Audiology and Neurotology

Original Paper

Comprehensive Analysis of Head-Shaking Nystagmus in Patients with Vestibular Neuritis

Lee Y.J.a · Shin J.E.a · Park M.S.a · Kim J.M.a · Na B.R.a · Kim C.-H.a · Park H.J.b

Author affiliations

Departments of Otorhinolaryngology-Head and Neck Surgery,aKonkuk University School of Medicine, and bAsan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Keywords: VertigoVestibular function testsNystagmusCaloric testHead shakingVestibular neuritis

Related Articles for ""
Audiol Neurotol 2012;17:228–234
https://doi.org/10.1159/000336958

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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: September 20, 2011
Accepted: January 23, 2012
Published online: April 05, 2012
Issue release date: June 2012

Number of Print Pages: 7
Number of Figures: 2
Number of Tables: 3

ISSN: 1420-3030 (Print)
eISSN: 1421-9700 (Online)

For additional information: https://www.karger.com/AUD

Abstract

Although biphasic head-shaking nystagmus (HSN) is a basic response to head shaking in patients with unilateral vestibular loss, monophasic HSN is commonly seen in patients with dizziness of undetermined etiology. Since the clinical significance of HSN remains unclear, we sought to characterize different types of HSN in patients with vestibular neuritis (VN) during the acute stage (within 7 days after the onset of vertigo) and at follow-up (about 2 months after the onset of vertigo), and to compare HSN and caloric responses. We analyzed HSN, spontaneous nystagmus and caloric tests in 66 patients with VN. Overall, HSN showed high abnormal rates (94 and 89%) during the acute and follow-up stages and could detect vestibular hypofunction even when canal paresis (CP) had normalized at follow-up. All patients in the acute stage and most patients at follow-up showed HSN with the slow phase to the lesioned side (paretic). Biphasic HSN was common at follow-up, and many patients with a monophasic paretic pattern during the acute stage had evolved to a biphasic paretic pattern at follow-up. Initial slow-phase eye velocities (SPVs) in biphasic HSN were larger than those in monophasic HSN at follow-up. Absence of HSN or reversal of its direction was closely related to normalized caloric responses, but SPVs of HSN did not correlate with the severity of CP. These findings indicate that the HSN test is a sensitive detector of vestibular hypofunction upon 2-Hz head rotation. HSN may reveal previous vestibular hypofunction in the 2-Hz frequency range even at follow-up, when caloric responses detecting vestibular hypofunction in the low-frequency range had normalized. The two tests utilize different mechanisms to assess vestibular hypofunction and are complementary. Biphasic paretic HSN is the most common pattern at follow-up and occurs when the initial SPVs induced by head rotation are large enough to induce the adaptation of primary vestibular afferent activity. Monophasic HSN, which is commonly found in dizzy patients, indicates less severe vestibular hypofunction than biphasic HSN in the 2-Hz frequency range, and the caloric tests can provide further information about the side and presence of vestibular hypofunction at lower frequencies.

© 2012 S. Karger AG, Basel



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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: September 20, 2011
Accepted: January 23, 2012
Published online: April 05, 2012
Issue release date: June 2012

Number of Print Pages: 7
Number of Figures: 2
Number of Tables: 3

ISSN: 1420-3030 (Print)
eISSN: 1421-9700 (Online)

For additional information: https://www.karger.com/AUD

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2012, Vol.17, No. 4

June 2012

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Additional Information

Y.J.L. and J.E.S. contributed equally to this article.

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