REVIEW PAPER
LITERATURE REVIEW AND TWO STUDY CASES OF VESTIBULAR PAROXYSMIA FROM AN OTORHINOLARYNGOLOGY CENTRE
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Oskar Rosiak 2, A,E-F
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1
Students' Scientific Circle, Department of Otolaryngology, Polish Mother Memorial Hospital Research Institute, Lodz, Poland
 
2
Department of Otolaryngology, Polish Mother Memorial Hospital Research Institute, Lodz, Poland
 
 
A - Research concept and design; B - Collection and/or assembly of data; C - Data analysis and interpretation; D - Writing the article; E - Critical revision of the article; F - Final approval of article;
 
 
Submission date: 2023-01-31
 
 
Final revision date: 2023-05-26
 
 
Acceptance date: 2023-06-02
 
 
Online publication date: 2023-07-08
 
 
Publication date: 2023-07-08
 
 
Corresponding author
Oskar Rosiak   

Department of Otolaryngology, Polish Mother Memorial Hospital Research Institute, Rzgowska, 93-338, Lodz, Poland
 
 
J Hear Sci 2023;13(2):16-25
 
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Vestibular paroxysmia is a rare disorder of the balance system manifested by recurrent attacks of vertigo, the etiology of which is associated with compression of a blood vessel on the vestibulocochlear nerve. The exact mechanism for triggering the symptoms is not fully understood. The condition occurs in all age groups and without gender predilection. The purpose of the study was to review the literature on vestibular paroxysmia, discuss criteria for the diagnosis of the disease, diagnostic management, proposed therapy, and present clinical cases from the authors’ own practice.

Material and methods:
A review of the scientific literature was conducted via the PubMed database using the keywords “vestibular paroxysmia,” “neurovascular conflict cochlear nerve,” and “neurovascular conflict vestibular nerve”. PRISMA guidelines for systematic reviews were applied.

Results:
There were 146 publications found; after analysis of titles and abstracts, 56 were included in the review; another 10 manuscripts were identified during reference review. Among them, 11 studies were devoted to diagnostic imaging, 19 described the clinical course of the condition based on retrospective studies, 15 were case reports, and 11 other reports and reviews. Following evaluation of this literature, two clinical cases of vestibular paroxysm from the authors’ own practice are described. These cases are presented along with their diagnosis and therapy.

Conclusions:
Imaging studies are of significant value in diagnosing many vascular–neural conflicts, but for vestibular paroxysmia the diagnosis is made on the basis of clinical symptoms and according to the division proposed by the Bárány Society in 2016. Pharmacological therapy is recommended, and response to therapy is one of the criteria for diagnosing the condition. Surgical treatment is reserved for the most severe cases.

REFERENCES (64)
1.
Mendel B, Bergenius J, Langius-Eklöf A. Dizziness: a common, troublesome symptom but often treatable. J Vestib Res, 2010; 20(5): 391–8. https://doi.org/10.3233/VES-20....
 
2.
Humphriss RL, Hall AJ. Dizziness in 10 year old children: an epidemiological study. Int J Pediatr Otorhinolaryngol, 2011; 75(3): 395–400. https://doi.org/10.1016/j.ijpo....
 
3.
Neuhauser HK. The epidemiology of dizziness and vertigo. Handb Clin Neurol, 2016; 137: 67–82. https://doi.org/10.1016/B978-0....
 
4.
Obermann M, Bock E, Sabev N, Lehmann N, Weber R, Gerwig M, et al. Long-term outcome of vertigo and dizziness associated disorders following treatment in specialized tertiary care: the Dizziness and Vertigo Registry (DiVeR) Study. J Neurol, 2015; 262(9): 2083–91. https://doi.org/10.1007/s00415....
 
5.
Lempert T. Recurrent spontaneous attacks of dizziness. Continuum, 2012; 18(5): 1086–101. https://doi.org/10.1212/01.CON....
 
6.
Dlugaiczyk J, Lempert T, Lopez-Escamez JA, Teggi R, von Brevern M, Bisdorff A. Recurrent vestibular symptoms not otherwise specified: clinical characteristics compared with vestibular migraine and Menière’s disease. Front Neurol, 2021; 12: 674092. https://doi.org/10.3389/fneur.....
 
