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Grove CR, Loyd BJ, Dibble LE, Schubert MC. Evidence for the differential efficacy of yaw and pitch gaze stabilization mechanisms in people with multiple sclerosis. Exp Brain Res 2024; 242:1797-1806. [PMID: 38839617 DOI: 10.1007/s00221-024-06864-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/24/2024] [Indexed: 06/07/2024]
Abstract
People with multiple sclerosis (PwMS) who report dizziness often have gaze instability due to vestibulo-ocular reflex (VOR) deficiencies and compensatory saccade (CS) abnormalities. Herein, we aimed to describe and compare the gaze stabilization mechanisms for yaw and pitch head movements in PwMS. Thirty-seven PwMS (27 female, mean ± SD age = 53.4 ± 12.4 years old, median [IQR] Expanded Disability Status Scale Score = 3.5, [1.0]. We analyzed video head impulse test results for VOR gain, CS frequency, CS latency, gaze position error (GPE) at impulse end, and GPE at 400 ms after impulse start. Discrepancies were found for median [IQR] VOR gain in yaw (0.92 [0.14]) versus pitch-up (0.71 [0.44], p < 0.001) and pitch-down (0.81 [0.44], p = 0.014]), CS latency in yaw (258.13 [76.8]) ms versus pitch-up (208.78 [65.97]) ms, p = 0.001] and pitch-down (132.17 [97.56] ms, p = 0.006), GPE at impulse end in yaw (1.15 [1.85] degs versus pitch-up (2.71 [3.9] degs, p < 0.001), and GPE at 400 ms in yaw (-0.25 [0.98] degs) versus pitch-up (1.53 [1.07] degs, p < 0.001) and pitch-down (1.12 [1.82] degs, p = 0.001). Compared with yaw (0.91 [0.75]), CS frequency was similar for pitch-up (1.03 [0.93], p = 0.999) but lower for pitch-down (0.65 [0.64], p = 0.023). GPE at 400 ms was similar for yaw and pitch-down (1.88 [2.76] degs, p = 0.400). We postulate that MS may have preferentially damaged the vertical VOR and saccade pathways in this cohort.
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Affiliation(s)
- Colin R Grove
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
- Division of Physical Therapy, Department of Rehabilitation Medicine, School of Medicine, Emory University, Atlanta, GA, USA.
- Applied Vestibular Physiology Laboratory, Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, 1441 Clifton Road, NE, Atlanta, GA, 30322, USA.
| | - Brian J Loyd
- School of Physical Therapy and Rehabilitation Sciences, College of Health, University of Montana, Missoula, MT, USA
- School of Integrative Physiology and Athletic Training, College of Health, University of Montana, Missoula, MT, USA
| | - Leland E Dibble
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - Michael C Schubert
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Skelmose TBK, Houmøller AM, Yavarian Y, Borregaard NR, Hougaard DD. Individualized repositioning with a mechanical rotational chair facilitates successful treatment of patients with very retractable benign paroxysmal positional vertigo. Am J Otolaryngol 2024; 45:104241. [PMID: 38574512 DOI: 10.1016/j.amjoto.2024.104241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 02/22/2024] [Accepted: 02/24/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND About 12.5 % of patients diagnosed with benign paroxysmal positional vertigo (BPPV), experience persistent BPPV where it is unknown why some BPPV cases are very refractory (vrBPPV) to treatment. OBJECTIVES The primary objective was to investigate if patients with vrBPPV could be successfully treated with a mechanical rotation chair (MRC) adjusted to the exact vertical semicircular canal (SCC) angles of the individual patient. Secondary endpoint was to determine if inner ear anomalies were predominant in these patients. METHODS This prospective clinical trial included 20 patients (main group) who underwent computed tomography (CT) with measurements of the bony island and the width between the SCC walls of the posterior leg of the lateral SCCs. The inter-SCC angles, the angles between the sagittal plane and the vertical SCCs were compared to the presumed mean standard angles of the SCCs. Of these, 14 patients (subgroup) underwent individualized treatment with the Rotundum® repositioning chair according to their measured SCC angles. RESULTS All measured SCC angles differed significantly (p < 0.05) from the presumed mean standard SCC angles, except the angle between the sagittal plane and the left posterior SCC (p-SCC). Three out of 14 patients experienced subjective and objective remission after treatment with this MRC. Six out of 14 patients experienced either subjective remission or objective remission. CONCLUSIONS Patients with vrBPPV have vertical SCC angles that differ significantly from the presumed mean standard SCC angles. Individualized treatment with this MRC successfully treated 21.4 % of the patients with vrBPPV and provided subjective relief for 42.9 %.
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Affiliation(s)
| | | | - Yousef Yavarian
- Department of Radiology, Aalborg University Hospital, Denmark
| | | | - Dan Dupont Hougaard
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Balance & Dizziness Centre, Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Aalborg University Hospital, Aalborg, Denmark
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Allred AR, Lippert AF, Wood SJ. Galvanic Vestibular Stimulation Advancements for Spatial Disorientation Training. Aerosp Med Hum Perform 2024; 95:390-398. [PMID: 38915170 DOI: 10.3357/amhp.6362.2024] [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: 06/26/2024]
Abstract
INTRODUCTION: Spatial disorientation (SD) remains the leading contributor to Class A mishaps in the U.S. Navy, consistent with historical trends. Despite this, SD training for military aircrew is largely confined to the classroom and experiential training replicating SD illusions is limited and infrequent. Static flight simulators are most commonly used for training but offer no vestibular stimulation to the flight crew, omitting the source of vestibular-mediated SD.BACKGROUND: We first cover vestibular-mediated SD illusions which may be replicated through galvanic vestibular stimulation (GVS) in a static environment. GVS is a safe, reliable, low-cost avenue for providing vestibular sensory stimulation. We review the underlying mechanisms of GVS such as the excitement and inhibition of the afferent neurons innervating the vestibular system, particularly in the binaural bipolar electrode montage.APPLICATIONS: Two approaches for how GVS may be used to enhance SD training are examined. The first is a means for providing unreliable vestibular sensory perceptions to pilots, and the second details how GVS can be leveraged for replicating vestibular-mediated SD illusions.DISCUSSION: We recommend GVS be pursued as an enhancement to existing SD training. The ability to disorient aircrew in the safe training environment of a static flight simulator would allow for aircrew familiarization to SD, serving as an opportunity to practice life-saving checklist items to recover from SD. A repeatable training profile that could be worn by military aircrew in a static flight simulator may afford a low-cost training solution to the number one cause of fatalities in military aviation.Allred AR, Lippert AF, Wood SJ. Galvanic vestibular stimulation advancements for spatial disorientation training. Aerosp Med Hum Perform. 2024; 95(7):390-398.
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Arán-Tapia I, Soto-Varela A, Pérez-Muñuzuri V, Santos-Pérez S, Arán I, Muñuzuri AP. Numerical Simulations of the Epley Maneuver With Clinical Implications. Ear Hear 2024; 45:1033-1044. [PMID: 38439150 PMCID: PMC11175731 DOI: 10.1097/aud.0000000000001493] [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: 05/12/2023] [Accepted: 01/23/2024] [Indexed: 03/06/2024]
Abstract
OBJECTIVES Canalith repositioning procedures to treat benign paroxysmal positional vertigo are often applied following standardized criteria, without considering the possible anatomical singularities of the membranous labyrinth for each individual. As a result, certain patients may become refractory to the treatment due to significant deviations from the ideal membranous labyrinth, that was considered when the maneuvers were designed. This study aims to understand the dynamics of the endolymphatic fluid and otoconia, within the membranous labyrinth geometry, which may contribute to the ineffectiveness of the Epley maneuver. Simultaneously, the study seeks to explore methods to avoid or reduce treatment failure. DESIGN We conducted a study on the Epley maneuver using numerical simulations based on a three-dimensional medical image reconstruction of the human left membranous labyrinth. A high-quality micro-computed tomography of a human temporal bone specimen was utilized for the image reconstruction, and a mathematical model for the endolymphatic fluid was developed and coupled with a spherical particle model representing otoconia inside the fluid. This allowed us to measure the position and time of each particle throughout all the steps of the maneuver, using equations that describe the physics behind benign paroxysmal positional vertigo. RESULTS Numerical simulations of the standard Epley maneuver applied to this membranous labyrinth model yielded unsatisfactory results, as otoconia do not reach the frontside of the utricle, which in this study is used as the measure of success. The resting times between subsequent steps indicated that longer intervals are required for smaller otoconia. Using different angles of rotation can prevent otoconia from entering the superior semicircular canal or the posterior ampulla. Steps 3, 4, and 5 exhibited a heightened susceptibility to failure, as otoconia could be accidentally displaced into these regions. CONCLUSIONS We demonstrate that modifying the Epley maneuver based on the numerical results obtained in the membranous labyrinth of the human specimen under study can have a significant effect on the success or failure of the treatment. The use of numerical simulations appears to be a useful tool for future canalith repositioning procedures that aim to personalize the treatment by modifying the rotation planes currently defined as the standard criteria.
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Affiliation(s)
- Ismael Arán-Tapia
- Group of Non-Linear Physics, Department of Physics, Campus Sur, University of Santiago de Compostela, Santiago de Compostela, Spain
- Galician Center for Mathematical Research and Technology, Santiago de Compostela, Spain
- Cross-disciplinary Research Center in Environmental Technologies (CRETUS), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Andrés Soto-Varela
- Division of Neurotology, Department of Otorhinolaryngology, Complexo Hospitalario Universitario, Santiago de Compostela, Spain
- Department of Surgery and Medical-Surgical Specialities, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
- Health Research Institute of Santiago, Santiago de Compostela, Spain
| | - Vicente Pérez-Muñuzuri
- Group of Non-Linear Physics, Department of Physics, Campus Sur, University of Santiago de Compostela, Santiago de Compostela, Spain
- Cross-disciplinary Research Center in Environmental Technologies (CRETUS), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Sofía Santos-Pérez
- Division of Neurotology, Department of Otorhinolaryngology, Complexo Hospitalario Universitario, Santiago de Compostela, Spain
- Department of Surgery and Medical-Surgical Specialities, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
- Health Research Institute of Santiago, Santiago de Compostela, Spain
| | - Ismael Arán
- Department of Otorhinolaryngology, Complexo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Alberto P. Muñuzuri
- Group of Non-Linear Physics, Department of Physics, Campus Sur, University of Santiago de Compostela, Santiago de Compostela, Spain
- Galician Center for Mathematical Research and Technology, Santiago de Compostela, Spain
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d’Onofrio F, Neri L, Neri G. Vertical saccades during horizontal head impulses: a sign of posterior semicircular canal hypofunction. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2024; 44:198-203. [PMID: 38712769 PMCID: PMC11166218 DOI: 10.14639/0392-100x-n2508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 10/16/2023] [Indexed: 05/08/2024]
Abstract
Objective We describe an uncharacteristic vestibular-ocular reflex (VOR) pattern, studied by video head impulse tests (VHIT) in patients suffering from unilateral isolated posterior semicircular canal (PSC) hypofunction. In these patients, we found an upward sliding of the eyes, followed by an oblique downward catch-up saccade during horizontal head impulse to the healthy side. Methods We present a retrospective study of all VHIT exams presenting isolated PSC hypofunction between May 2020 and November 2022. Results We found 37 patients, which led to the discovery of such incongruent eye movement in 19 cases; their gain data are shown and compared to the remaining 18 cases in which such an anomaly was absent. A control group of 31 healthy subjects was recruited to define the reference criteria for VHIT gain values. The correlation between the amplitude of the vertical saccade and the relative functional imbalance of the vertical semicircular canals was studied. Conclusions We have observed that in approximately half of the subjects with isolated CSP deficiency, there is a VOR anomaly. A possible pathophysiological explanation of the unbalanced effect of vertical semicircular canal stimulation of a labyrinth during horizontal head thrust toward the opposite side is proposed. The planar incongruity of the response of the VOR described here appears more evident at the onset of the CSP deficit. Current VHIT systems do not detect this incongruent eye reflex. They can lead to an error in gain evaluation (pseudo-deficit) of the lateral semicircular canal of the healthy side and problems in performing the test (trace rejected). In the future, software for VHIT should take into account the possibility of non-coplanar ocular responses to cephalic stimuli.
