Effect of ocular fixation on positional nystagmus in BPPV patients.

OBJECTIVE: The quantitative suppression rate of positional nystagmus (PN) by ocular fixation (OF) is unknown. This study aims to analyse the effect of OF on the slow phase velocity (SPV) of PN during diagnostic positional manoeuvres (DPMs) with videonystagmography in patients with benign paroxysmal positional vertigo (BPPV). DESIGN: DPMs were performed on 58 patients with BPPV, 33 (56.9%) of whom were women. OF was initiated when PN was most evident, and recording was continued. The mean SPV of three consecutive nystagmus before (F0) and after (F1) OF initiation was calculated. The rate of suppression of PN by OF was found in percent with the formula (F0 - F1) x 100/F0. STUDY SAMPLE: 58 patients were included in this study. RESULTS: The mean age was 56.1 ± 11.2 (range 27-76). F0 and F1 values were calculated as 5.742 ± 5.589 and 1.948 ± 3.424 degrees/second, respectively (p < 0.001). The rate of suppression of PN by OF was found to be 66.1%. CONCLUSIONS: OF significantly suppresses PN during DPMs in BPPV patients. Elimination of OF during DPMs is important for accurate diagnosis.

Vestibular dysfunction in cochlear implant candidates: Prevalence and outcomes.

PURPOSE: Cochlear implantation (CI) has been shown to reduce vestibular function postoperatively in the implanted ear. The objective of this study was to identify the prevalence of preoperative vestibular weakness in CI candidates and identify any risk factors for postoperative dizziness. STUDY DESIGN: Retrospective cohort study. MATERIALS AND METHODS: Patients who underwent CI and had preoperative videonystagmography (VNG) at the Silverstein Institute from January 1, 2017 to May 31, 2020 were evaluated. The primary endpoint was dizziness lasting more than one month postoperatively. RESULTS: One hundred and forty nine patients were evaluated. Preoperative VNG revealed that 46 (30.9%) had reduced vestibular response (RVR) on one side and 32 (21.5%) had bilateral vestibular hypofunction (BVH). Postoperative dizziness occurred in 14 (9.4%) patients. Patients with postoperative dizziness were more likely to have abnormal preoperative VNG (RVR or BVH), compared to patients without postoperative dizziness (78.6% versus 49.6%, p = 0.0497). In cases of RVR, implantation of the weaker or stronger vestibular ear did not affect the postoperative dizziness (16.1% versus 6.7%, p = 0.38). Postoperative VNG in patients with dizziness showed decreased caloric responses in the implanted ear (28.4 to 6.4 degrees/s, p = 0.02). CONCLUSION: Preoperative caloric weakness is prevalent in CI candidates and abnormal preoperative vestibular testing may be a predictor of postoperative dizziness. CI has the potential to cause vestibular injury and preoperative testing may aid in both counseling and decision-making.

Vestibular Function in Children with Type 1 Diabetes: Videonystagmography Testing.

BACKGROUND: Vestibular system is critical for maintaining balance and learning complex tasks. This study aimed to determine the frequencies, types, and predictors of vestibular dysfunctions (VDs) in children with type 1 diabetes (T1D) using videonystagmography (VNG). PATIENTS AND METHODS: This study included 65 patients (children with T1D = 40; controls = 25). The patients underwent VNG. RESULTS: Patients (boys = 15; girls = 25) had a mean age of 14.05 ± 1.82 years and duration of illness of 6.30 ± 2.84 years. The majority had frequent attacks of diabetic ketoacidosis (DKA) (65%) and hypoglycemia (40%). Dizziness was reported in 20%. VNG abnormalities were reported in 70% (n = 28), of them 71.43 and 28.57% had central and peripheral VDs, respectively. Dizziness was associated with peripheral VD. Compared to patients without VDs, those with VDs were older and had earlier age at onset and longer duration of diabetes (>5 years), higher levels of HbA1c (>7%), higher frequencies of DKA and hypoglycemic attacks, comorbid medical conditions, and diabetic complications. Multiple logistic regression analysis showed that presence of VNG abnormalities (VDs) was independently correlated with diabetes duration >5 years (odds ratio [OR] = 4.52 [95% confidence interval [CI] = 3.55-7.04], p = 0.001), HbA1c% levels >7% (OR = 3.42 [95% CI = 2.84-5.75], p = 0.001), and presence of hypoglycemic attacks (OR = 4.65 [95% CI = 2.85-7.55]). CONCLUSIONS: -VDs are prevalent in children with T1D and correlated with the duration and severity of diabetes and the occurrence of hypoglycemic attacks. Therefore, optimizing glycemic control and prevention and treatment of diabetic complications and comorbidities are important. Multidisciplinary follow-ups are required for early detection and management of diabetic VDs.

