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  • Title: Functional significance of peripheral head-shaking nystagmus.
    Author: Pérez P, Llorente JL, Gómez JR, Del Campo A, López A, Suárez C.
    Journal: Laryngoscope; 2004 Jun; 114(6):1078-84. PubMed ID: 15179217.
    Abstract:
    OBJECTIVES/HYPOTHESIS: The objective was to determine the characteristics of horizontal head-shaking nystagmus of peripheral origin and its relationship to vestibular dysfunction. STUDY DESIGN: Retrospective case series. METHODS: Eighty-three patients met the inclusion criteria of having peripheral and unilateral vestibular disease. Patients were tested with video nystagmography. Head-shaking nystagmus was performed in the horizontal plane during 30 cycles at a frequency of approximately 3 Hz. Head-shaking nystagmus was classified as monophasic or biphasic and, based on the pathological ear, as ipsilateral or contralateral related to nystagmus fast phases. The two-tailed t test, ANOVA, Mann-Whitney and chi2 tests, and lineal and polynomial regression tests were used for statistical analysis. RESULTS: Twenty-three patients showed a positive head-shaking nystagmus. All cases of head-shaking nystagmus observed were horizontal. There were four biphasic and 19 monophasic cases of head-shaking nystagmus. First phases of biphasic head-shaking nystagmus beat toward the normal ear. Eleven of the monophasic cases of head-shaking nystagmus were ipsilateral, and nine were contralateral. There was a statistically significant correlation between caloric weakness and head-shaking nystagmus. Ipsilateral head-shaking nystagmus corresponded to lower caloric asymmetries, and contralateral and biphasic head-shaking nystagmus corresponded to greater caloric weakness (P <.001). As the caloric asymmetry increased, the maximal slow-phase eye velocity of head-shaking nystagmus was greater (P =.01) and its duration shortened (P =.008). Ipsilateral responses could be distinguished from contralateral responses based on their latency (P =.03), maximal slow-phase eye velocity (P <.05), and duration (P =.02). The frequency of head-shaking nystagmus was significantly higher among older patients. There was no correlation between head-shaking nystagmus and clinical patterns. CONCLUSION: Head-shaking nystagmus of peripheral vestibular origin is a response both qualitatively and quantitatively associated with the degree of the vestibular loss.
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