7.
Strupp M, Dlugaiczyk J, Ertl-Wagner BB, Rujescu D, Westhofen M, Dieterich M. Vestibular disorders. Dtsch Arztebl Int, 2020; 117(17): 300–10. https://doi.org/10.3238/arzteb....
 
8.
Strupp M, Mandalà M, López-Escámez JA. Peripheral vestibular disorders: an update. Curr Opin Neurol, 2019; 32(1): 165–73. https://doi.org/10.1097/WCO.00....
 
9.
Prell T, Finn S, Zipprich HM, Axer H. What predicts improvement of dizziness after multimodal and interdisciplinary day care treatment? J Clin Med, 2022; 11(7): 2005. https://doi.org/10.3390/jcm110....
 
10.
Lahmann C, Henningsen P, Brandt T, Strupp M, Jahn K, Dietrich M, et al. Psychiatric comorbidity and psychosocial impairment among patients with vertigo and dizziness. J Neurol Neurosurg Psychiatry, 2015; 86(3): 302–8. https://doi.org/10.1136/jnnp-2....
 
11.
Strupp M, Dieterich M, Brandt T. The treatment and natural course of peripheral and central vertigo. Dtsch Arztebl Int, 2013; 110(29–30): 505–16. https://doi.org/10.3238/arzteb....
 
12.
Dieterich M, Staab JP. Functional dizziness: from phobic postural vertigo and chronic subjective dizziness to persistent postural-perceptual dizziness. Curr Opin Neurol, 2017; 30(1): 107–13. https://doi.org/10.1097/WCO.00....
 
13.
Gruber M, Cohen-Kerem R, Kaminer M, Shupak A. Vertigo in children and adolescents: characteristics and outcome. Scientific World Journal, 2012; 2012: 109624. https://doi.org/10.1100/2012/1....
 
14.
Jahn K. Vertigo and dizziness in children. Handb Clin Neurol, 2016; 137: 353–63. https://doi.org/10.1016/B978-0....
 
15.
Karatas M. Vascular Vertigo. Neurologist, 2011; 17(1): 1–10. https://doi.org/10.1097/NRL.0b....
 
16.
Morinaga Y, Nii K, Sakamoto K, Inoue R, Mitsutake T, Hanada H. Neurovascular compression syndrome of the brain stem with opsoclonus-myoclonus syndrome combined with vestibular paroxysmia and autonomic symptoms. Drug Discov Ther, 2019; 13(4): 228–31. https://doi.org/10.5582/ddt.20....
 
17.
Han J, Wang T, Xie Y, Cao D, Kang Z, Song X. Successive occurrence of vertebrobasilar dolichectasia induced trigeminal neuralgia, vestibular paroxysmia and hemifacial spasm. Medicine, 2018; 97(25): e11192. https://doi.org/10.1097/MD.000....
 
18.
Lehnen N, Langhagen T, Heinen F, Huppert D, Brandt T, Jahn K. Vestibular paroxysmia in children: a treatable cause of short vertigo attacks. Dev Med Child Neurol, 2015; 57(4): 393–6. https://doi.org/10.1111/dmcn.1....
 
19.
Sui-Lin Teh C, Noordiana SH, Shamini S, Prepageran N. Vascular loops: the innocent bystander for vestibular paroxysmia. Ann Otol Rhinol Laryngol, 2022; 131(6): 604–8. https://doi.org/10.1177/000348....
 
20.
Shi X, Zhang X, Xu L, Xu Z. Neurovascular compression syndrome: trigeminal neuralgia, hemifacial spasm, vestibular paroxysmia, glossopharyngeal neuralgia, four case reports and review of literature. Clin Neurol Neurosurg, 2022; 221: 107401. https://doi.org/10.1016/j.clin....
 
21.
Lee S-U, Kim H-J, Choi J-Y, Kim J-S. Lower brainstem melanocytoma masquerading as vestibular paroxysmia. J Neurol, 2018; 265(5): 1222–5. https://doi.org/10.1007/s00415....
 
