Journal of Vestibular Research - Volume 32, issue 6

Authors: Seemungal, Barry M. | Agrawal, Yuri | Bisdorff, Alexander | Bronstein, Adolfo | Cullen, Kathleen E. | Goadsby, Peter J. | Lempert, Thomas | Kothari, Sudhir | Lim, Phang Boon | Magnusson, Måns | Marcus, Hani J. | Strupp, Michael | Whitney, Susan L.

Article Type: Research Article

Abstract: This paper describes the Bárány Society Classification OverSight Committee (COSC) position on Cervical Dizziness, sometimes referred to as Cervical Vertigo. This involved an initial review by a group of experts across a broad range of fields, and then subsequent review by the Bárány Society COSC. Based upon the so far published literature, the Bárány Society COSC takes the view that the evidence supporting a mechanistic link between an illusory sensation of self-motion (i.e. vertigo – spinning or otherwise) and neck pathology and/or symptoms of neck pain - either by affecting the cervical vertebrae, soft tissue structures or cervical nerve roots …- is lacking. When a combined head and neck movement triggers an illusory sensation of spinning, there is either an underlying common vestibular condition such as migraine or BPPV or less commonly a central vestibular condition including, when acute in onset, dangerous conditions (e.g. a dissection of the vertebral artery with posterior circulation stroke and, exceedingly rarely, a vertebral artery compression syndrome). The Committee notes, that migraine, including vestibular migraine, is by far, the commonest cause for the combination of neck pain and vestibular symptoms. The committee also notes that since head movement aggravates symptoms in almost any vestibular condition, the common finding of increased neck muscle tension in vestibular patients, may be linked as both cause and effect, to reduced head movements. Additionally, there are theoretical mechanisms, which have not been explored, whereby cervical pain may promote vaso-vagal, cardio-inhibitory reflexes and hence by presyncopal mechanisms, elicit   transient   disorientation and/or imbalance. The committee accepts that further research is required to answer the question as to whether those rare cases in which neck muscle spasm is associated with a vague sense of spatial disorientation and/or imbalance, is indeed linked to impaired neck proprioception. Future studies should ideally be placebo controlled and double-blinded where possible, with strict inclusion and exclusion criteria that aim for high specificity at the cost of sensitivity. To facilitate further studies in “cervical dizziness/vertigo”, we provide a narrative view of the important confounds investigators should consider when designing controlled mechanistic and therapeutic studies. Hence, currently, the Bárány COSC refrains from proposing any preliminary diagnostic criteria for clinical use outside a research study. This position may change as new research evidence is provided. Show more

Keywords: Cervical, cervicogenic, neck, dizziness, vertigo, vestibular

DOI: 10.3233/VES-220202

Citation: Journal of Vestibular Research, vol. 32, no. 6, pp. 487-499, 2022

Authors: Lim, Koeun | Teaford, Max | Merfeld, Daniel M.

Article Type: Research Article

Abstract: BACKGROUND: Previous research suggested that the method of adjustment and forced choice variants of the subjective visual vertical (SVV) produce comparable estimates of both bias and variability. However, variants of the SVV that utilize a method of adjustment procedure are known to be heavily influenced by task parameters, including the stimulus rotation speed, which was not accounted for in previous SVV research comparing the method of adjustment to forced-choice. OBJECTIVE: The aim of the present study was to determine if (1) the SVV with a forced-choice procedure produces both bias and variability estimates that are comparable to those …obtained using a method of adjustment procedure, (2) to see if rotation speed impacts the comparability of estimates and (3) quantify correlations between the estimates produced by different procedures. METHODS: Participants completed a variant of the SVV which utilized a forced-choice procedure as well as two variants of the SVV using a method of adjustment procedure with two different rotation speeds (6°/s and 12°/s). RESULTS: We found that the bias estimates were similar across all three conditions tested and that the variability estimates were greater in the SVV variants that utilized a method of adjustment procedure. This difference was more pronounced when the rotation speed was slower (6°/s). CONCLUSIONS: The results of this study suggest that forced-choice and method of adjustment methodologies yield similar bias estimates and different variability estimates. Given these results, we recommend utilizing forced-choice procedures unless (a) forced-choice is not feasible or (b) response variability is unimportant. We also recommend that clinicians consider the SVV methods when interpreting a patient’s test results, especially for variability metrics. Show more

