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Castellucci A, Dumas G, Abuzaid SM, Armato E, Martellucci S, Malara P, Alfarghal M, Ruberto RR, Brizzi P, Ghidini A, Comacchio F, Schmerber S. Posterior Semicircular Canal Dehiscence with Vestibulo-Ocular Reflex Reduction for the Affected Canal at the Video-Head Impulse Test: Considerations to Pathomechanisms. Audiol Res 2024; 14:317-332. [PMID: 38666899 PMCID: PMC11047701 DOI: 10.3390/audiolres14020028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/10/2024] [Accepted: 03/21/2024] [Indexed: 04/29/2024] Open
Abstract
Posterior semicircular canal dehiscence (PSCD) has been demonstrated to result in a third mobile window mechanism (TMWM) in the inner ear similar to superior semicircular canal dehiscence (SSCD). Typical clinical and instrumental features of TMWM, including low-frequency conductive hearing loss (CHL), autophony, pulsatile tinnitus, sound/pressure-induced vertigo and enhanced vestibular-evoked myogenic potentials, have been widely described in cases with PSCD. Nevertheless, video-head impulse test (vHIT) results have been poorly investigated. Here, we present six patients with PSCD presenting with a clinical scenario consistent with a TMWM and an impaired vestibulo-ocular reflex (VOR) for the affected canal on vHIT. In two cases, an additional dehiscence between the facial nerve and the horizontal semicircular canal (HSC) was detected, leading to a concurrent VOR impairment for the HSC. While in SSCD, a VOR gain reduction could be ascribed to a spontaneous "auto-plugging" process due to a dural prolapse into the canal, the same pathomechanism is difficult to conceive in PSCD due to a different anatomical position, making a dural herniation less likely. Alternative putative pathomechanisms are discussed, including an endolymphatic flow dissipation during head impulses as already hypothesized in SSCD. The association of symptoms/signs consistent with TMWM and a reduced VOR gain for the posterior canal might address the diagnosis toward PSCD.
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Affiliation(s)
- Andrea Castellucci
- ENT Unit, Department of Surgery, Azienda USL—IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Georges Dumas
- EA 3450 DevAH–Development, Adaptation and Handicap, Faculty of Medicine, University of Lorraine, 54500 Nancy, France;
| | - Sawsan M. Abuzaid
- Otorhinolaryngology Department, Royal Medical Services, Amman 11855, Jordan;
| | - Enrico Armato
- Ph.D. Program in Development, Adaptation and Handicap, Faculty of Medicine, University of Lorraine, 54500 Vandoeuvre-lès-Nancy, France;
| | | | - Pasquale Malara
- Audiology & Vestibology Service, Centromedico, 6500 Bellinzona, Switzerland;
| | - Mohamad Alfarghal
- Otorhinolaryngology—Head and Neck Section, Surgery Department, King Abdulaziz Medical City, Jeddah 21556, Saudi Arabia;
| | - Rosanna Rita Ruberto
- Audiology and Ear Surgery Unit, Azienda USL—IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (R.R.R.); (P.B.)
| | - Pasquale Brizzi
- Audiology and Ear Surgery Unit, Azienda USL—IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (R.R.R.); (P.B.)
