Journal of Vestibular Research - Volume 25, issue 5-6

Authors: Čakrt, Ondřej | Slabý, Kryštof | Kmet', Jan | Kolář, Pavel | Jeřábek, Jaroslav

Article Type: Research Article

Abstract: Perception of verticality can be assessed in two different ways: measuring of subjective visual vertical (SVV) and subjective haptic vertical (SHV). The evidence on aging of SVV and SVH is not conclusive and there is just little knowledge focused on this issue. The aim of this study was to compare accuracy of perception of SVV and SHV between groups of young and elderly healthy subjects. SVV examination was performed using the bucket test. An experimental tactile device was used to assess perceived SHV. Measurements of SVV and SHV were made in 27 young healthy and 30 elderly healthy subjects, both …groups were right-handed due to self-report. SHV estimated position was significantly different (p< 0.01) in young and elderly (counterclockwise shift of 0.72 ± 3.70° and 3.51 ± 3.99°, respectively) and the SHV range (4.17 ± 5.40° and 9.64 ± 7.42°, respectively) was also different (p< 0.01). The differences were caused by significant difference in the supination maneuver (clockwise rod rotation, p< 0.001) which resulted in counterclockwise shift of 2.80 ± 4.90° and 8.33 ± 4.62° in young and elderly respectively. Pronation part of the SHV task (counterclockwise rod rotation) did not significantly differ between groups. SVV estimated position and range were not statistically different between young and elderly. These results provide evidence that the ability to detect SVV is not impaired, SHV seems also not to be affected by aging but there may be methodologic issues in SHV testing in elderly which should be controled for in future studies. Results of both pronation and supination maneuvers should be provided along with SHV position. Show more

Keywords: Perception, somatosensory system, vestibular system, aging, orientation

DOI: 10.3233/VES-150562

Citation: Journal of Vestibular Research, vol. 25, no. 5-6, pp. 195-199, 2015

Authors: Kheradmand, Amir | Gonzalez, Grisel | Otero-Millan, Jorge | Lasker, Adrian

Article Type: Research Article

Abstract: BACKGROUND: Perception of upright is often assessed by aligning a luminous line to the subjective visual vertical (SVV). OBJECTIVE: Here we investigated the effects of visual line rotation and viewing eye on SVV responses and whether there was any change with head tilt. METHODS: SVV was measured using a forced-choice paradigm and by combining the following conditions in 22 healthy subjects: head position (20° left tilt, upright and 20° right tilt), viewing eye (left eye, both eyes and right eye) and direction of visual line rotation (clockwise [CW] and counter clockwise [CCW]). …RESULTS: The accuracy and precision of SVV responses were not different between the viewing eye conditions in all head positions (P> 0.05, Kruskal-Wallis test). The accuracy of SVV responses was % significantly different between the CW and CCW line rotations (p ≈ 0.0001; Kruskal-Wallis test) and SVV was tilted in the same direction as the line rotation. This effect of line rotation was however not consistent across head tilts and was only present in the upright and right tilt head positions. The accuracy of SVV responses showed a higher variability among subjects in the left head tilt position with no significant difference between the CW and CCW line rotations (P> 0.05; post-hoc Dunn's test). CONCLUSIONS: In spite of the challenges to the estimate of upright with head tilt, normal subjects did remarkably well irrespective of the viewing eye. The physiological significance of the asymmetry in the effect of line rotation between the head tilt positions is unclear but it %may suggest suggests a lateralizing effect of head tilt on the visual perception of upright. Show more

Keywords: Subjective visual vertical, head tilt, line rotation, monocular, binocular

