What does the head impulse test versus caloric dissociation reveal about vestibular dysfunction in Ménière's disease?

Abstract:

:In patients with Ménière's disease (MD), caloric testing can show, depending on the stage and activity of the disease, a variety of results. Between attacks, many, or perhaps even most, patients with unilateral early or mild MD have normal caloric tests; late MD can show abnormalities ranging from mild to severe unilateral canal paresis with or without directional preponderance. The explanation of canal paresis in MD is not clear. The most obvious explanation, severe loss of lateral canal hair cells, is not likely to be correct because hair cell loss will not explain the fluctuating canal paresis to caloric stimulation. In contrast, the published evidence is that rotational testing of semicircular canal function in MD patients typically shows little reduction in function and even enhancement of vestibulo-ocular reflex gain, at least in the early stages of the disease. Here, we offer a novel explanation for this dissociation. We propose that hydropic expansion of the lateral canal membranous labyrinth permits convective recirculation within the duct that allows dissipation of the hydrostatic force that would normally cause cupular displacement and nystagmus in the caloric test.

journal_name

Ann N Y Acad Sci

authors

McGarvie LA,Curthoys IS,MacDougall HG,Halmagyi GM

doi

10.1111/nyas.12687

subject

Has Abstract

pub_date

2015-04-01 00:00:00

pages

58-62

eissn

0077-8923

issn

1749-6632

journal_volume

1343

pub_type

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