Journal of Vestibular Research - Volume 28, issue 3-4

Authors: Kabbaligere, Rakshatha | Layne, Charles S. | Karmali, Faisal

Article Type: Research Article

Abstract: BACKGROUND: Vibration applied on the mastoid has been shown to be an excitatory stimulus to the vestibular receptors, but its effect on vestibular perception is unknown. OBJECTIVE: Determine whether mastoid vibration affects yaw rotation perception using a self-motion perceptual direction-recognition task. METHODS: We used continuous, bilateral, mechanical mastoid vibration using a stimulus with frequency content between 1 and 500 Hz. Vestibular perception of 10 healthy adults (M±S.D. = 34.3±12 years old) was tested with and without vibration. Subjects repeatedly reported the perceived direction of threshold-level yaw rotations administered at 1 Hz by a motorized platform. A cumulative …Gaussian distribution function was fit to subjects’ responses, which was described by two parameters: bias and threshold. Bias was defined as the mean of the Gaussian distribution, and equal to the motion perceived on average when exposed to null stimuli. Threshold was defined as the standard deviation of the distribution and corresponded to the stimulus the subject could reliably perceive. RESULTS: The results show that mastoid vibration may reduce bias, although two statistical tests yield different conclusions. There was no evidence that yaw rotation thresholds were affected. CONCLUSIONS: Bilateral mastoid vibration may reduce left-right asymmetry in motion perception. Show more

DOI: 10.3233/VES-180636

Citation: Journal of Vestibular Research, vol. 28, no. 3-4, pp. 283-294, 2018

Authors: Clément, Gilles | Reschke, Millard F.

Article Type: Research Article

Abstract: BACKGROUND: It has been proposed that individual susceptibility to motion sickness is related to the vestibulo-ocular reflex (VOR) through the activation of the velocity storage mechanism. OBJECTIVE: We investigated whether motion sickness level was related to the gain and phase of the VOR. METHODS: VOR gain and phase were measured in 214 subjects while they rotated in yaw at 0.01 Hz, 0.02 Hz, 0.04 Hz, 0.08 Hz, and 0.16 Hz in darkness, and results were compared to the severity of symptoms the subjects experienced during subsequent tests to provoke motion sickness. These tests included cross-coupled angular accelerations, sudden stops in light …or in dark, off-vertical axis rotation, and parabolic flight. The subjects were grouped according to the motion sickness level reached during these tests (none, low, medium, or high). RESULTS: No correlation was found between the horizontal VOR gain and motion sickness level. However, for the subjects with high motion sickness level, the VOR phase lead was significantly lower during rotation at frequencies ranging from 0.04 Hz to 0.16 Hz (i.e. the VOR time constant was longer) than the other motion sickness groups. CONCLUSION: These results support the theory that the longer the time constant for velocity storage, the more severe the motion sickness. Show more

Keywords: Motion sickness, sensory conflict, vestibular nystagmus, velocity storage

DOI: 10.3233/VES-180632

Citation: Journal of Vestibular Research, vol. 28, no. 3-4, pp. 295-304, 2018

Authors: Devantier, Louise | Hoskison, Emma | Ovesen, Therese | Henriksen, Jens-Jacob MØlby

Article Type: Research Article

Abstract: BACKGROUND: Suppression Head Impulse Paradigm (SHIMP), a novel variant of the Head Impulse Test has been introduced. At the same time, the Head Impulse Test was renamed to the Head Impulse Paradigm (HIMP). Contrary to HIMP saccades, SHIMP saccades are a sign of vestibular function. OBJECTIVE: 1) To compare SHIMP and HIMP feasibility, vestibular-ocular reflex (VOR) gain value and the saccadic pattern in healthy adolescents. 2) To compare SHIMP and HIMP feasibility in the hands of an experienced and an inexperienced HIMP examiner. METHOD: A total of 29 adolescents from Skåde Municipal School, Denmark were tested …with HIMP and then with SHIMP. RESULTS: Neither covert nor overt saccades were observed in the HIMP, whereas SHIMP saccades were observed in all SHIMP reports. SHIMP gain values were statistically lower than HIMP gain values. A statistically significant difference was observed between the two examiners’ right SHIMP gain values, but not for the left SHIMP gain values or the HIMP gain values. CONCLUSIONS: We found that HIMP and SHIMP tests are feasible in healthy adolescents for experienced as well as inexperienced examiners. However, one must be aware of potential pitfalls in the execution and interpretation of both tests. This is a well-known fact for the HIMP test, but additional considerations are needed to obtain reliable results from the SHIMP test. Show more

