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<b>Introduction:</b> The vestibular organ (VO) is essential for maintaining balance and stabilizing visual images during head movements. To evaluate its function, the strength of the vestibulo-ocular reflex (VOR) is assessed using kinetic tests like the Sinusoidal Harmonic Acceleration Test (SHAT), video Head Impulse Test (vHIT), and slow-phase peak velocity (SPV) measurement in the caloric test (CT). Despite their limited sensitivity and specificity, they are used to determine eligibility for positions requiring strong balance control.<b>Aim:</b> To determine the range of VOR gain in young healthy individuals in SHAT, vHIT and CT. To search for correlations between vestibular test results and age and gender of the subjects.<b>Materials and methods:</b> Sixty two healthy individuals, with 32 males and 30 females, aged 7 to 33 who met the inclusion criteria were included in the study. Each participant underwent SHAT, vHIT and CT. Standard statistical methods and Spearman's rank correlation were used.<b>Results:</b> The age of the subjects correlated negatively with the VOR gain in SHAT. There was no correlation between results for SHAT, vHIT or CT.<b>Discussion:</b> Various factors, such as vestibular stimulation and anatomical variations, affect vestibular test results. While these tests complement each other in diagnosing vertigo, they are not recommended for healthy individuals qualifying for high-vestibular-performance occupations.<b>Conclusions:</b> With age, the sensitivity of the VO to kinetic stimuli decreases. The inability to calibrate stimuli can result in varied responses among individuals. A comprehensive evaluation of the VO requires testing across different frequency ranges.

Background and Purpose: - Our objectives were to determine the differences in the vestibular evoked myogenic potential (VEMP) responses in patients diagnosed with early staged idiopathic Parkinson's disease (PD) compared to the normal population and evaluate the vestibular system disorder causing balance-posture disorders. Second aim of this study was to investigate caloric test responses particularly in early staged PD compared to normal popu-lation., Methods: Thirty patients (14 females and 16 males; mean age, 60.6 ± 13.1 years) diagnosed with idiopathic PD and 28 healthy subjects (20 males and 8 females; mean age, 59.1 ± 6.4 years) were included. The patient and control groups were subdivided according to their age, gender and the patient group was subdivided according to onset time of the Parkinson symptoms, Hoehn-Yahr staging. The subgroups were compared for VEMP and caloric test responses., Results: There were no significant differences between the study and control groups for right and left VEMP measurements. Patients over 60 years and under 60 years did not show significant differences in terms of right and left mean VEMP measurements. However, P1 amplitude was significantly lower in patients over 60 years old (P = .004). Gender, disease duration, BERG balance scale and Hoehn-Yahr stage had no effect on the VEMP amplitudes. There was no significant correlation with the side of Parkinsonian symptoms to the side of canal paresis (P = .566) and the side on which no VEMP response was obtained in caloric test., Conclusion: VEMP responses were not different between PD and healthy subjects. VEMP P1 amplitude was decreased with age in PD group. Canal paresis and symptoms side were not statistically correlated in caloric test.

Objectives (1) To describe the relationships among the main instrumental features characterizing an acute unilateral vestibulopathy and (2) to clarify the role of the video head impulse test in predicting the development of chronic vestibular insufficiency. Study Design Case series with chart review. Setting Tertiary referral center. Subjects and Methods Sixty patients suffering from acute unilateral vestibulopathy were retrospectively analyzed: 30 who recovered spontaneously (group 1) and 30 who needed a vestibular rehabilitation program (group 2). The main outcome measures included Dizziness Handicap Inventory score, canal paresis, high-velocity vestibulo-oculomotor reflex gain, and catch-up saccade parameters. The tests were all performed between 4 and 8 weeks from the onset of symptoms. Results The high-velocity vestibulo-oculomotor reflex gain correlated with the Dizziness Handicap Inventory score ( P = .004), with the amplitude of covert and overt saccades ( P < .001), and with the prevalence of overt saccades ( P < .001). Patients in need for vestibular rehabilitation programs had a significantly lower gain ( P < .001) and a higher prevalence and amplitude of overt saccades ( P = .002 and P = .008, respectively). Conversely, we found no differences in terms of response to the caloric test ( P = .359). Conclusions Lower values of high-velocity vestibulo-oculomotor reflex gain and a high prevalence of overt saccades are related to a worse prognosis after acute unilateral vestibulopathy. This is of great interest to clinicians in identifying which patients are less likely to recover and more likely to need a vestibular rehabilitation program.

Objective: To analyze and summarize the effect of bilateral large vestibular aqueducts in peripheral vestibular organ function., Methods: Eighteen patients with bilateral large vestibular aqueduct syndrome (LVAS; Study Group) and 18 healthy volunteers (Control Group) were investigated using audiometry, caloric test, sensory organization test (SOT), and vestibular-evoked myogenic potential (VEMP) tests., Results: All 18 patients (36 ears) exhibited sensorineural hearing loss. For cervical VEMP (cVEMP), the Study Group showed lower thresholds (Study Group vs., Control Group: 71.4vs. 75.3dBnHL; p=0.006), N1 latencies (24.1vs. 25.2ms; p=0.026) and shorter P1 (15.3vs. 16.6ms; p=0.003), and higher amplitudes (400.7vs. 247.2µV; p<0.001) than the Control Group. For ocular VEMP (oVEMP), the Study Group had lower thresholds (79.3vs. 81.8dBnHL; p=0.046) and higher amplitudes (40.6vs. 14.4µV; p<0.001) than the Control Group. Fourteen of 16 patients (87.5%) who completed caloric tests had abnormal results, and 10 of 18 patients (55.6%) exhibited abnormal results in SOTs., Conclusions: The hyperfunction of vestibular test in otolithic organs and the hypofunction of vestibular test in semicircular canals, as well as the dysfunction in the balance test were demonstrated in patients with LVAS., Significance: Our findings can help clinicians gain a better understanding of the characteristics of vestibular organ function in patients with LVAS, which can facilitate optimal targeted treatment., (Copyright © 2017 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.)

Objective: To review the results of caloric test and the video head impulse test (vHIT) in a cohort of VM patients and assessed the value of each for predicting the prognosis in VM patients. Method: A retrospective analysis was performed on VM patients in our vertigo clinic, vestibular function were assessed by caloric test and vHIT at the initial visit and 6 months after treatment. Complete response (CR) was defined as no need for continued medication, uncomplete response (UR) as improved symptoms but need for continued medication, no symptomatic improvement. Result: At the initial evaluation, 15 of 75 (15.0%) exhibited abnormal caloric test results, 9 of 75 patients (12.0%) exhibited abnormal vHIT results. Six months later, 58 of 75 patients (77.3%) no longer required medication (CR), while 17 (22.7%）UR patients need for continued medication. The ratio of abnormal vHIT gain and abnormal caloric results were significantly different between group (CR) and group (UR) ( P <0.05). Conclusion: Abnormal vHIT and caloric test results revealed semicircular canal dysfunction in VM patients, peripheral vestibular abnormalities are closely related to the development of vertigo in VM patients and predicted prolonged preventive medication and vestibular rehabilitation requirement., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Introduction: An early acquired or congenital absence of sensory input of the vestibule will lead to severe delayed posturomotor milestones. Previous studies have proven modifications and even complete ipsilateral loss of vestibular function after unilateral cochlear implantation. The objective of this study was to evaluate whether sequential cochlear implantation has an impact on vestibular function., Methods: Retrospective study from January 2012 to January 2015 including 26 patients. The first stage consisted of determining the vestibular status of 26 hearing impaired children who were candidates for a second cochlear implant. Three months after contralateral implantation, we reevaluated the vestibular function of the same patients. The vestibular evaluation consisted of multiple tests for canal and otolith function. A complete clinical vestibular evaluation was performed, including the head thrust test. This was followed by an instrumental assessment composed of the classic bicaloric test and vestibular evoked myogenic potentials testing with tone bursts., Results: A high prevalence of vestibular dysfunction (69%) was found in our group of unilaterally implanted children. Three patients had a unique functional vestibule at the not yet implanted ear. Vestibular evoked myogenic potentials responses stayed present in 15 of the 19 patients with a VEMP-response before contralateral implantation. Results of the caloric test changed for 6 patients after contralateral implantation., Conclusions: After contralateral implantation, 37% of our patients manifested modifications of their vestibular status. Intrasubject comparison of bicaloric and vestibular evoked myogenic potentials testing before and after contralateral cochlear implantation showed that canal function was better preserved than saccular function. Seeing the high prevalence of vestibular dysfunction in our test group of unilateral implanted children, sequential implantation must be preceded by a vestibular assessment to prevent complete bilateral vestibular areflexia and its potential consequences. Presence of hyporeflexia at the yet-to-be implanted ear seems to be a situation particularly at risk., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Objective: To explore the clinical value of vestibular autorotation test (VAT) in the treatment for otogenic vertigo patients. Method: One hundred and twenty-nine definite otogenic vertigo patients were included. All patients underwent the VAT and caloric test (CT). The results were analyzed statistically. Result: In VAT examination, 89 (69.0%) cases were abnormal. In CT examination, 56 (43.4%) cases were abnormal. In the contrast test of VAT and CT, VAT results were abnormal in 47 (36.4%) patients and CT results were abnormal in 14 (10.9%) patients. The number of patients whose both VAT and CT results were abnormal was 42 (32.6%). The total number of patients with various abnormal results was 103 (79.8%). According to statistical analysis, the abnormal result rate of VAT was higher than that of CT. The abnormal result rate of both VAT and CT was higher than that of each single test. There was statistic significance in the difference (χ²=1.670, P <0.05). Conclusion: For otogenic vertigo patients, their abnormal result rate of VAT is higher than that of CT. VAT and CT can be mutually complementary. The combination of VAT and CT can help to understand the function of semicircular canal in the general and provide reference for the treatment of otogenic vertigo diseases., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Background: Patients with delayed endolymphatic hydrops (DEH) often show caloric hypofunction and endolymphatic hydrops (ELH) on gadolinium (Gd) enhanced magnetic resonance imaging (MRI) of the inner ear. Objectives: We aimed to investigate the relationship between the ELH in vivo and caloric results in ipsilateral DEH. Material and Methods: Twelve patients with ipsilateral DEH were included, who underwent delayed MRI following intratympanic Gd application, pure-tone audiometry, caloric test, and video head impulse test (vHIT). Results: For the affected ears, the overall prevalence of inner ear hydrops was 91.7%, including 75% in the cochlear and 50% in vestibular compartment. For the non-affected ears, the overall prevalence of inner ear hydrops was 25%, including 25% in cochlear and 16.7% in vestibular region. Caloric hypofunction was demonstrated in 75% of the affected ears. No pathologic vHIT were found. Caloric results were in agreement with the radiological evidence of inner ear hydrops on affected and non-affected ears in 9 cases. There was fair concordance between inner ear hydrops and canal paresis abnormality on the affected side. Conclusions and significance: MRI provides auxiliary evidence of ELH in vivo in the ipsilateral DEH-affected ears. The association between morphological alterations and caloric hypofunction warrants further investigation. [ABSTRACT FROM AUTHOR]