Video-nystagmographic evidence in more than 700 consecutive cases of road traffic whiplash injury.

PURPOSE: Whiplash injury is a frequent traumatic lesion occurring mainly in road accidents, which may also cause dizziness severe enough to impact everyday life. Vestibular examination is routinely performed on these patients, although the role of the neuro-otologist is still not clearly defined. The main endpoint of this study was to describe the videonystagmography (VNG) evidence in a large cohort of patients who underwent road traffic whiplash injury. METHODS: 717 consecutive patients who reported whiplash-associated disorders due to a road traffic accident underwent clinical examination and VNG. RESULTS: Patients with saccadic test latency anomalies more frequently complained of vertigo, nausea and cochlear symptoms after trauma (p = 0.031, 0.028 and 0.006), while patients with bilateral vestibular weakness at caloric stimulation more often displayed neck pain after trauma (p = 0.005). Patients complaining of positional or cochlear symptoms or with accuracy anomalies at the saccadic test were significantly older than those with no positional, no cochlear symptoms and without accuracy anomalies (p = 0.022, p = 0.034 and p = 0.001). Patients with bilateral vestibular hypofunction were significantly younger (p < 0.001). CONCLUSIONS: VNG evidence, particularly vestibular function and saccadic tests, may be related to damage in the cervical region due to whiplash trauma. These findings suggest that neuro-otologic examination may play a role in properly identifying those who suffer damage caused by whiplash trauma, and in characterizing the severity and prognosis of whiplash-associated disorders.

Comparison of the results of caloric and video head impulse tests in patients with Meniere's disease and vestibular migraine.

PURPOSE: To compare the results of video head impulse test (vHIT) and caloric testing (CT) in patients with vestibular migraine (VM) and Ménière's disease (MD) and to investigate the relationship between these two tests. METHODS: Patients with definite unilateral MD and VM were included in the study. All patients underwent both vHIT and CT. The vestibulo-ocular reflex (VOR) gains of lateral semicircular canals and saccadic waves in vHIT and the canal paresis factor for the CT were examined. RESULTS: CT was found abnormal in 39 (66.1%) patients with MD and in 17 (34%) patients with VM, while abnormal gain of the lateral canal was obtained in 23 MD (39%) patients and 9 (18%) VM patients. In all, 11.9% of patients with an abnormal vHIT had a normal CT, whereas 33.9% of those with an abnormal CT had a normal vHIT. CONCLUSION: Loss of VOR detected by caloric testing is more common and severe in MD than VM. Although vHIT is useful and can give complementary information, vestibular testing with the caloric test still seems more sensitive for detecting hVOR pathology.

Evaluation of Patients with Delayed Endolymphatic Hydrops by Videonystagmography, Vestibular-Evoked Myogenic Potentials, and Electrocochleography.

INTRODUCTION: The categorization of delayed endolymphatic hydrops (DEH) based on the ear which produces vertigo may sometimes cause misdiagnosis. OBJECTIVES: The aim of this study was investigating the vestibular-evoked myogenic potentials (VEMPs), electrocochleography (ECoG), and videonystagmography (VNG) in cases with DEH to determine the ear that originates symptoms. METHODS: In this cross-sectional study, 34 patients - 20 males and 14 females - with profound unilateral sensorineural deafness and vertigo attacks were recruited and evaluated by the ECoG, VNG, and VEMPs tests. RESULTS: The average age was around 43; the summating potential/action potential was abnormal in 29.4% of patients in their normal auditive ear. In 32.4, 17.6, and 50% of cases with a deaf ear, absent, normal, and abnormal VEMPs results were sequentially observed, respectively. In normal-hearing ears, absent, normal, and abnormal VEMPs were observed in 23.5, 50, and 26.5%, respectively. In the normal-hearing ear, the distribution of abnormal VEMPs was 26.5%, and in the deaf ear, this parameter was abnormal in 50% of the opposite ear (p value = 0.00021). In the VNG test, among patients with a normal-hearing ear, results in 27 and 7 patients were sequentially normal and hypofunction. CONCLUSION AND SIGNIFICANCE: The probability of a hypofunction VNG test in a normal-hearing ear might be greater when the VEMPs results of the contralateral deaf ear are normal. In patients with a normal-hearing ear, the distribution of abnormal VEMPs in the contralateral deaf ear is greater, although the intact side may also manifest abnormality in VEMPs tests. The initial evaluation should begin in a deaf ear as well as for the normal-hearing ear ere utilizing ablation surgery.

