Dissociation of Caloric and Video Head Impulse Tests in Patients With Delayed Endolymphatic Hydrops

Leng, Yangming; Liu, Bo

doi:10.3389/fneur.2020.00362

Cited by 14 publications

(12 citation statements)

References 36 publications

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“…As rapid angular head movement is common in everyday activities, the high-frequency VOR may recover more readily from the vestibular hypofunction. [ 22 ] Our results were consistent with previous studies, confirming such discrepancy in MD patients, which may be a new diagnostic marker for MD. [ 4 , 6 , 9 , 15 , 16 ]…”

Section: Discussionsupporting

confidence: 93%

Vestibulo-ocular reflex tests may reflect unilateral Ménière disease progression

Zhou¹,

Leng²,

Liu³

2020

Medicine

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Vestibular disorders can manifest several patterns of horizontal vestibulo-ocular reflex (VOR) impairment, which can be detected by caloric test and video head impulse test (vHIT). Several studies have examined the patterns of caloric-vHIT response in Ménière disease (MD). The purpose of this study was to investigate the diversity of caloric-vHIT response and its related factors in unilateral MD patients. We also explore the possibility of assessing the progression of unilateral MD by using the horizontal VOR tests. Ninety-eight patients with unilateral MD were enrolled and underwent a battery of audio-vestibular evaluations, including the pure tone audiogram, caloric test, and horizontal vHIT. Some patients received the electrocochleography and glycerol test. The combined results of caloric test and horizontal vHIT were categorized qualitatively into 4 patterns: Pattern I: normal caloric and vHIT responses; Pattern II: abnormal caloric and normal vHIT responses; Pattern III: normal caloric and abnormal vHIT response; and Pattern IV: abnormal caloric and vHIT responses. The abnormal caloric results were semi-quantitatively subdivided into sub-patterns as mild, moderate, and severe abnormality. The associations between these patterns/sub-patterns and related factors were analyzed. Pattern I was found in 35 cases (35.7%), Pattern II in 57 (58.2%), and Pattern IV in 6 (6.1%). No patient had Pattern III. No significant differences were found between the patterns/sub-pattern distribution and age, electrocochleography, and glycerol test results. Disease duration was not associated with the pattern distribution, while remained a relation with sub-pattern distribution. The pattern/sub-pattern distribution varied significantly across MD stages. The proportion of pattern II or pattern IV increased with the stage of unilateral MD. MD can manifest several patterns of horizontal VOR impairment, of which the impaired caloric response with normal vHIT is the most common pattern. With the progression of unilateral MD, the caloric-vHIT pattern tends to shift, which may reflect the deterioration of endolymphatic hydrops and vestibular hair cells impairments.

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Section: Discussionsupporting

confidence: 93%

Vestibulo-ocular reflex tests may reflect unilateral Ménière disease progression

Zhou¹,

Leng²,

Liu³

2020

Medicine

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“…In our analysis, utricular invasion was observed in 17% of patients, which led us to speculate that the deterioration of caloric response in MD patients was due to vestibule invasion, not dilatation of the endolymphatic duct within the canal. In a previous study using IV-Gd inner-ear MRI 13 , significant caloric response degradation (canal paresis) was seen only in these groups and not in those without canal invasion, which supports our findings and explains the recently reported dissociation of caloric and vHIT results in patients with MD or delayed EH 35 , 36 .…”

Section: Discussionsupporting

confidence: 92%

Validation of inner ear MRI in patients with Ménière’s disease by comparing endolymphatic hydrops from histopathologic specimens

