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Stevens MN, Garrison DB, Kaylie DM. What is the potential clinical utility of vHIT when assessing adult patients with dizziness? Laryngoscope 2017; 127:2689-2690. [PMID: 28699192 PMCID: PMC5687996 DOI: 10.1002/lary.26774] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2017] [Indexed: 12/20/2022]
Affiliation(s)
| | - Douglas B. Garrison
- Duke University Medical Center, Division of Otolaryngology – Head and Neck Surgery, Durham, NC, USA
| | - David M. Kaylie
- Duke University Medical Center, Division of Otolaryngology – Head and Neck Surgery, Durham, NC, USA
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102
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Choi JE, Kim YK, Cho YS, Lee K, Park HW, Yoon SH, Kim HJ, Chung WH. Morphological correlation between caloric tests and vestibular hydrops in Ménière's disease using intravenous Gd enhanced inner ear MRI. PLoS One 2017; 12:e0188301. [PMID: 29190293 PMCID: PMC5708622 DOI: 10.1371/journal.pone.0188301] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 10/08/2017] [Indexed: 11/18/2022] Open
Abstract
The purpose of this study was to prove the hypothesis that caloric response in Ménière's disease (MD) is reduced by hydropic expansion of the vestibular labyrinth, not by vestibular hypofunction, by evaluating the correlation morphologically using an intravenous Gadolinium (IV-Gd) inner ear MRI. In study I, the prevalence of abnormal video Head Impulse Test (vHIT) results among the patients with definite unilateral MD (n = 24) and vestibular neuritis (VN) (n = 22) were investigated. All patients showed abnormal canal paresis (CP) (> 26%) on caloric tests. The prevalence of abnormal vHIT in patients with abnormal CP was significantly lower in MD patients (12.5%) than that in VN patients (81.8%) (p < 0.001). In study II, morphological correlation between caloric tests and vestibular hydrops level was evaluated in unilateral MD patients (n = 16) who had normal vHIT results. Eleven patients (61%) had abnormal CP. After taking the images of IV-Gd inner ear MRI, the vestibular hydrops ratio (endolymph volume/total lymph volume = %VH) was measured. In addition, the relative vestibular hydrops ratio (%RVH = (%VHaffected ear-%VHunaffected ear) / (%VHaffected ear + %VHunaffected ear)) was calculated. Each ratio (%VH and %RVH) was compared with average peak slow phase velocity (PSPV) and CP, respectively. In the MD patients, %VH of the affected ear correlated significantly with mean PSPV on the same side (rs = -0.569, p = 0.024), while %RVH correlated significantly with CP (rs = 0.602, p = 0.014). In most MD patients (87.5%) compared to VN patients, vHIT results were normal even though the caloric function was reduced. In addition, the reduced caloric function with normal vHIT was related to the severity of the vestibular hydrops measured by the IV-Gd inner ear MRI. These findings concluded that the abnormal caloric tests with normal vHIT in MD indicated severe endolymphatic hydrops rather than vestibular hypofunction.
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Affiliation(s)
- Ji Eun Choi
- Department of Otorhinolaryngology—Head and Neck Surgery, Dankook University Hospital, Cheonan, Republic of Korea
| | - Yi-Kyung Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Sang Cho
- Department of Otorhinolaryngology—Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kieun Lee
- Department of Otorhinolaryngology—Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun Woo Park
- Department of Otorhinolaryngology—Head and Neck Surgery, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Sung Hoon Yoon
- Hearing Research Laboratory, Samsung Medical Center, Seoul, Republic of Korea
| | - Hyung-Jin Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won-Ho Chung
- Department of Otorhinolaryngology—Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- * E-mail:
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103
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Cordero-Yanza JA, Arrieta Vázquez EV, Hernaiz Leonardo JC, Mancera Sánchez J, Hernández Palestina MS, Pérez-Fernández N. Comparative study between the caloric vestibular and the video-head impulse tests in unilateral Menière's disease. Acta Otolaryngol 2017; 137:1178-1182. [PMID: 28741403 DOI: 10.1080/00016489.2017.1354395] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Compare the caloric vestibular test (CVT) and the video head impulse test (vHIT) in the evaluation of Meniere's disease (MD) and to analyze their diagnostic accuracy. MATERIALS AND METHODS Retrospective review of CVT and vHIT performed in MD patients at a tertiary care referral center in Spain. RESULTS A total of 88 patients were reviewed. The CVT was abnormal in 67% (n = 59) of patients, while the vHIT was abnormal in 66% (n = 58) of them. Agreement between both tests was poor, regardless of whether the horizontal semicircular canal (SCC) or all SCC were analyzed (kappa = .21). Anterior SCC pathology was found in 30% (n = 27) of the subjects while 51% (n = 45) had altered gains in the posterior SCC. CONCLUSIONS Our study shows that patients with MD can have functional deficit involving the vertical semicircular canals, which cannot be detected by the CVT alone. Therefore, both tests should be used in a complementary fashion.
