Evaluation of Bilateral Vestibular Dysfunction in Iranian Adults and Elderlies by Electronystagmography and Video Head Impulse Test

Document Type: Original

Authors

1 Department of Audiology, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Department of Otolaryngology, Sina Hospital, Mashhad, Iran.

3 Department of Otolaryngology, Mashhad University of Medical Sciences, Mashhad, Iran.

4 Markazi Vestibular Assessment and Rehabilitation Center, Mashhad, Iran.

Abstract

Introduction:
Vestibular abnormalities are common problems in the whole world, which can lead to bilateral vestibular dysfunction (BVD). That results in symptoms, such as vertigo, unsteadiness, falling, oscillopsia, and lower quality of life. The Objective of this study was to determine BVD in adults and elderlies with vertigo and unsteadiness.
 
Materials and Methods:
This study was conducted on 384 patients in two categories of adults (age range of 18-64 years) and elderlies (65 years old and above) through Electronystagmography (ENG), including caloric test and video head impulse test (vHIT). Patients called bilateral vestibular dysfunction when they have an abnormal bilateral weakness (summation of nystagmus response less than 20 for 4 stimulations and less than 12 for each ear) in caloric test and their vHIT has a gain lower than 0.6. The results of caloric tests were categorized into four groups, including normal, unilateral weakness, bilateral weakness, and central abnormalities.
 
Results:
The obtained results revealed that the frequency of BVD is higher than previously reported data in the medical literature. The frequency of BVD was 10.9% for the investigated patients (39.1% abnormal caloric, 12.5% abnormal vHIT, and 10.9% abnormal in both tests). The 38.5% of elderly patients had bilateral abnormal results in both tests.
 
Conclusion:
The results of this study showed BVD in some cases by caloric and vHIT tests.Elderlies showed more cases of BVD compared to adult patients.

Keywords

Main Subjects


1. Neuhauser HK, von Brevern M, Radtke A, Lezius F, Feldmann M, Ziese T, et al. Epidemiology of vestibular vertigo: a neurotologic survey of the general population. Neurology. 2005;65(6):898-904.

2. Ward BK, Agrawal Y, Hoffman HJ, Carey JP, Della Santina CC. Prevalence and impact of bilateral vestibular hypofunction: results from the 2008 US National Health Interview Survey. JAMA Otolaryngol Head Neck Surg. 2013;139(8):803-10.

3. Zingler VC, Weintz E, Jahn K, Huppert D, Cnyrim C, Brandt T, et al. Causative factors, epidemiology, and follow-up of bilateral vestibulopathy. Annals of the New York Academy of Sciences. 2009;1164:505-8.

4. Rinne T, Bronstein AM, Rudge P, Gresty MA, Luxon LM. Bilateral loss of vestibular function: clinical findings in 53 patients. Journal of neurology. 1998;245(6-7):314-21.

5. Ghazizadeh Hashemi SA, Jafarzadeh S, Haddadi Aval M, Hosseinabadi R. Ocular Motor Function in Patients with Bilateral Vestibular Weakness. Iran J Otorhinolaryngol. 2016;28(86):177-81.

6. Furman JM, Raz Y, Whitney SL. Geriatric vestibulopathy assessment and management. Curr Opin Otolaryngol Head Neck Surg. 2010; 18(5): 386-91.

7. Agrawal Y, Carey JP, Della Santina CC, Schubert MC, Minor LB. Disorders of balance and vestibular function in US adults: data from the National Health and Nutrition Examination Survey, 2001-2004. Archives of internal medicine. 2009; 169(10): 938-44.

8. Herdman SJ, Blatt P, Schubert MC, Tusa RJ. Falls in patients with vestibular deficits. Am J Otol. 2000;21(6):847-51.

9. Guinand N, Pijnenburg M, Janssen M, Kingma H. Visual acuity while walking and oscillopsia severity in healthy subjects and patients with unilateral and bilateral vestibular function loss. Archives of otolaryngology--head & neck surgery. 2012;138(3):301-6.

10. Herdman SJ, Hall CD, Schubert MC, Das VE, Tusa RJ. Recovery of dynamic visual acuity in bilateral vestibular hypofunction. Archives of otolaryngology--head & neck surgery. 2007; 133(4): 383-9.

11. Jacobson GP, Calder JH. Self-perceived balance disability/handicap in the presence of bilateral peripheral vestibular system impairment. J Am Acad Audiol. 2000;11(2):76-83.

12. Guinand N, Boselie F, Guyot JP, Kingma H. Quality of life of patients with bilateral vestibulopathy. Ann Otol Rhinol Laryngol. 2012; 121(7): 471-7.

13. Sun DQ, Ward BK, Semenov YR, Carey JP, Della Santina CC. Bilateral Vestibular Deficiency: Quality of Life and Economic Implications. JAMA Otolaryngol Head Neck Surg. 2014;14(6):527-34.

14. Furman JM, Kamerer DB. Rotational responses in patients with bilateral caloric reduction. Acta Otolaryngol. 1989;108(5-6):355-61.

15. Bittar RS, Pedalini ME, Ramalho JR, Carneiro CG. Bilateral vestibular loss after caloric irrigation: clinical application of vestibular rehabilitation. Rev Laryngol Otol Rhinol (Bord). 2005;126(1):3-6.

16. McGath JH, Barber HO, Stoyanoff S. Bilateral vestibular loss and oscillopsia. J Otolaryngol. 1989; 18(5):218-21.

17. Brown KE, Whitney SL, Wrisley DM, Furman JM. Physical therapy outcomes for persons with bilateral vestibular loss.Laryngoscope.2001;111 (10): 1812-7.

18. Iwasaki S, Yamasoba T. Dizziness and Imbalance in the Elderly: Age-related Decline in the Vestibular System.Aging Dis. 2015;6(1):38-47.