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蔡 沁, 冷 杨, 孙 宇. [Semicircular canal occlusion]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2024; 38:122-126. [PMID: 38297865 PMCID: PMC11116138 DOI: 10.13201/j.issn.2096-7993.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Indexed: 02/02/2024]
Abstract
Semicircular canal occlusion(SCO) is a surgical technique widely used for treating vertigo symptoms. It is primarily aimed at treating benign paroxysmal positional vertigo(BPPV), Ménière's disease(MD), labyrinthine fistula, and superior semicircular canal dehiscence syndrome, among others. This review aims to comprehensively summarize the development, evolution, relevant basic research, and clinical applications of semicircular canal occlusion, especially the application of endoscopic technology in recent years, and explore its practical value in the field of surgical treatment for vertigo.
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Affiliation(s)
- 沁明 蔡
- 华中科技大学同济医学院附属协和医院耳鼻咽喉头颈外科(武汉,430022)Department of Otorhinolaryngology Head Neck Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - 杨名 冷
- 华中科技大学同济医学院附属协和医院耳鼻咽喉头颈外科(武汉,430022)Department of Otorhinolaryngology Head Neck Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - 宇 孙
- 华中科技大学同济医学院附属协和医院耳鼻咽喉头颈外科(武汉,430022)Department of Otorhinolaryngology Head Neck Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
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Yang Y, Tian J, Otero-Millan J, Schubert MC, Kheradmand A. Video Ocular Counter-Roll (vOCR): Otolith-Ocular Function and Compensatory Effect of the Neck Following Vestibular Loss. Otolaryngol Head Neck Surg 2023; 169:669-678. [PMID: 36861848 PMCID: PMC10474240 DOI: 10.1002/ohn.304] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 02/02/2023] [Accepted: 02/04/2023] [Indexed: 03/03/2023]
Abstract
OBJECTIVE Assessment of recovery following vestibular loss has been limited by the lack of bedside measures in clinical settings. Here, we used the video ocular counter-roll (vOCR) test to study otolith-ocular function and compensatory effect of neck proprioception in patients at different stages of vestibular loss. STUDY DESIGN Case-control study. SETTING Tertiary care center. METHODS Fifty-six subjects were recruited including patients with acute (9 ± 2 days [mean ± standard error of mean]), subacute (61 ± 11 days), and chronic (1009 ± 266 days) unilateral loss of vestibular function, as well as a group of healthy controls. We used a video-oculography method based on tracking the iris for vOCR measurement. To examine the effect of neck inputs, vOCR was recorded during two simple tilt maneuvers in all subjects while seated: 30° head-on-body tilt and 30° head-and-body tilt. RESULTS The vOCR responses evolved at different stages following vestibular loss with improvement of the gains in the chronic stage. The deficit was more pronounced when the whole body was tilted (acute: 0.08 ± 0.01, subacute: 0.11 ± 0.01, chronic: 0.13 ± 0.02, healthy control: 0.18 ± 0.01), and the gain of vOCR improved when the head was tilted on the body (acute: 0.11 ± 0.01, subacute: 0.14 ± 0.01, chronic: 0.13 ± 0.02, healthy control: 0.17 ± 0.01). The time course of vOCR response was affected as well with reduced amplitude and slower response in the acute stage of vestibular loss. CONCLUSION The vOCR test can be valuable as a clinical marker to measure vestibular recovery and compensatory effect of neck proprioception in patients at different stages following loss of vestibular function.
