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Author: search.filters.author.Jafarov, Sabuhisearch.filters.applied.f.rights: search.filters.rights.info:eu-repo/semantics/openAccess

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    Clinical Interpretation of Positional Nystagmus Provoked by both Dix-Hallpike and Supine Head-Roll Tests
    (2022) Hizal, Evren; Jafarov, Sabuhi; Erbek, Seyra H.; Ozluoglu, Levent N.; 35894530
    BACKGROUND: Both the Dix-Hallpike test and the supine head-roll test can provoke positional nystagmus in a group of benign paroxysmal positional vertigo patients, including but not limited to those with multiple canal involvement. This study aimed to determine the incidence and interpret the clinical significance of positional nystagmus provoked by both the Dix-Hallpike and the supine head-roll tests. METHODS: The results of video-nystagmography sessions recorded in the computer database that included both the Dix-Hallpike and the supine head-roll tests were examined. RESULTS: The records belonging to 2880 video-nystagmography sessions of 2387 patients were examined. Nystagmus was detected in both the Dix-Hallpike and the supine head-roll tests of 131 (5.5%) patients. The video images belonging to 142 session records of 122 patients were accessed and further analyzed. The diagnosis was posterior canal BPPV in 9.0%, and lateral canal BPPV in 62.3%. More than one canal was involved in 3.3%, one rehabilitation maneuver was performed in 75.0%, and recurrence was observed in 7.4% of those patients. CONCLUSION: In both geotropic and apogeotropic variants of lateral canal BPPV, nystagmus can be observed during the Dix-Hallpike test in addition to the supine head-roll test. In patients with posterior canal benign paroxysmal positional vertigo, nystagmus can also be observed in the head-roll test. To reach a correct and comprehensive diagnosis and apply appropriate treatment in benign paroxysmal positional vertigo, the Dix-Hallpike test and the head-roll test should be completely performed on both sides, and the results of those tests must be interpreted concomitantly.
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    The Effect of Postmenopausal Osteoporosis on Middle Ear Resonance Frequency
    (2021) Baytaroglu, Berk; Jafarov, Sabuhi; Erbek, Selim Sermed; 35177390
    BACKGROUND: The effect of postmenopausal osteoporosis on the middle ear mechano-acoustic system is unknown. The aim of this study is to investigate whether or not middle ear resonance frequency is affected in females with postmenopausal osteoporosis. METHODS: The study included postmenopausal women aged 45-60 years, separated into 2 groups as females with postmenopausal osteoporosis and healthy postmenopausal females (control group). A detailed anamnesis was taken from all subjects and then the ear, nose, and throat examinations were done followed by pure tone audiometry, tympanometry, and multifrequency tympanometry tests. The groups were compared in respect of pure tone average, bone conduction threshold, RF, static admittance, and tympanometric peak pressure values. RESULTS: The mean age of the patients was 59.2 +/- 4.53 years (range, 48-65 years) in the postmenopausal osteoporosis group and 57.11 +/- 4.27 years (range, 48-65 years) in the control group (P>.05). The mean resonance frequency values for the postmenopausal osteoporosis and control group were 954.41 +/- 127.47 and 935.29 +/- 126.39 Hz (P>.05). The mean static admittance values for the postmenopausal osteoporosis and control group were 0.82 +/- 0.33 and 0.85 +/- 0.3 mmho, and mean tympanometric peak pressure values were -7.35 +/- 18.52 and -6.94 +/- 19.52 daPa (P>.05 for both static admittance and tympanometric peak pressure). The mean pure tone averagevalues for the postmenopausal osteoporosis and control group were 20.96 +/- 6.82 and 15.60 +/- 7.81 dB, and mean bone conduction threshold values were 17.57 +/- 6.03 and 12.10 +/- 6.52 dB (P<.05 for both pure tone average and bone conduction threshold). CONCLUSIONS: The results showed that the middle ear resonance frequency values were not affected in postmenopausal osteoporosis patients, but there was seen to be greater sensorineural hearing loss in females with postmenopausal osteoporosis compared to healthy postmenopausal females.
