Clin Exp Otorhinolaryngol.  2022 Aug;15(3):213-219. 10.21053/ceo.2021.00794.

Saccular Pathology Is Most Commonly Found in Patients With General Vestibular Disorders

• Lee JM
• Lee HJ
• Kim J
• Shin SH
• Na G
• Shim DB
• Kim SH

• KMID: 2532985
• DOI: http://doi.org/10.21053/ceo.2021.00794

Abstract

Objectives
. The first purpose of this study was to investigate the difference in the frequency of involvement of the superior vestibular nerve (SVN) and inferior vestibular nerve (IVN) territories in general vestibular disorders, and to identify which IVN territory was more commonly involved in patients with IVN lesions. The second purpose was to investigate the correlation of the degree of each saccular and posterior semicircular canal (PSCC) dysfunction, as represented by the parameters of cervical vestibular evoked myogenic potential (cVEMP) and video head impulse test (vHIT), in patients with pathology of the IVN territory.
Methods
. In total, 346 patients with dizziness who underwent the caloric test, cVEMP, and vHIT were enrolled. Canal weakness in the caloric test, interaural amplitude difference (IAD) of cVEMP, and vestibulo-ocular reflex gain of the vestibulo-ocular reflex gain of the posterior semicircular canal (p-VOR) in vHIT were analyzed.
Results
. Among the enrolled patients, 15.6% had total vestibular nerve dysfunction, 14.5% had solely SVN dysfunction, and 29.5% had solely IVN dysfunction. Isolated saccular pathology was most common in patients with IVN pathology, followed by those with total IVN dysfunction and PSCC dysfunction. IAD and p-VOR were statistically well correlated, and the correlation was strongest in patients with both pathologic IAD and pathologic p-VOR (n=23, r=0.944), followed by patients with normal IAD and pathologic p-VOR (n=27, r=0.762) and patients with pathologic IAD and normal p-VOR (n=106, r=0.339).
Conclusion
. Abnormal results were more common in vestibular tests investigating the IVN than in vestibular tests investigating the SVN in patients with general vestibular disorders. Isolated saccular pathology was more frequent than PSCC or combined pathology in patients with IVN dysfunction. Patients with abnormal p-VOR in vHIT had a higher probability of having both saccular and PSCC pathologies than patients with an abnormal IAD. This study describes the characteristics of vestibular-system subregions and provides guidance for clinically interpreting the combination of cVEMP and vHIT results.

Keyword

Head Impulse Test; Vestibular Evoked Myogenic Potentials; Vestibular Nerve; Dizziness

Figure

• 

  Fig. 1. Normal interaural amplitude difference (IAD) values calculated from 189 healthy subjects. The subjects were aged between 15 and 88 years (mean±standard deviation [SD], 41.1±18.4 years), and 101 were men. The average IAD value was 19.9%±14.7%, and the reference range was 0%–49.3%. According to the reference range, an IAD ≥50% was considered pathologic in the present study.

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  Fig. 2. The correlation between the interaural amplitude difference (IAD) and the vestibulo-ocular reflex gain of the posterior semicircular canal (p-VOR). They were significantly correlated in the total population (A: n=346, r=0.440, P<0.01). The correlations were also statistically significant in four subgroups: (1) patients who had normal IAD and normal p-VOR (B: n=190, r=0.284, P<0.01), (2) patients who had pathologic IAD and normal p-VOR (C: n=106, r=0.339, P<0.01), (3) patients who had normal IAD and pathologic p-VOR (D: n=27, r=0.762, P<0.01), and (4) patients with both pathologic IAD and pathologic p-VOR (E: n=23, r=0.944, P<0.01).

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