Road traffic whiplash injury in the elderly: Clinical and video-nystagmographic features.

PURPOSE: Whiplash is a type of trauma typically caused by a rear end collision in a road accident. About one in two patients who experience whiplash report dizziness and balance problems, which can severely affect their activities in daily life. In industrialized countries, the number of elderly people with a driving license has increased in recent years. The aims of the present study were to describe the video-nystagmographic features in a consecutive series of elderly patients experiencing whiplash injury in a road accident, comparing them with similar injuries in a group of young adults. METHODS: Twenty-seven patients aged 65 years or more and a control group of 32 young adults between 18 and 21 years old were retrospectively selected. All patients underwent oto-vestibular assessment and video-nystagmography. RESULTS: After whiplash trauma, vertigo was more common in elderly patients with decreased peak velocity during the saccadic ocular motricity test (p = 0.017) and with evidence of bilateral vestibular hypofunction after caloric stimulation (p = 0.033). Comparing the two age groups, neck pain after the trauma was reported significantly more by young adults (p = 0.003), who also showed more frequently bilateral vestibular hypofunction (p = 0.025). CONCLUSION: Clinical and instrumental findings seem to support the hypothesis of a functional lesion to the brainstem regions after a whiplash injury. There is an undeniable need, however, for tools capable of objectively assessing the functional or anatomical damage resulting from whiplash-associated disorders, for both clinical and medico-legal reasons.

[Abnormal eye movements in patients with idiopathic rapid eye movement sleep behavior disorder].

OBJECTIVE: To analyze the characteristics of eye movements in patients with idiopathic rapid eye movement sleep behavior disorder (iRBD). METHODS: Twenty two patients with iRBD and 20 controls were enrolled between January 2017 and May 2019 from Sir Run Run Shaw Hospital, Zhejiang University School of Medicine. Clinical data including polysomnogram (PSG) results were collected. Videonystagmography (VNG) including spontaneous nystagmus, gaze, saccade, tracking and optokinetic test were performed. The difference of VNG results between iRBD patients and controls were analyzed. The factors related to the abnormal VNG results were analyzed by using logistic regression analysis. RESULTS: No significant differences were found between the iRBD and control groups in the spontaneous nystagmus, gaze nystagmus, square wave jerk, involuntary eye movement, saccade and optokinetic nystagmus (all P>0.05). In smooth pursuit of 0.4-0.5 Hz and 0.6-0.7 Hz, iRBD patients had more type Ⅲ-Ⅳ curve than controls (χ2=5.177 and 5.301, both P<0.05). Logistic regression analysis indicated that less sleep time of N3 stage was related to the abnormal results in smooth pursuit of 0.4-0.5 Hz (OR=0.963, P<0.05). iRBD patients with Ⅲ-Ⅳ type curve in smooth pursuit of 0.4-0.5 Hz had less N3 sleep time than iRBD patients with Ⅰ-Ⅱ type curve (52±28 min vs. 76±23 min, t=2.197, P<0.05). CONCLUSIONS: Abnormal smooth pursuit was found in iRBD patients, which might be related to the pathological mechanism of iRBD.

The association between video-nystagmography and sensory organization test of computerized dynamic posturography in patients with vestibular symptoms.