| | - Angelo Ghidini
- ENT Unit, Department of Surgery, Azienda USL—IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Francesco Comacchio
- ENT Unit, Regional Vertigo Specialized Center, University Hospital of Padova, Sant’Antonio Hospital, 35039 Padova, Italy;
| | - Sébastien Schmerber
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital, 38043 Grenoble, France;
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Lucieer F, van der Lubbe M, van Stiphout L, Janssen M, Van Rompaey V, Devocht E, Perez-Fornos A, Guinand N, van de Berg R. Multi-frequency VEMPs improve detection of present otolith responses in bilateral vestibulopathy. Front Neurol 2024; 15:1336848. [PMID: 38450070 PMCID: PMC10915078 DOI: 10.3389/fneur.2024.1336848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 01/31/2024] [Indexed: 03/08/2024] Open
Abstract
Objective To investigate whether multi-frequency Vestibular Evoked Myogenic Potential (VEMP) testing at 500, 750, 1,000, and 2,000 Hz, would improve the detection of present dynamic otolith responses in patients with bilateral vestibulopathy (BV). Methods Prospective study in a tertiary referral center. BV patients underwent multi-frequency VEMP testing. Cervical VEMPs and ocular VEMPs were recorded with the Neuro-Audio system (v2010, Neurosoft, Ivanovo, Russia). The stimuli included air-conducted tone bursts of 500, 750, 1,000, and 2,000 Hz, at a stimulation rate of 13 Hz. Outcome measures included the percentage of present and absent VEMP responses, and VEMP thresholds. Outcomes were compared between frequencies and type of VEMPs (cVEMPs, oVEMPs). VEMP outcomes obtained with the 500 Hz stimulus, were also compared to normative values obtained in healthy subjects. Results Forty-nine BV patients completed VEMP testing: 47 patients completed cVEMP testing and 48 patients completed oVEMP testing. Six to 15 % more present VEMP responses were obtained with multifrequency testing, compared to only testing at 500 Hz. The 2,000 Hz stimulus elicited significantly fewer present cVEMP responses (right and left ears) and oVEMP responses (right ears) compared to the other frequencies (p ≤ 0.044). Using multi-frequency testing, 78% of BV patients demonstrated at least one present VEMP response in at least one ear. In 46% a present VEMP response was found bilaterally. BV patients demonstrated a significantly higher percentage of absent VEMP responses and significantly higher VEMP thresholds than healthy subjects, when corrected for age (p ≤ 0.002). Based on these results, a pragmatic VEMP testing paradigm is proposed, taking into account multi-frequency VEMP testing. Conclusion Multi-frequency VEMP testing improves the detection rate of present otolith responses in BV patients. Therefore, multi-frequency VEMPs should be considered when evaluation of (residual) otolith function is indicated.
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Affiliation(s)
- F. Lucieer
- Division of Balance Disorders, Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - M. van der Lubbe
- Division of Balance Disorders, Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - L. van Stiphout
- Division of Balance Disorders, Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - M. Janssen
- Department of Methodology and Statistics, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - V. Van Rompaey
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - E. Devocht
- Division of Balance Disorders, Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - A. Perez-Fornos
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - N. Guinand
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - R. van de Berg
- Division of Balance Disorders, Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
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van Stiphout L, Szmulewicz DJ, Guinand N, Fornos AP, Van Rompaey V, van de Berg R. Bilateral vestibulopathy: a clinical update and proposed diagnostic algorithm. Front Neurol 2023; 14:1308485. [PMID: 38178884 PMCID: PMC10766383 DOI: 10.3389/fneur.2023.1308485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 11/29/2023] [Indexed: 01/06/2024] Open
Abstract
Bilateral vestibulopathy (BVP) is characterized by its heterogeneous and chronic nature with various clinical presentations and multiple etiologies. This current narrative review reflects on the main insights and developments regarding clinical presentation. In addition, it proposes a new diagnostic algorithm, and describes available and potential future therapeutic modalities.
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Affiliation(s)
- Lisa van Stiphout
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands
| | - David J. Szmulewicz
- Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, VIC, Australia
- Bionics Institute, Melbourne, VIC, Australia
| | - Nils Guinand
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Angélica Pérez Fornos
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Raymond van de Berg
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands
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Halmágyi GM, Akdal G, Welgampola MS, Wang C. Neurological update: neuro-otology 2023. J Neurol 2023; 270:6170-6192. [PMID: 37592138 PMCID: PMC10632253 DOI: 10.1007/s00415-023-11922-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 08/01/2023] [Indexed: 08/19/2023]
Abstract
Much has changed since our last review of recent advances in neuro-otology 7 years ago. Unfortunately there are still not many practising neuro-otologists, so that most patients with vestibular problems need, in the first instance, to be evaluated and treated by neurologists whose special expertise is not neuro-otology. The areas we consider here are mostly those that almost any neurologist should be able to start managing: acute spontaneous vertigo in the Emergency Room-is it vestibular neuritis or posterior circulation stroke; recurrent spontaneous vertigo in the office-is it vestibular migraine or Meniere's disease and the most common vestibular problem of all-benign positional vertigo. Finally we consider the future: long-term vestibular monitoring and the impact of machine learning on vestibular diagnosis.