Keywords: Subjective Visual Vertical, Gravitational Vertical, Vestibular, Visual-Vestibular Integration

DOI: 10.3233/VES-220046

Citation: Journal of Vestibular Research, vol. 32, no. 6, pp. 501-510, 2022

Authors: Alexander, Amy | Hattrup, Nicholas | Gerkin, Richard | Pardini, Jamie E.

Article Type: Research Article

Abstract: BACKGROUND: The Gaze Stabilization Test (GST) assesses vestibulo-ocular reflex (VOR) function by determining the maximum head velocity at which an individual can accurately perceive a fixed-size visual target. There is limited information about gaze stability performance in youth athletes. OBJECTIVE: The purpose of this study is to describe baseline performance of athletes ages 17 years and under on a computerized GST and explore the influence of demographic characteristics on performance. METHODS: Baseline GST and demographic data were acquired via retrospective chart review. RESULTS: The sample included 106 athletes aged 8 to 17 years (mean …13.9 years±1.79; 78% male). The median values for baseline GST function were 180 (IQR: 150–210) degrees per second (d/sec) in the leftward direction, and 190 d/sec (IQR: 160–220) in the rightward direction. There were no significant effects of sex/gender or concussion history on GST performance. CONCLUSIONS: The GST is one of many tools available for clinicians to use in a multi-modal approach to concussion management. Understanding how healthy young athletes perform can assist clinicians in determining vestibular impairment, formulating the exercise prescription, and estimating physiologic recovery. Show more

DOI: 10.3233/VES-210111

Citation: Journal of Vestibular Research, vol. 32, no. 6, pp. 511-515, 2022

Authors: Cleworth, Taylor W. | Kessler, Paul | Honegger, Flurin | Carpenter, Mark G. | Allum, John H.J.

Article Type: Research Article

Abstract: BACKGROUND AND AIMS: An acute unilateral peripheral vestibular deficit (aUPVD) due to vestibular neuritis causes deficient yaw axis vestibular ocular reflex (VOR) gains. Using video head impulse tests (vHITs), we examined phasic and tonic velocity gains of the VOR over time to determine if these differed at onset and during subsequent improvement. METHODS: The VOR responses of 61 patients were examined within 5 days of aUPVD onset, and 3 and 7 weeks later using vHIT with mean peak yaw angular velocities of 177°/s (sd 45°/s) and mean peak accelerations of 3660°/s2 (sd 1300°/s2 ). The phasic velocity …or acceleration gain (aG) was computed as the ratio of eye to head velocity around peak head acceleration, and the tonic velocity gain (vG) was calculated as the same ratio around peak head velocity. RESULTS: aG increased ipsi-deficit from 0.45 at onset to 0.67 at 3 weeks and 7 weeks later, and vG increased ipsi-deficit from 0.29 to 0.51 and 0.53, respectively, yielding a significant time effect (p  < 0.001 ). Deficit side aG was significantly greater (p  < 0.001 ) than vG at all time points. Deficit side gain improvements in aG and vG were similar. Contra-deficit aG increased from 0.86 to 0.95 and 0.94 at 3 weeks and 7 weeks, and vG contra-deficit increased from 0.84, to 0.89 and 0.87, respectively, also yielding a significant time effect (p  = 0.004 ). Contra-deficit aG and vG were normal at 3 weeks. Mean canal paresis values improved from 91% to 67% over the 7 weeks. CONCLUSIONS: Acceleration and velocity VOR gains on the deficit side are reduced by aUPVD and improve most in the first 3 weeks after aUPVD onset. Deficit side aG is consistently higher than deficit side vG following an aUPVD, suggesting that acceleration rather than velocity sensitive compensatory neural mechanisms are predominant during the compensation process for aUPVD. Show more

Keywords: Vestibular loss, vestibular neuritis, head impulse test, vestibular ocular reflex, neural compensation

DOI: 10.3233/VES-210153

Citation: Journal of Vestibular Research, vol. 32, no. 6, pp. 517-527, 2022

Authors: Alsubaie, Saud F. | Whitney, Susan L. | Furman, Joseph M. | Marchetti, Gregory F. | Sienko, Kathleen H. | Sparto, Patrick J.

