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

Authors: Meskers, Arjan J. H. | Houben, Mark M. J. | Pennings, Helena J. M. | Clément, Gilles | Groen, Eric

Article Type: Research Article

Abstract: BACKGROUND: During large angles of self-tilt in the roll plane on Earth, measurements of the subjective visual vertical (SVV) in the dark show a bias towards the longitudinal body axis, reflecting a systematic underestimation of self-tilt. OBJECTIVE: This study tested the hypothesis that self-tilt is underestimated in partial gravity conditions, and more so at lower gravity levels. METHODS: The SVV was measured in parabolic flight at three partial gravity levels: 0.25, 0.50, and 0.75 g. Self-tilt was varied amongst 0, 15, 30, and 45 deg, using a tiltable seat. The participants indicated their SVV by setting a …linear array of dots projected inside a head mounted display to the perceived vertical. The angles of participants’ body and head roll tilt relative to the gravito-inertial vertical were measured by two separate inertial measurement units. RESULTS: Data on six participants were collected. Per G-level, a regression analysis was performed with SVV setting as dependent variable and head tilt as independent variable. The latter was used instead of chair tilt, because not all the participants’ heads were aligned with their bodies. The estimated regression slopes significantly decreased with smaller G-levels, reflecting an increased bias of the SVV towards the longitudinal body axis. On average, the regression slopes were 0.95 (±0.38) at 0.75 g; 0.84 (±0.22) at 0.5 g; and 0.63 (±0.33) at 0.25 g. CONCLUSIONS: The results of this study show that reduced gravity conditions lead to increased underestimation of roll self-tilt. Show more

Keywords: Perception, orientation, A-effect, space, microgravity, subjective vertical

DOI: 10.3233/VES-201512

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

Authors: Redon, Sylvain | Elzière, Maya | Donnet, Anne

Article Type: Research Article

Abstract: The presence of endolymphatic hydrops has been studied in many neurological disorders. The pathophysiological mechanisms may involve CSF pressure variations, transmitted to the innear ear. This hydrops could play a role in vestibular or cochlear symptoms. For the ENT specialist, the etiological diagnosis of endolymphatic hydrops is a challenge, and neurological etiologies must be known. The treatment of these neurological causes could be effective on cochleo-vestibular symptoms. The knowledge of endolymphatic hydrops could also be a target for noninvasive tests, able to estimate CSF pressure variations. For the neurologist, this could represent a useful tool for the diagnosis and follow-up, …in some of these neurological disorders, related to a CSF pressure imbalance. The purpose of this paper is to summarize literature data on endolymphatic hydrops in neurological disorders. We define some neurological conditions, for which there is a particular interest in noninvasive investigations of endolymphatic hydrops. Show more

Keywords: Intracranial hypertension, intracranial hypotension, hydrocephalus, vestibular migraine, endolymphatic hydrops, DPOAE

DOI: 10.3233/VES-200790

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

Authors: Micarelli, Alessandro | Viziano, Andrea | Micarelli, Beatrice | Giulia, Di Fulvio | Alessandrini, Marco

Article Type: Research Article

Abstract: BACKGROUND: Posturography power spectra (PS) implementation has been proven to discriminate between sensory inputs detriment of vestibular and proprioceptive origin. OBJECTIVE: To deepen the role of posturography testing in the diagnostic route of dizzy conditions, by comparing two groups of patients –93 affected by cervicogenic dizziness (CGD) and 72 by unilateral vestibular hypofunction (UVH) –with a group of 98 age- and gender-matched healthy subjects, serving as control group (CON). METHODS: All participants underwent otoneurological testing including video head impulse test (vHIT) and posturography testing with PS analysis. They also filled in Dizziness Handicap Inventory (DHI), Tampa …Scale for Kinesiophobia and Hospital Anxiety and Depression Scale questionnaires. RESULTS: UVH and CGD patients were found to have significant increase in vestibular- and proprioceptive-related PS values when compared with CON. Receiver operating characteristic curves found PS values to reliably discriminate both groups from CON. Positive and negative correlations were respectively found between vestibular-/proprioceptive-related PS domain and DHI in both groups and between PS and vHIT scores in UVH patients. CONCLUSIONS: PS analysis demonstrated to be useful in differentiating CGD and UVH patients each other and when compared to CON, to objectively represent perceived symptoms filled along the DHI scale and to corroborate the rate of vestibular deficit in UVH patients. Show more