Introduction: In 2019, mild vestibular function deficiency in elder populations was defined as presbyvestibulopathy (PVP) by the Classification Committee of the Bárány Society. The diagnostic criteria include tests for low-, mid-, and high-frequency vestibular function, represented by caloric testing, rotary chair testing, and head impulse testing, respectively. However, there is still a lack of large-scale reports supporting the relationship between vestibular function tests (VFTs) and aging. In this study, we evaluated whether each test is correlated with aging in the elderly population aged over 50. Methods: This study retrospectively enrolled 1043 subjects from a single university hospital database after excluding those with unilateral and bilateral vestibulopathy, central dizziness, and acute dizziness. Enrolled subjects had caloric canal paresis <20%, vHIT lateral canal gain >0.6, vHIT interaural difference <0.3, and age >50 years old. Results: Significant negative correlations with age were identified in the vHIT (p < 0.001) and rotary chair test (RCT) 1.0 Hz gain (p = 0.030). However, the caloric test (p = 0.739 and 0.745 on the left and right sides, respectively) and RCT 0.12 Hz gain (p = 0.298) did not show a significant correlation with age. A total of 4.83% of subjects aged 70 years or older showed sub-normal vHIT gain that met the criteria of PVP, whereas only 0.50% of subjects aged 60 to 69 did. The prevalence of sub-normal caloric test results, however, was not significantly different between the two age groups (21.55% in the 60–69 age group and 26.59% in the >70 age group). Conclusions: The high-frequency range vestibular function seems vulnerable to aging, and this is more discernible at age >70 years. The weak correlation between age and low-frequency vestibular function tests, such as the caloric test and low-frequency rotary chair testing, suggests the need to revisit the diagnostic criteria for PVP. [ABSTRACT FROM AUTHOR]

Purpose: When a dizzy patient with episodic vertigo has an abnormal caloric and a normal video head impulse test (vHIT), this caloric–vHIT dissociation provides vital information for a diagnosis of Ménière's disease (MD). Endolymphatic hydrops (EH), a histological marker of MD, is hypothesized to be involved in the caloric–vHIT dissociation in MD through hydropic duct distension of the horizontal semicircular canal (SC). This study was designed to determine the impact of EH on the function of horizontal SC during caloric stimulation. Methods: Caloric test and vHIT were used to evaluate the function of horizontal SC every six months, annual magnetic resonance imaging (MRI) was used to evaluate the degree of EH size in the vestibule, and monthly vertigo and hearing evaluation was done for 12 months. EH shrinkage was defined as the size change of vestibular EH from significant to none. Results: Among 133 MD patients evaluated for eligibility, 67 patients with caloric–vHIT dissociation entered the study. Fifteen participants had EH shrinkage (G-I), while 52 participants had no remarkable EH change (G-II). Average values (IQR) of the maximum slow phase velocity in G-I and G-II were 29.6 (13.0–34.0) and 25.9 (17.3–31.3), respectively, at baseline, 26.1 (9.0–38.0) and 23.6 (18.0–28.3) at 12 months. Two-factor repeated-measures ANOVA showed no significant differences between the groups (P = 0.486). The values of vestibulo-ocular reflex gain of the horizontal SC in G-I and G-II remained above 0.8 during the study period. Conclusions: EH detected by MRI shows limited correlation with caloric stimulation results. [ABSTRACT FROM AUTHOR]

Introduction: Positional vertigo and nystagmus are the main symptoms and signs of dizziness, respectively. Despite the clinical utility of the supine roll test (SRT) and null point (NP) in diagnosing light cupula, a type of positional vertigo, there exists a notable gap in the literature concerning the comprehensive evaluation of lateralization values based on various nystagmus characteristics and the intensity of direction-changing positional nystagmus (DCPN) in the SRT, particularly in comparison to the NP. Additionally, limited data on abnormal canal paresis (CP) in light cupula patients underscores the need for further research with a larger patient population to elucidate this mechanism. This study aims to investigate the characteristics of positional nystagmus and lateralization of the horizontal semicircular canal (HSCC) light cupula, which is a type of positional vertigo and nystagmus that is poorly understood. Methods: Eighty-five patients (17 males, 68 females; mean age, 60.9 years) with light cupula were reviewed. We summarized the characteristics of spontaneous nystagmus and positional nystagmus, including supine positioning nystagmus, bow nystagmus, and lean nystagmus. Then, the side of the NP was identified as the affected side, and the values of the fast phase direction of the spontaneous nystagmus, supine positioning nystagmus, bow nystagmus, and lean nystagmus, as well as the intensity of the DCPN in the SRT, were used to diagnose the affected sides. Caloric testing was also performed for some patients. Results: Light cupula was observed in 5.7% of the patients with positional nystagmus. The frequencies of supine positioning nystagmus (88.2%), bow nystagmus (90.6%), and lean nystagmus (83.5%) were higher than spontaneous nystagmus (61.2%) (p < 0.001). The second NP (NP2) (92.9%) and third NP (NP3) (83.5%) were readily detected, affecting the left and right sides in 38 and 47 patients, respectively. Lateralization through the fast phase directions of bow nystagmus and lean nystagmus did not significantly differ from that of NP (all p > 0.05). However, the accuracy rate of lateralization through the sides with more vigorous DCPN in the SRT was 63.5%, significantly lower than through NP (p < 0.001). Particularly in patients with supine positioning nystagmus (n = 75), the rate was only 58.7% (p < 0.001). However, the rate was 100% in patients without supine positioning nystagmus (n = 10). Among the 70 patients who underwent caloric testing, 37 had abnormal CP, and the sides of the reduced caloric reaction were ipsilateral to the affected sides of the light cupula in 83.8% of the patients. Conclusion: Besides utilizing the NP to determine the affected side, the fast phase direction of the bow nystagmus or lean nystagmus can also aid in identification. However, a simple comparison of the intensity of DCPN in SRT cannot provide accurate lateralization, especially in patients with supine positioning nystagmus. There is a high incidence of CP on the affected side of the light cupula. [ABSTRACT FROM AUTHOR]

