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Direction-changing spontaneous nystagmus in patients with dizziness

  • Otology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

The present study aimed to investigate the clinical features of patients with direction-changing spontaneous nystagmus (DCSN) and gain insight into its underlying mechanisms.

Methods

Medical records and vestibular function test results collected in our dizziness clinic between February 2013 and February 2020 were retrospectively reviewed. Spontaneous nystagmus was recorded while sitting upright using videonystagmography for 2 min to confirm the spontaneous changes in nystagmus direction. Causative disease diagnoses were based on the patients’ clinical history, audiometry results, vestibular function tests, and imaging studies.

Results

Of 4786 patients, DCSN was observed in 41 (0.86%). Causative disease diagnoses included vestibular neuritis (n = 9), lateral semicircular canal cupulopathy (n = 9), cerebellopontine angle tumor (n = 8), vestibular paroxysmia (n = 2), vestibular migraine (n = 2), vestibular nucleus infarction (n = 1), sudden sensorineural hearing loss with vertigo (n = 2), Meniere’s disease (n = 2), Ramsay Hunt syndrome (n = 1), labyrinthine fistula due to middle ear cholesteatoma (n = 1), lateral semicircular canal dysplasia (n = 1), post tympanomastoidectomy dizziness (n = 1), and head trauma (n = 2).

Conclusions

Although the periodicity of DCSN could not be determined because of insufficiently long observation times, it was observed in various central and peripheral vestibulopathies. Careful examination of spontaneous nystagmus over a sufficient period may ensure the detection of DCSN when evaluating dizziness.

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Availability of data and materials

The datasets analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Leigh J, Zee D (2015) The neurology of eye movements. Oxford University Press, New York

    Book  Google Scholar 

  2. Moon IS, Kim JS, Choi KD et al (2009) Isolated nodular infarction. Stroke 40:487–491

    Article  PubMed  Google Scholar 

  3. Oh YM, Choi KD, Oh SY et al (2006) Periodic alternating nystagmus with circumscribed nodular lesion. Neurology 67:399

    Article  PubMed  Google Scholar 

  4. Jeong HS, Oh JY, Kim JS et al (2007) Periodic alternating nystagmus in isolated nodular infarction. Neurology 68:956–957

    Article  PubMed  Google Scholar 

  5. Kim SH, Chung WK, Kim BG et al (2014) Periodic alternating nystagmus of peripheral vestibular origin. Laryngoscope 124:980–983

    Article  PubMed  Google Scholar 

  6. Murofushi T, Chihara Y, Ushio M et al (2008) Periodic alternating nystagmus in Meniere’s disease: the peripheral type? Acta Otolaryngol 128:824–827

    Article  PubMed  Google Scholar 

  7. Kim CH, Yang YS, Im D et al (2016) Nystagmus in patients with unilateral acute otitis media complicated by serous labyrinthitis. Acta Otolaryngol 136:559–563

    Article  PubMed  Google Scholar 

  8. Kim CH, Choi KD (2021) Periodic tinnitus and direction-changing nystagmus in vestibular paroxysmia. J Clin Neurol 17:493–495

    Article  PubMed  PubMed Central  Google Scholar 

  9. Choi SY, Choi JH, Choi KD (2018) The nystagmus of vestibular paroxysmia. J Neurol 265:1711–1713

    Article  PubMed  Google Scholar 

  10. Kim SH, Kim JS (2019) Aperiodic alternating nystagmus in lateral medullary strokes. Can J Neurol Sci Le journal canadien des sciences neurologiques 46:486–488

    Article  Google Scholar 

  11. Kim CH, Choi KD (2019) Aperiodic alternating nystagmus in isolated vestibular nucleus infarction. J Neurol 266:2875–2877

    Article  PubMed  Google Scholar 

  12. Jeong H, Lee DH, Shin JE et al (2022) Direction-changing spontaneous nystagmus in cerebellopontine angle tumour. J Clin Neurosci 95:118–122

    Article  PubMed  Google Scholar 

  13. Basura GJ, Adams ME, Monfared A et al (2020) Clinical practice guideline: Ménière’s disease. Otolaryngol Head Neck Surg 162:S1-s55