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Affiliation(s)
- Gábor M Halmágyi
- Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia.
- Central Clinical School, University of Sydney, Sydney, Australia.
| | - Gülden Akdal
- Neurology Department, Dokuz Eylül University Hospital, Izmir, Turkey
- Neurosciences Department, Dokuz Eylül University Hospital, Izmir, Turkey
| | - Miriam S Welgampola
- Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia
- Central Clinical School, University of Sydney, Sydney, Australia
| | - Chao Wang
- Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia
- Central Clinical School, University of Sydney, Sydney, Australia
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Rodríguez-Villalba R, Caballero-Borrego M. Normative values for the video Head Impulse Test in children without otoneurologic symptoms and their evolution across childhood by gender. Eur Arch Otorhinolaryngol 2023; 280:4037-4043. [PMID: 36892616 PMCID: PMC10382384 DOI: 10.1007/s00405-023-07900-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/22/2023] [Indexed: 03/10/2023]
Abstract
PURPOSE The video Head Impulse Test is routinely used to assess semicircular canal function in adults, but to date, pediatric reference values are scarce. This study aimed to explore the vestibulo-ocular reflex (VOR) in healthy children at different development stages and to compare the obtained gain values with reference to those in an adult population. METHODS This prospective, single-center study recruited 187 children from among patients without otoneurological diseases, healthy relatives of these patients, and staff families from a tertiary hospital. Patients were divided into three groups by age: 3-6 years, 7-10 years, and 11-16 years. The vestibulo-ocular reflex was assessed by video Head Impulse Test, using a device with a high-speed infrared camera and accelerometer (EyeSeeCam®; Interacoustics, Denmark). RESULTS We found a lower vestibulo-ocular reflex gain of both horizontal canals in the 3-6-year-old group when compared with the other age groups. No increasing trend was found in the horizontal canals from age 7-10 years to age 11-16 years, and no differences were found by sex. CONCLUSION Gain values in the horizontal canals increased with age until children reached age 7-10 years and matched the normal values for adults.
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Affiliation(s)
- Rosana Rodríguez-Villalba
- Department of Otorhinolaryngology, Hospital Sant Joan de Déu, Barcelona, Spain
- Department of Otorhinolaryngology, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain
| | - Miguel Caballero-Borrego
- Otorhinolaryngology-Head and Neck Surgery Department, Hospital Clínic, University of Barcelona, C/Villarroel, 170, Esc. 8, 2ª, 08036, Barcelona, Spain.
- Institut d'Investigacions Biomèdiques Agusti Pi Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
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Money-Nolan LE, Flagge AG. Factors affecting variability in vestibulo-ocular reflex gain in the Video Head Impulse Test in individuals without vestibulopathy: A systematic review of literature. Front Neurol 2023; 14:1125951. [PMID: 36970532 PMCID: PMC10034038 DOI: 10.3389/fneur.2023.1125951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/20/2023] [Indexed: 03/11/2023] Open
Abstract
IntroductionThe purpose of this systematic review was to summarize and synthesize published evidence examining variations in vestibulo-ocular reflex (VOR) gain outcomes for the Video Head Impulse Test (vHIT) in healthy individuals without vestibulopathy in order to describe factors that may influence test outcomes.MethodsComputerized literature searches were performed from four search engines. The studies were selected based on relevant inclusion and exclusion criteria, and were required to examine VOR gain in healthy adults without vestibulopathy. The studies were screened using Covidence (Cochrane tool) and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards (PRISMA-2020).ResultsA total of 404 studies were initially retrieved, of which a total of 32 studies met inclusion criteria. Four major categories were identified which lead to significant variation in VOR gain outcomes: participant-based factors, tester/examiner-based factors, protocol-based factors, and equipment-based factors.DiscussionVarious subcategories are identified within each of these classifications and are discussed, including recommendations for decreasing VOR gain variability in clinical practice.
