Clinical Significance of Vibration-Induced Nystagmus and Head-Shaking Nystagmus Through Follow-Up Examinations in Patients With Vestibular Neuritis

Park, HongJu; Hong, Seokchan; Shin, Jeong Won

doi:10.1097/mao.0b013e318169281f

Cited by 37 publications

(33 citation statements)

References 20 publications

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“…We found that the initial slow phase of HSN was directed towards the lesioned side in all patients during the acute stage whereas 4 patients (6%) showed recovery HSN and 7 (11%) patients showed normalized CP at follow-up. This reversal may be due to peripheral recovery or a central increase in the vestibulo-ocular reflex in response to stimulation of the affected vestibular apparatus at a frequency of 2 Hz [Maire and van Melle, 2000;Matsuzaki and Kamei, 1995;Park et al, 2008;Perez et al, 2004]. Thus, for localizing the lesioned side the results of the HSN test during the compensated stage should be combined with the results of other tests including the caloric test.…”

Section: Directions Of Initial Hsnmentioning

confidence: 99%

“…However, patients with total unilateral vestibular loss are rarely encountered clinically and not all dizzy patients show HSN [Asawavichiangianda et al, 1999;Hall and Laird, 1992;Harvey et al, 1997;Iwasaki et al, 2004;Park et al, 2008;Perez et al, 2004]. HSN was reported to be closely related to the vestibular imbalance and more frequent in patients with peripheral vestibular dysfunction (Menière's disease, 58%; VN, 50%) than in patients with psychogenic dizziness (21%) [Asawavichiangianda et al, 1999].…”

Section: Incidence Of Hsn and Correlation With Cpmentioning

confidence: 99%

“…Vestibular neuritis (VN) is a single-episode disorder that can be used as a model for understanding the changes and mechanism of various forms of HSN. Although several studies have evaluated HSN in patients with VN [Kim et al, 2008;Park et al, 2008Park et al, , 2009], none to date has comprehensively analyzed the characteristics of HSN and its changes during the acute and follow-up stages. We have therefore characterized the features of HSN in patients with VN during acute and follow-up stages and assessed the clinical implication of HSN.…”

Section: Introductionmentioning

confidence: 99%

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Comprehensive Analysis of Head-Shaking Nystagmus in Patients with Vestibular Neuritis

et al. 2012

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Although biphasic head-shaking nystagmus (HSN) is a basic response to head shaking in patients with unilateral vestibular loss, monophasic HSN is commonly seen in patients with dizziness of undetermined etiology. Since the clinical significance of HSN remains unclear, we sought to characterize different types of HSN in patients with vestibular neuritis (VN) during the acute stage (within 7 days after the onset of vertigo) and at follow-up (about 2 months after the onset of vertigo), and to compare HSN and caloric responses. We analyzed HSN, spontaneous nystagmus and caloric tests in 66 patients with VN. Overall, HSN showed high abnormal rates (94 and 89%) during the acute and follow-up stages and could detect vestibular hypofunction even when canal paresis (CP) had normalized at follow-up. All patients in the acute stage and most patients at follow-up showed HSN with the slow phase to the lesioned side (paretic). Biphasic HSN was common at follow-up, and many patients with a monophasic paretic pattern during the acute stage had evolved to a biphasic paretic pattern at follow-up. Initial slow-phase eye velocities (SPVs) in biphasic HSN were larger than those in monophasic HSN at follow-up. Absence of HSN or reversal of its direction was closely related to normalized caloric responses, but SPVs of HSN did not correlate with the severity of CP. These findings indicate that the HSN test is a sensitive detector of vestibular hypofunction upon 2-Hz head rotation. HSN may reveal previous vestibular hypofunction in the 2-Hz frequency range even at follow-up, when caloric responses detecting vestibular hypofunction in the low-frequency range had normalized. The two tests utilize different mechanisms to assess vestibular hypofunction and are complementary. Biphasic paretic HSN is the most common pattern at follow-up and occurs when the initial SPVs induced by head rotation are large enough to induce the adaptation of primary vestibular afferent activity. Monophasic HSN, which is commonly found in dizzy patients, indicates less severe vestibular hypofunction than biphasic HSN in the 2-Hz frequency range, and the caloric tests can provide further information about the side and presence of vestibular hypofunction at lower frequencies.

