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

Authors: Micarelli, Alessandro | Viziano, Andrea | Lanzillotta, Alessia | Giorgino, Federica Maria | Pisano, Calogera | Ruvolo, Giovanni | Alessandrini, Marco

Article Type: Research Article

Abstract: BACKGROUND: Marfan syndrome (MFS) is a rare autosomal dominant connective tissue disorder affecting virtually every organ. Sleep disturbances, associated to high collapsibility in upper airways, are common in MFS; daytime sleepiness could lead to reduction in attention and motor coordination, with detrimental effects on balance. OBJECTIVE: To evaluate otoneurological function in MFS patients, compared to healthy subjects, and to investigate possible correlations with sleep deprivation extent. METHODS: Forty-one MFS patients underwent a thorough otoneurological examination, video Head Impulse Test (vHIT), and static posturography. Sleep parameters were recorded by home monitoring. Daytime sleepiness and dizziness-related handicap were …screened by means of Dizziness Handicap Inventory (DHI) and Epworth Sleepiness Scale (ESS). Results were compared with 49 healthy controls (HC). RESULTS: DHI and ESS scores were increased in MFS patients (p  < 0,01). vHIT scores showed no between-group effect. Classical (surface and length) and frequency-domain posturographic parameters were significantly increased in MFS with respect to HC (p  < 0,01). A positive correlation was found between ESS scores and posturographic parameters in MFS patients. CONCLUSIONS: An impaired postural control, related to the extent of sleep deprivation, was found in MFS patients. Such results could advocate for screening and treating sleep deprivation and balance dysfunctions in MFS patients. Show more

Keywords: Marfan syndrome, posturography, sleep apnea, sleep deprivation

DOI: 10.3233/VES-190684

Citation: Journal of Vestibular Research, vol. Pre-press, no. Pre-press, pp. 1-9, 2019

Authors: Matsuo, Lissa Maira | Nishino, Lucia Kazuko | Ribeiro, Fernando de Andrade Quintanilha

Article Type: Research Article

Abstract: Objective: To measure the time required in patients with tympanic perforation to reverse paradoxical stimulation (reverse pseudo-nystagmus) and to create a physical model of the process. Method: An analytical, observational, cross-sectional study with vestibular evaluation (electronystagmography) of 52 individuals with tympanic membrane perforation without otorrhea or concomitant disease. Increased duration of caloric stimulation in the presence of paradoxical stimulation (reverse pseudo-nystagmus) reverses nystagmic responses. Results: Reversal of nystagmus was observed in 90.9% of patients. The average reversal time was 105.5 seconds. The physical model we prepared provided supporting evidenced for the effects seen in these individuals: …warm stimulation in a moist environment initially caused a decrease in temperature (nystagmus to the unexpected side, which characterizes paradoxical stimulation in the warm caloric test); but, as time passed by, the moisture evaporated, and the temperature gradually increased (reversal of nystagmus). Conclusions: Increasing the stimulation time can be used as a strategy to differentiate reverse nystagmus from paradoxical stimulation. Confusion is thus avoided in diagnostic findings, allowing peripheral alterations to be distinguished from central ones. Show more

Keywords: Caloric tests, ear, middle, nystagmus, physiologic, tympanic membrane perforation

DOI: 10.3233/VES-190685

Citation: Journal of Vestibular Research, vol. Pre-press, no. Pre-press, pp. 1-6, 2019

Authors: Zhang, Daogong | Lv, Yafeng | Han, Yuechen | Li, Yawei | Li, Xiaofei | Wang, Jing | Song, Yongdong | Kong, Ligang | Jian, Huirong | Fan, Zhaomin | Wang, Haibo

Article Type: Research Article

Abstract: INTRODUCTION: Meniere’s disease is a common chronic inner ear disease. Because the definitive pathogenesis is still unknown, there is currently no cure for this disorder. Semicircular canal plugging (SCP), first used to treat patients with intractable benign paroxysmal positional vertigo, has since been applied to patients with intractable peripheral vertigo. This study was aimed to explore the long-term efficacy of triple semicircular canal plugging (TSCP) in the treatment of intractable Meniere’s disease (MD) so as to provide a new method in the framework of treatment with MD. METHODS: Three hundred and sixty-one unilateral MD patients, who were treated …with TSCP in our hospital between Dec. 2010 and Sep. 2016, were recruited in this study for retrospective analysis. Vertigo control and auditory function were monitored during a period of two-year follow-up. Seventy three patients who were subjected to intratympanic gentamicin were selected as a control group. Pure tone audiometry, caloric test, vestibular evoked myogenic potential (VEMP) were performed in two-year follow-up. RESULTS: The total control rate of vertigo in TSCP group was 97.8% (353/361) in the two-year follow-up, with complete control rate of 80.3% (290/361) and substantial control rate of 17.5% (63/361). The rate of hearing loss was 26.3% (95/361). The total control rate of vertigo in intratympanic gentamicin group was 83.6% (61/73), with complete control rate of 63.0% (46/73) and substantial control rate of 20.5% (15/73). The rate of hearing loss was 24.7% (18/73). The vertigo control rate of TSCP was significantly higher than that of chemical labyrinthectomy(χ 2  = 24.798, p  <  0.05). There was no significant difference of hearing loss rate between two groups. (χ 2  = 0.087, p  >  0.05). CONCLUSION: Triple semicircular canal plugging (TSCP), which can reduce vertiginous symptoms in patients with intractable Meniere’s disease (MD), represents an effective therapy for this disorder. It might become a new important method in the framework of treatment with MD. Show more