Cho

Kim

et al. 2021

Sci Rep

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Intravenous gadolinium-enhanced inner-ear magnetic resonance imaging (IV-Gd inner-ear MRI) has been used to visualize endolymphatic hydrops (EH) in clinical diagnosis of Ménière’s disease (MD). However, lack of histological validation has led to several concerns regarding how best to interpret the resulting images. Here, we compared hydropic changes in temporal bone specimens with the results of IV-Gd inner-ear MRI in patients with MD. Histopathologic images of temporal bones from 37 patients with MD and 10 healthy controls were collected from the National Temporal Bone Bank of the Massachusetts Eye and Ear Infirmary in the United States. The EH ratios in the vestibule and cochlea were calculated from temporal bones using the methods used for IV-Gd inner-ear MRI, and the degree to which the saccular and utricular hydrops contributed to vestibular hydrops was measured. The presence of hydropic change in each semicircular canal was assessed using temporal bone images and compared with IV-Gd inner-ear MRI scans of 74 patients with MD. Based on human temporal bone imagery, the EH ratios in the cochlea and the vestibule on the affected side were 0.314 and 0.757, respectively. In the healthy control group, the ratio was 0.064 for the cochlea and 0.289 for the vestibule; these values were significantly different from those for the affected side of MD patients. The values for the affected ear were similar to the ratios from the IV-Gd inner-ear MRI scans in MD patients. In the vestibule, saccular hydrops were more common than utricular hydrops. The average EH ratios in the saccule and utricle were 0.513 and 0.242, respectively. No significant hydropic change from each of three semicircular canals was evident in temporal bone histopathology. However, herniation of otolithic organs (saccule or utricle) into the lateral semicircular canal was found in 44.4% of the patients, with saccular herniation (24.8%) more common than utricular herniation (16.7%). Although IV-Gd inner-ear MRI might not reflect fully the results of actual histopathology due to the limited resolution of MRI and image-processing techniques, the measured EH ratios from temporal bone specimens and IV-Gd inner-ear MRI scans were similar. Hydropic change in the three semicircular canals was not significant at either the ampullated or nonampullated end. Canal invasion of vestibular hydrops seen on MRI also appeared in temporal bone histopathology, and saccular invasion was dominant.

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“…This inconsistency between the caloric test and vHIT was also exhibited in patients with MD, but not in patients with vestibular neuritis. Besides EVA and MD, disagreement of caloric and vHIT results has been described in many other vestibular disorders, such as DEH and inner ear malformation, which share a common imaging feature, i.e., endolymphatic hydrops ( 9 , 15 , 28 , 29 ). Gürkov termed the diseases as hydropic ear disease since endolymphatic hydrops has been morphologically confirmed by inner ear magnetic resonance imaging (MRI) ( 30 ).…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the laboratory tests for evaluating angular vestibulo-ocular reflex (VOR) function mainly include the caloric test, rotation test and video head impulse test (vHIT). The caloric response reflects the VOR function of horizontal semicircular canal (SCC) at low frequency (0.002–0.004 Hz), while the newly-developed vHIT measures the VOR function of six SCCs at high frequency (5–7 Hz) ( 8 , 9 ). Recently, the combination of caloric test and vHIT has provided deeper insights into the angular VOR function and the pathophysiological mechanisms of vestibular disorders ( 10 , 11 ).…”

Section: Introductionmentioning

confidence: 99%

Clinical Implication of Caloric and Video Head Impulse Tests for Patients With Enlarged Vestibular Aqueduct Presenting With Vertigo

Leng

Liu

2021

Front. Neurol.

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Background: By examining the clinical features and results of video head impulse test (vHIT) and caloric tests in patients with enlarged vestibular aqueduct (EVA) presenting with vertigo, we aimed to investigate the function of angular vestibulo-ocular reflex (VOR) and its clinical implications.Methods: Nine patients with EVA manifesting with vertigo were enrolled. The medical history, audiological examination, imaging, and the results of the caloric test and the vHIT were analyzed.Results: Of the nine patients with EVA (eight bilateral and one unilateral case), five were pediatric cases. All 17 ears exhibited sensorineural hearing loss (SNHL). Enlarged vestibular aqueduct patients can present with recurrent (seven cases) or single (two cases) vertigo attack, trauma-induced (two cases), or spontaneous (seven cases) vertigo. Diminished caloric responses were observed in 77.8% (7/9) of the patients (four cases unilaterally and three bilaterally), while unilateral abnormal vHIT results in 11.1% (1/9) patients. Abnormal caloric and normal horizontal vHIT responses were found in 66.7% (6/9) of EVA patients.Conclusions: Vestibular manifestations in EVA are diverse. Enlarged vestibular aqueduct patients with vertigo can present with a reduced caloric response and normal horizontal vHIT, and this pattern of angular VOR impairment was also found in other hydropic ear diseases.

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Dissociation of Caloric and Video Head Impulse Tests in Patients With Delayed Endolymphatic Hydrops

Cited by 14 publications

References 36 publications

Vestibulo-ocular reflex tests may reflect unilateral Ménière disease progression

Vestibulo-ocular reflex tests may reflect unilateral Ménière disease progression

Validation of inner ear MRI in patients with Ménière’s disease by comparing endolymphatic hydrops from histopathologic specimens

Clinical Implication of Caloric and Video Head Impulse Tests for Patients With Enlarged Vestibular Aqueduct Presenting With Vertigo

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