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Affiliation(s)
- Yuchen Yang
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Otolaryngology–Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jing Tian
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jorge Otero-Millan
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Herbert Wertheim School of Optometry and Vision Science, University of California, Berkeley, California, USA
| | - Michael C. Schubert
- Department of Otolaryngology–Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Physical Medicine and Rehabilitation, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Amir Kheradmand
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Otolaryngology–Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Wang T, Liu H, He DZ, Li Y. Occlusion of two semicircular canals does not disrupt normal hearing in adult mice. Front Neurol 2022; 13:997367. [PMID: 36188397 PMCID: PMC9520568 DOI: 10.3389/fneur.2022.997367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/29/2022] [Indexed: 11/24/2022] Open
Abstract
Vertigo is a debilitating disease affecting 15–20% of adults worldwide. Vestibular peripheral vertigo is the most common cause of vertigo, often due to Meniere's disease and benign paroxysmal positional vertigo. Although some vertigo symptoms can be controlled by conservative treatment and/or vestibular rehabilitation therapy, these treatments do not work for some patients. Semicircular canal occlusion surgery has proven to be very effective for these patients with intractable vertigo. However, its application is limited due to concern that the procedure will disrupt normal hearing. In this study, we investigated if occlusion of two semicircular canals would jeopardize auditory function by comparing auditory function and hair cell morphology between the surgical and contralateral ears before and after the surgery in a mouse model. By measuring the auditory brainstem response and distortion product otoacoustic emission 4 weeks post-surgery, we show that auditory function does not significantly change between the surgical and contralateral ears. In addition, confocal imaging has shown no hair cell loss in the cochlear and vestibular sensory epithelia, and scanning electron microscopy also indicates normal stereocilia morphology in the surgical ear. More importantly, the endocochlear potential measured from the surgical ear is not significantly different than that seen in the contralateral ear. Our study suggests that occlusion of two semicircular canals does not disrupt normal hearing in the mouse model, providing a basis to extend the procedure to patients, even those with normal hearing, benefitting more patients with intractable vertigo attacks.
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Affiliation(s)
- Tianying Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Huizhan Liu
- Department of Biomedical Sciences, Creighton University School of Medicine, Omaha, NE, United States
| | - David Z. He
- Department of Biomedical Sciences, Creighton University School of Medicine, Omaha, NE, United States
| | - Yi Li
- Department of Otorhinolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- *Correspondence: Yi Li
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Iwasaki S, Kamogashira T, Fujimoto C, Kabaya K, Kinoshita M, Yamasoba T. The Role of Neck Input in Producing Corrective Saccades in the Head Impulse Test. Front Neurol 2022; 13:881411. [PMID: 35655613 PMCID: PMC9152213 DOI: 10.3389/fneur.2022.881411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/03/2022] [Indexed: 12/21/2022] Open
Abstract
Background The head impulse test is a valuable clinical test that can help identify peripheral vestibular dysfunction by observing corrective saccades that return the eyes to the target of interest. Corrective saccades have been classified as covert if the onset occurs before the end of the head impulse and as overt if they occur afterwards. However, the mechanism that trigger these saccades remain unclear. Objective The objective of this study was to examine the role of neck input in generating overt as well as covert saccades. Methods Sixteen patients (9 males and 7 females: age 35-80 years, average 62.7 years old) who showed corrective saccades during the head impulse test were included. Twelve patients had unilateral vestibular dysfunction, and 4 patients had bilateral vestibular dysfunction. Patients underwent both the head impulse test (HIT) and the body impulse test (BIT) in a randomized order. While the head is rotated horizontally in HIT, the body is rotated horizontally in BIT. During BIT, the neck is fixed by a cervical collar (neck lock extrication collar) to reduce somatosensory input from the neck. The head movements and eye movements were recorded and analyzed by the video HIT recording system. Results In all 16 patients, corrective saccades were observed in HIT as well as in BIT. While there were no significant differences in peak head velocities between HIT and BIT (p = 0.33, paired t-test), the VOR gain in BIT was significantly smaller than that in HIT (p = 0.011, paired t-test). The number of overt saccades per trial in BIT was significantly decreased compared to that in HIT (p < 0.001, paired t-test) whereas there were no significant differences in the number of covert saccades between the two tests. The proportion of overt saccades among all corrective saccades in BIT was significantly lower than the proportion in HIT (p < 0.001, paired t-test). Conclusions Somatosensory input from the neck contributes to the generation of overt saccades and reinforces the vestibulo-ocular reflex complementing the retinal slip during high frequency head movements.