Keywords: Meniere’s disease, Semicircular canal plugging, Vertigo

DOI: 10.3233/VES-190682

Citation: Journal of Vestibular Research, vol. Pre-press, no. Pre-press, pp. 1-12, 2019

Authors: Bao, Tian | Klatt, Brooke N. | Carender, Wendy J. | Kinnaird, Catherine | Alsubaie, Saud | Whitney, Susan L. | Sienko, Kathleen H.

Article Type: Research Article

Abstract: BACKGROUND AND OBJECTIVE: This pilot study aimed to investigate the effects of incorporating vibrotactile sensory augmentation (SA) on balance performance among people with unilateral vestibular disorders (UVD). METHODS: Eight participants with UVD were recruited. Participants completed 18 balance training sessions across six weeks in a clinical setting. Four participants (68.1±7.5 yrs) were randomized to the experimental group (EG) and received trunk-based vibrotactile SA while performing the balance exercises, and four participants (63.1±11.3 yrs) were assigned to the control group (CG); CG participants completed the balance training without SA. Clinical and kinematic balance performance measures were collected before training; …midway through training; and one week, one month, and six months after training. RESULTS: All participants, regardless of group, demonstrated improvements in a subset of the clinical or balance metrics immediately following completion of the balance training protocol. The EG showed significantly greater improvements than the CG for the Activities-specific Balance Confidence Scale and postural stability during the two standing balance exercises with head movements. The EG also had larger improvements than the CG for the Sensory Organization Test (SOT), Mini Balance Evaluations Systems Test, Gait Speed Test, Dynamic Gait Index, Functional Gait Assessment, and vestibular reliance metric calculated based on the SOT. CONCLUSIONS: Incorporating vibrotactile SA into vestibular rehabilitation programs may lead to additional benefits that may be retained up to six months after training, compared to training without vibrotactile SA. A larger study is warranted to demonstrate statistical significance between the groups. Show more

Keywords: Sensory augmentation, unilateral vestibular disorders, balance, vestibular rehabilitation, biofeedback, Clinical trial registration Number: NCT02867683

DOI: 10.3233/VES-190683

Citation: Journal of Vestibular Research, vol. Pre-press, no. Pre-press, pp. 1-12, 2019

Authors: Tamás, László T. | Obrist, Dominik | Avan, Paul | Büki, Béla

Article Type: Research Article

Abstract: BACKGROUND: It has been shown that cold caloric irrigation decreases the vestibulo-ocular reflex (VOR) gain in the vertically positioned lateral canal as measured by head impulse testing. This effect is most probably caused by a sustained deflection of the cupula in the inhibitory direction. OBJECTIVE: The aim of the present experiment was to answer the question if a sustained excitatory deflection increases the gain of the reflex in healthy volunteers. METHODS: In order to deflect the cupula, cold caloric irrigation was applied in prone (forward head hanging) position. In this position cold thermal irrigation elicited an …excitatory caloric nystagmus with an ipsilateral fast phase. RESULTS: When head impulses were applied immediately after cold caloric irrigation, the gain of the VOR decreased in comparison to the values measured before irrigation. CONCLUSIONS: Together with the previous results cited above, these data show that biasing the cupula in either direction decreases its sensitivity with respect to high acceleration stimuli. This might occur because the deviation elicits a partial mechanical and electrophysiological saturation of the cupula. Show more

Keywords: Vestibular, caloric, cupula, vestibuloocular reflex

DOI: 10.3233/VES-190681

Citation: Journal of Vestibular Research, vol. Pre-press, no. Pre-press, pp. 1-6, 2019

Authors: Hüfner, Katharina | Sperner-Unterweger, Barbara

Article Type: Research Article

Abstract: The Barany society published recently the consensus document for the diagnostic criteria of persistent postural perceptual dizziness (PPPD). In this commentary we highlight the benefits of this new diagnosis and possible problems that can arise during the use of the criteria in day to day clinical practice at a University Clinic for Psychosomatic Medicine. The diagnostic criteria of PPPD are compared to those of somatic symptom disorder and bodily distress disorder. We think that a discussion from a psychosomatic point of view is important to improve the understanding between different specialties and how PPPD fits into the broader framework of …psychosomatic medicine. Show more

DOI: 10.3233/VES-190679

Citation: Journal of Vestibular Research, vol. Pre-press, no. Pre-press, pp. 1-3, 2019

Article Type: Letter

DOI: 10.3233/VES-190680

Citation: Journal of Vestibular Research, vol. Pre-press, no. Pre-press, pp. 1-3, 2019

Authors: Massingale, Shelly | Alexander, Amy | Gerkin, Richard | Leddon, Charles | McQueary, Elizabeth | Allred, Richard Cameron | Pardini, Jamie E.