22.
Lee S-U, Jeong S-H, Kim H-J, Kim J-S. Cerebellopontine angle meningioma mimicking vestibular paroxysmia. J Neurol, 2016; 263(1): 168–70. https://doi.org/10.1007/s00415....
 
23.
Brandt T, Strupp M, Dieterich M. Vestibular paroxysmia: a treatable neurovascular cross-compression syndrome. J Neurol, 2016; 263(S1): 90–6. https://doi.org/10.1007/s00415....
 
24.
Strupp M, Lopez-Escamez JA, Kim J-S, Straumann D, Jen J, Carey J, et al. Vestibular paroxysmia: diagnostic criteria. J Vestib Res, 2017; 26(5–6): 409–15. https://doi.org/10.3233/VES-16....
 
25.
Sun H, Tian X, Zhao Y, Jiang H, Gao Z, Wu H. Application of ABR in pathogenic neurovascular compression of the 8th cranial nerve in vestibular paroxysmia. Acta Neurochir (Wien), 2022; 164(11): 2953–62. https://doi.org/10.1007/s00701....
 
26.
Choi JW, Kim C-H. Vestibular paroxysmia caused by contralateral tortuous vertebral artery. Medicine, 2021; 100(45): e27815. https://doi.org/10.1097/MD.000....
 
27.
Jannetta PJ. Neurovascular cross-compression in patients with hyperactive dysfunction symptoms of the eighth cranial nerve. Surg Forum, 1975; 26: 467–9.
 
28.
Brandt T, Dieterich M. Vestibular paroxysmia: vascular compression of the eighth nerve? Lancet, 1994; 343(8900): 798–9. https://doi.org/10.1016/s0140-....
 
29.
Lee J, Park JY, Shin JE, Kim C-H. Direction-changing spontaneous nystagmus in patients with dizziness. Eur Arch Otorhinolaryngol, 2022; 280: 2725–33. https://doi.org/10.1007/s00405....
 
30.
Kim C-H, Choi K-D. Periodic tinnitus and direction-changing nystagmus in vestibular paroxysmia. J Clin Neurol, 2021; 17(3): 493. https://doi.org/10.3988/jcn.20....
 
31.
Choi S-Y, Choi J-H, Choi K-D. The nystagmus of vestibular paroxysmia. J Neurol, 2018; 265(7): 1711–3. https://doi.org/10.1007/s00415....
 
32.
Ward BK, Gold DR. Tinnitus, oscillopsia, and hyperventilation-induced nystagmus: vestibular paroxysmia. Open J Clin Med Case Rep, 2016; 2(7): 1100. http://www.jclinmedcasereports...
 
33.
Ihtijarevic B, Van Ombergen A, Celis L, Maes LK, Wuyts FL, Van de Heyning PH, et al. Symptoms and signs in 22 patients with vestibular paroxysmia. Clin Otolaryngol, 2019; 44(4): 682–7. https://doi.org/10.1111/coa.13....
 
34.
Orendorz-Frączkowska K, Jaworska M, Gawron W, Badowski R, Nadolska B. [Vestibulo-cochlear disturbances in the course of vaso-neural conflict of vestibule-cochlear nerve: diagnostic and therapeutic problems]. Pol J Otolaryngol, 2007; 61(4): 473–8 [in Polish]. https://doi.org/10.1016/S0030-....
 
35.
Ori M, Gambacorta V, Ricci G, Faralli M. Vestibular paroxysmia in vestibular neuritis: a case report. Audiol Res, 2018; 8(1): 206. https://doi.org/10.4081/audior....
 
36.
Brandt T, Grill E, Strupp M, Huppert D. Susceptibility to fear of heights in bilateral vestibulopathy and other disorders of vertigo and balance. Front Neurol, 2018; 9: 406. https://doi.org/10.3389/fneur.....
 
37.
Serra A, Chiaramonte R, Viglianesi A, Messina M, Maiolini L, Pero G, et al. MRI aspects of neuro-vascular conflict of the VIII nerve. Neuroradiol J, 2010; 23(6): 700–3. https://doi.org/10.1177/197140....
 
