Eriko Yoshimura

Association of air-conducted sound oVEMP findings with cVEMP and caloric test findings in patients with unilateral peripheral vestibular disorders

Abstract Conclusion: This study showed that the ocular vestibular evoked myogenic potential (oVEMP) in response to air-conducted sound (ACS) reflects functions of different parts of the vestibular labyrinth from cervical VEMP (cVEMP). Objective: To determine whether the origin of the vestibular end organs of the oVEMP in response to ACS (500 Hz tone bursts) is the same as that of cVEMP. Methods: Twenty patients definitively diagnosed with unilateral Menieres disease (MD), 6 patients with unilateral vestibular neuritis (VN), and 7 healthy subjects were enrolled. In these subjects, the oVEMP and cVEMP to air-conducted 500 Hz tone bursts (125 dBSPL) were measured. The patients also underwent caloric tests. Results: The MD patients did not show a significant association between their ACS oVEMP findings and ACS cVEMP findings but there was an association of ACS oVEMP findings with caloric test findings. When the MD patients were classified into four stages based on their hearing levels, the patients showed abnormal findings at earlier stages on ACS cVEMP than on other tests. While all six VN patients showed abnormal findings on ACS oVEMP and caloric tests, only two patients showed abnormal ACS cVEMPs. These findings support the hypothesis that the oVEMP in response to ACS predominantly reflects utricular functions while ACS cVEMP reflects saccular functions.

Damaged utricular function clarified by oVEMP in patients with benign paroxysmal positional vertigo

Abstract Conclusion: Utricular dysfunction in patients with posterior canal benign paroxysmal positional vertigo (pBPPV) was supported by findings for ocular vestibular evoked myogenic potential (oVEMP). Objective: To evaluate the utricular and saccular function in patients with pBPPV. Methods: This study focused on 12 patients definitively diagnosed with pBPPV showing typical nystagmus by Dix-Hallpike maneuver and 12 controls. In these subjects, oVEMPs and cVEMPs to air-conducted 500 Hz tone burst (125 dB SPL) were measured. The patients also underwent caloric tests. Results: More of the patients with pBPPV showed abnormal responses in oVEMPs by stimulation on their affected side than the controls, while the results of cVEMPs showed no significant differences between pBPPV patients and controls. The abnormal results for oVEMPs on the affected side showed a higher percentage than those for cVEMPs and caloric tests in pBPPV patients. There was no significant association between any of the tests. These findings support the possibility that oVEMP reflects the specific abnormal condition in pBPPV, i.e. that the urticular function in pBPPV patients was highly damaged.

Assessment of the otolith-ocular reflex using ocular vestibular evoked myogenic potentials in patients with episodic lateral tilt sensation

The otolith-ocular reflex in patients with episodic lateral tilt sensation without any other vestibular symptoms was assessed using ocular vestibular evoked myogenic potentials (oVEMP). Ten patients (6 men and 4 women, mean age=53.5) were enrolled. All patients had episodic lateral tilt sensation. Patients with a medical history of rotatory vertigo, loss of consciousness, head trauma, or symptoms or signs of central nervous dysfunction or proprioceptive dysfunction and those who had been definitely diagnosed with a disease that causes disequilibrium were excluded. All of the 10 patients had oVEMP tests and cervical VEMP (cVEMP) tests and underwent caloric tests. Eight of the 10 patients showed unilateral absence of oVEMP, one displayed a bilateral absence, and one displayed normal oVEMP. Concerning cVEMP, 4 patients showed a unilateral absence of cVEMP, one displayed unilaterally decreased responses and 5 displayed normal cVEMP. All patients showed normal bilateral caloric responses. The present study showed that patients with episodic lateral tilt sensation displayed abnormal otolith-ocular reflexes, as shown by their oVEMP, suggesting that these patients were suffering from utricular dysfunction.