Keywords: Posturography testing, cervicogenic dizziness, fast fourier transform, video-head impulse test, unilateral vestibular hypofunction

DOI: 10.3233/VES-190729

Citation: Journal of Vestibular Research, vol. Pre-press, no. Pre-press, pp. 1-12, 2021

Authors: Bery, Anand K. | Azzi, Jayson Lee | Le, Andre | Spitale, Naomi S. | Leech, Judith | Lelli, Daniel A. | Tse, Darren

Article Type: Research Article

Abstract: BACKGROUND: Obstructive sleep apnea (OSA) has been linked to vestibular dysfunction, but no prior studies have investigated the relationship between Persistent Postural Perceptual Dizziness (PPPD), a common cause of chronic dizziness, and OSA. OBJECTIVE AND METHODS: We determined the frequency of OSA in an uncontrolled group of PPPD patients from a tertiary dizziness clinic based on polysomnogram (PSG). We then assessed the sensitivity and specificity of common OSA questionnaires in this population. RESULTS: Twenty-five patients with PPPD underwent PSG (mean age 47, 60% female, mean BMI 29.5). A majority, or 56%, of patients were diagnosed with …OSA, and in most, the OSA was severe. OSA patients were older (56 years versus 40 years, p  = 0.0006) and had higher BMI (32 versus 26, p  = 0.0078), but there was no clear gender bias (56% versus 64% female, p  = 1.00). The mean sensitivity and specificity of the STOP BANG questionnaire for detecting OSA was 86% and 55%, respectively. Sensitivity and specificity of the Berlin Questionnaire was 79% and 45%, respectively. CONCLUSIONS: The prevalence of OSA was much higher in our small PPPD group than in the general population. Screening questionnaires appear to demonstrate good sensitivity to detect PPPD patients at risk of OSA in this small study. Future studies should confirm these findings and determine whether treatment of OSA improves symptoms in PPPD. Show more

Keywords: Dizziness, PPPD, sleep apnea, neuro-otology, sleep medicine

DOI: 10.3233/VES-201508

Citation: Journal of Vestibular Research, vol. Pre-press, no. Pre-press, pp. 1-6, 2021

Authors: Casani, Augusto Pietro | Canelli, Rachele | Lazzerini, Francesco | Navari, Elena

Article Type: Research Article

Abstract: OBJECTIVES: This cross-sectional study aims to describe the features of the suppression head impulse paradigm (SHIMP) in acute unilateral vestibulopathy (AUV) and to define its role in predicting the recovery of patients. METHODS: Thirty patients diagnosed with AUV were retrospectively analyzed. The dizziness handicap inventory score and video head impulse test parameters performed 4–8 weeks from the AUV onset constituted the main outcome measures. Patients with a worse recovery (Group 1) and patients who recovered spontaneously (Group 2) were compared. RESULTS: The SHIMP vestibulo-ocular reflex (VOR) gain was statistically significantly lower than the conventional head impulse …paradigm (HIMP) VOR gain (P  <  0.001). The SHIMP VOR gain was negatively correlated with the DHI (P  <  0.001) and was positively correlated with the HIMP VOR gain (P  <  0.001) and the SHIMP overt saccades (%) (P  <  0.001). Patients with a worse recovery exhibited the following: higher DHI (P  <  0.001), lower SHIMP and HIMP VOR gain (P  <  0.001 and P  = 0.007, respectively), and lower SHIMP and greater HIMP overt saccade prevalence values (P  = 0.007 and P  = 0.032, respectively). CONCLUSIONS: The SHIMP and HIMP help in improving our approach to AUV. SHIMP appears to better identify the extent of the vestibular damage in patient suffering from AUV than HIMP and could provide interesting information about the course of the disease. Particularly, the analysis of SHIMP VOR gain and overt saccade prevalence would provide useful information about the recovery of patients. Show more

Keywords: Video head impulse test, vestibular neuritis, acute unilateral vestibulopathy, vestibular rehabilitation, vertigo, vestibular compensation, SHIMP, HIMP

DOI: 10.3233/VES-210038

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

Article Type: Abstract

DOI: 10.3233/VES-200006

Citation: Journal of Vestibular Research, vol. Pre-press, no. Pre-press, pp. 1-52, 2021

Authors: Jacobsen, Chris L. | Abrahamsen, Emil R. | Skals, Regitze K. | Hougaard, Dan D.

