Journal of Vestibular Research - Volume 33, issue 3

Authors: Altena, Ellemarije | Buguet, Estelle | Higginson, Caitlin | Lee, Elliott | Douglass, Alan | Spitale, Naomi | Robillard, Rebecca

Article Type: Research Article

Abstract: OBJECTIVE/BACKGROUND: Though sleep problems (apnea, insomnia) and related daytime symptoms (fatigue, anxiety, depression) have been associated with vestibular problems (falls, dizziness), it is not well known which particular sleep features relate to vestibular problems. We thus assessed symptoms of vestibular problems in patients visiting a sleep clinic and evaluated how they were associated with objective sleep parameters derived from polysomnography and relevant daytime symptoms. PATIENTS/METHODS: The polysomnography data of thirty-one patients (61% female, between 20 and 79 years of age) who were referred for clinical sleep assessment was collated with subjective measures of symptoms linked to vestibular problems …(rated on the Situational Characteristics Questionnaire), as well as fatigue, anxiety and depression symptoms. Multiple linear regression was used to identify factors associated with vestibular symptoms, including analyses adjusted for age, sex, medication use and total sleep time. RESULTS: A higher percentage of REM sleep and more severe anxiety symptoms were independently associated with more severe vestibular symptoms, which survived adjusted analyses. Other sleep stages, as well as as sleep efficiency, apnea-hypopnea index and oxygen saturation were not significantly related to vestibular symptoms. CONCLUSIONS: These results point at vestibular symptoms as possible important and overlooked correlates of variations in sleep architecture in individuals with sleep complaints. Though replication is needed to confirm findings from this limited sample, the results highlight the importance of assessing vestibular symptoms in people with sleep complaints. In particular, further investigations will need to address the potential implication of REM sleep for vestibular functions and the directionality of this relation. Show more

Keywords: Vestibular functions, sleep, fatigue, mental health

DOI: 10.3233/VES-220113

Citation: Journal of Vestibular Research, vol. 33, no. 3, pp. 165-172, 2023

Authors: Büki, Bela | Migliaccio, Americo A.

Article Type: Research Article

Abstract: BACKGROUND: During near-viewing, the vestibulo-ocular reflex (VOR) response/gain increases to compensate for the relatively larger translation of the eyes with respect to the target. OBJECTIVE: To review vergence-mediated gain increase (VMGI) testing methods stimuli and responses (latency and amplitude), peripheral/central pathways and clinical relevance. METHODS: The authors discuss publications listed in PUBMED since 1980 in the light of their own studies. RESULTS: The VMGI can be measured during rotational, linear and combined head accelerations. It has short-latency, non-compensatory amplitude, and relies on irregularly discharging peripheral afferents and their pathways. It is driven by a …combination of perception, visual-context and internal modelling. CONCLUSIONS: Currently, there are technical barriers that hinder VMGI measurement in the clinic. However, the VMGI may have diagnostic value, especially with regards to measuring otolith function. The VMGI also may have potential value in rehabilitation by providing insight about a patient’s lesion and how to best tailor a rehabilitation program for them, that potentially includes VOR adaptation training during near-viewing. Show more

Keywords: Vergence, vestibuloocular reflex (VOR), gain increase, galvanic, gentamicin, vestibular neuritis, vestibular adaptation, irregular vestibular afferents, near-viewing

DOI: 10.3233/VES-220133

Citation: Journal of Vestibular Research, vol. 33, no. 3, pp. 173-186, 2023

Authors: Kučerová, Klára | Šafářová, Marcela | Illinger, Vojtěch | Koutná, Sára | Šonská, Kristýna | Levínská, Kateřina | Čakrt, Ondřej