OBJECTIVE: Vertigo is a complex symptom which imposes diagnostic and treatment challenges. Laboratory evaluation of vertigo includes video-nystagmography (VNG) and computerized dynamic posturography (CDP) for the evaluation of different aspects of this complaint. There are vague indications for each test and potential disagreements between them. The aim of this study is to examine the association between the test results of the VNG and sensory organization test (SOT) of CDP in patients referred for both vestibular tests. METHODS: Retrospective data regarding 56 patients age 17-82 years were collected. Patients suffered vestibular complaints and were referred for VNG and CDP evaluation on the same day. The level of agreement between VNG (including caloric test) and the vestibular input of the SOT for each patient was calculated. RESULTS: Among the study group, 10 showed abnormal caloric test results, of which 3 (5.4%) had normal vestibular input in the SOT, and 7 (12.5%) had impaired input (p = 0.724). Spontaneous nystagmus was recorded in 13 patients by VNG, of which 2(3.6%) had normal vestibular input and 11(19.6%) had impaired vestibular input (p = 0.056). CONCLUSIONS: This study shows no statistically significant association between the VNG test and SOT test results. Our results emphasize the difference between the tested aspects in each laboratory test, and the need to define specific indications for each of them. There is a marginally significant association between impaired vestibular input and spontaneous nystagmus, demonstrating the non-localizing nature of this sign.

Dizziness handicap and clinical characteristics of posterior and lateral canal BPPV.

PURPOSE: Benign paroxysmal positional vertigo (BPPV) is diagnosed and divided into subtypes based on positioning vertigo and nystagmus. Whether these subtypes entail any significant differences in patient-reported symptoms; is yet not known. Such differences may have clinical and therapeutic consequences. Our aim was to assess dizziness handicap and clinical characteristics of posterior and lateral canal BPPV. METHODS: This prospective observational multicentre study analysed consecutive patients with BPPV, confirmed by standardized procedures including videonystagmography under diagnostic manoeuvres in a biaxial rotational chair. Patients were screened for other neurological and otological disorders. OUTCOMES: Dizziness handicap inventory (DHI), posterior vs. lateral canal involvement. FACTORS: age, gender, positional nystagmus intensity (maximum slow-phase velocity), symptom duration, 25-hydroxyvitamin D-level and traumatic aetiology. RESULTS: 132 patients aged 27-90 (mean 57, SD 13) years were included. Higher DHI scores were associated with lateral canal BPPV [95% CI (1.59-13.95), p = 0.01] and female gender [95% CI (0.74-15.52), p = 0.03]. Lateral canal BPPV was associated with longer symptom duration [OR 1.10, CI (1.03-1.17), p = 0.01] and lower 25-hydroxyvitamin D-levels [OR 0.80, CI (0.67-0.95), p = 0.03]. There was no correlation between DHI scores and nystagmus intensity. CONCLUSIONS: This study suggests that patients with lateral canal BPPV have increased patient-perceived disability, lower vitamin D-levels and longer duration of symptoms. This subtype might therefore require closer follow-up. Patient-perceived disability is not related to positional nystagmus intensity.

[Functional assessment of patients with vertigo and dizziness in occupational medicine]. / Badanie czynnosciowe osób z zawrotami glowy i zaburzeniami równowagi dla potrzeb medycyny pracy.

BACKGROUND: Balance assessment relies on symptoms, clinical examination and functional assessment and their verification in objective tests. Our study was aimed at calculating the assessment compatibility between questionnaires, functional scales and objective vestibular and balance examinations. MATERIAL AND METHODS: A group of 131 patients (including 101 women; mean age: 59±14 years) of the audiology outpatient clinic was examined. Benign paroxysmal positional vertigo, phobic vertigo and central dizziness were the most common diseases observed in the study group. Patients' symptoms were tested using the questionnaire on Cawthworne-Cooksey exercises (CC), Dizziness Handicap Inventory (DHI) and Duke Anxiety-Depression Scale. Berg Balance Scale (BBS), Dynamic Gait Index (DGI), the Tinetti test, Timed Up and Go test (TUG), and Dynamic Visual Acuity (DVA) were used for the functional balance assessment. Objective evaluation included: videonystagmography caloric test and static posturography. RESULTS: The study results revealed statistically significant but moderate compatibility between functional tests BBS, DGI, TUG, DVA and caloric results (Kendall's W = 0.29) and higher for posturography (W = 0.33). The agreement between questionnaires and objective tests were very low (W = 0.08-0.11).The positive predictive values of BBS were 42% for caloric and 62% for posturography tests, of DGI - 46% and 57%, respectively. CONCLUSIONS: The results of functional tests (BBS, DGI, TUG, DVA) revealed statistically significant correlations with objective balance tests but low predictive values did not allow to use these tests in vestibular damage screening. Only half of the patients with functional disturbances revealed abnormal caloric or posturography tests. The qualification to work based on objective tests ignore functional state of the worker, which may influence the ability to work. Med Pr 2018;69(2):179-189.