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Affiliation(s)
| | | | - Juan Carlos Hernaiz Leonardo
- Department of Otolaryngology & Head and Neck Surgery, Instituto Nacional de Rehabilitación, CDMX, México, México
| | - Jimena Mancera Sánchez
- Department of Otolaryngology & Head and Neck Surgery, Instituto Nacional de Rehabilitación, CDMX, México, México
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104
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Mezzalira R, Bittar RSM, do Carmo Bilécki-Stipsky MM, Brugnera C, Grasel SS. Sensitivity of caloric test and video head impulse as screening test for chronic vestibular complaints. Clinics (Sao Paulo) 2017; 72:469-473. [PMID: 28954005 PMCID: PMC5577631 DOI: 10.6061/clinics/2017(08)03] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 04/07/2017] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE: This study compared the results of the caloric test with those of the video head impulse test obtained during the same session and evaluated whether the former can be used to screen for non-acute vestibular dysfunction. METHODS: A total of 157 participants complaining of dizziness with vestibular characteristics of varying durations and clinical courses completed the caloric test and video head impulse test. RESULTS: Significantly more caloric test results than video head impulse test results were abnormal. CONCLUSIONS: The results of the caloric test and video head impulse test are distinct but complement each other. Within our sample, the caloric test was more sensitive for vestibular dysfunction. Therefore, the video head impulse test is not a suitable screening tool of the vestibular system in patients with chronic complaints.
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Affiliation(s)
- Raquel Mezzalira
- Departamento de Otorrinolaringologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Clínica de Otorrinolaringologia do Instituto Penido Burnier, Campinas, SP, BR
- *Corresponding author. E-mail:
| | | | - Marcia Maria do Carmo Bilécki-Stipsky
- Departamento de Otorrinolaringologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Clínica de Otorrinolaringologia do Instituto Penido Burnier, Campinas, SP, BR
| | - Cibele Brugnera
- Departamento de Otorrinolaringologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Signe Schuster Grasel
- Departamento de Otorrinolaringologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
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105
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Judge PD, Janky KL, Barin K. Can the Video Head Impulse Test Define Severity of Bilateral Vestibular Hypofunction? Otol Neurotol 2017; 38:730-736. [PMID: 28178036 PMCID: PMC5749235 DOI: 10.1097/mao.0000000000001351] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The objective of the study was to compare rotary chair and video head impulse test (vHIT) findings in patients with bilateral vestibular hypofunction (BVH) to determine whether vHIT can: 1) define severity of BVH and 2) accurately predict rotary chair findings in patients with BVH. STUDY DESIGN Retrospective chart review. SETTING Research hospital. PATIENTS Twenty subjects with bilateral vestibular hypofunction as assessed by rotary chair. INTERVENTION Rotary chair and vHIT. MAIN OUTCOME MEASURES The main outcome measures were rotary chair phase, gain, and symmetry and vHIT vestibulo-ocular reflex (VOR) gain. Rotary chair and vHIT results were assessed and subjects were stratified into groups according to the severity of their vestibular hypofunction. For rotary chair, subjects were classified as mild, moderate, or severe BVH. For vHIT, subjects were classified as normal, unilateral, or bilateral. RESULTS Average lateral canal vHIT VOR gain: 1) significantly increased as severity of BVH decreased, and 2) demonstrated a significant and positive, linear relationship with rotary chair gains. vHIT was in disagreement with rotary chair in the classification of five subjects, which could be due to right-left asymmetry of BVH. CONCLUSION vHIT can serve as an initial tool for identifying patients with BVH. Lower vHIT gains are consistent with having severe BVH. There was disagreement between vHIT and rotary chair, though not for any patients with severe BVH. Compared with rotary chair, the clinical gold standard for identifying BVH, vHIT possesses 100% sensitivity for excluding severe BVH when average vHIT gains are greater than 0.46.
