathology ; Child ; Face/abnormalities/physiopathology ; Female ; Hematologic Diseases/complications/physiopathology ; Humans ; Strabismus/*etiology/physiopathology ; Vestibular Diseases/complications/physiopathology ; *Vision, Binocular ; *Visual Acuity

OBJECTIVE: To quantify the posture control ability of patients with peripheral vertigo by computed dynamic posturography (CDP). METHODS: Ninety-one subjects diagnosed with peripheral vertigo by caloric test were divided into unilateral vestibular dysfunction group (unilateral group) and bilateral vestibular disorder dysfunction group (bilateral group). CDP tests including sensory organization test (SOT) and motor control test (MCT) were performed on all subjects. The CDP results were compared with the normal data by t-test. RESULTS: In unilateral group, there was no statistically significant difference in SOT compared with normal data (P > 0.05). In bilateral group, the composite equilibrium score was lower than the normal data, especially during the moving of the platform and the changes of visual stimulation (P < 0.05). In MCT test, the latencies of both groups showed no statistically significant difference compared with normal data (P > 0.05). CONCLUSION During the non-acute period of peripheral vertigo, patients could maintain static equilibrium. Compared with normal people, dynamic equilibrium function is normal in patients with unilateral vestibular dysfunction, but declined in patients with bilateral vestibular dysfunction.
Adolescent ; Adult ; Electronystagmography ; Female ; Humans ; Male ; Motor Activity/physiology* ; Photic Stimulation ; Postural Balance/physiology* ; Posture/physiology* ; Vertigo/physiopathology* ; Vestibular Diseases/physiopathology* ; Vestibular Function Tests/methods* ; Young Adult

OBJECTIVETo investigate the balance function of the patients with unilateral vestibular hypofunction (UVH) by timed balance tests and static posturography (SPG).

METHODSSixty-five subjects with UVH and 92 healthy subjects were taken the timed balance tests under differential stance including (1) standard Romberg test, (2) feet apart stance test, (3) tandem and (4) unilateral standing tests with eyes open and eyes closed. The average timing that subjects kept balance before falling in each standing conditions was recorded by stopwatch as the timed result. The body sway velocity during the test (1) and (2) were also recorded by the SPG.

RESULTSThe timed results of the tandem and unilateral standing with eyes open and eyes closed in the UVH group were decreased (P < 0.001) compared with the control group. The body sway velocity of the standard Romberg test and foot apart stance with eyes open was not different between the UVH group and control group (P-value was 0.118 and 0.110 for the two tests respectively), and the difference was significant in the eyes closed condition (P < 0.001). For the two groups, the body sway velocity of foot apart standing was decreased than that of the standard Romberg test with eyes open and eyes closed (P < 0.05 or P < 0.001). Significant correlations were not found between the timed results and sway velocity results in both two groups respectively (P > 0.05).

CONCLUSIONSAccording to clinical assessment of balance function in UVH, the tandem and unilateral stance test could provide the additional information about the upright stance to the SPG measurement. The effect of foot position on the results of SPG should been considered in clinic.

Adult ; Case-Control Studies ; Female ; Humans ; Male ; Middle Aged ; Neurologic Examination ; Postural Balance ; Vestibular Diseases ; physiopathology

OBJECTIVE: To evaluate the vestibular function of motion sickness. METHOD: VNG, which tests the vestibular function of horizontal semicircular canal, and CPT, which tests vestibulospinal reflex and judge proprioceptive, visual and vestibular status, were performed in 30 motion sickness patients and 20 healthy volunteers (control group). Graybiel score was recorded at the same time. RESULT: Two groups' Graybiel score (12.67 +/- 11.78 vs 2.10 +/- 6.23; rank test P<0.05), caloric test labyrinth value [(19.02 +/- 8.59) degrees/s vs (13.58 +/- 5.25) degrees/s; t test P<0.05], caloric test labyrinth value of three patients in motion sickness group exceeded 75 degrees/s. In computerized posturography testing (CPT), motion sickness patients were central type (66.7%) and disperse type (23.3%); all of control group were central type. There was statistical significance in two groups' CTP area, and motion sickness group was obviously higher than control group. While stimulating vestibulum in CPT, there was abnormality (35%-50%) in motion sickness group and none in control group. Generally evaluating CPT, there was only 2 proprioceptive hypofunction, 3 visual hypofunction, and no vestibular hypofunction, but none hypofunction in control group. CONCLUSION Motion sickness patients have high vestibular susceptible, some with vestibular hyperfunction. In posturography, a large number of motion sickness patients are central type but no vestibular hypofunction, but it is hard to keep balance when stimulating vestibulum.
Adult ; Caloric Tests ; Case-Control Studies ; Female ; Humans ; Male ; Motion Sickness ; diagnosis ; physiopathology ; Vestibular Diseases ; diagnosis ; physiopathology ; Young Adult

OBJECTIVETo analyze the characteristics of subjective visual horizontal (SVH) and evaluate its clinical value for vestibular function in peripheral unilateral vestibular hypofunction (UVH).

