The clinical and electrophysiological characteristics of spontaneous vertigo syndromes

Abstract

Background: Robert Barany was an Austro-Hungarian otologist, who was awarded the 1914 Nobel Prize in medicine for his characterization of caloric nystagmus and its application to clinical practice. Until recent years the caloric test had been the only clinical means for evaluating the integrity of the vestibular labyrinth in one ear, in isolation from the contralateral labyrinth. The vestibular clinic today has an array of tests, the vestibular evoked myogenic potentials, video head impulses, video-oculography, and subjective visual testing allowing the entire five organs of the human labyrinth on each side, to be independently assessed. The characteristics of these tests help to differentiate the disorders of the vestibular system from one another including, vestibular migraine which will have an essentially normal vestibular test profile.

Method: Data was collected from the vestibular tests performed at two neurotology clinics on patients with three spontaneous vertigo syndromes. Five studies are focused on vestibular test characteristics and the sixth, is a prospective study on the effectiveness of a non-prescription therapies in the management of vestibular migraine patients.

Results: This thesis reports the characteristics that can be seen in the vestibular tests of patients with the three most common causes of spontaneous vertigo events, namely Menière’s disease, vestibular neuritis and vestibular migraine. It highlights differences in results seen from tests performed in modern neuro-otology clinics with a potentially new application of the caloric test subjective data and an observational study of vestibular migraine treatment, using non-prescription therapy.