Article Type: Research Article

Abstract: BACKGROUND: A method for prescribing the difficulty or intensity of standing balance exercises has been validated in a healthy population, but requires additional validation in individuals with vestibular disorders. OBJECTIVE: This study validated the use of ratings of perceived difficulty for estimation of balance exercise intensity in individuals with vestibular disorders. METHODS: Eight participants with a confirmed diagnosis of a vestibular disorder and 16 healthy participants performed two sets of 16 randomized static standing exercises across varying levels of difficulty. Root Mean Square (RMS) of trunk angular velocity was recorded using an inertial measurement unit. In …addition, participants rated the perceived difficulty of each exercise using a numerical scale ranging from 0 (very easy) to 10 (very difficult). To explore the concurrent validity of rating of perceived difficulty scale, the relationship between ratings of perceived difficulty and sway velocity was assessed using multiple linear regression for each group. RESULTS: The rating of perceived difficulty scale demonstrated moderate positive correlations RMS of trunk velocity in the pitch (r  = 0.51, p  < 0.001) and roll (r  = 0.73, p  < 0.001) directions in participants with vestibular disorders demonstrating acceptable concurrent validity. CONCLUSIONS: Ratings of perceived difficulty can be used to estimate the intensity of standing balance exercises in individuals with vestibular disorders. Show more

Keywords: Rating of Perceived Difficulty, dizziness, postural control

DOI: 10.3233/VES-210146

Citation: Journal of Vestibular Research, vol. 32, no. 6, pp. 529-540, 2022

Authors: Souza, Wagner Henrique | Grove, Colin R. | Gerend, Patricia L. | Ryan, Cynthia | Schubert, Michael C.

Article Type: Research Article

Abstract: BACKGROUND: Geographical location is known to affect health outcomes; however, evidence regarding whether location affects healthcare for persons suspected to have vestibular dysfunction is lacking. OBJECTIVE: To investigate whether location affects healthcare seeking and outcomes for adults with symptoms of vestibular pathology. METHODS: We assessed for regional disparities associated with demographics, diagnosis, chronological factors, and financial expenditures from Americans who participated in the Vestibular Disorders Association registry (N = 905, 57.4±12.5 years, 82.7% female, 94.8% White, and 8.1% Hispanic or Latino). Respondents were grouped per geographical regions defined by the United States Census Bureau. RESULTS: There …were no significant between-region differences for age (p  = 0.10), sex (p  = 0.78), or ethnicity (p  = 0.24). There were more Asian respondents in the West versus the Midwest (p  = 0.05) and more Black respondents in the South versus the West (p  = 0.05). The time to first seek care was shorter in the Northeast (17.3 [SD = 49.5] weeks) versus the South (42.4 [SD = 83.7] weeks), p  = 0.015. The time from the first healthcare visit to receiving a final diagnosis was shorter in the Northeast (46.5 [SD = 75.4] weeks) versus the South (68.9 [SD = 89.7] weeks), p  = 0.015. Compared to the Midwest, fewer respondents in the Northeast reported “no” out-of-pocket financial impact, p  = 0.039. CONCLUSIONS: Geographical location affects healthcare seeking and outcomes for persons suspected to have vestibular dysfunction. Show more

Keywords: Vestibular dysfunction, vestibular diagnosis, dizziness, balance, vertigo

DOI: 10.3233/VES-220022

Citation: Journal of Vestibular Research, vol. 32, no. 6, pp. 541-551, 2022