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

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: 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: Anton, Kristina | Ernst, Arne | Basta, Dietmar

Article Type: Research Article

Abstract: BACKGROUND: Postural stability might be influenced by auditory input as humans utilize spatiotemporal information to localise sound sources. Earlier studies investigated the acoustic influence on posture but unfortunately experimental setup, room acoustics and conditions of participants varied widely. OBJECTIVE: This study aimed at recording body sway velocity under clearly defined acoustic conditions in a homogenous group of young healthy participants. METHODS: Thirty participants performed five stance tasks (standing eyes open/closed, standing on a foam support eyes open/closed, Tandem Romberg test eyes closed) under five acoustic conditions (in quiet, with a loudspeaker presenting continuous/interrupted noise, with ear …protectors) in two different rooms (long/short reverberation time). Body sway velocity was determined close to body’s centre of gravity. RESULTS: Postural stability decreased significantly when continuous noise was applied and increased significantly when interrupted noise was presented in the reverberant room. The usage of ear protectors increased body sway velocity compared to quietness in both rooms. CONCLUSIONS: An impaired auditory input by plugging/acoustic masking reduced postural control. Interrupted noise seems to provide a continuously repeated feedback about the postural position in a reverberant room. Hence, the effect of hearing on posture highly depends on the structure of the auditory signal, the sensorimotor condition and the acoustic environment. Show more

Keywords: Auditory influence, mobile posturography, postural control, body sway, spatial cues

DOI: 10.3233/VES-190674

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

Authors: Micarelli, Alessandro | Viziano, Andrea | Alessandrini, Marco

Article Type: Letter

DOI: 10.3233/VES-180664

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