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

Authors: Necdet Ardıç, Fazıl | Alkan, Hakan | Tümkaya, Funda | Ardıç, Füsun

Article Type: Research Article

Abstract: BACKGROUND: The efforts to achieve better functional results in vestibular rehabilitation have been continued by using different visual and somatosensory stimuli for a long time. Whole-body vibration (WBV) is a mechanical vertical stimulation that provides high frequency vibration stimulus to the proprioceptive receptors. Biofeedback provides continuous information to the subject regarding postural changes. These techniques may aid to improve vestibular rehabilitation. OBJECTIVE: We aimed to investigate the effect of adding WBV or biofeedback postural training (BPT) to standard rehabilitation exercises in patients with chronic unilateral vestibular weakness. METHODS: Ninety patients were randomized into three groups. Group …1 had WBV and Group 2 BPT in addition to the standard rehabilitation exercises. Group 3 only carried out the home-based exercises and served as the control. Outcome measures such as static posturography, Berg Balance Scale, Timed Up-and-Go test, Visual Analog Scale, and Dizziness Handicap Inventory (DHI) were used for comparison. RESULTS: Statistically significant gains were achieved in all groups with all parameters at the end of treatment when compared to baseline (p  <  0.05). The patients in Group 1 (WBV), however, were significantly better than those in Groups 2 and 3 at the static posturographic stability score, Berg Balance Scale, and DHI (p  <  0.05). CONCLUSION: Adding WBV to a rehabilitation program may be an effective strategy to improve postural stability and achieve better physical, functional and emotional outcomes. Show more

Keywords: Vestibular rehabilitation, vestibular weakness, whole body vibration, biofeedback, posturography

DOI: 10.3233/VES-190753

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

Authors: Charpiot, Anne | Fath, Léa | Veillon, Francis | Venkatasamy, Aïna | Baumgartner, Daniel

Article Type: Research Article

Abstract: Endolymphatic hydrops is defined as an accumulation of endolymph in the inner ear leading to a buildup of pressure and distortion of intralabyrinthine structures. The pressure variation is neither obvious nor easy to measure and remains not clearly confirmed. The distortion of endolymphatic structures has been the main described phenomenon since Hallpike, Cairns and Yamakawa in 1938. However, some clinical symptoms associated with endolymphatic hydrops are in addition to the typical triad of symptoms of Meniere’s disease. This introduction to the state of the art is an analysis of the relationship between hydrops and clinical vestibular disorders, with a focus …on the dynamics of endolymphatic hydrops. The distortion of endolabyrinthine structures can be considered as a dynamic process modeled with mechanical elastic behavior. Show more

Keywords: Endolymphatic hydrops, MRI, Meniere disease, mechanics, inner ear, labyrinth

DOI: 10.3233/VES-200793

Citation: Journal of Vestibular Research, vol. Pre-press, no. Pre-press, pp. 1-3, 2021

Authors: Büki (Family name Büki), Béla | Tamás (Family name Tamás), László T. | Todd, Christopher J. | Schubert, Michael C. | Migliaccio, Americo A.

Article Type: Research Article

Abstract: BACKGROUND: The gain (eye-velocity/head-velocity) of the angular vestibuloocular reflex (aVOR) during head impulses can be increased while viewing near-targets and when exposed to unilateral, incremental retinal image velocity error signals. It is not clear however, whether the tonic or phasic vestibular pathways mediate these gain increases. OBJECTIVE: Determine whether a shared pathway is responsible for gain enhancement between vergence and adaptation of aVOR gain in patients with unilateral vestibular hypofunction (UVH). MATERIAL AND METHODS: 20 patients with UVH were examined for change in aVOR gain during a vergence task and after 15-minutes of ipsilesional incremental VOR …adaptation (uIVA) using StableEyes (a device that controls a laser target as a function of head velocity) during horizontal passive head impulses.A 5 % aVOR gain increase was defined as the threshold for significant change. RESULTS: 11/20 patients had >5% vergence-mediated gain increase during ipsi-lesional impulses. For uIVA, 10/20 patients had >5% ipsi-lesional gain increase. There was no correlation between the vergence-mediated gain increase and gain increase after uIVA training. CONCLUSION: Vergence-enhanced and uIVA training gain increases are mediated by separate mechanisms and/or vestibular pathways (tonic/phasic).The ability to increase the aVOR gain during vergence is not prognostic for successful adaptation training. Show more