38.
Sivarasan N, Touska P, Murdin L, Connor S. MRI findings in vestibular paroxysmia: an observational study. J Vestib Res, 2019; 29(2–3): 137–45. https://doi.org/10.3233/VES-19....
 
39.
Bae YJ, Jeon YJ, Choi BS, Koo J-W, Song J-J. The role of MRI in diagnosing neurovascular compression of the cochlear nerve resulting in typewriter tinnitus. AJNR Am J Neuroradiol, 2017; 38(6): 1212–7. https://doi.org/10.3174/ajnr.A....
 
40.
Karamitros A, Kalamatianos T, Stranjalis G, Anagnostou E. Vestibular paroxysmia: clinical features and imaging findings. A literature review. J Neuroradiol, 2022; 49(2): 225–33. https://doi.org/10.1016/j.neur....
 
41.
Badełek-Izdebska M, Zawadzka-Głos L. [Neurovascular conflict as a possible cause of dizziness and hearing loss in adolescents: a case report]. Otorynolaryngologia, 2015; 14(4): 235–9 [in Polish]. Available from: https://www.otorynolaryngologi... [Accessed 12.12.2022].
 
42.
Haller S, Etienne L, Kövari E, Varoquaux AD, Urbach H, Becker M. Imaging of neurovascular compression syndromes: trigeminal neuralgia, hemifacial spasm, vestibular paroxysmia, and glossopharyngeal neuralgia. AJNR Am J Neuroradiol, 2016; 37(8): 1384–92. https://doi.org/10.3174/ajnr.A....
 
43.
Best C, Gawehn J, Krämer HH, Thomke F, Ibis T, Muller-Forell W, et al. MRI and neurophysiology in vestibular paroxysmia: contradiction and correlation. J Neurol Neurosurg Psychiatry, 2013; 84(12): 1349–56. https://doi.org/10.1136/jnnp-2....
 
44.
Hufner K, Barresi D, Glaser M, Linn J, Adrion C, Mansmann U, et al. Vestibular paroxysmia: diagnostic features and medical treatment. Neurology, 2008; 71(13): 1006–14. https://doi.org/10.1212/01.wnl....
 
45.
Steinmetz K, Becker-Bense S, Strobl R, Grill E, Seelos K, Huppert D. Vestibular paroxysmia: clinical characteristics and long-term course. J Neurol, 2022; 269: 6237–45. https://doi.org/10.1007/s00415....
 
46.
Rommer PS, Wiest G, Kronnerwetter C, Zach H, Loader B, Elwischger K, et al. 7-Tesla MRI demonstrates absence of structural lesions in patients with vestibular paroxysmia. Front Neuroanat, 2015; 9: 81. https://doi.org/10.3389/fnana.....
 
47.
Bayer O, Brémová T, Strupp M, Hüfner K. A randomized double-blind, placebo-controlled, cross-over trial (Vestparoxy) of the treatment of vestibular paroxysmia with oxcarbazepine. J Neurol, 2018; 265(2): 291–8. https://doi.org/10.1007/s00415....
 
48.
Brandt T, Zwergal A, Strupp M. Medical treatment of vestibular disorders. Expert Opin Pharmacother, 2009; 10(10): 1537–48. https://doi.org/10.1517/146565....
 
49.
Hanskamp LAJ, Schermer TR, van Leeuwen RB. Long-term prognosis of vertigo attacks and health-related quality of life limitations in patients with vestibular paroxysmia. Otol Neurotol, 2022; 43(4): 475–81. https://doi.org/10.1097/MAO.00....
 
50.
Strupp M, Zwergal A, Feil K, Bremova T, Brandt T. Pharmacotherapy of vestibular and cerebellar disorders and downbeat nystagmus: translational and back-translational research. Ann NY Acad Sci, 2015; 1343(1): 27–36. https://doi.org/10.1111/nyas.1....
 
51.
Strupp M, Thurtell MJ, Shaikh AG, Brandt T, Zee DS, Leigh RJ. Pharmacotherapy of vestibular and ocular motor disorders, including nystagmus. J Neurol, 2011; 258(7): 1207–22. https://doi.org/10.1007/s00415....
 
