Journal of Vestibular Research - Volume 32, issue 1

Authors: Lempert, Thomas | Olesen, Jes | Furman, Joseph | Waterston, John | Seemungal, Barry | Carey, John | Bisdorff, Alexander | Versino, Maurizio | Evers, Stefan | Kheradmand, Amir | Newman-Toker, David

Article Type: Research Article

Abstract: This paper presents diagnostic criteria for vestibular migraine, jointly formulated by the Committee for Classification of Vestibular Disorders of the Bárány Society and the Migraine Classification Subcommittee of the International Headache Society (IHS). It contains a literature update while the original criteria from 2012 were left unchanged. The classification defines vestibular migraine and probable vestibular migraine. Vestibular migraine was included in the appendix of the third edition of the International Classification of Headache Disorders (ICHD-3, 2013 and 2018) as a first step for new entities, in accordance with the usual IHS procedures. Probable vestibular migraine may be included in a …later version of the ICHD, when further evidence has accumulated. The diagnosis of vestibular migraine is based on recurrent vestibular symptoms, a history of migraine, a temporal association between vestibular symptoms and migraine symptoms and exclusion of other causes of vestibular symptoms. Symptoms that qualify for a diagnosis of vestibular migraine include various types of vertigo as well as head motion-induced dizziness with nausea. Symptoms must be of moderate or severe intensity. Duration of acute episodes is limited to a window of between 5 minutes and 72 hours. Show more

Keywords: Migraine, vertigo, dizziness, vestibular, diagnostic criteria, Bárány Society, International Headache Society

DOI: 10.3233/VES-201644

Citation: Journal of Vestibular Research, vol. 32, no. 1, pp. 1-6, 2022

Authors: Cohen, Helen S. | Sangi-Haghpeykar, Haleh | Plankey, Michael W.

Article Type: Research Article

Abstract: BACKGROUND: Many epidemiologic studies of vestibular disorders are based on responses to questionnaires which have not been tested against objective tests of the vestibular system. OBJECTIVE: The goal was to determine if the dizziness and balance questions used in the National Health Interview Survey (NHIS) are valid and predict performance on objective tests of the vestibular system (VNG). METHODS: Data from 367 participants recruited from the community, aged 21.4 to 87.6 years, were collected in the Otolaryngology department at a tertiary care center. They were asked the eight NHIS questions twice, at least 30 minutes apart …and were tested on VNG. RESULTS: Question responses changed from Test 1 to Test 2 and differed between males and females. “Yes” responses did not predict abnormal VNG responses, for the total group and when the group was categorized into younger (<60 years) and older (>60 years) subjects. The sensitivity and specificity of all questions was low. CONCLUSION: The NHIS questions provide some information about what people recall of their experiences, but they may not provide insight into the diagnostic prevalence of vestibular and balance disorders because the sensitivity and specificity are too low. Questionnaire-based epidemiologic studies should be interpreted with caution. Show more

Keywords: Vestibular, dizziness, balance, screening, vertigo

DOI: 10.3233/VES-210022

Citation: Journal of Vestibular Research, vol. 32, no. 1, pp. 7-14, 2022

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

Keywords: Vestibular testing, dynamic visual acuity, virtual reality

DOI: 10.3233/VES-200782

Citation: Journal of Vestibular Research, vol. 32, no. 1, pp. 15-20, 2022

Authors: Riera-Tur, Laura | Caballero-Garcia, Andres | Martin-Mateos, Antonio J. | Lechuga-Sancho, Alfonso M.

Article Type: Research Article

Abstract: BACKGROUND: The subjective visual vertical (SVV) test is a sensitive test of vestibular dysfunction that allows the evaluation of otolithic organs; however, with the current method, there are technical and logistical limitations that make the application of this test difficult in the conventional clinic. OBJECTIVE: The objective of this study is to assess the effectiveness of detecting vestibular pathology using the SVV via a new screening method. METHODS: A consecutive sample of 62 patients with suspected vestibular pathology was included in the study. The patients were clinically diagnosed according to the Barany Society criteria. An exploratory …system was designed using a mobile application in Android that detects accelerometer oscillations and involves placing the smartphone on a rotating disk anchored to the wall. All patients underwent a SVV examination using the bucket method and the study test. A cut-off point of the ROC curve was calculated for each test, and its sensitivity, specificity, diagnostic accuracy and probability ratios for detecting vestibular pathology were analysed. The SVV results were compared using the bucket test and the study test. RESULTS: We observed significant differences in sensitivity between the two tests: 86.95% for the study test versus 67.4% for the bucket test (p  < 0.01). In the ROC curve, an area under the curve of 0.90 was observed for the study test, with a cut-off of 2.43 for a sensitivity of 86.95% and a specificity of 93.75%. CONCLUSIONS: SVV testing using a smartphone placed on a rotating disk anchored to the wall offers greater diagnostic accuracy than SVV using the bucket test. Both methods are inexpensive, harmless and easily accepted by patients. Show more

Keywords: Vestibular diseases, subjective visual vertical, smartphone, mobile applications, dizziness, mhealth

DOI: 10.3233/VES-201526

Citation: Journal of Vestibular Research, vol. 32, no. 1, pp. 21-27, 2022

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, especially in 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. 32, no. 1, pp. 29-37, 2022

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. 32, no. 1, pp. 39-47, 2022

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. 32, no. 1, pp. 49-56, 2022

Authors: Diao, Tongxiang | Han, Lin | Jing, Yuanyuan | Wang, Yixu | Ma, Xin | Yu, Lisheng | Zhang, Jilei | Zheng, Hongwei | Wang, Lin | Li, Xueshi | Chen, Nishan