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George M, Kolethekkat AA, Yoan P, Maire R. Video Head Impulse Test: A Comparison and Analysis of Three Recording Systems. Indian J Otolaryngol Head Neck Surg 2023; 75:60-66. [PMID: 37007889 PMCID: PMC10050493 DOI: 10.1007/s12070-022-03170-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 09/19/2022] [Indexed: 11/06/2022] Open
Abstract
The present study aimed to compare the efficacy and reproducibility of three existing systems in a group of healthy individuals for vHIT. A prospective randomized study was conducted on 12 healthy individuals. The vHIT tests were carried out. The values of the gains for the 3SCCs of each ear were collected using the three devices. The expected average gain of 1 was the gain standard. The statistical significance in the difference in gains were assessed. There is good reproducibility of the results of the vHIT examination. EyeSeeCam appeared to be the worst performing system with a slightly overstated average gain of 1.15. Otometrics has longest average examination time per patient. Synapsis is the system with the best quality/time invested and easiest to access. Video head impulse system depends on the examiner's preference, reproducible and superimposable depending on the examiner and experience.
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Affiliation(s)
- Mercy George
- ENT Service, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon, 46, 1011 Lausanne, Switzerland
| | | | - Perez Yoan
- ENT Service, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon, 46, 1011 Lausanne, Switzerland
| | - Raphael Maire
- ENT Service, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon, 46, 1011 Lausanne, Switzerland
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Liu Y, Leng Y, Zhou R, Liu J, Wang H, Xia K, Liu B, Xiao H. Discrepancies of video head impulse test results in patients with idiopathic sudden sensorineural hearing loss with vertigo and vestibular neuritis. Front Neurosci 2023; 17:1102512. [PMID: 37139518 PMCID: PMC10150120 DOI: 10.3389/fnins.2023.1102512] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/13/2023] [Indexed: 05/05/2023] Open
Abstract
Objective Sudden sensorineural hearing loss with vertigo (SHLV) and vestibular neuritis (VN) remain frequent causes of acute vestibular syndrome (AVS). The aim of study was to compare the results of video head impulse test (vHIT) in patients with SHLV and VN. The characteristics of high-frequency vestibule-ocular reflex (VOR) and the differences of the pathophysiological mechanisms underlying these two AVS were explored. Methods Fifty-seven SHLV patients and 31 VN patients were enrolled. vHIT was conducted at the initial presentation. The VOR gains and occurrence of corrective saccades (CSs) of anterior, horizontal, and posterior semicircular canals (SCCs) in two groups were analyzed. Pathological vHIT results refer to impaired VOR gains and presence of CSs. Results In SHLV group, pathological vHIT results was most prevalent in the posterior SCC on the affected side (30/57, 52.63%), followed by horizontal (12/57, 21.05%) and anterior SCC (3/57, 5.26%). In VN group, pathological vHIT preferentially affected horizontal SCC (24/31, 77.42%), followed by anterior (10/31, 32.26%) and posterior SCC (9/31, 29.03%) on the affected side. As for anterior and horizontal SCC on the affected side, the incidences of pathological vHIT results in VN group were significantly higher than those in SHLV group (β = 2.905, p < 0.01; β = 2.183, p < 0.001). There were no significant differences in the incidence of pathological vHIT result in posterior SCC between two groups. Conclusion Comparison of vHIT results in patients with SHLV and VN revealed discrepancies in the pattern of SCCs impairments, which may be explained by different pathophysiological mechanisms underlying these two vestibular disorders presenting as AVS.