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Affiliation(s)
- Francesco d’Onofrio
- Department of Neurosciences, Imaging, and Clinical Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Letizia Neri
- Department of Otorhinolaryngology, University of Insubria and ASST Sette Laghi, Varese, Italy
| | - Giampiero Neri
- Department of Neurosciences, Imaging, and Clinical Sciences, University of Chieti-Pescara, Chieti, Italy
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Kwon E, Jeong HS, Jeong SH, Kim HJ, Kim JS. Central paroxysmal positional nystagmus mimicking posterior canal benign paroxysmal positional vertigo in pontine infarction: a case report and literature review. J Neurol 2024; 271:3672-3677. [PMID: 38551741 DOI: 10.1007/s00415-024-12346-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 05/30/2024]
Affiliation(s)
- Eunjin Kwon
- Department of Neurology, Chungnam National University Hospital, 282 Munwha-Ro, Joong-Gu, Daejeon, 35015, Korea
| | - Hye Seon Jeong
- Department of Neurology, Chungnam National University Hospital, 282 Munwha-Ro, Joong-Gu, Daejeon, 35015, Korea
| | - Seong-Hae Jeong
- Department of Neurology, Chungnam National University Hospital, 282 Munwha-Ro, Joong-Gu, Daejeon, 35015, Korea.
- Department of Neurology, College of Medicine, Chungnam National University, Daejeon, South Korea.
| | - Hyo-Jung Kim
- Biomedical Research Institute, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ji-Soo Kim
- Department of Neurology, Dizziness Center, and Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
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Furman JM, Shirey I, Roxberg J, Kiderman A. The vertical computerized rotational head impulse test. J Vestib Res 2024; 34:29-38. [PMID: 38393869 PMCID: PMC10894580 DOI: 10.3233/ves-230121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/29/2023] [Indexed: 02/25/2024]
Abstract
The computerized rotational head impulse test (crHIT) uses a computer-controlled rotational chair to deliver whole-body rotational impulses to assess the semicircular canals. The crHIT has only been described for horizontal head plane rotations. The purpose of this study was to describe the crHIT for vertical head plane rotations. In this preliminary study, we assessed four patients with surgically confirmed unilateral peripheral vestibular abnormalities and two control subjects. Results indicated that the crHIT was well-tolerated for both horizontal head plane and vertical head plane stimuli. The crHIT successfully assessed each of the six semicircular canals. This study suggests that the crHIT has the potential to become a new laboratory-based vestibular test for both the horizontal and vertical semicircular canals.
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Affiliation(s)
- Joseph M. Furman
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Jillyn Roxberg
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA
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Arán-Tapia I, Soto-Varela A, Pérez-Muñuzuri V, Santos-Pérez S, Arán I, Muñuzuri AP. Numerical simulations to determine the stimulation of the crista ampullaris during the Head Impulse Test. Comput Biol Med 2023; 163:107225. [PMID: 37437361 DOI: 10.1016/j.compbiomed.2023.107225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/13/2023] [Accepted: 06/30/2023] [Indexed: 07/14/2023]
Abstract
The Head Impulse Test, the most widely accept test to assess the vestibular function, comprises rotations of the head based on idealized orientations of the semicircular canals, instead of their individual arrangement specific for each patient. In this study, we show how computational modelling can help personalize the diagnosis of vestibular diseases. Based on a micro-computed tomography reconstruction of the human membranous labyrinth and their simulation using Computational Fluid Dynamics and Fluid-Solid Interaction techniques, we evaluated the stimulus experienced by the six cristae ampullaris under different rotational conditions mimicking the Head Impulse Test. The results show that the maximum stimulation of the crista ampullaris occurs for directions of rotation that are more aligned with the orientation of the cupulae (average deviation from alignment of 4.7°, 9.8°, and 19.4° for the horizontal, posterior, and superior maxima, respectively) than with the planes of the semicircular canals (average deviation from alignment of 32.4°, 70.5°, and 67.8° for the horizontal, posterior, and superior maxima, respectively). A plausible explanation is that when rotations are applied with respect to the center of the head, the inertial forces acting directly over the cupula become dominant over the endolymphatic fluid forces generated in the semicircular canals. Our results indicate that it is necessary to consider cupulae orientation to ensure optimal conditions for testing the vestibular function.
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Affiliation(s)
- Ismael Arán-Tapia
- Group of Non-Linear Physics, Campus Sur, University of Santiago de Compostela, Spain; Galician Center for Mathematical Research and Technology (CITMAga), Santiago de Compostela, Spain; CRETUS Institute, Santiago de Compostela, Spain.
| | - Andrés Soto-Varela
- Division of Neurotology, Department of Otorhinolaryngology, Complexo Hospitalario Universitario, Santiago de Compostela, Spain; Department of Surgery and Medical-Surgical Specialities, Universidade de Santiago de Compostela, Santiago de Compostela, Spain; Health Research Institute of Santiago (IDIS), Santiago de Compostela, Spain
| | - Vicente Pérez-Muñuzuri
- Group of Non-Linear Physics, Campus Sur, University of Santiago de Compostela, Spain; CRETUS Institute, Santiago de Compostela, Spain
| | - Sofía Santos-Pérez
- Division of Neurotology, Department of Otorhinolaryngology, Complexo Hospitalario Universitario, Santiago de Compostela, Spain; Department of Surgery and Medical-Surgical Specialities, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Ismael Arán
- Otoneurology Unit of the Complexo Hospitalario Universitario de Pontevedra, Spain
| | - Alberto P Muñuzuri
- Group of Non-Linear Physics, Campus Sur, University of Santiago de Compostela, Spain; Galician Center for Mathematical Research and Technology (CITMAga), Santiago de Compostela, Spain.
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Forbes PA, Kwan A, Mitchell DE, Blouin JS, Cullen KE. The Neural Basis for Biased Behavioral Responses Evoked by Galvanic Vestibular Stimulation in Primates. J Neurosci 2023; 43:1905-1919. [PMID: 36732070 PMCID: PMC10027042 DOI: 10.1523/jneurosci.0987-22.2023] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 01/25/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
Noninvasive electrical stimulation of the vestibular system in humans has become an increasingly popular tool with a broad range of research and clinical applications. However, common assumptions regarding the neural mechanisms that underlie the activation of central vestibular pathways through such stimulation, known as galvanic vestibular stimulation (GVS), have not been directly tested. Here, we show that GVS is encoded by VIIIth nerve vestibular afferents with nonlinear dynamics that differ markedly from those predicted by current models. GVS produced asymmetric activation of both semicircular canal and otolith afferents to the onset versus offset and cathode versus anode of applied current, that in turn produced asymmetric eye movement responses in three awake-behaving male monkeys. Additionally, using computational methods, we demonstrate that the experimentally observed nonlinear neural response dynamics lead to an unexpected directional bias in the net population response when the information from both vestibular nerves is centrally integrated. Together our findings reveal the neural basis by which GVS activates the vestibular system, establish that neural response dynamics differ markedly from current predictions, and advance our mechanistic understanding of how asymmetric activation of the peripheral vestibular system alters vestibular function. We suggest that such nonlinear encoding is a general feature of neural processing that will be common across different noninvasive electrical stimulation approaches.SIGNIFICANCE STATEMENT Here, we show that the application of noninvasive electrical currents to the vestibular system (GVS) induces more complex responses than commonly assumed. We recorded vestibular afferent activity in macaque monkeys exposed to GVS using a setup analogous to human studies. GVS evoked notable asymmetries in irregular afferent responses to cathodal versus anodal currents. We developed a nonlinear model explaining these GVS-evoked afferent responses. Our model predicts that GVS induces directional biases in centrally integrated head motion signals and establishes electrical stimuli that recreate physiologically plausible sensations of motion. Altogether, our findings provide new insights into how GVS activates the vestibular system, which will be vital to advancing new clinical and biomedical applications.
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Affiliation(s)
- Patrick A Forbes
- Department of Neuroscience, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | | | | | - Jean-Sébastien Blouin
- School of Kinesiology, University of British Columbia, Vancouver, British Colombia V6T 1Z1, Canada
| | - Kathleen E Cullen
- Physiology, McGill University, Montréal, Québec H3G 1Y6, Canada
- Departments of Biomedical Engineering
- Otolaryngology-Head and Neck Surgery
- Neuroscience, Johns Hopkins University, Baltimore, Maryland 21205
- Kavli Neuroscience Discovery Institute, Johns Hopkins University, Baltimore, Maryland 21205
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Schoo DP, Ayiotis AI, Brillet CF, Chow MR, Lane KE, Ward BK, Carey JP, Santina CCD. Vestibular Implantation Can Work Even After More Than 20 Years of Bilateral Vestibular Hypofunction. Otol Neurotol 2023; 44:168-171. [PMID: 36624598 PMCID: PMC9851668 DOI: 10.1097/mao.0000000000003768] [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] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To determine whether prosthetic stimulation delivered via a vestibular implant can elicit artificial sensation of head movement despite long (23-yr) duration adult-onset ototoxic bilateral vestibular hypofunction (BVH). STUDY DESIGN Case report. SETTING Tertiary care center as part of a first-in-human clinical trial. PATIENTS One. INTERVENTIONS Unilateral vestibular implantation with an investigational multichannel vestibular implant in a 55-year-old man with a well-documented 23-year history of aminoglycoside-induced BVH. MAIN OUTCOME MEASURES Electrically evoked vestibulo-ocular reflexes (eeVOR). RESULTS Vestibular implant stimulation can drive stimulus-aligned eeVOR and elicit a vestibular percept 23 years after the onset of bilateral vestibulopathy. Prosthetic stimulation targeting individual semicircular canals elicited eye movements that approximately aligned with each targeted canal's axis. The magnitude of the eeVOR response increased with increasing stimulus current amplitude. Response alignment and magnitude were similar to those observed for implant recipients who underwent vestibular implantation less than 10 years after BVH onset. Responses were approximately stable for 18 months of continuous device use (24 h/d except during sleep). CONCLUSIONS Vestibular implantation and prosthetic electrical stimulation of semicircular canal afferent nerves can drive canal-specific eye movement responses more than 20 years after the onset of ototoxic vestibular hypofunction.
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Affiliation(s)
- Desi P. Schoo
- Johns Hopkins University School of Medicine, Department of Otolaryngology-Head and Neck Surgery
| | - Andrianna I. Ayiotis
- Johns Hopkins University School of Medicine, Department of Biomedical Engineering
| | | | - Margaret R. Chow
- Johns Hopkins University School of Medicine, Department of Biomedical Engineering
- Labyrinth Devices, LLC, Baltimore, Maryland, USA
| | - Kelly E. Lane
- Johns Hopkins University School of Medicine, Department of Biomedical Engineering
| | - Bryan K. Ward
- Johns Hopkins University School of Medicine, Department of Otolaryngology-Head and Neck Surgery
| | - John P. Carey
- Johns Hopkins University School of Medicine, Department of Otolaryngology-Head and Neck Surgery
| | - Charles C. Della Santina
- Johns Hopkins University School of Medicine, Department of Otolaryngology-Head and Neck Surgery
- Johns Hopkins University School of Medicine, Department of Biomedical Engineering
- Labyrinth Devices, LLC, Baltimore, Maryland, USA
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Curthoys IS, McGarvie LA, MacDougall HG, Burgess AM, Halmagyi GM, Rey-Martinez J, Dlugaiczyk J. A review of the geometrical basis and the principles underlying the use and interpretation of the video head impulse test (vHIT) in clinical vestibular testing. Front Neurol 2023; 14:1147253. [PMID: 37114229 PMCID: PMC10126377 DOI: 10.3389/fneur.2023.1147253] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/20/2023] [Indexed: 04/29/2023] Open
Abstract
This paper is concerned mainly with the assumptions underpinning the actual testing procedure, measurement, and interpretation of the video head impulse test-vHIT. Other papers have reported in detail the artifacts which can interfere with obtaining accurate eye movement results, but here we focus not on artifacts, but on the basic questions about the assumptions and geometrical considerations by which vHIT works. These matters are crucial in understanding and appropriately interpreting the results obtained, especially as vHIT is now being applied to central disorders. The interpretation of the eye velocity responses relies on thorough knowledge of the factors which can affect the response-for example the orientation of the goggles on the head, the head pitch, and the contribution of vertical canals to the horizontal canal response. We highlight some of these issues and point to future developments and improvements. The paper assumes knowledge of how vHIT testing is conducted.