Frequency preference in cervical vestibular evoked myogenic potential of idiopathic otolithic vertigo patients. Does it reflect otolithic endolymphatic hydrops

Abstract Conclusion: Idiopathic otolithic vertigo (IOV) with relatively long duration of attacks might be caused by endolymphatic hydrops in the otolith organ. Objectives: To clarify the pathophysiology underlying IOV, episodic tilting or translational sensation attacks by unknown causes, especially the possibility of endolymphatic hydrops in the otolith organ. Methods: Sixteen patients (6 men and 10 women) diagnosed with having IOV were enrolled. In these subjects, frequency preference in cervical vestibular evoked myogenic potential (cVEMP) was studied. The subjects underwent cVEMP testing using 500 Hz and 1000 Hz short tone bursts (STB) (125 dB SPL, air-conducted sound). The 500–1000 Hz cVEMP slope was calculated and assessed in comparison with data from healthy subjects in the preceding study. Results: Twelve of the 16 examined patients had a significant preference of 1000 Hz to 500 Hz, which was suggestive of endolymphatic hydrops in the saccule. Patients with frequency preference of 1000 Hz to 500 Hz showed a tendency for longer vertigo attacks than patients without preference of 1000 Hz.

Is Alteration of Tuning Property in Cervical Vestibular-Evoked Myogenic Potential Specific for Ménière’s Disease?

Objective The aim of this study is to show sensitivity and specificity of cervical vestibular-evoked myogenic potential (cVEMP) tuning property test to Ménière’s disease (MD) in comparison with healthy controls (HC) and patients with other vestibular diseases. Subjects Totally 92 subjects (50 women and 42 men, 20–77 years of age) were enrolled in this study. Subjects were composed of 38 definite unilateral MD patients, 11 unilateral benign paroxysmal positional vertigo patients, 14 vestibular migraine patients, 19 unilateral vestibular neuritis patients, and 10 HC. Methods The subjects underwent cVEMP testing to 500 and 1,000 Hz short tone bursts (125 dBSPL). The corrected amplitudes of the first biphasic responses (p13–n23) (cVEMP) were measured. Then, a tuning property index (the 500–1,000 Hz cVEMP slope) was calculated. Results The area of under the ROC curve (AUC) was 0.75 in comparison with other vestibular disease patients, while AUC was 0.77 in comparison with other vestibular disease patients plus HC. The best cutoff point of the 500–1,000 Hz cVEMP slope was −19.9. Sensitivity of the tuning property test to MD was 0.74, while specificity was 0.76 to other vestibular disease patients. Conclusion The tuning property test of cVEMP is useful as a screening test of MD.

Is otolithic vertigo accompanied by hearing loss caused by sacculocochlear endolymphatic hydrops

Abstract Conclusion: Otolithic vertigo is sometimes accompanied by hearing loss. Otolithic vertigo accompanied by hearing loss seems to be caused by sacculocochlear endolymphatic hydrops. Objectives: To clarify the lesion site and pathophysiology of otolithic vertigo (OV) accompanied by hearing loss. Methods: The clinical records of four patients (two men and two women) that had been diagnosed with OV accompanied by hearing loss according to pre-determined diagnostic criteria were reviewed. Results: The patients’ main symptoms involved a sensation of movement in the pitch plane. All of the patients had low frequency-dominant hearing loss and either exhibited decreased cervical vestibular evoked myogenic potentials (cVEMP) or did not produce cVEMP. Two patients produced normal ocular VEMP (oVEMP). Caloric tests obtained normal results in all patients.

A case of cerebellar arteriovenous malformation presented with vertigo, hearing loss, and headache

Abstract We report a 48-year-old man presented with episodic rotatory vertigo accompanied by right hearing loss and headache. He did not have medical history of migraine. His hearing loss was progressive. He showed unilateral (right-sided) absence of cervical and ocular vestibular evoked myogenic potentials (cVEMP and oVEMP) to the right ear stimulation, while his caloric tests were normal on both sides. His signs and symptoms were suggestive of right peripheral vestibular vertigo except for headache. MRI revealed cerebellar arteriovenous malformation (AVM). Headache might be a sole cue for correct diagnosis. On the diagnosis of vertigo patients with headache, vertigo associated with secondary headache must be considered.

Otolithic vertigo in children: Report of 3 cases

Abstract Tilting and/or pulling sensation without a sensation of rotation might be caused by otolithic disorders and may be called otolithic vertigo. We report 3 children (a 5-year-old boy, a 15-year-old girl, and an 8-year-old boy) who presented with episodic tilting or pulling sensation in the roll plane. Common findings of these 3 patients were unilateral abnormal ocular vestibular evoked myogenic potential responses (oVEMP). They did not show any other abnormal findings, and were diagnosed as idiopathic otolithic vertigo (IOV). On the basis of their medical histories, their episodes might be caused by mechanism similar to migraine-associated vertigo.