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Affiliation(s)
| | | | | | | | | | | | - Bo Liu
- *Correspondence: Bo Liu, ; Hongjun Xiao,
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Pleshkov M, Zaitsev V, Starkov D, Demkin V, Kingma H, van de Berg R. Comparison of EOG and VOG obtained eye movements during horizontal head impulse testing. Front Neurol 2022; 13:917413. [PMID: 36119710 PMCID: PMC9479731 DOI: 10.3389/fneur.2022.917413] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/05/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Video head impulse testing is frequently used to evaluate the vestibular function. During this test, eye movement responses are recorded with video-oculography (VOG). However, the use of VOG can sometimes be challenging, especially due to pupil detection problems (e.g., blinking, droopy eyelids, etc.). Therefore, this study investigated whether electro-oculography (EOG), a technique that does not depend on pupil tracking but on the orientation of the corneoretinal potential, might be an alternative to VOG for quantifying eye movement responses during head impulse testing. Subjects and methods Head impulse testing was performed in 19 healthy subjects without a prior history of vestibular symptoms. Horizontal eye movements were recorded simultaneously with EOG (using an EOG system) and VOG (using a VHIT system: ICS Impulse). The eye movement responses to each side of both techniques were compared using a concordance correlation coefficient (rc), t-testing, and Bayes Factor (BF) paired t-testing. Results EOG and VOG obtained eye movement traces that correlated well with each other during head impulse testing (average rc = 0.89). Average VOR gains obtained with EOG and VOG were not significantly different from each other for all subjects during left head impulses. However, VOG gains differed between both techniques regarding right head impulses. VOG showed significant VOR gain asymmetry (5% to the right), whereas EOG showed no significant asymmetry (1% to the right). Conclusion This study demonstrated the use of EOG to record eye movements during head impulse testing for the first time. EOG and VOG obtained eye movement traces that correlated well with each other during horizontal head impulse testing. In addition, EOG showed smaller VOR gain asymmetry in healthy individuals, in contrast to VOG. These findings indicate that EOG might potentially be applicable as an alternative to VOG for collecting eye movement responses during head impulse testing. Trial registration number 10192021-38 dated 19.10.21.
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Affiliation(s)
- Maksim Pleshkov
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, Maastricht University Medical Center, School for Mental Health and Neuroscience, Maastricht, Netherlands
- *Correspondence: Maksim Pleshkov
| | - Vasilii Zaitsev
- Faculty of Physics, National Research Tomsk State University, Tomsk, Russia
| | - Dmitrii Starkov
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, Maastricht University Medical Center, School for Mental Health and Neuroscience, Maastricht, Netherlands
| | - Vladimir Demkin
- Faculty of Physics, National Research Tomsk State University, Tomsk, Russia
| | - Herman Kingma
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, Maastricht University Medical Center, School for Mental Health and Neuroscience, Maastricht, Netherlands
| | - Raymond van de Berg
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, Maastricht University Medical Center, School for Mental Health and Neuroscience, Maastricht, Netherlands
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van Dooren T, Starkov D, Lucieer F, Dobbels B, Janssen M, Guinand N, Pérez Fornos A, Kingma H, Van Rompaey V, van de Berg R. Suppression Head Impulse Test (SHIMP) versus Head Impulse Test (HIMP) When Diagnosing Bilateral Vestibulopathy. J Clin Med 2022; 11:jcm11092444. [PMID: 35566570 PMCID: PMC9102589 DOI: 10.3390/jcm11092444] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 02/05/2023] Open
Abstract
The Suppression Head Impulse (SHIMP) test was introduced as an alternative to the Head Impulse Paradigm (HIMP) to overcome challenges in VOR gain calculation due to the interference of covert saccades. The objectives of this study were (1) to determine if SHIMP, compared to HIMP, reduces covert saccades in BV patients and (2) to define the agreement on diagnosing BV between SHIMP and HIMP. First, the number of covert saccades was compared between SHIMP and HIMP. Secondly, VOR gain was compared between SHIMP and HIMP. Lastly, the agreement between SHIMP and HIMP on identifying BV (horizontal VOR gain <0.6) was evaluated. A total of 98 BV patients were included. To our knowledge, this is the largest study population on SHIMP testing in BV patients. Covert saccades were significantly reduced, and a lower VOR gain was found during SHIMP compared to HIMP (p < 0.001). However, the clinical relevance of these statistically significant differences is small. In 93% of the patients, an agreement was found between the two paradigms regarding the diagnosis of BV, and both paradigms detect BV in the vast majority of patients.
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Affiliation(s)
- Tessa van Dooren
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands; (F.L.); (N.G.); (H.K.); (R.v.d.B.)
- Correspondence:
| | - Dmitrii Starkov
- Faculty of Physics, Tomsk State Research University, 634050 Tomsk, Russia;
| | - Florence Lucieer
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands; (F.L.); (N.G.); (H.K.); (R.v.d.B.)
| | - Bieke Dobbels
- Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerp, Belgium; (B.D.); (V.V.R.)
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, 2650 Edegem, Belgium
| | - Miranda Janssen
- Department of ENT/Audiology, School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands;
- Department of Methodology and Statistics, Care and Public Health Research Institute (CAPHRI), Maastricht University, 6211 LK Maastricht, The Netherlands
| | - Nils Guinand
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands; (F.L.); (N.G.); (H.K.); (R.v.d.B.)