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Affiliation(s)
- Ian S. Curthoys
- Vestibular Research Laboratory, School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia
- *Correspondence: Ian S. Curthoys
| | - Leigh A. McGarvie
- Neurology Department, Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Hamish G. MacDougall
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Ann M. Burgess
- Vestibular Research Laboratory, School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia
| | - Gabor M. Halmagyi
- Neurology Department, Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Jorge Rey-Martinez
- Neurotology Unit, Department of Otorhinolaryngology Head and Neck Surgery, Donostia University Hospital, Donostia-San Sebastian, Spain
- Biodonostia Health Research Institute, Otorhinolaryngology Area, Osakidetza Basque Health Service, Donostia-San Sebastian, Spain
| | - Julia Dlugaiczyk
- Department of Otorhinolaryngology, Head and Neck Surgery and Interdisciplinary Center of Vertigo, Balance and Ocular Motor Disorders, University Hospital Zurich (USZ), University of Zurich (UZH), Zurich, Switzerland
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Karabin MJ, Harrell RG, Sparto PJ, Furman JM, Redfern MS. Head and vestibular kinematics during vertical semicircular canal impulses. J Vestib Res 2023; 33:367-376. [PMID: 37574748 PMCID: PMC10789328 DOI: 10.3233/ves-230010] [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: 02/07/2023] [Accepted: 07/17/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND The video head impulse test (vHIT) is a common assessment of semicircular canal function during high-speed impulses. Reliability of the vHIT for assessing vertical semicircular canals is uncertain. Vertical head impulses require a complex head movement, making it difficult to isolate a single semicircular canal and interpret resulting eye rotations. OBJECTIVE The purpose of this study was to provide descriptive head kinematics and vestibular stimuli during vertical plane impulses to ultimately improve impulse delivery and interpretation of vHIT results for vertical semicircular canals. METHODS Six participants received right anterior (RA) and left posterior (LP) semicircular canal impulses. Linear displacements, rotational displacements, and rotational velocities of the head were measured. Peak velocities in semicircular canal planes and peak-to-peak gravitoinertial accelerations at the otolith organs were derived from head kinematics. RESULTS The largest rotational velocities occurred in the target semicircular canal plane, with non-negligible velocities occurring in non-target planes. Larger vertical displacements and accelerations occurred on the right side of the head compared to the left for RA and LP impulses. CONCLUSIONS These results provide a foundation for designing protocols to optimize stimulation applied to a singular vertical semicircular canal and for interpreting results from the vHIT for vertical semicircular canals.
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Affiliation(s)
- Michelle J. Karabin
- Department of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, PA, USA
| | - Regan G. Harrell
- Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, PA, USA
| | - Patrick J. Sparto
- Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, PA, USA
| | - Joseph M. Furman
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Eye & Ear Institute, Pittsburgh, PA, USA
| | - Mark S. Redfern
- Department of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, PA, USA
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13
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Unidirectional Vertical Vestibuloocular Reflex Adaptation in Humans Using 1D and 2D Scenes. Otol Neurotol 2022; 43:e1039-e1044. [PMID: 36075099 DOI: 10.1097/mao.0000000000003684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
HYPOTHESIS The vertical vestibuloocular reflex (VOR) in response to pitch head impulses can be optimally trained to increase in one direction using a two-dimensional (2D) visual training target with minimal effect on the horizontal VOR. BACKGROUND We modified the incremental VOR adaptation (IVA) technique, shown to increase the horizontal VOR in patients with vestibular hypofunction, to drive vertical VOR adaptation in healthy control subjects. METHODS We measured the horizontal and vertical active (self-generated) and passive (imposed) head impulse VOR gains (eye velocity/head velocity) before and after 15 minutes of unidirectional downward IVA training. IVA training consisted of two sessions, one using a single-dot one-dimensional (1D) target, the other a grid-of-dots 2D target. RESULTS The downward head impulse VOR gain significantly increased because of training by 13.3%, whereas the upward VOR gain did not change. The addition of extraretinal (2D) feedback did not result in greater adaptation, i.e., 1D and 2D gain increases were 15.5% and 10.6%, respectively. The vertical VOR gain increase resulted in a 3.2% decrease in horizontal VOR gain. CONCLUSION This preliminary study is the first to show that physiologically relevant (high frequency) unidirectional increases in vertical VOR gain are possible with just 15 minutes of training. This study sets the basis for future clinical trials examining vertical IVA training in patients, which may provide the first practical rehabilitation treatment to functionally improve the vertical VOR.
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14
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Li X, Fu P, Yin H, Wang Z, Zhu Z, Qin Y, Zhuo L. A geometric alignment for human temporal bone CT images via lateral semicircular canals segmentation. Med Phys 2022; 49:6439-6450. [PMID: 35904081 DOI: 10.1002/mp.15889] [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: 08/12/2021] [Revised: 04/28/2022] [Accepted: 07/17/2022] [Indexed: 11/11/2022] Open
Abstract
PURPOSE Due to the different posture of the subject and settings of CT scanners, the CT images of the human temporal bone should be geometrically aligned with multi-planar reconstruction to ensure the symmetry of the bilateral anatomical structure. Manual alignment is a time-consuming task for radiologists and an important pre-processing step for further computer-aided CT analysis. We propose a fully automatic alignment algorithm for temporal bone CT images via Lateral Semicircular Canals (LSCs) segmentation. METHODS The LSCs are segmented with our proposed multi-feature fusion network as anchors at first. Then, we define a standard 3D coordinate system and propose an alignment procedure. RESULTS The experimental results show that our LSC segmentation network achieved a higher segmentation accuracy. The acceptable rate is achieved 85% over 910 raw temporal bone CT sequences. The alignment speed is reduced from 10 minutes by manual to 60s. CONCLUSIONS Aiming at the problem of bilateral asymmetry in the raw temporal bone CT images, we propose an automatic geometric alignment method. Our proposed method can help to perform alignment of temporal bone CT images efficiently. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Xiaoguang Li
- Faculty of Information Technology, Beijing University of Technology, Beijing, 100124, China.,Beijing Key Laboratory of Computational Intelligence and Intelligent System, Beijing University of Technology, Beijing, 100124, China
| | - Peng Fu
- Faculty of Information Technology, Beijing University of Technology, Beijing, 100124, China
| | - Hongxia Yin
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Ziyao Zhu
- Faculty of Information Technology, Beijing University of Technology, Beijing, 100124, China
| | - Yating Qin
- Faculty of Information Technology, Beijing University of Technology, Beijing, 100124, China
| | - Li Zhuo
- Faculty of Information Technology, Beijing University of Technology, Beijing, 100124, China.,Beijing Key Laboratory of Computational Intelligence and Intelligent System, Beijing University of Technology, Beijing, 100124, China
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15
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Martellucci S, Castellucci A, Malara P, Ralli G, Pagliuca G, Botti C, Gallo A, Ghidini A, Asprella Libonati G. Is it possible to diagnose Posterior Semicircular Canal BPPV from the sitting position? The role of the Head Pitch Test and the upright tests along the RALP and LARP planes. Am J Otolaryngol 2022; 43:103474. [PMID: 35561430 DOI: 10.1016/j.amjoto.2022.103474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/25/2022] [Accepted: 05/01/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE The diagnosis of benign paroxysmal positional vertigo (BPPV) involving the posterior semicircular canal (PSC) is traditionally entrusted to positioning tests where patients are rapidly brought in the supine position. This prospective study aims to define the role of a diagnostic protocol for PSC-BPPV including only upright tests. MATERIALS AND METHODS 109 patients with PSC-BPPV were enrolled. The Head Pitch Test (HPT) was carried out first. If uneventful, the patient's head was turned 45° to each side and bent back-and-forth along the plane aligning either with the right anterior-left posterior (RALP) or left anterior-right posterior (LARP) canals, thus performing the upright RALP / upright LARP (uRALP/uLARP) test. Nystagmus observed was used to predict the diagnosis, which was therefore confirmed by Dix-Hallpike tests. RESULTS PSC-BPPV could be correctly diagnosed in 75.2% of cases with the sole HPT and in 87.2% of cases by adding the uRALP/uLARP test (Upright Protocol). The time elapsed from symptoms onset was closely related to the protocol sensitivity, as it reached 100% (64/64) in acute patients while decreased to 68.9% (31/45) in cases evaluated after 7 days (p < 0.001). CONCLUSIONS Upright maneuvers could correctly diagnose PSC-BPPV in most cases. uRALP/uLARP test demonstrated to improve the sensitivity of the HPT, mainly in recent-onset BPPV.
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16
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Nagururu NV, Akbar A, Ward BK. Using magnetic resonance imaging to improve diagnosis of peripheral vestibular disorders. J Neurol Sci 2022; 439:120300. [DOI: 10.1016/j.jns.2022.120300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/18/2022] [Accepted: 05/23/2022] [Indexed: 12/01/2022]
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17
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Go CC, Taskin HO, Ahmadi SA, Frazzetta G, Cutler L, Malhotra S, Morgan JI, Flanagin VL, Aguirre GK. Persistent horizontal and vertical, MR-induced nystagmus in resting state Human Connectome Project data. Neuroimage 2022; 255:119170. [PMID: 35367649 DOI: 10.1016/j.neuroimage.2022.119170] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE Strong magnetic fields from magnetic resonance (MR) scanners induce a Lorentz force that contributes to vertigo and persistent nystagmus. Prior studies have reported a predominantly horizontal direction for healthy subjects in a 7 Tesla (T) MR scanner, with slow phase velocity (SPV) dependent on head orientation. Less is known about vestibular signal behavior for subjects in a weaker, 3T magnetic field, the standard strength used in the Human Connectome Project (HCP). The purpose of this study is to characterize the form and magnitude of nystagmus induced at 3T. METHODS Forty-two subjects were studied after being introduced head-first, supine into a Siemens Prisma 3T scanner. Eye movements were recorded in four separate acquisitions over 20 minutes. A biometric eye model was fitted to the recordings to derive rotational eye position and then SPV. An anatomical template of the semi-circular canals was fitted to the T2 anatomical image from each subject, and used to derive the angle of the B0 magnetic field with respect to the vestibular apparatus. RESULTS Recordings from 37 subjects yielded valid measures of eye movements. The population-mean SPV ± SD for the horizontal component was -1.38 ± 1.27 deg/sec, and vertical component was -0.93 ± 1.44 deg/sec, corresponding to drift movement in the rightward and downward direction. Although there was substantial inter-subject variability, persistent nystagmus was present in half of subjects with no significant adaptation over the 20 minute scanning period. The amplitude of vertical drift was correlated with the roll angle of the vestibular system, with a non-zero vertical SPV present at a 0 degree roll. INTERPRETATION Non-habituating vestibular signals of varying amplitude are present in resting state data collected at 3T.
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Affiliation(s)
- Cammille C Go
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Huseyin O Taskin
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Seyed-Ahmad Ahmadi
- NVIDIA GmbH, Einsteinstraße 172, 81677 Munich, Germany; German Center for Vertigo and Balance Disorders, LMU Klinikum, 81377, Munich, Germany
| | - Giulia Frazzetta
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Laura Cutler
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Saguna Malhotra
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jessica Iw Morgan
- Department of Ophthalmology, Scheie Eye Institute, Penn Presbyterian Medical Center, 51 N 39th St, Philadelphia, PA 19104, USA
| | - Virginia L Flanagin
- German Center for Vertigo and Balance Disorders, LMU Klinikum, 81377, Munich, Germany
| | - Geoffrey K Aguirre
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
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18
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The human vestibulo-ocular reflex and compensatory saccades in schwannoma patients before and after vestibular nerve section. Clin Neurophysiol 2022; 138:197-213. [DOI: 10.1016/j.clinph.2022.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 01/25/2022] [Accepted: 02/13/2022] [Indexed: 11/19/2022]
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19
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Study on the Perception Mechanism of Utricles Based on Bionic Models. Biomimetics (Basel) 2022; 7:biomimetics7010028. [PMID: 35323185 PMCID: PMC8945493 DOI: 10.3390/biomimetics7010028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/22/2022] [Accepted: 02/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The relationship between utricle diseases and structural lesions is not very clear in the clinic due to the complexity and delicacy of the utricle structure. Therefore, it is necessary to study the perception mechanism of the utricle. Methods: Imitating the sensory cells in the macula of the utricle, a symmetrical metal core PVDF fiber (SMPF) was designed as a bionic hair sensor to fabricate a bionic macula (BM), a bionic macula with sand (BMS) and a bionic utricle (BU). Then experiments were carried out on them. Results: This indicated the SMPF sensor can sense its bending deformation, which was similar to the sensory cell. The amplitude of the output charges of the SMPF in BMS and BU were significantly improved. The SMPF, whose electrode boundary was perpendicular to the impact direction, exhibited the largest output charges. Conclusion: The presence of otoliths and endolymph can improve the sensing ability of the utricle. The human brain can judge the direction of head linear accelerations based on the location of the sensory cell in the macula that produces the largest nerve signals. This provides a possibility of studying utricle abnormal functions in vitro in the future.