    PubMed  Google Scholar 

  14. Lopez-Escamez JA, Carey J, Chung WH et al (2015) Diagnostic criteria for Menière’s disease. J Vestib Res 25:1–7

    Article  PubMed  Google Scholar 

  15. Strupp M, Mandalà M, López-Escámez JA (2019) Peripheral vestibular disorders: an update. Curr Opin Neurol 32:165–173

    Article  PubMed  Google Scholar 

  16. Bhattacharyya N, Gubbels SP, Schwartz SR et al (2017) Clinical practice guideline: benign paroxysmal positional vertigo (Update). Otolaryngol Head Neck Surg 156:S1-s47

    PubMed  Google Scholar 

  17. Kim CH, Kim MB, Ban JH (2014) Persistent geotropic direction-changing positional nystagmus with a null plane: the light cupula. Laryngoscope 124:E15–E19

    Article  PubMed  Google Scholar 

  18. Erickson NJ, Schmalz PGR, Agee BS et al (2019) Koos classification of vestibular schwannomas: a reliability study. Neurosurgery 85:409–414

    Article  PubMed  Google Scholar 

  19. Neves Cavada M, Fook-Ho Lee M, Jufas NE et al (2021) Intracanalicular vestibular schwannoma: a systematic review and meta-analysis of therapeutics outcomes. Otol Neurotol 42:351–362

    Article  PubMed  Google Scholar 

  20. Strupp M, Lopez-Escamez JA, Kim JS et al (2016) Vestibular paroxysmia: diagnostic criteria. J Vestib Res 26:409–415

    Article  PubMed  Google Scholar 

  21. Lempert T (2012) Vestibular migraine: diagnostic criteria. J Vestib Res 22:167–172

    Article  PubMed  Google Scholar 

  22. Chandrasekhar SS, Tsai Do BS, Schwartz SR et al (2019) Clinical practice guideline: sudden hearing loss (Update). Otolaryngol Head Neck Surg 161:S1-s45

    PubMed  Google Scholar 

  23. Kuhweide R, Van de Steene V, Vlaminck S et al (2002) Ramsay Hunt syndrome: pathophysiology of cochleovestibular symptoms. J Laryngol Otol 116:844–848

    Article  CAS  PubMed  Google Scholar 

  24. Minor LB (2003) Labyrinthine fistulae: pathobiology and management. Curr Opin Otolaryngol Head Neck Surg 11:340–346

    Article  PubMed  Google Scholar 

  25. Sennaroglu L, Saatci I (2002) A new classification for cochleovestibular malformations. Laryngoscope 112:2230–2241

    Article  PubMed  Google Scholar 

  26. Waespe W, Cohen B, Raphan T (1985) Dynamic modification of the vestibulo-ocular reflex by the nodulus and uvula. Science 228:199–202

    Article  CAS  PubMed  Google Scholar 

  27. Oosterveld WJ, Rademakers WJ (1979) Nystagmus alternans. Acta Otolaryngol 87:404–409

    Article  CAS  PubMed  Google Scholar 

  28. Borries GV (1920) Periodisch alternierender nystagmus bei labyrinthfistel. Int Zbl Laryng 36:308–310

    Google Scholar 

  29. Choi B, Lee DH, Shin JE et al (2020) Nystagmus in patients with lateral semicircular canal dysplasia. Acta Otolaryngol 140:971–976

    Article  PubMed  Google Scholar 

  30. Choi JW, Kim CH (2021) Vestibular paroxysmia caused by contralateral tortuous vertebral artery: a case report. Medicine 100:e27815

    Article  PubMed  PubMed Central  Google Scholar 

  31. Eggers SDZ, Bisdorff A, von Brevern M et al (2019) Classification of vestibular signs and examination techniques: Nystagmus and nystagmus-like movements. J Vestib Res 29:57–87

    Article  PubMed  PubMed Central  Google Scholar 

  32. Lee MY, Son HR, Rah YC et al (2019) Recovery phase spontaneous nystagmus, its existence and clinical implication. J Audiol Otol 23:33–38

    Article  CAS  PubMed  Google Scholar 

  33. Lange G (1965) Erholungs-Nystagmus nach einseitigen Labyrinthschaden und seine. Begleitsympome Beobachtung seiner Entstehung und seines Verlaufes. Arch Ohren Nasen Kehlkopfheilkunde 184:521–535

    Article  Google Scholar 

  34. Schuknecht HF (1993) Pathology of the ear. Lea & Febiger, Malvern

    Google Scholar 

  35. Hiruma K, Numata T (2004) Positional nystagmus showing neutral points. ORL J Otorhinolaryngol Relat Spec 66:46–50

    Article  PubMed  Google Scholar 

  36. Tang X, Huang Q, Chen L et al (2019) Clinical findings in patients with persistent positional nystagmus: the designation of “Heavy and Light Cupula.” Front Neurol 10:326

