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

Authors: Shigeno, Kohichiro | Ogita, Hideaki | Funabiki, Kazuo

Article Type: Research Article

Abstract: BACKGROUND: Patients with posterior- and lateral-(canal)-benign paroxysmal positional vertigo (BPPV)-canalolithiasis sleep in the affected-ear-down head position. Posterior-BPPV-canalolithiasis typically affects the right than left ear; sleeping in the right-ear-down head position may be causal. OBJECTIVE: To investigate the relationship between habitual head position during sleep and the onset of BPPV variants. METHODS: Among 1,170 cases of BPPV variants with unknown etiology, the affected ears, habitual head positions during sleep based on interviews, and relationships among them were investigated. RESULTS: Posterior-BPPV-canalolithiasis and lateral-BPPV-canalolithiasis-geotropic affected the right ear significantly more often. Significantly more patients with posterior-BPPV-canalolithiasis and …lateral-BPPV-canalolithiasis-apogeotropic habitually slept in the right-ear-down head position. Patients with posterior- and lateral-BPPV-canalolithiasis and light cupula were more likely to sleep habitually in the affected-ear-down position than in the healthy-ear-down head position; no relationship was observed in patients with posterior- and lateral-BPPV-cupulolithiasis. In patients with posterior-BPPV-canalolithiasis and lateral-BPPV-canalolithiasis-geotropic, the proportion of right-affected ears in those sleeping habitually in the right-ear-down head position was significantly greater than that for the left-affected ear. CONCLUSIONS: A habitual affected-ear-down head position during sleep may contribute to BPPV-canalolithiasis and light cupula onset, but not BPPV-cupulolithiasis onset. However, habitual sleeping in the right-ear-down head position cannot explain the predominance of right-affected ears. Show more

Keywords: Benign paroxysmal positional vertigo, canalolithiasis, cupulolithiasis, light cupula, habitual head position, sleep

DOI: 10.3233/VES-180616

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

Authors: Holford, Kenneth C. | Jagodinsky, Adam E. | Saripalle, Rishi | McAllister, Poonam

Article Type: Research Article

Abstract: BACKGROUND: Virtual reality (VR) use as a platform for vestibular rehabilitation is widespread. However, the utility of VR based vestibular assessments remains unknown. OBJECTIVE: To compare dynamic visual acuity (DVA) scores, perceived balance, and perceived dizziness when using traditional versus VR environments for DVA testing among healthy individuals. METHODS: DVA testing occurred for both a traditional clinical protocol and in a VR variant. Horizontal, vertical, and no head motion conditions were conducted for both clinical and VR test protocols. DVA scores, balance ratings, and dizziness ratings were obtained per condition. Two-way ANOVAs with repeated measures were …used to assess differences in DVA scores, balance, and dizziness ratings. RESULTS: No differences in DVA results, balance or dizziness ratings were observed when comparing traditional clinical protocol versus the VR variant. Differences across head motion conditions were observed, with no motion trials exhibiting significantly higher DVA scores and perceived balance, and lower perceived dizziness compared to vertical and horizontal head motion. Vertical head motion exhibited this same trend compared to horizontal. CONCLUSION: DVA testing conducted in VR demonstrated clinical utility for each measure. Effects of head motion were similar across test variants, indicating DVA testing in VR produces similar effects on vestibular function than traditional clinical testing. Additional research should be conducted to assess the feasibility of VR assessment in individuals with vestibular disorder. Show more

DOI: 10.3233/VES-200782

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

Authors: Wang, Ruijie | Chao, Xiuhua | Luo, Jianfen | Zhang, Daogong | Xu, Jiliang | Liu, Xianfeng | Fan, Zhaomin | Wang, Haibo | Xu, Lei