Keywords: Adolescents, vestibular test, video head impulse test, suppression head impulse test (SHIMP)

DOI: 10.3233/VES-180643

Citation: Journal of Vestibular Research, vol. 28, no. 3-4, pp. 311-317, 2018

Authors: Pyykkö, Ilmari | Manchaiah, Vinaya | Zou, Jing | Levo, Hilla | Kentala, Erna

Article Type: Research Article

Abstract: The purpose of the present study was to characterize the occurrence of Tumarkin attacks in patients with Ménière’sdisease (MD), and to study its association with reported complaints, severity of consequences, and also self-reported work ability. The study used a cross-sectional design. Data obtained from the Finnish Ménière Federation using an electronic survey was analyzed. 602 people with MD responded to the survey (62% response rate) with a mean age of 56.7 years and a mean duration of the disease 12.4 years. 49% of the respondents experienced Tumarkin attacks, which lasted for a few seconds to a few minutes. There were …significant differences in complaints reported by MD patients with and without Tumarkin attacks. Respondents with Tumarkin attacks experienced various consequences, including tripping, falls, fear, anxiety, problems in dyadic life, and even transient loss of consciousness. Respondents with Tumarkin attacks had more frequently applied for pension than those not having Tumarkin attacks. On an average, respondents with Tumarkin attacks had less self-reported working ability when compared to those without Tumarkin attacks. The current study results suggest various differences in terms of complaints reported, severity of consequences, and the self-reported working ability in MD patients with and without Tumarkin attacks. Hearing healthcare professionals must examine Tumarkin attacks and their consequences in patients with MD during clinical examinations. In addition, the therapy should focus on alleviating the consequences and improving work ability. Show more

Keywords: Vasovagal attack, unconsciousness, vestibular syncope, Tumarkin attacks, drop attacks

DOI: 10.3233/VES-180634

Citation: Journal of Vestibular Research, vol. 28, no. 3-4, pp. 319-330, 2018

Authors: Krstulovic Roa, Claudio

Article Type: Research Article

Abstract: BACKGROUND: Galvanic Vestibular Stimulation (GVS) has long been used as a vestibular stimulus. A major issue observed in GVS research was the high variability of the responses, which has led some researchers to question its diagnostic utility. OBJECTIVES: Determine the diagnostic accuracy of galvanically induced nystagmus for the diagnosis of subjects with unilateral peripheral vestibular hypofunction. METHODS: A total of 195 dizzy patients were prospectively enrolled, forming a consecutive series as they were received. Individuals with spontaneous nystagmus or using vestibular sedatives were excluded. Nystagmus induced by a 4 mA galvanic stimulus was compared with the caloric …test as a reference standard. RESULTS: Of the 195 subjects tested with GVS, 115 were subjects with a unilateral peripheral vestibular hypofunction. The presence of nystagmus showed an AUC of only 0.529 (0.478 to 0.580, p  = 0.125), and the maximum slow phase velocity of nystagmus showed an AUC of only 0.523 (0.472 to 0.573, p  = 0.439). CONCLUSIONS: Since neither AUC is better than random discrimination, this study concludes that GVS-induced nystagmus is not useful as a diagnostic tool for unilateral peripheral vestibular hypofunction. These findings discourage the use of GVS-induced nystagmus in the clinical setting. Show more

Keywords: Vestibular, diagnostic tests, routine, galvanic skin response

DOI: 10.3233/VES-180642

Citation: Journal of Vestibular Research, vol. 28, no. 3-4, pp. 331-338, 2018

Authors: Lindell, Ellen | Finizia, Caterina | Johansson, Mia | Karlsson, Therese | Nilson, Jerker | Magnusson, Måns

