Specific features of bilateral otolith manifestations in patients with vestibular balance disorder
Authors: Grebenuk O. V. , Svetlik M. V. , Alifirova V. M. , Demkin V. P. , Akinina M. D. , Melnichuk S. V. , Rudenko T. V. , Smaglii L. V. , Demkin O. V. , Vishnevskaya Ya. B. , Trukhanov A. E. 
Published: October 2024

Bilateral asymmetry in the function of the semicircular canals underlies dizziness and vestibular balance disorders. According to the traditional view, otolith dysfunction does not have a significant effect on the clinical picture in individuals with peripheral vestibular disorders. In recent years, interest in studying the contribution of vestibular function to the control of posture and movements has increased. However, we have not identified any studies addressing the reactivity of otolith organs in vestibular balance disorders in the available literature.

Aim: To study bilateral otolith reactions in patients with vestibular balance disorders using the method of cervical vestibular evoked myogenic potentials (cVEMP) in patients with episodic and chronic vestibular disorders.

Material and Methods. A clinical examination was carried out in 63 patients complaining of dizziness and balance problems. They were hospitalized on an emergency and planned basis in the neurological departments of the clinics of the Siberian State Medical University and the Medical and Sanitary Unit No 2 in Tomsk. From the total group, 28 patients (8 men and 20 women aged from 22 to 84 years) were selected for assessment of vestibular function; the average age was 63.87 ± 11.52 years and 57.2 ± 18.5 years for men and women respectively. They had chronic and episodic vestibular dysfunction unrelated to acute or progressive neurological disease and inflammatory pathology of the inner ear.

Results. 27 patients (96.4%) complained of dizziness. Systemic dizziness, characterized by a feeling of objects rotating around the subject, was detected in 29.63% of patients; non-systemic dizziness, including a feeling of “failing” – in 81.48%. Both types of complaints appeared in 10.71% of those examined, which made it possible to identify 2 groups of patients: Group A – with chronic vestibular disorders (7 patients) and Group B – with episodic vestibular disorders (21 patients). During the study of the groups of patients, differences were found in the amplitudes of cVEMP latency P13 and the coefficient of vestibular asymmetry between Groups A and B, as well as the absence of a difference in amplitudes in Group A and the presence of a difference in Group B on the right.

Conclusion. Despite the fact that patients presented with predominantly one complaint of dizziness, clinical and instrumental tests of vestibular dysfunction showed the presence of damage to both the semicircular canals and otolithic organs; asymmetry of vestibular reflexes and/or bilateral damage to the vestibular organs. The results of the study allow us to consider the cVEMP method as one of the methods for objectively assessing the condition of the otolithic apparatus in patients with impaired vestibular function. In this regard, it is recommended to use this method in routine neurological practice.