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20
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Liu W, Chen G, Xie J, Liang T, Zhang C, Liao X, Liao W, Song L, Zhang X. A New Coordinate System for Magnetic Resonance Imaging of the Vestibular System. Front Neurol 2022; 12:789887. [PMID: 35069419 PMCID: PMC8766740 DOI: 10.3389/fneur.2021.789887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/06/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: To develop and evaluate a new coordinate system for MRI of the vestibular system. Methods: In this study, 53 internal auditory canal MRI and 78 temporal bone CT datasets were analyzed. Mimics Medical software version 21.0 was used to visualize and three-dimensionally reconstruct the image data. We established a new coordinate system, named W–X, based on the center of the bilateral eyeballs and vertex of the bilateral superior semicircular canals. Using the W–X coordinate system and Reid's coordinate system, we measured the orientations of the planes of the anterior semicircular canal (ASCC), the lateral semicircular canal (LSCC), and the posterior semicircular canal (PSCC). Results: No significant differences between the angles measured using CT and MRI were found for any of the semicircular canal planes (p > 0.05). No statistical differences were found between the angles measured using Reid's coordinate system (CT) and the W–X coordinate system (MRI). The mean values of ∠ASCC & LSCC, ∠ASCC & PSCC, and ∠LSCC & PSCC were 84.67 ± 5.76, 94.21 ± 3.81, and 91.79 ± 5.22 degrees, respectively. The angle between the LSCC plane and the horizontal imaging plane was 15.64 ± 3.92 degrees, and the angle between the PSCC plane and the sagittal imaging plane was 48.79 ± 4.46 degrees. Conclusion: A new W–X coordinate system was developed for MRI studies of the vestibular system and can be used to measure the orientations of the semicircular canals.
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Affiliation(s)
- Weixing Liu
- State Key Laboratory of Respiratory Disease, Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Gui Chen
- State Key Laboratory of Respiratory Disease, Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Junyang Xie
- State Key Laboratory of Respiratory Disease, Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Tianhao Liang
- State Key Laboratory of Respiratory Disease, Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chunyi Zhang
- State Key Laboratory of Respiratory Disease, Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiao Liao
- State Key Laboratory of Respiratory Disease, Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wenjing Liao
- State Key Laboratory of Respiratory Disease, Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Lijuan Song
- State Key Laboratory of Respiratory Disease, Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaowen Zhang
- State Key Laboratory of Respiratory Disease, Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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21
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Kim JG, Kim SH, Lee SU, Lee CN, Kim BJ, Kim JS, Park KW. Head-impulse tests aid in differentiation of multiple system atrophy from Parkinson's disease. J Neurol 2021; 269:2972-2979. [PMID: 34767067 DOI: 10.1007/s00415-021-10885-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 10/19/2022]
Abstract
The integrity of the vestibulo-ocular reflex (VOR) remains to be delineated in patients with parkinsonism. We aimed to define the findings of the VOR using head-impulse tests (HITs) and their differential diagnostic value in patients with Parkinson's disease (PD) and multiple system atrophy (MSA). From December 2019 to January 2021, 30 patients with PD and 23 patients with MSA (17 with cerebellar-type MSA and 6 with parkinsonian-type MSA) had a video-oculographic recording of HITs at two university hospitals in South Korea. Reversed (p = 0.034) and perverted (p = 0.015) catch-up saccades were more frequently observed in MSA than in PD during HITs. The gain difference between the ACs and the PCs were larger in MSA than in PD (p = 0.031), and positively correlated with the disease duration in patients with MSA (Spearman's coefficient = 0.512, p = 0.012). Multivariate logistic regression analysis showed that reversed (p = 0.044) and perverted (p = 0.039) catch-up saccades were more frequently associated with MSA than with PD during HITs. In conclusion, HITs aid in differentiation of MSA from PD, and may serve as a surrogate marker for the clinical decline.
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Affiliation(s)
- Jae-Gyum Kim
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Sung-Hwan Kim
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea. .,Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea.
| | - Chan-Nyoung Lee
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Byung-Jo Kim
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea.,BK21 FOUR Program in Learning Health Systems, Korea University, Seoul, South Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea.,Dizziness Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kun-Woo Park
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
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22
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Wu S, Lin P, Zheng Y, Zhou Y, Liu Z, Yang X. Measurement of Human Semicircular Canal Spatial Attitude. Front Neurol 2021; 12:741948. [PMID: 34630312 PMCID: PMC8498035 DOI: 10.3389/fneur.2021.741948] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 08/27/2021] [Indexed: 11/16/2022] Open
Abstract
Located deep in the temporal bone, the semicircular canal is a subtle structure that requires a spatial coordinate system for measurement and observation. In this study, 55 semicircular canal and eyeball models were obtained by segmentation of MRI data. The spatial coordinate system was established by taking the top of the common crus and the bottom of the eyeball as the horizontal plane. First, the plane equation was established according to the centerline of the semicircular canals. Then, according to the parameters of the plane equation, the plane normal vectors were obtained. Finally, the average unit normal vector of each semicircular canal plane was obtained by calculating the average value of the vectors. The standard normal vectors of the and left posterior semicircular canal, superior semicircular canal and lateral semicircular canal were [−0.651, 0.702, 0.287], [0.749, 0.577, 0.324], [−0.017, −0.299, 0.954], [0.660, 0.702, 0.266], [−0.739, 0.588, 0.329], [0.025, −0.279, 0.960]. The different angles for the different ways of calculating the standard normal vectors of the right and left posterior semicircular canal, superior semicircular canal and lateral semicircular canal were 0.011, 0.028, 0.008, 0.011, 0.024, and 0.006 degrees. The technology for measuring the semicircular canal spatial attitudes in this study are reliable, and the measurement results can guide vestibular function examinations and help with guiding the diagnosis and treatment of BPPV.
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Affiliation(s)
- Shuzhi Wu
- Neurology Department, Third Affiliated Hospital of Shanghai University, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou People's Hospital, Wenzhou, China
| | - Ping Lin
- Neurology Department, Third Affiliated Hospital of Shanghai University, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou People's Hospital, Wenzhou, China
| | - Yanyan Zheng
- Neurology Department, Third Affiliated Hospital of Shanghai University, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou People's Hospital, Wenzhou, China
| | - Yifei Zhou
- ENT Department, Third Affiliated Hospital of Shanghai University, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou People's Hospital, Wenzhou, China
| | - Zhaobang Liu
- Department of Medical Imaging, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Xiaokai Yang
- Neurology Department, Third Affiliated Hospital of Shanghai University, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou People's Hospital, Wenzhou, China
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23
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Hyperactive and cross-coupled head impulse signs in recurrent strokes: clinical signs of global cerebellar dysfunction. J Neurol 2021; 269:1698-1700. [PMID: 34608520 DOI: 10.1007/s00415-021-10827-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/25/2021] [Accepted: 09/27/2021] [Indexed: 10/20/2022]
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24
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Ling X, Kim HJ, Lee JH, Choi JY, Yang X, Kim JS. Diagnostic Value of Straight Head Hanging in Posterior Canal Benign Paroxysmal Positional Vertigo. J Clin Neurol 2021; 17:558-562. [PMID: 34595864 PMCID: PMC8490902 DOI: 10.3988/jcn.2021.17.4.558] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/26/2021] [Accepted: 05/26/2021] [Indexed: 11/29/2022] Open
Abstract
Background and Purpose To determine the diagnostic value of straight head hanging (SHH) in benign paroxysmal positional vertigo involving the posterior semicircular canal (PC-BPPV). Methods We retrospectively included 62 patients (age=56.2±15.0 years, 47 female) with unilateral PC-BPPV who underwent both the Dix-Hallpike maneuver and SHH before receiving canalith repositioning therapy (CRT) between September 2017 and July 2020 at the Dizziness Center of Seoul National University Bundang Hospital in South Korea (16 patients, 25.8%) or the Neurology Outpatient Clinic of Aerospace Central Hospital in China (46 patients, 74.2%). SHH was performed before (n=29, group A) or after (n=33, group B) the Dix-Hallpike maneuver. Results Torsional upbeat nystagmus typical of PC-BPPV was induced during SHH in 52 (83.9%) patients, and the incidence of this type of positional nystagmus did not differ between the groups A and B (79.3% vs. 87.9%, p=0.569). The maximum slow-phase velocity of the induced upbeat nystagmus was higher during SHH than during the Dix-Hallpike maneuver toward the lesion side [range=2.0–60.0°/s (median=18.5°/s) vs. range=2.7–40.0°/s (median=13.4°/s), p<0.001]. Reversal of the positional nystagmus was observed upon resuming the sitting position after SHH in 47 (75.8%) patients and after the Dix-Hallpike maneuver in 54 (87.7%) patients, with no significant difference between the groups (p=0.082). Conclusions SHH is effective for diagnosing PC-BPPV. Given its simplicity, SHH may be performed before the Dix-Hallpike maneuver, and CRT may be attempted thereafter when the typical positional nystagmus for unilateral PC-BPPV is induced during SHH.
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Affiliation(s)
- Xia Ling
- Department of Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hyo Jung Kim
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jong Hee Lee
- Dizziness Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong Yoon Choi
- Dizziness Center, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
| | - Xu Yang
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Ji Soo Kim
- Dizziness Center, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Neurology, Seoul National University College of Medicine, Seoul, Korea.
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25
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Automatic Semicircular Canal Segmentation of CT Volumes Using Improved 3D U-Net with Attention Mechanism. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2021; 2021:9654059. [PMID: 34545284 PMCID: PMC8448990 DOI: 10.1155/2021/9654059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/24/2021] [Indexed: 11/17/2022]
Abstract
The vestibular system is the sensory apparatus that helps the body maintain its postural equilibrium, and semicircular canal is an important organ of the vestibular system. The semicircular canals are three membranous tubes, each forming approximately two-thirds of a circle with a diameter of approximately 6.5 mm, and segmenting them accurately is of great benefit for auxiliary diagnosis, surgery, and treatment of vestibular disease. However, the semicircular canal has small volume, which accounts for less than 1% of the overall computed tomography image. Doctors have to annotate the image in a slice-by-slice manner, which is time-consuming and labor-intensive. To solve this problem, we propose a novel 3D convolutional neural network based on 3D U-Net to automatically segment the semicircular canal. We added the spatial attention mechanism of 3D spatial squeeze and excitation modules, as well as channel attention mechanism of 3D global attention upsample modules to improve the network performance. Our network achieved an average dice coefficient of 92.5% on the test dataset, which shows competitive performance in semicircular canals segmentation task.
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Moroz M, Choy M, Lee CW, Hadfield H, Lasenby J, Stone T, Bance M. Evaluating the Epley Canalolith Repositioning Procedure With and Without a Visual Assistive Device. Otol Neurotol 2021; 42:765-773. [PMID: 33492058 DOI: 10.1097/mao.0000000000003017] [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: 11/25/2022]
Abstract
HYPOTHESIS The primary goal of this study was to examine how accuracy is affected when we employ a guidance device to assist with the execution of the Epley canalolith repositioning procedure. BACKGROUND Benign paroxysmal positional vertigo is a common cause of vestibular vertigo. Treatment is noninvasive and generally effective when performed correctly. Deficiencies in clinical application result in unnecessary failures in response for those affected. METHODS Ten participants were each taken through six iterations of the Epley canalolith repositioning procedure. Iterations were divided evenly between those conducted with and without the use of a guidance device. One clinician performed all 60 procedures. Head movements were recorded using motion capture cameras and strategically placed motion tracking markers. RESULTS Results showed that the guidance device significantly improved the latter phase maneuver accuracy. Rotation error was significantly reduced for hold3 with-device (M = 20.23°, SD = 12.08°) versus without-device (M = 40.13°, SD = 14.62°, p = 0.001). Maximal rotation error during rotation4 of the maneuver demonstrated a similar reduction of error with-device (M = 24.44°, SD = 10.43°) versus without-device (M = 41.36°, SD = 12.89°, p = 0.002). CONCLUSION A simple visual guidance device can increase the execution accuracy of canalith repositioning procedures. Further research is required to show how such improvements influence treatment efficacy.