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    Perifik vestibüler sistem hastalıklarının değerlendirilmesinde video baş itme testi (vHIT) ile kalorik test, spontan nistagmus, post-head shakıng nıstagmus ve servikal vemp sonuçlarının karşılaştırılması
    (Başkent Üniversitesi Tıp Fakültesi, 2017) Jafarov, Sabuhi; Özlüoğlu, Levet N.
    Video Baş İtme Testi (Video Head Impulse Test, vHIT), kolay ve kısa sürede uygulanabilmesi ve semisirküler kanalların tamamı hakkında bilgi verebilmesi nedeniyle vestibüler sistem hastalıklarının değerlendirilmesinde sık kullanılmaktadır. Ancak vHIT’in sensitivite, spesifitesi ve vestibüler sistemin değerlendirilmesinde kullanılan diğer testlerle korelasyonu ile ilgili literatürde sınırlı sayıda çalışma bulunmaktadır. vHIT’in kalorik testin bir alternatifi olup olmadığı konusu da netlik kazanmış değildir. Bu çalışmanın amacı vHIT’in sensitivite ve spesifitesini araştırmak; vHIT’in kalorik test, spontan nistagmus, post-head shaking nistagmus, servikal vestibüler uyarılmış myojenik potansiyeller (VEMP) gibi testlerle korelasyonunu belirlemektir. Bu araştırma, prospektif, kör bir klinik çalışma olarak tasarlandı. Çalışmaya, 2015-2016 yılları arasında Başkent Üniversitesi Kulak Burun Boğaz ve Baş-Boyun Cerrahisi Ana Bilim Dalı Nörootoloji kliniğine başvuran; vHIT, saf ses odyometrisi, servikal VEMP, spontan nistagmus, post-head shaking nistagmus ve kalorik testlerin tamamının uygulandığı; Benign Paroksismal Pozisyonel Vertigo (BPPV), Meniere hastalığı, vestibüler migren, vestibüler nörit, vestibüler schwannom, kronik vestibülopati tanıları konulan 88 hasta alındı. Tüm odyo-vestibüler testler iki deneyimli odyometrist tarafından uygulandı. Testlerin değerlendirilmesi ise iki deneyimli nörootoloji uzmanı tarafından hastalara kör olarak yapıldı. Testlerden elde edilen veriler incelenerek vHIT’in sensitivitesi, spesifitesi, pozitif prediktif değeri, negatif prediktif değeri ve testlerin temel gücü hesaplandı. Çalışmaya dahil edilen 88 hastanın 31’i Meniere hastalığı, 25’i vestibüler nörit, 11’i vestibüler migren, 11’i kronik vestibülopati, 8’i BPPV ve 2’si vestibüler schwannom tanısı aldı. Hastalık ayırımı yapılmaksızın lateral vHIT’in sensitivitesi %74.6, spesifitesi %53.65 olarak hesaplandı. Lateral vHIT’in sensitivitesi ve spesifitesi Meniere hastalığı için sırasıyla %87.5 ve %42.85; vestibüler nörit için ise sırasıyla %60 ve %53.3 olarak bulundu. Patolojik vHIT, hastaların %81.8’inde (72/88), kanal parezisi %54.5’inde, patolojik servikal VEMP %60.2’sinde, spontan nistagmus %23.9’unda, post-head shaking nistagmus ise %72.7’sinde saptandı. Etkilenen kulak kalorik test sonuçları ile etkilenen kulak lateral vHIT sonuçları karşılaştırıldığında; kalorik testte kanal parezisi olanların %74.5’inde, kanal parezisi olmayanların ise %46.3’ünde patolojik lateral vHIT testi mevcuttu (p<0.05). Etkilenen kulak kalorik test sonuçları ile etkilenen kulak posterior vHIT sonuçları karşılaştırıldığında; kalorik testte kanal parezisi olanların %44.7’sinde, kanal parezisi olmayanların ise %65.9’unda patolojik posterior vHIT mevcuttu (p<0.05). Etkilenen kulak spontan nistagmus test sonuçları ile etkilenen kulak lateral vHIT sonuçları karşılaştırıldığında; spontan nistagmusu olanların %42.9’unda, olmayanların ise %67.2’sinde etkilenen kulakta patolojik lateral vHIT testi mevcuttu (p<0,05). vHIT ile kalorik test, spontan nistagmus, post-head shaking ve servikal VEMP testleri arasında istatistiksel açıdan anlamlı korelasyon tespit edilmedi (p>0.05). Çalışmada elde edilen sonuçlar, vHIT’in tektaraflı vestibüler zayıflığı yüksek oranda tespit ettiğini gösterdi. Bu nedenle, patolojik lateral vHIT tespit edildiği ve bu bulguların diğer odyo-vestibüler testlerle de uyumlu olduğu durumlarda