A sound- and pressure-induced vestibuloocular reflex (VOR) has been described as vertical and torsional in superior canal dehiscence (SCD), and the rotational axes of induced VOR have been assumed to fit with the axis of the affected superior semicircular canal (SC). However, it has been difficult to characterize the pattern of vibration-induced VOR (ViVOR). We aimed to characterize the pattern of ViVOR by comparing the intensity and the axis of ViVOR with several clinical parameters of SCD. Ten symptomatic SCD patients were recruited. SCD size and location were measured on a reformatted image in the plane of the SC. Unilateral vibratory stimulation (100 Hz) was applied to the mastoid surface. ViVOR were recorded using 3D videooculography. The median 3D velocity of ViVOR was measured and the 3D vector trajectory plotted for reference against the axes of the human semicircular canals. A correlation between the magnitude of ViVOR and the size of SCD was evaluated. We also compared the location of SCD with the vertical-to-torsional component ratio of the ViVOR. ViVOR were present in 7 patients; 6 patients showed a substantial horizontal component in the excitatory direction in addition to strong torsional and weak vertical components. The computed rotational axes of ViVOR were located mostly between the axes of the ipsilateral SC and horizontal canal (HC) with a variable deviation to the axis of the ipsilateral posterior canal (PC). The magnitude of ViVOR was not related to the size of the SCD. The vertical-to-torsional component ratio of ViVOR tended to decline as the dehiscence was closer to the common crus. In SCD, mastoid vibration may stimulate the affected-side HC and PC as well as the SC. SCD can be suspected when excitatory horizontal torsional ViVOR direct to the side of the auditory symptoms.

1.
Aw ST, Aw GE, Todd MJ, Bradshaw AP, Halmagyi GM: Three-dimensional vibration-induced vestibulo-ocular reflex identifies vertical semicircular canal dehiscence. J Assoc Res Otolaryngol 2011;12:549-558.
2.
Aw ST, Todd MJ, Aw GE, Magnussen JS, Curthoys IS, Halmagyi GM: Click-evoked vestibulo-ocular reflex: stimulus-response properties in superior canal dehiscence. Neurology 2006;66:1079-1087.
3.
Aw ST, Todd MJ, Aw GE, McGarvie LA, Halmagyi GM: Benign positional nystagmus: a study of its three-dimensional spatio-temporal characteristics. Neurology 2005;64:1897-1905.
4.
Baloh RW, Honrubia V, Konrad HR: Ewald's second law re-evaluated. Acta Otolaryngol 1977;83:475-479.
5.
Brantberg K, Bagger-Sjöbäck D, Mathiesen T, Witt H, Pansell T: Posterior canal dehiscence syndrome caused by an apex cholesteatoma. Otol Neurotol 2006;27:531-534.
6.
Brantberg K, Bergenius J, Tribukait A: Vestibular-evoked myogenic potentials in patients with dehiscence of the superior semicircular canal. Acta Otolaryngol 1999;119:633-640.
7.
Choi KD, Oh SY, Kim HJ, Kim JS: The vestibulo-ocular reflexes during head impulse in Wernicke's encephalopathy. J Neurol Neurosurg Psychiatry 2007;78:1161-1162.
8.
Choi KD, Oh SY, Park SH, Kim JH, Koo JW, Kim JS: Head-shaking nystagmus in lateral medullary infarction: patterns and possible mechanisms. Neurology 2007;68:1337-1344.
9.
della Santina CC, Potyagaylo V, Migliaccio AA, Minor LB, Carey JP: Orientation of human semicircular canals measured by three-dimensional multiplanar CT reconstruction. J Assoc Res Otolaryngol 2005;6:191-206.
10.
Dumas G, Lavieille JP, Schmerber S: Vibratory test and head shaking test and caloric test: a series of 87 patients (in French). Ann Otolaryngol Chir Cervicofac 2004;121:22-32.
11.
Halmagyi GM, Curthoys IS: A clinical sign of canal paresis. Arch Neurol 1998;45:737-739.
12.
Halmagyi GM, Curthoys IS, Colebatch JG, Aw ST: Vestibular responses to sound. Ann NY Acad Sci 2005;1039:54-67.
13.
Hamann KF, Schuster EM: Vibration-induced nystagmus: a sign of unilateral vestibular deficit. ORL J Otorhinolaryngol Relat Spec 1999;61:74-79.
14.
Hong SK, Koo JW, Kim JS, Park MH: Implication of vibration induced nystagmus in Ménière's disease. Acta Otolaryngol Suppl 2007;128-131.
15.
Karlberg M, Aw ST, Black RA, Todd MJ, MacDougall HG, Halmagyi GM: Vibration-induced ocular torsion and nystagmus after unilateral vestibular deafferentation. Brain 2003;126:956-964.
16.
Kim JS, Kim HJ: Inferior vestibular neuritis. J Neurol 2012;259:1553-1560.
17.
Koo JW, Hong SK, Kim DK, Kim JS: Superior semicircular canal dehiscence syndrome by the superior petrosal sinus. J Neurol Neurosurg Psychiatry 2010;81:465-467.
18.
Koo JW, Kim JS, Hong SK: Vibration-induced nystagmus after acute peripheral vestibular loss: comparative study with other vestibule-ocular reflex tests in the yaw plane. Otol Neurotol 2011;32:466-471.
19.
Lackner JR, Graybiel A: Elicitation of vestibular side effects by regional vibration of the head. Aerosp Med 1974;45:1267-1272.
20.
Lee H, Kim HJ, Koo JW, Kim JS: Superior divisional vestibular paresis in anterior inferior cerebellar artery infarction. J Neurol Sci 2009;285:250-253.
21.
Manzari L, Modugno GC, Brandolini C, Pirodda A: Bone vibration-induced nystagmus is useful in diagnosing superior semicircular canal dehiscence. Audiol Neurotol 2008;13:379-387.
22.
Michel J, Dumas G, Lavieille JP, Charachon R: Diagnostic value of vibration-induced nystagmus obtained by combined vibratory stimulation applied to the neck muscles and skull of 300 vertiginous patients. Rev Laryngol Otol Rhinol (Bord) 2001;122:89-94.
23.
Minor LB: Clinical manifestations of superior semicircular canal dehiscence. Laryngoscope 2005;115:1717-1727.
24.
Minor LB, Solomon D, Zinreich JS, Zee DS: Sound- and/or pressure-induced vertigo due to bone dehiscence of the superior semicircular canal. Arch Otolaryngol Head Neck Surg 1998;124:249-258.
25.
Ohki M, Murofushi T, Nakahara H, Sugasawa K: Vibration-induced nystagmus in patients with vestibular disorders. Otolaryngol Head Neck Surg 2003;129:255-258.
26.
Park H, Shin J, Shim D: Mechanisms of vibration-induced nystagmus in normal subjects and patients with vestibular neuritis. Audiol Neurotol 2007;12:189-197.
27.
Pfammatter A, Darrouzet V, Gärtner M, Somers T, van Dinther J, Trabalzini F, Ayache D, Linder T: A superior semicircular canal dehiscence syndrome multicenter study: is there an association between size and symptoms? Otol Neurotol 2010;31:447-454.
28.
Robinson DA: A method of measuring eye movement using a scleral search coil in a magnetic field. IEEE Trans Biomed Eng 1963;10:137-145.
29.
White JA, Hughes GB, Ruggieri PN: Vibration-induced nystagmus as an office procedure for the diagnosis of superior semicircular canal dehiscence. Otol Neurotol 2007;28:911-916.
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