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

Authors: Fujiwara, Keishi | Morita, Shinya | Fukuda, Atsushi | Akamatsu, Hiroki | Yanagi, Hiroko | Hoshino, Kimiko | Nakamaru, Yuji | Kano, Satoshi | Homma, Akihiro

Article Type: Research Article

Abstract: OBJECTIVE: The aim of the present study was to investigate the factors influencing semicircular canal function as evaluated by video Head Impulse Test (vHIT) in patients with vestibular schwannoma. METHODS: Twenty-four patients with untreated vestibular schwannoma underwent vHIT examination. The correlations between semicircular canal function and factors including age, tumor size, disease duration and hearing loss were evaluated. RESULTS: The functions of all three semicircular canals on the affected side evaluated by vHIT were significantly lower than those on the unaffected side. Although there were no significant correlations between semicircular canal function and age, tumor size …or disease duration, a negative significant correlation between vestibulo-ocular reflex (VOR) gain as evaluated by vHIT and hearing loss was observed. CONCLUSIONS: From the results of the relationship between hearing loss and VOR gain, the damage to the audio and vestibular systems in patients with VS may be correlated. As it has been suggested that tumor size was not a significant factor in the VOR gain evaluated by vHIT, multifactorial causes rather than the simple compression of the vestibular nerves alone may be related to the dysfunction of the semicircular canals in patients with vestibular schwannoma. Show more

Keywords: vestibular schwannoma, video head impulse test, semicircular canal function, tumor size, hearing loss

DOI: 10.3233/VES-200695

Citation: Journal of Vestibular Research, vol. Pre-press, no. Pre-press, pp. 1-8, 2020

Authors: Cho, In Hee | Kwon, Jung Won | Yeo, Sang Seok

Article Type: Research Article

Abstract: OBJECTIVE: Subjective visual vertical (SVV) deviation can indicate impairments of motion perception and spatial orientation in individuals with vestibular disorders. This study investigated the influence of SVV on tandem gait ability by assessing differences between temporal, spatial, and kinematic characteristics in young adults. METHODS: We recruited sixteen young adults with increased SVV and 17 age-matched control subjects. All subjects recruited for this study were with no history of neurological or musculoskeletal diseases.Knee and hip-joint kinematic data, spatio-temporal parameters, and gait variability were measured during tandem gait. RESULTS: Stride time variability and stride velocity variability were significantly …greater in the experimental group than the control group (p  < 0.05). In addition, a significant correlation was observed between stride time variability and SVV results (r  = 0.345, p  < 0.05). However, hip and knee joint angles were non-significantly different in the experimental and control groups (p  > 0.05) and spatio-temporal parameters were similarbetween the two groups (p  > 0.05). CONCLUSION: Stride time variability and stride velocity variability during tandem gait were significantly different in the experimental and control groups. We presume that increased SVV deviation is related to greater gait variability during tandem gait. Show more

Keywords: Tandem gait, subjective visual vertical, gait analysis, gait variability

DOI: 10.3233/VES-200694

Citation: Journal of Vestibular Research, vol. Pre-press, no. Pre-press, pp. 1-7, 2020

Authors: Patel, Mitesh | Roberts, Ed | Arshad, Qadeer | Bunday, Karen | Golding, John F. | Kaski, Diego | Bronstein, Adolfo M.

