Revisión sobre la prueba de hiperventilación y la de Valsalva
Resumen Introducción y objetivo: Con este trabajo pretendemos explicar las características y el campo de aplicación de dos exploraciones clínicas utilizadas en el paciente con sospecha de patología vestibular, la maniobra de hiperventilación y la de Valsalva. Metodología: Revisión narrativa. Resultados: A través de diferentes mecanismos neurofisiológicos, la hiperventilación puede inducir un nistagmo en casos de asimetría vestibular, tanto de causa periférica como central. Por su parte, la maniobra de Valsalva puede también desencadenar nistagmo y vértigo, consecuencia de la transmisión directa de la presión al oído interno en casos de fístula perilinfática, anomalías de la unión craneocervical (malformación de Arnold-Chiari) y otras alteraciones de los osículos, de la ventana oval y del sáculo. Discusión y conclusiones: Tanto el test de hiperventilación como el de la maniobra de Valsalva deberían incluirse en la batería diagnóstica de pacientes con patología vestibular para, en función de los resultados obtenidos, ubicar anatómicamente el sitio de la lesión y justificar el uso de técnicas de imagen.
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Bance ML, O'Driscoll M, Patel N, Ramsden RT. Vestibular disease unmasked by hyperventilation. Laryngoscope. 1998;108(4):610–4. https://doi.org/10.1097/00005537-199804000-00027 / PMid:9546279
Bradley JP, Hullar TE, Neely JG, Goebel JA. Hyperventilation-Induced Nystagmus and Vertigo After Stereotactic Radiotherapy for Vestibular Schwannoma. Otol Neurotol. 2011;32(8):1336–8. https://doi.org/10.1097/MAO.0b013e31822e8666 / PMid:21897322
Brantberg K, Greitz D, Pansell T. Subarcuate venous malformation causing audio-vestibular symptoms similar to those in superior canal dehiscence syndrome. Otol Neurotol. 2004;25(6):993–7. https://doi.org/10.1097/00129492-200411000-00022 / PMid:15547432
Califano L, Iorio G, Salafia F, Mazzone S, Califano M. Hyperventilation-Induced Nystagmus in Patients With Vestibular Schwannoma. Otol Neurotol. 2015 Feb;36(2):303–6. https://doi.org/10.1097/MAO.0000000000000699 / PMid:25569362
Califano L, Mazzone S, Salafia F. Utility of the hyperventilation test in the evaluation of the dizzy patient. Curr Opin Otolaryngol Head Neck Surg. 2013;21(5):487–91. https://doi.org/10.1097/MOO.0b013e328364a8bb / PMid:23892795
Califano L, Melillo MG, Vassallo A, Mazzone S. Hyperventilation-induced nystagmus in a large series of vestibular patients. Acta Otorhinolaryngol Ital. 2011;31(1):17–26. PMid:21808459 PMCid:PMC3146331
Carmona, Sergio; Asprella Libonati G. Una aproximación fisiopatológica a la evaluación clínica del paciente con vértigo. In: Neuro-otologia. 3a ed. Buenos Aires: Libreria Akadia editorial; 2013. p. 19–25.
Choi K-D, Cho HJ, Koo J-W, Park S-H, Kim JS. Hyperventilation-induced nystagmus in vestibular schwannoma. Neurology. 2005 Jun 28;64(12):2062. https://doi.org/10.1212/01.WNL.0000170969.19299.D7 / PMid:15985572
Choi KD, Kim JS, Kim HJ, Koo JW, Kim JH, Kim CY, et al. Hyperventilation-induced nystagmus in peripheral vestibulopathy and cerebellopontine angle tumor. Neurology. 2007;69(10):1050–9. https://doi.org/10.1212/01.wnl.0000271378.54381.6a / PMid:17785675
Esquivel, P; Zú-iga J. Síndrome de dehiscencia del canal semicircular superior. Rev Otorrinolaringol Cir Cabeza Cuello. 2005;65:233–40.
Finn S, Dietzek M, Karvouniari P, Klingner CM, Neumann R, Guntinas-Lichius O, et al. Bilateral vestibulopathy with positive Tullio phenomenon. Laryngoscope. 2017;1–5.