    Article  PubMed  PubMed Central  Google Scholar 

  37. Ichijo H (2016) Neutral position of persistent direction-changing positional nystagmus. Eur Arch Otorhinolaryngol 273:311–316

    Article  PubMed  Google Scholar 

  38. Imai T, Matsuda K, Takeda N et al (2015) Light cupula: the pathophysiological basis of persistent geotropic positional nystagmus. BMJ Open 5:e006607

    Article  PubMed  PubMed Central  Google Scholar 

  39. Shigeno K, Ogita H, Funabiki K (2022) Variants of benign paroxysmal positional vertigo in relation to head position during sleep. J Vestib Res 32:39–47

    Article  PubMed  Google Scholar 

  40. Kim MB, Hong SM, Choi H et al (2018) The light cupula: an emerging new concept for positional vertigo. J Audiol Otol 22:1–5

    Article  PubMed  Google Scholar 

  41. Shin JE, Jeong KH, Ahn SH et al (2015) Conversion between geotropic and apogeotropic persistent direction-changing positional nystagmus. Acta Otolaryngol 135:1238–1244

    Article  PubMed  Google Scholar 

  42. Im DH, Yang YS, Choi H et al (2017) Pseudo-spontaneous nystagmus in horizontal semicircular canal canalolithiasis. Medicine 96:e7849

    Article  PubMed  PubMed Central  Google Scholar 

  43. Kujala J, Aalto H, Hirvonen T (2010) Video-oculography findings and vestibular symptoms on the day of stapes surgery. Eur Arch Otorhinolaryngol 267:187–190

    Article  PubMed  Google Scholar 

  44. Young AS, Nham B, Bradshaw AP et al (2021) Clinical, oculographic, and vestibular test characteristics of vestibular migraine. Cephalalgia 41:1039–1052

    Article  PubMed  Google Scholar 

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Funding

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIP) (2021R1F1A1062019).

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Authors and Affiliations

  1. Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Chungju Hospital, Chungju, Republic of Korea

    Jiyeon Lee

  2. Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, 120-1 Neungdong-Ro, Gwangjin-gu, Seoul, 05030, Republic of Korea

    Joon Yong Park, Jung Eun Shin & Chang-Hee Kim

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  1. Jiyeon Lee
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  3. Jung Eun Shin
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Correspondence to Chang-Hee Kim.

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Supplementary Information

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Supplemental video 1. Representative video clip of DCSN in a patient with the left-side VN (No. 1 in table 2). Left-beating nystagmus in 0–6s, right-beating nystagmus in 7–48s, left-beating nystagmus in 55–71s, right-beating nystagmus in 82–120s

Supplemental video 2. Representative video clip of DCSN in a patient with labyrinthine fistula in the left lateral semicircular canal due to middle ear cholesteatoma. Left-beating nystagmus in 8–20s, right-beating nystagmus in 23–29s, left-beating nystagmus in 30–110s, right-beating nystagmus in 110–120s

Supplemental video 3. Representative video clip of DCSN in a patient with bilateral lateral semicircular canal dysplasia. Left-beating nystagmus is dominant, and weak right-beating nystagmus occurs in 110–115s

Supplemental video 4. Representative video clip of DCSN in a patient with the left-sided vestibular paroxysmia. Right-beating nystagmus in 0–9s, left-beating nystagmus in 10–40s, right-beating nystagmus in 41–140s, left-beating nystagmus in 141–173s

Supplemental video 5. Representative video clip of DCSN in a patient with acute infarct in the left vestibular nucleus. Left-beating nystagmus in 0–6s, right-beating nystagmus in 7–39s, left-beating nystagmus in 40–45s, right-beating nystagmus in 46–51s

Supplemental video 6. Spontaneous nystagmus at the initial evaluation in a patient with the left-sided VN whose DCSN is presented in supplemental video 1 (no. 1 in Table 2). Note that spontaneous nystagmus beats toward the healthy side

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Lee, J., Park, J.Y., Shin, J.E. et al. Direction-changing spontaneous nystagmus in patients with dizziness. Eur Arch Otorhinolaryngol 280, 2725–2733 (2023). https://doi.org/10.1007/s00405-022-07761-5

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  • DOI: https://doi.org/10.1007/s00405-022-07761-5

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