BER TESTING

[Padro46]

I have had this test done twice now Once ina Nuero,s office by his Tech (Positive for Vestibular Nueritis) and Now by a ENT Doc.  At the ENT it was done by a Audiologist. Negative.  My question now I have two differant answers to the same test while neither have been able to explain my lightheadedness nor back of the head numbness, any suggestions from the forum would be helpful

[Padro46]

BER-Testing came back NEG from ENT---so I am no further along with my lightheadedness

[Padro46]

Nueros Last Visit under IMPRESSION  1. Cranial Neuritis--This may be a post infectious syndrome.  So far, this appears to be mainly peripheral in origin.

[Nancy T]

I will not comment on anything else W/a/J has said except to refute one thing: a positive BAER does NOT necessarily mean a tumor. I am living proof of that. W/a/J, if you wish to tell me I'm wrong (I'm not an audiologist, after all), I'll send you the results of my positive BAER and negative thin-slice MRI w/ gad (2x).

Other than that, Padro, take everything you read with a grain of salt. Everyone on these forums has their own experiences and level of knowledge and not everything you read is correct.

Nancy T.

[Padro46]

So my search goes on??--Any suggestions on a Direction to go??

[Wear/a/Jimmy]

Have you seen a patient with "negative" BAER, but still having balance problems?


Sure I have, and if you are the pateint that is a good thing. A positive BAER means a tumor...  a negative BAER means no tumor (90% of the time).  If you do not have a tumor, then the hope is, whatever is causing the diziness is a lot less serious than a tumor.

The popular choice of the day is Benging Proxisimal Positional Vertigo (sp) or Vestibular Neuronitis.  Either way, the doctor needs to make up something in order for insurance to pay him or her....

The fact that there are no tests indicating what is really the matter is not a surprise to me. The field of medicine is not always "cut and dry.

[boron]

Have you seen a patient with "negative" BAER, but still having balance problems?

What bothers me is this: several individuals on EBV forum are reporting neurologic symptoms (dizzines, tingling) and nothing is found by any imaging or other test.

Padro's test results are quite innocent, but symptoms quite bothering. I still want to find some "lab" evidence of his facial tingling/numbness.  

[Padro46]

So back to MS or one of  its mimics possible???

[Wear/a/Jimmy]

My question:
1. Is it possible that vestibulocohlear nerve is affected to the point where it causes dizziness, but BAER is negative?

Even if it did, my guess is the other balance symptoms within the body such as propreosensory (sp) and the eyes would compensate for ear issues. Dymelenation is not an over night process, thus alowing compensation over time...

juts a guess

[Padro46]

ENT Doc advised My Testing with him was Negative for VN

[Padro46]

Forgot also complete Heart work-up with Caroid artery ultrasound

[boron]

Hi, I'm following Padro's symptoms for some months...online. I have medical faculty, but I have no real clue about evoked potentials.

Padro's problem is facial and back-of-the-head tingling/numbness and some sort of dizzines, that appears during walking. The main problem is chronic fatigue, lasting for a good year now.

All MRIs of the spinal cord and brain were negative.

My hypothesis is, that several roots of cranial/upper cervical nerves (or related part of brainstem) are affected (Trigeminus - facial numbness, Vestibular - Dizzines, C1-3 - Back of the head numbness)...either by demyelinization...or just some inflammation.

My question:
1. Is it possible that vestibulocohlear nerve is affected to the point where it causes dizziness, but BAER is negative?

[Padro46]

June 08 MRI  Brain C-Spine with out

Nov 08 Brain With/Without   MRA of Neck with and With/Out

[Wear/a/Jimmy]

Just curious, was your MRI done with and without contrast?

[Padro46]

F.Y.I

The nuero has not ruled out MS or one of its mimics just due to my nunbness and tingling that move around, however due to clean MRI six months apart we are at a stand still until something changes dont want to do a LP just to do one and the lightheadedness has lessened a bit.  Thanks P  will see what both the Nuero and the ENT have to say next week--

[Nancy T]

Padro--hope you learn something more on your followup visit and find some relief for your symptoms.

W/a/J: Re your "flattered" comment, I'm sorry if my remark sounded insulting to you; I certainly didn't mean it so.

What the heck am I doing here anyway.

