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Vibration-Induced Shift of the Subjective Visual Horizontal
A Sign of Unilateral Vestibular Deficit
Mikael Karlberg, MD, PhD;
Swee T. Aw, MBBS, PhD;
G. Michael Halmagyi, MD, FRACP;
Ross A. Black, M Biomed E
Arch Otolaryngol Head Neck Surg. 2002;128:21-27.
Background Vibration to the head or neck excites vestibular and neck muscle spindle
afferents. Can such vibrations improve the sensitivity of the subjective visual
horizontal (SVH) test to chronic unilateral deficit of the vestibular system?
Design Controlled experimental study.
Setting Tertiary referral center.
Patients and Controls Thirteen healthy subjects and 23 patients with chronic unilateral vestibular
deficits after vestibular neurectomy or neurolabyrinthitis. Results of head-impulse
test showed unilateral loss of function of all 3 semicircular canals in 14
patients and loss of anterior and lateral semicircular canals in 9 patients.
Intervention Unilateral vibration (92 Hz; 0.6-mm amplitude) applied to sternocleidomastoid
muscle (SCM) or mastoid bone.
Main Outcome Measure Results of SVH test (in degrees).
Results Without vibration, 13 of 23 patients and all healthy subjects had SVH
of less than 3° (sensitivity, 43%; specificity, 100%). During vibration
to the ipsilesional SCM, SVH increased to greater than 3° in 21 of 23
patients but in only 1 of 13 healthy subjects (sensitivity, 91%; specificity,
92%). The patient group had significantly greater SVH shifts to the ipsilesional
side than did healthy subjects in response to SCM and mastoid bone vibration
on either side. The SVH shift during vibration to the ipsilesional SCM was
significantly greater than that during vibration to the contralesional muscle
(P<.001) or to the mastoid bone on either side
(P<.05). The vibration-induced SVH shift was significantly
greater in those patients with loss of 3 semicircular canals than in those
with loss of 2 (P<.01).
Conclusions The sensitivity of the SVH test to chronic unilateral vestibular deficits
can be improved by applying vibration to the SCM. The magnitude of vibratory
SVH shift is related to the extent of unilateral deficit of the otolithic
organs, vertical canals, or both.
From the Department of Neuro-otology, Royal Prince Alfred Hospital,
Sydney, Australia (Drs Karlberg, Aw, Halmagyi, and Black); and the Department
of Oto-rhino-laryngology, Lund University Hospital, Lund, Sweden (Dr Karlberg).
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