Vertigo/dizziness is a common complaint in patients who are seeking a primary health clinic. Vertigo is traditionally attributed to damage of the vestibular system. Many peripheral and central vestibular disorders are usually presented with vertigo. However, patients with benign paroxysmal positional vertigo (BPPV), a leading cause of vertigo, may present with postural lightheadedness, near faint, imbalance rather than true vertigo. On the contrary, patients with orthostatic hypotension may present with true spinning vertigo, not dizziness. Persistent postural perceptual dizziness, a second most common cause of dizziness (after BPPV), is mainly occurred after organic vestibular disorders such as BPPV or vestibular neuritis, and classified as a chronic functional vestibular disorder. This article describes non-vestibular disorders presenting dizziness and/or vertigos, which conditions may be misdiagnosed as structural vestibular disorders.
Benign Paroxysmal Positional Vertigo ; Diagnosis ; Dizziness ; Humans ; Hypotension, Orthostatic ; Orthostatic Intolerance ; Vertigo ; Vestibular Neuronitis ; Vestibulocochlear Nerve Diseases

Peripheral vestibular disorder (PVD) is serious and common. Clinically, giving an accurate diagnosis of PVD can be challenging. Vestibular evoked myogenic potential (VEMP) is an objective test to evaluate the integrity of vestibular organs, particularly saccule and/or inferior vestibular nerve. This study was performed to determine the sensitivity and specificity of VEMP using different stimuli. Fourty normal and 65 PVD subjects who fulfilled the inclusion criteria were recruited. While sitting comfortably, VEMP waveforms were recorded with active electrode on sternocleidomastoid muscle and negative electrode on upper forehead. Tone bursts (500, 750 and 1000 Hz) were delivered via headphones at 90 dBnHL and 5/s presentation rate. VEMP parameters for each stimulus (amplitude and latency of P1 and N1 peak) were analyzed accordingly. Receiver operating characteristic (ROC) was performed to determine the sensitivity and specificity of VEMP at different test frequencies. N1 amplitude of 750 Hz stimulus produced the most ideal sensitivity (65% on right and 63% on left) and specificity (83% on right and 78% on left). The importance of using a few tone bursts in VEMP test in order to minimize the false negative in cases might be encountered in clinics as the certain tone burst had inadequate sensitivity in detecting PVD cases. The 750 Hz stimulus produced the most ideal VEMP with adequate values of sensitivity and specificity, at least in this study.
Vestibulocochlear Nerve Diseases

BACKGROUND AND OBJECTIVES: Etiology of acute unilateral peripheral vestibulopathy (AUPV) includes virus, ischemia, and autoimmune. As anatomical distribution is similar between vasculature and innervation, AUPV with vascular risk factors could be ischemic origin. We investigated the pattern of audiovestibular dysfunction to explore the influence of risk factors on AUPV. MATERIALS AND METHODS: We collected records of 162 AUPV patients from 2011 to 2013 who were admitted within 7 days from vertigo onset and diagnosed as AUPV by caloric test and neuro-otologic examination. Vascular risk factors are stroke history, hypertension, diabetes, body mass index >25, age >60, and vertebrobasilar stenosis. Bedside examination includes spontaneous nystagmus grade, head impulse test, head shaking test. Results of rotatory chair test (n=125), caloric test (n=162), cervical (n=33) and ocular (n=23) vestibular evoked myogenic potential (VEMP), subjective visual vertical (SVV) (n=91), and pure tone audiometry (PTA) (n=62) are collected. RESULTS: Abnormalities of PTA are found more in patients with vascular risk factor than without any risk factor. Specifically, hypertension (p=0.008) and old age (p=0.025) are associated with PTA abnormality (p=0.006). Tilt angle of vertical is larger in risk factor group (p=0.019). The number of vascular risk factor correlates with abnormalities of PTA (p=0.025) and tilt angle of SVV. Results of bedside examination, rotatory chair test, caloric test, cervical and ocular VEMP are not associated with vascular risk factors. CONCLUSION: AUPV patients with vascular risk factors have more extensive involvement of audiovestibular function. Ischemic etiology may contribute to pathogenesis of extensive AUPV.
Audiometry ; Body Mass Index ; Caloric Tests ; Constriction, Pathologic ; Head ; Head Impulse Test ; Humans ; Hypertension ; Ischemia ; Risk Factors ; Stroke ; Vertigo ; Vestibular Neuronitis ; Vestibulocochlear Nerve Diseases

Audiometry ; Humans ; Vestibulocochlear Nerve Diseases ; etiology ; physiopathology

Cochlear Implantation ; Cochlear Implants ; Humans ; Vestibulocochlear Nerve Diseases

Hearing Loss, Central ; genetics ; Humans ; Vestibulocochlear Nerve Diseases

Hair Cells, Auditory, Inner ; Humans ; Synapses ; Vestibulocochlear Nerve Diseases

Humans ; Standard of Care ; Vestibulocochlear Nerve Diseases ; diagnosis ; therapy

Child ; Child, Preschool ; Humans ; Vestibulocochlear Nerve Diseases ; diagnosis ; prevention & control

OBJECTIVETo analyze the clinical diagnosis of auditory neuropathy by retrospective review of the articles published in Chinese Journals in the past 10 years.

METHODSThe key word of "auditory neuropathy" was used to search all of the articles published in Chinese Journals by the Chinese Bio-medicine Literature Data Base and Chinese Journal Net from 1995 to 2004. The selected subjects of auditory function examination, diagnosis standards were analyzed, respectively.

RESULTSForty-two articles were collected, and 23 articles were clinical researches and case reports. There were 573 patients (1146 ears) in all series, and 480 ears (42%) were accords with the standards of diagnosis of auditory neuropathy. Others were accompanied by cochlea, brain stem and peripheral nerve disorders.

CONCLUSIONThe clinical manifestation and hearing examination on auditory neuropathy in Chinese journal literatures is inconsistent with the diagnosis standards, moreover, it is necessary to further explore the pathological location and unify the diagnosis standards of auditory neuropathy.