Goodwin D, Halvorson AR. Chiari I malformation presenting as downbeat nystagmus: clinical presentation, diagnosis, and management. Optometry. 2012;83(2):80–6. PMid:23231368
Guerra Jiménez G, Mazón Gutiérrez Á, Marco de Lucas E, Valle San Román N, Martín Laez R, Morales Angulo C. Manifestaciones audiovestibulares en la malformación de Chiari tipo i. Serie decasos y revisión bibliográfica. Acta Otorrinolaringol Esp. 2015;66(1):28–35. https://doi.org/10.1016/j.otorri.2014.05.002 / https://doi.org/10.1016/j.otoeng.2014.05.019 / PMid:25195076
Hitier M, Barbier C, Marie- Aude T, Moreau S, Courtheoux P, Patron V. New Treatment of Vertigo Caused by Jugular Bulb Abnormalities. Surg Innov. 2014;21(4):365–71. https://doi.org/10.1177/1553350613505918 / PMid:24379171
Hong JH, Yang JG, Kim HA, Yi HA, Le H. Hyperventilation-induced nystagmus in vestibular neuritis: Pattern and clinical implication. Eur Neurol. 2013;69(4):213–20. https://doi.org/10.1159/000345802 / PMid:23328213
Kaski D, Davies R, Luxon L, Bronstein AM, Rudge P. The Tullio phenomenon: A neurologically neglected presentation. J Neurol. 2012;259(1):4–21. https://doi.org/10.1007/s00415-011-6130-x / PMid:21743992
Kim C-H, Jeong K-H, Ahn SH, Shin DH, Kim YW, Shin JE. Vibration- and hyperventilation-induced nystagmus in patients with Ramsay Hunt syndrome with vertigo. Otolaryngol - Head Neck Surg. 2015;152(5):912–8. https://doi.org/10.1177/0194599815570283 / PMid:25672836
Kumar A, Patni AH, Charbel F. The Chiari I malformation and the neurotologist. Otol Neurotol. 2002;23(5):727–35. https://doi.org/10.1097/00129492-200209000-00021 / PMid:12218627
Lloyd B. Superior Canal Dehiscence Syndrome. Am J Otol. 2000;21:9–19. https://doi.org/10.1016/S0196-0709(00)80068-X / https://doi.org/10.1016/S0196-0709(00)80105-2
Mandalà M, Giannuzzi A, Astore S, Trabalzini F, Nuti D. Hyperventilation-induced nystagmus in vestibular schwannoma and unilateral sensorineural hearing loss. Eur Arch Oto-Rhino-Laryngology. 2013;270(7):2007–11. https://doi.org/10.1007/s00405-012-2236-8 / PMid:23108420
Manuel Oliva Domínguez. La exploración oculomotora. 2000; Available from: http://webs.ono.com/nistagmoteca/OCULOMOT.pdf
McCaslin, DL; Dundas, JA; Jacobson G. Balance function assessment and management. In: The bedside assessment of the vestibular system. 1st ed. United Kingdom: Plural publishing; 2008. p. 63–97.
Minor LB, Haslwanter T, Straumann D, Zee DS. Hyperventilation-induced nystagmus in patients with vestibular schwannoma. Neurology. 1999;53(9):2158–68. https://doi.org/10.1212/WNL.53.9.2158 / PMid:10599798
Park HJ, Shin JE, Lee YJ, Park MS, Kim JM, Na BR. Hyperventilation-induced nystagmus in patients with vestibular neuritis in the acute and follow-up stages. Audiol Neurotol. 2011;16(4):248–53. https://doi.org/10.1159/000320841 / PMid:20980745
Pfammatter A, Darrouzet V, Gärtner M, Somers T, Van Dinther J, Trabalzini F, et al. A superior semicircular canal dehiscence syndrome multicenter study: is there an association between size and symptoms? Otol Neurotol. 2010;31(3):447–54. https://doi.org/10.1097/MAO.0b013e3181d27740 / PMid:20118818
Plaza Mayor G, Báron Rubio M, Herraiz Puchol C, López Lafuente J, Aparicio Fernández JM. Neuro-otological manifestations as presentacion of type I Chiari malformation. An Otorrinolaringol Ibero Am. 2006;33(6):613–22. PMid:17233277
