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Significance of head-shaking nystagmus in the evaluation of the dizzy patient.
Acta Otolaryngol Suppl. 1999; 540:27-33.AO

Abstract

In a series of studies, the phenomenon of head-shaking nystagmus (HSN) was assessed in 50 control subjects and 1364 consecutive dizzy patients who underwent formal electronystagmography (ENG) at the Toronto Hospital Center for Advanced Hearing and Balance Testing. HSN was compared in a series of 30 patients who underwent conventional electro-oculography (EOG) vs magnetic (scleral) coil eye movement recordings. Clinical correlation of HSN to other parameters of the ENG test battery was performed in another sub-series of 300 patients with known diagnoses. HSN was identified in 31.7% of dizzy patients vs 24% of control subjects. No significant difference in its manifestation was noted between active vs passive head-shaking tests or on EOG vs magnetic (scleral) coil eye movement recordings. When compared to other aspects of the ENG test battery, HSN was neither specific nor sensitive for vestibular dysfunction. It nevertheless correlated well with the presence of a caloric reduction and with increasing R/L excitability differences on ENG testing. When present, HSN was characteristically monophasic in 76.8%, biphasic in 22.7% and triphasic in 0.5% of subjects. The initial direction of HSN generally obeyed Ewald's second law, but the reverse was noted in 27% with monophasic and 17.6% of patients with biphasic HSN. In the subseries of 300 patients with known diagnoses, the presence of HSN was statistically significant (p < 0.05) in patients with peripheral vestibular dysfunction vs psychogenic dizziness. Its presence was also significant in well-documented peripheral vestibular disorders such as Meniere's disease (p < 0.01), vestibular neuronitis (p < 0.05) and acoustic neuroma (p < 0.05). Localization of the disease involvement based on the initial direction of HSN was especially unpredictable in patients with Meniere's disease. The significance and usefulness of the head-shake test in the otoneurological evaluation of the dizzy patient is further commented on.

Authors+Show Affiliations

Department of Otolaryngology, Chulalongkorn University, Bangkok, Thailand.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

10445075

Citation

Asawavichiangianda, S, et al. "Significance of Head-shaking Nystagmus in the Evaluation of the Dizzy Patient." Acta Oto-laryngologica. Supplementum, vol. 540, 1999, pp. 27-33.
Asawavichiangianda S, Fujimoto M, Mai M, et al. Significance of head-shaking nystagmus in the evaluation of the dizzy patient. Acta Otolaryngol Suppl. 1999;540:27-33.
Asawavichiangianda, S., Fujimoto, M., Mai, M., Desroches, H., & Rutka, J. (1999). Significance of head-shaking nystagmus in the evaluation of the dizzy patient. Acta Oto-laryngologica. Supplementum, 540, 27-33.
Asawavichiangianda S, et al. Significance of Head-shaking Nystagmus in the Evaluation of the Dizzy Patient. Acta Otolaryngol Suppl. 1999;540:27-33. PubMed PMID: 10445075.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Significance of head-shaking nystagmus in the evaluation of the dizzy patient. AU - Asawavichiangianda,S, AU - Fujimoto,M, AU - Mai,M, AU - Desroches,H, AU - Rutka,J, PY - 1999/8/13/pubmed PY - 1999/8/13/medline PY - 1999/8/13/entrez SP - 27 EP - 33 JF - Acta oto-laryngologica. Supplementum JO - Acta Otolaryngol Suppl VL - 540 N2 - In a series of studies, the phenomenon of head-shaking nystagmus (HSN) was assessed in 50 control subjects and 1364 consecutive dizzy patients who underwent formal electronystagmography (ENG) at the Toronto Hospital Center for Advanced Hearing and Balance Testing. HSN was compared in a series of 30 patients who underwent conventional electro-oculography (EOG) vs magnetic (scleral) coil eye movement recordings. Clinical correlation of HSN to other parameters of the ENG test battery was performed in another sub-series of 300 patients with known diagnoses. HSN was identified in 31.7% of dizzy patients vs 24% of control subjects. No significant difference in its manifestation was noted between active vs passive head-shaking tests or on EOG vs magnetic (scleral) coil eye movement recordings. When compared to other aspects of the ENG test battery, HSN was neither specific nor sensitive for vestibular dysfunction. It nevertheless correlated well with the presence of a caloric reduction and with increasing R/L excitability differences on ENG testing. When present, HSN was characteristically monophasic in 76.8%, biphasic in 22.7% and triphasic in 0.5% of subjects. The initial direction of HSN generally obeyed Ewald's second law, but the reverse was noted in 27% with monophasic and 17.6% of patients with biphasic HSN. In the subseries of 300 patients with known diagnoses, the presence of HSN was statistically significant (p < 0.05) in patients with peripheral vestibular dysfunction vs psychogenic dizziness. Its presence was also significant in well-documented peripheral vestibular disorders such as Meniere's disease (p < 0.01), vestibular neuronitis (p < 0.05) and acoustic neuroma (p < 0.05). Localization of the disease involvement based on the initial direction of HSN was especially unpredictable in patients with Meniere's disease. The significance and usefulness of the head-shake test in the otoneurological evaluation of the dizzy patient is further commented on. SN - 0365-5237 UR - https://www.unboundmedicine.com/medline/citation/10445075/Significance_of_head_shaking_nystagmus_in_the_evaluation_of_the_dizzy_patient_ L2 - https://medlineplus.gov/dizzinessandvertigo.html DB - PRIME DP - Unbound Medicine ER -