Introduction: Vestibular assessment in children with sensorineural hearing loss (SNHL) is critical for early vestibular rehabilitation therapy to promote (motor) development or guide decision making towards cochlear implantation (timing of surgery and laterality). It can be challenging from a clinical viewpoint to decide which vestibular tests should be performed for a pediatric patient. The aim of this study was to evaluate the diagnostic accuracy of several clinically available vestibular tests in children with SNHL, and to provide recommendations for the implementation of vestibular testing of children in clinical practice, to screen for vestibular hypofunction (VH). Methods: A two-center retrospective chart review was conducted. Eighty-six patients between the age of 0 and 18 years were included in this study with SNHL. Vestibular tests included video headimpulse test (VHIT), caloric test (performed at the age of four or higher), rotatory chair and cervical vestibular evoked myogenic potential (cVEMP). A combination of the clinical assessment and (combinations of) vestibular test outcomes determined the diagnosis. The diagnostic quality of tests and combination of tests was assessed by diagnostic accuracy, sensitivity and specificity. Results: VH was diagnosed in 44% of the patients. The VHIT and caloric test showed the highest diagnostic accuracy compared to the rotatory chair and cVEMP. All combinations of VHIT, caloric test and cVEMP showed improvement of the diagnostic accuracy compared to the respective tests when performed singularly. All combinations of tests showed a relatively similar diagnostic accuracy, with the VHIT combined with the caloric test scoring the highest. Adding a third test did not substantially improve the diagnostic accuracy. Discussion: Vestibular testing is feasible and VH is highly prevalent in children with SNHL. A proposed diagnostic algorithm recommends starting with VHIT, followed by cVEMP for children under the age of four, and caloric testing for older children if VH is not confirmed with the first test. Performing a third test is redundant as the diagnostic accuracy does not improve substantially. However, challenges remain, including the lack of a gold standard and the subjective nature of the diagnosis, highlighting the need for standardized testing and increased understanding of VH in this population. [ABSTRACT FROM AUTHOR]

Hearing loss is important in the diagnosis and treatment of Meniere's disease (MD). However, little is known about the factors associated with hearing changes in MD. This study aimed to investigate the correlation between hearing prognosis and caloric test (CT) results in MD. Ninety consecutive patients diagnosed with unilateral definite MD underwent pure tone audiometry (PTA) and CT at initial visits, and were re-tested PTA at the 6-month follow-up. Fifty-three of ninety MD patients (58.89%) had abnormal CT results. The change of PTA (cPTA = initial PTA-last PTA) was negatively correlated with canal paresis (CP) values (overall association p = 0.032 and non-linear association p = 0.413). Multivariate linear model showed that as the CP value changed from 0 to 1, the cPTA decreased by −13.31 dB (95% CI: −24.03, −2.6) (p = 0.016). Stratified analysis found that the association was present in MD patients of Stage 1 and 2 (p < 0.05) but not in patients of Stage 3 and 4 (p > 0.05). Elevated CP values may be linked to worse hearing outcomes in MD, especially in Stage 1 and 2 patients. Conducting a caloric test at the initial consultation may aid in assessing hearing regression in MD. [ABSTRACT FROM AUTHOR]

Background: Nystagmus generated during bithermal caloric test assesses the horizontal vestibulo-ocular-reflex. Any induced symptoms are considered unwanted side effects rather than diagnostic information. Aim: We hypothesized that nystagmus slow-phase-velocity (SPV) and subjective symptoms during caloric testing would be higher in vestibular migraine (VM) patients compared with peripheral disorders such as Meniere's disease (MD) and non-vestibular dizziness (NVD). Methods: Consecutive patients (n = 1373, 60% female) referred for caloric testing were recruited. During caloric irrigations, patients scored their subjective sensations. We assessed objective-measures, subjective vertigo (SVS), subjective nausea (SNS), and test completion status. Results: Nystagmus SPV for VM, MD (unaffected side), and NVD were 29 ± 12.8, 30 ± 15.4, and 28 ± 14.2 for warm irrigation and 24 ± 8.9, 22 ± 10.0, and 25 ± 12.8 for cold-irrigation. The mean SVS were 2.5 ± 1.1, 1.5 ± 1.33, and 1.5 ± 1.42 for warm irrigation and 2.2 ± 1.1, 1.1 ± 1.19, and 1.1 ± 1.16 for cold-irrigation. Age was significantly correlated with SVS and SNS, (p < 0.001) for both. The SVS and SNS were significantly higher in VM compared with non-VM groups (p < 0.001), and there was no difference in nystagmus SPV. VM patients SVS was significantly different to the SVS of migraineurs in the other diagnostic groups (p < 0.001). Testing was incomplete for 34.4% of VM and 3.2% of MD patients. To separate VM from MD, we computed a composite value representing the caloric data, with 83% sensitivity and 71% specificity. Application of machine learning to these metrics plus patient demographics yielded better separation (96% sensitivity and 85% specificity). Conclusion: Perceptual differences between VM and non-VM patients during caloric stimulation indicate that subjective ratings during caloric testing are meaningful measures. Combining objective and subjective measures could provide optimal separation of VM from MD. [ABSTRACT FROM AUTHOR]

AIM: To comprehensively evaluate the dynamic change of vestibular function during long-term follow-up of vestibular neuritis, as well as the co-relationship with the outcomes of vestibular neuritis (VN), which provides the recommendations for vestibular function tests during the course of VN. METHODS: A prospective cohort study was conducted on 16 patients with acute VN. Caloric test, vHIT, rotatory chair tests, VEMP, dizziness handicap inventory (DHI) score, and dynamic dizzy scales (VAS-DD) was first performed within 7 days of neuritis onset, which were further re-evaluated during the 6–12 months of follow-up. The dynamic changes on multiple objective vestibular examinations were analyzed during the acute and recovery stage of VN. We further evaluated the co-relationship between the vestibular dysfunction scales and the prognosis of VN. RESULTS: In more than 6 months of follow-up, 44% of the ultralow frequency, 94% of the low-to-mid frequency, and 44% of the high-frequency function of the horizontal semicircular canal returned to normal (p < 0.05). The change degree in symmetry of the rotatory chair test was correlated with the gain of the horizontal semicircular canal on the vHIT and the unilateral weakness (UW) value on the caloric test (p < 0.05). The change in DHI score was correlated with the phase; change in VAS-DD level correlated with the symmetry and TC of the rotatory chair test at VN recovery stage (p < 0.05). There was no significant correlation between the change in DHI score or change in VAS-DD and the degree of vestibular function recovery (p > 0.05). CONCLUSION: In general, vestibular function improved during the course of VN. The rotatory chair test can be used to evaluate the overall function of the vestibular system and the compensatory state in patients with VN. [ABSTRACT FROM AUTHOR]

Objective measures and questionnaire. We believe that the improvement of the affected horizontal semicircular canal gain value in the vHIT can be used as a reference indicator of the degree of improvement of vestibular symptoms with superior vestibular neuritis. [ABSTRACT FROM AUTHOR]

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Objective: The caloric test (C-test) and video head impulse test (vHIT) are known to occasionally show contradictory results in patients with Meniere's disease (MD). The reasons underlying this discrepancy between the two tests are currently unclear. We aimed to reveal the mechanisms responsible for this discrepancy by performing volumetric evaluation of the endolymphatic space (ELS) by using endoluminal contrast-enhanced inner ear MRI (ieMRI).Methods: We enrolled 136 patients (174 ears) who visited the vertigo/dizziness center of our university and underwent the C-test and vHIT between February 2018 and February 2020. Inner ear MRI was also performed to determine the presence of endolymphatic hydrops (EH). The percentage of patients diagnosed with each vestibular disease was as follows: MD, 23.0%; benign paroxysmal positional vertigo (BPPV), 17.8%; bilateral vestibular disorder (BVD), 9.2%; sudden deafness with vertigo (SD), 8.0%; peripheral dizziness (PD), 7.5%; unilateral vestibular disorder (UVD), 6.9%; vestibular neuritis (VN), 6.3%; delayed endolymphatic hydrops (DEH), 3.4%; central dizziness (CD), 2.9%; Hunt syndrome (Hunt), 1.2%; and other disorders (OD), 13.8%.Results: Among the ears in the present study, 46.0% (80/174) showed a discrepancy in the results of the C-test and vHIT, and the disease-related distribution of patients showing this discrepancy was as follows; MD, 38.8% (27/80; p = 0.0019); BVD, 13.8% (11/80); UVD, 12.5% (10/80); SD, 7.5% (6/80); BPPV, 6.3% (5/80); PD, 6.3% (5/80); VN, 3.8% (3/80); DEH, 3.8% (3/80); CD, 2.5% (2/80); Hunt, 0.0% (0/80); and OD, 10.0% (8/80). In all cases, the discrepancy presented as a positive C-test result and negative vHIT result. The ELS ratio was measured for the whole inner ear, cochlea, vestibule, and semicircular canal, and the relationships between the rates and the presence of discrepancy was examined. Inner ear ELS ratio was 17.9% ± 10.8% in patients with the discrepancy and 15.2% ± 8.8% in those without the discrepancy (p = 0.036). Cochlear ELS ratio was 14.9% ± 11.3% in patients with the discrepancy and 11.9% ± 10.3% in those without the discrepancy (p = 0.0012). Vestibular ELS ratio was 22.3% ± 16.2% in patients with the discrepancy and 17.2% ± 12.7% in those without the discrepancy (p = 0.032). Semicircular canal ELS ratio was 18.0% ± 11.0% in patients with the discrepancy and 16.5% ± 9.6% in those without the discrepancy (p = 0.442).Conclusion: The volume of the ELS may affect the discrepancy of results between the C-test and vHIT. [ABSTRACT FROM AUTHOR]