DOI: 10.3233/VES-160565

Citation: Journal of Vestibular Research, vol. 25, no. 5-6, pp. 201-209, 2015

Authors: Li, Yuan-Jun | Jin, Zhan-Guo | Xu, Xian-Rong

Article Type: Research Article

Abstract: BACKGROUND: Ménière's disease (MD) is defined as an idiopathic disorder of the inner ear characterized by the triad of tinnitus, vertigo, and sensorineural hearing loss. Although many studies have evaluated the association between variants in the KCNE1 or KCNE3 gene and MD risk, debates still exist. OBJECTIVE: Our aim is to evaluate the association between KCNE gene variants, including KCNE1 rs1805127 and KCNE3 rs2270676, and the risk of MD by a systematic review. METHODS: We searched the literature in PubMed, SCOPUS and EMBASE through May 2015. We calculated pooled odds ratios (OR) and …95% confidence intervals (CIs) using a fixed-effects model or a random-effects model for the risk to MD associated with different KCNE gene variants. The heterogeneity assumption decided the effect model. RESULTS: A total of three relevant studies, with 302 MD cases and 515 controls, were included in this meta-analysis. The results indicated that neither the KCNE1 rs1805127 variant (for G vs. A: OR = 0.724, 95%CI 0.320, 1.638, P= 0.438), nor the KCNE3 rs2270676 variant (for T vs. C: OR = 0.714, 95%CI 0.327, 1.559, P = 0.398) was associated with MD risk. CONCLUSIONS: Based on current evidence from published studies, neither of the two variants from KCNE was significantly associated with the risk of MD. Larger studies with mixed ethnicity subjects and stratified by clinical and sub-clinical characteristics are needed to validate our findings. Show more

Keywords: Gene variant, meta-analysis, Ménière's disease, KCNE1, KCNE3

DOI: 10.3233/VES-160569

Citation: Journal of Vestibular Research, vol. 25, no. 5-6, pp. 211-218, 2015

Authors: Allum, John H.J. | Honegger, Flurin

Article Type: Research Article

Abstract: BACKGROUND: Acute unilateral peripheral vestibular deficit (aUPVD) patients have balance deficits that can improve after several weeks. Determining differences in vestibulo-spinal reflex (VSR) influences on balance control and vestibular ocular reflex (VOR) responses with peripheral recovery and central compensation would provide insights into CNS plasticity mechanisms. Also, clinically, knowing when balance control is approximately normal again should contribute to decisions about working ability after aUPVD. Usually VORs are employed for this purpose, despite a lack of knowledge about correlations with balance control. Given this background, we examined whether balance and VOR measures improve similarly and are correlated. Further whether …balance improvements are different for stance and gait. METHODS: 26 patients were examined at onset of aUPVD, and 3, 6 and 13 weeks later. To measure balance control and thereby assess the contribution of VSR influences during stance and gait, body-worn gyroscopes mounted at lumbar 1-3 recorded the angular velocity of the lower trunk in the roll (lateral) and pitch (anterior-posterior) directions. These signals were integrated to yield angle deviations. To measure VOR function, rotating chair (ROT) tests were performed with triangular velocity profiles with accelerations of 20°/s2 and 5°/s2 , and caloric tests with bithermal (44 and 30°C) water irrigation of the external auditory meatus. Changes in average balance and VOR measures at the 4 examination time points were modelled with exponential decays. Improvements were assumed to plateau when model values were to within 10% of steady state. RESULTS: Balance improvement rates were task and direction dependent, ranging from 3-9 weeks post aUPVD, similar to the range of ROT VOR improvement rates. Stance balance control improved similarly in the pitch and roll directions. Both reached steady state at 7.5 weeks. However, changes in visual and proprioceptive influences on stance sway velocities continued to decrease in favour of vestibular influences for over 10 weeks with the visual influence being correlated with ROT deficit side responses (R= 0.475). Spontaneous nystagmus and stance roll velocity were weakly correlated (R= 0.24). Pitch control during gait tests improved faster than roll. Gait speed was slower and only recovered normal velocity at 6-9 weeks. Pitch velocity when walking eyes closed was correlated (R= 0.38) with ROT asymmetry. Other balance and VOR measures were more weakly correlated (R< 0.2) even if these had similar improvement rates. CONCLUSIONS: These results indicate that balance control for stance improves equally fast in the pitch and roll directions. For gait, pitch control improves faster than roll. On average, stance and gait tests show normal balance control at 6-9 weeks post aUPVD onset. As few balance measures are correlated with those of VOR function and then with low (R< 0.5) coefficients, we suggest that VOR tests should not be used to assess improvements in balance control after aUPVD. The lack of strong correlations between balance and VOR measures included in this study during peripheral recovery and central compensation of aUPVD supports the hypothesis that recovery of balance function after an aUPVD involves different CNS pathways and neural plasticity mechanisms. Show more

Keywords: Unilateral vestibular loss, balance control, recovery rates, stance, gait

DOI: 10.3233/VES-150561

Citation: Journal of Vestibular Research, vol. 25, no. 5-6, pp. 219-231, 2015

Authors: D'Silva, Linda J. | Staecker, Hinrich | Lin, James | Sykes, Kevin J. | Phadnis, Milind A. | McMahon, Tamara M. | Connolly, Dan | Sabus, Carla H. | Whitney, Susan L. | Kluding, Patricia M.