Article Type: Research Article

Abstract: BACKGROUND: Idiopathic scoliosis (IS) is a structural spinal deformity that can affect the position of the head. One of the etiological hypotheses is that it can be caused by dysfunction of the vestibular system, which can cause abnormal perception of subjective visual vertical (SVV). OBJECTIVE: This study aimed to evaluate the differences in head position and its possible correlation with the perception of SVV in children with IS. METHODS: We examined 37 patients with IS and 37 healthy individuals. The position of the head was evaluated from digital photographs, where we compared the coronal head tilt …and the coronal shoulder angle. Measurement of SVV perception was performed using the Bucket method. RESULTS: Coronal head tilt values were significantly different between the groups (median 2.3° [interquartile range 1.8–4.2] vs 1.3° [0.9–2.3], p  = 0.001; patients vs. controls). There was a significant difference in SVV between the groups (2.33° [1.40–3.25] vs 0.50° [0.41–1.10], p  < 0.001; patients vs controls). There was a correlation between the side of head tilt and the side of SVV in patients with IS (χ2  = 5.6, p  = 0.02). CONCLUSIONS: Patients with IS had a greater head tilt in the coronal plane and impaired SVV perception. Show more

Keywords: Head tilt, vestibular function, spine deformity, space orientation

DOI: 10.3233/VES-230005

Citation: Journal of Vestibular Research, vol. 33, no. 3, pp. 187-193, 2023

Authors: Nouini, Adrâa | Mat, Quentin | Van Nechel, Christian | Bostan, Alionka | Dachy, Bernard | Ourtani, Anissa

Article Type: Research Article

Abstract: BACKGROUND: The management of dizziness and vertigo can be challenging in the emergency department (ED). It is important to rapidly diagnose vertebrobasilar stroke (VBS), as therapeutic options such as thrombolysis and anticoagulation require prompt decisions. OBJECTIVE: This study aims to assess the rate of misdiagnosis in patients with dizziness caused by VBS in the ED. METHODS AND RESULTS: The cohort was comprised of 66 patients with a mean age 56 years; 48% were women and 52% men. Among dizzy patients, 14% had VBS. We used Cohen’s kappa test to quantify the agreement between two raters –namely, …emergency physicians and neurologists –regarding the causes of dizziness in the ED. The Kappa value was 0.27 regarding the final diagnosis of central vertigo disorders and VBS, thus showing the low agreement. We used the χi2 test to show the association between the presence of two or more cardiovascular risk factors and admission to the stroke unit (p  = 0.015 ). CONCLUSION: There is a substantial rate of misdiagnosis in patients with dizziness caused by VBS in the ED. To reduce the number of missing diagnoses of VBS in the future, there is a need to train emergency physicians in neurovestibular examinations, including the HINTS examination for acute vestibular syndrome (AVS) and the Dix-Hallpike (DH) maneuver for episodic vestibular syndrome. Using video head impulse test could help reduce the rate of misdiagnosis of VBS in the ED. Show more

Keywords: Dizziness, emergency department, vertebrobasilar stroke, misdiagnosis, head impulse test.

DOI: 10.3233/VES-220109

Citation: Journal of Vestibular Research, vol. 33, no. 3, pp. 195-202, 2023

Authors: Peng, Hao | Wang, Liyi | Song, Haitao | Gao, Bo | Yang, Yi | Lyu, Fan

Article Type: Research Article

Abstract: BACKGROUND: The etiology and mechanism of persistent geotropic horizontal direction-changing positional nystagmus (DCPN) are still unclear. Whether this pattern of nystagmus is a subtype of benign paroxysmal positional vertigo (BPPV) remains controversial. OBJECTIVE: The goal of this study was to observe the clinical characteristics of persistent geotropic horizontal DCPN involving the lateral semicircular canal. METHODS: The analysis was performed to participants with episodic positional vertigo in our clinic from 2014 to 2021. Participants were included via positional test. We observed and summarized the distribution data, vertigo history, follow-up tests, and recurrence situations of 189 persistent geotropic …horizontal DCPN participants. RESULTS: The mean age at the first time showing of persistent geotropic horizontal DCPN was 56±14.7 and more women than men were affected by persistent geotropic horizontal DCPN (female-to-male ratio 2.4 : 1). Overall, 58.7% (57/94) of participants who came for the first-week follow-up test were asymptomatic. Thirty-three participants experienced recurrence (female-to-male ratio: 4.5 : 1). Fifty-three (28.0%) participants experienced the conversion of the patterns of DCPN in the history, the follow-up tests and the recurrence compared to the first showing of persistent geotropic horizontal DCPN. 24(12.1%) participants still experienced persistent geotropic horizontal DCPN attack in the follow-up tests and the recurrences without benign paroxysmal positional vertigo history. CONCLUSION: Persistent geotropic horizontal DCPN affected more women than men. The persistent geotropic horizontal DCPN that with conversion to transient geotropic horizontal DCPN or to persistent apogeotropic horizontal DCPN might be a subtype of BPPV or in a stage of BPPV process. However, the persistent geotropic horizontal DCPN without conversion might be an independent disease that is not related to BPPV. Show more