To compare the diagnostic accuracies of air caloric testing with electronystagmography and the vHIT (video-head impulse test). Prospective, controlled study. MD (Ménière's disease), 26; vestibular neuritis, 27; control, 56. In MD, CP (canal paresis) was pathological in 88.5%, the GA (gain asymmetry) on vHIT was pathological in 65.3%, and the gain was abnormal in only one patient. The GA and CP, were significantly higher in the MD group than in the control group, indicating hypofunction of the horizontal canals in MD, whereas a hyperfunction may also occur. No correlation was observed between the results of the two tests for evaluating MD, suggesting that pathological outcomes of one test do not guarantee abnormalities on the other test. For vestibular neuritis, significantly higher CP (96.3%), GA (81.5%), and gain (51.9%) values were detected. A correlation was identified between the two tests for vestibular neuritis, indicating a similar diagnostic efficiency. The higher percentage of pathological GA versus pathological gain values indicates that the asymmetry may be more informative. The vHIT showed a higher specificity, whereas the caloric test a higher sensitivity. No correlation between the two methods was observed; therefore, the tests appear to provide complementary information. [ABSTRACT FROM AUTHOR]

Background: The video head impulse test (vHIT) is a valuable clinical tool that can help identify dysfunction of the semicircular canals. While in cases with semicircular canal dysfunction, both decreased vestibulo-ocular reflex (VOR) gain and corrective saccades (CS) are usually observed, there are cases which show CS despite normal VOR gain in vHIT. Objective: This study aimed to investigate the clinical characteristics of patients who showed CS with normal VOR gain in vHIT. Materials and methods: Among 390 patients who underwent vHIT, 51 patients (20 males and 31 females, age 31-87 years, average 61.3 years old) who showed CS with normal VOR gain unilaterally during horizontal vHIT were included. All patients had normal vHIT (normal VOR gain and absent CS) on the contralateral side. The VOR gain of vHIT, the maximum slow phase velocity in the caloric test, and the amplitude of cervical and ocular vestibular evoked myogenic potentials (cVEMPs and oVEMPs) were analyzed. Results: The VOR gain on the affected side (0.95 ± 0.08) was significantly smaller than that on the contralateral side (1.03 ± 0.13) in horizontal vHIT (p < 0.001). The maximum slow phase velocity in the caloric test on the affected side (17.9 ± 17.8 degrees/s) was significantly smaller than that on the contralateral side (21.3 ± 16.6 degrees/s, p = 0.020). There were no significant differences in the amplitude of cVEMPs or oVEMPs between the affected side and the contralateral side (p = 0.096 for cVEMP; p = 0.770 for oVEMP). Conclusion: The side that showed CS with normal VOR gain in horizontal vHIT showed significantly smaller VOR gain as well as smaller caloric responses compared to the contralateral side. Having CS with normal VOR gain could be a sensitive indicator of mild dysfunction of the semicircular canals. [ABSTRACT FROM AUTHOR]

Objectives: This study focuses on the diagnostic precision of caloric testing in detecting vestibular neuritis (VN). Materials and methods: In this study, 99 patients (36 men, 63 women, mean age: 44.63 years ± 12.08 SD) with superior VN were involved, and 157 participants with a normal functioning vestibular system were also investigated. All patients underwent a complete neurotological examination, including the caloric test with electronystagmography registration. The canal paresis (CP) and directional preponderance (DP) values were analysed. Results: A VN on the right side was diagnosed in 31.3% and on the left side in 68.7%. When the CP parameters between the control and VN patients were contrasted, a statistically significant difference was observed (p < 0.00001*, Mann–Whitney U test), indicating higher values in the latter group. The prediction of VN based on the CP value was successful in 71%, and statistical analysis indicated a significant result [p < 0.0001*; OR: 5.730 (95% CI 3.301–9.948)]. The DP values were also significantly higher in the VN group (p < 0.00001*). The prediction of VN according to the DP value was successful in 69.8%. A significant result was also observed in this case [p < 0.001*; OR: 4.162 (95% CI 2.653–8.017)]. When both CP and DP were considered, a predictive value of 84.8% with a significant outcome [p < 0.0001*; OR: 82.7 (95% CI 28.4–241.03)] was detected. Conclusions: Including the CP and DP parameters of the caloric test, VN could be detected in around 85%. Therefore, the caloric helps diagnose the disorder, but both parameters must be considered. [ABSTRACT FROM AUTHOR]

Objective: To assess semicircular canal function in benign paroxysmal positional vertigo (BPPV) using the video head impulse test (vHIT) and caloric test. Methods: We retrospectively reviewed 39 patients with idiopathic BPPV who underwent both vHIT and the caloric test. Twenty‐one patients had posterior BPPV (p‐BPPV) and eighteen had horizontal BPPV (h‐BPPV). Vestibulo‐ocular reflex (VOR) gain and corrective saccades (CS) were analyzed in vHIT and canal paresis (CP) was calculated in the caloric test. Results: The mean VOR gain of the posterior canal in p‐BPPV was 0.75 ± 0.28 on the affected side, which was significantly smaller than that on the contralateral side (0.93 ± 0.24, p =.00738). On the other hand, there were no significant differences in the VOR gain of the horizontal canal in h‐BPPV between the affected and the contralateral sides (p =.769). The rates of the presence of CS were not significantly different between the affected canal and the contralateral canal either in p‐BPPV (p =.111) or h‐BPPV (p =.0599). The mean CP value in h‐BPPV patients (43.5 ± 31.3%) was significantly higher than that in p‐BPPV patients (22.2 ± 22.9%; p =.0184). Conclusion: The VOR gain of vHIT in the affected canal was significantly smaller than that in the contralateral canal in p‐BPPV, but not in h‐BPPV. The caloric responses of the affected canal are reduced to a significantly larger extent in h‐BPPV compared to p‐BPPV. These results suggest that BPPV affects the semicircular canal function differently depending on which semicircular canal is involved. [ABSTRACT FROM AUTHOR]

The objective of this systematic review is to compare the diagnostic value of endolymphatic hydrops (EH) magnetic resonance imaging (MRI) with audiovestibular function tests, including electro cochleography (ECochG), cervical vestibular evoked myogenic potential (cVEMP) and caloric tests for the diagnosis of definite Meniere's disease (DMD). An electronic search was performed in the PubMed, Embase and Cochrane databases in August 2022. Original studies which reported the efficacy of gadolinium MRI for diagnosis of DMD were compared with ECochG, cVEMP and caloric tests from 2007 to 2022 published in English. Two reviewers extracted the methodology and results of MRI and functional tests, assessing them independently. A modified version of the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) was used for the assessment of the quality and the risk of bias of each study. The proportion of DMD cases diagnosed by MRI hydrops vs corresponding functional tests were calculated and the relationship between MRI and functional tests were evaluated using the Cohen's Kappa test. Concerning the MRI, the proportion diagnostic of DMD was 0.67 by cochlear EH and 0.80–0.82 by vestibular EH. Regarding the functional test, the propotiojn diagnostic of DMD was 0.48 by ECochG, 0.76 by cVEMP and 0.65 by caloric test. The findings of this systematic review were that the vestibular EH on imaging most effectively assisted in diagnosing DMD. Among the functional tests, cVEMP was the second most effective test. The agreement between imaging and cVEMP was moderate (0.44), indicating a gap between the patients identified by the imaging and functional tests based on the relatively small number of patients. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate subjective vestibulo-spinal reflex test sensitivity in subjects with unilateral vestibular loss. Forty subjects diagnosed with UVL within 7 days of onset and 30 subjects without dizziness/balance disorder complaints were included in the study as the unilateral vestibular loss and control groups (70 subjects aged 18–60 years [mean: 42.95 ± 10.82]). Bithermal caloric test, Fukuda, Babinski Weil, tandem walking, and past pointing tests were performed. The subjective VSR tests' sensitivities were compared among the various methods. The Fukuda test was determined to have the highest sensitivity value (65%; kappa coefficient: 0.352). The sensitivity values of the other tests, in descending order, are: Babinski Weil (55%, Kappa coefficient: 0.274), tandem walking (10%, Kappa coefficient: 0.022), and past pointing (2.5%, Kappa coefficient: −0.014). A positive moderate correlation was obtained between canal paresis asymmetry and Fukuda deviation degree (p = 0.009, r = 0.407). There was no correlation between Babinski Weil (p = 0.619), tandem walking (p = 0.538), and past pointing test results and canal paresis asymmetry (p > 0.05). Fukuda and Babinski Weil tests can be used under conditions where all subjective tests are not performed because of limited time. However, these tests must be used alongside objective vestibular test batteries owing to their limited specificity and sensitivity. [ABSTRACT FROM AUTHOR]

