Journal of Vestibular Research - Volume 26, issue 3

Authors: Whitney, Susan L. | Alghadir, Ahmad | Alghwiri, Alia | Alshebber, Kefah M. | Alshehri, Mohammed | Furman, Joseph M. | Mueller, Martin | Grill, Eva

Article Type: Research Article

Abstract: People with vestibular disorders report changes in symptoms based on their environment with many situations increasing their symptoms. The purpose of this paper was to utilize the International Classification of Functioning Disability and Health (ICF) from the World Health Organization (WHO) to describe common environmental triggers for dizziness in persons living with balance and vestibular disorders. A multi-centre cross-sectional study was conducted with four different centres on three different continents, including patients from the United States (Pittsburgh), Germany (Munich), Jordan (Amman) and Saudi Arabia (Riyadh). Subjects: Three hundred eighty one persons with vestibular disorders participated. Methods: A 9-item questionnaire (the …Vestibular Environmental Scale) was developed from existing ICF items, which were compared to Dizziness Handicap Inventory (DHI) scores. Sixty-five percent of participants reported that “quick movements in the vicinity” increased symptoms, “crowds” at 45%, and “design of buildings, e.g. narrow hallways, stairs, elevators” at 42%. The “crowds” item was a good positive predictor of psychogenic vertigo (OR 1.8, 95% Confidence Interval 1.03–3.16), while “food” (OR 0.47, 95% Confidence Interval 0.17–1.29) and “light” (OR 0.41 95% Confidence Interval 0.23–0.75) were negative predictors of psychogenic vertigo. There also was a positive correlation between the number of triggers and DHI score (Spearman correlation coefficient 0.47, p  < 0.0001). Sixty-eight percent of the subjects reported an increase in symptoms with between 1 and 4 environmental triggers. In our cross cultural sample, environmental triggers affect dizziness in persons living with balance and vestibular disorders. The use of items from the ICF of the WHO may help to promote cross cultural sharing of information in persons with dizziness. Show more

Keywords: Vestibular, ICF, environment, dizziness, rehabilitation, vestibular rehabilitation

DOI: 10.3233/VES-160580

Citation: Journal of Vestibular Research, vol. 26, no. 3, pp. 297-302, 2016

Authors: Holmeslet, B. | Klaksvik, J. | Goplen, F. | Bugten, V. | Foss, O.A.

Article Type: Research Article

Abstract: BACKGROUND: The measurement of ocular Vestibular Evoked Myogenic Potentials (oVEMP) is a novel method for investigating vestibular function. Stimulus and recording techniques vary in the literature. A standardized test procedure is desirable in order to ensure repeatable results. OBJECTIVE: To investigate the magnitude and repeatability of the asymmetry ratio (AR) of oVEMPs in response to low-frequency bone conducted vibration (BCV) applied to the forehead and vertex in a healthy population. METHODS: 20 healthy subjects were tested three times by stimulating with 125 Hz BCV at the forehead and the vertex. The first two tests were performed …with the subject remaining in the examining room and the electrodes in place. After a short break, a third test was performed with a new set of electrodes. The AR was calculated for each test based on the evoked oVEMPs responses from the left and the right side. The AR magnitude, variance and repeatability coefficients were evaluated to determine which of the two stimulus sites is best suited in clinical use. RESULTS: Stimulation at the forehead resulted in a statistically significant lower median AR compared to the vertex. The forehead had lower repeatability coefficients, and statistically significantly lower variances. CONCLUSIONS: This study indicates that the forehead is a better stimulation site than the vertex for low-frequency BCV in clinical use. Show more

Keywords: oVEMP, bone conducted vibration, low-frequency, forehead, vertex, repeatability, asymmetry ratio

DOI: 10.3233/VES-160584

Citation: Journal of Vestibular Research, vol. 26, no. 3, pp. 303-309, 2016

Authors: Uffer, Denis S. | Hegemann, Stefan C.A.

Article Type: Research Article

Abstract: OBJECTIVE: To determine whether patients with acute unilateral peripheral vestibulopathy (PVP), often called “vestibular neuritis/neuronitis or neuropathy” (VN) have a vestibular lesion pattern consistent with the distribution of the neurological afferents. BACKGROUND: Much is known about the clinical nature of PVP, however less so about its etiology and pathogenesis. Due to the frequency with which VN is used to describe the syndrome, an inflammation of the vestibular nerve or of one of its branches is often assumed to be the cause of PVP, though there is insufficient data so far to support this assumption. METHODS: …We conducted a retrospective study of 25 patients who had presented to our clinic with PVP and had all vestibular receptor organs tested shortly after start of symptoms. We analysed their vestibular lesion patterns in order to determine whether they were consistent with the neuritis hypothesis (NH). RESULTS: The lesion patterns varied conspicuously. 76% did not follow an innervation pattern, thereby contradicting the NH and only 24% had a lesion pattern that either definitely (16%) or probably (8%) supported the NH. CONCLUSION: These results should remind us to be careful before jumping to quick conclusions about the pathogenetic nature of PVP. With any reason to question VN as the only cause of PVP, we should reconsider the treatment approach to PVP. If the cause probably or even possibly lies inside the vestibular labyrinth, an intratympanic steroid injection might prove to be a more effective measure, even in first-line treatment. If the etiology is unsure, a combination of systemic and intratympanic steroid treatment may be adequate. Show more

Keywords: Vestibular neuritis, peripheral vestibulopathy, lesion pattern, etiology, receptor testing

DOI: 10.3233/VES-160581

Citation: Journal of Vestibular Research, vol. 26, no. 3, pp. 311-317, 2016

Authors: Söhsten, Eliane | Bittar, Roseli S.M. | Staab, Jeffrey P.

