Vestibulo-cochlear function in inflammatory neuropathies

Publication date: Available online 20 December 2017
Source:Clinical Neurophysiology
Author(s): Marisa Blanquet, Jens A. Petersen, Antonella Palla, Dorothe Veraguth, Konrad P. Weber, Dominik Straumann, Alexander A. Tarnutzer, Hans H. Jung
ObjectiveWe aimed to quantify peripheral-vestibular deficits that may contribute to imbalanced stance/gait in patients with inflammatory neuropathies.MethodsTwenty-one patients (58±15y [mean age±1SD]; chronic-inflammatory-demyelinating-polyneuropathy=10, Guillain-Barré Syndrome=5, Anti-MAG peripheral neuropathy=2, multifocal-motor-neuropathy=4) were compared with 26 healthy controls. All subjects received video-head-impulse testing (vHIT), caloric irrigation and cervical/ocular vestibular-evoked myogenic-potentials (VEMPs). The Yardley vertigo-symptom-scale (VSS) was used to assess vertigo/dizziness. Postural stability was assessed using the functional gait-assessment (FGA). Pure-tone audiograms (n=18), otoacoustic emissions (n=12) and auditory brainstem responses were obtained (n=12).ResultsSemicircular-canal hypofunction was noted in 9/21 (43%) patients (vHIT=6; caloric irrigation=5), whereas otolith function was impaired in 12/21 (57%) (oVEMPs=8; cVEMPs=5), resulting in vestibular impairment of at least one sensor in 13/21 (62%). On average, 2.4±1.1 vestibular end organs (each side: anterior/posterior/horizontal canal, utriculus, sacculus; total=10) were affected. The VSS-scores were higher in patients (16.8±8.6 vs. 9.5±6.2, p=0.002) but did not correlate with the number of affected organs. Auditory neuropathy was found in 1/12 (8%) patients.ConclusionImpairment of one or more vestibular end organs was frequent, but usually mild, possibly contributing to imbalance of stance/gait in inflammatory neuropathies.SignificanceWhile our data does not support routine vestibular testing in inflammatory neuropathies, this may be considered in selected cases.



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