Measurement properties of the Dizziness Handicap Inventory by cross-sectional and longitudinal designs

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Caloric test and simultaneous recording of sympathetic skin response

Conclusions. It was found that there was a close correlation between sympathetic skin response (SSR) parameters and nystagmus parameters obtained in caloric tests. Further studies are needed to investigate the clinical correlation of these findings. Objectives. To investigate whether the caloric response creates a measurable SSR and, if so, to compare the SSR parameters with the nystagmus parameters and the feelings of the patient. Material and methods. Patients completed an autonomic symptom questionnaire (ASQ) regarding their past history of autonomic symptoms. They used a visual analog scale (VAS) to assess the severity of symptoms during simultaneous SSR and caloric tests. Symptoms were also noted separately by the investigator. Results. Eighteen patients were included in the study (13 females, 5 males). Eight of the patients had central and 10 had peripheral vertigo. The mean VAS score was 6.6 +/- 1.9 and the mean ASQ score was 7.2 +/- 3.6. In terms of the recorded parameters, there were no significant differences between patients with central and peripheral vertigo, males and females or warm and cold irrigation. The number of SSR waves increased significantly when the slow-phase velocity was > 26 degrees/s (p < 0.01) and the nystagmus latency was <= 27 s (p < 0.05). The VAS score was also correlated with the number of SSR waves (p < 0.01)

Caloric test and simultaneous recording of sympathetic skin response

Conclusions. It was found that there was a close correlation between sympathetic skin response (SSR) parameters and nystagmus parameters obtained in caloric tests. Further studies are needed to investigate the clinical correlation of these findings. Objectives. To investigate whether the caloric response creates a measurable SSR and, if so, to compare the SSR parameters with the nystagmus parameters and the feelings of the patient. Material and methods. Patients completed an autonomic symptom questionnaire (ASQ) regarding their past history of autonomic symptoms. They used a visual analog scale (VAS) to assess the severity of symptoms during simultaneous SSR and caloric tests. Symptoms were also noted separately by the investigator. Results. Eighteen patients were included in the study (13 females, 5 males). Eight of the patients had central and 10 had peripheral vertigo. The mean VAS score was 6.6 +/- 1.9 and the mean ASQ score was 7.2 +/- 3.6. In terms of the recorded parameters, there were no significant differences between patients with central and peripheral vertigo, males and females or warm and cold irrigation. The number of SSR waves increased significantly when the slow-phase velocity was > 26 degrees/s (p < 0.01) and the nystagmus latency was <= 27 s (p < 0.05). The VAS score was also correlated with the number of SSR waves (p < 0.01).C1 Pamukkale Univ, Sch Med, Dept Otolaryngol, Denizli, Turkey

Does the stapes reflex remain the same after Bell's palsy?

Objective: The authors investigated the integrity and function of nervus stapedius 1 year after facial paralysis.Study Design: Patients with Bell's palsy were observed prospectively for 1 year and compared with healthy patients.Setting: The follow-up of patients was done in the outpatient clinic and tests were applied in the audiology unit.Patients: The mean age of 32 patients was 41.03 years. Eight of 32 patients were grade II (25%), 11 were grade III (35%), and 13 were grade IV (40%) according to House-Brackman grading system. The mean age of the control group (10 persons) was 36.5 years.Intervention: Contralateral stimulus was used in acoustic reflex test at 500 and 1,000 Hz with 80-, 90-, 100-, and 110-dB stimulus intensity. Tests were applied in three ways: normal position, eye-closed position, and grin position. Tests were done in the first 15 days of facial paralysis and repeated at least 1 year thereafter. The millimeter difference in amplitude of impedance recording of middle ear between the normal ear and paralyzed ear was accepted as criterion.Main Outcome Measures: There were 6- to 9-mm amplitude differences between normal side and healed side of grade IV patients with 100- and 110-dB stimuli.Results: In the second test (after 1 year), statistically significant differences were present between control group and grade IV patients on 1,000 and 500 Hz frequencies with 100- and 110-dB stimulus intensity (p < 0.05). There were no significant differences between grade II and control group and between made III and control group.Conclusions: A permanent partial denervation is present on the stapedial nerve, especially after grade IV paralysis, and it affects the function of stapes muscle in high decibel sounds. But it does not affect the stapes reflex threshold. No synkinetic innervation was found in the authors' patient group with their test method

Does the stapes reflex remain the same after Bell's palsy?

