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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