[Padro46]

First of all let me say thanks so much for responding, I have more information from the two of you than I have from my last several Doctor visits.  But in all fairness let me give a little more history--I began feeling bad in Dec 07-Primary said I had High EBV numbers and ride it out. well this went on and many test were performed which you can looke at my past post to review, just will go over Nuero referral here.  I was exaimed in his office after the ENT visit, The FIRST ENT visit did not include the BER test, I went to his office for the back of the head brain freeze and lightheadeness he (ENT) did the standard hearing test and looked in my ears advised he did not think it was vestbular and sent me to the Nuero.  The nuero did the standard testing that Nancy spoke of vision evoked test I was shocked a couple of times and he did the old nystagmus test on me, The following was the results.

Impression:
1. Vestibular Neuritis.
2. Post Epstein Barr Virus Syndrome  
3. Peripheral neuropathy, rule out demyelinating disorder, rule out CIDP

Plan
1. Diagnostics-Had MRI and MRA  Clear
2. Therapeutics--English Increase Topamax and Xanax
3. Follow-up Three Months

This Brings us to the follow-up with the ENT he did not like the VN DX thus the reason for his audiologist to do it again--and I have a follow-up with him on 2-4-09--so my thinking is again WHAT have I gained here--still really dont know if I have a ear problem or MS or Something else

[Wear/a/Jimmy]

Nancy,  

I am so flattered:  ".... am glad to see W/a/J say that ABR can't test for vestibular neuritis/neuronitis, because I didn't think it could! "

I don't think, I know it can not.

Nancy, ABR technology is ancient and to heavily rely on it for any diagnostic value is dangerous.  In a round about way you mentioned ENG testing. The "hit rate" on ENG studies is 40%.  That means I could toss a coin and get more accurate results....

I can not say with asuerety what the training is for Neurologist (but I do seriously doubt they can read and interpret ABR near the level of audiologist). I do know that ENTs can not, and if I met one that did, that is because he or she took the time to learn how to do so after their education.

ABR etc, are something "that the audiologist deal with" that is what we do that is what they expect us to do, and that is why we go to shcool for 8 years.  We learn about one area of the body, the ears, we do not study delve into the throat, or the nose for that matter.... we focus on one specif part of the body, EVERY day on the job and in school.

Nancy, if you took the time, you would realize interpretting ABRs is really an art, and requires a person to do t it a lot before that person gets any proficiency at it. I see screwed up ABR all the time done by techies, and signed off by physicians. Example...   bad OAE, a profound loss in the left ear (audio gram) flat Tymp and a normal left ABR.....     I saw that last week and was asked to write my interpretation of the data....    Don't worry, I was PC... I did not use terms like, idiot, stupid, unecessary testing, useless, waste of money, con artist, unqualified, etc etc.  The ENT from the get go, should have known not to order an ABR based on the audiogram results....  he or she should have ordered an MRI.  But rather than doing that, he or she sends them off for an ABR done by a techie, that does not have enough since to figure out that if a person can not hear, then they will not hear the stimulus for an ABR...  so they sit down and mark a bunch of artifact as a "Wave" and create a normal ABR....   then eventually the ABR makes it way to me when things get out of hand.  (and no, I do not work for these hospitals, I do consultant work for them when needed)

Regarding my thoughts toward MDs. I have two MDs in my family, fabulous folks. I don't think much about MDs that are in the trade for money, (which there are plenty of them). I also don't think much about the health care system.  I think it is difficult to find a doctor that really spends time with his or her patients or really cares for them.

If it was such a good system, this web site would not exsist to begin with.

[Nancy T]

P.S. Padro, what did your ENT say? Did he/she offer any theories for the lightheadedness and numbness/tingling?

Given that you have numbness and tingling, I would be more inclined to follow up with a neurologist or get another neurologist's opinion if the first one wasn't very helpful. I do not think ENT problems cause numbness in the back of the head. However, these problems could possibly be unrelated. Good luck in any case!

[Nancy T]

W/a/J--you sure don't think much of MDs, do you! :)

Are you saying that neurologists aren't qualified to interpret results of nerve testing? I am not an expert, and I know you are a well-qualified audiologist, but as I understand it, the ABR/BER tests NERVE function, the hearing-nerve pathways, from the inner ear up through the brainstem. And neurologists do nerves (and brains).

I don't know how well qualified MOST neurologists would be to fully interpret an ABR, but I know for sure that at least SOME of them are, namely oto-neurologists, i.e., neurologists who specialize in the inner ear and its connections to the brain.

My ABR was performed by an audiologist in the vestibular lab headed by an MD neurologist who also has a Ph.D. in auditory neuroscience and who specializes in the ear. And then she sends the results to the MD. He is probably as well qualified as anyone on the planet to interpret an ABR.

