BACKGROUND AND OBJECTIVES: One of the characteristics of Meniere’s disease is pure tone threshold shift at low frequencies in the lesion; although, in some patients, more pure tone threshold shifts were also shown at mid or high frequencies. Authors speculated that the most varied pure tone frequency may be related with diversity of clinical symptoms and other characteristics. SUBJECTS AND METHOD: We reviewed medical records of 85 patients who met the criteria of definite Meniere’s disease (1995 American Academy of Otolaryngology-Head and Neck Surgery). Patients were classified into 3 groups (high frequency, mid frequency, low frequency) depending on the frequency at which pure tone threshold changes encountered the most. The vestibular function tests and clinical characteristics were compared between the groups. RESULTS: Thirty-six patients (42.0%) showed pure tone threshold changes at 0.25 or 0.5 kHz (low frequency group). Twenty-five patients (30.0%) showed greatest pure tone threshold change at 1 or 2 kHz (mid frequency group). Twenty-four patients (28.0%) belonged to the high frequency group with most changes taking place not lower than 4 kHz. Frequency of vertigo attack, and duration of vertigo attack did not differ between the groups. Low frequency group showed more chance of tinnitus with statistical significance. Vestibular evoked myogenic potentials (VEMP) abnormality was more frequently encountered in the low frequency group. CONCLUSION: This study shows that changes in the pure tone threshold is not confined to low frequencies in definite Meniere’s disease. Patients with pure tone threshold changes at low frequencies have more chance of tinnitus and abnormal cVEMP.
Humans ; Medical Records ; Meniere Disease ; Methods ; Neck ; Tinnitus ; Vertigo ; Vestibular Evoked Myogenic Potentials ; Vestibular Function Tests

BACKGROUND AND OBJECTIVES: Even patients with compensated peripheral vestibular dysfunction may report a sense of disequilibrium during daily activities, which often fail conventional vestibular function tests as attentional demand required for postural control may increase in these patients. The study aims to assess the feasibility of dual task test using concurrent cognitive tasks in a modified clinical test of sensory interaction on balance (mCTSIB) to measure increased attentional demand for posture control. SUBJECTS AND METHOD: Nineteen patients suspected with chronic dizziness were recruited by history reviews and physical examinations. Data for center of pressure (COP) variability and mean velocity during mCTSIB on a force long plate were analyzed, and time taken to react to the auditory stimuli were used to measure the attentional demand required for adequate postural control during platform perturbation. RESULTS: The mean COP range and velocity during mCTSIB were comparable between single and dual task conditions in patients with dizziness. Reaction time (RT) to auditory stimulus of 1 kHz pure tone in patients with chronic dizziness was also comparable to normal subjects. Interestingly, there was a tendency for increased RT in patients with documented caloric weakness, suggesting that attentional demand is increased in these patients. CONCLUSION: RT of dual task tests using auditory stimuli during mCTSIB may provide additional information about increased attentional demand for postural control in patients with vestibular dysfunction.
Dizziness* ; Humans ; Methods ; Physical Examination ; Posture ; Reaction Time ; Task Performance and Analysis ; Vestibular Diseases ; Vestibular Function Tests

BACKGROUND AND OBJECTIVES: We evaluated the clinical characteristics and vestibular function of patients with direction changing vibration induced nystagmus (DC VIN) and unilateral vestibular hypofunction and suggest clinical implication and a proposed mechanism of DC VIN. SUBJECTS AND METHOD: The records of 315 patients who underwent the VIN test were reviewed retrospectively. Among these, 18 patients (5.7%) showed DC VIN, and out of whom, 15 patients (4.8%) were diagnosed as unilateral vestibular hypofunction by caloric, rotation chair (RCT), and video head impulse test (vHIT). We analyzed the relationship between DC VIN and the dizziness characteristics, duration of disease, and the outcome of the vestibular function test. RESULTS: The mean age of 15 patients was 67.4±10.7 years and the mean duration of dizziness was 13.6±29.7 months. The caloric test revealed 25% of the patients to have significant canal paresis [Caloric vestibular neuritis (VN)], while 75% showed normal caloric response. However, unilateral vestibular hypofunction was observed by abnormal results in RCT or vHIT (Non-caloric VN). Seven patients showed ipsilateral DC VIN (nystagmus to vibrated side) and eight patients contralateral DC VIN (nystagmus to opposite side of vibration). Patients with ipsilateral DC VIN were shown to have a significant longer duration of dizziness than those with contralateral DC VIN. CONCLUSION: Although rare, DC VIN can also be found in patients with unilateral vestibular hypofunction. Patients with DC VIN had a mild vestibular asymmetry with Non-caloric VN or Caloric VN in the process of compensation. The mechanism of ipsilateral DC VIN seems to be due to the small amount of vestibular asymmetry, which is smaller than the interaural attenuation of vibration.
Caloric Tests ; Compensation and Redress ; Dizziness ; Head Impulse Test ; Humans ; Methods ; Paresis ; Retrospective Studies ; Vestibular Function Tests ; Vestibular Neuronitis ; Vibration*

