Contralesional subjective visual horizontal predicts endolymphatic hydrops

Abstract

Background: The subjective visual horizontal (SVH) is a test of utricular function that assesses conjugate ocular torsion which is a component of the ocular tilt reaction (OTR). In unilateral destructive peripheral vestibular lesions, the OTR and so the SVH tilt is usually ipsiversive.

Aims/objective: Our study aimed to profile the causes of a contraversive SVH tilt in patients with a confirmed unilateral peripheral vestibular deficit.

Materials and methods: The clinical records, nystagmus and vestibular investigation characteristics of 52 patients with a unilateral canal paresis (CP) on caloric of ≥30%, a contraversive SVH tilt of ≥4 degrees and at least one pure tone audiometry were retrospectively analysed.

Results: The most common diagnosis of patients (n = 39) with a contraversive SVH and ipsilesional CP was endolymphatic hydrops: 35 (67.3%) had Meniere’s disease (MD) and 4 (7.7%) had delayed endolymphatic hydrops (DEH). The remaining 13 (25%) of cases had other peripheral aetiologies or an unknown diagnosis. 16 (30.8%) patients had ictal spontaneous nystagmus at the time of SVH or caloric testing.

Conclusions and significance: A contraversive SVH with unilateral CP suggests endolymphatic hydrops.

Chinese abstract

背景：主观视觉水平（SVH）是一项评估眼倾斜反应（OTR）和泡囊功能的测试。在单侧外周前庭病变中, SVH倾斜和OTR通常是同向的, 很少是反向的。

目的：我们的研究旨在概述确诊单侧外周前庭缺损患者出现反向SVH倾斜的原因。

材料与方法：回顾性分析了52例单侧管道麻痹（CP）, 热量测试为30％, 反向SVH倾斜度为4度, 至少一次纯音测听的患者的临床记录、眼球震颤及前庭检查特点。

结果：反向 SVH和同向CP相互矛盾的患者（n¼39）的最常见诊断是内淋巴积液：35例（67.3％）患有美尼尔氏病（MD）, 而4例（7.7％）患有延迟性内淋巴积液（DEH）。其余13例（25％）是其他外围病因或诊断不明。 SVH或热量测试时, 有16名（30.8％）患者出现自发性眼球震颤。

结论和意义：具单侧CP的反向SVH患者提示内淋巴积液。

Keywords:

• Ocular torsion
• subjective visual horizontal
• subjective visual vertical
• otolithic function
• canal paresis
• Meniere’s disease

Acknowledgments

The authors would like to thank Ms Trang Le for assisting in data extraction.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by Garnett Passe and Rodney Williams Memorial Foundation and National Health and Medical Research Council.