Article Type: Research Article

Abstract: OBJECTIVE: Benign Paroxysmal Positional Vertigo (BPPV) has been linked to comorbidities like diabetes and hypertension. However, the relationship between type 2 diabetes (DM) and BPPV is unclear. The purpose of this retrospective study was to examine the relationship between DM and BPPV in the presence of known contributors like age, gender and hypertension. METHODS: A retrospective review of the records of 3933 individuals was categorized by the specific vestibular diagnosis and for the presence of type 2 DM and hypertension. As the prevalence of BPPV was higher in people with type 2 DM compared to those …without DM, multivariable logistic regressions were used to identify variables predictive of BPPV. The relationship between type 2 DM, hypertension and BPPV was analyzed using mediation analysis. RESULTS: BPPV was seen in 46% of individuals with type 2 DM, compared to 37% of individuals without DM (p< 0.001). Forty two percent of the association between type 2 DM and BPPV was mediated by hypertension, and supported hypertension as a complete mediator in the relationship between type 2 DM and BPPV. CONCLUSIONS: Hypertension may provide the mediating pathway by which diabetes affects the vestibular system. Individuals with complaints of dizziness, with comorbidities including hypertension and diabetes, may benefit from a screening for BPPV. Show more

Keywords: Type 2 Diabetes, hypertension, benign paroxysmal positional vertigo

DOI: 10.3233/VES-150563

Citation: Journal of Vestibular Research, vol. 25, no. 5-6, pp. 233-239, 2015

Authors: Schlick, Cornelia | Schniepp, Roman | Loidl, Verena | Wuehr, Max | Hesselbarth, Kristin | Jahn, Klaus

Article Type: Research Article

Abstract: BACKGROUND: Vertigo and dizziness are among the most prevalent symptoms in neurologic disorders. Although many of these patients suffer from postural instability and gait disturbances, there is only limited data on their risk of falling. METHODS: We conducted a controlled cross-sectional study at the tertiary care outpatient clinic of the German Center for Vertigo and Balance Disorders using a self-administered questionnaire to assess falls, fall-related injuries, and fear of falling. The recruitment period was 6 months. RESULTS: A total of 569 patients (mean age 59.6 ± 17.1 years, 55% females) and 100 …healthy participants were included (response rate > 90%). Dizzy patients with central balance disorders (Parkinsonian, cerebellar, and brainstem oculomotor syndromes) had the highest fall rates (> 50% recurrent fallers, odds ratio > 10). The rate of recurrent fallers was 30% in bilateral vestibular failure and peripheral neuropathy (odds ratio > 5). Patients with functional dizziness (somatoform or phobic vertigo) were concerned about falling but did not fall more often than healthy controls (odds ratio 0.87). CONCLUSION: Falls are common in patients presenting to a dizziness unit. Those with central syndromes are at risk of recurrent and injurious falling. Fall rates and fear of falling should be assessed in balance disorders and used to guide the regimen of rehabilitation therapy. The identification of risk factors would help provide protective measures to these groups of patients. Show more

Keywords: Balance, dizziness, falls, gait disorders, vertigo

DOI: 10.3233/VES-150564

Citation: Journal of Vestibular Research, vol. 25, no. 5-6, pp. 241-251, 2015

Authors: Alghwiri, Alia A. | Alghadir, Ahmad H. | Al-momani, Murad O. | Whitney, Susan L.

Article Type: Research Article

Abstract: Persons with vestibular disorders are susceptible to imbalance. The Activities-specific Balance Confidence (ABC) scale and Berg Balance Scale (BBS) have been validated in persons with vestibular disorders. The purpose of this study was to examine the reliability and validity of the Arabic versions of ABC and BBS among Arabic-speaking persons with vestibular disorders in Jordan and Saudi Arabia. Therefore, the A-ABC and A-BBS were administered to a convenience sample of 82 persons with vestibular disorders (age = 43 ± 14), (56% female). The test-retest reliability of the A-ABC item and total score as well as the inter-rater and intra-rater reliability …of the A-BBS total score reflected high agreement. Significant and large correlations were found between the A-ABC and the A-BBS (r= 0.54, P< 0.05), the A-ABC and the Arabic Dizziness Handicap Inventory (A-DHI) (r= -0.76, P< 0.05), and the A-BBS and the A-DHI (r= -0.56, P< 0.05). The A-ABC and the A-BBS demonstrated good reliability and validity and can be utilized with Arabic-speaking persons with vestibular disorders. Show more