Article Type: Research Article

Abstract: BACKGROUND: Benign paroxysmal positional vertigo (BPPV) is the single most common cause of vestibular vertigo and is characterised by short episodes of rotational vertigo precipitated by changes in head positions like lying down or turning in bed. OBJECTIVE: This study aims to assess useful questions when suspecting benign paroxysmal positional vertigo (BPPV) caused dizziness as well as identifying if a single question can be useful in identify or distinguish patients with BPPV from other dizziness aetiology. METHOD: A total of 149 patients admitted due to dizziness were included. Patients answered a questionnaire and were investigated for …BPPV with diagnostic manoeuvres. RESULT: Two of the 15 questions were of diagnostic importance. Dizziness when laying down or turning in bed, increased likelihood of BPPV by an odds ratio (95% confidence interval) of 60 (7.47–481.70). Continuous dizziness duration as opposed to lasting seconds decreased likelihood of BPPV with an odds ratio of 0.06 (0.01–0.27). CONCLUSION: Vertiginous attacks by turning or laying down in bed together with dizziness <1 minute, are important questions and strongly related to BPPV. Such questions are important when taking a medical history and may help to early identify BPPV, also for non-medical staff, as well as reduce the need of further investigations. Show more

Keywords: BPPV, vertigo, diagnosis, dizziness, prevalence

DOI: 10.3233/VES-180637

Citation: Journal of Vestibular Research, vol. 28, no. 3-4, pp. 339-347, 2018

Authors: Roller, Robert Alan | Hall, Courtney D.

Article Type: Research Article

Abstract: BACKGROUND: Current vestibular rehabilitation for peripheral vestibular hypofunction is an exercise-based approach that improves symptoms and function in most, but not all patients, and includes gaze stabilization exercises focused on duration of head movement. One factor that may impact rehabilitation outcomes is the speed of head movement during gaze stability exercises. OBJECTIVE: Examine outcomes of modified VOR X1 exercises that emphasize a speed-based approach for gaze stabilization while omitting substitution and habituation exercises. Balance training focused on postural realignment and hip strategy performance during altered visual and somatosensory inputs. METHODS: A retrospective chart review of 159 …patients with vestibular deficits was performed and five outcome measures were analyzed. RESULTS: All outcomes – self-report dizziness and balance function, dynamic gait index, modified clinical test of sensory interaction and balance, and clinical dynamic visual acuity improved significantly and approached or achieved normal scores. CONCLUSIONS: The combination of modified VOR X1 gaze stability exercises, wherein patients achieved high-velocity head movement (240°/s) during short exercise bouts, with “forced use” gait and balance exercises for postural realignment and hip strategy recruitment, achieved 93–99% of normal scores for all five outcomes. These results compare favorably to the outcomes for current VR techniques and warrant further investigation. Show more

Keywords: Vestibular rehabilitation, peripheral vestibular hypofunction, outcomes

DOI: 10.3233/VES-180633

Citation: Journal of Vestibular Research, vol. 28, no. 3-4, pp. 349-357, 2018

Authors: Zhu, Meichan | Yu, Feng | Zhou, Feng | Wang, Haitao | Jiao, Yuenong | Wang, Meng | Huang, Lifen | Liang, Zijian

Article Type: Research Article

Abstract: OBJECTIVE: We studied the clinical features of benign paroxysmal positional vertigo (BPPV) associated with Meniere’s disease. METHODS: The medical records of 120 patients with BPPV was retrospectively analyzed. Complete otolaryngological, audiological, and neurotological evaluation results were available for all patients, including nystagmography. All patients were diagnosed using the Dix-Hallpike test or roll test and treated with the canalith repositioning procedure. The outcomes were compared among the three groups. RESULTS: A series of 120 BPPV cases. Results showed that Group A and Group B based on the following features: unilateral semicircular canal BPPV occurred more often than …bilateral BPPV and the posterior semicircular canal was the most common canal involved. Additionally, Meniere’s disease patients with multiple semicircular canal BPPV required repeated canalith repositioning procedures and had a higher recurrence rate. CONCLUSION: A lower treatment success rate and a higher recurrence rate were found in the BPPV patients with Meniere’s disease compared with the patients without Meniere’s disease. The recurrence rate was highest in the patients with multiple semicircular canal BPPV with Meniere’s disease. Show more

Keywords: Benign paroxysmal positional vertigo, Meniere’s disease, canalith repositioning procedure, nystagmography

DOI: 10.3233/VES-180638

Citation: Journal of Vestibular Research, vol. 28, no. 3-4, pp. 359-364, 2018

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

Article Type: Letter

DOI: 10.3233/VES-180640

Citation: Journal of Vestibular Research, vol. 28, no. 3-4, pp. 365-366, 2018

Authors: Cohen, Helen S | Mulavara, Ajitkumar P | Bloomberg, Jacob J | Nair, Maitreyi A

Article Type: Letter

DOI: 10.3233/VES-180641

Citation: Journal of Vestibular Research, vol. 28, no. 3-4, pp. 367-367, 2018