Rambold H, Heide W, Sprenger A, Haendler G, Helmchen C. Perilymph fistula associated with pulse-synchronous eye oscillations. Neurology. 2001;56(12):1769–71. https://doi.org/10.1212/WNL.56.12.1769 / PMid:11425953
Robichaud J, DesRoches H, Bance M. Is hyperventilation-induced nystagmus more common in retrocochlear vestibular disease than in end-organ vestibular disease? J Otolaryngol. 2002;31(3):140–3. https://doi.org/10.2310/7070.2002.10796
PMid:12121015
Wenzel A, Ward BK, Schubert MC, Kheradmand A, Zee DS, Mantokoudis G, et al. Patients With Vestibular Loss, Tullio Phenomenon, and Pressure-Induced Nystagmus. Otol Neurotol. 2014 Jun;35(5):866–72. https://doi.org/10.1097/MAO.0000000000000366 / PMid:24770400
Yagi T, Koizumi Y. 3D analysis of cough-induced nystagmus in a patient with superior semicircular canal dehiscence. Auris Nasus Larynx. 2009;36(5):590–3. https://doi.org/10.1016/j.anl.2009.01.012 / PMid:19361939
Bance ML, O'Driscoll M, Patel N, Ramsden RT. Vestibular disease unmasked by hyperventilation. Laryngoscope. 1998;108(4):610–4. https://doi.org/10.1097/00005537-199804000-00027 / PMid:9546279
Bradley JP, Hullar TE, Neely JG, Goebel JA. Hyperventilation-Induced Nystagmus and Vertigo After Stereotactic Radiotherapy for Vestibular Schwannoma. Otol Neurotol. 2011;32(8):1336–8. https://doi.org/10.1097/MAO.0b013e31822e8666 / PMid:21897322
Brantberg K, Greitz D, Pansell T. Subarcuate venous malformation causing audio-vestibular symptoms similar to those in superior canal dehiscence syndrome. Otol Neurotol. 2004;25(6):993–7. https://doi.org/10.1097/00129492-200411000-00022 / PMid:15547432
Califano L, Iorio G, Salafia F, Mazzone S, Califano M. Hyperventilation-Induced Nystagmus in Patients With Vestibular Schwannoma. Otol Neurotol. 2015 Feb;36(2):303–6. https://doi.org/10.1097/MAO.0000000000000699 / PMid:25569362
Califano L, Mazzone S, Salafia F. Utility of the hyperventilation test in the evaluation of the dizzy patient. Curr Opin Otolaryngol Head Neck Surg. 2013;21(5):487–91. https://doi.org/10.1097/MOO.0b013e328364a8bb / PMid:23892795
Califano L, Melillo MG, Vassallo A, Mazzone S. Hyperventilation-induced nystagmus in a large series of vestibular patients. Acta Otorhinolaryngol Ital. 2011;31(1):17–26. PMid:21808459 PMCid:PMC3146331
Carmona, Sergio; Asprella Libonati G. Una aproximación fisiopatológica a la evaluación clínica del paciente con vértigo. In: Neuro-otologia. 3a ed. Buenos Aires: Libreria Akadia editorial; 2013. p. 19–25.
Choi K-D, Cho HJ, Koo J-W, Park S-H, Kim JS. Hyperventilation-induced nystagmus in vestibular schwannoma. Neurology. 2005 Jun 28;64(12):2062. https://doi.org/10.1212/01.WNL.0000170969.19299.D7 / PMid:15985572
Choi KD, Kim JS, Kim HJ, Koo JW, Kim JH, Kim CY, et al. Hyperventilation-induced nystagmus in peripheral vestibulopathy and cerebellopontine angle tumor. Neurology. 2007;69(10):1050–9. https://doi.org/10.1212/01.wnl.0000271378.54381.6a / PMid:17785675
Esquivel, P; Zú-iga J. Síndrome de dehiscencia del canal semicircular superior. Rev Otorrinolaringol Cir Cabeza Cuello. 2005;65:233–40.
Finn S, Dietzek M, Karvouniari P, Klingner CM, Neumann R, Guntinas-Lichius O, et al. Bilateral vestibulopathy with positive Tullio phenomenon. Laryngoscope. 2017;1–5.