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Affiliation(s)
- Shinichi Iwasaki
- Department of Otolaryngology & Head and Neck Surgery, Nagoya City University Graduate School of Medicine, Nagoya, Japan
| | - Teru Kamogashira
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Chisato Fujimoto
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kayoko Kabaya
- Department of Otolaryngology & Head and Neck Surgery, Nagoya City University Graduate School of Medicine, Nagoya, Japan
| | - Makoto Kinoshita
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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Bauer RM, Jaffee MS. Behavioral and Cognitive Aspects of Concussion. Continuum (Minneap Minn) 2021; 27:1646-1669. [PMID: 34881730 DOI: 10.1212/con.0000000000001057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW This review provides the reader with an overview of concussion and mild traumatic brain injury (TBI). Key aspects of the pathophysiology, signs, and symptoms, treatment and rehabilitation, and recovery from concussion/mild TBI are reviewed with an emphasis on the variety of factors that may contribute to cognitive concerns following injury. RECENT FINDINGS Concussion remains a clinical diagnosis based on symptoms that occur in the immediate aftermath of an applied force and in the hours, days, and weeks thereafter. Although advances have been made in advanced diagnostics, including neuroimaging and fluid biomarkers in hopes of developing objective indicators of injury, such markers currently lack sufficient specificity to be used in clinical diagnostics. The symptoms of concussion are heterogeneous and may be seen to form subtypes, each of which suggests a targeted rehabilitation by the interdisciplinary team. Although the majority of patients with concussion recover within the first 30 to 90 days after injury, some have persistent disabling symptoms. The concept of postconcussion syndrome, implying a chronic syndrome of injury-specific symptoms, is replaced by a broader concept of persistent symptoms after concussion. This concept emphasizes the fact that most persistent symptoms have their basis in complex somatic, cognitive, psychiatric, and psychosocial factors related to risk and resilience. This framework leads to the important conclusion that concussion is a treatable injury from which nearly all patients can be expected to recover. SUMMARY Concussion/mild TBI is a significant public health problem in civilian, military, and organized athletic settings. Recent advances have led to a better understanding of underlying pathophysiology and symptom presentation and efficacious treatment and rehabilitation of the resulting symptoms. An interdisciplinary team is well-positioned to provide problem-oriented, integrated care to facilitate recovery and to advance the evidence base supporting effective practice in diagnosis, treatment, and prevention.
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Importance of Video Head Impulse Test Parameters for Recovery of Symptoms in Acute Vestibular Neuritis. Otol Neurotol 2021; 41:964-971. [PMID: 32658401 DOI: 10.1097/mao.0000000000002669] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the importance of video head impulse test parameter for recovery of symptoms in acute vestibular neuritis (AVN). STUDY DESIGN Prospective study. SETTING Tertiary referral hospital. PATIENTS/INTERVENTIONS Twenty-seven patients with AVN were enrolled. We divided patients into two groups according to both dizziness handicap inventory (DHI) score and visual analog scale (VAS) at 6 months: Group F (symptoms free), DHI = 0 and VAS = 0; Group R (symptoms residual), DHI more than zero or VAS more than zero. MAIN OUTCOME MEASURE All patients underwent video head impulse test paradigm (HIMP), and suppression head impulse test paradigm (SHIMP) initially and at 1 month. Patients were also asked to complete DHI and VAS initially, at 1 month and 6 months. We compared measured parameters between Group F and R. RESULTS In HIMP, Group F showed higher vestibular-ocular reflex (VOR) gain, higher occurrence of covert corrective saccade (CS), lower occurrence and peak velocity of overt CS, and lower PR score than Group R at 1 month. In SHIMP, Group F showed higher VOR gain, higher occurrence and peak velocity of anti-CS, and higher PR score than Group R at 1 month. CONCLUSIONS Above parameters of both HIMP and SHIMP at 1 month would be important factors to predict the residual symptoms in chronic phase of AVN.