The knowledge, experience, and qualifications of the neurologist and his tech who performed and interpreted Padro's ABR is another question.

One thing I do know is that when testing for MS, neurologists may run 3 types of evoked-potential nerve testing, namely auditory evoked potentials (ABR/BER), visual evoked potentials (testing the optic nerve), and somatosensory evoked potentials (testing nerve pathways elsewhere, e.g. from the legs). (I bring up MS only because that's the context where I learned about these forms of nerve testing--I'm not suggesting you have it, Padro.)

These tests are not just "rule-outs"; they can provide positive evidence of nerve-conduction slowing, therefore nerve damage of some kind, although this may not tell the doctor WHAT caused the damage.

ABR may be used mainly to rule acoustic-nerve tumor (as you say, W/a/J) but as I understand it (i.e., from what I've heard and read, so what I know may be superficial) it also has other uses, including supporting a diagnosis of some other kind of nerve pathology such as MS (perhaps others). I was diagnosed with "cranial neuropathy" on the basis of my bad ABR, which just means, something wrong with the nerves, we don't know why. (MRI had previously ruled out acoustic neuroma.)

Padro: it sounds like your ENT and neurologist are really not sure what's going on. I can tell you that is quite common--often it's difficult to sort out whether a dizziness problem is due to the brain/nerves or something in the inner ear. It can be VERY frustrating for the patient when the doctors don't agree, or they change their minds, or they waffle, or send you home with a shrug of the shoulders. But honestly, sometimes they just can't be sure.

You have already seen an ENT and a neurologist. What you might do is try to get a third opinion, from a doctor (either ENT or neurologist--or both) who SPECIALIZES in dizziness. If you're in the US, check the American Neurotology Society Web site for someone near you (realizing that some of those people are PhDs, not MDs, but I think it gives their degree in the lists).

It may take a long time to figure out your problem, or it may never get figured out (as in my case). Keep at the doctors until you find some relief for your worst symptom, if something is seriously affecting your life. Explain to them how you feel and which symptom(s) are interfering seriously with your life. They may come up with a medication or therapy that helps, even if they can't give you complete answers. You do NOT have to have a diagnosis in order to seek and expect treatment--they can keep trying to find something that helps. Lots of medications out there to try. Also, I guess your primary-care doctor has ruled out cardiac or blood-circulation issues?

I am glad to see W/a/J say that ABR can't test for vestibular neuritis/neuronitis, because I didn't think it could! The neurologist might have thought you had VN, but ABR results in themselves would not be a proof of that.

Best of luck,
Nancy T.

[Wear/a/Jimmy]

Nancy, that is a laugh.

A neurologist could not even begin to read an ABR, BAER, ECoG, or a OAE...  not even to save his or her life.


Padro46...

Audiologist have AT LEAST a MS degree, and almost 60% have doctorate degrees. There is absolutley no one in the field that can do a better job and performing and interpetating diagnostic tests for the auditory and vestibular system.  PERIOD

An ABR would be a ruling out test done, meaning "if not this, than something else...."

What the audiologist found was that you are negative for a retro cochlear pathology... (no tumor)   This does not mean 100% you have a vestibular nueronitis, it only means that we are 90+% sure you do not have an acoustic neuroma.  


ABRs can not test FOR VESTIBULAR NEURONITIS, so there is NO WAY you tested POSITIVE for it via the techy. It only means that the techy found no evidence of an acoustic tumor, so the doctor said you tested positve for a neurinitis...  Which is an incorect statement...

It is much like if you tested for HIV and you tested negative, but you still have HIV primary infection symptons, so the doctor then says you tested positive for German measels.  

So either your Neurologist has no idea what he or she is talking about, or he is spoon feeding you information, using terminology that he/she figures you will understand..

But in a nut shell the techy and the audiologist test results are in agreement, neither test results are positve for an acoustic tumor;

[Padro46]

I have had lightheaded feelings and back of the head Numbness/Tingling for a year or so. several MRI with/without contrast, Nuero did exam with nystigmus than several test EEG Evoked and BER and This is where he came up with VN DX and also possible iffammatory nueropathy.  I think this is why the ENT questioned why the VN DX anyway this still has not got me a fix still have the same problem

[Nancy T]

I would follow up with the neurologist, given that that was who found a positive result and also because of numbness in your head.

I did not know that a BER (aka BAER, ABR, etc.) could diagnose vestibular neuritis. What exactly did the neurologist say?

What have your symptoms been? Vestibular neuritis usually involves an acute attack of dizziness; did you have such an attack?