Skull Vibration Induced Nystagmus Test: Correlations with Semicircular Canal and Otolith Asymmetries

Abstract

Background: To establish in patients with peripheral vestibular disorders relations between skull vibration-induced nystagmus (SVIN) different components (horizontal, vertical, torsional) and the results of different structurally related vestibular tests.

Methods: SVIN test, canal vestibular test (CVT: caloric test + video head impulse test: VHIT), otolithic vestibular test (OVT: ocular vestibular evoked myogenic potential oVEMP + cervical vestibular evoked myogenic potential cVEMP) performed on the same day in 52 patients with peripheral vestibular diseases (age < 65 years), and 11 control patients were analyzed. Mixed effects logistic regression analysis was performed to assert whether the presence of nystagmus in SVIN (3D analysis) have an association with the presence of peripheral vestibular dysfunction measured by vestibular explorations (CVT or OVT).

Results: We obtained different groups: Group-Co (control group), Group-VNT (dizzy patients with no vestibular tests alterations), Group-O (OVT alterations only), Group-C (CVT alterations only), Group-M (mixed alterations). SVIN-SPV horizontal component was significantly higher in Group-M than in the other groups (p = 0.005) and correlated with alterations of lateral-VHIT (p < 0.001), caloric test (p = 0.002) and oVEMP (p = 0.006). SVIN-SPV vertical component was correlated with the anterior-VHIT and oVEMP alterations (p = 0.007; p = 0.017, respectively). SVIN-SPV torsional component was correlated with the anterior-VHIT positivity (p = 0.017). SVIN was the only positive test for 10% of patients (83% of Group-VNT).

Conclusion: SVIN-SPV analysis in dizzy patients shows significant correlation to both CVT and OVT. SVIN horizontal component is mainly relevant to both vestibular tests exploring lateral canal and utricle responses. SVIN-SPV is significantly higher in patients with combined canal and otolith lesions. In some patients with dizziness, SVIN may be the only positive test.

Keywords: dizziness; skull vibration induced nystagmus; unilateral vestibular loss; vestibular functional tests.

Figure 1

Inner right ear diagram with vestibular structures and their respective tests. CaT: caloric test; OVAR test: off vertical axis rotation test; SCC: semi-circular canal; SVV: subjective visual vertical; VHIT: video head impulse test; VEMPs: vestibular evoked myogenic potential (ocular and cervical).

Figure 2

H-SPV bar chart with standard error by pathological groups. (**: p < 0.01).

Figure 3

H-SPV bar chart with standard error comparison between positive and negative results of vestibular tests. (**: p < 0.01, ***: p < 0.001).

Figure 4

V-SPV (a) and T-SPV (b) bar charts with standard error comparison between positive and negative results of vestibular tests. (*: p < 0.05, **: p < 0.01).