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The influence of cervical movement on eye stabilization reflexes: a randomized trial. Exp Brain Res 2017; 236:297-304. [PMID: 29147731 DOI: 10.1007/s00221-017-5127-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 11/08/2017] [Indexed: 12/20/2022]
Abstract
To investigate the influence of the amount of cervical movement on the cervico-ocular reflex (COR) and vestibulo-ocular reflex (VOR) in healthy individuals. Eye stabilization reflexes, especially the COR, are changed in neck pain patients. In healthy humans, the strength of the VOR and the COR are inversely related. In a cross-over trial the amplitude of the COR and VOR (measured with a rotational chair with eye tracking device) and the active cervical range of motion (CROM) was measured in 20 healthy participants (mean age 24.7). The parameters were tested before and after two different interventions (hyperkinesia: 20 min of extensive active neck movement; and hypokinesia: 60 min of wearing a stiff neck collar). In an additional replication experiment the effect of prolonged (120 min) hypokinesia on the eye reflexes were tested in 11 individuals. The COR did not change after 60 min of hypokinesia, but did increase after prolonged hypokinesia (median change 0.220; IQR 0.168, p = 0.017). The VOR increased after 60 min of hypokinesia (median change 0.155, IQR 0.26, p = 0.003), but this increase was gone after 120 min of hypokinesia. Both reflexes were unaffected by cervical hyperkinesia. Diminished neck movements influences both the COR and VOR, although on a different time scale. However, increased neck movements do not affect the reflexes. These findings suggest that diminished neck movements could cause the increased COR in patients with neck complaints.
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Recovery of Vestibulo-Ocular Reflex Symmetry After an Acute Unilateral Peripheral Vestibular Deficit: Time Course and Correlation With Canal Paresis. Otol Neurotol 2017; 37:772-80. [PMID: 27159843 DOI: 10.1097/mao.0000000000001054] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We investigated how response asymmetries and deficit side response amplitudes for head accelerations used clinically to test the vestibular ocular reflex (VOR) are correlated with caloric canal paresis (CP) values. METHODS 30 patients were examined at onset of an acute unilateral peripheral vestibular deficit (aUPVD) and 3, 6, and 13 weeks later with three different VOR tests: caloric, rotating chair (ROT), and video head impulse tests (vHIT). Response changes over time were fitted with an exponential decay model and compared with using linear regression analysis. RESULTS Recovery times (to within 10% of steady state) were similar for vHIT-asymmetry and CP (>10 weeks) but shorter for ROT asymmetry (<4 weeks). Regressions with CP were similar (vHIT asymmetry, R = 0.68, ROT, R = 0.62). Responses to the deficit side were also equally well correlated with CP values (R = 0.71). Specificity for vHIT and 20 degrees/s ROT deficit side responses was 100% in comparison to CP values, sensitivity was 74% for vHIT, 75% for ROT. A decrease in normal side responses occurred for ROT but not for vHIT at 3 weeks. Normal side responses were weekly correlated with CP for ROT (R = 0.49) but not for vHIT (R = 0.17). CONCLUSIONS These results indicate that vHIT deficit side VOR gains are slightly better correlated with CP values than ROT, probably because of similar recovery time courses of vHIT and caloric responses and the lack of normal side vHIT changes. However, specificity and sensitivity is the same for vHIT and ROT tests.
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Cheever K, Kawata K, Tierney R, Galgon A. Cervical Injury Assessments for Concussion Evaluation: A Review. J Athl Train 2016; 51:1037-1044. [PMID: 27835042 PMCID: PMC5264559 DOI: 10.4085/1062-6050-51.12.15] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND A concussion is a complex pathophysiologic process that is induced by biomechanical forces and affects the brain. Cervical injuries and concussion can share similar mechanisms and nearly identical symptoms or causes. Therefore, symptoms or causes alone may be insufficient to differentiate between patients with a concussion and patients with cervical injuries. OBJECTIVE To demonstrate the homogeneous causes and symptoms observed in patients with a concussion and patients with cervical injury and to provide information on clinical tests that can differentiate cervical injury from pathologic conditions of vestibular or central origin. SUMMARY Given that concussion and cervical injury share similar causes and symptoms, this information alone may be insufficient to diagnose a concussion. Clinical assessments, such as the cervical joint-reposition error test, smooth-pursuit neck-torsion test, head-neck differentiation test, cervical flexion-rotation test, and physical examination of the cervical spine, can be performed after a head and neck pathomechanical event to identify the presence of cervical injury. Differentiating between a concussion and cervical injury is clinically vital for timely and appropriate evidence-based treatment. CONCLUSIONS Specific clinical tests should be used after a head and neck pathomechanical event to differentiate between symptoms due to a concussion and cervical injury. Continued research on the clinical utility of the 5 identified cervicogenic tests is also recommended.
