Journal of Vestibular Research - Volume Pre-press, issue Pre-press

Authors: Du, Yi | Liu, Xingjian | Ren, Lili | Wu, Nan | Guo, Weiwei | Wu, Ziming | Yang, Shiming

Article Type: Research Article

Abstract: BACKGROUND: Unapparent saccades in video head impulse test (vHIT) are usually present in MD patients but tend to be ignored by the clinician. The result of vHIT is constantly questioned in MD patients due to a lack of uniform metrics. A more effective indicator is needed for indicating MD’s pathological progress. OBJECTIVES: To get a comprehensive understanding of the nature and usability of saccades in different MD stages. METHODS: 118 patients diagnosed with unilateral MD were recruited in this study. Patient history, audiological examination, caloric test, vHIT were performed. We proposed ‘raw saccades’ to represent all …showed wave peaks behind the head peak and named saccades by their appearance sequence: 1st saccade, 2nd saccade and 3rd saccade. An exploratory saccade analysis was executed to investigate the effectiveness of saccade attributes in identifying MD stages. RESULTS: MD patients have greater detectable 1st saccade than PR score as well as 2nd saccade. The time and velocity of the 1st saccade show high interaural variability (p  = 0.028, p  = 0.000 respectively). No statistical difference concerning the vHIT gain, PR score and 2nd saccade among stages could be recognized on both affected and contralateral sides. Multiple comparisons show the affected 1st saccade velocity and affected 1st saccade absolute velocity have stage-difference. At late stages (3&4), the affected 1st saccade is manifested as a speed increase, and this measure shows a relatively high correlation with MD stages compared to other vestibular indicators. CONCLUSION: The 1st saccade velocity on the affected side could indicate the MD disease process and severity. Show more

Keywords: PR score, vHIT, Meniere’s disease, caloric test, saccades

DOI: 10.3233/VES-201642

Citation: Journal of Vestibular Research, vol. Pre-press, no. Pre-press, pp. 1-10, 2021

Authors: Fröhlich, L. | Wilke, M. | Plontke, S.K. | Rahne, T.

Article Type: Research Article

Abstract: BACKGROUND: Treatment with a cochlear implant (CI) poses the risk of inducing a behaviorally unmeasurable air-bone gap leading to false negative absence of cervical and ocular vestibular evoked myogenic potentials (cVEMPs, oVEMPs) to air conducted sound (ACS). OBJECTIVE: To investigate VEMP response rates to ACS and bone conducted vibration (BCV) in CI patients and the applicability of the B81 transducer for BCV stimulation. METHODS: Prospective experimental study including unilateral CI patients, measuring cVEMPs and oVEMPs to ACS and to BCV, comparing response rates, signed asymmetry ratios, latencies, and amplitudes. RESULTS: Data of 13 CI …patients (mean age 44±12 years) were analyzed. For the CI side, oVEMP and cVEMP response rates were significantly higher for BCV (77%cVEMP, 62%oVEMP) compared to ACS (23%cVEMP, 8%oVEMP). For the contralateral side, no difference between response rates to ACS (85%cVEMP, 69%oVEMP) and BCV (85%cVEMP, 77%oVEMP) was observed. Substantially higher asymmetries were observed for ACS (–88±23%for cVEMPs, –96±11%for oVEMPs) compared to BCV (–12±45%for cVEMPs, 4±74%for oVEMPs). CONCLUSIONS: BCV is an effective stimulus for VEMP testing in CI patients. The B81 is a feasible stimulator. Show more

Keywords: Cochlear implant, vestibular function, VEMP, air conduction, bone conduction, transducer, air-bone gap, asymmetry

DOI: 10.3233/VES-210028

Citation: Journal of Vestibular Research, vol. Pre-press, no. Pre-press, pp. 1-11, 2021

Authors: Verdecchia, Daniel H. | Hernandez, Daniel | Andreu, Mauro F. | Salzberg, Sandra E. | Whitney, Susan L.