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Geneva, Switzerland;
| | - Angelica Pérez Fornos
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Geneva, Switzerland;
| | - Herman Kingma
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands; (F.L.); (N.G.); (H.K.); (R.v.d.B.)
| | - Vincent Van Rompaey
- Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerp, Belgium; (B.D.); (V.V.R.)
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, 2650 Edegem, Belgium
| | - Raymond van de Berg
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands; (F.L.); (N.G.); (H.K.); (R.v.d.B.)
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van Stiphout L, Pleshkov M, Lucieer F, Dobbels B, Mavrodiev V, Guinand N, Pérez Fornos A, Widdershoven J, Strupp M, Van Rompaey V, van de Berg R. Patterns of Vestibular Impairment in Bilateral Vestibulopathy and Its Relation to Etiology. Front Neurol 2022; 13:856472. [PMID: 35386413 PMCID: PMC8979031 DOI: 10.3389/fneur.2022.856472] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/17/2022] [Indexed: 11/23/2022] Open
Abstract
Objective This study aimed to investigate (1) the patterns of vestibular impairment in bilateral vestibulopathy (BVP) and subsequently, the implications regarding patient eligibility for vestibular implantation, and (2) whether this pattern and severity of vestibular impairment is etiology dependent. Methods A total of one hundred and seventy-three subjects from three tertiary referral centers in Europe were diagnosed with BVP according to the Bárány Society diagnostic criteria. The subjects underwent vestibular testing such as the caloric test, torsion swing test, video Head Impulse Test (vHIT) in horizontal and vertical planes, and cervical and/or ocular vestibular evoked myogenic potentials (c- and oVEMPs). The etiologies were split into idiopathic, genetic, ototoxicity, infectious, Menière's Disease, (head)trauma, auto-immune, neurodegenerative, congenital, and mixed etiology. Results The caloric test and horizontal vHIT more often indicated horizontal semicircular canal impairment than the torsion swing test. The vHIT results showed significantly higher gains for both anterior canals compared with the horizontal and posterior canals (p < 0.001). The rates of bilaterally absent oVEMP responses were higher compared to the bilaterally absent cVEMP responses (p = 0.010). A total of fifty-four percent of the patients diagnosed with BVP without missing data met all three Bárány Society diagnostic test criteria, whereas 76% of the patients were eligible for implantation according to the vestibular implantation criteria. Regarding etiology, only horizontal vHIT results were significantly lower for trauma, neurodegenerative, and genetic disorders, whereas the horizontal vHIT results were significantly higher for Menière's Disease, infectious and idiopathic BVP. The exploration with hierarchical cluster analysis showed no significant association between etiology and patterns of vestibular impairment. Conclusion This study showed that caloric testing and vHIT seem to be more sensitive for measuring vestibular impairment, whereas the torsion swing test is more suited for measuring residual vestibular function. In addition, no striking patterns of vestibular impairment in relation to etiology were found. Nevertheless, it was demonstrated that although the implantation criteria are stricter compared with the Bárány Society diagnostic criteria, still, 76% of patients with BVP were eligible for implantation based on the vestibular test criteria. It is advised to carefully examine every patient for their overall pattern of vestibular impairment in order to make well-informed and personalized therapeutic decisions.
