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Head-shaking nystagmus predicts greater disability in unilateral peripheral vestibulopathy.
Am J Otolaryngol. 2011 Nov-Dec; 32(6):522-7.AJ

Abstract

OBJECTIVES

The objective of this study was to determine the association of the bedside test of head-shaking nystagmus (HSN) with patients' self-perceived dizziness handicap as well as this test's sensitivity and specificity in unilateral peripheral vestibular hypofunction.

STUDY DESIGN

A retrospective case-control study was performed.

SETTING

The study was held at an academic, tertiary referral center.

METHODS

Fifty-three adult patients with unilateral peripheral hypofunction defined by the caloric test of the videonystagmography with documented bedside HSN and who had completed questionnaires of self-perceived dizziness handicap were included. The sensitivity and specificity of the bedside HSN in patients and 10 healthy controls in diagnosing unilateral vestibular hypofunction defined by videonystagmographic caloric testing and by abnormal gain and symmetry of the vestibular-ocular reflex by rotary chair testing were determined. Scores of the screening test of the Dizziness Handicap Index and Functional Level Scale questionnaires were taken.

RESULTS

When using the caloric irrigation test as the reference standard for unilateral vestibular hypofunction, the sensitivity, specificity, and positive predictive value of the bedside HSN were 31%, 96%, and 97%, respectively. When comparing with results of rotational chair testing (vestibular-ocular reflex gain and symmetry), the sensitivity of the HSN test increases to 71%. Patients with positive bedside HSN had higher scores (greater self-perceived dizziness handicap) of the Dizziness Handicap Index (P = .049) and higher (worse) scores of the Functional Level Scale (P = .0377) than those with negative bedside HSN (Wilcoxon rank test).

CONCLUSIONS

Greater perceived handicap was correlated with a positive bedside HSN in patients with unilateral peripheral vestibulopathy. The HSN has sufficient sensitivity to be used as screening test of uncompensated vestibulopathy in this series. However, a negative HSN alone does not rule out the diagnosis of peripheral vestibular dysfunction.

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Authors+Show Affiliations

Angeli SI
Department of Otolaryngology, University of Miami Ear Institute, University of Miami Miller School of Medicine, FL 33136, USA. sangeli@med.miami.edu
Velandia S
No affiliation info available
Snapp H
No affiliation info available

MeSH

AdultAgedAged, 80 and overCaloric TestsCase-Control StudiesDisability EvaluationDizzinessFemaleHead MovementsHumansMaleMiddle AgedNystagmus, PathologicPredictive Value of TestsReference ValuesRetrospective StudiesSelf-AssessmentSensitivity and SpecificitySeverity of Illness IndexStatistics, NonparametricSurveys and QuestionnairesVertigoVestibular DiseasesVestibular Function TestsYoung Adult

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

21306790

Citation

Angeli, Simon I., et al. "Head-shaking Nystagmus Predicts Greater Disability in Unilateral Peripheral Vestibulopathy." American Journal of Otolaryngology, vol. 32, no. 6, 2011, pp. 522-7.
Angeli SI, Velandia S, Snapp H. Head-shaking nystagmus predicts greater disability in unilateral peripheral vestibulopathy. Am J Otolaryngol. 2011;32(6):522-7.
Angeli, S. I., Velandia, S., & Snapp, H. (2011). Head-shaking nystagmus predicts greater disability in unilateral peripheral vestibulopathy. American Journal of Otolaryngology, 32(6), 522-7. https://doi.org/10.1016/j.amjoto.2010.11.004
Angeli SI, Velandia S, Snapp H. Head-shaking Nystagmus Predicts Greater Disability in Unilateral Peripheral Vestibulopathy. Am J Otolaryngol. 2011 Nov-Dec;32(6):522-7. PubMed PMID: 21306790.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Head-shaking nystagmus predicts greater disability in unilateral peripheral vestibulopathy. AU - Angeli,Simon I, AU - Velandia,Sandra, AU - Snapp,Hillary, Y1 - 2011/02/08/ PY - 2010/07/30/received PY - 2010/11/19/accepted PY - 2011/2/11/entrez PY - 2011/2/11/pubmed PY - 2012/3/23/medline SP - 522 EP - 7 JF - American journal of otolaryngology JO - Am J Otolaryngol VL - 32 IS - 6 N2 - OBJECTIVES: The objective of this study was to determine the association of the bedside test of head-shaking nystagmus (HSN) with patients' self-perceived dizziness handicap as well as this test's sensitivity and specificity in unilateral peripheral vestibular hypofunction. STUDY DESIGN: A retrospective case-control study was performed. SETTING: The study was held at an academic, tertiary referral center. METHODS: Fifty-three adult patients with unilateral peripheral hypofunction defined by the caloric test of the videonystagmography with documented bedside HSN and who had completed questionnaires of self-perceived dizziness handicap were included. The sensitivity and specificity of the bedside HSN in patients and 10 healthy controls in diagnosing unilateral vestibular hypofunction defined by videonystagmographic caloric testing and by abnormal gain and symmetry of the vestibular-ocular reflex by rotary chair testing were determined. Scores of the screening test of the Dizziness Handicap Index and Functional Level Scale questionnaires were taken. RESULTS: When using the caloric irrigation test as the reference standard for unilateral vestibular hypofunction, the sensitivity, specificity, and positive predictive value of the bedside HSN were 31%, 96%, and 97%, respectively. When comparing with results of rotational chair testing (vestibular-ocular reflex gain and symmetry), the sensitivity of the HSN test increases to 71%. Patients with positive bedside HSN had higher scores (greater self-perceived dizziness handicap) of the Dizziness Handicap Index (P = .049) and higher (worse) scores of the Functional Level Scale (P = .0377) than those with negative bedside HSN (Wilcoxon rank test). CONCLUSIONS: Greater perceived handicap was correlated with a positive bedside HSN in patients with unilateral peripheral vestibulopathy. The HSN has sufficient sensitivity to be used as screening test of uncompensated vestibulopathy in this series. However, a negative HSN alone does not rule out the diagnosis of peripheral vestibular dysfunction. SN - 1532-818X UR - https://www.unboundmedicine.com/medline/citation/21306790/Head_shaking_nystagmus_predicts_greater_disability_in_unilateral_peripheral_vestibulopathy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0196-0709(10)00236-X DB - PRIME DP - Unbound Medicine ER -