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Affiliation(s)
| | - Matthew Choy
- School of Clinical Medicine, University of Cambridge
| | - Chang Woo Lee
- Department of ENT, Royal Surrey County Hospital, Guildford
| | | | - Joan Lasenby
- Department of Engineering, University of Cambridge
| | - Thomas Stone
- Department of Clinical Engineering, Addenbrooke's Hospital, Cambridge, UK
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Smith CM, Curthoys IS, Mukherjee P, Wong C, Laitman JT. Three-dimensional visualization of the human membranous labyrinth: The membrana limitans and its role in vestibular form. Anat Rec (Hoboken) 2021; 305:1037-1050. [PMID: 34021723 DOI: 10.1002/ar.24675] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/16/2021] [Accepted: 04/18/2021] [Indexed: 11/06/2022]
Abstract
The inner ear contains the end organs for balance (vestibular labyrinth) and hearing (cochlea). The vestibular labyrinth is comprised of the semicircular canals (detecting angular acceleration) and otolith organs (utricle and saccule, which detect linear acceleration and head tilt relative to gravity). Lying just inferior to the utricle is the membranous membrana limitans (ML). Acting as a keystone to vestibular geometry, the ML provides support for the utricular macula and acts as a structural boundary between the superior (pars superior) and inferior (pars inferior) portions of the vestibular labyrinth. Given its importance in vestibular form, understanding ML morphology is valuable in establishing the spatial organization of other vestibular structures, particularly the utricular macula. Knowledge of the 3D structure and variation of the ML, however, remain elusive. Our study addresses this knowledge gap by visualizing, in 3D, the ML and surrounding structures using micro-CT data. By doing so, we attempt to clarify: (a) the variation of ML shape; (b) the reliability of ML attachment sites; and (c) the spatial relationship of the ML to the stapes footplate using landmark-based Generalized Procrustes, Principal Component and covariance analyses. Results indicate a consistent configuration of three distinct bony ML attachments including an anterolateral, medial, and posterior attachment which all covary with bony structure. Our results set the stage for further understanding into vestibular and more specifically, utricular macula spatial configuration within the human head, offering the potential to aid in clinical and evolutionary studies which rely on a 3D understanding of vestibular spatial configuration.
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Affiliation(s)
- Christopher M Smith
- Department of Anthropology, The Graduate Center, City University of New York, New York City, New York, USA.,Center for Anatomy and Functional Morphology, Icahn School of Medicine at Mount Sinai., New York City, New York, USA.,New York Consortium in Evolutionary Primatology, New York City, New York, USA
| | - Ian S Curthoys
- Vestibular Research Laboratory, School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Payal Mukherjee
- RPA Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Christopher Wong
- Vestibular Research Laboratory, School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Jeffrey T Laitman
- Department of Anthropology, The Graduate Center, City University of New York, New York City, New York, USA.,Center for Anatomy and Functional Morphology, Icahn School of Medicine at Mount Sinai., New York City, New York, USA.,New York Consortium in Evolutionary Primatology, New York City, New York, USA.,Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
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Clinical Implications of Horizontal Beating Nystagmus Induced by Dix-Hallpike Test in the Diagnosis of Horizontal Canal Benign Paroxysmal Positional Vertigo. Otol Neurotol 2021; 42:585-591. [PMID: 33710997 DOI: 10.1097/mao.0000000000003026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The purpose of this study was to identify the diverse patterns of nystagmus during the Dix-Hallpike test (DHT) and analyze their clinical significance in horizontal canal benign paroxysmal positional vertigo (HC-BPPV). STUDY DESIGN Retrospective medical records review. PATIENTS Two hundred ninety-five patients diagnosed with HC-BPPV. METHODS Various nystagmus patterns identified during the DHT in patients with HC-BPPV were analyzed. The correlation between the affected side of HC-BPPV and the direction of the horizontal beating nystagmus (HBN) during the DHT was also analyzed. RESULTS The nystagmus pattern during the DHT in 128 patients with geotropic HC-BPPV demonstrated, direction-changing positional nystagmus on both sides in 48 (37.5%) patients, HBN toward one side in 25 (19.6%) patients, and no nystagmus in 55 (42.9%) patients. In 144 patients with apogeotropic HC-BPPV, 54 (37.5%) patients presented with direction-changing positional nystagmus on both sides, 27 (18.8%) patients presented with HBN toward one side, and 63 (43.7%) patients did not show nystagmus during the DHT. The direction of HBN provoked by the DHT was significantly correlated with the affected side in each subtype of HC-BPPV (geotropic type, p = 0.049; apogeotropic type, p = 0.040; respectively). CONCLUSION More than half of the patients with HC-BPPV (56.6%) showed HBN during the DHT. When HBN was present during the DHT, it may provide a clue for determining the subtype and affected side in diagnosis of HC-BPPV before performing the supine roll test.
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Bhandari A, Kingma H, Bhandari R. BPPV Simulation: A Powerful Tool to Understand and Optimize the Diagnostics and Treatment of all Possible Variants of BPPV. Front Neurol 2021; 12:632286. [PMID: 33841305 PMCID: PMC8032929 DOI: 10.3389/fneur.2021.632286] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 03/03/2021] [Indexed: 11/13/2022] Open
Abstract
BPPV is a mechanical disorder caused by the displacement of otolith debris into the semicircular canals. The treatment involves different repositioning maneuvers to bring the debris back into the utricle. This study aims to show how dynamic simulation models based on fluid dynamics and MRI, can help to visualize and understand the movement of the debris within the canals during head movement in 3D as a function of time. The user can define the rotation angle and plane at each step of the maneuver and then the model visualizes the canal and the otoconial movement in 3D. The simulation developed also allows alteration of various parameters like the rotational head acceleration, the duration of each step of the maneuver, the initial position of the otoconial debris in the canal, the size and the number of the particles and fluid dynamics of endolymph. The clod movement is visualized in such a way that it allows a better understanding of the impact and efficacy of various liberation maneuvers and why certain maneuvers might fail when not applied properly in the clinic. The model allows simulation of multi-canal BPPV. In this paper we demonstrate the power of the model applied on the maneuvers of Semont and Yacovino when executed in different ways. The model aims to provide a visual explanation for the need of specific maneuvers for each type of BPPV. The simulator presented here can be used to test the efficacy of existing maneuvers and help in the development of new maneuvers to treat different BPPV variants.
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Affiliation(s)
| | - Herman Kingma
- Department of Ear Nose Throat, Maastricht University, Maastricht, Netherlands.,Faculty of Physics, Tomsk State National Research University, Tomsk, Russia.,Department of Ear Nose Throat, Aalborg University, Aalborg, Denmark
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Gebhart I, Götting C, Hool SL, Morrison M, Korda A, Caversaccio M, Obrist D, Mantokoudis G. Sémont Maneuver for Benign Paroxysmal Positional Vertigo Treatment: Moving in the Correct Plane Matters. Otol Neurotol 2021; 42:e341-e347. [PMID: 33165161 PMCID: PMC7880166 DOI: 10.1097/mao.0000000000002992] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
HYPOTHESIS We aimed to investigate the effect of the head excursion angle on the success of the Sémont Maneuver (SM). BACKGROUND SM is performed with the head turned by 45 degrees toward the unaffected ear. In clinical routine, it is unlikely that physicians can turn the head to a position of exactly 45 degrees. Moreover, it is unclear how possible deviations from 45 degrees would affect the outcome with SM. METHODS We used an in vitro model (upscaled by ×5) of a posterior semicircular canal with canalithiasis to study head excursion angles (0-75 degrees) and minimum waiting times in SM. Additionally, we measured actual head excursion angles performed by trained physicians during SM on a healthy subject. RESULTS Successful canalith repositioning to the utricle was possible at head excursion angles between 21 and 67 degrees. Waiting time increased from 16 to 30 seconds with increasing deviation from 45 degrees. Angles larger than 67 degrees or smaller than 21 degrees did not lead to successful repositioning even after a waiting period of 5 minutes. Physicians set head excursion angles of 50 degrees ±SD 4.8 degrees while performing the SM. CONCLUSION Angular deviations up to ±20 degrees from the ideal SCC plane (45 degrees) still allows for successful SM. Although the tested physicians tended to underestimate the actual head excursion angle by 5 degrees (and more), the success of SM will not be affected provided that the waiting time is sufficiently long. Further, the results suggest that the Brandt-Daroff maneuver is a form of habituation training rather than a liberatory maneuver.
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Affiliation(s)
- Isabel Gebhart
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern
| | - Carina Götting
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern
| | - Sara-Lynn Hool
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern
| | - Miranda Morrison
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern
| | - Athanasia Korda
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern
| | - Marco Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern
| | - Dominik Obrist
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Georgios Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern
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IE-Map: a novel in-vivo atlas and template of the human inner ear. Sci Rep 2021; 11:3293. [PMID: 33558581 PMCID: PMC7870663 DOI: 10.1038/s41598-021-82716-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 12/17/2020] [Indexed: 12/26/2022] Open
Abstract
Brain atlases and templates are core tools in scientific research with increasing importance also in clinical applications. Advances in neuroimaging now allowed us to expand the atlas domain to the vestibular and auditory organ, the inner ear. In this study, we present IE-Map, an in-vivo template and atlas of the human labyrinth derived from multi-modal high-resolution magnetic resonance imaging (MRI) data, in a fully non-invasive manner without any contrast agent or radiation. We reconstructed a common template from 126 inner ears (63 normal subjects) and annotated it with 94 established landmarks and semi-automatic segmentations of all relevant macroscopic vestibular and auditory substructures. We validated the atlas by comparing MRI templates to a novel CT/micro-CT atlas, which we reconstructed from 21 publicly available post-mortem images of the bony labyrinth. Templates in MRI and micro-CT have a high overlap, and several key anatomical measures of the bony labyrinth in IE-Map are in line with micro-CT literature of the inner ear. A quantitative substructural analysis based on the new template, revealed a correlation of labyrinth parameters with total intracranial volume. No effects of gender or laterality were found. We provide the validated templates, atlas segmentations, surface meshes and landmark annotations as open-access material, to provide neuroscience researchers and clinicians in neurology, neurosurgery, and otorhinolaryngology with a widely applicable tool for computational neuro-otology.
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Zhang X, Bai Y, Chen T, Wang W, Han X, Li S, Liu Q, Wen C. A Show of Ewald's Law: I Horizontal Semicircular Canal Benign Paroxysmal Positional Vertigo. Front Neurol 2021; 12:632489. [PMID: 33613438 PMCID: PMC7887281 DOI: 10.3389/fneur.2021.632489] [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: 11/23/2020] [Accepted: 01/04/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To evaluate horizontal semicircular canal (HSC) effects according to Ewald's law and nystagmus characteristics of horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV) in the supine roll test. Methods: Patients with HSC-BPPV (n = 72) and healthy subjects (n = 38) were enrolled. Latency, duration, and intensity of nystagmus elicited by supine roll test were recorded using video nystagmography. Results: In patients with HSC-BPPV, horizontal nystagmus could be elicited by right/left head position (positional nystagmus) and during head-turning (head-turning nystagmus), and nystagmus direction was the same as that of head turning. Mean intensity values of head-turning nystagmus in HSC-BPPV patients were (44.70 ± 18.24)°/s and (44.65 ± 19.27)°/s on the affected and unaffected sides, respectively, which was not a significant difference (p = 0.980), while those for positional nystagmus were (40.81 ± 25.56)°/s and (17.69 ± 9.31)°/s (ratio, 2.59 ± 1.98:1), respectively, representing a significant difference (p < 0.0001). There was no positional nystagmus in 49 HSC-BPPV patients after repositioning treatment, nor in the 38 healthy subjects. No significant difference in head-turning nystagmus was detected in HSC-BPPV patients with or without repositioning. Conclusions: The direction and intensity of nystagmus elicited by supine roll test in patients with HSC-BPPV, was broadly consistent with the physiological nystagmus associated with a same HSC with single factor stimulus. Our findings suggest that HSC-BPPV can be a show of Ewald's law in human body.
