High-Frequency Skull Vibration-Induced Nystagmus Test in Partial Vestibular Lesions

Objectives: To establish the effectiveness of the skull vibration-induced nystagmus test (SVINT) as a rapid high-frequency stimulation test, in the evaluation of partial unilateral vestibular lesions (pUVL). Methods: SVINT (30, 60, and 100 Hz), caloric, and head-shaking tests were performed in 99 patients with pUVL. These results were compared with those in 9 patients with symmetrical partial bilateral labyrinthine malformations, 131 patients with total unilateral vestibular lesions (tUVL), and 95 control subjects. Results: A skull vibratory nystagmus (SVN) was found in 75% of patients with pUVL and 98% with tUVL. In pUVL: SVINT revealed asymmetric responses in 20% of patients where other tests were normal; SVN direction at 100 Hz was opposite to the head-shaking nystagmus direction in 30% and opposite to SVN at 30 Hz in 10% of cases. At 100 Hz, SVN beat toward the safe side in 91% of cases; SVN values at 60 and 100 Hz were higher than those at 30 Hz (p < 0.005). SVN was found in unilateral superior canal dehiscences. Partial bilateral labyrinthine malformations revealed no nystagmus. Conclusion: SVINT complements head-shaking and caloric tests in multifrequency assessment of patients with pUVL, as a global vestibular test. In contrast with tUVL results, SVINT does not always indicate the side of partial lesions, neither does it locate their level on the vestibulo-ocular pathway. This test is useful to reveal a vestibular asymmetry as a bedside examination test and may be used as a "vestibular Weber."

[1]  Juno Kim,et al.  Bone conducted vibration selectively activates irregular primary otolithic vestibular neurons in the guinea pig , 2006, Experimental Brain Research.

[2]  J. Colebatch,et al.  A utricular origin of frequency tuning to low-frequency vibration in the human vestibular system? , 2009, Neuroscience Letters.

[3]  T. Yagi,et al.  Role of dorsal neck proprioceptive inputs to vestibular compensation in humans. , 1998, Nihon Ika Daigaku zasshi.

[4]  S. Aw,et al.  Vibration-induced shift of the subjective visual horizontal: a sign of unilateral vestibular deficit. , 2002, Archives of otolaryngology--head & neck surgery.

[5]  E D Young,et al.  Responses of squirrel monkey vestibular neurons to audio-frequency sound and head vibration. , 1977, Acta oto-laryngologica.

[6]  Haim Sohmer,et al.  Bone conduction experiments in animals – evidence for a non-osseous mechanism , 2000, Hearing Research.

[7]  Georg v. Békésy,et al.  Zur Theorie des Hörens bei der Schallaufnahme durch Knochenleitung , 1932 .

[8]  C. S. Hallpike.  [The caloric test]. , 1955, Practica oto-rhino-laryngologica.

[9]  I Pyykkö,et al.  Effect of proprioceptor stimulation on postural stability in patients with peripheral or central vestibular lesion. , 1991, Acta oto-laryngologica.

[10]  Stefan Stenfelt,et al.  Bone-Conducted Sound: Physiological and Clinical Aspects , 2005, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[11]  Hongju Park,et al.  Lessons From Follow-Up Examinations in Patients With Vestibular Neuritis: How to Interpret Findings From Vestibular Function Tests at a Compensated Stage , 2009, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[12]  T. Brandt,et al.  Perceptual and oculomotor effects of neck muscle vibration in vestibular neuritis. Ipsilateral somatosensory substitution of vestibular function. , 1998, Brain : a journal of neurology.

[13]  G. Hughes,et al.  Vibration-Induced Nystagmus as an Office Procedure for the Diagnosis of Superior Semicircular Canal Dehiscence , 2007, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[14]  J. Lavieille,et al.  [Semiologic value and optimum stimuli trial during the vibratory test: results of a 3D analysis of nystagmus]. , 2000, Annales d'oto-laryngologie et de chirurgie cervico faciale : bulletin de la Societe d'oto-laryngologie des hopitaux de Paris.

[15]  H. MacDougall,et al.  Vibration-induced ocular torsion and nystagmus after unilateral vestibular deafferentation. , 2003, Brain : a journal of neurology.

[16]  P. Fransson,et al.  Changes in postural control in healthy elderly subjects are related to vibration sensation, vision and vestibular asymmetry. , 2001, Acta oto-laryngologica.

[17]  L. Minor,et al.  Horizontal vestibuloocular reflex evoked by high-acceleration rotations in the squirrel monkey. III. Responses after labyrinthectomy. , 2000, Journal of neurophysiology.

[18]  A Tjellström,et al.  Resonance frequencies of the human skull in vivo. , 1988, The Journal of the Acoustical Society of America.

[20]  J Tonndorf,et al.  Bone conduction. Studies in experimental animals. , 1966, Acta Oto-Laryngologica.

[21]  A. Chays,et al.  Nystagmus induit par des vibrations : physiopathogénie et intérêt en clinique , 2004 .

[22]  Seok-Chan Hong,et al.  Clinical Significance of Vibration-Induced Nystagmus and Head-Shaking Nystagmus Through Follow-Up Examinations in Patients With Vestibular Neuritis , 2008, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[23]  S. Stenfelt,et al.  Linearity of sound transmission through the human skull in vivo. , 1996, The Journal of the Acoustical Society of America.

[24]  J R Lackner,et al.  Elicitation of vestibular side effects by regional vibration of the head. , 1974, Aerospace medicine.

[25]  P. Perrin,et al.  Nystagmus induced by high frequency vibrations of the skull in total unilateral peripheral vestibular lesions , 2008, Acta oto-laryngologica.

[26]  K. Hamann,et al.  Vibration-Induced Nystagmus – A Sign of Unilateral Vestibular Deficit , 1999, ORL.

[27]  J. Tonndorf.  A new concept of bone conduction. , 1968, Archives of otolaryngology.

[28]  M. Ohki,et al.  Vibration-Induced Nystagmus in Patients with Vestibular Disorders , 2003, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[29]  A. Hudspeth,et al.  Hair-bundle movements elicited by transepithelial electrical stimulation of hair cells in the sacculus of the bullfrog , 2003, Proceedings of the National Academy of Sciences of the United States of America.

[30]  P. Perrin,et al.  [Skull vibratory test in partial vestibular lesions--influence of the stimulus frequency on the nystagmus direction]. , 2005, Revue de laryngologie - otologie - rhinologie.

[31]  Igal Savion,et al.  Bone conduction experiments in humans – a fluid pathway from bone to ear , 2000, Hearing Research.