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Piker EG, Picou E, Jacobson GP, Coltisor A. Agreement Between Caloric and Horizontal Video Head Impulse Testing in School-Aged Children Presenting With Dizziness. Am J Audiol 2022; 31:299-304. [PMID: 35286154 DOI: 10.1044/2021_aja-21-00224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE The purpose of this investigation was to determine the relationship between the horizontal semicircular canal video head impulse test (hvHIT) and the caloric test in a sample of school-age children evaluated due to complaints of dizziness or imbalance. In adults, these two tests provide different but complementary information regarding vestibular function and/or pathology. However, the most common causes of vestibular loss in children are different than those in adults, and it is not clear how these two tests of horizontal semicircular canal function are related in a pediatric population. METHOD This is a retrospective study of electronic records of pediatric patients (< 18 years old) who were referred for vestibular function testing and completed both hvHIT and caloric testing. Agreement between both test results was evaluated by examining measures of sensitivity, specificity, and calculating Cohen's kappa. RESULTS Results from 117 patients (mean age = 13.7 years, age range: 8-17 years, 37 males) were analyzed. Most patients (97/115 [84.3%]) demonstrated both normal hvHIT and caloric test results. Compared to caloric testing, the hvHIT had poor sensitivity (38.9%) and excellent specificity (98.0%). Cohen's kappa analysis revealed moderate agreement between the methods (coefficient = 0.49 [0.24, 0.73]). Where disagreement between the two tests occurred, the final diagnosis was not contingent on either test result. CONCLUSIONS There is a moderate agreement between the hvHIT and the caloric test in pediatric patients presenting to a tertiary care medical center for a vestibular evaluation. Most patients in this cohort presented with normal findings. The specificity of hvHIT was excellent, although the sensitivity was low. This may be related to the low prevalence of peripheral vestibular system disease in this study cohort, and these results do not generalize to centers that serve populations of children where vestibular disorders are more prevalent (e.g., children with sensorineural hearing loss).
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Affiliation(s)
- Erin G. Piker
- Department of Communication Sciences and Disorders, James Madison University, Harrisonburg, VA
| | - Erin Picou
- Division of Vestibular Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Gary P. Jacobson
- Division of Vestibular Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Allison Coltisor
- Division of Vestibular Sciences, Vanderbilt University Medical Center, Nashville, TN
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Crampton A, Garat A, Shepherd HA, Chevignard M, Schneider KJ, Katz-Leurer M, Gagnon IJ. Evaluating the Vestibulo-Ocular Reflex Following Traumatic Brain Injury: A Scoping Review. Brain Inj 2021; 35:1496-1509. [PMID: 34495773 DOI: 10.1080/02699052.2021.1972450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Purpose:To identify the tests and tools used to evaluate vestibulo-ocular reflex (VOR) function after traumatic brain injury (TBI) in all age groups and across TBI severity.Methods: An electronic search was conducted to include relevant peer-reviewed literature published up to November 2019. Studies included those done with humans, of all ages, and had assessments of oculomotor and/or vestibulo-ocular function in TBI.Results: Of the articles selected (N = 48), 50% were published in 2018/2019. A majority targeted mild TBI, with equal focus on non-computerized versus computerized measures of VOR. Computerized assessment tools used were videonystagmography, dynamic visual acuity/gaze stability, rotary chair, and caloric irrigation. Non-computerized tests included the head thrust, dynamic visual acuity, gaze stability, head shaking nystagmus, rotary chair tests and the vestibular/oculomotor screening tool. High variability in administration protocols were identified. Namely: testing environment, distances/positioning/equipment used, active/passive state, procedures, rotation frequencies, and variables observed.Conclusions: There is a rapid growth of literature incorporating VOR tests in mild TBI but moderate and severe TBI continues to be under-represented. Determining how to pair a clinical test with a computerized tool and developing standardized protocols when administering tests will help in developing an optimal battery assessing the VOR in TBI.