Objective: The authors investigated the integrity and function of nervus stapedius 1 year after facial paralysis.Study Design: Patients with Bell's palsy were observed prospectively for 1 year and compared with healthy patients.Setting: The follow-up of patients was done in the outpatient clinic and tests were applied in the audiology unit.Patients: The mean age of 32 patients was 41.03 years. Eight of 32 patients were grade II (25%), 11 were grade III (35%), and 13 were grade IV (40%) according to House-Brackman grading system. The mean age of the control group (10 persons) was 36.5 years.Intervention: Contralateral stimulus was used in acoustic reflex test at 500 and 1,000 Hz with 80-, 90-, 100-, and 110-dB stimulus intensity. Tests were applied in three ways: normal position, eye-closed position, and grin position. Tests were done in the first 15 days of facial paralysis and repeated at least 1 year thereafter. The millimeter difference in amplitude of impedance recording of middle ear between the normal ear and paralyzed ear was accepted as criterion.Main Outcome Measures: There were 6- to 9-mm amplitude differences between normal side and healed side of grade IV patients with 100- and 110-dB stimuli.Results: In the second test (after 1 year), statistically significant differences were present between control group and grade IV patients on 1,000 and 500 Hz frequencies with 100- and 110-dB stimulus intensity (p < 0.05). There were no significant differences between grade II and control group and between made III and control group.Conclusions: A permanent partial denervation is present on the stapedial nerve, especially after grade IV paralysis, and it affects the function of stapes muscle in high decibel sounds. But it does not affect the stapes reflex threshold. No synkinetic innervation was found in the authors' patient group with their test method

Clinical and electronystagmographical evaluation of vestibular symptoms in relapsing remitting multiple sclerosis.

OBJECTIVE: Multiple sclerosis (MS) may give rise to a variety of clinical signs and symptoms including vertigo and/or other problems related with equilibrium. In this study, we aimed to evaluate clinical and electronystagmographical (ENG) characteristics of relapsing remitting MS (RRMS) patients. DESIGN: This is a prospective controlled study consisting of 30 patients who were diagnosed as definite RRMS according to McDonald's diagnostic criteria and 30 healthy individuals. SETTING: Entire population of patients were examined and followed up at the same tertiary centre during the period of September 2003 and March 2005. Clinical examination and detailed electronystagmographic investigations were performed in each group. METHODS: Vestibular laboratory testing was carried out by a computerized ENG system. All ENG subtests including tracking, saccade, optokinetic, gaze, positional and Dix-Hallpike tests were performed in each group but caloric, which is relatively an invasive test, was performed only in the patient group. MAIN OUTCOME MEASURES: We aimed to find the ratio of abnormal tests indicating, central and/or peripheral pathology in ENG. We also analyzed the correlation of total number of abnormal tests in ENG with clinical parameters. RESULTS: Differences of ENG abnormality indicating central and/or peripheral pathology and ENG abnormality indicating only central pathology between the two groups were statistically significant. Correlation of total number of abnormal tests in ENG with EDSS score was statistically significant. CONCLUSION: ENG is sensitive in detecting the vestibular system involvement in RRMS patients if all subtests are performed and evaluated in detail with clinical symptoms and signs

Paraspinal muscle response to electrical vestibular stimulation.

