Journal of Vestibular Research - Volume 32, issue 3

Authors: Kim, Ji-Soo | Newman-Toker, David E. | Kerber, Kevin A. | Jahn, Klaus | Bertholon, Pierre | Waterston, John | Lee, Hyung | Bisdorff, Alexandre | Strupp, Michael

Article Type: Research Article

Abstract: This paper presents diagnostic criteria for vascular vertigo and dizziness as formulated by the Committee for the Classification of Vestibular Disorders of the Bárány Society. The classification includes vertigo/dizziness due to stroke or transient ischemic attack as well as isolated labyrinthine infarction/hemorrhage, and vertebral artery compression syndrome. Vertigo and dizziness are among the most common symptoms of posterior circulation strokes. Vascular vertigo/dizziness may be acute and prolonged (≥24 hours) or transient (minutes to  < 24 hours). Vascular vertigo/dizziness should be considered in patients who present with acute vestibular symptoms and additional central neurological symptoms and signs, including central HINTS signs (normal …head-impulse test, direction-changing gaze-evoked nystagmus, or pronounced skew deviation), particularly in the presence of vascular risk factors. Isolated labyrinthine infarction does not have a confirmatory test, but should be considered in individuals at increased risk of stroke and can be presumed in cases of acute unilateral vestibular loss if accompanied or followed within 30 days by an ischemic stroke in the anterior inferior cerebellar artery territory. For diagnosis of vertebral artery compression syndrome, typical symptoms and signs in combination with imaging or sonographic documentation of vascular compromise are required. Show more

Keywords: Vertigo, dizziness, imbalance, infarction, stroke, brainstem, cerebellum

DOI: 10.3233/VES-210169

Citation: Journal of Vestibular Research, vol. 32, no. 3, pp. 205-222, 2022

Authors: Wellons, Rachel D. | Duhe, Sydney E. | MacDowell, Sara G. | Hodge, April | Oxborough, Sara | Levitzky, Elizabeth E.

Article Type: Research Article

Abstract: BACKGROUND: Vestibular Rehabilitation Therapists (VRT) utilize outcome measures to quantify gait and balance abilities in individuals with vestibular disorders (IVD). The minimal clinically important difference (MCID) in gait and balance outcome measures for IVD is unknown. OBJECTIVE: The purpose of this study is to estimate the MCID of the Activities-specific Balance Confidence Scale (ABC), Functional Gait Assessment (FGA), and Gait Speed (GS) using distribution and anchor-based methods relative to the Dizziness Handicap Inventory (DHI) in IVD. METHODS: Data were collected using a retrospective chart review from two outpatient Vestibular Rehabilitation (VR) clinics. Data included demographic characteristics, …diagnosis, VR course, and pre and post outcome measures including DHI, ABC, FGA, and GS. The DHI was used to classify subjects as “responders” or “non-responders” in order to calculate MCID values. RESULTS: The total number of subjects analyzed for each outcome measure was 222 for the ABC, 220 for FGA, and 237 for GS. Subjects made statistically significant improvements in ABC, DHI, FGA, and GS (p  < 0.001) from pre to post VR. The MCID calculated for ABC, FGA, and GS using the anchor-based approach was 18.1%, 4 points, and 0.09 m/s respectively. The MCIDs calculated using distribution-based approach for the ABC ranged between 7.5–23.5%, FGA ranged between 1.31–4.15 points, and GS ranged between 0.07 m/s–0.22 m/s. CONCLUSIONS: The anchor-based calculations of the MCID of 18.1%, 4 points, and 0.09 m/s for ABC, FGA, and GS respectively for IVD should be used over distribution-based calculations. This is due to strength of DHI as the anchor and statistical analysis. VRT and researches can use these values to indicate meaningful changes in gait and balance function in IVD. Show more

Keywords: Minimal clinically important difference, activities-specific balance confidence scale, functional gait assessment, gait speed, vestibular disorders

DOI: 10.3233/VES-201630

Citation: Journal of Vestibular Research, vol. 32, no. 3, pp. 223-233, 2022

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: The VVA-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. 32, no. 3, pp. 235-243, 2022

Authors: Janky, Kristen L. | Thomas, Megan | Al-Salim, Sarah | Robinson, Sara

Article Type: Research Article

Abstract: BACKGROUND: In adults, vestibular loss is associated with cognitive deficits; however, similar relationships have not been studied in children. OBJECTIVE: Evaluate the effect of vestibular loss on working memory and executive function in children with a cochlear implant (CCI) compared to children with normal hearing (CNH). METHODS: Vestibular evoked myogenic potential, video head impulse, rotary chair, and balance testing; and the following clinical measures: vision, hearing, speech perception, language, executive function, and working memory. RESULTS: Thirty-eight CNH and 37 CCI participated (26 with normal vestibular function, 5 with unilateral vestibular loss, 6 with bilateral …vestibular loss). Children with vestibular loss demonstrated the poorest balance performance. There was no significant reduction in working memory or executive function performance for either CCI group with vestibular loss; however, multivariate regression analysis suggested balance performance was a significant predictor for several working memory subtests and video head impulse gain was a significant predictor for one executive function outcome. CONCLUSIONS: CCI with vestibular loss did not have significantly reduced working memory or executive function; however, balance performance was a significant predictor for several working memory subtests. Degree of hearing loss should be considered, and larger sample sizes are needed. Show more

Keywords: Vestibular, cognition, working memory

DOI: 10.3233/VES-201556

Citation: Journal of Vestibular Research, vol. 32, no. 3, pp. 245-260, 2022

Authors: Hawkins, Kim E. | Chiarovano, Elodie | Paul, Serene S. | Burgess, Ann M | MacDougall, Hamish G. | Curthoys, Ian S.