kalorik test yapılmayabilir. Ancak vHIT’in normal olduğu veya diğer odyo-vestibüler testler ve öykü ile uyumlu olmadığı durumlarda kalorik test yapılmalıdır. Video head impulse test (vHIT) is commonly used for the evaluation of vestibular system disorders because it can be performed easily in a short period of time and gives information about all of the semicircular channels. However, studies regarding the sensitivity, specifity and correlation of vHIT with the other tests that are used for assessment of vestibular system are limited in the literature. It is not clear whether vHIT is an alternative to the caloric test or not. The aim of this study is to investigate the sensitivity and specifity of vHIT and to find out the correlation between vHIT and other vestibular tests such as caloric test, spontan nystagmus, post-head shaking nystagmus and cervical vestibular evoked myogenic potentials (VEMP). This study was designed as a prospective, blinded study. The patients who applied to the Neurotology Clinic of the Baskent University Otolaryngology Department between the years of 2015-2016 constituted for the study population. Patients in whom vHIT, pure tone audiometry, cervical VEMP, spontaneous nystagmus, post-head shaking test and caloric test were performed and that were diagnosed as BPPV, Meniere’s disease, vestibular neuritis, vestibular migraine, vestibular schwannoma and chronic vestibulopathy were enrolled. The audiovestibular tests were performed by two experienced audiometrists and were evaluated by two experienced neurootologists who were blinded to the nature of patients. The data has been examined and sensitivity, specificity, positive predictive value, negative predictive value and power of the vHIT were calculated. A total of 88 patients were enrolled to the study. Thirty-one patients were diagnosed as Meniere’s disease, 25 patients were diagnosed as vestibular neuritis, 11 patients were diagnosed as vestibular migrain, 11 patients were diagnosed as chronic vestibulopathy, 8 patients were diagnosed as BPPV and 2 patients were diagnosed as vestibular schwannoma. Overall sensitivity and specifity of lateral vHIT for vestibular disease, i.e. when specific diagnosis was not considered, was 74.6% and 53.65%, respectively. The diagnosis specific sensitivity and specifity was 87.5%, and 42.85% for Meniere’s disease and 60% and 53.3% for vestibular neuritis. 81.8% of the patients (72/88) had pathological vHIT while 54.5% had canal paresia, 60.2% had pathological cVEMP, 23.9% had spontaneous nystagmus and 72.7% had post-head shaking nystagmus. Pathological lateral vHIT was deteremined in 74.5% of patients who had canal paresis in caloric test and pathological lateral vHIT was determined in 46.3% of patients who had normal caloric test results (p<0.05). Pathological posterior vHIT was determined in 44.7% of patients who had canal paresis in caloric test and pathological posterior vHIT was determined in 65.9% of patients who had normal caloric test results (p<0.05). Pathological lateral vHIT was determined in 42.9% of patients who had spontaneous nystagmus and pathological lateral vHIT was determined in 67.2% of patients who had not spontaneous nystagmus (p<0.05). There was no statistically significant correlation between vHIT and the caloric test, post-head shaking test, spontan nystagmus and cervical VEMP. Our results show that vHIT determines unilateral vestibular hypofunction with high.accuracy. Therefore, if vHIT results are patological and compatible with the results of other audiovestibular tests, caloric test may not be performed. If vHIT results are normal or pathological results are not compatible with the results of other audiovestibular tests, caloric test should be performed.