Article Type: Research Article

Abstract: BACKGROUND: Although vestibular lesions degrade postural control we do not know the relative contributions of the magnitude of the vestibular loss and subjective vestibular symptoms to locomotor adaptation. OBJECTIVE: To study how dizzy symptoms interfere with adaptive locomotor learning. METHODS: We examined patients with contrasting peripheral vestibular deficits, vestibular neuritis in the chronic stable phase (n  = 20) and strongly symptomatic unilateral Meniere’s disease (n  = 15), compared to age-matched healthy controls (n  = 15). We measured locomotor adaptive learning using the “broken escalator” aftereffect, simulated on a motorised moving sled. RESULTS: Patients with Meniere’s disease had …an enhanced “broken escalator” postural aftereffect. More generally, the size of the locomotor aftereffect was related to how symptomatic patients were across both groups. Contrastingly, the degree of peripheral vestibular loss was not correlated with symptom load or locomotor aftereffect size. During the MOVING trials, both patient groups had larger levels of instability (trunk sway) and reduced adaptation than normal controls. CONCLUSION: Dizziness symptoms influence locomotor adaptation and its subsequent expression through motor aftereffects. Given that the unsteadiness experienced during the “broken escalator” paradigm is internally driven, the enhanced aftereffect found represents a new type of self-generated postural challenge for vestibular/unsteady patients. Show more

Keywords: Vestibular system, vertigo, dizziness, motor control, Meniere’s disease, vestibular neuritis, locomotor adaptation

DOI: 10.3233/VES-200693

Citation: Journal of Vestibular Research, vol. Pre-press, no. Pre-press, pp. 1-14, 2020

Authors: Lacroix, Emilie | Edwards, Martin Gareth | De Volder, Anne | Noël, Marie-Pascale | Rombaux, Philippe | Deggouj, Naima

Article Type: Research Article

Abstract: BACKGROUND: The impact of vestibular loss (VL) on cognition has been previously studied in experimental animal, human and adult patient studies showing links between VL, and cognitive impairments in space orientation, working memory, mental rotation and selective attention. However, few studies have been conducted on children with VL. OBJECTIVE: We investigated for the first time, the impact of a VL on children’s cognition. METHODS: 13 children with VL (10 years, 5 months) and 60 average-age matched controls performed a neuropsychological assessment consisting of visuospatial working memory, selective visual attention, mental rotation and space orientation tasks. …RESULTS: Children with VL recalled smaller sequences for both forward and backward memory subtasks (mean±SD = 6.3±1.9 and 5.3±2.6) than controls (8.2±2.3 and 7.3±2.0), have less accurate mental rotation scores (25.4±6 versus 30.8±5.1) and greater additional distance travelled in the maze task (96.4±66.6 versus 60.4±66.3); all corrected p -values <0.05. Selective visual attention measures do not show significant differences. CONCLUSIONS: Children with VL show similar cognitive difficulties that adults with VL, in tasks involving dynamic cognitive processes (higher attentional load) that in tasks requiring static cognitive processes such as visual attention task. Show more

Keywords: Vestibular, children, neuropsychology, cognitive abilities, vestibular loss

DOI: 10.3233/VES-200689

Citation: Journal of Vestibular Research, vol. Pre-press, no. Pre-press, pp. 1-9, 2020

Authors: Le Cao, Thuy Tien | Brewer, Kelly | Serrador, Jorge | Schubert, Michael C.

Article Type: Research Article

Abstract: BACKGROUND: Exposure to brain injury via blast or blunt mechanisms disrupts multiple sensorimotor systems simultaneously. Large numbers of US Gulf War era and Operation Iraqi/Enduring Freedom veterans with traumatic brain injury (TBI) are suffering the symptom of dizziness – presumed due to “Multi-Sensory Impairment”, a clinical pattern of damage to the auditory, visual and vestibular sensorimotor systems. OBJECTIVE: To describe the oculomotor response to rapid head rotation in a population of veterans with dizziness. We also describe the reliability of using the video head impulse test (vHIT) in a veteran population. METHODS: We used the vHIT …to evaluate the vestibular-ocular reflex (VOR) gain and presence of compensatory saccades (CS) in each semicircular canal of 81 veterans (31% TBI) with dizziness. Data was collected using the GN Otometric™ vHIT. Data was processed using both the Otometric™ software and custom software written in MATLAB™. This data was evaluated through Kruskal-Wallis rank-sum test and analysis of regression. RESULTS: Veterans with dizziness recruit CS in all semicircular canal planes even though their VOR gain is normal. The vHIT is a reliable clinical test to quantify the metrics of the VOR and CS in veterans. CONCLUSION: Veterans with dizziness symptoms use compensatory saccades in all planes of semicircular canal rotation, despite having normal peripheral VOR gain during rapid head rotation. The video head impulse test is a stable measure of vestibular slow phase and metrics of compensatory saccades in veterans with dizziness. Show more

