Korean Journal of Otorhinolaryngology-Head and Neck Surgery

Korean Society of Otolaryngology-Head and Neck Surgery (대한이비인후과학회)
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Clinical Implication and Proposed Mechanism of Direction Changing Vibration Induced Nystagmus in Unilateral Vestibular Hypofunction

일측 전정기능 저하 환자에서 방향전환 진동유발안진의 임상적 의의와 발생 기전 제안

  • Lee, Dong Han (Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital) ;
  • Park, Moo Kyun (Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital) ;
  • Lee, Jun Ho (Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital) ;
  • Oh, Seung-Ha (Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital) ;
  • Suh, Myung-Whan (Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital)
  • 이동한 (서울대학교병원 이비인후과) ;
  • 박무균 (서울대학교병원 이비인후과) ;
  • 이준호 (서울대학교병원 이비인후과) ;
  • 오승하 (서울대학교병원 이비인후과) ;
  • 서명환 (서울대학교병원 이비인후과)
  • Received : 2017.09.15
  • Accepted : 2018.01.08
  • Published : 2018.11.25
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Abstract

Background and Objectives We evaluated the clinical characteristics and vestibular function of patients with direction changing vibration induced nystagmus (DC VIN) and unilateral vestibular hypofunction and suggest clinical implication and a proposed mechanism of DC VIN. Subjects and Method The records of 315 patients who underwent the VIN test were reviewed retrospectively. Among these, 18 patients (5.7%) showed DC VIN, and out of whom, 15 patients (4.8%) were diagnosed as unilateral vestibular hypofunction by caloric, rotation chair (RCT), and video head impulse test (vHIT). We analyzed the relationship between DC VIN and the dizziness characteristics, duration of disease, and the outcome of the vestibular function test. Results The mean age of 15 patients was $67.4{\pm}10.7years$ and the mean duration of dizziness was $13.6{\pm}29.7months$. The caloric test revealed 25% of the patients to have significant canal paresis [Caloric vestibular neuritis (VN)], while 75% showed normal caloric response. However, unilateral vestibular hypofunction was observed by abnormal results in RCT or vHIT (Non-caloric VN). Seven patients showed ipsilateral DC VIN (nystagmus to vibrated side) and eight patients contralateral DC VIN (nystagmus to opposite side of vibration). Patients with ipsilateral DC VIN were shown to have a significant longer duration of dizziness than those with contralateral DC VIN. Conclusion Although rare, DC VIN can also be found in patients with unilateral vestibular hypofunction. Patients with DC VIN had a mild vestibular asymmetry with Non-caloric VN or Caloric VN in the process of compensation. The mechanism of ipsilateral DC VIN seems to be due to the small amount of vestibular asymmetry, which is smaller than the interaural attenuation of vibration.

Keywords

Acknowledgement

Supported by : Seoul National University Hospital

References

  1. Lucke K. [A vibratory stimulus of 100 Hz for provoking pathological nystagmus (author's transl)]. Z Laryngol Rhinol Otol 1973;52(10):716-20.
  2. Ohki M, Murofushi T, Nakahara H, Sugasawa K. Vibration-induced nystagmus in patients with vestibular disorders. Otolaryngol Head Neck Surg 2003;129(3):255-8. https://doi.org/10.1016/S0194-5998(03)00529-1
  3. Michel J, Dumas G, Lavieille JP, Charachon R. Diagnostic value of vibration-induced nystagmus obtained by combined vibratory stimulation applied to the neck muscles and skull of 300 vertiginous patients. Rev Laryngol Otol Rhinol (Bord) 2001;122(2):89-94.
  4. Park H, Shin J, Shim D. Mechanisms of vibration-induced nystagmus in normal subjects and patients with vestibular neuritis. Audiol Neurootol 2007;12(3):189-97. https://doi.org/10.1159/000099023
  5. Xie S, Guo J, Wu Z, Qiang D, Huang J, Zheng Y, et al. Vibrationinduced nystagmus in patients with unilateral peripheral vestibular disorders. Indian J Otolaryngol Head Neck Surg 2013;65(4):333-8.
  6. Perez N. Vibration induced nystagmus in normal subjects and in patients with dizziness. a videonystagmography study. Rev Laryngol Otol Rhinol (Bord) 2003;124(2):85-90.
  7. Jung JY, Kim YH, Suh MW. Difference in the nature of dizziness between vestibular neuritis and sudden sensorineural hearing loss with vertigo. Otol Neurotol 2012;33(4):623-8. https://doi.org/10.1097/MAO.0b013e318245cc86
  8. Han JJ, Hong S, Park H, Koo JW, Lee JH, Oh SH, et al. Preoperative vestibular function in adults with cochlear implantation: comparison between prelingual and poslingual deafness. Korean J Otorhinolaryngol-Head Neck Surg 2014;57(2):89-95. https://doi.org/10.3342/kjorl-hns.2014.57.2.89
  9. Yang CJ, Lee JY, Kang BC, Lee HS, Yoo MH, Park HJ. Quantitative analysis of gains and catch-up saccades of video-head-impulse testing by age in normal subjects. Clin Otolaryngol 2016;41(5):532-8. https://doi.org/10.1111/coa.12558
  10. Normative data for the balance master system [computer program]. Seattle (WA): Natus;2017.
  11. Wuyts FL, Furman J, Vanspauwen R, Van de Heyning P. Vestibular function testing. Curr Opin Neurol 2007;20(1):19-24. https://doi.org/10.1097/WCO.0b013e3280140808
  12. Cousins S, Kaski D, Cutfield N, Arshad Q, Ahmad H, Gresty MA, et al. Predictors of clinical recovery from vestibular neuritis: a prospective study. Ann Clin Transl Neurol 2017;4(5):340-6. https://doi.org/10.1002/acn3.386
  13. Hamann KF, Schuster EM. Vibration-induced nystagmus-a sign of unilateral vestibular deficit. ORL J Otorhinolaryngol Relat Spec 1999;61(2):74-9. https://doi.org/10.1159/000027645
  14. Young ED, Fernandez C, Goldberg JM. Responses of squirrel monkey vestibular neurons to audio-frequency sound and head vibration. Acta Otolaryngol 1977;84(5-6):352-60. https://doi.org/10.3109/00016487709123977
  15. Ulmer E, Chays A, Bremond G. [Vibration-induced nystagmus: mechanism and clinical interest]. Ann Otolaryngol Chir Cervicofac 2004;121(2):95-103. https://doi.org/10.1016/S0003-438X(04)95495-3
  16. Barnes G. Adaptation in the oculomotor response to caloric irrigation and the merits of bithermal stimulation. Br J Audiol 1995;29(2):95-106. https://doi.org/10.3109/03005369509086586
  17. Dumas G, Schmerber S, Lavieille JP. [Nystagmus and vibratory test: evidence for mechanism. Material conditions and methods in the fast detection of unilateral vestibular lesions]. Ann Otolaryngol Chir Cervicofac 2003;120(5):286-95.
  18. Snow JB. Ballenger's manual of otorhinolaryngology head and neck surgery. Shelton: Pmph usa;2003.
  19. Koo JW, Moon IJ, Hong SL, Moon SY, Choi KD, Kim JS. Clinical significance of vibration-induced nystagmus in unilateral peripheral vestibular loss. Korean J Otorhinolaryngol-Head Neck Surg 2006;49(9):897-903.