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Affiliation(s)
- Lisa van Stiphout
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands
- *Correspondence: Lisa van Stiphout
| | - Maksim Pleshkov
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands
- Faculty of Physics, Tomsk State University, Tomsk, Russia
- Maksim Pleshkov
| | - Florence Lucieer
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands
| | - Bieke Dobbels
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine and Health Sciences, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Vergil Mavrodiev
- Department of Neurology and German Center for Vertigo, Ludwig-Maximilians University, Munich, Germany
| | - Nils Guinand
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Angelica Pérez Fornos
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Josine Widdershoven
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine and Health Sciences, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Michael Strupp
- Department of Neurology and German Center for Vertigo, Ludwig-Maximilians University, Munich, Germany
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine and Health Sciences, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Raymond van de Berg
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands
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12
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Abstract
PURPOSE OF REVIEW The current review covers recent advances in bilateral vestibulopathy (BVP) in terms of its etiology, diagnosis, and treatments. RECENT FINDINGS The etiology of BVP depends on its clinical course and associated findings, and genetic abnormalities are increasingly recognized in isolated as well as complicated form of BVP. Recent developments in evaluation of the vestibular function have greatly enhanced the detection of BVP, and introduction of the consensus diagnostic criteria by Barany Society has facilitated research on BVP. Vestibular prosthesis may improve vestibular function, posture, gait and quality of life in patients with BVP and would expand the therapeutic options for BVP in near future. SUMMARY Genetics is expanding its role in identifying the causes of BVP of hitherto unknown etiology. The detection and investigation of BVP have been greatly enhanced by introduction of consensus diagnostic criteria and recent developments in methodology evaluating the vestibular function. Vestibular prothesis appears promising in managing BVP. VIDEO ABSTRACT http://links.lww.com/CONR/A59.
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Affiliation(s)
- Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul
- Dizziness Center, Clinical Neuroscience Center, and Department of Neurology, Seoul National University Bundang Hospital, Seongnam
| | - Hyo-Jung Kim
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam, South Korea
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13
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Machner B, Erber K, Choi JH, Sprenger A, Helmchen C, Trillenberg P. A Simple Gain-Based Evaluation of the Video Head Impulse Test Reliably Detects Normal Vestibulo-Ocular Reflex Indicative of Stroke in Patients With Acute Vestibular Syndrome. Front Neurol 2021; 12:741859. [PMID: 34777209 PMCID: PMC8585749 DOI: 10.3389/fneur.2021.741859] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/06/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: The head impulse test (HIT) assesses the vestibulo-ocular reflex (VOR) and is used to differentiate vestibular neuritis (abnormal VOR) from stroke (normal VOR) in patients presenting with an acute vestibular syndrome (AVS). The video-oculography-based HIT (vHIT) quantifies VOR function and provides information imperceptible for the clinician during clinical bedside HIT. However, the vHIT—like an electrocardiogram—requires experienced interpretation, which is especially difficult in the emergency setting. This calls for a simple, reliable and rater-independent way of analysis. Methods: We retrospectively collected 171 vHITs performed in patients presenting with AVS to our emergency department. Three neuro-otological experts comprehensively assessed the vHITs including interpretability (artifacts), VOR gain (eye/head velocity ratio), velocity profile (abrupt decline) and corrective saccades (overt/covert). Their consensus rating (abnormal/peripheral vs. normal/central) was compared to a simple algorithm that automatically classified the vHITs based on a single VOR gain cutoff (0.7). Results: Inter-rater agreement between experts was high (Fleiss' kappa = 0.74). Five (2.9 %) vHITs were “uninterpretable” according to experts' consensus, 80 (46.8 %) were rated “normal” and 86 (50.3 %) “abnormal”. The algorithm had substantial agreement with the experts' consensus (Cohen's kappa = 0.75). Importantly, it correctly classified all of the normal/central vHITs denoted by the experts (100% specificity) and at the same time it had sufficient sensitivity (75.6%) in detecting abnormal/peripheral vHITs. Conclusion: A simple, automated, gain-based evaluation of the vHIT reliably detects normal/central VOR and may be a feasible and effective tool to screen AVS patients for potentially underlying stroke in the emergency setting.