Article Type: Research Article

Abstract: BACKGROUND: Parkinson’s disease (PD) is a common multi-system neurodegenerative disorder with possible vestibular system dysfunction, but prior vestibular function test findings are equivocal. OBJECTIVE: To report and compare vestibulo-ocular reflex (VOR) gain as measured by the video head impulse test (vHIT) in participants with PD, including tremor dominant and postural instability/gait dysfunction phenotypes, with healthy controls (HC). METHODS: Forty participants with PD and 40 age- and gender-matched HC had their vestibular function assessed. Lateral and vertical semicircular canal VOR gains were measured with vHIT. VOR canal gains between PD participants and HC were compared with independent …samples t -tests. Two distinct PD phenotypes were compared to HC using Tukey’s ANOVA. The relationship of VOR gain with PD duration, phenotype, severity and age were investigated using logistic regression. RESULTS: There were no significant differences between groups in vHIT VOR gain for lateral or vertical canals. There was no evidence of an effect of PD severity, phenotype or age on VOR gains in the PD group. CONCLUSION: The impulsive angular VOR pathways are not significantly affected by the pathophysiological changes associated with mild to moderate PD. Show more

Keywords: vHIT, VOR, Parkinson’s disease, vestibular, HIMP

DOI: 10.3233/VES-201626

Citation: Journal of Vestibular Research, vol. 32, no. 3, pp. 261-269, 2022

Authors: Ihler, Friedrich | Stoycheva, Ivelina | Spiegel, Jennifer L. | Polterauer, Daniel | Müller, Joachim | Strobl, Ralf | Grill, Eva

Article Type: Research Article

Abstract: BACKGROUND: The diagnosis of Menière’s disease (MD) is made according to diagnostic criteria, the last revision of which was in 2015. For diagnosis, symptoms are weighted with audiometric findings and this can be challenging in individual patients. OBJECTIVE: To analyze patient’s characteristics and symptoms in a real-life cohort of 96 patients with diagnosed MD regarding sociodemographic parameters, clinical specifics, and audiometry. METHODS: Prospective clinical patient registry containing demographic and socioeconomic parameters, symptoms, as well as pure-tone audiometry data. RESULTS: 31 patients with definite MD, and 36 with probable MD were identified. 29 patients showed …typical clinical signs of MD, but did not meet the full diagnostic criteria, and were considered separately. Mean duration of symptoms prior to presentation was 3.9±4.6 years. Significant differences between categories were found regarding aural fullness, tinnitus, and fluctuating hearing. If multiple audiograms were available, 28.6 % (6/21) documented fluctuating hearing. CONCLUSIONS: Current diagnostic criteria probably do not represent patients with monosymptomatic presentation or an early stage very well. Long-term follow-up with repeated audiometry is advisable. Show more

Keywords: Menière’s disease, CHE diagnostic criteria, dizziness registry, international classification of vestibular disorders

DOI: 10.3233/VES-201634

Citation: Journal of Vestibular Research, vol. 32, no. 3, pp. 271-283, 2022

Authors: Azzi, Jayson Lee | Khoury, Michel | Séguin, Jeanne | Rourke, Ryan | Hogan, Debora | Tse, Darren | Lelli, Daniel A.

Article Type: Research Article

Abstract: BACKGROUND: Persistent Postural Perceptual Dizziness (PPPD) is a newly defined condition which was added to the International Classification of Vestibular Disorders in 2017. Little is known about its impact on patients. OBJECTIVE: The goal of this study was to analyze the symptomology, epidemiology and impact of PPPD on patients. METHODS: A retrospective chart review was done to identify patients who attended the Multidisciplinary Dizziness Clinic (MDC) and were diagnosed with PPPD. Responses to demographic questions, health-related quality of life surveys and several well-validated questionnaires commonly used to assess dizziness severity were analyzed. RESULTS: One …hundred patients were diagnosed with PPPD between March 2017 and January 2019, of which 80%(80/100) were females. The average Dizziness Handicap Index score was 60.3±19.0. Responses to the Patient Health Questionnaire classified 53 patients (53/99;53.5%) as moderately to severely depressed. Sixty-four patients (64/100;64.0%) were minimally or mildly anxious according to the Generalized Anxiety Disorder scale. The average Vertigo Symptom Scale score was 24.1/60. The average Situational Vertigo Questionnaire score was 2.00. Forty-nine (49/100;49.0%) patients had migraine symptoms according to the Migraine Screen Questionnaire. CONCLUSIONS: In conclusion, patients with PPPD display important handicap and an elevated risk of depression, anxiety and migraines. Show more

Keywords: Persistent postural perceptual dizziness, PPPD, vertigo, dizziness

DOI: 10.3233/VES-190749

Citation: Journal of Vestibular Research, vol. 32, no. 3, pp. 285-293, 2022

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 in 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. 32, no. 3, pp. 295-304, 2022