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Affiliation(s)
- Kelly Cheever
- Department of Kinesiology and ‡Department of Physical Therapy, Temple University, Philadelphia, PA
| | - Keisuke Kawata
- Department of Kinesiology, Indiana University, Bloomington
| | - Ryan Tierney
- Department of Kinesiology and ‡Department of Physical Therapy, Temple University, Philadelphia, PA
| | - Anne Galgon
- Department of Kinesiology and ‡Department of Physical Therapy, Temple University, Philadelphia, PA
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Grasso C, Li Volsi G, Cataldo E, Manzoni D, Barresi M. Effects of bicuculline application on the somatosensory responses of secondary vestibular neurons. Neuroscience 2016; 335:122-33. [PMID: 27579770 DOI: 10.1016/j.neuroscience.2016.08.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 08/19/2016] [Accepted: 08/21/2016] [Indexed: 01/05/2023]
Abstract
Limb somatosensory signals modify the discharge of vestibular neurons and elicit postural reflexes, which stabilize the body position. The aim of this study was to investigate the contribution of the γ-amino-butyric-acid (GABA) to the responsiveness of vestibular neurons to somatosensory inputs. The activity of 128 vestibular units was recorded in anesthetized rats in resting conditions and during sinusoidal foreleg rotation around the elbow or shoulder joints (0.026-0.625Hz, 45° peak amplitude). None of the recorded units was influenced by elbow rotation, while 40% of them responded to shoulder rotation. The selective GABAA antagonist receptor, bicuculline methiodine (BIC), was applied by microiontophoresis on single vestibular neurons and the changes in their activity at rest and during somatosensory stimulation was studied. In about half of cells the resting activity increased after the BIC application: 75% of these neurons showed also an increased response to somatosensory inputs whereas 17% exhibited a decrease. Changes in responsiveness in both directions were detected also in the units whose resting activity was not influenced by BIC. These data suggest that the responses of vestibular neurons to somatosensory inputs are modulated by GABA through a tonic release, which modifies the membrane response to the synaptic current. It is also possible that a phasic release of GABA occurs during foreleg rotation, shaping the stimulus-elicited current passing through the membrane. If this is the case, the changes in the relative position of body segments would modify the GABA release inducing changes in the vestibular reflexes and in learning processes that modify their spatio-temporal development.
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Affiliation(s)
- C Grasso
- Department of Biomedical and Biotechnological Sciences - Section of Physiology, University of Catania, I-95125 Catania, Italy
| | - G Li Volsi
- Department of Biomedical and Biotechnological Sciences - Section of Physiology, University of Catania, I-95125 Catania, Italy
| | - E Cataldo
- Department of Physics, University of Pisa, I-56127 Pisa, Italy
| | - D Manzoni
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, I-56127 Pisa, Italy
| | - M Barresi
- Department of Drug Sciences, University of Catania, I-95125 Catania, Italy.
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Abstract
This chapter provides an introduction to the topic of multisensory integration in balance control in, both, health and disease. One of the best-studied examples is that of visuo-vestibular interaction, which is the ability of the visual system to enhance or suppress the vestibulo-ocular reflex (VOR suppression). Of clinical relevance, examination of VOR suppression is clinically useful because only central, not peripheral, lesions impair VOR suppression. Visual, somatosensory (proprioceptive), and vestibular inputs interact strongly and continuously in the control of upright balance. Experiments with visual motion stimuli show that the visual system generates visually-evoked postural responses that, at least initially, can override vestibular and proprioceptive signals. This paradigm has been useful for the study of the syndrome of visual vertigo or vision-induced dizziness, which can appear after vestibular disease. These patients typically report dizziness when exposed to optokinetic stimuli or visually charged environments, such as supermarkets. The principles of the rehabilitation treatment of these patients, which use repeated exposure to visual motion, are presented. Finally, we offer a diagnostic algorithm in approaching the patient reporting oscillopsia - the illusion of oscillation of the visual environment, which should not be confused with the syndrome mentioned earlier of visual vertigo.