Aim: Otosclerosis is one of the common otologic diseases. The mechanism and the probable site of vestibular involvement are not yet fully understood. The present study aimed to perform a comprehensive vestibular evaluation in patients with otosclerosis, compared to the cases without otosclerosis. Materials and methods: patients underwent a comprehensive cochleovestibular evaluation, including audiometry, ocular and cervical vestibular evoked myogenic potential (o-VEMP and c-VEMP), video head impulse (vHIT) and caloric tests. The results were compared with those obtained from the non-otosclerosis control group. Results: A total of 61 individuals were included in the study who were divided into two groups of the case (50.82%) and control (49.18%). The results showed that there was a significant difference in the mean vHIT gain between the case and control groups (P < 0.05). However, the mean gain was still within the normal range. Besides, the patients with otosclerosis had significant bilateral or unilateral weaknesses according to caloric test results. Moreover, their o-VEMP and c-VEMP results were significantly abnormal as well (P < 0.05). Conclusion: Based on the results of the present study, the vestibular system even in asymptomatic cases, is affected by otosclerosis. Furthermore, it seems that the otolithic system has a higher chance of involvement, compared to the semicircular canals. [ABSTRACT FROM AUTHOR]

This retrospective study completed at a tertiary care center aimed to assess the monothermal caloric test (MCT) as a screening test, using the bithermal caloric test (BCT) as a reference. Additionally, it attempts to measure the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of a fixed inter-auricular difference (IAD) value for both cold and warm stimuli using water irrigation. Medical records of 259 patients referred for vestibular symptoms who underwent BCT with water irrigation were reviewed. Patients with bilateral vestibular weakness and caloric tests using air irrigation were excluded. BCT showed 40.9% unilateral weakness. Two formulas were used to determine the monothermal caloric asymmetry (MCA-1 and MCA-2). The measurement of agreement Kappa between the two formulas in comparison with BCT revealed moderate agreement at 0.54 and 0.53 for hot and cold stimulation, respectively. The monothermal warm stimulating test (MWST) using MCA-2 showed better results, with a sensitivity of 80%, specificity of 91%, PPV of 83.1%, and NPV of 89.2%. Thirty-four patients had horizontal spontaneous nystagmus (HSN) with a mean velocity of 2.25°/s. These patients showed better sensitivity but lower specificity after adjustment of HSN using the MCA-2 formula at warm temperatures. Therefore, they should complete the caloric test with cold irrigation to perform the BCT. MCT is efficient as a screening test if the warm stimulus is used with the MCA-2 formula fixed at 25%. If present, HSNs should be adjusted. Negative IAD (normal) in the absence or presence of adjusted HSN or slow-phase eye velocity ≤ 6°/s at each right and left warm stimulation should be accomplished by the BCT. [ABSTRACT FROM AUTHOR]

Hearing protection apparatus (HPAs) are frequently used to prevent the detrimental effect of noise on the hearing system. However, it is not known exactly whether wearing HPAs in workers protects the vestibular system. This study aims to investigate the effectiveness of wearing HPAs in preventing vestibular loss caused by noise. Eighty-one workers exposed to chronic noise were divided into three groups according to their HPAs wearing status. Pure-tone audiometry test was used to evaluate the hearing. Caloric test and visual analogue scale were used to evaluate their vestibular systems. The pure-tone average of the workers who constantly wore HPAs was better than that of the other groups (p< 0.05). There was no difference between the groups in the vestibular tests (p > 0.05). This study demonstrated that HPAs do not protect the vestibular system but protect the hearing system in the inner ear from the harmful effects of noise [ABSTRACT FROM AUTHOR]

Objective: This study investigates the association between vestibular function and prognosis in patients with unilateral idiopathic sudden sensorineural hearing loss (UISSNHL). Design: A retrospective analysis of 64 patients with UISSNHL was performed. Pure tone audiometry and vestibular function tests for otoliths and semicircular canals were performed to assess the influence of vestibular functional status on the outcome of patients with UISSNHL. Results: Patients with abnormal cervical vestibular evoked myogenic potential (cVEMP) or ocular vestibular evoked myogenic potential (oVEMP) responded less favorably to treatment. In the ineffective group, cVEMP was normal in four patients (6.3%) and oVEMPs in three (4.7%). Meanwhile, cVEMP was abnormal in 32 patients (50.0%) and oVEMP in 33 (51.6%). Better hearing recovery occurred in those with normal cVEMP (33.76 ± 15.07 dB HL improvement) or oVEMP (32.55 ± 19.56 dB HL improvement), but this was not the case in those with normal caloric tests. Patients with abnormalities in both cVEMP and oVEMP were less responsive to treatment and had worse hearing recovery than those with normal results in only one of the two tests. Conclusion: Abnormal oVEMP and/or cVEMP results indicate poor auditory outcomes in patients with UISSNHL. Patients with impaired otolith organ function are likely to have a larger and more severe pathological change in their inner ear. [ABSTRACT FROM AUTHOR]

Vestibular schwannoma (VS) is a benign tumor which develops in the internal auditory canal and the cerebellopontine angle, potentially diminishing hearing or balance. Most VS tumors arise from one of two vestibular branches: the superior or inferior vestibular nerve. Determining the specific nerve of origin could improve patient management in terms of preoperative counseling, treatment selection, and surgical decision-making and planning. The aim of this study was to introduce a preoperative testing protocol with high accuracy to determine the nerve branch of origin. The nerve of origin was predicted on the basis of preoperative vestibular evoked myogenic potentials (VEMPs), caloric stimulation test, and pure tone audiometry on 26 recipients. The acquired data were entered into a statistic scoring system developed to allocate the tumor origin. Finally, the nerve of origin was definitively determined intraoperatively. Receiver operating characteristic (ROC) curves analysis of preoperative testing data showed the possibility of predicting the branch of origin. In particular, ROC curve of combined VEMPs absence, nystagmus detectable at caloric stimulation, and PTA < 75 dB HL allowed to obtain high accuracy for inferior vestibular nerve implant of the tumor (area under the curve-AUC = 0.8788, p = 0.012). In 24 of 26 cases, the preoperatively predicted tumor origin was the same as the origin determined during surgery. Preoperative audiological and vestibular evaluation can predict the vestibular tumor branch of origin with high accuracy. Despite the necessity of larger prospective cohort studies, these findings may change preoperative approach, possible functional aspects, and counseling with the patients. [ABSTRACT FROM AUTHOR]

We report a novel type of idiopathic bilateral vestibulopathy with acute simultaneous involvement of the vestibulo-ocular reflex limited to the low-frequency range. A 64-year-old female presented with dizziness, oscillopsia, and difficulty walking. She did not experience rotatory vertigo and did not show any nystagmus. Vestibular function tests showed absent caloric responses in both ears, while vestibulo-ocular reflex (VOR) gains in the video head impulse test (vHIT) were preserved in all six semicircular canals. Cervical and ocular vestibular evoked myogenic potentials in response to air-conducted sound were absent on both sides. Since the caloric test and vHIT measures low-frequency and high-frequency VOR, respectively, we diagnosed the patient as having a bilateral VOR deficit limited to the low-frequency range. During a 1-year follow-up with vestibular rehabilitation, the subjective symptom of dizziness gradually recovered while recovery of vestibular function was minimal. [ABSTRACT FROM AUTHOR]