Keywords: Vestibular neuritis, vestibular adaptation, vestibuloocular reflex

DOI: 10.3233/VES-201560

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

Authors: Yu, Shen | Wang, Jizhe | Shen, Shuang | Tang, Yuanyuan | Sun, Xiuzhen | Liu, Yingxi

Article Type: Research Article

Abstract: Abstract. From a biomechanical point of view, the process of Benign paroxysmal positional vertigo (BPPV) includes 2 fluid¯solid coupling effects: the interaction between particles and endolymph and the interaction between endolymph and cupula. The interaction between the canaliths and the wall would affect the coupling effects. This study aimed to investigate the entire process of cupula motion caused by canaliths motion and the influence of canalith particles composition. A biomechanical numerical model was established to simulate the canalith falling process and study the influence of canalith diameter, number, and initial falling position on cupula movement. Simultaneously, the relationship between cupula …displacement and the nystagmus signal was analyzed in BPPV patients. The results revealed that the particle velocity was proportional to the particle diameter. The pressure difference between the two sides of the cupula was directly proportional to the canalith diameter and number. The degree of vertigo was positively related to the slow angular velocity of the nystagmus and, therefore, reflected canalith number and diameter. The BPPV latent period and vertigo duration were inversely related to particle diameter. Thus, the number of particles, particle radius, and initial falling position affected cupula movement, which was reflected in the nystagmus. Show more

Keywords: Benign paroxysmal positional vertigo, biomechanics, semicircular duct of inner ear, nystagmus, cupula

DOI: 10.3233/VES-201547

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

Authors: van de Berg, Raymond | Widdershoven, Josine | Bisdorff, Alexandre | Evers, Stefan | Wiener-Vacher, Sylvette | Cushing, Sharon L. | Mack, Kenneth J. | Kim, Ji Soo | Jahn, Klaus | Strupp, Michael | Lempert, Thomas

Article Type: Research Article

Abstract: This paper describes the diagnostic criteria for “Vestibular Migraine of Childhood”, “probable Vestibular Migraine of Childhood” and “Recurrent Vertigo of Childhood” as put forth by the Committee for the Classification of Vestibular Disorders of the Bárány Society (ICVD) and the Migraine Classification subgroup of the International Headache Society. Migraine plays an important role in some subgroups of children with recurrent vertigo. In this classification paper a spectrum of three disorders is described in which the migraine component varies from definite to possibly absent. These three disorders are: Vestibular Migraine of Childhood, probable Vestibular Migraine of Childhood and Recurrent Vertigo of …Childhood. The criteria for Vestibular Migraine of Childhood (VMC) include (A) at least five episodes with vestibular symptoms of moderate or severe intensity, lasting between five minutes and 72 hours, (B) a current or past history of migraine with or without aura, and (C) at least half of episodes are associated with at least one migraine feature. Probable Vestibular Migraine of Childhood (probable VMC) is considered when at least three episodes with vestibular symptoms of moderate or severe intensity, lasting between five minutes and 72 hours, are accompanied by at least criterion B or C from the VMC criteria. Recurrent Vertigo of Childhood (RVC) is diagnosed in case of at least three episodes with vestibular symptoms of moderate or severe intensity, lasting between 1 minute and 72 hours, and none of the criteria B and C for VMC are applicable. For all disorders, the age of the individual needs to be below 18 years old. It is recommended that future research should particularly focus on RVC, in order to investigate and identify possible subtypes and its links or its absence thereof with migraine. Show more

DOI: 10.3233/VES-200003

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

Authors: Djennaoui, Idir | Avan, Paul

Article Type: Research Article

Abstract: Meniere’s disease (MD) still raises since its discovery in 1860 pathophysiological and etiopathogenical issues. The main pathophysiological feature that has emerged for decades is an anatomic one, the endolymphatic hydrops (EH), defined by the inflation of the endolymphatic part of the membranous labyrinth. However, the causal relationship between EH and MD has not been proven. Several attempts have been achieved in animals to induce EH. The best known is the blockage of the vestibular duct, which causes a chronic volume inflation of the endolymphatic part. This model is characterized by the discrepancy between electrophysiological findings and scala media inflation. …Pressure measurements vary among studies. The endolymphatic infusion model, which attempts to model the acute clinical picture of MD consistently shows pressure equilibration between the endolymphatic and perilymphatic compartments, and rapid recovery of the electrophysiological finding once the injection is stopped. Show more

DOI: 10.3233/VES-200791

Citation: Journal of Vestibular Research, vol. Pre-press, no. Pre-press, pp. 1-5, 2020

Authors: Domínguez-Durán, E. | Domènech-Vadillo, E. | Bécares-Martínez, C. | Montilla-Ibáñez, M.A. | Álvarez-Morujo de Sande, M.G. | González-Aguado, R. | Guerra-Jiménez, G.