Article Type: Research Article

Abstract: BACKGROUND: To date, systematically objective evaluations of vestibular function in children with cochlear implantation (CI) have been conducted sparsely, especiallyin children with large vestibular aqueduct syndrome (LVAS). OBJECTIVE: Our goal was to investigate the function of all five vestibular end-organs pre- and post-cochlear implantation in children with LVAS and normal CT. METHODS: In this retrospective cohort study, 34 children (age 4–17 years) with bilateral profound sensorineural hearing loss (SNHL) undergoing unilateral CI were included. Participants included 18 (52.9%) children with LVAS. Objective modalities to evaluate vestibular function included the caloric test, cervical vestibular-evoked myogenic potentials (cVEMP), …ocular vestibular-evoked myogenic potentials (oVEMP), and video head impulse test (vHIT). All measurements were performed before surgery and 9 months after surgery. RESULTS: Mean age at CI was 8.1±3.7 years. Caloric testing showed hypofunction in 38.2%of cases before implantation and in 50%after (p  >  0.05 ). We found a significant increase of overall abnormality rate in cVEMP and oVEMP from pre- to post-CI (p  <  0.05 ). In all three semicircular canals tested by vHIT, there were no statistically significant mean gain changes (p  >  0.05 ). Higher deterioration rates in cVEMP (53.3%) and oVEMP (52.0%) after surgery were observed (p  <  0.05 ). In children with LVAS, cVEMP revealed a higher deterioration rate than superior semicircular canal (SSC) and posterior semicircular canal (PSC) (p  <  0.05 ). In children with normal CT, the deterioration rates in VEMPs were both higher than those in vHIT (p  <  0.05 ). CONCLUSIONS: In general, the otolith organs were the most affected peripheral vestibular sensors in children after cochlear implantation. The variations in otolith function influenced by CI were different between children with LVAS and normal CT. We recommend the use of this vestibular function test battery for children with cochlear implantation. Show more

Keywords: Cochlear implantation, children, LVAS, vestibular function

DOI: 10.3233/VES-190763

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

Authors: Soyuyuce, Ozlem Gedik | Dikmen, Pinar Yalinay | Korkut, Nazim

Article Type: Research Article

Abstract: BACKGROUND: The caloric vestibular test (CVT) may evoke headache and vestibular symptoms in susceptible people. Patients with migraines have higher susceptibility to motion sickness. In migraines, impaired habituation to repetitive stimuli is a well-known interictal abnormality. OBJECTIVE: This study is aimed at evaluating CVT-evoked headache, nausea, vomiting, and imbalance in patients with and without migraine and/or motion sickness. METHODS: A retrospective data analysis was performed on 554 patients with a complaint of dizziness who underwent bithermal CVT at a tertiary referral center. The occurrences of CVT-evoked headache, nausea, vomiting, and imbalance were observed in four groups: …patients with only migraine (MG; n  = 94), those with only motion sickness (MSG; n  = 89), those with migraine and motion sickness (MMSG; n  = 122), and those without migraine and motion sickness (non-MMSG; n  = 146). The differences between the groups were assessed. RESULTS: The mean ages of groups were similar (p  = 0.534). The proportions of females were higher in the MG, MSG, and MMSG (p  = 0.001). The severity of nausea and headache for each gender was higher in the MG, MSG, and MMSG (p  <  0.001). Vomiting was more common in MMSG among males (p  = 0.003), while there was no difference between groups among females (p  = 0.099). Imbalance was more common in MMSG among females (p  <  0.001). A relationship was detected between age and imbalance (p  <  0.001), where an increased risk for imbalance was evident with greater age. Three patients in the MMSG needed hospitalization after CVT. CONCLUSIONS: Special caution is needed when performing caloric testing for patients with migraines or MS since CVT-evoked symptoms may occur with higher incidence and intensity, which might be related to a lack of habituation in neuronal information processing after robust sensory stimuli like CVT. Show more

Keywords: Caloric tests, dizziness, headache, migraine, motion sickness

DOI: 10.3233/VES-210046

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

Authors: Mohammadi, Midya | Enayati, Zakaria | Shaabani, Moslem | Vahedi, Mohsen

Article Type: Research Article

Abstract: BACKGROUND: Auditory cues might play a role in postural control. OBJECTIVE: The primary aim of this study was to investigate the association between white noise and head-shake (HS) related changes in postural sway. METHODS: Fifty healthy adults underwent Synapsys Posturography System (SPS) evaluation. The posturography (PG) evaluation consisted of two protocols: sensory organization test (SOT) and SOT with head-shake (HS) (HS-SOT). The standard SOT protocol of SPS involves a battery of six postural conditions. In the current study, participants underwent only four SOT conditions. The participants were asked to stand barefoot on the SPS platform (static …platform and foam). The SOT standing conditions were as follow: (1) firm surface (force platform only) with eyes open (SOT1); (2) firm surface with eyes closed (SOT2); (3) foam surface (which was positioned on the force platform) with eyes open (SOT4); and (4) foam surface with eyes closed (SOT5). For the HS-SOT protocol, we asked the participants to move their heads left and right (i.e., yaw head rotation) in the mentioned SOT conditions. Each postural condition was 10 seconds long. Both SOT and HS-SOT postural conditions were conducted across the two hearing modes of silence and noise. To achieve our aims, comparison of sway parameters between SOT and HS-SOT, and between hearing modes were considered. RESULTS: White noise was associated with a reduction in postural sway. The reduction observed in sway area, sway amplitude, and sway frequency. Moreover, HS significantly increased postural sway in all HS-SOT conditions compared to their SOT equivalents (i.e., HS-SOT1 compared to SOT1, etc.). The presence of white noise was associated with a decrease in the HS-related increase in postural sway. CONCLUSIONS: Considering the results, this study adds to the body of literature suggesting that white noise contributes to postural control, and the implications of this for rehabilitation need to be further investigated. Show more

