Integrated clinical and laboratory vestibular evaluation

Paydarfar, Joseph A.; Goebel, Joel A.

doi:10.1097/00020840-200010000-00001

Cited by 9 publications

(8 citation statements)

References 20 publications

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“…Thus, vestibulo-ocular reflex deficits not revealed by EOG caloric testing might be revealed by the SHA protocol. 27 Our findings confirm the results of a previous study, which failed to find a correlation between caloric test results and the vestibulo-ocular response to rotation on follow-up examination after acute peripheral vestibulopathy, 25 and reports of a prolonged deficient dynamic response to acceleration at high frequencies after peripheral vestibular deafferentation. 9,16,25,28 Spatial orientation and postural control depend on the integration of information from the proprioceptive, vestibular, and visual sensory systems.…”

Section: Discussionsupporting

confidence: 91%

Vestibular Neuronitis in Pilots: Follow‐up Results and Implications for Flight Safety

Shupak¹,

Nachum²,

Stern³

et al. 2003

The Laryngoscope

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OBJECTIVES To report our experience over the past 12 years with the evaluation and follow-up of pilots with vestibular neuronitis and to discuss points relevant to flight safety and the resumption of flying duties. STUDY DESIGN A retrospective, consecutive case series.METHODS Eighteen military pilots with vestibular neuronitis were examined and followed up. A complete otoneurological workup was performed, including both physical examination and laboratory evaluation. The latter included electro-oculography (EOG) and a rotatory chair test using the smooth harmonic acceleration protocol. RESULTS The mean patient age was 35 +/- 6 years (range, 23 to 42 y), and the average follow-up period was 20.5 +/- 12.8 months (mean +/- standard deviation [SD]; (range, 11 to 48 mo). Electro-oculography caloric test on presentation documented significant unilateral hypofunction in all patients. Thirteen of the 18 patients (72%) had abnormal smooth harmonic acceleration test results. None of the pilots reported any symptoms on follow-up. However, five (28%) had positive otoneurological examination findings, and eight (44%) still had significant caloric lateralization (>25%). The average caloric hypofunction was reduced from 67.8% +/- 29.3% at onset to 40% +/- 16% (mean +/- SD, <.05, paired test). Seven of the patients (39%) had additional electro-oculography findings beyond caloric hypofunction. These included spontaneous, positional, and positioning nystagmus. Smooth harmonic acceleration disease on follow-up was documented in eight patients (44%), five of whom had canal paresis. Eleven patients (61%) demonstrated residual vestibular damage on follow-up. In 6 of these 11 cases (55%), the laboratory evaluation revealed vestibular deficits otherwise undiagnosed by the bedside test battery. CONCLUSIONS The vestibular system plays a central role in orientation awareness and is often challenged by flying conditions. The finding that approximately 60% of pilots who have had vestibular neuronitis continue to show signs of vestibular malfunction, despite apparent clinical recovery, emphasizes the need for a complete vestibular evaluation, including specific bedside testing and laboratory examinations, before flying duties can be resumed.

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Section: Discussionsupporting

confidence: 91%

Vestibular Neuronitis in Pilots: Follow‐up Results and Implications for Flight Safety

Shupak¹,

Nachum²,

Stern³

et al. 2003

The Laryngoscope

View full text Add to dashboard Cite

show abstract

“…For example, among our patients, although most denied symptoms of oscillopsia when questioned, all of the patients with bilateral vestibular loss demonstrated impaired dynamic visual acuity when tested. Furthermore, patients may compensate for vestibular losses and be asymptomatic after an ototoxic insult; however, cell losses in the peripheral labyrinth caused by ototoxicity are cumulative (sensory cells do not regenerate) . Subsequent ototoxic insults will eventually exhaust the brain's compensatory capacity.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, patients may compensate for vestibular losses and be asymptomatic after an ototoxic insult; however, cell losses in the peripheral labyrinth caused by ototoxicity are cumulative (sensory cells do not regenerate). 7,17,20,31,39 Subsequent ototoxic insults will eventually exhaust the brain's compensatory capacity.…”

Section: Discussionmentioning

confidence: 99%

“…Complicating factors in identifying the prevalence of vestibular dysfunction are the variable presentation of symptoms within individual patients, the variable compensatory adjustments of the symptoms, and the difficulty in measuring vestibular function in pediatric patients. Furthermore, there are no commonly accepted protocols for monitoring vestibular function, especially in children . In addition, CF patients typically receive multiple AGS treatments that may include gentamicin and amikacin as well as tobramycin (systemically and inhaled).…”

Section: Introductionmentioning

confidence: 99%

“…Thomsen et al 15 children. [17][18][19][20] In addition, CF patients typically receive multiple AGS treatments that may include gentamicin and amikacin as well as tobramycin (systemically and inhaled). These factors lead to difficulty is estimating the prevalence of vestibular dysfunction in this patient population.…”

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confidence: 99%

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