Article Type: Research Article

Abstract: BACKGROUND: Visual vertigo (VV), triggered by environmental or dynamic visual stimuli and repetitive visual patterns, can affect daily life activities. The Visual Vertigo Analogue Scale (VVAS) is a valid and reliable self-administered questionnaire to assess VV, which has been culturally adapted to the Argentine population but has not been validated. OBJECTIVE: To validate the Argentine version of VVAS (VVAS-A) by confirming its psychometric properties in patients with vestibular disorders. METHODS: Vestibular patients (n  = 82) completed the VVAS-A and the Dizziness Handicap Inventory Argentine version (DHI-A) during their initial visit and one week later. The VVAS-A's internal …consistency, test retest reliability, ceiling and floor effects, and construct validity were determined. Test-retest data (n  = 71) was used to calculate reliability using the intraclass correlation coefficient (ICC 2.1). RESULTS: A ceiling effect was observed in 12 patients (14.6%). Internal consistency was acceptable (Cronbach’s alpha: 0.91). The reliability was r  = 0.764 [CI 95%: 0.7 –0.86]). Correlations were observed between the VVAS-A and the total DHI-A score (rho = 0.571), the DHI-A physical subscale (rho: 0.578), and DHI-A functional and emotional subscales of the DHI-A (rho: 0.537 and 0.387, respectively). CONCLUSION: VVAS-A is a valid, reliable tool to evaluate VV in patients with vestibular disorders. Show more

Keywords: Vertigo, questionnaire, validation studies, psychometric properties, Argentina

DOI: 10.3233/VES-210062

Citation: Journal of Vestibular Research, vol. Pre-press, no. Pre-press, pp. 1-9, 2021

Authors: Fellmann, Jonas | Bächinger, David | Dalbert, Adrian | Röösli, Christof | Huber, Alexander | Wettstein, Vincent G.

Article Type: Research Article

Abstract: BACKGROUND: Surgical treatment of vestibular schwannoma (VS) leads to acute ipsilateral vestibular loss if there is residual vestibular function before surgery. To overcome the sequelae of acute ipsilateral vestibular loss and to decrease postoperative recovery time, the concept of preemptive vestibular ablation with gentamicin and vestibular prehabilitation before surgery has been developed (“vestibular prehab”). OBJECTIVE: Studying postural stability during walking and handicap of dizziness over a 1-year follow-up period in VS patients undergoing vestibular prehab before surgical treatment of VS. METHODS: A retrospective review of consecutive patients with a diagnosis of a VS undergoing surgical therapy …from June 2012 to March 2018 was performed. All patients were included with documentation of the length of hospital duration and the Dizziness Handicap Inventory (DHI) and the Functional Gait Assessment (FGA) assessed preoperatively as well as 6 weeks and 1 year postoperatively. RESULTS: A total 68 VS patients were included, of which 29 patients received preoperative vestibular ablation by intratympanic injection of gentamicin. Mean VS diameter was 20.2 mm (SD 9.4 mm) and mean age at surgery was 49.6 years (SD 11.5 years). Vestibular prehab had no effect on DHI and FGA at any time point studied. CONCLUSIONS: We found no effect of vestibular prehab on postural stability during walking and on the handicap of dizziness. These findings add to the body of knowledge consisting of conflicting results of vestibular prehab. Therefore, vestibular prehab should be applied only in selected cases in an experimental setting. Show more

Keywords: Balance, dizziness, prehab, dizziness handicap inventory, functional gait assessment, gentamicin, rehabilitation, surgery, vestibular ablation

DOI: 10.3233/VES-200023

Citation: Journal of Vestibular Research, vol. Pre-press, no. Pre-press, pp. 1-8, 2021

Authors: Pomante, A. | Selen, L.P.J. | Romano, F. | Bockisch, C.J. | Tarnutzer, A.A. | Bertolini, G. | Medendorp, W.P.

Article Type: Research Article

Abstract: The percept of vertical, which mainly relies on vestibular and visual cues, is known to be affected after sustained whole-body roll tilt, mostly at roll positions adjacent to the position of adaptation. Here we ask whether the viewing of panoramic visual cues during the adaptation further influences the percept of the visual vertical. Participants were rotated in the frontal plane to a 90° clockwise tilt position, which was maintained for 4-minutes. During this period, the subject was either kept in darkness, or viewed panoramic pictures that were either veridical (aligned with gravity) or oriented along the body longitudinal axis. Errors …of the subsequent subjective visual vertical (SVV), measured at various tilt angles, showed that the adaptation effect of panoramic cues is local, i.e. for a narrow range of tilts in the direction of the adaptation angle. This distortion was found irrespective of the orientation of the panoramic cues. We conclude that sustained exposure to panoramic and vestibular cues does not adapt the subsequent percept of vertical to the direction of the panoramic cue. Rather, our results suggest that sustained panoramic cues affect the SVV by an indirect effect on head orientation, with a 90° periodicity, that interacts with a vestibular cue to determine the percept of vertical. Show more

DOI: 10.3233/VES-210051

Citation: Journal of Vestibular Research, vol. Pre-press, no. Pre-press, pp. 1-9, 2021