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Section: Directions Of Initial Hsnmentioning

confidence: 99%

Section: Incidence Of Hsn and Correlation With Cpmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comprehensive Analysis of Head-Shaking Nystagmus in Patients with Vestibular Neuritis

et al. 2012

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“…They were diagnosed with definite Meniere's disease (MD) [10] in 58 (left 32, right 26), vestibular neuritis [11] in 18 (left 10, right 8), recurrent vestibulopathy [12] in 10 (left 6, right 4), the vertigo accompanying sudden deaf [13] in 13 (left 6, right 7), vestibular involved inner ear malformation [14] in 5 (left dominant 3, right dominant 7), acoustic neuromas [15] before surgery in 2 (both right), labyrinth involved temporal bone fracture [16] in 2 (both right), delayed endolymphatic hydrops [17] in 2 (both right), idiopathic loss of inner ear function [18] in 2 (both right). The patients with spontaneous nystagmus, eardrum perforation and cervical spondylosis were excluded from the present study.…”

Section: Patients Groupmentioning

confidence: 99%

Vibration-Induced Nystagmus in Patients with Unilateral Peripheral Vestibular Disorders

Xie

Guo

Wu³

et al. 2013

Indian J Otolaryngol Head Neck Surg

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This study was done to clarify the clinical significance of vibration-induced nystagmus (VIN) and to calculate the sensitivity and the specificity of the vibration test. One hundred and twelve patients with unilateral peripheral vestibular disorders and thirty normal subjects were enrolled into this study. However, patients with spontaneous nystagmus were excluded. Vibration stimuli (approximately 100 Hz) were presented to the mastoids and the forehead. Patients and normal subjects also underwent head shaking nystagmus (HSN) test and caloric testing. Among the 112 patients, 91(81 %) showed VIN which were mainly horizontal. VIN was more frequently elicited on the mastoids than on the forehead. In the majority of patients (76 cases), the direction of VIN was toward the healthy side, whereas patients with Meniere's disease (15 cases), showed nystagmus toward the affected side. None of 30 normal subjects showed VIN. Whereas HSN was found in 70 (63 %) patients and 9 (30 %) in normal subjects. Among 112 patients, 10 showed a canal paresis (CP) value of caloric testing less than 25 %, while 32 with a CP value between 25 and 40 %, 48 with a CP value between 40 and 70 %, and 22 with a CP value no less than 70 %. It is notable that with increasing CP value on caloric testing, VIN was more likely to be elicited. So VIN test is a simple, non-invasive and well-tolerated clinical test that indicates unilateral peripheral vestibular dysfunction. VIN test had greater sensitivity and specificity than HSN test in the diagnosis of unilateral peripheral vestibular disorders.

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“…Detection of such pathological shift of SVV may be based on vibration of the neck or mastoid area, which is known to increase the pathological SVV shift, and is useful to detect unilateral vestibular deficit [4]. On the other hand, neck vibration also induces nystagmus in patients with unilateral vestibular dysfunction, of which the slow phase is directed to the lesion side [8][9][10][11]. However, the relationship between the vibrationinduced SVV shift and vibration-induced nystagmus is not fully clarified.…”

Section: Introductionmentioning

confidence: 98%

Effects of neck muscle vibration on subjective visual vertical: comparative analysis with effects on nystagmus

Kawase

Maki

Takata

et al. 2010

Eur Arch Otorhinolaryngol

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In patients with unilateral vestibular dysfunction, vibratory stimulation to the neck muscles not only induces shift of the subjective visual vertical (SVV), but also enhances the generation of nystagmus. In the present study, the effects of neck vibration on the SVV were compared with those on nystagmus in patients with unilateral vestibular schwannoma (14 patients; 6 males and 8 females, mean age 54.2 years). The results indicated that the presence of nystagmus and magnitude of the SVV were generally correlated, neck vibration significantly increased the abnormal shift of the SVV and the presence of nystagmus, and the effects of vibration to the ipsilateral dorsal neck were significantly larger than those to the contralateral dorsal neck on the SVV, whereas no significant difference was observed in slow phase velocity of nystagmus. The present study suggests that both SVV and nystagmus induced by vibration have many similar clinical features and may be important in assessing the unilateral vestibular dysfunction.

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Clinical Significance of Vibration-Induced Nystagmus and Head-Shaking Nystagmus Through Follow-Up Examinations in Patients With Vestibular Neuritis

Cited by 37 publications

References 20 publications

Comprehensive Analysis of Head-Shaking Nystagmus in Patients with Vestibular Neuritis

Comprehensive Analysis of Head-Shaking Nystagmus in Patients with Vestibular Neuritis

Vibration-Induced Nystagmus in Patients with Unilateral Peripheral Vestibular Disorders

Effects of neck muscle vibration on subjective visual vertical: comparative analysis with effects on nystagmus

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