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

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

BACKGROUND AND OBJECTIVES: To analyze the difference in audiologic-vestibular and clinical characteristics between acute cochlea-vestibulopathy (ACV) and idiopathic sudden sensorineural hearing loss (ISSNHL). SUBJECTS AND METHOD: We retrospectively analyzed the clinical characteristics of 91 patients diagnosed as sudden hearing loss (ACV; n=20, ISSNHL; n=71). Patients with vestibular hypofunction were categorized as ACV and all others as ISSNHL. Demographics and clinical findings were compared. Audiologic features such as degree of hearing loss, type of audiometric configuration and hearing improvements were analyzed. In addition, vestibular function test results and hearing recovery were further analyzed among ACV group. RESULTS: Demographics and other clinical findings were not much different between groups. There was a significant difference with respect to audiologic features between the ACV group and ISSNHL group: the initial hearing threshold of the ACV group was higher than that of the ISSNHL group, and their treatment onset was also shorter. There was also a significant difference in the hearing outcome showing very low rate of complete recovery in ACV group. The final hearing threshold of the ACV group was higher than that of the ISSNHL group. Dizziness was the only significant variable in the multiple regression analysis. In the ACV group, the cervical vestibular evoked myogenic potential inter-aural amplitude difference (cVEMP IAD) ratio showed a correlation to the hearing recovery in some frequencies; patients with no cVEMP response showed poor outcome compared to those with cVEMP waveform. CONCLUSION: The ACV group shows a poor prognosis just as in the case of sudden hearing loss defined in the traditional sense of vertigo. The IAD value of the vestibular evoked myogenic potentials test will be helpful in assessing hearing improvement, especially when a high IAD value at the middle frequency is associated with a poor prognosis.
Demography ; Dizziness ; Hearing ; Hearing Loss ; Hearing Loss, Sensorineural ; Hearing Loss, Sudden ; Humans ; Methods ; Prognosis ; Retrospective Studies ; Vertigo ; Vestibular Evoked Myogenic Potentials ; Vestibular Function Tests

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

Dizziness is the most common symptom in elderly patients and has been identified as a risk factor for falls. They can affect objectively the ability to achieve a stable gaze, posture, and gait. Research on the relationship between vestibular hypofunction and falls in elderly people has been rarely performed and the evidence is controversial. Because falls result from various combinations of many factors, validated tools should be used for assessment of falling. Many of the tests and numerous parameters associated with the risk of falling have already been introduced, however guidance on which test is most appropriate for use in a specific setting still lack in the medical community. Therefore, developement of comprehensive fall risk management guideline and assessment tool including physical, psychosocial, environmental factors are necessary to prevent falls in the elderly. Establishment of validity and reliability for relationship among several vestibular function test are more important to evaluate efficiently risk of falls in the dizzy patients. Also we can expect that decreasing risk of fall when conduct the developement of additional customized intervention method using verified assessment tools.
Accidental Falls ; Aged ; Dizziness ; Gait ; Humans ; Methods ; Posture ; Reproducibility of Results ; Risk Factors ; Risk Management ; Vestibular Function Tests

OBJECTIVE: To investigate the sensory organization in the postural stability under sensory conflict induced by standing foam surface in normal individuals. METHOD: One hundred and six normal subjects were tested using the computerized posturography under 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 sway velocity (SV) of body under different sensory conflict condition was recorded as parameter of postural stability and the effect of organization between the vestibular, visions and somatosensory was analyzed quantitatively. RESULT: (1) The SV decreased when the visual cue or/and somatosensory cue be interrupted (P<0.01); (2) The decreased degrees of SV induced by the change of visual cue were (12.12+/-6.1)% and (30.58+/-9.69)% when the somatosensory cue be interrupted or not. The decreased degrees of SV induced by the change of somatosensory cue were (18.31+/-6.56)% and (36.25+/-8.90)% when the visual cue be interrupted or not. The decreased degrees of SV induced by the change of both somatosensory and visual cue were (46.21+/-8.67)%; (3) The most important sensory input for keeping balance is vestibular cue, followed by the somatosensory and visual cues and the relationship among these three sensory is nonlinear. CONCLUSION Through recording the postural stability quantitatively under different conditions of sensory conflict induced by standing foam surface or closing eyes, it is possible to evaluate the sensory organization of the three kinds of sensory input including the visual, somatosensory, and vestibular input in postural control. It exist the various balance strategy for keeping postural stability under sensory conflict in normal subjects. When one or two sensory input was interrupted in the static balance, the center nervous system has a complicated mechanism of sensory organization to keep balance even in the normal subject.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Postural Balance ; physiology ; Vestibular Function Tests ; instrumentation ; methods ; Young Adult

BACKGROUND AND OBJECTIVES: Various hearing tests and vestibular function tests are used to diagnose acoustic neuroma. We analyzed the clinical characteristics and the results of audiovestibular function tests between patients of intrameatal and extrameatal acoustic neuroma. SUBJECTS AND METHOD: Reviewing the medical records for 64 patients with acoustic neuroma between March 2007 and February 2014, we divided the patients into two groups, intrameatal (31 patients) and extrameatal acoustic neuroma (33 patients) according to the involvement of cerebropontine angle. We compared the clinical characteristics, pure tone audiograms, speech audiometry, caloric test, and vestibular evoked myogenic potential (VEMP) between the two groups. RESULTS: While hearing loss was the most frequent presenting symptom in patients with intrameatal acoustic neuroma, dizziness was the most common symptom in patients with extrameatal acoustic neuroma. Hearing thresholds measured by pure tone audiometry and speech discrimination scores were significantly worse for patients with extrameatal acoustic neuroma. Abnormal unilateral canal paresis of caloric test was significantly higher for extrameatal acoustic neuroma than for intrameatal acoustic neuroma. Most patients with acoustic neuroma showed abnormal findings in the VEMP test, but the number of patients between intrameatal and extrameatal acoustic neuroma did not differ significantly. CONCLUSION: Clinical symptoms and the results of audiovestibular function tests differed according to the tumor size of acoustic neuroma. Physicians should counsel patients presenting with audiovestibular symptoms of the possibility of acoustic neuroma.
Acoustics* ; Audiometry ; Audiometry, Speech ; Caloric Tests ; Dizziness ; Hearing ; Hearing Loss ; Hearing Tests ; Humans ; Medical Records ; Methods ; Neuroma, Acoustic* ; Paresis ; Speech Perception ; Vestibular Function Tests