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Affiliation(s)
- A M Bronstein
- Neuro-otology Unit, Imperial College London, Charing Cross Hospital and National Hospital for Neurology and Neurosurgery, London, United Kingdom.
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Manzari L, Burgess AM, MacDougall HG, Curthoys IS. Vestibular function after vestibular neuritis. Int J Audiol 2013; 52:713-8. [PMID: 23902522 DOI: 10.3109/14992027.2013.809485] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To measure horizontal semicircular canal function over days, weeks, and months after an acute attack of vestibular neuritis. DESIGN The video head impulse test (vHIT) was used to measure the eye movement response to small unpredictable passive head turns at intervals after the attack. STUDY SAMPLE Two patients diagnosed with acute right unilateral vestibular neuritis. RESULTS There was full restoration of horizontal canal function in one patient (A) as shown by the return of the slow phase eye velocity response to unpredictable head turns, while in the other patient (B) there was little or no recovery of horizontal canal function. Instead this second patient generated covert saccades during head turns. CONCLUSION Despite the objective evidence of their very different recovery patterns, both patients reported, at the final test, being happy and feeling well recovered, even though in one of the patients there was clear absence of horizontal canal function. The results indicate covert saccades seem a successful way of compensating for loss of horizontal canal function after unilateral vestibular neuritis. Factors other than recovery of the slow phase eye velocity are significant for patient recovery.
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Affiliation(s)
- L Manzari
- * MSA ENT Academy Center , Cassino (FR) , Italy
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Peters BT, Mulavara AP, Cohen HS, Sangi-Haghpeykar H, Bloomberg JJ. Dynamic visual acuity testing for screening patients with vestibular impairments. J Vestib Res 2013; 22:145-51. [PMID: 23000614 DOI: 10.3233/ves-2012-0440] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Dynamic visual acuity (DVA) may be a useful indicator of the function of the vestibulo-ocular reflex (VOR) but most DVA tests involve active head motion in the yaw plane. During gait the passive, vertical VOR may be more relevant and passive testing would be less likely to elicit compensatory strategies. The goal of this study was to determine if testing dynamic visual acuity during passive vertical motion of the subject would differentiate normal subjects from patients with known vestibular disorders. Subjects, normals and patients who had been diagnosed with either unilateral vestibular weaknesses or were post-acoustic neuroma resections, sat in a chair that could oscillate vertically with the head either free or constrained with a cervical orthosis. They viewed a computer screen 2 m away that showed Landholt C optotypes in one of 8 spatial configurations and which ranged in size from 0.4 to 1.0 logMAR. They were tested while the chair was stationary and while it was moving. Scores were worse for both groups during the dynamic condition compared to the static condition. In the dynamic condition patients' scores were significantly worse than normals' scores. Younger and older age groups differed slightly but significantly; the sample size was too small to examine age differences by decade. The data suggest that many well-compensated patients have dynamic visual acuity that is as good as age-matched normals. Results of ROC analyses were only moderate, indicating that the differences between patients and normals were not strong enough, under the conditions tested, for this test to be useful for screening people to determine if they have vestibular disorders. Modifications of the test paradigm may make it more useful for screening potential patients.