Keywords: Vestibular disorders, measurements, adaptation, Arabic

DOI: 10.3233/VES-160568

Citation: Journal of Vestibular Research, vol. 25, no. 5-6, pp. 253-259, 2015

Authors: Salviz, Mehti | Yuce, Turgut | Acar, Hurtan | Taylan, Isil | Yuceant, Gulsah Acar | Karatas, Abdullah

Article Type: Research Article

Abstract: Overlaps can be seen between vestibular migraine (VM) Ménière's Disease (MD) and diagnosis is difficult if hearing is normal. We aimed to investigate the sacculo-collic pathway in VM patients, MD patients, and healthy controls to define the diagnostic role of cervical VEMP (cVEMP). VEMP testing in response to 500 Hz and 1000 Hz air-conducted tone burst (TB) stimulation was studied prospectively in 22 subjects with definite VM (according to Bárány nomenclature), 30 subjects with unilateral definite MD, and 18 volunteers matched healthy controls. In VM subjects, response rate, p13 and n23 latencies were similar to healthy controls, but peak-to-peak amplitudes …were bilaterally reduced at 500 Hz TBs (p= 0.005). cVEMP differentiated MD patients from VM and healthy controls with asymmetrically reduced amplitudes on affected ears with low response rates at 500 Hz TBs, and alteration of frequency dependent responses at 500 and 1000 Hz TBs. These findings suggest that cVEMP can be used as a diagnostic test to differentiate MD from VM. On the other hand, VEMP responses are symmetrically reduced on both sides in VM patients, suggesting that otolith organs might be affected by migraine-induced ischemia. Show more

Keywords: VEMP, amplitudes, migraine, vertigo, endolymphatic hydrops, otolith

DOI: 10.3233/VES-160567

Citation: Journal of Vestibular Research, vol. 25, no. 5-6, pp. 261-266, 2015

Authors: Luis, L. | Lehnen, N. | Muñoz, E. | de Carvalho, M. | Schneider, E. | Valls-Solé, J. | Costa, J.

Article Type: Research Article

Abstract: BACKGROUND: Differentiating central from peripheral origins of spontaneous nystagmus (SN) is challenging. Looking for a simple sign of peripheral disease with the video Head Impulsive Test we noticed anti-compensatory eye movements (AQEM) in patients with peripheral etiologies of spontaneous nystagmus (SN). Here we assess the diagnostic accuracy of AQEM in differentiating peripheral from central vestibular disorders. METHODS: We recorded the eye movements in response to horizontal head impulses in a group of 43 consecutive patients with acute vestibular syndrome (12 with central, 31 with peripheral disorders), 5 patients after acute vestibular neurectomy (positive controls) and …39 healthy subjects (negative controls). AQEM were defined as quick eye movements (peak velocity above 50°/s) in the direction of the head movement. RESULTS: All patients with peripheral disorders and positive controls had AQEM (latency 231 ± 53 ms, amplitude 3.4 ± 1.4°, velocity 166 ± 55°/s) when their head was moved to the opposite side of the lesion. Central patients did not have AQEM. AQEM occurrence rate was higher in peripheral patients with contralesional (74 ± 4%, mean ± SD) in comparison to ipsilesional (1 ± 4%) impulses (p< 0.001). Overall diagnostic accuracy for differentiating central from peripheral patients was 96% (95% CI for AUC ROC curve: 0.90 to 1.0) for VOR gain and 100% (95% CI: 1.0 to 1.0) for AQEM occurrence rate. CONCLUSIONS: These results suggest that AQEM are a sign of vestibular imbalance in a peripheral deficit. In addition to VOR gain they should be added to the evaluation of the head impulse test. Show more

Keywords: Neuro-otology, vestibulo-ocular reflex (VOR), vestibular function tests

DOI: 10.3233/VES-160566

Citation: Journal of Vestibular Research, vol. 25, no. 5-6, pp. 267-271, 2015

Article Type: Research Article

Citation: Journal of Vestibular Research, vol. 25, no. 5-6, pp. 273-275, 2015