Age predicts the absence of caloric-induced vertig

Age predicts the absence of caloric-induced vertigo

Gary P.Jacobson a ,Erin G.Piker b,*,Sarah L.Grantham a ,Lauren N.English a

a

Department of Hearing and Speech Sciences,Divisions of Audiology and Vestibular Sciences,Vanderbilt University Medical Center,Nashville,TN,USA

b

Department of Communication Sciences and Disorders,James Madison University,Harrisonburg,VA,USA

Received 27September 2017;revised 16October 2017;accepted 26October 2017

Abstract

Introduction :The absence of vertigo during the caloric test,despite a robust response,has been suggested to represent a central vestibular system phenomenon.The purpose of this investigation was to determine the prevalence of absent caloric-induced vertigo perception in an unselected group of patients and to assess possible predicting variables.

Methods :Prospective investigation of 92unselected patients who underwent caloric testing.Inclusion criteria were that each patient generate a maximum slow phase velocity (maxSPV) 15deg/sec and a caloric asymmetry of 10%.Following the caloric,patients were asked,“Did you have any sensation of motion?”

Results :Results showed 75%of patients reported motion with a mean age of 56.51years compared to a mean age of 66.55in the 25%of patients reporting an absence of motion.A logistic regression was performed and the overall model was statistically signi?cant accounting for 29%of the variance in caloric perception.The signi?cant predictor variables were patient age and maxSPV of the caloric response.The effect size for both variables was small with an odds ratio of .9for maxSPV and 1.06for age.

Conclusions :The current investigation showed that both age and maxSPV of the caloric response were signi?cant predictors of vertigo perception during the caloric exam.However,the association between age and caloric perception is not conclusive.Although there is evidence to suggest that these ?ndings represent age-related changes in the central processing of vestibular system stimulation,there are additional un-measured factors that in?uence the perception of caloric-induced vertigo.

Copyright ?2017,PLA General Hospital Department of Otolaryngology Head and Neck Surgery.Production and hosting by Elsevier (Singapore)Pte Ltd.This is an open access article under the CC BY-NC-ND license (https://www.wendangku.net/doc/0312234173.html,/licenses/by-nc-nd/4.0/).

keywords:Vestibular;Vertigo;Central processing;Caloric test;Aging

1.Introduction

Clinicians who evaluate vestibular function may be pre-sented with a patient that perceives the cutaneous aspects of the caloric stimulus (i.e.the hot or cold water rushing in their ear),but reports having no sensation of motion or vertigo during the caloric exam.They may comment that they feel

“nothing ”or a mild sensation of “?oating ”.These cases are most perplexing in patients whose peripheral vestibular system generates a robust response measured through the vestibulo-ocular re?ex (VOR).Anecdotal evidence suggests that these patients usually are elderly.The underlying mechanism and clinical signi?cance of the absent post-caloric self-motion perception in the presence of a clinically normal peripheral vestibular response is unknown.However,there is evidence to suggest this phenomenon may implicate the central vestibular system pathways and may produce postural instability.

Takeda et al.,1995,?rst reported this phenomenon in pa-tients with known lesions involving the parieto-temporal lobe (i.e.analogous to the “vestibular cortex ”in nonhuman mam-mals).The investigators described the patients as experiencing

Abbreviations:SPV ,slow phase velocity;VNG,videonystagmography.*Corresponding author.James Madison University,235Martin Luther King Jr.Way,MSC 4304,Harrisonburg,V A 22807,USA.

E-mail address:pikereg@https://www.wendangku.net/doc/0312234173.html, (E.G.Piker).

Peer review under responsibility of PLA General Hospital Department of Otolaryngology Head and Neck

Surgery.

Available online at https://www.wendangku.net/doc/0312234173.html,

ScienceDirect

Journal of Otology 13(2018)5e

9

https://www.wendangku.net/doc/0312234173.html,/journal-of-otology/

https://https://www.wendangku.net/doc/0312234173.html,/10.1016/j.joto.2017.10.005

1672-2930/Copyright ?2017,PLA General Hospital Department of Otolaryngology Head and Neck Surgery.Production and hosting by Elsevier (Singapore)Pte Ltd.This is an open access article under the CC BY-NC-ND license (https://www.wendangku.net/doc/0312234173.html,/licenses/by-nc-nd/4.0/).