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Affiliation(s)
- Xueqing Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Tianjin First Central Hospital, Tianjin, China.,Tianjin First Central Hospital, Institute of Otolaryngology of Tianjin, Tianjin, China.,Key Laboratory of Auditory Speech and Balance Medicine, Department of Otorhinolaryngology Head and Neck Surgery, Tianjin First Central Hospital, Tianjin, China.,Key Clinical Discipline of Tianjin (Otolaryngology), Tianjin, China.,Otolaryngology Clinical Quality Control Centre, Tianjin, China
| | - Yanru Bai
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Taisheng Chen
- Department of Otorhinolaryngology Head and Neck Surgery, Tianjin First Central Hospital, Tianjin, China.,Tianjin First Central Hospital, Institute of Otolaryngology of Tianjin, Tianjin, China.,Key Laboratory of Auditory Speech and Balance Medicine, Department of Otorhinolaryngology Head and Neck Surgery, Tianjin First Central Hospital, Tianjin, China.,Key Clinical Discipline of Tianjin (Otolaryngology), Tianjin, China.,Otolaryngology Clinical Quality Control Centre, Tianjin, China
| | - Wei Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Tianjin First Central Hospital, Tianjin, China.,Tianjin First Central Hospital, Institute of Otolaryngology of Tianjin, Tianjin, China.,Key Laboratory of Auditory Speech and Balance Medicine, Department of Otorhinolaryngology Head and Neck Surgery, Tianjin First Central Hospital, Tianjin, China.,Key Clinical Discipline of Tianjin (Otolaryngology), Tianjin, China.,Otolaryngology Clinical Quality Control Centre, Tianjin, China
| | - Xi Han
- Department of Otorhinolaryngology Head and Neck Surgery, Tianjin First Central Hospital, Tianjin, China.,Tianjin First Central Hospital, Institute of Otolaryngology of Tianjin, Tianjin, China.,Key Laboratory of Auditory Speech and Balance Medicine, Department of Otorhinolaryngology Head and Neck Surgery, Tianjin First Central Hospital, Tianjin, China.,Key Clinical Discipline of Tianjin (Otolaryngology), Tianjin, China.,Otolaryngology Clinical Quality Control Centre, Tianjin, China
| | - Shanshan Li
- Department of Otorhinolaryngology Head and Neck Surgery, Tianjin First Central Hospital, Tianjin, China.,Tianjin First Central Hospital, Institute of Otolaryngology of Tianjin, Tianjin, China.,Key Laboratory of Auditory Speech and Balance Medicine, Department of Otorhinolaryngology Head and Neck Surgery, Tianjin First Central Hospital, Tianjin, China.,Key Clinical Discipline of Tianjin (Otolaryngology), Tianjin, China.,Otolaryngology Clinical Quality Control Centre, Tianjin, China
| | - Qiang Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Tianjin First Central Hospital, Tianjin, China.,Tianjin First Central Hospital, Institute of Otolaryngology of Tianjin, Tianjin, China.,Key Laboratory of Auditory Speech and Balance Medicine, Department of Otorhinolaryngology Head and Neck Surgery, Tianjin First Central Hospital, Tianjin, China.,Key Clinical Discipline of Tianjin (Otolaryngology), Tianjin, China.,Otolaryngology Clinical Quality Control Centre, Tianjin, China
| | - Chao Wen
- Department of Otorhinolaryngology Head and Neck Surgery, Tianjin First Central Hospital, Tianjin, China.,Tianjin First Central Hospital, Institute of Otolaryngology of Tianjin, Tianjin, China.,Key Laboratory of Auditory Speech and Balance Medicine, Department of Otorhinolaryngology Head and Neck Surgery, Tianjin First Central Hospital, Tianjin, China.,Key Clinical Discipline of Tianjin (Otolaryngology), Tianjin, China.,Otolaryngology Clinical Quality Control Centre, Tianjin, China
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Korda A, Sauter TC, Caversaccio MD, Mantokoudis G. Quantifying a Learning Curve for Video Head Impulse Test: Pitfalls and Pearls. Front Neurol 2021; 11:615651. [PMID: 33551973 PMCID: PMC7862580 DOI: 10.3389/fneur.2020.615651] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/29/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: The video head impulse test (vHIT) is nowadays a fast and objective method to measure vestibular function. However, its usability is controversial and often considered as a test performed by experts only. We sought to study the learning curve of novices and to document all possible mistakes and pitfalls in the process of learning. Methods: In a prospective cohort observational study, we included 10 novices. We tested their ability to perform correctly horizontal head impulses recorded with vHIT. We assessed vHITs in 10 sessions with 20 impulses per session giving a video instruction after the first session (S1) and individual feedback from an expert for session 2 (S2) up to session 10 (S10). We compared VOR gain, the HIT acceptance rate by the device algorithm, mean head velocity, acceleration, excursion, and overshoot between sessions. Results: A satisfying number of accepted HITs (80%) was reached after an experience of 160 vHITs. Mean head velocity between sessions was always in accepted limits. Head acceleration was too low at the beginning (S1) but improved significantly after the video instruction (p = 0.001). Mean head excursion and overshoot showed a significant improvement after 200 head impulses (p < 0.001 each). Conclusions: We showed that novices can learn to perform head impulses invHIT very fast provided that they receive instructions and feedback from an experienced examiner. Video instructions alone were not sufficient. The most common pitfall was a low head acceleration.
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Affiliation(s)
- Athanasia Korda
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Thomas C Sauter
- Department of Emergency Medicine, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Marco Domenico Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Georgios Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
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Hedjoudje A, Schoo DP, Ward BK, Carey JP, Della Santina CC, Pearl M. Vestibular Implant Imaging. AJNR Am J Neuroradiol 2021; 42:370-376. [PMID: 33361382 PMCID: PMC7872165 DOI: 10.3174/ajnr.a6991] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 09/10/2020] [Indexed: 11/07/2022]
Abstract
Analogous to hearing restoration via cochlear implants, vestibular function could be restored via vestibular implants that electrically stimulate vestibular nerve branches to encode head motion. This study presents the technical feasibility and first imaging results of CT for vestibular implants in 8 participants of the first-in-human Multichannel Vestibular Implant Early Feasibility Study. Imaging characteristics of 8 participants (3 men, 5 women; median age, 59.5 years; range, 51-66 years) implanted with a Multichannel Vestibular Implant System who underwent a postimplantation multislice CT (n = 2) or flat panel CT (n = 6) are reported. The device comprises 9 platinum electrodes inserted into the ampullae of the 3 semicircular canals and 1 reference electrode inserted in the common crus. Electrode insertion site, positions, length and angle of insertion, and number of artifacts were assessed. Individual electrode contacts were barely discernible in the 2 participants imaged using multislice CT. Electrode and osseous structures were detectable but blurred so that only 12 of the 18 stimulating electrode contacts could be individually identified. Flat panel CT could identify all 10 electrode contacts in all 6 participants. The median reference electrode insertion depth angle was 9° (range, -57.5° to 45°), and the median reference electrode insertion length was 42 mm (range, -21-66 mm). Flat panel CT of vestibular implants produces higher-resolution images with fewer artifacts than multidetector row CT, allowing visualization of individual electrode contacts and quantification of their locations relative to vestibular semicircular canals and ampullae. As multichannel vestibular implant imaging improves, so will our understanding of the relationship between electrode placement and vestibular performance.
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Affiliation(s)
- A Hedjoudje
- From the Department of Otolaryngology-Head and Neck Surgery (A.H., D.P.S., B.K.W., J.P.C., C.C.D.S.)
- Division of Interventional Neuroradiology (A.H., M.P.)
- Neuroradiology Unit (A.H.), Service of diagnostic and interventional imaging, Sion Hospital, Sion, Valais, Switzerland
| | - D P Schoo
- From the Department of Otolaryngology-Head and Neck Surgery (A.H., D.P.S., B.K.W., J.P.C., C.C.D.S.)
| | - B K Ward
- From the Department of Otolaryngology-Head and Neck Surgery (A.H., D.P.S., B.K.W., J.P.C., C.C.D.S.)
| | - J P Carey
- From the Department of Otolaryngology-Head and Neck Surgery (A.H., D.P.S., B.K.W., J.P.C., C.C.D.S.)
| | - C C Della Santina
- From the Department of Otolaryngology-Head and Neck Surgery (A.H., D.P.S., B.K.W., J.P.C., C.C.D.S.)
- Department of Biomedical Engineering (C.C.D.S.), Johns Hopkins University School of Medicine, Baltimore, Maryland
- Labyrinth Devices (C.C.D.S.), Baltimore, Maryland
| | - M Pearl
- Division of Interventional Neuroradiology (A.H., M.P.)
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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: 41] [Impact Index Per Article: 13.7] [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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Traboulsi H, Teixido M. BPPV Viewer: A downloadable 3D BPPV model for study of otolith disease. World J Otorhinolaryngol Head Neck Surg 2021; 7:34-39. [PMID: 33474542 PMCID: PMC7801242 DOI: 10.1016/j.wjorl.2018.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 09/20/2018] [Accepted: 10/07/2018] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To develop a downloadable three-dimensional (3D) study tool of the membranous labyrinth in order to facilitate the study of benign paroxysmal positional vertigo (BPPV). BACKGROUND The diagnosis and treatment of BPPV depend on an understanding of the anatomy of the vestibular labyrinth and its position relative to the head. To date, many illustrations have been made to explain principles of diagnosis and treatment of BPPV, but few have been based on anatomical studies of the membranous labyrinth. METHODS A previously reported 3D model of a human labyrinth was transposed to a 3D development software to allow the creation of markers along the semicircular ducts and utricle. These markers represent otoliths at different positions during movement of the model within the 3D environment. User-friendly tools were created to navigate the model, to allow clear documentation and communication of studied problems, and to study the model across relevant planes. The final model can be downloaded and is available for general useat https://bppvviewer.com/download/. RESULTS The model allows visualization of true membranous labyrinth anatomy in both ears simultaneously. The dependent portion of each semicircular duct, the planes of the cristae, and the position of the utricle can easily be visualized in any head position. Moveable markers can mark the expected progress of otolith debris with changes in head position and images can be captured to document simulations in various draw styles. CONCLUSION This simple model could offer insights that lead to more accurate diagnosis and treatment of BPPV. It may also be useful as a tool to teach BPPV.
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D'Albora Rivas R, Teixido M, Casserly RM, Mónaco MJ. Short CRP for Anterior Canalithiasis: A New Maneuver Based on Simulation With a Biomechanical Model. Front Neurol 2020; 11:857. [PMID: 32903468 PMCID: PMC7438444 DOI: 10.3389/fneur.2020.00857] [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: 03/19/2020] [Accepted: 07/07/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction/Objective: Anterior canalithiasis is an uncommon and challenging diagnosis. This is due in part to the difficulty of defining the affected side, the extreme positioning required to carry out described therapeutic maneuvers, and the infrequent use of specific maneuvers. Our objective is to present a new treatment alternative for anterior canalithiasis which is based on the well-known canalith repositioning procedure (CRP) described by Epley and which is used routinely in the treatment of both posterior and anterior canalithiasis. Analysis of the standard CRP for anterior canalithiasis with a biomechanical model validates that this new maneuver is an enhanced treatment option for anterior canalithiasis. We call the new maneuver the “short CRP.” Methods: A previously published 3D biomechanical model of the human labyrinths for the study of BPPV was used to analyze the conventional CRP in the treatment of anterior canalithiasis. The expected position of free otoliths near the anterior ampulla of the anterior semicircular duct was followed while recreating the sequential positions of the CRP. Although the standard CRP was possibly effective, certain enhancements were evident that could increase successful repositioning. These enhancements were incorporated into the modification of the CRP presented here as the “short CRP” for anterior canalithiasis. Results: The traditional CRP used for posterior canalithiasis can also be used for anterior canalithiasis. Although in the traditional CRP the head hangs 30° below horizontal, our simulation shows that a 40° head-hang below horizontal is an enhancement and may ensure progression of anterior otolith debris. Elimination of Position 4 of the classic CRP, in which the face is turned 45° toward the floor, was also seen as an enhancement as this position is predicted to cause retrograde movement of otoliths back into the anterior canal if the patient tucks the chin in position 4 or when sitting up. Conclusion: A modification of the CRP called the “short CRP” can be used to treat anterior canalithiasis. Model analysis predicts possible increased efficacy over the standard CRP. Model analysis of existing BPPV treatments is a valuable exercise for examination and can lead to realistic enhancements in patient care.