Keywords: Traumatic brain injury, compensatory saccade, vestibular-ocular reflex, video head impulse test

DOI: 10.3233/VES-200692

Citation: Journal of Vestibular Research, vol. Pre-press, no. Pre-press, pp. 1-7, 2020

Authors: Wedtgrube, A. | Bockisch, C.J. | Tarnutzer, A.A.

Article Type: Research Article

Abstract: BACKGROUND: While verticality perception is normally accurate when upright, a systematic bias (“post-tilt bias”) is seen after prolonged roll-tilt. The source of the bias could either be central (shifting “null” position) or related to changes in torsional eye-position. OBJECTIVE: To study the mechanisms of the post-tilt bias in vision-dependent and vision-independent paradigms and to characterize the impact of optokinetic stimulation. METHODS: The subjective visual-vertical (SVV) and subjective haptic-vertical (SHV) were measured after static roll-tilt (±90deg ear-down (“adaptation”) position; duration = 5 min; n  = 9 subjects). To assess the effect of visual stimuli, a control condition (darkness) was compared with …an optokinetic stimulus (clockwise/counter-clockwise rotation, 60deg/sec) during adaptation. RESULTS: A significant post-tilt bias was more frequent for the SVV than the SHV (72% vs. 54%, p  = 0.007) with shifts pointing towards or away from the adaptation position with similar frequency. Exponential-decay time-constants were comparable for both paradigms and directions of shifts. The optokinetic stimulus had no effect on the bias for either paradigm. CONCLUSIONS: Emerging in both vision-dependent and vision-independent paradigms, the results support the hypothesis that the post-tilt bias results from a shift in the internal estimate of direction of gravity, while optokinetic nystagmus seems not to be a major contributor. Show more

Keywords: Perception, multisensory integration, subjective visual vertical, subjective haptic vertical, vestibular

DOI: 10.3233/VES-200690

Citation: Journal of Vestibular Research, vol. Pre-press, no. Pre-press, pp. 1-16, 2020

Authors: Monsanto, Rafael da Costa | Kasemodel, Ana Luiza Papi | Tomaz, Andreza | Abrahão Elias, Thais Gomes | Paparella, Michael Mauro | de Oliveira Penido, Norma

Article Type: Research Article

Abstract: BACKGROUND: Evidence to support potential links between chronic otitis media (COM) and vestibular impairment/postural balance control issues is lacking. OBJECTIVE: To investigate whether COM associates with vestibular symptoms, balance problems, and abnormalities in vestibular function tests. METHODS: We selected patients with COM and excluded patients with any identifiable underlying causes for vestibular dysfunction. Fifty-two healthy volunteers were included as controls. All subjects underwent anamnesis, physical examination, posturography, and video-head impulse tests. RESULTS: We found a high prevalence of vestibular symptoms (58.4%) among patients with COM, while only 2% of the controls had vestibular symptoms. …There was a positive correlation between COM activity with the presence of tinnitus and vestibular symptoms (P  < 0.05). Clinical vestibular tests were abnormal in 63% of patients with COM, and those positively associated with presence of vestibular symptoms. Posturography results shown worse postural balance control in patients with COM as compared with controls, especially in the limit of stability (LOS) (Mean LOS, COM = 157.56 cm2 ; controls = 228.98 cm2 ; p  < 0.001), and in the test with eyes closed while standing on a foam mattress (sway area, COM = 10.91 cm2 ; controls = 5.90 cm2 ; p  < 0.001). We did not observe differences in the average vestibuloocular reflex gains in the video-head impulse test between our COM and control groups. CONCLUSIONS: Our results show that COM associates with a high prevalence of vestibular symptoms, worse postural control, and more severe hearing loss as compared with controls. Among patients with COM, the activity of the middle-ear inflammation seemed to positively associate with more severe hearing and balance problems. Show more