Article Type: Research Article

Abstract: INTRODUCTION: Patients with episodic vestibular syndrome (EVS) whose symptoms resemble those of vestibular migraine (VM) but who do not meet the criteria for it are common. OBJECTIVE: To describe those patients suffering from EVS in whom defined etiologies have been ruled out in order to determine if their symptoms can be linked to VM. MATERIAL AND METHODS: Prospective multicenter study. The medical records of patients with VM and patients with EVS suggestive of VM but not meeting the criteria for it were examined. The characteristics of headache, the number and the length of attacks, the association …of vestibular symptoms and headache, the intensity of symptoms and the response to treatment were recorded. RESULTS: 58 patients met the criteria for VM or probable VM; 30 did not. All of the symptoms improved significantly in the treated patients with VM or probable VM; in the rest of the treated patients, only the vestibular symptoms improved. CONCLUSION: A subgroup of patients that cannot be attributed to any known vestibulopathy according to present day VM criteria profited from migraine treatment, suggesting that their vestibular symptoms belong to the migraine spectrum; whereas some do not, yet our analysis could not identify distinctive features that allowed subgroup attribution. Show more

Keywords: Migraine disorders, vestibular diseases, therapeutics

DOI: 10.3233/VES-201559

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

Authors: West, Niels | Klokker, Mads | Cayé-Thomasen, Per

Article Type: Research Article

Abstract: BACKGROUND: Cochlear implantation may be complicated by concurrent injury to the vestibular apparatus, potentially resulting in disabling vertigo and balance problems. Information on vestibular function before implantation as measured by the video head impulse test (VHIT) and cervical vestibular evoked myogenic potentials (cVEMPs) is scarce and literature on long-term effects is non-existing. OBJECTIVE: We aimed to evaluate how vestibular function was affected by cochlear implantation (CI), as measured by VHIT and cVEMPs in the late phase after implantation. METHODS: Retrospective repeated measurement study. Patients: Among the 436 patients elected for CI surgery during 2013 to 2018, …45 patients met the inclusion criteria (CI recipients with a vestibular assessment prior to the first CI and a repeated vestibular assessment after the CI operation). Intervention: VHIT and cVEMPs before and after cochlear implantation. Main outcome measures were vestibular function as evaluated by VHIT gain, saccades and cVEMPs. RESULTS: The mean time between first and second vestibular screening was 19 months. The mean VHIT gain on implanted ears was 0.79 before the operation and showed no change at follow-up (p  = 0.65). Likewise, the number of abnormal VHIT gain values was equal before and after the operation (p  = 0.31). Preoperatively, saccades were present on 12 ears (14% ) compared with 25 ears (29% ) postoperatively (p  = 0.013) and were associated with significantly lower VHIT gain values. Preoperatively, positive cVEMPs were found in 20 CI ears (49% ) and 24 contralateral ears (62% ). 10 CI ears lost cVEMP postoperatively compared with 2 ears on the contralateral side (p  = 0.0047). CONCLUSIONS: Even though VHIT gain has been reported to be affected in the immediate post-implantation period, the findings in this study show that VHIT gain is normalized in the long-term. However, cochlear implantation is associated with the occurrence of VHIT saccades in the long-term and these are associated with lower VHIT gain values. In addition, cVEMP responses are significantly reduced long-term on implanted ears, which agrees with other studies with shorter follow-up. Show more

Keywords: Vestibulopathy, vestibular testing, cochlear implant, treatment, hearing rehabilitation, hearing loss

DOI: 10.3233/VES-190760

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

Authors: Martínez-Gallardo, Sergio | Miguel-Puga, José A. | Cooper-Bribiesca, Davis | Bronstein, Adolfo M. | Jáuregui-Renaud, Kathrine