Goodwin D, Halvorson AR. Chiari I malformation presenting as downbeat nystagmus: clinical presentation, diagnosis, and management. Optometry. 2012;83(2):80–6. PMid:23231368
Guerra Jiménez G, Mazón Gutiérrez Á, Marco de Lucas E, Valle San Román N, Martín Laez R, Morales Angulo C. Manifestaciones audiovestibulares en la malformación de Chiari tipo i. Serie decasos y revisión bibliográfica. Acta Otorrinolaringol Esp. 2015;66(1):28–35. https://doi.org/10.1016/j.otorri.2014.05.002 / https://doi.org/10.1016/j.otoeng.2014.05.019 / PMid:25195076
Hitier M, Barbier C, Marie- Aude T, Moreau S, Courtheoux P, Patron V. New Treatment of Vertigo Caused by Jugular Bulb Abnormalities. Surg Innov. 2014;21(4):365–71. https://doi.org/10.1177/1553350613505918 / PMid:24379171
Hong JH, Yang JG, Kim HA, Yi HA, Le H. Hyperventilation-induced nystagmus in vestibular neuritis: Pattern and clinical implication. Eur Neurol. 2013;69(4):213–20. https://doi.org/10.1159/000345802 / PMid:23328213
Kaski D, Davies R, Luxon L, Bronstein AM, Rudge P. The Tullio phenomenon: A neurologically neglected presentation. J Neurol. 2012;259(1):4–21. https://doi.org/10.1007/s00415-011-6130-x / PMid:21743992
Kim C-H, Jeong K-H, Ahn SH, Shin DH, Kim YW, Shin JE. Vibration- and hyperventilation-induced nystagmus in patients with Ramsay Hunt syndrome with vertigo. Otolaryngol - Head Neck Surg. 2015;152(5):912–8. https://doi.org/10.1177/0194599815570283 / PMid:25672836
Kumar A, Patni AH, Charbel F. The Chiari I malformation and the neurotologist. Otol Neurotol. 2002;23(5):727–35. https://doi.org/10.1097/00129492-200209000-00021 / PMid:12218627
Lloyd B. Superior Canal Dehiscence Syndrome. Am J Otol. 2000;21:9–19. https://doi.org/10.1016/S0196-0709(00)80068-X / https://doi.org/10.1016/S0196-0709(00)80105-2
Mandalà M, Giannuzzi A, Astore S, Trabalzini F, Nuti D. Hyperventilation-induced nystagmus in vestibular schwannoma and unilateral sensorineural hearing loss. Eur Arch Oto-Rhino-Laryngology. 2013;270(7):2007–11. https://doi.org/10.1007/s00405-012-2236-8 / PMid:23108420
Manuel Oliva Domínguez. La exploración oculomotora. 2000; Available from: http://webs.ono.com/nistagmoteca/OCULOMOT.pdf
McCaslin, DL; Dundas, JA; Jacobson G. Balance function assessment and management. In: The bedside assessment of the vestibular system. 1st ed. United Kingdom: Plural publishing; 2008. p. 63–97.
Minor LB, Haslwanter T, Straumann D, Zee DS. Hyperventilation-induced nystagmus in patients with vestibular schwannoma. Neurology. 1999;53(9):2158–68. https://doi.org/10.1212/WNL.53.9.2158 / PMid:10599798
Park HJ, Shin JE, Lee YJ, Park MS, Kim JM, Na BR. Hyperventilation-induced nystagmus in patients with vestibular neuritis in the acute and follow-up stages. Audiol Neurotol. 2011;16(4):248–53. https://doi.org/10.1159/000320841 / PMid:20980745
Pfammatter A, Darrouzet V, Gärtner M, Somers T, Van Dinther J, Trabalzini F, et al. A superior semicircular canal dehiscence syndrome multicenter study: is there an association between size and symptoms? Otol Neurotol. 2010;31(3):447–54. https://doi.org/10.1097/MAO.0b013e3181d27740 / PMid:20118818
Plaza Mayor G, Báron Rubio M, Herraiz Puchol C, López Lafuente J, Aparicio Fernández JM. Neuro-otological manifestations as presentacion of type I Chiari malformation. An Otorrinolaringol Ibero Am. 2006;33(6):613–22. PMid:17233277
Rambold H, Heide W, Sprenger A, Haendler G, Helmchen C. Perilymph fistula associated with pulse-synchronous eye oscillations. Neurology. 2001;56(12):1769–71. https://doi.org/10.1212/WNL.56.12.1769 / PMid:11425953
Robichaud J, DesRoches H, Bance M. Is hyperventilation-induced nystagmus more common in retrocochlear vestibular disease than in end-organ vestibular disease? J Otolaryngol. 2002;31(3):140–3. https://doi.org/10.2310/7070.2002.10796
PMid:12121015
Wenzel A, Ward BK, Schubert MC, Kheradmand A, Zee DS, Mantokoudis G, et al. Patients With Vestibular Loss, Tullio Phenomenon, and Pressure-Induced Nystagmus. Otol Neurotol. 2014 Jun;35(5):866–72. https://doi.org/10.1097/MAO.0000000000000366 / PMid:24770400
Yagi T, Koizumi Y. 3D analysis of cough-induced nystagmus in a patient with superior semicircular canal dehiscence. Auris Nasus Larynx. 2009;36(5):590–3. https://doi.org/10.1016/j.anl.2009.01.012 / PMid:19361939
Mena-Domínguez, E. A. (2017). Revisión sobre la prueba de hiperventilación y la de Valsalva. Revista ORL, 9(2), 133–137. https://doi.org/10.14201/orl.17385
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