Keywords: Otitis media, vestibular function tests, vertigo, dizziness, postural balance

DOI: 10.3233/VES-200691

Citation: Journal of Vestibular Research, vol. Pre-press, no. Pre-press, pp. 1-11, 2020

Authors: Power, Laura | Murray, Katherine | Szmulewicz, David J

Article Type: Research Article

Abstract: QUESTION: Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of dizziness presenting to specialist vestibular centres and accounts for approximately 20–30% of referrals to these clinics. In spite of the amount of clinical knowledge surrounding its diagnosis and management, the treatment of BPPV remains challenging for even the most experienced clinicians. This study outlines the incidence of BPPV in a specialised vestibular physiotherapy clinic and discusses the various nuances encountered during assessment and treatment of BPPV. DESIGN: Observational Study PARTICIPANTS: 314 patients with various forms of Benign Paroxysmal Positional Vertigo (BPPV) INTERVENTION: …Canalith repositioning manoeuvres (CRP) for posterior canal (PC) or horizontal canal (HC) BPPV depending on the canal and variant of BPPV. OUTCOME MEASURES: Negative Dix-Hallpike (DHP) or Supine roll test (SRT) examination. RESULTS: In 91% of cases, PC BPPV was effectively treated in 2 manoeuvres or less. Similarly, 88% of HC BPPV presentations were effectively managed with 2 treatments. Bilateral PC, multiple canal or canal conversions required a greater number of treatments. There was no noticeable difference in treatment outcomes for patients who had nystagmus and symptoms during the Epley manoeuvre (EM) versus those who did not have nystagmus and symptoms throughout the EM. Nineteen percent of patients experienced post treatment down-beating nystagmus (DBN) and vertigo or “Otolithic crisis” after the first or even the second consecutive EM. CONCLUSION: Based on the data collected, we make several clinical recommendations for assessment and treatment of BPPV. Firstly, repeated testing and treatment of BPPV within the same session is promoted as a safe and effective approach to the management of BPPV with a low risk of canal conversion. Secondly, vertigo and nystagmus throughout the EM is not indicative of treatment success. Thirdly, clinicians must remain vigilant and mindful of the possibility of post treatment otolithic crisis following the treatment of BPPV. This is to ensure patient safety and to prevent possible injurious falls. Our results challenge several clinical assumptions about the assessment and treatment of BPPV including the utility of certain markers of treatment success; hence influencing the current clinical guidelines and clinical practice and paving the way for future studies of the assessment and management of patients with BPPV. Show more

Keywords: Benign Paroxysmal Positional Vertigo (BPPV)

DOI: 10.3233/VES-190687

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

Authors: Lee, Ho-Won | Lim, Yong-Hyun | Kim, Sung-Hee

Article Type: Research Article

Abstract: Accumulating evidences show that the vestibular system contributes to cognitive function, including visuospatial ability, memory, and attention. Conversely, cognitive processes appear to affect the vestibular system. Based on the assumption that cognitive impairment correlates to increased perceived dizziness, we recruited 308 adults with cognitive decline from neurodegenerative disorders and administered neuropsychological tests and the Dizziness Handicap Inventory. Global cognitive measures did not correlate with increased dizziness, whereas attentional and visuospatial cognitive ability was correlated with scores of the Dizziness Handicap Inventory. Furthermore, patients with both cognitive impairment and postural instability experienced notably worse dizziness than those without postural instability, suggesting …that postural instability is an important determinant of dizziness. Show more

Keywords: Dizziness, cognition, posture, dementia, parkinsonism

DOI: 10.3233/VES-190686

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