Bedside vestibular examination in patients with unilateral definite Ménière's disease

Abstract

Conclusion: Although vestibular clinical examinations are quite variable in Ménière's disease (MD), when used in a grouped fashion they attach valuable information to the understanding of MD. Objective: Evaluation of unilateral MD vestibular bedside examination. Methods: This was a retrospective study of patients with definite unilateral MD at a tertiary care facility. Assessment of spontaneous nystagmus (SN), head-shaking nystagmus (HSN), head impulse test (HIT) and vibration-induced nystagmus (VIN) was carried out. Clinical manifestations and auditory and vestibular function were studied. Results: The study included 97 patients: 47 presented SN, 75 a positive HSN (biphasic in 14) and in 73 a VIN was observed. After excluding patients with biphasic HSN, a homogeneous response was observed in 43.4%: no nystagmus in 15.7%; nystagmus of similar direction in 27.8% (paretic, 14.5%; irritative, 13.3%). There were no significant differences in duration of the disease, functional level and vertigo index, although a trend towards a shorter time since last crisis was observed in patients with an irritative nystagmus. In 36.1% nystagmus was revealed with a consistent direction in at least one of the tests and in 20.5% it was non-coherent, something more frequently observed closer to the crisis. Independently only in VIN an irritative response was associated with a higher functional level and a shorter time from last attack.

Keywords::

• Nystagmus
• vertigo
• vestibular function tests

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.