Article Type: Research Article

Abstract: BACKGROUND/OBJECTIVE: Persistent postural-perceptual dizziness (PPPD) was defined by expert consensus for the forthcoming International Classification of Diseases, 11th edition. Its diagnostic criteria were derived from phobic postural vertigo and chronic subjective dizziness. Two key symptoms are postural unsteadiness and visually induced dizziness. We observed that patients with PPPD tended to perform poorly on multiple conditions of the EquiTest® Sensory Organization Test (SOT) and sought to investigate this phenomenon systematically. METHODS: We examined cross-sectional, pair-wise group differences in mean scores from SOT conditions 1–6 and composite scores among 20 patients with PPPD, 15 patients recovered from acute …vestibular syndromes, and 15 normal individuals (all female, 43 ± 9 years old). We also compared proportions of patients in each group with abnormal sensory analyses, and poor performance across multiple conditions. RESULTS: Patients with PPPD had significantly lower mean scores than normal individuals on conditions 2–6 and the composite, and lower than recovered patients on conditions 2–3. Recovered patients had significantly lower mean scores than normal individuals on conditions 4–6 and the composite. Patients with PPPD had the greatest likelihood of abnormal sensory analyses. CONCLUSIONS: Patients with PPPD had difficulties with postural control across multiple sensory challenges, consistent with postulated neurophysiologic mechanisms of this condition. Show more

Keywords: Posturography, Sensory Organization Test, vestibular function tests, persistent postural-perceptual dizziness, anxiety

DOI: 10.3233/VES-160583

Citation: Journal of Vestibular Research, vol. 26, no. 3, pp. 319-326, 2016

Authors: Luis, L. | Costa, J. | Muñoz, E. | de Carvalho, M. | Carmona, S. | Schneider, E. | Gordon, C.R. | Valls-Solé, J.

Article Type: Research Article

Abstract: OBJECTIVE: Although the diagnosis of inherited ataxias is ultimately genetic, this usually means an extensive and expensive process. This justifies the search for distinct clinical signs that may potentially help orient molecular diagnosis. METHODS: We explored the vestibulo-ocular reflex (VOR) with the video Head Impulse Test in patients diagnosed with spinocerebellar ataxia (SCA) type 3 (n  = 15), type 1 (n  = 4) and type 2 (n  = 4), Friedreich’s ataxia (FA) (n  = 9) and healthy controls (n  = 40). We estimated the latency, regression (VORr) and instantaneous VOR gain at 40, 60 and 80 ms (VOR40, VOR60 and VOR80), and determined …the latency, peak-velocity and occurrence rate of catch-up saccades triggered with head-impulses. RESULTS: VOR latency was higher in FA (p  < 0.001) and SCA3 (p  = 0.02) as compared to controls, discriminating FA from other ataxic patients with an overall diagnostic accuracy of 88%. VORr, VOR40 and VOR60 were significantly lower in FA and SCA3 (p  < 0.01). VOR80 was only significantly lower than controls in SCA3 (p  < 0.01), discriminating these from other ataxic patients with an overall diagnostic accuracy of 78%. Covert saccades were only triggered in SCA3 but with low occurrence rate and peak velocity (11.1 ± 28.5% and 77.50 ± 15.30°/s) whereas overt saccades were present in all groups. VORr gain showed a negative correlation with disease severity evaluated with SARA (Spearman r  = –0.46, p  = 0.01). CONCLUSIONS: vHIT provides phenotypic information that differentiates these autosomal ataxias and can serve as a strategy to orient genetic diagnosis. A correlation between VOR and SARA raises the possibility of using VOR gain as a neurophysiologic biomarker for disease severity. Show more

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

DOI: 10.3233/VES-160579

Citation: Journal of Vestibular Research, vol. 26, no. 3, pp. 327-334, 2016

Authors: Horii, Arata | Imai, Takao | Kitahara, Tadashi | Uno, Atsuhiko | Morita, Yuka | Takahashi, Kuniyuki | Inohara, Hidenori

Article Type: Research Article

Abstract: BACKGROUND: Psychiatric comorbidities are an important issue in the treatment of chronic dizziness patients. OBJECTIVE: To test the correlation between psychiatric status and subjective handicaps and to examine the effects of milnacipran on handicaps. METHODS: Hospital anxiety and depression scale (HADS) and handicaps were assessed by a questionnaire before and eight weeks after milnacipran treatment (50 mg/day) in 29 consecutive patients with chronic dizziness. Effects of milnaciplan were compared with fluvoxamine (200 mg/day). RESULTS: A significant correlation was found between anxious and depressive scale scores and also between HADS and handicaps. Duration of symptoms was …longer in the anxious/depressive group (HADS≧13) than in the non-anxious/depressive group. Handicaps and HADS were significantly decreased after treatment only in the anxious/depressive group. There were no overall differences in drug effects between milnaciplan and fluvoxamine. However, the rate of patients with a post/pre ratio of handicaps <80% was higher in milnaciplan group compared with the fluvoxamine group. CONCLUSIONS: Not only anxiety disorders but also depression should be considered as comorbid psychiatric disorders in patients with chronic dizziness. Dizzy patients with psychiatric comorbidities have a longer duration of symptoms and more handicaps than those without psychiatric disorders. Milnacipran may be chosen as a treatment for patients with chronic dizziness with comorbid psychiatric disorders in case of and insufficient response to SSRIs. Show more

Keywords: Chronic dizziness, SNRI, milnacipran, anxiety, depression

DOI: 10.3233/VES-160582

Citation: Journal of Vestibular Research, vol. 26, no. 3, pp. 335-340, 2016