Article Type: Research Article

Abstract: BACKGROUND: Several different video Head Impulse Test systems (vHIT) exist. The function of each individual semicircular canal (SCC) may be determined by performing this test. All vHIT systems provide information about the function of the vestibular ocular reflex by means of two modalities: SACCADES and GAIN. However, different gain calculation methods exist. OBJECTIVE: Primary endpoint: • Is instantaneous gain or regression gain the most reproducible and reliable gain value when performing vHIT with testing of the lateral SCCs? Secondary endpoints: • Comparison of each of the instantaneous gain values at 40, 60, …and 80ms with the regression gain. • Examination of any Intra- and inter examiner variability. • Mean instantaneous gain values, and at different velocities, compared with regression gain values of the lateral SCCs. METHODS: 60 subjects between 18–65 years were included. All patients filled out the Dizziness Handicap Inventory (DHI) questionnaire and underwent four separate vHIT tests, two by an experienced neurotologist and two by an inexperienced examiner. RESULTS/CONCLUSIONS: 240 datasets were obtained, displaying both regression and instantaneous gain values. Regression gain was more reproducible than instantaneous gain. The experienced examiner provided the most reproducible results. When comparing instantaneous gain, we found the gain at 40 ms to be the least reproducible. There was no significant difference between 60 ms and 80 ms.For both examiners no significant intra examiner variability was found. Show more

Keywords: vHIT, gain, video head impulse test. EyeSeeCam, vestibular ocular reflex, regression gain, Instantaneous gain

DOI: 10.3233/VES-180639

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

Authors: Lacour, Michel | Thiry, Alain | Tardivet, Laurent

Article Type: Research Article

Abstract: BACKGROUND: The crucial role of early vestibular rehabilitation (VR) to recover a dynamic semicircular canal function was recently highlighted in patients with unilateral vestibular hypofunction (UVH). However, wide inter-individual differences were observed, suggesting that parameters other than early rehabilitation are involved. OBJECTIVE: The aim of the study was to determine to what extent the degree of vestibular loss assessed by the angular vestibulo-ocular reflex (aVOR) gain could be an additional parameter interfering with rehabilitation in the recovery process. And to examine whether different VR protocols have the same effectiveness with regard to the aVOR recovery. METHODS: …The aVOR gain and the percentage of compensatory saccades were recorded in 81 UVH patients with the passive head impulse test before and after early VR (first two weeks after vertigo onset: N = 43) or late VR (third to sixth week after onset: N = 38) performed twice a week for four weeks. VR was performed either with the unidirectional rotation paradigm or gaze stability exercises. Supplementary outcomes were the dizziness handicap inventory (DHI) score, and the static and dynamic subjective visual vertical. RESULTS: The cluster analysis differentiated two distinct populations of UVH patients with pre-rehab aVOR gain values on the hypofunction side below 0.20 (N = 42) or above 0.20 (N = 39). The mean gain values were respectively 0.07±0.05 and 0.34±0.12 for the lateral canal (p  <  0.0001), 0.09±0.06 and 0.44±0.19 for the anterior canal (p  <  0.0001). Patients with aVOR gains above 0.20 and early rehab fully recovered dynamic horizontal canal function (0.84±0.14) and showed very few compensatory saccades (18.7% ±20.1%) while those with gains below 0.20 and late rehab did not improve their aVOR gain value (0.16±0.09) and showed compensatory saccades only (82.9% ±23.7%). Similar results were found for the anterior canal function. Recovery of the dynamic function of the lateral canal was found with both VR protocols while it was observed with the gaze stability exercises only for the anterior canal. All the patients reduced their DHI score, normalized their static SVV, and exhibited uncompensated dynamic SVV. CONCLUSIONS: Early rehab is a necessary but not sufficient condition to fully recover dynamic canal function. The degree of vestibular loss plays a crucial role too, and to be effective rehabilitation protocols must be carried out in the plane of the semicircular canals. Show more