Introduction: We are now able to detect abnormalities for any semicircular canal with the use of the video head impulse test (vHIT). Prior to the vHIT, the gold standard for unilateral canal paresis of the lateral canal was considered the caloric test. Clinical cases where the caloric test and vHIT are discordant are not uncommon. Methods: Retrospective study. All consecutive cases of dizziness seen from 11/2020 to 12/2021 for which the patient underwent both caloric and vHIT tests performed within 10 days, were reviewed. Patients with discordant results were included. We evaluated the caloric response, vHIT gains for all canals and saccades, with and without gain abnormalities. Results: We included 74 cases of dizziness with dissociated results. The most common finding was a normal caloric response with abnormal vHIT results (60.8%); the main abnormal finding on vHIT was the presence of saccades. In this group, 37.7% of patients had normal gains and refixation saccades. In addition, the most found low gain was for the posterior canal. The main diagnosis in this group was vestibular migraine. For the group with unilateral caloric paresis and normal vHIT gain in the lateral canal, the main diagnosis was Ménière's disease. Discussion: The most common disorders with discordant results were Ménière's disease and vestibular migraine. The caloric test and vHIT are complementary and combining both tests provide greater clinical information. Further research is needed to understand refixation saccades with normal gains. [ABSTRACT FROM AUTHOR]

The condition of vestibular dysfunction and blood flow in the vertebral artery (VA) in transient vascular vertigo/dizziness (TVV) is not well established. To clarify the pathophysiology of TVV, especially the difference between the isolation of vestibular symptoms. Ten TVV patients with central nervous system symptoms (TVVw) and 12 TVV patients without central nervous system symptoms (TVVo) underwent duplex color-coded ultrasonographic evaluation of VAs, caloric test, and cervical vestibular-evoked myogenic potential (cVEMP). The mean flow velocity (MV) ratio (peak MV of contralateral VA divided by target VA) was significantly higher in TVVw than in TVVo. There was no difference in the occurrence of canal paresis between TVVw and TVVo. Abnormal asymmetry ratios (ARs) of cVEMP were observed only in TVVo cases (6 of 12 cases), revealing a statistically significant difference in the number of cases between TVVw and TVVo. Measuring VAs using duplex color-coded ultrasonography and cVEMP may help evaluate TVV. Different results of MV ratio and cVEMP between TVV cases with or without central nervous system symptoms may indicate differences in the pathophysiology between TVVw and TVVo. [ABSTRACT FROM AUTHOR]

This study aimed to determine the incidence, pattern, and etiology of dissociated vestibulo-ocular reflex (VOR) function according to the stimulus frequency in dizzy patients. We retrospectively evaluated the results of bithermal caloric tests and video-head impulse tests (vHITs) in 1022 patients with dizziness or vertigo between July 2016 and April 2021. Patients were classified into concordant group (normal or abnormal results on both tests) and discordant group (dissociated results between two tests). Of 1022 patients, discordant group had 159 (16%), comprising abnormal horizontal vHITs with normal caloric responses (n = 36, 23%) and abnormal caloric tests with normal horizontal vHITs (n = 123, 77%). The former group showed similar frequency of peripheral (44%) and central (42%) causes, and more common involvement of bilateral horizontal semicircular canals in central than peripheral causes (86.7 vs 37.5%, p = 0.005). The most common peripheral causes were Meniere's disease and chronic vestibular neuritis, while central causes were variable, but mainly affecting the cerebellum. In the latter group, peripheral causes were common (67%), with the main etiologies being Meniere's disease and vestibular neuritis, whereas central causes were found in only 5%. The degree of canal paresis did not differ significantly between patients with central and peripheral causes. Discordant VOR function according to the stimulus frequency was not uncommon in dizzy patients. Specific patterns of VOR dissociation according to the disease etiologies may offer insight into underlying pathophysiology. [ABSTRACT FROM AUTHOR]

Vestibular assessment tests such as the video head impulse test (vHIT) for the horizontal semicircular canal, and caloric test (Cal), both evaluate horizontal canal function. One would assume that the outcomes for these tests should lead to concordant results, yet several studies have suggested that dissociation can occur in certain pathological conditions. As this topic remains inconclusive, this review aims to analyze the scientific evidence regarding the patterns of hypofunction observed in vHIT and Cal in different otoneurological diseases. A comprehensive review of the literature regarding dissociation between these tests in common neurotological diseases was carried out. Articles were analyzed when data for vHIT and Cal were described in a way that it was possible to calculate discordance rates; both retrospective and prospective studies were analyzed. In this review, the discordance rates were as follows: 56% in Ménière's disease, 51.5% in vestibular migraine, 37.2% in vestibular schwannoma, and 20.8% in vestibular neuritis. These results highlight the benefit of using both Cal and vHIT, and that they are complementary tests. [ABSTRACT FROM AUTHOR]

Background: It is generally accepted that headshake nystagmus (HSN) is generated from an asymmetrical peripheral vestibular input and a correlation exists between HSN and canal paresis. There have been limited reports, however, how HSN correlates with the more recently introduced tests of vestibular function. Aims/objectives: To evaluate the correlation between HSN and unilateral weakness on caloric testing, high-frequency vestibulo-ocular reflex (VOR) function on video head impulse testing (VHIT) and otolith function determined by vestibular evoked myogenic potentials (VEMPs). Methods: A retrospective study of all patients who underwent complete vestibular function testing at our tertiary referral center from 2016 to 2019 was performed. Demographic data, clinical diagnosis (where available), the results of video-nystagmography, vHIT, and VEMPs were evaluated. Results: Of the 1499 patients in the study period, 101 (6.7%) had HSN. Vestibular test abnormalities were more common in patients with HSN. The sensitivity of HSN for underlying pathology was low in comparison with vestibular testing. However, HSN demonstrated a high specificity. Conclusions and significance: HSN generation is likely more complex than caloric-induced nystagmus, probably due to additional variables within the vestibular system. HSN may provide clinicians with additional information concerning high-frequency VOR function involving lateral semicircular and otolith dysfunction. [ABSTRACT FROM AUTHOR]

Objective: To analyze the preoperative patterns of caloric test, eye tracking test (ETT), and optokinetic pattern (OKP) in patients with acoustic neuroma (AN) and compare them with the postoperative patterns of ETT and OKP results METHODS: A total of 166 patients with AN (102 women; mean age: 41 years, range: 11-79 years) who were being treated at our hospital between 2013 and 2016 were enrolled. Preoperatively, a detailed history was taken regarding the presence of subjective symptoms of equilibrium dysfunction, and the patients underwent caloric test, ETT, and OKP. They were classified into three groups based on the preoperative ETT and OKP results as follows: Group A, normal ETT and OKP; Group B, either ETT or OKP was abnormal; and Group C, both ETT and OKP were abnormal. All patients were evaluated for subjective symptoms of vestibular dysfunction and were also grouped based on the tumor size on imaging. All surgeries were performed by a neurosurgeon using the lateral suboccipital retrosigmoid approach. About one month later after surgery, postoperatively ETT was performed on 150 patients and OKP was performed on 148 patients. The preoperative and postoperative ETT and OKP results were compared. The same two specialists analyzed the postoperative ETT and OKP findings as improved, unchanged, or worse. Student t-test was used for statistical analysis and a P-value of <0.05 was considered to indicate a statistically significant difference.Results: The average canal paresis(CP) % was 65.8%. No correlation was found between tumor size and CP%. The other side, the average tumor size in each group was 26.6 mm, 28.7 mm, and 37.8 mm in the Group A, B, and C, respectively. The average tumor size in Group C was significantly greater than those of Group A and B (P<0.01). The presence of gait disturbance in Group C was significantly higher than the other groups (P<0.01). The other side, abnormal ETT and OKP were seen in 32.5% and 31.9% of all patients, respectively. ETT and OKP results improved postoperatively in 67.4% and 68.9% of these patients.Conclusions: Abnormal ETT and OKP results showed positive correlations with the tumor size and presence of subjective symptoms. Further, dysfunction of cerebellum and brain stem owing to tumor compression was observed to recover in many cases after surgery. [ABSTRACT FROM AUTHOR]

Objective: The skull vibration-induced-nystagmus test (SVINT) is a noninvasive and effective screening tool for the function of the otolith and canal structures in children. It can instantaneously assess vestibular asymmetry. This study aimed to analyze the SVINT results of healthy children vs. children with hearing loss (HL) and to correlate it with sensory organization test (SOT) results as a functional balance evaluation tool. Design: This case-controlled study compared the results of SVINT to the results of the SOT of the computerized dynamic posturography (CDP) in a control group of 120 healthy normal-hearing children (i.e., NH group) vs. hearing loss (HL) group of 60 children, including 30 children with hearing aids (HAs) and 30 children with a unilateral cochlear implant (CI). The SVINT results were compared to the caloric test (CaT) and video head impulse test (vHIT) and associated with SOT scores. Results: Thirty-one children in the HL group had normal SVINT and normal SOT results. A total of 21 children in the HL group had SVINT-negative and abnormal results in the SOT (possibly due to bilateral vestibular loss (BVL)). Eight children in the HL group had positive SVINT and abnormal SOT results. However, none of the children had only positive SVINT with normal SOT findings. Moreover, 52% of children had a normal result on both the SOT and CaT, whereas 27% had abnormal results on both tests (17% bilateral weakness and 10% unilateral), and 22% had the only result of the SOT suggesting a functional abnormality. Similarly, when associating the result to vHIT, 51% had normal results on both tests, and 25% had abnormal results (13% bilateral and 12% unilateral weakness). Conclusions: SVINT findings can be correlated with SOT findings in the case of the unilateral vestibular lesion (UVL), which adds a diagnostic value in these pediatric cases but may differ in the case of the bilateral vestibular lesion (BVL). However, SVINT findings need to be cautiously interpreted in light of other test findings such as the SOT, CaT, and vHIT. [ABSTRACT FROM AUTHOR]