Authors: Byun, Hayoung | Chung, Jae Ho | Jeong, Jin Hyeok | Ryu, Jiin | Lee, Seung Hwan

Article Type: Research Article

Abstract: BACKGROUND: Obstructive sleep apnea(OSA) could influence peripheral vestibular function adversely via intermittent hypoxia and its consequences. OBJECTIVE: This study aimed to evaluate the risk of peripheral vestibular disorders in OSA using a nationwide population-based retrospective cohort study. METHODS: The National Health Insurance Service–National Sample Cohort represents the entire Korean population from 2002 to 2015. OSA was defined as individuals who had used medical services twice or more under a diagnosis of OSA(G47.33 in ICD-10). A comparison cohort consisted of socio-demographically matched non-OSA subjects in a ratio of 1:4. The incidences of benign paroxysmal positional vertigo(BPPV), Meniere’s …disease, and vestibular neuritis were evaluated in each cohort. RESULTS: A total of 2,082 individuals with OSA and 8,328 matched non-OSA subjects were identified. The incidence rates(IRs) of peripheral vertigo in OSA and non-OSA were 149.86 and 23.88 per 10,000 persons, respectively (Ratio of IR, IRR = 6.28, 95%CI 4.89 to 8.08). In multivariable analysis, the risk of peripheral vertigo was significantly higher in OSA(adjusted HR = 6.64, 95%CI 5.20 to 8.47), old age(adjusted HR = 1.03, 95%CI 1.02 to 1.04), female sex(adjusted HR = 1.92, 95%CI 1.48 to 2.50), and comorbidities(adjusted HR = 1.09, 95%CI 1.003 to 1.19). The IRRs of each vestibular disorder in the two groups were 7.32(95%CI 4.80 to 11.33) for BPPV, 3.61(95%CI 2.24 to 5.81) for Meniere’s disease, and 9.51(95%CI 3.97 to 25.11) for vestibular neuritis. CONCLUSIONS: Subjects diagnosed with OSA had a higher incidence of peripheral vestibular disorders than those without OSA, according to national administrative claims data. It is recommended to take peripheral vertigo into account when counseling OSA. Show more

Keywords: Dizziness, vertigo, BPPV, Meniere’s disease, vestibular neuritis, vestibulopathy

DOI: 10.3233/VES-210012

Citation: Journal of Vestibular Research, vol. Pre-press, no. Pre-press, pp. 1-8, 2021

Authors: Diao, Tongxiang | Han, Lin | Jing, Yuanyuan | Wang, Yixu | Ma, Xin | Yu, Lisheng | Zhang, Jilei | Zheng, Hongwei | Wang, Lin | Li, Xueshi | Chen, Nishan

Article Type: Research Article

Abstract: BACKGROUND: Migraine is more common in Meniere’s disease patients, who have some certain anatomical variations. But there are limited studies focusing on the anatomical variations in patients with Meniere’s disease and migraine. OBJECTIVE: To explore the clinical and anatomical features in Meniere’s disease patients with and without migraine, determining whether the coexistence of migraine can be used as a basis for clinical subtyping of Meniere’s disease. METHODS: Ninety-five Meniere’s disease patients and ninety-five healthy subjects matched with age, sex were selected. A detailed questionnaire based on the diagnosis criteria of Meniere’s disease and migraine was designed. …According to the CT scan, we divided the mastoid cell system of all the subjects into two types: well-pneumatization type and poor-pneumatization type. Meanwhile, the shortest distance between the sigmoid sinus and the posterior wall of the external acoustic canal was measured. RESULTS: Compared with those without migraine, Meniere‘s disease patients with migraine had a higher female comorbidity, poorer mastoid pneumatization, shorter distance between the sigmoid sinus and posterior wall of the external acoustic canal, longer history, higher frequency of vertigo attacks and better average hearing threshold. CONCLUSIONS: In our study, anatomical features as well as several clinical manifestations were proved to differ significantly between Meniere’s disease patients with and without migraine, indicating the coexistence of migraine may be one standard for the clinical subtyping of Meniere’s disease. Show more

Keywords: Meniere’s disease, anatomical features, clinical manifestations, migraine, subtype

DOI: 10.3233/VES-190755

Citation: Journal of Vestibular Research, vol. Pre-press, no. Pre-press, pp. 1-11, 2021

Authors: Riera-Tur, Laura | Caballero-Garcia, Andres | Martin-Mateos, Antonio J. | Lechuga-Sancho, Alfonso M.