Keywords: Unilateral vestibular hypofunction, degree of vestibular loss, early vs late vestibular rehabilitation, vestibulo-ocular reflex gain, compensatory saccades

DOI: 10.3233/VES-201557

Citation: Journal of Vestibular Research, vol. Pre-press, no. Pre-press, pp. 1-15, 2021

Authors: Lubetzky, Anat V. | Aharoni, Moshe M.H. | Arie, Liraz | Krasovsky, Tal

Article Type: Research Article

Abstract: BACKGROUND: People with PPPD report imbalance, increase in symptoms and impaired function within complex visual environments, but understanding of the mechanism for these behaviors is still lacking. OBJECTIVE: To investigate postural control in PPPD we compared changes in center of pressure (COP) and head kinematics of people with PPPD (N = 22) and healthy controls (N = 20) in response to different combinations of visual and cognitive perturbations during a challenging balance task. METHODS: Participants stood in a tandem position. Static or moving stars (0.2 Hz, 5 mm or 32 mm amplitude, anterior-posterior direction) were displayed through a head-mounted display (HTC Vive). On …half the trials, participants performed a serial-3 subtraction task. We measured medio-lateral and anterior-posterior path and acceleration of COP and head. RESULTS: Controls significantly increased all COP and head parameters with the cognitive task whereas PPPD increased only COP ML path and acceleration. Only controls significantly increased head anterior-posterior & medio-lateral acceleration with moving visual load. Cognitive task performance was similar between groups. CONCLUSIONS: We observed altered postural strategies in people with PPPD, in the form of reduced movement with challenge, particularly around the head segment. The potential of this simple and portable head-mounted display setup for differential diagnosis of vestibular disorders should be further explored. Show more

Keywords: PPPD, balance, sensory integration, dual task, head mounted display, virtual reality

DOI: 10.3233/VES-201552

Citation: Journal of Vestibular Research, vol. Pre-press, no. Pre-press, pp. 1-13, 2021

Authors: Yadav, Harsha | Irugu, DVK | Ramakrishanan, Lakshmy | Singh, Archana | Abraham, Ransi | sikka, Kapil | Thakar, Alok | verma, Hitesh

Article Type: Research Article

Abstract: BACKGROUND: Serum otolin-1 is an inner ear protein exclusively expressed in otoconia and cells of vestibule and cochlea. Serum otolin-1 is found to be quantifiable in patients with BPPV. Low Vitamin-D is associated with pathogenesis of BPPV. Since otoconia degeneration contributes to BPPV, lack of Vitamin-D may impact otoconia structure and integrity. OBJECTIVE: We aimed at studying the s.otolin-1 as biomarker and significance of vit-D in BPPV. MATERIAL AND METHOD: 23 patients in test and control groups respectively were chosen within the age of 20 to 65 years. All the patients were diagnosed using Dix Hallpike …menouver and head roll test, patients were treated with appropriate Canal Reposition Menouver (CRM). RESULTS: Serum Otolin-1 levels among the test ranged from 366 to 882 pg/mL with mean of 585.17 pg/mL whereas in control group ranged from 223 to 462 pg/mL with mean of 335.26 pg/mL. Mean Vitamin-D levels among the test group was 22.67 ng/mL (Range = 6.3–68.4) and that of control 15.43 pg/mL (Range = 5.4–27.7) respectively. The relationship between the serum Otolin-1 and Vitamin-D was not statistically significant. CONCLUSION: Otolin-1 levels is increased in BPPV patients and is sensitive in BPPV, specificity needs to be validated. Role of vitamin-D with respect to inner ear proteins needs further investigation. Show more

Keywords: Otolin-1, vitamin D, inner ear, Dix hallpike, canalith reposition procedure, semicircular canal

DOI: 10.3233/VES-201601

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