DISCUSSION
The function of the otolithic and inferior vestibular nerves can be
tested through the use of cervical vestibular evoked myogenic potentials
(cVEMP). The accessory nerve, which innervates the sternocleidomastoid
(SCM) muscle, is responsible for transmitting the signals from these
nerve, leading to the production of cVEMP waves. While these waves are
typically observed in healthy individuals, some elderly subjects may not
produce an observable response.9
Many clinician tend to attribute vertiginous symptoms in patients with a
cervical hernia to cervical vertigo, but a recent study suggests
otherwise.10 Consistent with our own findings, this
study has also identified benign paroxysmal positional vertigo (BPPV) as
the most prevalent type of peripheral vertigo among patients with
cervical degenerative myelopathies. Benign paroxysmal positional vertigo
(BPPV) has also been declared as the predominant peripheral vertigo
subtype among patients diagnosed with cervical
spondylosis.11 ,12
The findings of the study indicate that the majority of patients with
cervical hernias who experience vertiginous symptoms are actually
suffering from benign paroxysmal positional vertigo (BPPV). This is a
noteworthy observation, as it implies that the root cause of vertigo in
these patients may not be directly linked to the hernia itself, but
instead attributed to an underlying disturbance within the inner
ear.12 It has been hypothesized that abnormal movement
of the cervical vertebrae resulting from the hernia may affect the inner
ear.13 This underscores the criticality of accurate
diagnosis and appropriate treatment of cervical hernias to mitigate the
occurrence of BPPV-related symptoms.
Based on our findings, there was no observable statistical difference in
cVEMP results with respect to the presence or absence of cervical
hernia. Cervical myopathies also thought to be a factor that changes the
myogenic potentials of the muscles of the
neck.14,13, From this perspective,
we anticipated observing modifications in cervical vestibular-evoked
myogenic potential (cVEMP) results among patients with cervical hernia.
This contradiction could be attributed to the possibility that cervical
hernias may exclusively impact the cervical rootlets.. Affection of
cVEMP may rather be attributed to pathologies that result in compression
of the vestibular nucleus or the pathway through the spinal accessory
nerve nuclei.15 In addition to our results, a previous
report has been observed that when addressing disc pathologies that
occur at multiple levels, surgical interventions lead to varying degrees
of improvement in vertigo symptoms..16 This research
involved assessing patients with vertigo caused by multiple degenerated
cervical discs, both before and after surgical treatment, using
subjective tests like the Visual Analog Score (VAS) and the Cervical
Vertigo Evaluation Score (CVES)
A similar metholody with our study had similar results with our
findings.17 The study was limited in its scope as it
solely enrolled patients diagnosed with cervical disc herniation and
excluded those with peripheral vertigo symptoms. Our study, in contrast,
investigated vertigo patients with reference to their specific cervical
pathology status.
Limitations were the population is relatively small for the different
diagnosis of the peripherical vertigo. Only air-conductive type of tone
burts was utilized. Therefore, conductive type of hearing loss was an
exclusion criteria. Given these limitations, further research with a
larger sample size is necessary to confirm and validate our findings.
The present study’s findings indicate that the occurrence of cervical
disc herniation does not strongly relate to the different types of
peripheral vertigo that patients experience. Moreover, cWEMP results may
not be notably influenced by cervical herniation in patients with
peripheral vertigo.
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