Article Type: Research Article

Abstract: BACKGROUND: The ability to clearly perceive an object while the head is in motion is important in athletics, as it relates to performance and potentially to injury prevention. Normative data for healthy adults on measures of gaze stability have been established. However, data for elite athletes is scarce. OBJECTIVE: To describe performance of elite athletes on computerized gaze stability testing and establish normative data for reference. METHODS: Data were acquired via retrospective chart review. 134 male professional baseball players completed computerized Visual Acuity, Visual Perception Time Test and Gaze Stability Tests as part of a multi-modal …baseline testing session. RESULTS: Performance of all athletes was superior to general population norms reported in the literature. There were no significant differences between the optimal and suboptimal consistency groups or between English-speaking and non- or limited-English speaking players. CONCLUSIONS: Similar to prior studies with smaller samples that have examined GST in athletes, we found high levels of GST performance in professional baseball players relative to normative data for the general population. Normative data for elite athletes was established using this healthy sample. This study underscores the importance of understanding the unique abilities of elite athletes when providing therapy after injury. Show more

Keywords: Gaze stability, elite athlete, sport

DOI: 10.3233/VES-190678

Citation: Journal of Vestibular Research, vol. Pre-press, no. Pre-press, pp. 1-8, 2019

Authors: Bretl, Kathrine N. | Sherman, Sage O. | Dixon, Jordan B. | Mitchell, Thomas R. | Clark, Torin K.

Article Type: Research Article

Abstract: BACKGROUND: Humans can adapt to the “Coriolis” cross-coupled illusion with repeated exposure, improving the tolerability of faster spin rates and enabling short-radius, intermittent centrifugation for artificial gravity implementation. OBJECTIVE: This investigation assesses the criticality of personalization in acclimation to the cross-coupled illusion. METHODS: We used the median stimulus sequence of our previous effective and tolerable personalized, threshold-based protocol to develop a standardized (non-personalized) approach. During each of 10, 25-minute sessions, the spin rate was incremented independent of whether each subject reported experiencing the cross-coupled illusion. RESULTS: In comparison to the previous personalized protocol, the …standardized protocol resulted in significantly reduced acclimation to the cross-coupled illusion (17.7 RPM threshold for the personalized protocol versus 11.8 RPM threshold for the standardized) and generally increased motion sickness reports (average reporting of 1.08/20 (personalized) versus 1.98/20 (standardized)), on average. However, the lack of individualization also leads to significantly less variance in subjects’ acclimation. CONCLUSIONS: These findings are critical for future missions that may require several astronauts to be acclimated concurrently, due to resource and time constraints. Assessing feasibility of fast spin rate, short-radius centrifugation is crucial for the future of artificial gravity implementation during spaceflight. Show more

Keywords: Artificial gravity, short-radius centrifuge, physiological countermeasure, standardized acclimation

DOI: 10.3233/VES-190673

Citation: Journal of Vestibular Research, vol. Pre-press, no. Pre-press, pp. 1-12, 2019

Authors: Holly, Jan E. | Cohen, Helen S. | Masood, M. Arjumand

Article Type: Research Article

Abstract: BACKGROUND: Perception of self-motion is difficult for patients to describe. In addition, the relationship between perceived rotation and eye movements is poorly understood, because most studies of patients have investigated only static orientation. OBJECTIVE: First, to determine whether patients with benign paroxysmal positional vertigo (BPPV) can use visual images to report perceived rotation elicited by the Dix-Hallpike maneuver. Second, to determine if the direction of patients’ perceptions align with data on classical nystagmus direction. METHODS: After the Dix-Hallpike maneuver, BPPV patients viewed images – sketches or video animations – representing possible perceived motions. They selected one …or more images representing perception. RESULTS: All subjects could select images. The directions of the videos were most often backward pitch and/ or ipsilateral roll and yaw relative to body orientation in the supine Dix-Hallpike position, generally consistent with the canal stimulus. Perceived direction of rotation was statistically significantly different from the direction of eye movements as published previously, suggesting a difference in mechanisms for perception and eye movements. CONCLUSION: Patients can easily learn to use a video language to describe their experiences. Perception is generally aligned with canal stimulus and nystagmus, but not exactly. Show more

Keywords: Spatial orientation, vertigo, nystagmus, self-motion perception

DOI: 10.3233/VES-190676

Citation: Journal of Vestibular Research, vol. Pre-press, no. Pre-press, pp. 1-9, 2019