Galvanic (electrical) vestibular stimulation (GVS) has been used to study the role of the vestibular system in postural control by inducing postural sway in standing subjects. The purpose of this study was to determine the timing and pattern of activation in the paraspinal muscles in response to GVS and to compare these responses with those in the muscles of the lower leg. Binaural-bipolar GVS was applied to the skin overlying the mastoid processes of 10 subjects while they stood on a force plate with their eyes closed. The stimulus consisted of a 0.6 mA 5-pulse sequence. Each pulse lasted for 2 s, followed by 4 s of rest. The centre of pressure (COP) vs. time for each trial was calculated from the reaction forces and moments. Surface electromyographic (EMG) signals from the paraspinal and gastrocnemius muscles were recorded bilaterally. The EMG signals were rectified and integrated (iEMG). The iEMG from the muscles on the cathodal side of the body were then subtracted from the iEMG of the anodal side muscles, to yield a differential EMG (dEMG). Both the paraspinal and gastrocnemius muscles became activated in response to the stimulus. The pattern of activation was consistent with the changes observed in the centre of pressure. The primary response in both muscles acted to move the body toward the anode. This primary response began at 74 +/- 20 ms in the paraspinal muscles and at 118 +/- 18 ms in the gastrocnemius. A second component of the response began at 232 +/- 27 ms in the paraspinal muscles and 262 +/- 54 ms in the gastrocnemius muscles. This second phase of the response was opposite in direction to the primary response and was responsible for decelerating the body and maintaining the deviated position of the centre of mass over the base of support. Following the termination of the stimulus, the opposite pattern of muscle activation in both the paraspinal and the gastrocnemius muscles was observed. The results of this study suggest that the paraspinal muscles may play a significant role in the frontal plane response to vestibular stimulation during stance in humans

Paraspinal muscle response to electrical vestibular stimulation

Galvanic (electrical) vestibular stimulation (GVS) has been used to study the role of the vestibular system in postural control by inducing postural sway in standing subjects. The purpose of this study was to determine the timing and pattern of activation in the paraspinal muscles in response to GVS and to compare these responses with those in the muscles of the lower leg. Binaural-bipolar GVS was applied to the skin overlying the mastoid processes of 10 subjects while they stood on a force plate with their eyes closed. The stimulus consisted of a 0.6 mA 5-pulse sequence. Each pulse lasted for 2 s, followed by 4 s of rest. The centre of pressure (COP) vs. time for each trial was calculated from the reaction forces and moments. Surface electromyographic (ER-IG) signals from the paraspinal and gastrocnemius muscles were recorded bilaterally. The EMG signals were rectified and integrated (iEMG). The iEMG from the muscles on the cathodal side of the body were then subtracted from the iEMG of the anodal side muscles, to yield a differential EMG (dEMG). Both the paraspinal and gastrocnemius muscles became activated in response to the stimulus. The pattern of activation was consistent with the changes observed in the centre of pressure. The primary response in both muscles acted to move the body toward the anode. This primary response began at 74 +/- 20 ms in the paraspinal muscles and at 118 +/- 18 ms in the gastrocnemius. A second component of the response began at 232 +/- 27 ms in the paraspinal muscles and 262 +/- 54 ms in the gastrocnemius muscles. This second phase of the response was opposite in direction to the primary response and was responsible for decelerating the body and maintaining the deviated position of the centre of mass over the base of support. Following the termination of the stimulus, the opposite pattern of muscle activation in both the paraspinal and the gastrocnemius muscles was observed. The results of this study suggest that the paraspinal muscles may play a significant role in the frontal plane response to vestibular stimulation during stance in humans

Impact of multiple etiology on dizziness handicap

Objective: Our aim was to find the ratio of multiple diagnosis in dizziness patients and to evaluate the effect of multiple etiologies on handicap level of the patient.Study Design: Retrospective chart review.Setting: Tertiary referral center.Intervention: The data of 703 patients (178 men and 525 women) were included in the study. Diagnoses of the patients were made in a multiple-specialty environment including otolaryngology, neurology, cardiology, internal medicine, and rehabilitation medicine.Main Outcome Measures: All patients filled the dizziness handicap inventory and pointed the severity of dizziness on a 10-point visual analog scale.Results: Four hundred thirty-three patients (61.6%) have only one diagnosis, whereas 183 (26%) had two. Three diseases have been found in 34 patients (4.8%), and four diseases were present in eight patients (1.1%). The mean number of diagnosis in one patient was 1.32 +/- 0.71. There was a significant difference between two sexes on the number of disease. There was no correlation between age and the number of diagnosis. There was no significant difference in functional scale, but the statistically significant increases are present in both physical (p < 0.05) and emotional (p < 0.01) scales. There was no correlation between age and handicap levels.Conclusion: Multiple diagnoses were important factors on physical and emotional handicaps. It was also found that this problem is not limited with older age group.C1 Pamukkale Univ, Sch Med, Dept Otolaryngol, Denizli, Turkey