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Lennox-Bowley A, Dasgupta S. Modernising vestibular assessment. J Laryngol Otol 2024; 138:S3-S7. [PMID: 38247298 DOI: 10.1017/s0022215123002128] [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] [Indexed: 01/23/2024]
Abstract
BACKGROUND There is a high prevalence of dizziness, vertigo and balance symptoms in the general population. Symptoms can be generated by many inner-ear vestibular disorders and there are several diagnostic tests available that can help identify the site of the vestibular lesion. There is little consensus on what diagnostic tests are appropriate, with diagnostics either not completed or minimally performed, leading to missed diagnosis, unsatisfactory results for patients and costs to healthcare systems. METHODS This study explored the literature for different neuro-vestibular diagnostic tests not currently considered in the traditional standard vestibular test battery, and examined how they fit effectively into a patient care pathway to help quickly and succinctly identify vestibular function. RESULTS A vestibular patient care pathway is presented for acute and subacute presentation of vestibular disorders. CONCLUSION An accurate diagnosis following a rigorous anamnesis and vestibular testing is paramount for successful management and favourable outcomes.
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Affiliation(s)
- Amy Lennox-Bowley
- Audio-Vestibular Clinic, Hypatia Dizziness and Balance Clinic, Liverpool, UK
| | - Soumit Dasgupta
- Audio-Vestibular Medicine, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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Bosmans J, Gommeren H, Zu Eulenburg P, Gilles A, Mertens G, Van Ombergen A, Cras P, Engelborghs S, Van Rompaey V. Is vestibular function related to human hippocampal volume? J Vestib Res 2024; 34:3-13. [PMID: 37927291 DOI: 10.3233/ves-230076] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
BACKGROUND Recent studies implicate the effect of vestibular loss on cognitive decline, including hippocampal volume loss. As hippocampal atrophy is an important biomarker of Alzheimer's disease, exploring vestibular dysfunction as a risk factor for dementia and its role in hippocampal atrophy is of interest. OBJECTIVE To replicate previous literature on whole-brain and hippocampal volume in semicircular canal dysfunction (bilateral vestibulopathy; BV) and explore the association between otolith function and hippocampal volume. METHODS Hippocampal and whole-brain MRI volumes were compared in adults aged between 55 and 83 years. Participants with BV (n = 16) were compared to controls individually matched on age, sex, and hearing status (n = 16). Otolith influence on hippocampal volume in preserved semicircular canal function was evaluated (n = 34). RESULTS Whole-brain and targeted hippocampal approaches using volumetric and surface-based measures yielded no significant differences when comparing BV to controls. Binary support vector machines were unable to classify inner ear health status above chance level. Otolith parameters were not associated with hippocampal volume in preserved semicircular canal function. CONCLUSIONS No significant differences in whole-brain or hippocampal volume were found when comparing BV participants with healthy controls. Saccular parameters in subjects with preserved semicircular canal function were not associated with hippocampal volume changes.
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Affiliation(s)
- Joyce Bosmans
- Faculty of Medicine and Health Sciences, Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, University of Antwerp, Belgium
| | - Hanne Gommeren
- Faculty of Medicine and Health Sciences, Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, University of Antwerp, Belgium
- University Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Peter Zu Eulenburg
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
- Graduate School of Systemic Neurosciences, Munich, Germany
- Institute for Neuroradiology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Annick Gilles
- Faculty of Medicine and Health Sciences, Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, University of Antwerp, Belgium
- University Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
- Department of Education, Health and Social Work, University College Ghent, Ghent, Belgium
| | - Griet Mertens
- Faculty of Medicine and Health Sciences, Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, University of Antwerp, Belgium
- University Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Angelique Van Ombergen
- Faculty of Medicine and Health Sciences, Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, University of Antwerp, Belgium
- Discipline Lead for Life Sciences, SciSpacE Team, Directorate for Human Spaceflight and Robotic Exploration Programmes, European Space Agency
| | - Patrick Cras
- Faculty of Medicine and Health Sciences, Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, University of Antwerp, Belgium
- Department of Neurology, Antwerp University Hospital and Born-Bunge Institute, University of Antwerp, Antwerp, Belgium
| | - Sebastiaan Engelborghs
- Department of Neurology, Universitair Ziekenhuis Brussel and Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Vincent Van Rompaey
- Faculty of Medicine and Health Sciences, Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, University of Antwerp, Belgium
- University Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
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Wu Z, Liu B. [Expert consensus on the diagnosis of isolated otolith dysfunction]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2023; 37:409-414. [PMID: 37253512 PMCID: PMC10495805 DOI: 10.13201/j.issn.2096-7993.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 05/15/2023] [Indexed: 06/01/2023]
Abstract
Isolated otolith dysfunction(iOD) involves a group of unexplained vestibular syndromes that manifest clinically as a sense of translation, tilting or floating, and blurred vision with head movement, with normal semicircular canal function but abnormal otolith function on laboratory vestibular testing. As vestibular medicine has gained widespread popularity in recent years, increasing attention has also been paid to iOD and case reports, clinical studies and diagnostic criteria have been published. However, there is no consensus document to guide the diagnosis of this disease in China. In this context, the Special Committee on Vertigo of China Medical Education Association organized a group of domestic experts in vestibular medicine and formulated this diagnostic consensus after thorough discussion based on the latest evidence in China and abroad, in order to promote the best clinical practice for iOD.
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Waissbluth S, Oyarzún J. Case Report: Isolated Idiopathic Saccular Dysfunction. Front Neurol 2021; 12:753433. [PMID: 34867738 PMCID: PMC8634261 DOI: 10.3389/fneur.2021.753433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/04/2021] [Indexed: 11/13/2022] Open
Abstract
Advances in vestibular testing have now allowed us to test each semicircular canal as well as the utricle and saccule, independently. This has led to the discovery of new patterns of vestibular dysfunction that were once impossible to evaluate. This report describes the case of a 20-year-old woman with a 2-month history of recurrent dizziness. She had a complete audiovestibular assessment. The only abnormality observed was the absence of a cervical vestibular-evoked myogenic potential response for the right side, hence an isolated saccular dysfunction. In conclusion, isolated otolithic dysfunction is probably an overlooked and neglected clinical presentation. Its true incidence is unknown, and further research is needed to understand this clinical entity.
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Affiliation(s)
- Sofia Waissbluth
- Department of Otolaryngology, Pontificia Universidad Católica de Chile, Santiago, Chile
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