Keywords: Light cupula, benign paroxysmal positional vertigo, positional nystagmus of direction changing type, light debris, cupulolithiasis, canalolithiasis

DOI: 10.3233/VES-220086

Citation: Journal of Vestibular Research, vol. 33, no. 3, pp. 203-211, 2023

Authors: Lubetzky, Anat V. | Harel, Daphna | Krishnamoorthy, Santosh | Fu, Gene | Morris, Brittani | Medlin, Andrew | Wang, Zhu | Perlin, Ken | Roginska, Agnieszka | Cosetti, Maura | Kelly, Jennifer

Article Type: Research Article

Abstract: Objective: The purpose of this study was to determine the extent to which sensory integration strategies via head sway, derived from a Head-Mounted Display (HMD), change in people with vestibular disorders following vestibular rehabilitation. Design: Randomized Controlled Trial Setting: Vestibular Rehabilitation Clinic Participants: Thirty participants with vestibular dysfunction and 21 age-matched controls. Main Outcome Measures: Participants experienced two levels of visual surround (static or moving ‘stars’, front to back at 0.2 Hz, 32 mm) and white noise (none or rhythmic) while their head sway was recorded via the HTC Vive. We quantified head sway …via Directional Path (DP) and Root Mean Square Velocity (RMSV) in 5 directions: anterior-posterior, medio-lateral, pitch, yaw, and roll and Power Spectral Density in low (PSD 1), medium (PSD 2) and high (PSD 3) frequencies in the anterior-posterior direction. Interventions: Participants performed the assessment prior to being randomized into 8-weeks of contextual sensory integration training in virtual reality or traditional vestibular rehabilitation and once again following completion of the intervention. Controls performed the assessment once. Twelve participants dropped out, half due to covid lock-down. We applied an intention to treat analysis. Results: We observed significant increases in AP DP, RMSV and all PSDs with change in visual level. Both intervention groups significantly decreased medio-lateral, pitch and roll DP and RMSV and anterior-posterior PSD 2 with no group differences. Vestibular participants were significantly higher than controls on all outcomes pre rehabilitation. Post rehabilitation they were only significantly higher on PSD 2. Sound was not a significant predictor of head sway in this protocol. Conclusions: Head sway decreased following vestibular rehabilitation regardless of visual load or type of intervention applied. This change was measured via head kinematics derived from a portable HMD which can serve as a sensitive in-clinic assessment for tracking improvement over time Show more

Keywords: Balance, postural control, head kinematics, dizziness, virtual reality

DOI: 10.3233/VES-220107

Citation: Journal of Vestibular Research, vol. 33, no. 3, pp. 213-226, 2023

Authors: Micarelli, Alessandro | Viziano, Andrea | Alessandrini, Marco

Article Type: Article Commentary

DOI: 10.3233/VES-180664

Citation: Journal of Vestibular Research, vol. 33, no. 3, pp. 227-228, 2023

Authors: Rosiak, Oskar | Jozefowicz-Korczynska, Magdalena

Article Type: Article Commentary

DOI: 10.3233/VES-180665

Citation: Journal of Vestibular Research, vol. 33, no. 3, pp. 229-230, 2023