Sakurako Komiyama

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.

Detection of Saccular Endolymphatic Hydrops in Ménièreʼs Disease Using a Modified Glycerol cVEMP Test in Combination With the Tuning Property Test

Objective: To determine the optimal method for detecting saccular endolymphatic hydrops (EH) in patients with Ménières disease (MD) using a glycerol cervical vestibular evoked myogenic potential (cVEMP) test in combination with a tuning property test. Study Design: Prospective patients series. Setting: Tertiary referral center. Patients: Twenty-three subjects (age: 36–77 years) were enrolled in this study. Seventeen subjects were diagnosed with definite MD. Six subjects were diagnosed with possible MD. Intervention: Diagnostic. Main Outcome Measure: The corrected amplitudes of p13-n23 (cVEMP) were measured before and after the administration of 10% glycerol (500 ml, 2 h, intravenously). A tuning property index and the p13-n23 amplitude improvement ratio were calculated. Results: The positivity rate (PR) during the tuning property test was 55% (definite MD-affected ears), 35% (definite MD-unaffected ears), and 25% (possible MD ears). The PR during the glycerol cVEMP amplitude test was 60, 8, and 0%, respectively. The use of modified criteria for the glycerol cVEMP test in combination with the tuning property test resulted in the PR increasing to 75, 57, and 25%, respectively. The pre-glycerol stage results obtained using the tuning property test almost (except in two ears) completely agreed with the glycerol cVEMP test results by the modified criteria. Conclusion: The tuning property test is an easy and useful way of detecting saccular EH. However, the glycerol cVEMP test is required in patients that do not respond to either 500 or 1000 Hz short tone bursts (STB).

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.

Pharyngolaryngeal paralysis in a patient with pharyngeal tuberculosis

Pharyngeal tuberculosis is a rare disease, and its commonly reported symptoms include sore throat, dysphagia, and throat discomfort. The dysphagia in pharyngeal tuberculosis cases is not due to pharyngolaryngeal paralysis but due to odynophagia. Herein, we describe the first case of dysphagia caused by pharyngolaryngeal paralysis secondary to pharyngeal tuberculosis. An irregular mass at the right nasopharynx was detected in a 57-year-old female patient, along with dysphagia and hoarseness. She had poor right soft palate elevation, inadequate right velopharyngeal closure, poor constrictor pharyngus muscle contraction, and an immobilized right vocal cord, which collectively indicate right pharyngolaryngeal paralysis. Pathological examination and culture testing revealed pharyngeal tuberculosis. She was diagnosed with pharyngolaryngeal paralysis secondary to pharyngeal tuberculosis. The pharyngolaryngeal paralysis resolved after beginning anti-tuberculous treatment. Right pharyngolaryngeal paralysis was attributed to glossopharyngeal and vagus nerve impairment in the parapharyngeal space. Prior reports indicate that peripheral nerve paralysis, including recurrent laryngeal nerve paralysis caused by tuberculous lymphadenitis, often recovers after anti-tuberculous treatment. Pharyngeal tuberculosis rarely causes dysphagia and hoarseness attributable to pharyngolaryngeal paralysis. The neuropathy may recover after anti-tuberculous treatment. Pharyngeal tuberculosis is a new potential differential diagnosis in pharyngolaryngeal paralysis.