Neurovestibular analysis and falls in Parkinson's disease and atypical parkinsonism.

The primary aim of our study was to determine the extent of vestibular dysfunction in patients with Parkinson's disease (PD). Our secondary aim was to determine if vestibular dysfunction in PD is a risk factor for falling. The tertiary aim was to determine both the extent of vestibular dysfunction and if this dysfunction is a risk factor for falling in patients with atypical parkinsonism (AP). Twenty-five healthy subjects, 30 PD patients and 14 AP patients were matched for age and gender in a case-control study design. All subjects underwent clinical neurological and neurotological assessments, cervical and ocular vestibular evoked myogenic potentials (VEMPs), brainstem auditory evoked potentials (BAEPs), subjective visual vertical measurements, and videonystagmography with caloric and rotatory chair stimulation. Ninety per cent of PD patients (27 of 30) and all 14 AP patients had signs of vestibular dysfunction on laboratory examinations. The evoked potential (VEMPs and BAEPs) test results of PD patients showed significant prolongation of the p13, n1 and interpeak III-V latencies on the symptomatic brainstem side (0.003 ≤  P ≤ 0.019) compared with healthy subjects. Also, vestibular testing abnormalities were correlated with an increased risk for falling when fallers among PD and AP patients were compared with the non-fallers (P ≤ 0.001). To conclude, vestibular dysfunction on vestibular laboratory testing is highly prevalent in both PD and AP patients compared with healthy subjects, and is associated with an increased risk for falling.

Investigation into the verification of the Synapsys videonystagmography (VNG) Ulmer calibration system.

OBJECTIVE: To assess the accuracy and stability of the Synapsys VNG Ulmer calibration system when the goggles and infrared camera are repositioned, and the accuracy of the equipment's geometric calibration system. DESIGN: Prospective data collection involved participants conducting the system's horizontal calibration test. Eye measurements were then recorded for a 60° deviation (looking from 30° right to -30° left) and repeated after the goggles and infrared camera were removed/repositioned. Participants' eye measurements were also recorded after the geometric calibration had been activated. STUDY SAMPLE: Twenty-two participants with no history of visual or vestibular pathology were recruited for this study. RESULTS: No significant differences were found when the goggles were removed and replaced (p = 0.21); when the infrared camera was repositioned within the goggles (p = 0.50); or when the goggles were removed and the camera repositioned (p = 0.18) after horizontal calibration. A significant difference was found during the assessment of geometric calibration (p < 0.01). CONCLUSIONS: Calibration is not affected by removal or repositioning of the goggles and/or infrared camera within the goggles, therefore suggesting recalibration may not be necessary. Caution should be exercised when using the equipment's geometric calibration and should only be used when the patient is unable to conduct the system's horizontal calibration test.

A Study of Quality of Life Improvement in Videonystagmography Guided Epley's Manoeuvre in Posterior Canal Benign Paroxysmal Positional Vertigo.

To assess Quality of life improvement in Videonystagmography guided Epley's Manoeuvre in posterior canal benign paroxysmal positional vertigo. The design of present study is cross-sectional analytical study. The study is conducted in the Department of Otorhinolaryngology, Sri Aurobindo Medical College and Post Graduate Institute, Indore in association with Sri Aurobindo Institute of speech and hearing, Indore. Current study done to assess the effectiveness of canalolith repositioning procedures (Epley's maneuver) with and without drug therapy in posterior canal benign paroxsymal positional vertigo and to assess the patients based on Dizziness Handicap Inventory. All Patients who come to ENT OPD at Sri Aurobindo Medical College and Post Graduate Institute, Indore in the specified duration and according to the inclusion criteria were chosen in the study. Majority of the patients were in the age group of 18-58 years with the median age of 32 and subjective symptomatic relief on Epley's manoeuvre and DHI on day 15, 46 out of 60 subjects reported symptomatic relief with a percentage of 76.6%. This group of 46 subjects with symptomatic relief was labeled as resolved group. The age range in resolved group was between 18 and 58 years. Remaining 14 subjects, labelled as relapsed group were prescribed beta-histine and repeat Epley's maneuver was performed to assess the effectiveness of adjunct therapy. We conclude that a single Videonystagmography guided Epley's maneuver is an excellent tool for effective rehabilitation of majority of posterior canal BPPV alone and combined with adjunct betahistine therapy can even cure refractory cases providing them with better quality of life.