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Affiliation(s)
- Ricardo D'Albora Rivas
- Department of ENT, Hospital de Clínicas, University of the Republic, Montevideo, Uruguay
| | - Michael Teixido
- Christiana Care Health Systems, Newark, DE, United States.,Department of Otolaryngology, University of Pennsylvania, Philadelphia, PA, United States.,Department of Otolaryngology, Thomas Jefferson University, Philadelphia, PA, United States
| | | | - María Julia Mónaco
- Audiology Department Arauz Otorhinolaryngology Institute (IORL Arauz), Buenos Aires, Argentina
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Yılmazer R, Topçuoğlu OM. Three-Dimensional Reconstruction of the Semicircular Canals with a Two-Hands Model. Turk Arch Otorhinolaryngol 2020; 57:176-181. [PMID: 32128514 DOI: 10.5152/tao.2019.4412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 09/24/2019] [Indexed: 11/22/2022] Open
Abstract
Objective To help understand the anatomy and the diseases of the semicircular canals (SCCs) by defining the three-dimensional reconstruction of the SCCs in a model reconstructed using the two hands (two-hands model) and to determine the three-dimensional configuration of the two hands by measuring the angle between the SCCs and the sagittal plane. Methods Patients older than 18 years of age with computed tomography (CT) scans of the temporal bones taken between 2017 and 2018 at the Yeditepe University Hospital were included in the study. CT images were evaluated by a radiologist. The angles between every SCC and the sagittal plane were measured with the MIMICS 12.1 program. Mean angles between the SCCs and the sagittal plane were measured. These angles were demonstrated on the two-hands model of the SCCs by means of a goniometer and photographed. Results Thirty patients and 60 temporal bones were included in the study. Mean angles between the superior, the posterior, and the horizontal SCCs and the sagittal plane were found as 37.1±3.3°, 50.4±4.1°, and 89.5±4.7°, respectively. Conclusion This is the first study to define the three-dimensional representation of the SCCs with a two-hands model. This may allow for a better understanding and the better teaching of the anatomy and diseases of SCCs.
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Affiliation(s)
- Rasim Yılmazer
- Department of Otorhinolaryngology, Demiroğlu Bilim University School of Medicine, İstanbul, Turkey
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Lee SU, Kim JS, Kim HJ, Choi JY, Park JY, Kim JM, Yang X. Evolution of the vestibular function during head impulses in spinocerebellar ataxia type 6. J Neurol 2020; 267:1672-1678. [DOI: 10.1007/s00415-020-09756-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/06/2020] [Accepted: 02/08/2020] [Indexed: 12/19/2022]
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40
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Shayman CS, Peterka RJ, Gallun FJ, Oh Y, Chang NYN, Hullar TE. Frequency-dependent integration of auditory and vestibular cues for self-motion perception. J Neurophysiol 2020; 123:936-944. [PMID: 31940239 DOI: 10.1152/jn.00307.2019] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Recent evidence has shown that auditory information may be used to improve postural stability, spatial orientation, navigation, and gait, suggesting an auditory component of self-motion perception. To determine how auditory and other sensory cues integrate for self-motion perception, we measured motion perception during yaw rotations of the body and the auditory environment. Psychophysical thresholds in humans were measured over a range of frequencies (0.1-1.0 Hz) during self-rotation without spatial auditory stimuli, rotation of a sound source around a stationary listener, and self-rotation in the presence of an earth-fixed sound source. Unisensory perceptual thresholds and the combined multisensory thresholds were found to be frequency dependent. Auditory thresholds were better at lower frequencies, and vestibular thresholds were better at higher frequencies. Expressed in terms of peak angular velocity, multisensory vestibular and auditory thresholds ranged from 0.39°/s at 0.1 Hz to 0.95°/s at 1.0 Hz and were significantly better over low frequencies than either the auditory-only (0.54°/s to 2.42°/s at 0.1 and 1.0 Hz, respectively) or vestibular-only (2.00°/s to 0.75°/s at 0.1 and 1.0 Hz, respectively) unisensory conditions. Monaurally presented auditory cues were less effective than binaural cues in lowering multisensory thresholds. Frequency-independent thresholds were derived, assuming that vestibular thresholds depended on a weighted combination of velocity and acceleration cues, whereas auditory thresholds depended on displacement and velocity cues. These results elucidate fundamental mechanisms for the contribution of audition to balance and help explain previous findings, indicating its significance in tasks requiring self-orientation.NEW & NOTEWORTHY Auditory information can be integrated with visual, proprioceptive, and vestibular signals to improve balance, orientation, and gait, but this process is poorly understood. Here, we show that auditory cues significantly improve sensitivity to self-motion perception below 0.5 Hz, whereas vestibular cues contribute more at higher frequencies. Motion thresholds are determined by a weighted combination of displacement, velocity, and acceleration information. These findings may help understand and treat imbalance, particularly in people with sensory deficits.
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Affiliation(s)
- Corey S Shayman
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon.,School of Medicine, University of Utah, Salt Lake City, Utah
| | - Robert J Peterka
- Department of Neurology, Oregon Health and Science University, Portland, Oregon.,National Center for Rehabilitative Auditory Research-VA Portland Health Care System, Portland, Oregon
| | - Frederick J Gallun
- National Center for Rehabilitative Auditory Research-VA Portland Health Care System, Portland, Oregon.,Oregon Hearing Research Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
| | - Yonghee Oh
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, Florida
| | - Nai-Yuan N Chang
- Department of Preventive and Restorative Dental Sciences-Division of Bioengineering and Biomaterials, University of California, San Francisco, San Francisco, California
| | - Timothy E Hullar
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon.,Department of Neurology, Oregon Health and Science University, Portland, Oregon.,National Center for Rehabilitative Auditory Research-VA Portland Health Care System, Portland, Oregon
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Woo EJ, Siegmund GP, Reilly CW, Blouin JS. Asymmetric Unilateral Vestibular Perception in Adolescents With Idiopathic Scoliosis. Front Neurol 2019; 10:1270. [PMID: 31849828 PMCID: PMC6903771 DOI: 10.3389/fneur.2019.01270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 11/18/2019] [Indexed: 11/13/2022] Open
Abstract
The cause of Adolescent Idiopathic Scoliosis (AIS) remains unclear, but one proposed cause of AIS is asymmetric vestibular function and the related descending drive to the spine musculature. The objective of this study was to determine if asymmetric vestibular function is present in individuals with AIS. Ten individuals with AIS (8F, 2M) and 10 healthy age- and sex-matched controls were exposed to 10s-long virtual rotations induced by monaural or binaural electrical vestibular stimulation (EVS), and 10s-long real rotations delivered by a rotating chair. Using a forced-choice paradigm, participants indicated their perceived rotation direction (right or left) to stimuli of varying intensity. A Bayesian adaptive algorithm adjusted the stimulus intensity and direction to identify a stimulus level, which we called the direction recognition threshold, at which participants correctly identified the rotation direction 69% of the time. For unilateral vestibular stimuli (monaural EVS), the direction recognition thresholds were more asymmetric in all participants with AIS compared to control participants [(0.22-1.00 mA) vs. (0.01-0.21 mA); p < 0.001]. For bilateral vestibular stimuli, however, the direction recognition thresholds did not differ between groups for either the real or virtual rotations (multiple p > 0.05). Previous reports of semicircular canal orientation asymmetry in individuals with AIS could not explain the magnitude of the vestibular function asymmetry we observed, suggesting a functional cause to the observed vestibular asymmetry. Thus, the present results suggest that a unilateral vestibular dysfunction is linked to AIS, potentially revealing a new path for the screening and monitoring of scoliosis in adolescents.
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Affiliation(s)
- Emma J Woo
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Gunter P Siegmund
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada.,MEA Forensic Engineers & Scientists, Richmond, BC, Canada
| | - Christopher W Reilly
- British Columbia Children's Hospital, Vancouver, BC, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jean-Sébastien Blouin
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada.,Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada.,Institute for Computing, Information, and Cognitive System, University of British Columbia, Vancouver, BC, Canada
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Chen A, Khosravi-Hashemi N, Kuo C, Kramer JK, Blouin JS. Development of a conversion model between mechanical and electrical vestibular stimuli. J Neurophysiol 2019; 123:548-559. [PMID: 31851563 DOI: 10.1152/jn.00276.2019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The vestibular end-organs encode for linear and angular head accelerations in space contributing to our internal representation of self-motion. Activation of the vestibular system with transmastoid electrical current has recently grown in popularity; however, a direct relationship between electrically evoked and mechanically evoked vestibular responses remains elusive in humans. We have developed and tested a mechanical-to-electrical vestibular stimulus conversion model incorporating physiological activation of primary vestibular afferents identified in nonhuman primates. We compared ocular torsional responses between mechanical (chair rotation) and model-derived electrical (binaural-bipolar) stimuli in separate experiments for an angular velocity step change (±10 deg/s over 1 s, ±4-mA peak amplitude; n = 10) and multisine angular velocities (±10 deg/s, 9.7 mA peak to peak, 0.05-1 Hz; n = 5), respectively. Perception of whole body rotation (n = 18) to our step-change stimuli was also evaluated. Ocular torsional slow-phase velocity responses between stimulation types were similar (paired two one-sided tests of equivalence: multiple P < 0.002; one-sample t test: P = 0.178) and correlated (Pearson's coefficient: multiple P < 0.001). Bootstrap analysis of perceived angular velocity likewise showed similarity in perceptual decay dynamics. These data suggest that central processing between stimuli was similar, and our vestibular stimulus conversion model with a conversion factor of ∼0.4 mA per deg/s for an angular velocity step change can generate electrical stimuli that replicates dynamic vestibular activation elicited by mechanical whole body rotations. This proposed vestibular conversion model represents an initial framework for using electrical stimuli to generate mechanically equivalent activation of primary vestibular afferents for use in biomedical applications and immersive reality technologies.NEW & NOTEWORTHY With the growing popularity of electrical vestibular stimulation in biomedical and immersive reality applications, a direct conversion model between electrical and mechanical vestibular stimuli is needed. We developed a model to generate electrical stimuli mimicking the physiological activation of vestibular afferents evoked by mechanical rotations. Ocular and perceptual responses evoked by mechanical and model-derived electrical stimuli were similar, thus providing a critical first step toward generation of electrically induced vestibular responses that have a realistic mechanical equivalent.
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Affiliation(s)
- A Chen
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - N Khosravi-Hashemi
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada.,International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
| | - C Kuo
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada.,Department of Computer Science, University of British Columbia, Vancouver, BC, Canada
| | - J K Kramer
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
| | - J-S Blouin
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
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Rutel IB, Stoner J, Kota P, Dormer K, Alleman A. Orientation of the round window membrane: A normative study of inner ear anatomical orientation using 2D projections of 3D volumes. Anat Rec (Hoboken) 2019; 303:2847-2856. [PMID: 31815368 DOI: 10.1002/ar.24327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 10/18/2019] [Accepted: 10/28/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Orientation of the Round Window Membrane (RWM) is an important metric to establish if utilized as a potential access for targeted delivery of magnetically guided nanomedicines to the inner ear. Orientation with respect to an internal reference frame (such as the planes defined by the semicircular-canals [SCC]) may provide an internally consistent basis if the basis is orthogonal and consistent (from patient to patient). MATERIALS AND METHODS Utilizing a micro computed tomography (CT), 20 temporal bones are scanned for anatomical information. The scanned data sets are loaded into an imaging program to provide volumetric reconstruction and segmentation. Volumetric models of the anatomical relationships between the inner ear SCC and the RWM are utilized to get normative projection angle information and are statistically analyzed. RESULTS Micro-CT shows low to moderate reliability for reproducibility, intraobserver, and interobserver measurements; in addition, it provides mean values (±SD) for the various measured angles. The combined mean angular values for surface orientation of the RWM, with respect to the SCC basis (quasi-orthogonal spherical coordinate system), was 57.0° ± 20.9°as measured from the line defining the posterior SCC plane in the direction of the line defining the superior SCC plane. An angle of 65.2° ± 19.1° was measured for an angle away from the line defining the horizontal SCC plane.