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Affiliation(s)
- Björn Machner
- Department of Neurology, University Hospitals Schleswig-Holstein, Lübeck, Germany
| | - Kira Erber
- Department of Anesthesiology and Intensive Care, University Hospitals Schleswig-Holstein, Lübeck, Germany
| | - Jin Hee Choi
- Department of Neurology, University Hospitals Schleswig-Holstein, Lübeck, Germany
| | - Andreas Sprenger
- Department of Neurology, University Hospitals Schleswig-Holstein, Lübeck, Germany
| | - Christoph Helmchen
- Department of Neurology, University Hospitals Schleswig-Holstein, Lübeck, Germany
| | - Peter Trillenberg
- Department of Neurology, University Hospitals Schleswig-Holstein, Lübeck, Germany
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14
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Starkov D, Vermorken B, Van Dooren TS, Van Stiphout L, Janssen M, Pleshkov M, Guinand N, Pérez Fornos A, Van Rompaey V, Kingma H, Van de Berg R. The Effect of Different Head Movement Paradigms on Vestibulo-Ocular Reflex Gain and Saccadic Eye Responses in the Suppression Head Impulse Test in Healthy Adult Volunteers. Front Neurol 2021; 12:729081. [PMID: 34630303 PMCID: PMC8492894 DOI: 10.3389/fneur.2021.729081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/18/2021] [Indexed: 02/03/2023] Open
Abstract
Objective: This study aimed to identify differences in vestibulo-ocular reflex gain (VOR gain) and saccadic response in the suppression head impulse paradigm (SHIMP) between predictable and less predictable head movements, in a group of healthy subjects. It was hypothesized that higher prediction could lead to a lower VOR gain, a shorter saccadic latency, and higher grouping of saccades. Methods: Sixty-two healthy subjects were tested using the video head impulse test and SHIMPs in four conditions: active and passive head movements for both inward and outward directions. VOR gain, latency of the first saccade, and the level of saccade grouping (PR-score) were compared among conditions. Inward and active head movements were considered to be more predictable than outward and passive head movements. Results: After validation, results of 57 tested subjects were analyzed. Mean VOR gain was significantly lower for inward passive compared with outward passive head impulses (p < 0.001), and it was higher for active compared with passive head impulses (both inward and outward) (p ≤ 0.024). Mean latency of the first saccade was significantly shorter for inward active compared with inward passive (p ≤ 0.001) and for inward passive compared with outward passive head impulses (p = 0.012). Mean PR-score was only significantly higher in active outward than in active inward head impulses (p = 0.004). Conclusion: For SHIMP, a higher predictability in head movements lowered gain only in passive impulses and shortened latencies of compensatory saccades overall. For active impulses, gain calculation was affected by short-latency compensatory saccades, hindering reliable comparison with gains of passive impulses. Predictability did not substantially influence grouping of compensatory saccades.
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Affiliation(s)
- Dmitrii Starkov
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands.,Faculty of Physics, Tomsk State Research University, Tomsk, Russia
| | - Bernd Vermorken
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - T S Van Dooren
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Lisa Van Stiphout
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Miranda Janssen
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands.,Department of Methodology and Statistics, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Maksim Pleshkov
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands.,Faculty of Physics, Tomsk State Research University, Tomsk, Russia
| | - Nils Guinand
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands.,Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Angelica Pérez Fornos
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Vincent Van Rompaey
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Herman Kingma
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands.,Faculty of Physics, Tomsk State Research University, Tomsk, Russia
| | - Raymond Van de Berg
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands.,Faculty of Physics, Tomsk State Research University, Tomsk, Russia
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15
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Starkov D, Strupp M, Pleshkov M, Kingma H, van de Berg R. Diagnosing vestibular hypofunction: an update. J Neurol 2021; 268:377-385. [PMID: 32767115 PMCID: PMC7815536 DOI: 10.1007/s00415-020-10139-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/31/2020] [Accepted: 08/01/2020] [Indexed: 12/13/2022]
Abstract
Unilateral or bilateral vestibular hypofunction presents most commonly with symptoms of dizziness or postural imbalance and affects a large population. However, it is often missed because no quantitative testing of vestibular function is performed, or misdiagnosed due to a lack of standardization of vestibular testing. Therefore, this article reviews the current status of the most frequently used vestibular tests for canal and otolith function. This information can also be used to reach a consensus about the systematic diagnosis of vestibular hypofunction.
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Affiliation(s)
- Dmitrii Starkov
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
- Faculty of Physics, Tomsk State Research University, Tomsk, Russia.
- Maastricht University ENT Department, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| | - Michael Strupp
- German Center for Vertigo and Balance Disorders, Ludwig Maximilians University, Munich, Germany
- Department of Neurology, Ludwig Maximilians University, Munich, Germany
| | - Maksim Pleshkov
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- Faculty of Physics, Tomsk State Research University, Tomsk, Russia
| | - Herman Kingma
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- Faculty of Physics, Tomsk State Research University, Tomsk, Russia
| | - Raymond van de Berg
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- Faculty of Physics, Tomsk State Research University, Tomsk, Russia
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