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Affiliation(s)
- Paul D Judge
- *University of Nebraska Medical Center †Boys Town National Research Hospital, Omaha, Nebraska ‡The Ohio State University, Eye and Ear Institute, Columbus, Ohio
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106
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Xie Y, Bigelow RT, Frankenthaler SF, Studenski SA, Moffat SD, Agrawal Y. Vestibular Loss in Older Adults Is Associated with Impaired Spatial Navigation: Data from the Triangle Completion Task. Front Neurol 2017; 8:173. [PMID: 28496432 PMCID: PMC5406402 DOI: 10.3389/fneur.2017.00173] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 04/12/2017] [Indexed: 12/03/2022] Open
Abstract
Background Vestibular inputs have been shown to play a critical role in spatial navigation. In this study, we sought to evaluate whether vestibular loss due to aging contributes to impaired spatial navigation as measured by the triangle completion task (TCT). Materials and methods We recruited three types of participants: young controls <55 years of age, older controls ≥55 years of age, and older patients from a Neurotology Clinic with evidence of vestibular physiologic impairment but who did not have any known vestibular disorder. We performed the cervical vestibular-evoked myogenic potential to evaluate saccular function and video head impulse testing to quantify horizontal semicircular canal vestibulo-ocular reflex gain. To assess spatial navigation ability, we administered the TCT, in which participants were conveyed along two segments of a pre-drawn triangular path and instructed to complete the final segment independently. We measured the angle (degrees) and distance (centimeters) of deviation from the correct trajectory. We evaluated the influence of vestibular inputs on TCT performance. Results Forty-eight adults participated in the study (mean age: 62.0 years; 52.1% females), including 9 young controls, 15 older controls, and 24 clinic patients. Clinic patients had the greatest distance of deviation (67.7 cm), followed by older controls (45.4 cm), then young controls (27.8 cm; p < 0.01). Similarly, clinic patients had greater rotational angles (22.1°) compared to older (13.3°) and younger controls (12.4°; p < 0.01). Following multivariate linear regression adjusting for demographic variables, loss of otolith function was associated with an 18.2 cm increase in distance of deviation (95% CI: 15.2–47.4) and a 9.2° increase in rotational angle (95% CI: 3.0–15.5). Abnormal semicircular canal function was associated with a 26.0 cm increase in distance of deviation (95% CI: 0.2–51.8) and a 10.8° increase in rotational angle (95% CI: 3.0–15.5). Participants with both otolith and canal abnormalities had a larger distance error (β = 25.3, 95% CI: 6.2–44.4) and angle of deviation (β = 18.1, 95% CI: 10.1–26.2) than with either condition alone. Conclusion Vestibular loss in older adults was associated with poorer performance on a dynamic spatial navigation task relative to old and young controls.
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Affiliation(s)
- Yanjun Xie
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Robin T Bigelow
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Scott F Frankenthaler
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stephanie A Studenski
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, National Institute of Health, Baltimore, MD, USA
| | - Scott D Moffat
- Department of Cognition and Brain Science, Cognitive Aging, School of Psychology, Georgia Institute of Technology, Atlanta, GA, USA
| | - Yuri Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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107
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Unilateral Head Impulses Training in Uncompensated Vestibular Hypofunction. Case Rep Otolaryngol 2017; 2017:2145173. [PMID: 28243476 PMCID: PMC5294356 DOI: 10.1155/2017/2145173] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 11/29/2016] [Accepted: 12/26/2016] [Indexed: 11/30/2022] Open
Abstract
The aim of this paper is to report a case of a young woman with unilateral vestibular chronic failure with a poorly compensated vestibuloocular reflex during rapid head rotation. Additionally, she developed migraine symptoms during the treatment with associated chronic dizzy sensations and blurred vision. Her report of blurred vision only improved after she completed a rehabilitation program using fast head impulse rotations towards the affected side for 5 consecutive days. We discuss why we elected this form of treatment and how this method may be useful for different patients.