Article Type: Research Article

Abstract: BACKGROUND: Magnetic Resonance Imaging (MRI) scanning can induce psychological effects. No studies have investigated the role of magnetic vestibular stimulation (MVS) in 3TMRI scanner-induced psychological reactions. OBJECTIVE: To assess depersonalization/derealization(DD), state anxiety and motion-perception in a 3TMRI scanner, acutely and long-term. PARTICIPANTS: 48 healthcare professionals and students were included, after preliminary rejection of claustrophobes and neuro-otology and psychiatry assessments. PROCEDURES: Participants completed questionnaires on personal habits, dissociation, anxiety/depression and motion sickness susceptibility. Validated DD and state anxiety questionnaires were administered before and after magnetic exposure twice, entering the bore head and feet first in …random order, one week apart. During the following week, dizziness/disorientation was reported daily. One month later, 11 subjects repeated the procedure to assess reproducibility. RESULTS: Considerable individual susceptibility was observed, circa 40% of the subjects reported self-motion perception related to the exposure, with variable increase on DD symptoms. Multivariate analysis showed that DD scores after any exposure were influenced by entering the bore “feet first”, motion-perception, and the mean sleep hours/week (MANCOVA, R = 0.58, p = 0.00001). There was no clear effect of scanner exposure on state anxiety, which was related to trait anxiey but not to DD scores. During repeated exposures, about half of all subjects re-entering the scan reported motion-perception, but DD or anxiety symptoms were not consistent. CONCLUSION: Psychological effects during 3TMRI scanning result from multiple, interacting factors, including novelty of the procedure (first-exposure effect), motion-perception due to MVS, head/body orientation, sleeping habits and individual susceptibility. Forewarning subjects of these predisposing factors may increase tolerance to MRI scanning. Show more

Keywords: Magnetic resonance imaging, vestibular, depersonalization, anxiety

DOI: 10.3233/VES-201577

Citation: Journal of Vestibular Research, vol. Pre-press, no. Pre-press, pp. 1-12, 2020

Authors: Chen, Po-Yin | Jheng, Ying-Chun | Huang, Shih-En | Po-Hung Li, Lieber | Wei, Shun-Hwa | Schubert, Michael C | Kao, Chung-Lan

Article Type: Research Article

Abstract: BACKGROUND: Embedded within most rapid head rotations are gaze shifts, which is an initial eye rotation to a target of interest, followed by a head rotation towards the same target. Gaze shifts are used to acquire an image that initially is outside of the participant’s current field of vision. Currently, there are no tools available that evaluate the functional relevance of a gaze shift. OBJECTIVE: The purpose of our study was to measure dynamic visual acuity (DVA) while performing a gaze shift. METHODS: Seventy-one healthy participants (42.79±16.89 years) and 34 participants with unilateral vestibular hypofunction (UVH) …(54.59±20.14 years) were tested while wearing an inertial measurement unit (IMU) sensor on the head and walking on a treadmill surrounded by three monitors. We measured visual acuity during three subcomponent tests: standing (static visual acuity), while performing an active head rotation gaze shift, and an active head rotation gaze shift while walking (gsDVAw). RESULTS: While doing gsDVAw, patients with Left UVH (n  = 21) had scores worse (p  = 0.023) for leftward (0.0446±0.0943 LogMAR) head rotation compared with the healthy controls (–0.0075±0.0410 LogMAR). Similarly, patients with right UVH (N  = 13) had worse (p  = 0.025) gsDVAw for rightward head motion (0.0307±0.0481 LogMAR) compared with healthy controls (–0.0047±0.0433 LogMAR). As a whole, gsDVAw scores were worse in UVH compared to the healthy controls when we included the ipsilesional head rotation on both sides gsDVAw (0.0061±0.0421 LogMAR healthy vs. 0.03926±0.0822 LogMAR UVH, p  = 0.003). Controlling for age had no effect, the gsDVAw scores of the patients were always worse (p  <  0.01). CONCLUSION: The gaze shift DVA test can distinguish gaze stability in patients with UVH from healthy controls. This test may be a useful measure of compensation for patients undergoing various therapies for their vestibular hypofunction. Show more

Keywords: Vestibular hypofunction, gaze shift, dynamic visual acuity, and vestibular evaluation

DOI: 10.3233/VES-201506

Citation: Journal of Vestibular Research, vol. Pre-press, no. Pre-press, pp. 1-10, 2020