Article Type: Research Article

Abstract: BACKGROUND: The subjective visual vertical (SVV) test is a sensitive test of vestibular dysfunction that allows the evaluation of otolithic organs; however, with the current method, there are technical and logistical limitations that make the application of this test difficult in the conventional clinic. OBJECTIVE: The objective of this study is to assess the effectiveness of detecting vestibular pathology using the SVV via a new screening method. METHODS: A consecutive sample of 62 patients with suspected vestibular pathology was included in the study. The patients were clinically diagnosed according to the Barany Society criteria. An exploratory …system was designed using a mobile application in Android that detects accelerometer oscillations and involves placing the smartphone on a rotating disk anchored to the wall. All patients underwent a SVV examination using the bucket method and the study test. A cut-off point of the ROC curve was calculated for each test, and its sensitivity, specificity, diagnostic accuracy and probability ratios for detecting vestibular pathology were analysed. The SVV results were compared using the bucket test and the study test. RESULTS: We observed significant differences in sensitivity between the two tests: 86.95% for the study test versus 67.4% for the bucket test (p  <  0.01). In the ROC curve, an area under the curve of 0.90 was observed for the study test, with a cut-off of 2.43 for a sensitivity of 86.95% and a specificity of 93.75%. CONCLUSIONS: SVV testing using a smartphone placed on a rotating disk anchored to the wall offers greater diagnostic accuracy than SVV using the bucket test. Both methods are inexpensive, harmless and easily accepted by patients. Show more

Keywords: Vestibular diseases, subjective visual vertical, smartphone, mobile applications, dizziness, mhealth

DOI: 10.3233/VES-201526

Citation: Journal of Vestibular Research, vol. Pre-press, no. Pre-press, pp. 1-7, 2021

Authors: Lin, Yufeng | Mukherjee, Mukul | Stergiou, Nicholas | Chien, Jung Hung

Article Type: Research Article

Abstract: BACKGROUND: The mastoid vibration (MV) has been used to investigate unilateral vestibular dysfunction by inducing nystagmus. Additionally, this MV can be used to quantify the effect of deterioration by aging on the vestibular system during walking. Could such MV be used to assess the uni/bilateral vestibular deterioration by aging during standing? OBJECTIVE: This study attempted to determine the feasibility of using MV for identifying the uni/bilateral vestibular deterioration by aging during standing. METHODS: Fifteen young and ten old adults’ balance control patterns were assessed by three random MV conditions: 1) No MV; 2) Unilateral MV; 3) …Bilateral MV. The dependent variables were the 95% confidence ellipse areas and the sample entropy values, which were calculated based on the center of gravity displacement within each condition. RESULTS: Significant main effects of MV and aging were found on all outcome variables. A significant interaction between aging and different MV types was observed in the 95% confidence ellipse area (p  = 0.002) and the length of the short axis (anterior-posterior direction, p  = 0.001). CONCLUSIONS: We concluded that the MV could be used to identify different vestibular dysfunctions, specifically in old adults. Show more

Keywords: Mastoid vibration, balance control, aging

DOI: 10.3233/VES-210042

Citation: Journal of Vestibular Research, vol. Pre-press, no. Pre-press, pp. 1-10, 2021

Authors: Cohen, Helen S. | Sangi-Haghpeykar, Haleh | Plankey, Michael W.

Article Type: Research Article

Abstract: BACKGROUND: Many epidemiologic studies of vestibular disorders are based on responses to questionnaires which have not been tested against objective tests of the vestibular system. OBJECTIVE: The goal was to determine if the dizziness and balance questions used in the National Health Interview Survey (NHIS) are valid and predict performance on objective tests of the vestibular system (VNG). METHODS: Data from 367 participants recruited from the community, aged 21.4 to 87.6 years, were collected in the Otolaryngology department at a tertiary care center. They were asked the eight NHIS questions twice, at least 30 minutes apart …and were tested on VNG. RESULTS: Question responses changed from Test 1 to Test 2 and differed between males and females. “Yes” responses did not predict abnormal VNG responses, for the total group and when the group was categorized into younger (<60 years) and older (>60 years) subjects. The sensitivity and specificity of all questions was low. CONCLUSION: The NHIS questions provide some information about what people recall of their experiences, but they may not provide insight into the diagnostic prevalence of vestibular and balance disorders because the sensitivity and specificity are too low. Questionnaire-based epidemiologic studies should be interpreted with caution. Show more

Keywords: Vestibular, dizziness, balance, screening, vertigo

DOI: 10.3233/VES-210022

Citation: Journal of Vestibular Research, vol. Pre-press, no. Pre-press, pp. 1-8, 2021