Comparing Efficiency Epley and Semont Manoeuvre with Videonystagmography.

Videonystagmography (VNG) is useful and reliable in diagnosing vertigo. Benign Paroxysmal Positional Vertigo (BPPV) is the most common peripheral vestibular disorder in adults, and posterior canal is the commonest canalinvolved. The treatment of choice for posterior canal BPPV is repositioning manoeuvres. Epley and Semontmanoeuvres are the two most commonly used treatment manoeuvres for the management of posterior canalBPPV. In this study, we use VNG to compare the two. Epley Repositioning Manoeuvre was found to be moreeffective than Semont Liberatory Manoeuvre. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03901-3.

Cross-Sectional Analysis of Videonystagmography (VNG) Findings in Balance Disorders.

OBJECTIVE: To understand the videonystagmography (VNG) findings in various balance disorders in 67 patients who presented to the outpatient department of an otorhinolaryngology clinic. MATERIALS AND METHODS: This cross-sectional study was conducted in the outpatient department of the otorhinolaryngology clinic of a tertiary care center. A total of 67 patients between the age group of 18 and 70 years with balance disorders were included in the study. VNG findings in different balance disorders were observed and analyzed. RESULTS: A total of 67 patients were enrolled in the study. Findings like caloric inversion and optokinetic nystagmus do not always indicate a central balance disorder due to technical errors and other limitations during the test. However, abnormal saccades seem to be a more relevant finding in central disorders. Rare variants of benign paroxysmal positional vertigo (BPPV) like multiple canal BPPV were also diagnosed using VNG. CONCLUSION: VNG has come out as a very useful test in our study aiding in 75% of diagnoses. The overall benefits of VNG in balance disorders are immense and necessitate their inclusion in every vertigo clinic.

Eye Movement Abnormalities During Different Periods in Patients with Vestibular Migraine.

Purpose: The aim of this study was to assess abnormal eye movement signs during different periods, namely, ictal periods and symptom-free intervals, in patients with vestibular migraine. Patients and Methods: We assessed oculomotor signs using videonystagmography in 90 patients with VM (40 during ictal periods and 50 during symptom-free intervals) according to validated diagnostic criteria. Results: Abnormal saccades, smooth pursuit and optokinetic test results; spontaneous nystagmus; and positional nystagmus were all observed in vestibular migraine patients, and there was no significant difference between different periods. Positional nystagmus was the most common in both the ictal and asymptomatic periods (60% and 36%, respectively). Positional nystagmus was induced in a variety of positions during both periods, and the slow-phase velocity ranged from <2 to 10°/s. The duration of positional nystagmus was over 60s in most cases. Overall, central oculomotor dysfunctions occurred in 27.5% of patients during VM attacks and 4% of patients during symptom-free intervals; this difference was statistically significant (p = 0.002). Conclusion: In patients with VM, abnormal oculomotor signs can be found during both vertigo attacks and asymptomatic intervals. Positional nystagmus is the most common of these abnormalities and can be induced in different positions. The amplitude of these patients' positional nystagmus tends to be low, and the duration tends to be long. Observing changes in eye movements by videonystagmography may be helpful in the diagnosis of VM.

Vestibular function, subjective complaints, perceived disability in daily life, and sports activities in patients with cochlear implants performed during childhood: a prospective cross-section study.