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Affiliation(s)
- Brian T Peters
- Wyle Integrated Science and Engineering Group, Houston, TX 77030, USA
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Asama Y, Goto F, Tsutsumi T, Ogawa K. Objective evaluation of neck muscle tension and static balance in patients with chronic dizziness. Acta Otolaryngol 2012; 132:1168-71. [PMID: 22831284 DOI: 10.3109/00016489.2012.699197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Increase in the average value of bilateral neck muscle tension (ANT) indicates the increase in neck muscle tension to stabilize static posture resulting from vestibular compensation. Asymmetry of neck muscle tension was closely related to postural imbalance. OBJECTIVE Patients with dizziness often complain of neck symptoms with stiff neck. This study was conducted to clarify the pathophysiological mechanism of neck symptoms in patients with dizziness. METHODS We objectively measured bilateral trapezius muscle tension in patients with chronic dizziness and determined its relationship with static postural perturbation. The study included 26 patients with chronic dizziness caused by unilateral vestibular deficit and 24 healthy controls. The tension of bilateral trapezius muscles was objectively measured using a neck muscle tension meter. ANT and the ratio (right/left) of the bilateral neck muscle tension (RNT) were calculated. Static posturography was performed to measure total length of path (LNG). RESULTS ANT was negatively correlated to LNG under the eyes closed (EC) condition only in the case of the patients (r = -0.44, p < 0.05). In the case of both the controls and the patients with a unilateral vestibular deficit, RNT was positively correlated to LNG under the EC condition.
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Posterior semicircular canal occlusion for intractable benign positional vertigo: outcome in 55 ears in 53 patients operated upon over 20 years. The Journal of Laryngology & Otology 2012; 126:677-82. [PMID: 22583830 DOI: 10.1017/s0022215112000758] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To report the outcome of posterior semicircular canal occlusion surgery for intractable benign positional vertigo, regarding vertigo cure rate and hearing and balance outcomes. METHODS Retrospective review of 53 patients presenting with benign positional vertigo, unresponsive to repositioning manoeuvres, who eventually underwent posterior canal occlusion, over a 20 year period. RESULTS From 1991 to 2011, 5364 benign positional vertigo patients were treated in our balance disorders clinic; 53 of those who failed to respond to repositioning underwent posterior canal occlusion. All 53 were cured of their benign positional vertigo. Nine suffered some symptomatic permanent hearing loss (>20 dB at low and >25 dB at high frequencies). Ten patients suffered caloric vestibular function deterioration, with mild but permanent subjective imbalance in five; a further 10 patients with no post-operative caloric test changes also had some permanent imbalance. Benign positional vertigo later developed in the operated ear lateral canal in two patients and in the opposite ear posterior canal in eight patients. Two patients needed bilateral sequential posterior canal occlusion. CONCLUSION Posterior canal occlusion is a highly effective treatment for intractable benign positional vertigo, with what is probably an acceptable risk to hearing and balance: five of six patients will have no hearing problem and nine of 10 no balance problem after surgery.
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Macdougall HG, Curthoys IS. Plasticity during Vestibular Compensation: The Role of Saccades. Front Neurol 2012; 3:21. [PMID: 22403569 PMCID: PMC3289127 DOI: 10.3389/fneur.2012.00021] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 02/03/2012] [Indexed: 01/18/2023] Open
Abstract
This paper is focused on one major aspect of compensation: the recent measures of saccadic responses to high acceleration head turns during human vestibular compensation and their possible implications for recovery after unilateral vestibular loss (UVL). New measurement techniques have provided additional insights into how patients recover after UVL and have given clues for vestibular rehabilitation. Prior to this it has not been possible to quantify the level of function of all the peripheral vestibular sense organs. Now it is. By using vestibular-evoked myogenic potentials to measure utricular and saccular function and by new video head impulse testing to measure semicircular canal function to natural values of head accelerations. With these new video procedures it is now possible to measure both slow phase eye velocity and also saccades during head movements with natural values of angular acceleration. The present evidence is that after UVL there is little or no restoration/compensation of slow phase eye velocity responses to natural head accelerations. It is doubtful as to whether the modest changes in slow phase eye velocity to small angular accelerations are functionally effective during compensation. On the other hand it is now clear that saccades can play a very important role in helping patients compensate and return to a normal lifestyle. Preliminary evidence suggests that different patterns of saccadic response may predict how well patients recover. Furthermore it may be possible to train patients to produce more effective saccadic patterns in the first days after their unilateral loss and possibly improve their compensation process. Some patients do learn new strategies, new behaviors, to conceal their inadequate vestibulo-ocular response but when those strategies are prevented from operating by using passive, unpredictable, high acceleration natural head movements, as in the head impulse test, the vestibular loss can be demonstrated. It is those very strategies which the tests exclude, which may be the cause of their successful compensation.