METHODSEighty-five patients with UVH (study group) and 39 normal persons (control group) accepted vestibular function tests, including SVH, subjective visual vertical (SVV) and caloric test by video-nystagmography. The parameters of the angle of SVH and SVV, directional preponderance (DP) and unilateral weakness (UW) of caloric test were observed. The correlation between SVH/SVV, DP, UW and the course of disease were investigated respectively. SPSS 16.0 software was used to analyze the data.

RESULTSReference range of SVH and SVV was from -2° to 2° in the control group. Among the 85 patients, 46 cases (54.1%) and 43 cases (50.6%) had the abnormal values of SVH and SVV respectively, with no statistical significance (χ(2) = 12.5, P = 0.481) by chi square test. Fifty-five cases (64.7%) with abnormal DP had no statistical significance when compared with SVH and SVV respectively (χ(2) values were 0.19 and 2.86, respectively, P value were 0.164, 0.067, respectively). In UVH, there were positive correlation between SVH, SVV and DP (r value was 0.939, 0.648, 0.658, all P < 0.05) respectively, but no correlation between UW and SVH or SVV (r value was 0.048, 0.085, all P > 0.05). According to the permutation and combination of the four parameters, positive or negative, three main groups could be defined [SVH(+)DP(+)UW(+), SVH(-)DP(+)UW(+), SVH(-)DP(-)UW(+); SVV(+)DP(+)UW(+), SVV(-)DP(+)UW(+), SVV(-)DP(-)UW(+)]. The course of disease in the three main groups was positively skewed distribution, with median of 5.0, 10.0, 15.0 d and 5.0, 9.5, 14.5 d respectively. By Kruskal-Wallis Test, χ(2) value were 8.80 and 6.26, respectively(P value were 0.012, 0.040, respectively), with statistical significance between the above three main groups.

CONCLUSIONSThe SVH value can evaluate the function of the otolithic. The angle of SVH and SVV are changing in the course of disease, SVH and SVV can be used as a guidance of the vestibular compensation evaluation.

Adolescent ; Adult ; Aged ; Caloric Tests ; Case-Control Studies ; Child ; Female ; Humans ; Male ; Middle Aged ; Vestibular Diseases ; physiopathology ; Vestibular Function Tests ; methods ; Visual Perception ; Young Adult

OBJECTIVETo evaluate the function of vestibular ocular reflex (VOR) in patients with unilateral peripheral vestibular disorder (uPVD) by the head impulse test (HIT).

METHODSThe HIT and caloric test were carried out in 135 cases of patients with uPVD. The results of HIT were considered as normal (negative reaction) and abnormal (positive reaction). The results of vestibular function evaluated by caloric test were divided into three kinds, including normal, decreased and deficit according to the degree of canal paresis as less than 30 percent, from 30 to 99 percent, and equal to 100 percent, respectively. The sensitivity, specificity, positive and negative predictive value of HIT in assessing the vestibular function was analyzed.

RESULTSFor the 135 patients with uPVD, the HIT was normal in 90 (66.7%) cases and abnormal in 45 (33.3%) cases. When the caloric test was normal, the HIT was normal or abnormal in 58 cases and 6 cases, respectively. And when the canal paresis was from 30 to 99 percent, the HIT was normal or abnormal in 28 and 24 cases, respectively. When the vestibular function was deficit (CP was 100%), the HIT was normal or abnormal in 4 cases and 15 cases, respectively. When the results of caloric test were considered as the standard method to evaluate the VOR, the sensitivity, specificity, positive and negative predictive value of HIT were 54.9%, 90.6%, 86.7%, and 64.4%, respectively.

CONCLUSIONSWhen assessing the function of VOR in patients with uPVD, the HIT could not replace the caloric test, but it can be a supplementary method. The information from both the HIT and caloric test can be combined to evaluate the patients with vestibular hypofunction comprehensively.

Adult ; Caloric Tests ; Female ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Reflex, Vestibulo-Ocular ; Sensitivity and Specificity ; Vestibular Diseases ; diagnosis ; physiopathology ; Vestibular Function Tests ; methods ; Young Adult