Article Type: Research Article

Abstract: BACKGROUND: Migraine is more common in Meniere’s disease patients, who have some certain anatomical variations. But there are limited studies focusing on the anatomical variations in patients with Meniere’s disease and migraine. OBJECTIVE: To explore the clinical and anatomical features in Meniere’s disease patients with and without migraine, determining whether the coexistence of migraine can be used as a basis for clinical subtyping of Meniere’s disease. METHODS: Ninety-five Meniere’s disease patients and ninety-five healthy subjects matched with age, sex were selected. A detailed questionnaire based on the diagnosis criteria of Meniere’s disease and migraine was designed. …According to the CT scan, we divided the mastoid cell system of all the subjects into two types: well-pneumatization type and poor-pneumatization type. Meanwhile, the shortest distance between the sigmoid sinus and the posterior wall of the external acoustic canal was measured. RESULTS: Compared with those without migraine, Meniere‘s disease patients with migraine had a higher female comorbidity, poorer mastoid pneumatization, shorter distance between the sigmoid sinus and posterior wall of the external acoustic canal, longer history, higher frequency of vertigo attacks and better average hearing threshold. CONCLUSIONS: In our study, anatomical features as well as several clinical manifestations were proved to differ significantly between Meniere’s disease patients with and without migraine, indicating the coexistence of migraine may be one standard for the clinical subtyping of Meniere’s disease. Show more

Keywords: Meniere’s disease, anatomical features, clinical manifestations, migraine, subtype

DOI: 10.3233/VES-190755

Citation: Journal of Vestibular Research, vol. 32, no. 1, pp. 57-67, 2022

Authors: Powell, Georgina | Penacchio, Olivier | Derry-Sumner, Hannah | Rushton, Simon K. | Rajenderkumar, Deepak | Sumner, Petroc

Article Type: Research Article

Abstract: BACKGROUND: Images that deviate from natural scene statistics in terms of spatial frequency and orientation content can produce visual stress (also known as visual discomfort), especially for migraine sufferers. These images appear to over-activate the visual cortex. OBJECTIVE: To connect the literature on visual discomfort with a common chronic condition presenting in neuro-otology clinics known as persistent postural perceptual dizziness (PPPD). Patients experience dizziness when walking through highly cluttered environments or when watching moving stimuli. This is thought to arise from maladaptive interaction between vestibular and visual signals for balance. METHODS: We measured visual discomfort to …stationary images in patients with PPPD (N = 30) and symptoms of PPPD in a large general population cohort (N = 1858) using the Visual Vertigo Analogue Scale (VVAS) and the Situational Characteristics Questionnaire (SCQ). RESULTS: We found that patients with PPPD, and individuals in the general population with more PPPD symptoms, report heightened visual discomfort to stationary images that deviate from natural spectra (patient comparison, F (1, 1865) = 29, p  < 0.001; general population correlations, VVAS, rs (1387) = 0.46, p  < 0.001; SCQ, rs (1387) = 0.39, p  < 0.001). These findings were not explained by co-morbid migraine. Indeed, PPPD symptoms showed a significantly stronger relationship with visual discomfort than did migraine (VVAS, zH  = 8.81, p  < 0.001; SCQ, zH  = 6.29, p  < 0.001). CONCLUSIONS: We speculate that atypical visual processing –perhaps due to a visual cortex more prone to over-activation –may predispose individuals to PPPD, possibly helping to explain why some patients with vestibular conditions develop PPPD and some do not. Show more

Keywords: Persistent postural perceptual dizziness (PPPD), visually-induced dizziness, visual stress, sensory overload

DOI: 10.3233/VES-190578

Citation: Journal of Vestibular Research, vol. 32, no. 1, pp. 69-78, 2022

Authors: Se To, Phui Lin | Singh, Devinder Kaur Ajit | Whitney, Susan L.

Article Type: Research Article

Abstract: BACKGROUND: Adults with unilateral posterior canal benign paroxysmal positional vertigo (BPPV) may continue to present with residual dizziness and balance impairments after the canalith repositioning maneuver (CRM). Customized Vestibular rehabilitation (VR) in addition to the standard CRM may improve postural control in adults with BPPV. However, the effectiveness of this intervention for improving dyanmic gait measures in adults with BPPV is unknown. OBJECTIVE: We aimed to determine the effectiveness of customized VR in addition to the standard CRM on dynamic gait measures among adults with unilateral posterior canal BPPV. METHODS: In this double blind, randomized controlled …trial, 28 adults with BPPV were randomized to either control (n  = 14, age: 54.36±8.55) or experimental (n  = 14, age: 50.71±9.88) groups. The experimental and control groups received customized VR plus standard CRM for six weeks and standard CRM for two weeks respectively. Dynamic gait measures (duration of a complete gait cycle, stride velocity, turning duration and number of steps while turning) were recorded using a portable mobility sensor (iTUG) at baseline, week 4 and 6. A mixed model ANOVA was used to estimate the main effects of the interventions. RESULTS: During walking, a group effect was demonstrated on gait duration, stride velocity, turning duration and number of steps while turning (p  < 0.05). CONCLUSIONS: Six weeks of customized VR performed in addition to the standard CRM was more effective than the standard CRM alone in improving balance and gait in adults with posterior canal BPPV. (252 words) Show more

Keywords: Keywords:Vestibular rehabilitation, canalith repositioning maneuver, benign paroxysmal positional vertigo, BPPV, balance, gait, mobility

DOI: 10.3233/VES-190731

Citation: Journal of Vestibular Research, vol. 32, no. 1, pp. 79-86, 2022