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Affiliation(s)
- Hamish Gavin Macdougall
- Vestibular Research Laboratory, School of Psychology, The University of Sydney Sydney, NSW, Australia
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McCall AA, Yates BJ. Compensation following bilateral vestibular damage. Front Neurol 2011; 2:88. [PMID: 22207864 PMCID: PMC3246292 DOI: 10.3389/fneur.2011.00088] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 12/12/2011] [Indexed: 01/22/2023] Open
Abstract
Bilateral loss of vestibular inputs affects far fewer patients than unilateral inner ear damage, and thus has been understudied. In both animal subjects and human patients, bilateral vestibular hypofunction (BVH) produces a variety of clinical problems, including impaired balance control, inability to maintain stable blood pressure during postural changes, difficulty in visual targeting of images, and disturbances in spatial memory and navigational performance. Experiments in animals have shown that non-labyrinthine inputs to the vestibular nuclei are rapidly amplified following the onset of BVH, which may explain the recovery of postural stability and orthostatic tolerance that occurs within 10 days. However, the loss of the vestibulo-ocular reflex and degraded spatial cognition appear to be permanent in animals with BVH. Current concepts of the compensatory mechanisms in humans with BVH are largely inferential, as there is a lack of data from patients early in the disease process. Translation of animal studies of compensation for BVH into therapeutic strategies and subsequent application in the clinic is the most likely route to improve treatment. In addition to physical therapy, two types of prosthetic devices have been proposed to treat individuals with bilateral loss of vestibular inputs: those that provide tactile stimulation to indicate body position in space, and those that deliver electrical stimuli to branches of the vestibular nerve in accordance with head movements. The relative efficacy of these two treatment paradigms, and whether they can be combined to facilitate recovery, is yet to be ascertained.
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Affiliation(s)
- Andrew A McCall
- Department of Otolaryngology, University of Pittsburgh Pittsburgh, PA, USA
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Yakushin SB, Dai M, Raphan T, Suzuki JI, Arai Y, Cohen B. Spatial orientation of the angular vestibulo-ocular reflex (aVOR) after semicircular canal plugging and canal nerve section. Exp Brain Res 2011; 210:583-94. [PMID: 21340443 DOI: 10.1007/s00221-011-2586-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 01/28/2011] [Indexed: 10/18/2022]
Abstract
We investigated spatial responses of the aVOR to small and large accelerations in six canal-plugged and lateral canal nerve-sectioned monkeys. The aim was to determine whether there was spatial adaptation after partial and complete loss of all inputs in a canal plane. Impulses of torques generated head thrusts of ≈ 3,000°/s². Smaller accelerations of ≈ 300°/s² initiated the steps of velocity (60°/s). Animals were rotated about a spatial vertical axis while upright (0°) or statically tilted fore-aft up to ± 90°. Temporal aVOR yaw and roll gains were computed at every head orientation and were fit with a sinusoid to obtain the spatial gains and phases. Spatial gains peaked at ≈ 0° for yaw and ≈ 90° for roll in normal animals. After bilateral lateral canal nerve section, the spatial yaw and roll gains peaked when animals were tilted back ≈ 50°, to bring the intact vertical canals in the plane of rotation. Yaw and roll gains were identical in the lateral canal nerve-sectioned monkeys tested with both low- and high-acceleration stimuli. The responses were close to normal for high-acceleration thrusts in canal-plugged animals, but were significantly reduced when these animals were given step stimuli. Thus, high accelerations adequately activated the plugged canals, whereas yaw and roll spatial aVOR gains were produced only by the intact vertical canals after total loss of lateral canal input. We conclude that there is no spatial adaptation of the aVOR even after complete loss of specific semicircular canal input.
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Affiliation(s)
- Sergei B Yakushin
- Department of Neurology, Mount Sinai School of Medicine, New York, NY 10029, USA.
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