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Affiliation(s)
- Adrienne Crampton
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - A Garat
- Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, Paris, France.,Sorbonne Université, GRC 24 Handicap Moteur et Cognitif et Réadaptation, Paris, France
| | - H A Shepherd
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Alberta, Canada
| | - M Chevignard
- Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, Paris, France.,Sorbonne Université, GRC 24 Handicap Moteur et Cognitif et Réadaptation, Paris, France.,Rehabilitation Department for Children with Acquired Neurological Injury and Outreach Team for Children and Adolescents with Acquired Brain Injury, Saint Maurice Hospitals, Saint Maurice, France
| | - K J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
| | - M Katz-Leurer
- Physical Therapy Department, University of Tel-Aviv, Tel-Aviv, Israel
| | - I J Gagnon
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Montreal Children's Hospital-McGill University Health Centre, Montreal, Canada
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Piker EG, Riska K, Garrison D, Kaylie DM. Vestibular function after cochlear implantation: A test battery and case-by-case approach. Laryngoscope Investig Otolaryngol 2020; 5:560-571. [PMID: 32596501 PMCID: PMC7314491 DOI: 10.1002/lio2.413] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/01/2020] [Accepted: 05/22/2020] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES The purpose of this study was to assess the effects of cochlear implantation on the functional integrity of the horizontal semicircular canal using multiple methodologies, and to discuss and highlight the limitations of using isolated vestibular tests to assess vestibular function in surgical ears. METHODS Ten cochlear implant patients were consented to undergo a preoperative and 3-month postoperative vestibular assessment. The horizontal semicircular canal (SCC) was assessed using three different vestibular test measures that assess function using different stimuli and at different frequencies ranges: caloric testing, sinusoidal harmonic acceleration testing in the rotary chair, and video head impulse testing in the plane of the horizontal SCC. Data was analyzed using different methods: descriptive, statistical, and by an examination of individual case studies. RESULTS Each analysis method yielded a different interpretation. Statistical analysis showed no significant group mean differences between baseline pre-op vestibular test results and 3-month post-op vestibular test results. Descriptive analysis showed 30% of individuals presented with postoperative abnormal vestibular testing findings. A case study examination showed that only one patient presented with a post-op decrease in vestibular function in the implanted ear. CONCLUSIONS There are several limitations of conventional vestibular testing in postsurgical cochlear implant patients. A test-battery approach, including case history, and test interpretation made on a case-by-case basis is needed to determine whether the patient has undergone vestibular damage, is at risk for falling, or in need of further management. LEVEL OF EVIDENCE 2b individual cohort study.
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Affiliation(s)
- Erin G. Piker
- Department of Communication Sciences and DisordersJames Madison UniversityHarrisonburgVirginiaUSA
| | - Kristal Riska
- Department of Head and Neck Surgery and Communication SciencesDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Doug Garrison
- Department of Head and Neck Surgery and Communication SciencesDuke University School of MedicineDurhamNorth CarolinaUSA
| | - David M. Kaylie
- Department of Head and Neck Surgery and Communication SciencesDuke University School of MedicineDurhamNorth CarolinaUSA
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Walther LE, Löhler J, Schmucker C. What Does Head Impulse Testing Really Test?-Reply. JAMA Otolaryngol Head Neck Surg 2019; 145:1080-1081. [PMID: 31556932 DOI: 10.1001/jamaoto.2019.2779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Leif Erik Walther
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jan Löhler
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Christine Schmucker
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
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Curthoys IS, Halmagyi GM. What Does Head Impulse Testing Really Test? JAMA Otolaryngol Head Neck Surg 2019; 145:1080. [DOI: 10.1001/jamaoto.2019.2788] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ian S. Curthoys
- School of Psychology, Vestibular Research Laboratory, University of Sydney, Sydney, New South Wales, Australia
| | - Gabor M. Halmagyi
- Department of Neurology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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