Objective: Because of the anatomically close relationship between the cochlea and the vestibular organs, cochlear function disorders may be accompanied by vestibular disorders. This study aimed to evaluate vestibular functions in patients with idiopathic sudden sensorineural hearing loss using VEMP, caloric test, and VNG test battery and its relation to prognosis.Materials and Methods: For this study, 42 patients aged 18-55 years with idiopathic sudden sensorineural hearing loss and 30 volunteers who had no hearing and balance problems were included. Audiometry, cVEMP, oVEMP, caloric tests, and VNG tests were performed. Moreover, the effects of age, sex, time of admission, degree and configuration of hearing loss, accompanying vertigo, tinnitus, and ear fullness on improvement in hearing were evaluated.Results: Of the 42 patients in the study group, 26 (56.52%) were male, 20 (43.48%) were female, and the mean age was 41.54 ± 12.23 years. Of the 30 individuals in the control group, 19 (63.3%) were male, 11 (36.7%) were female, and the mean age was 39.53 ± 13.03 years. There was no significant difference in the incidence of sudden sensorineural hearing loss in terms of sex and age, and the prognosis was better for female patients. Early admission to treatment was a factor of good prognosis; profound hearing loss, bilateral hearing loss and vertigo were factors of poor prognosis. Prognosis was better in patients with rising type audiogram configuration, while the prognosis was worse in patients with flat, descending and total hearing loss. Tinnitus and ear fullness had no effect on the prognosis. No anomalies were observed in VNG findings. Moreover, abnormal caloric response was higher in patients with profound hearing loss and total hearing configuration. Shortening was observed in cVEMP / oVEMP P1 and N1 latency after treatment. Furthermore, there was an improvement in abnormal responses after treatment.Conclusion: In this study, vestibular function was affected in patients with idiopathic sudden sensorineural hearing loss. The present study can help the development of a clinical strategy in the evaluation of the vestibular system in idiopathic SSNHL, patient follow-up, patient information, and the implementation of vestibular rehabilitation. Note that additional studies involving larger patients series are required. [ABSTRACT FROM AUTHOR]

Objective: To assess the prevalence and annual incidence of bilateral vestibulopathy (BV) diagnosed in the Japanese adult population.Methods: We conducted a mail-based survey targeting otolaryngologic clinics and hospitals across Japan to estimate the annual number of patients who were diagnosed as having bilateral vestibulopathy after vestibular function tests during a 12-month period ending March 2019. Using a stratified sampling method, we selected 1,106 departments and asked them to report the number of patients with BV and their demographics. The total number of patients was estimated by multiplying the reported numbers by the reciprocal of the sampling rate and response rate.Results: The overall survey response rate was 51.4% (568 departments). The estimated number of patients diagnoses with BV in 2018 was 1,063 (95% confidential interval [CI], 127-1,998) which included 407 patients (95% CI: 134-680) newly-diagnosed with BV. The prevalence and annual incidence of BV in Japan were 0.84 and 0.32, respectively per 100,000 population in Japan. The male-to-female ratio of BV patients was 1.29, and the mean age was 63.7 ± 16.4 years (range 18-84 years). The most frequent etiologies of BV were Meniere's disease (11.4%), meningitis (3.4%), and ototoxic agents (3%).Conclusions: Patients who were diagnosed as having BV were extremely rare in Japan. [ABSTRACT FROM AUTHOR]

BACKGROUND: Unapparent saccades in video head impulse test (vHIT) are usually present in Meniere's disease (MD) patients but tend to be ignored by the clinician. The result of vHIT is constantly questioned in MD patients due to a lack of uniform metrics. A more effective indicator is needed for indicating MD's pathological progress. OBJECTIVES: To get a comprehensive understanding of the nature and usability of saccades in different MD stages. METHODS: 118 patients diagnosed with unilateral MD were recruited in this study. Patient history, audiological examination, caloric test, vHIT were performed. We proposed 'raw saccades' to represent all showed wave peaks behind the head peak and named saccades by their appearance sequence: 1st saccade, 2nd saccade and 3rd saccade. An exploratory saccade analysis was executed to investigate the effectiveness of saccade attributes in identifying MD stages. RESULTS: MD patients have greater detectable 1st saccade than PR score as well as 2nd saccade. The time and velocity of the 1st saccade show high interaural variability (p = 0.028, p = 0.000 respectively). No statistical difference concerning the vHIT gain, PR score and 2nd saccade among stages could be recognized on both affected and contralateral sides. Multiple comparisons show the affected 1st saccade velocity and affected 1st saccade absolute velocity have stage-difference. At late stages (3&4), the affected 1st saccade is manifested as a speed increase, and this measure shows a relatively high correlation with MD stages compared to other vestibular indicators. CONCLUSION: The 1st saccade velocity on the affected side could indicate the MD disease process and severity. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate objective vestibular function after endolymphatic sac surgery (ELSS) for Menière's disease (MD), using comparative vestibular function tests: videonystagmography (VNG), vestibular evoked myogenic potentials (VEMP) and video head-impulse test (VHIT) Methods: Patients with definite MD using the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) of 1995 criteria modified in 2015 and treated with ELSS (sac decompression or sac opening) were included. The primary outcome was the preservation of vestibular function, comparing pre- and postoperative vestibular function tests: VNG, VEMP, VHIT. Secondary outcomes were control of episodes of vertigo, hearing outcome using AAO-HNS criteria, and QoL using the Menière's disease outcome questionnaire. Results: 73 patients were included in the study. We found a significant preservation of vestibular function as measured by VNG and VHIT. There was no statistical difference in the presence or absence of cervical and ocular (P13/N23 and N1/P1) waves on VEMP pre- and postoperatively. 67% of patients had good control of episodes of vertigo post-operatively, with significantly better results in the sac opening group (75%). There was no significant change in hearing postoperatively, and QoL scores were significantly improved after surgery (p < 0.0001). Conclusion: Endolymphatic sac surgery (ELSS) is a conservative surgical treatment, which does not negatively impact vestibular function. It was associated with improved control of episodes of vertigo, preservation of hearing, and a clear improvement in QoL scores. Despite its pathophysiology not being fully understood, it remains a first-line procedure preserving vestibular function, for MD refractory to medical management. [ABSTRACT FROM AUTHOR]

Background: By examining the clinical features and results of video head impulse test (vHIT) and caloric tests in patients with enlarged vestibular aqueduct (EVA) presenting with vertigo, we aimed to investigate the function of angular vestibulo-ocular reflex (VOR) and its clinical implications. Methods: Nine patients with EVA manifesting with vertigo were enrolled. The medical history, audiological examination, imaging, and the results of the caloric test and the vHIT were analyzed. Results: Of the nine patients with EVA (eight bilateral and one unilateral case), five were pediatric cases. All 17 ears exhibited sensorineural hearing loss (SNHL). Enlarged vestibular aqueduct patients can present with recurrent (seven cases) or single (two cases) vertigo attack, trauma-induced (two cases), or spontaneous (seven cases) vertigo. Diminished caloric responses were observed in 77.8% (7/9) of the patients (four cases unilaterally and three bilaterally), while unilateral abnormal vHIT results in 11.1% (1/9) patients. Abnormal caloric and normal horizontal vHIT responses were found in 66.7% (6/9) of EVA patients. Conclusions: Vestibular manifestations in EVA are diverse. Enlarged vestibular aqueduct patients with vertigo can present with a reduced caloric response and normal horizontal vHIT, and this pattern of angular VOR impairment was also found in other hydropic ear diseases. [ABSTRACT FROM AUTHOR]

