Review about hiperventilation test and Valsalva Maneuver
Abstract Introduction and objective: With this paper, we pretend to explain the characteristics and the field of application of two clinical explorations used in the patient with suspected vestibular pathology, the hyperventilation maneuver and the Valsalva maneuver. Methodology: Narrative review. Results: Through different neurophysiological mechanisms, hyperventilation can induce nystagmus in cases of vestibular asymmetry, both peripheral and central. The Valsalva maneuver may also trigger nystagmus and vertigo because of direct transmission of internal ear pressure in cases of perilymphatic fistula, anomalies of the cranio-cervical junction (Arnold-Chiari malformation), and other ossicles, oval window and saccule pathologies. Discussion and conclusions: Both the hyperventilation test and the Valsalva maneuver should be included in the battery of tests for patients with vestibular pathology to, depending on the results obtained, anatomically locate the site of the lesion and justify the use of imaging techniques.
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Ahle G, Visser W, Juergens A, Schlegel U. Successful treatment of hyperventilation-induced nystagmus in vestibular schwannoma with oxcarbacepine. J Neurol. 2008;255(7):1093. https://doi.org/10.1007/s00415-008-0842-6 / PMid:18500495
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). Review about hiperventilation test and Valsalva Maneuver. Revista ORL, 9(2), 133–137. https://doi.org/10.14201/orl.17385
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