Keywords: Postural control, auditory cues, white noise, sensory organization test, head-shake

DOI: 10.3233/VES-201616

Citation: Journal of Vestibular Research, vol. Pre-press, no. Pre-press, pp. 1-14, 2021

Authors: Alharbi, Ahmad A. | Johnson, Eric G. | Albalwi, Abdulaziz A. | Ambode, Oluwaseun I. | Cordett, Tim K. | Alshehri, Fahad H. | Daher, Noha S. | DrPH

Article Type: Research Article

Abstract: BACKGROUND: Chronic motion sensitivity (CMS) is a combination of autonomic symptoms provoked by exposure to motion. The correlation between anxiety and CMS is not yet well understood. OBJECTIVES: 1) To compare median anxiety levels between young adults with and without CMS. 2) To examine the effect of anxiety on postural stability with immersion virtual reality. 3) To compare anxiety levels between sexes. METHODS: Participants included 60 adults (20–40 years), with and without CMS. After determining their current and general anxiety levels, postural stability was measured. RESULTS: There were significant differences in median (minimum, maximum) …state- and trait-anxiety scores between participants with and without CMS, but no significant differences in median state- and trait-anxiety scores between males and females with CMS. There was a significant inverse relationship between state- and trait-anxiety scores and postural stability (ρ = –0.28, p  = 0.03, and ρ = –0.32, p  = 0.01, respectively). The stepwise regression analysis showed the Motion Sickness Susceptibility Questionnaire-Short Form score to be the only variable contributing significantly to postural stability (R2  = 26.2%; t  = –4.5, p  <  0.001). CONCLUSIONS: Young adults with CMS are more anxious, although anxiety does not contribute to postural stability in this group. Anxiety levels do not appear to differ between young adult males and females with CMS. Show more

Keywords: Motion sickness, anxiety, postural stability

DOI: 10.3233/VES-201625

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

Authors: Truong, Michelle | Bester, Christo | Orimoto, Kumiko | Vartanyan, Maria | Phyland, Debra | MacDougall, Hamish | Tari, Sylvia | Rousset, Alex | Curthoys, Ian | O’Leary, Stephen

Article Type: Research Article

Abstract: BACKGROUND: Dizziness is a common perioperative complication after cochlear implantation (CI). To date, the exact cause behind this phenomenon remains unclear. There is recent evidence to suggest that otolith function, specifically utricular, may be affected shortly after CI surgery, however whether these changes are related to patient symptoms has not yet been investigated. OBJECTIVE: To determine whether CI surgery and perioperative dizziness is associated with changes on utricular function. METHODS: We performed an observational study on patients undergoing routine CI surgery. Utricular function was assessed using the Subjective Visual Vertical (SVV), and perioperative dizziness was determined …using a questionnaire. The study followed patients before surgery and then again 1-day, 1-week and 6-weeks after implantation. RESULTS: Forty-one adult CI recipients participated in the study. The SVV deviated away from the operated ear by an average of 2.17° a day after implantation, 0.889° 1 week and –0.25° 6 weeks after surgery. Dizziness contributed to a tilt of 0.5° away from the implanted ear. These deviations were statistically significant. CONCLUSIONS: CI surgery causes utricular hyperfunction in the operated ear that resolves over 6 weeks. SVV tilts were greater in participants experiencing dizziness, suggesting that utricular hyperfunction may contribute to the dizziness. Show more

Keywords: Cochlear implantation, subjective visual vertical, utricle, cochlear implant trauma, endolymphatic hydrops

DOI: 10.3233/VES-210053

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

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: 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