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108
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Superficial siderosis syndrome with progressive hearing loss and bilateral vestibular failure, 51 years after a neurosurgical procedure: diagnostic value of combined MRI and video head impulse test. J Neurol 2016; 264:391-393. [PMID: 27981351 DOI: 10.1007/s00415-016-8358-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 11/30/2016] [Accepted: 12/01/2016] [Indexed: 10/20/2022]
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109
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Shen Q, Magnani C, Sterkers O, Lamas G, Vidal PP, Sadoun J, Curthoys IS, de Waele C. Saccadic Velocity in the New Suppression Head Impulse Test: A New Indicator of Horizontal Vestibular Canal Paresis and of Vestibular Compensation. Front Neurol 2016; 7:160. [PMID: 27721805 PMCID: PMC5033987 DOI: 10.3389/fneur.2016.00160] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 09/12/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To determine whether saccadic velocity in the suppression head impulse paradigm (SHIMP) test is a reliable indicator of vestibular loss at the acute and at the chronic stage in patients suffering from different vestibular pathologies. METHODS Thirty-five normal subjects and 57 patients suffering from different vestibular pathologies associated with unilateral vestibular loss (UVL) or bilateral vestibular loss (BVL) were tested in the SHIMPs paradigm. SHIMPs were performed by turning the head 10 times at high velocities to the left or right side, respectively. The patients were instructed to fixate on a red spot generated by a head-fixed laser projected on the wall. In this SHIMPs paradigm, healthy subjects made a large anti-compensatory saccade at the end of the head turn (a SHIMP saccade). The peak saccadic velocity, the percentage of the trials completed with saccades in 10 trials, and the latency of the saccades were quantified in each group. A video-head impulse test (v-HIT) was systematically performed in all of our subjects as well as a caloric test. The dizziness handicap inventory questionnaire was also given to chronic UVL and BVL patients. RESULTS At the acute stage after a complete UVL, patients had zero or a few anti-compensatory saccades for low velocity head turns toward the lesioned side. These saccades had lower velocity than the anti-compensatory saccades recorded during head rotation toward the intact side and/or compared with the saccades measured in control subjects. At the chronic stage, some of the patients recovered the ability to perform SHIMP saccades at each head turn toward the lesioned side, but very often these saccades were of significantly lower velocity. In BVL patients, no anti-compensatory saccades, or only significantly smaller ones, could be detected for head turns to both sides. CONCLUSION SHIMP is a specific and sensitive test to detect a complete horizontal canal loss at the acute stage. In addition, it reflects the ability of patients with moderate horizontal vestibulo-ocular reflex gain decrease to generate anti-compensatory saccades in the chronic stage. In association with v-HIT, it allows determination of the residual vestibular function and to detect anti-compensatory saccades.
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Affiliation(s)
- Qiwen Shen
- Cognition and Action Group, CNRS UMR8257, Centre Universitaire des Saints-Peres, Universite Paris Descartes, Paris, France
| | - Christophe Magnani
- Cognition and Action Group, CNRS UMR8257, Centre Universitaire des Saints-Peres, Universite Paris Descartes, Paris, France
| | | | | | - Pierre-Paul Vidal
- Cognition and Action Group, CNRS UMR8257, Centre Universitaire des Saints-Peres, Universite Paris Descartes, Paris, France
| | - Julien Sadoun
- Cognition and Action Group, CNRS UMR8257, Centre Universitaire des Saints-Peres, Universite Paris Descartes, Paris, France
| | - Ian S. Curthoys
- Vestibular Research Laboratory, School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Catherine de Waele
- Cognition and Action Group, CNRS UMR8257, Centre Universitaire des Saints-Peres, Universite Paris Descartes, Paris, France
- ENT Department, Salpetriere Hospital, Paris, France
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