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Affiliation(s)
- Isaac B Rutel
- Department of Radiological Sciences, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, Oklahoma
| | - Julie Stoner
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, Oklahoma
| | - Pravina Kota
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, Oklahoma
| | - Kenneth Dormer
- Department of Community and Global Health, Campbell University, Jerry M. Wallace School of Osteopathic Medicine, Lillington, North Carolina
| | - Anthony Alleman
- Department of Radiological Sciences, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, Oklahoma
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Systematic Method for Morphological Reconstruction of the Semicircular Canals Using a Fully Automatic Skeletonization Process. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9224904] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We present a novel method to characterize the morphology of semicircular canals of the inner ear. Previous experimental works have a common nexus, the human-operator subjectivity. Although these methods are mostly automatic, they rely on a human decision to determine some particular anatomical positions. We implement a systematic analysis where there is no human subjectivity. Our approach is based on a specific magnetic resonance study done in a group of 20 volunteers. From the raw data, the proposed method defines the centerline of all three semicircular canals through a skeletonization process and computes the angle of the functional pair and other geometrical parameters. This approach allows us to assess the inter-operator effect on other methods. From our results, we conclude that, although an average geometry can be defined, the inner ear anatomy cannot be reduced to a single geometry as seen in previous experimental works. We observed a relevant variability of the geometrical parameters in our cohort of volunteers that hinders this usual simplification.
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Boutros PJ, Schoo DP, Rahman M, Valentin NS, Chow MR, Ayiotis AI, Morris BJ, Hofner A, Rascon AM, Marx A, Deas R, Fridman GY, Davidovics NS, Ward BK, Treviño C, Bowditch SP, Roberts DC, Lane KE, Gimmon Y, Schubert MC, Carey JP, Jaeger A, Della Santina CC. Continuous vestibular implant stimulation partially restores eye-stabilizing reflexes. JCI Insight 2019; 4:128397. [PMID: 31723056 DOI: 10.1172/jci.insight.128397] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 10/04/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUNDBilateral loss of vestibular (inner ear inertial) sensation causes chronically blurred vision during head movement, postural instability, and increased fall risk. Individuals who fail to compensate despite rehabilitation therapy have no adequate treatment options. Analogous to hearing restoration via cochlear implants, prosthetic electrical stimulation of vestibular nerve branches to encode head motion has garnered interest as a potential treatment, but prior studies in humans have not included continuous long-term stimulation or 3D binocular vestibulo-ocular reflex (VOR) oculography, without which one cannot determine whether an implant selectively stimulates the implanted ear's 3 semicircular canals.METHODSWe report binocular 3D VOR responses of 4 human subjects with ototoxic bilateral vestibular loss unilaterally implanted with a Labyrinth Devices Multichannel Vestibular Implant System vestibular implant, which provides continuous, long-term, motion-modulated prosthetic stimulation via electrodes in 3 semicircular canals.RESULTSInitiation of prosthetic stimulation evoked nystagmus that decayed within 30 minutes. Stimulation targeting 1 canal produced 3D VOR responses approximately aligned with that canal's anatomic axis. Targeting multiple canals yielded responses aligned with a vector sum of individual responses. Over 350-812 days of continuous 24 h/d use, modulated electrical stimulation produced stable VOR responses that grew with stimulus intensity and aligned approximately with any specified 3D head rotation axis.CONCLUSIONThese results demonstrate that a vestibular implant can selectively, continuously, and chronically provide artificial sensory input to all 3 implanted semicircular canals in individuals disabled by bilateral vestibular loss, driving reflexive VOR eye movements that approximately align in 3D with the head motion axis encoded by the implant.TRIAL REGISTRATIONClinicalTrials.gov: NCT02725463.FUNDINGNIH/National Institute on Deafness and Other Communication Disorders: R01DC013536 and 2T32DC000023; Labyrinth Devices, LLC; and Med-El GmbH.
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Affiliation(s)
| | - Desi P Schoo
- Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Mehdi Rahman
- Labyrinth Devices, LLC, Baltimore, Maryland, USA
| | | | | | | | | | | | | | | | | | - Gene Y Fridman
- Department of Biomedical Engineering and.,Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Bryan K Ward
- Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Carolina Treviño
- Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Stephen P Bowditch
- Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Dale C Roberts
- Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Kelly E Lane
- Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Yoav Gimmon
- Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Michael C Schubert
- Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - John P Carey
- Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Charles C Della Santina
- Department of Biomedical Engineering and.,Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.,Labyrinth Devices, LLC, Baltimore, Maryland, USA
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Khosravi‐Hashemi N, Forbes PA, Dakin CJ, Blouin J. Virtual signals of head rotation induce gravity‐dependent inferences of linear acceleration. J Physiol 2019; 597:5231-5246. [DOI: 10.1113/jp278642] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 09/03/2019] [Indexed: 12/11/2022] Open
Affiliation(s)
| | - Patrick A. Forbes
- Department of NeuroscienceErasmus MCUniversity Medical Center Rotterdam Rotterdam The Netherlands
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Eggers SD, Bisdorff A, von Brevern M, Zee DS, Kim JS, Perez-Fernandez N, Welgampola MS, Della Santina CC, Newman-Toker DE. Classification of vestibular signs and examination techniques: Nystagmus and nystagmus-like movements. J Vestib Res 2019; 29:57-87. [PMID: 31256095 PMCID: PMC9249296 DOI: 10.3233/ves-190658] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This paper presents a classification and definitions for types of nystagmus and other oscillatory eye movements relevant to evaluation of patients with vestibular and neurological disorders, formulated by the Classification Committee of the Bárány Society, to facilitate identification and communication for research and clinical care. Terminology surrounding the numerous attributes and influencing factors necessary to characterize nystagmus are outlined and defined. The classification first organizes the complex nomenclature of nystagmus around phenomenology, while also considering knowledge of anatomy, pathophysiology, and etiology. Nystagmus is distinguished from various other nystagmus-like movements including saccadic intrusions and oscillations. View accompanying videos at http://www.jvr-web.org/ICVD.html
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Affiliation(s)
| | - Alexandre Bisdorff
- Department of Neurology, Centre Hospitalier Emile Mayrisch, Esch-sur-Alzette, Luxembourg
| | - Michael von Brevern
- Private Practice of Neurology and Department of Neurology, Charité, Berlin, Germany
| | - David S. Zee
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Korea
| | | | - Miriam S. Welgampola
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Central Clinical School, University of Sydney, Sydney, Australia
| | - Charles C. Della Santina
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David E. Newman-Toker
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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48
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Boutros PJ, Valentin NS, Hageman KN, Dai C, Roberts D, Della Santina CC. Nonhuman primate vestibuloocular reflex responses to prosthetic vestibular stimulation are robust to pulse timing errors caused by temporal discretization. J Neurophysiol 2019; 121:2256-2266. [PMID: 30995152 DOI: 10.1152/jn.00887.2018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Electrical stimulation of vestibular afferent neurons to partially restore semicircular canal sensation of head rotation and the stabilizing reflexes that sensation supports has potential to effectively treat individuals disabled by bilateral vestibular hypofunction. Ideally, a vestibular implant system using this approach would be integrated with a cochlear implant, which would provide clinicians with a means to simultaneously treat loss of both vestibular and auditory sensation. Despite obvious similarities, merging these technologies poses several challenges, including stimulus pulse timing errors that arise when a system must implement a pulse frequency modulation-encoding scheme (as is used in vestibular implants to mimic normal vestibular nerve encoding of head movement) within fixed-rate continuous interleaved sampling (CIS) strategies used in cochlear implants. Pulse timing errors caused by temporal discretization inherent to CIS create stair step discontinuities of the vestibular implant's smooth mapping of head velocity to stimulus pulse frequency. In this study, we assayed electrically evoked vestibuloocular reflex responses in two rhesus macaques using both a smooth pulse frequency modulation map and a discretized map corrupted by temporal errors typical of those arising in a combined cochlear-vestibular implant. Responses were measured using three-dimensional scleral coil oculography for prosthetic electrical stimuli representing sinusoidal head velocity waveforms that varied over 50-400°/s and 0.1-5 Hz. Pulse timing errors produced negligible effects on responses across all canals in both animals, indicating that temporal discretization inherent to implementing a pulse frequency modulation-coding scheme within a cochlear implant's CIS fixed pulse timing framework need not sacrifice performance of the combined system's vestibular implant portion. NEW & NOTEWORTHY Merging a vestibular implant system with existing cochlear implant technology can provide clinicians with a means to restore both vestibular and auditory sensation. Pulse timing errors inherent to integration of pulse frequency modulation vestibular stimulation with fixed-rate, continuous interleaved sampling cochlear implant stimulation would discretize the smooth head velocity encoding of a combined device. In this study, we show these pulse timing errors produce negligible effects on electrically evoked vestibulo-ocular reflex responses in two rhesus macaques.
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Affiliation(s)
- Peter J Boutros
- Department of Biomedical Engineering, Johns Hopkins School of Medicine , Baltimore, Maryland
| | - Nicolas S Valentin
- Department of Biomedical Engineering, Johns Hopkins School of Medicine , Baltimore, Maryland
| | - Kristin N Hageman
- Department of Biomedical Engineering, Johns Hopkins School of Medicine , Baltimore, Maryland
| | - Chenkai Dai
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine , Baltimore, Maryland
| | - Dale Roberts
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine , Baltimore, Maryland
| | - Charles C Della Santina
- Department of Biomedical Engineering, Johns Hopkins School of Medicine , Baltimore, Maryland.,Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine , Baltimore, Maryland
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49
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Balaban CD, Black RD, Silberstein SD. Vestibular Neuroscience for the Headache Specialist. Headache 2019; 59:1109-1127. [DOI: 10.1111/head.13550] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Carey D. Balaban
- Department of Otolaryngology University of Pittsburgh Pittsburgh PA USA
- Department of Neurobiology University of Pittsburgh Pittsburgh PA USA
- Department of Communication Sciences and Disorders University of Pittsburgh Pittsburgh PA USA
- Department of Bioengineering University of Pittsburgh Pittsburgh PA USA
| | | | - Stephen D. Silberstein
- Jefferson Headache Center, Department of Neurology Thomas Jefferson University Philadelphia PA USA
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50
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Ren PY, Li BW, Dong SY, Wu M, Han P. Improvement of Mechanical Stability for Single Unit Recording Based on Skull Cap in Living Chinchilla. Curr Med Sci 2019; 39:166-172. [PMID: 30868508 DOI: 10.1007/s11596-019-2015-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 10/17/2018] [Indexed: 11/29/2022]
Abstract
Three-point head fixation was constructed to provide mechanical stability for single unit recording (SUR) on vestibular sensory system in living chinchilla previously. However, it is no more qualified to this work when the stimulation intensity becomes large because of frequent unit losing and neuron damage, which strongly implies that the mechanical stability has been broken during the stimulation. Here, we constructed a novel head fixation (skull cap assistant head fixation) provided by skull cap on the basis of three-point head fixation in order to improve the mechanical stability for SUR under the stimulation with large magnitude. The large area bone connection is the feature and advantage of this improved method, which directly fixes the tested local nervous tissue and microelectrode in an intact stable system through skull cap except two ear bars and a tube face mask. Our data exhibited that skull cap assistant head fixation could significantly improve the success rate of neural response activity recording in the population of semicircular canal neurons under the stimulation with large intensity (amplitude ≥100 deg/s). Based on the analysis of neural response activity and noise base-line during stimulation, our data further indicated that this method could significantly improve the mechanical stability for SUR during high-speed motion stimulation on vestibular system in living chinchilla. Skull cap assistant head fixation extends the application of SUR on vestibular neuron in linear response range and provides a solid foundation for electrophysiological research on vestibular sensory system in further studies.
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Affiliation(s)
- Peng-Yu Ren
- Department of Neurosurgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China.,Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, 21205, USA
| | - Bo-Wen Li
- Division of Health Sciences Informatics, Johns Hopkins University School of Medicine, Baltimore, 21205, USA
| | - Shi-Yao Dong
- School of Mathematics and Statistics, Central China Normal University, Wuhan, 430079, China
| | - Ming Wu
- School of Mathematics and Statistics, Central China Normal University, Wuhan, 430079, China.
| | - Peng Han
- Department of Otolaryngology-Head & Neck Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China.
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