BACKGROUND: Vestibular function (VF) in patients with cochlear implantation (CI) performed during childhood is underinvestigated. OBJECTIVE: To study VF in patients receiving CI during childhood. MATERIAL & METHODS: Sixty patients (22 females) from 7-34 years old, unilaterally (n = 21) and bilaterally (n = 39) implanted, were included. Deafness was congenital (n = 45), consequential to meningitis (n = 3), skull fracture (n = 1), perinatal CMV infection (n = 1), ototoxic drugs (n = 1), unknown etiology (n = 9). VF was measured between 1 to 22 years after implantation, including calorics, v-HIT, c-VEMPS. Dizziness handicap inventory (DHI), age at independent walking(IW), sport activities were also investigated. RESULTS: Nine CI-patients (15%) reported dizziness/vertigo either prior or months to years after surgery. Comparison between symptomatic (15%), asymptomatic (85%), uni-bilaterally CI-patients showed no significant difference on VF's impairment for calorics (p = .603) and v-HIT (p = 1). Symptoms were not related to vestibular impairment. Age at implantation (p = 0.956), uni- bilateral (p = .32), simultaneous versus sequential (p = .134) did not influence IW age. DHI showed a tendency for being symptomatic at higher implantation age. Interval between CI, IWage, current age between surgery and vestibular evaluation did not have a significant effect on symptomatology. CONCLUSION & SIGNIFICANCE: This first middle to long-term evaluation of the VF in CI-patients, implanted in childhood, pointed out that 85% of patients were asymptomatic, with a mean time of >10 years after surgery. Vestibular impairment and symptoms seem to be mainly due to the underlying inner ear's disease rather than surgery.

Vestibular and Oculomotor Findings in Vestibular Migraine Patients.

BACKGROUND: Vestibular migraine (VM) is the most frequent etiology of recurrent spontaneous episodic vertigo. Vestibular and oculomotor abnormalities have been described in VM; however, the diagnosis is currently based on symptoms. The objective of this study was to determine the most frequent abnormalities in videonystagmography (VNG), caloric testing (Cal) and video head impulse test (vHIT) in patients with VM. METHODS: A retrospective cohort study was conducted, including all VM and probable VM patients seen from January 2021 to July 2022. Demographics, auditory symptoms and results via VNG, Cal and vHIT were evaluated. VNG results were compared with a control group. RESULTS: Sixty patients, 81.7% with VM and 18.3% with probable vestibular migraine, were included. VNG revealed the following abnormalities: 21.7% spontaneous nystagmus; 33.3% positional nystagmus, mostly central; 26.7% optokinetic nystagmus; 56.7% smooth pursuit abnormalities and 70% saccade test abnormalities, mostly velocity and latency. An abnormal unilateral caloric response was seen in 22.9%, while vHIT revealed a low gain in at least one canal in 21.7%, and saccades were seen in at least one canal with normal gains in 18.3%. Concordant results between Cal and lateral vHIT were seen in 77.1% of cases. CONCLUSIONS: Although VM is a clinical diagnosis, vestibular and oculomotor abnormalities are commonly seen. The most frequent oculomotor findings were an abnormal saccade test, abnormal smooth pursuit and central positional nystagmus.

Vestibular Schwannoma: Long-term Outcome of the Vestibular Function After Stereotactic Radiosurgery.

Objective: Evaluation at long term of the impact of the stereotactic surgery (SRS) on the vestibular function in vestibular schwannoma (VS) patients. Study design and setting: Retrospective study in a tertiary referral center. Patients: Fifty-one VS patients were included (34 females;17 males), aged from 41 to 78 years treated exclusively with SRS. Intervention: Vestibular function was assessed before SRS and with median time interval of 14 (FU1) and 25 (FU2) months after treatment. Vestibular evaluation included: history, clinical vestibular examination, videonystagmography, head impulse test (v-HIT) and cervical vestibular evoked myogenic potentials (c-VEMPS). Results: Before SRS, caloric testing (Caloric) was impaired in 77%; after treatment, in 92% (FU1) and 77% (FU2). Lateral HIT was decreased in 22% before SRS, in 39% at FU1 and FU2. C-VEMPS were absent in 50% before SRS, in 76% at FU1 and, FU2. Before SRS, no statistically significant association was found between asymptomatic and symptomatic patients with respect to the results of Caloric, v-HIT and c-VEMPS. This lack of association was also seen after SRS, at FU1 and FU2. Conclusion: Our study showed that the impairment of the vestibular function might be attributed to the VS itself as well as to the radiation of the inner ear during SRS. The lateral SSC at low frequencies and the saccular function seem to be more involved with the time.