High-resolution MR imaging enables the visualization of individual nerves in the internal auditory canal (IAC). Cochlear nerve deficiency (CND) is recognized as one of the major causes of sensory neural hearing loss (SNHL), especially in cases of unilateral hearing loss in childhood. Some patients with CND are thought to have accompanying vestibular nerve deficiency (VND). However, there have been few reports focusing on VND and vestibular function in these children. The aim of this study was to evaluate the frequency of VND and vestibular dysfunction in children with unilateral SNHL caused by CND. Thirty-eight children with unilateral SNHL, who were diagnosed with CND by 3 T-MRI, were evaluated for VND and underwent caloric testing and cervical vestibular evoked potential (cVEMP). Fourteen of 38 patients (37%) had VND, and eleven (29%) of the patients [ten of the patients (71%) with VND] had at least one vestibular dysfunction. The patients with VND had significantly worse hearing and an IAC of smaller diameter than did patients without VND. We should pay attention to VND as well as vestibular dysfunction in hearing loss patients with CND. [ABSTRACT FROM AUTHOR]

Background/Aim: the aim of this study was to assess the skull vibration-induced nystagmus test (SVINT) results and vestibular residual function after horizontal semicircular canal (HSCC) plugging. Methods: In this retrospective chart review performed in a tertiary referral center, 11 patients who underwent unilateral horizontal semicircular canal plugging (uHSCCP) for disabling Menière's disease (MD) were included. The skull vibration-induced nystagmus (SVIN) slow-phase velocity (SPV) was compared with the results of the caloric test (CaT), video head impulse test (VHIT), and cervical vestibular-evoked myogenic potentials (cVEMP) performed on the same day. Results: Overall, 10 patients had a strong SVIN beating toward the intact side (Horizontal SVIN-SPV: 8.8°/s ± 5.6°/s), 10 had a significant or severe ipsilateral CaT hypofunction, 10 had an ipsilateral horizontal VHIT gain impairment, and 3 had altered cVEMP on the operated side. Five had sensorineural hearing worsening. SVIN-positive results were correlated with CaT and horizontal VHIT (HVHIT) results (p < 0.05) but not with cVEMP. SVIN-SPV was correlated with CaT hypofunction in % (p < 0.05). Comparison of pre- and postoperative CaT % hypofunction showed a significant worsening (p = 0.028). Conclusion: SVINT results in a human model of horizontal canal plugging are well correlated with vestibular tests exploring horizontal canal function, but not with cVEMP. SVINT always showed a strong lesional nystagmus beating away from the lesion side. SVIN acts as a good marker of HSCC function. This surgical technique showed invasiveness regarding horizontal canal vestibular function. [ABSTRACT FROM AUTHOR]

Caloric tests are useful for disease surveillance of Meniere's disease (MD), although the interpretation of caloric tests remains controversial during the attacks of MD. Therefore, we aimed to characterize the findings of caloric tests during the attacks of MD. We analyzed the results of bithermal caloric tests during and between the attacks in 43 patients with unilateral definite MD. Evaluation was performed during the irritative/recovery phase in 22 and during the paretic phase in 26 patients. During the irritative/recovery phase, less than half of patients (10/22, 45%) showed a caloric asymmetry of more than 25%, lesser responses in the affected ear in six and in the healthy ear in the other four. In contrast, patients usually showed a caloric asymmetry of more than 25% during the paretic phase (19/26, 73%) with a decreased response almost always in the affected ear (18/19, 95%). Between the attacks, caloric asymmetry was found in less than half of the patients (20/43, 47%) with a decreased response almost always in the affected ear (19/20, 95%) when observed. The caloric asymmetry was less during the irritative/recovery phases than between the attacks (p = 0.007). In contrast, the caloric asymmetry was larger during the paretic phase than between the attacks (p = 0.041). The caloric asymmetry decreased during the irritative/recovery phases with an estimated mean difference of 34% (adjusted 95% CI 16–53%, p < 0.001) and 23% (adjusted 95% CI 8–38%, p = 0.002) compared to the paretic and interictal phases. Caloric responses fluctuate during and between the attacks of MD depending on the electrophysiologic status of the vestibular afferents. The results of caloric tests in MD, thus should be interpreted with consideration of each phase when the evaluation was done. [ABSTRACT FROM AUTHOR]

Objectives: Video head impulse test (v-HIT) is a quick, non-invasive and relatively cheap test to evaluate vestibular function compared to the caloric test. The latter is, however, needed to decide on the optimal side to perform cochlear implantation to avoid the risk on inducing a bilateral vestibular areflexia. This study evaluates the effectiveness of using the v-HIT to select cochlear implant (CI) candidates who require subsequent caloric testing before implantation, in that way reducing costs and patient burden at the same time. Study Design: Retrospective study using clinical data from 83 adult CI-candidates, between 2015 and 2020 at the Leiden University Medical Center. Materials and Methods: We used the v-HIT mean gain, MinGain_LR, the gain asymmetry (GA) and a newly defined parameter, MGS (Minimal Gain & Saccades) as different models to detect the group of patients that would need the caloric test to decide on the ear of implantation. The continuous model MGS was defined as the MinGain_LR, except for the cases with normal gain (both sides ≥0.8) where no corrective saccades were present. In the latter case MGS was defined to be 1.0 (the ideal gain value). Results: The receiver operating characteristics curve showed a very good diagnostic accuracy with and area under the curve (AUC) of 0.81 for the model MGS. The v-HIT mean gain, the minimal gain and GA had a lower diagnostic capacity with an AUC of 0.70, 0.72, and 0.73, respectively. Using MGS, caloric testing could be avoided in 38 cases (a reduction of 46%), with a test sensitivity of 0.9 (i.e., missing 3 of 28 cases). Conclusions: The newly developed model MGS balances the sensitivity and specificity of the v-HIT better than the more commonly evaluated parameters such as mean gain, MinGain_LR and GA. Therefore, taking the presence of corrective saccades into account in the evaluation of the v-HIT gain can considerably reduce the proportion of CI-candidates requiring additional caloric testing. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background How significant asymmetries in otolith organ function in the presence of symmetrical and asymmetrical semicircular canal function influence skull vibration- induced nystagmus testing (SVINT) has not been well described. Purpose The aim of the study is to examine the agreement between SVINT and caloric testing, ocular vestibular-evoked myogenic potentials (oVEMP), and cervical vestibular- evoked myogenic potentials (cVEMP) for detecting asymmetric vestibular function. Research Design This is a retrospective study of patients presenting with the chief complaint of vertigo, dizziness, or imbalance. Study Sample A total of 812 patients were studied with a median age at testing of 59 years (interquartile range 46-70; range 18-93) and included 475 (59%) women. Intervention Either the monothermal warm caloric test or alternate binaural bithermal caloric test, oVEMP, and cVEMP tests were administered to all patients. All patients underwent the SVINT prior to vestibular laboratory testing. Data Collection and Analysis Agreement between tests categorized as normal versus abnormal was summarized using percent concordance (PC). Sensitivity and specificity values were calculated for SVINT compared with other tests of vestibular function. Results There was higheragreement between ipsilateral and contralateral SVINT with the caloric test (PC = 80% and 81%, respectively) compared with oVEMP (PC = 63% and 64%, respectively) and cVEMP (PC = 76% and 78%, respectively). Ipsilateral and contralateral SVINT showed higher sensitivity for the caloric test (sensitivity = 47% and 36%, respectively) compared with oVEMP (sensitivity = 26% and 21%, respectively), or cVEMP (sensitivity = 33% vs. 27%, respectively). Specificity of SVINTwas high (>80%) for all assessments of vestibular function. [ABSTRACT FROM AUTHOR]

Background: Vestibular dysfunction is a complication of cochlear implantation (CI). Reports on the evaluation of vestibular function before and after CI are limited, especially in children. We investigated the effect of CI on vestibular function in pediatric patients. Patients and Methods: We routinely evaluated vestibular function before but not immediately after CI. Therefore, patients who underwent sequential bilateral CI were enrolled in this study. Seventy-three children who underwent sequential CI from 2003 to 2020 at our hospital were included. Since the vestibular function of the first implanted ear was evaluated before the second surgery for the contralateral ear, post-CI evaluation timing differed among the cases. The evaluation included a caloric test, a cervical vestibular-evoked myogenic potential (cVEMP) test, and a damped rotation test. The objective variables included the results of these tests, and the explanatory variables included the age at surgery, cause of hearing loss, electrode type, and surgical approach used. The associations of these tests were analyzed. Results: cVEMP was the most affected after CI (36.1%), followed by the caloric test (23.6%), and damped rotation test (7.8%). Cochleostomy was significantly more harmful than a round window (RW) approach or an extended RW approach based on the results of the caloric test (p = 0.035) and damped rotation test (p = 0.029). Perimodiolar electrodes affected the caloric test results greater than straight electrodes (p = 0.041). There were no significant associations among these tests' results. Conclusions: Minimally invasive surgery in children using a round window approach or an extended round window approach with straight electrodes is desirable to preserve vestibular function after CI. [ABSTRACT FROM AUTHOR]