52.
Chen C-C, Lee T-Y, Lee H-H, Kuo Y-H, Bery AK, Chang T-P. Vestibular paroxysmia: long-term clinical outcome after treatment. Front Neurol, 2022; 13: 1036214. https://doi.org/10.3389/fneur.....
 
53.
Brandt T, Huppert T, Hüfner K, Zingler VC, Dieterich M, Strupp M. Long-term course and relapses of vestibular and balance disorders. Restor Neurol Neurosci, 2010; 28(1): 69–82. https://doi.org/10.3233/RNN-20... 54. Xue H, Xiang W, Yu Y, Guorong L, Chong Y, Zhou J. Randomized trial of betahistine mesilate tablets as augmentation for oxcarbazepine and carbamazepine in treating vestibular paroxysmia. Drug Des Devel Ther, 2018; 12: 837–43. https://doi.org/10.2147/DDDT.S....
 
54.
Yi C, Wenping X, Hui X, Xin H, Xiue L, Jun Z, et al. Efficacy and acceptability of oxcarbazepine vs carbamazepine with betahistine mesilate tablets in treating vestibular paroxysmia: a retrospective review. Postgrad Med, 2016; 128(5): 492–5. https://doi.org/10.1080/003254....
 
55.
Strupp M, Dieterich M, Brandt T, Feil K. Therapy of vestibular paroxysmia, superior oblique myokymia, and ocular neuromyotonia. Curr Treat Options Neurol, 2016; 18(7): 34. https://doi.org/10.1007/s11940....
 
56.
Strupp M, Elger C, Goldschagg N. Treatment of vestibular paroxysmia with lacosamide. Neurol Clin Pract, 2019; 9(6): 539–41. https://doi.org/10.1212/CPJ.00....
 
57.
Liu F, Wei C, Huang W. Clinical long-term observation of the keyhole microvascular decompression with local anesthesia on diagnosis and treatment of vestibular paroxysmia. Acta Otolaryngol, 2020; 140(5): 378–82. https://doi.org/10.1080/000164....
 
58.
Møller MB, Møller AR, Jannetta PJ, Sekhar L. Diagnosis and surgical treatment of disabling positional vertigo. J Neurosurg, 1986; 64(1): 21–8. https://doi.org/10.3171/jns.19....
 
59.
Tanrikulu L, Scholz T, Nikoubashman O, Wiesmann M, Clusmann H. Preoperative MRI in neurovascular compression syndromes and its role for microsurgical considerations. Clin Neurol Neurosurg, 2015; 129: 17–20. https://doi.org/10.1016/j.clin....
 
60.
Bernard-Demanze L, Elzière M, Oddon PA, Montava M, Lavieille JP. Effects of microvascular decompression surgery on posture control: a case report in an elderly patient. Neurophysiol Clin, 2015; 45(3): 191–201. https://doi.org/10.1016/j.neuc....
 
61.
Strupp M, von Stuckrad-Barre S, Brandt T, Tonn JC. Teaching NeuroImages: compression of the eighth cranial nerve causes vestibular paroxysmia. Neurology, 2013; 80(7): 77. https://doi.org/10.1212/WNL.0b....
 
62.
de Salles AAF, Soleymani T, Pezeshkian P, Pieton D, Pezeshkian P, Miller P, et al. Surgical approaches to tinnitus treatment: a review and novel approaches. Surg Neurol Int, 2011; 2(1): 154. https://doi.org/10.4103/2152-7....
 
63.
di Stadio A, Dipietro L, Ralli M, Faralli M, Volpe AD, Ricci G, et al. Loop characteristics and audio-vestibular symptoms or hemifacial spasm: is there a correlation? A multiplanar MRI study. Eur Radiol, 2020; 30(1): 99–109. https://doi.org/10.1007/s00330....
 
64.
Brandt T, Strupp M, Dieterich M. Vestibular paroxysmia: a treatable neurovascular cross-compression syndrome. J Neurol, Springer; 2016; 263: 90–6. https://doi.org/10.1007/s00415....
 
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