Effects of caloric stimulation on respiratory frequency and heart rate and blood pressure variability

Blood Pressure Response to the Head-Up Tilt Test in Benign Paroxysmal Positional Vertigo

The vestibular organ is involved in controlling blood pressure through vestibulosympathetic reflexes of the autonomic nervous system. This study aimed to investigate the effect of benign paroxysmal positional vertigo (BPPV) on blood pressure control by the autonomic nervous system by observing changes in blood pressure before and after BPPV treatment using the head-up tilt test (HUTT). A total of 278 patients who underwent the HUTT before and after treatment were included. The HUTT measured blood pressure repeatedly on the day of diagnosis and the day of complete recovery, and the results were analyzed using repeated measures analysis of variance. Regarding the difference in the systolic blood pressure of patients with BPPV, the blood pressure at 1, 2, and 3 min in the upright position after complete recovery was significantly lower than before treatment (p = 0.001, p = 0.001, and p = 0.012, respectively). Blood pressure at 1 and 2 min in the diastolic blood pressure of patients with BPPV in the upright position after complete recovery was significantly lower than before treatment (p = 0.001 and p = 0.034, respectively). This study shows that BPPV increases blood pressure during the initial response to standing in the HUTT.

Interoception and embodiment in patients with bilateral vestibulopathy

There are tight functional and anatomical links between the vestibular and interoceptive systems, and both systems have shown to fundamentally underlie emotional processes and our sense of a bodily self. Yet, nothing is known about how long-term bilateral vestibulopathy (BVP) influences interoception and its relation to embodiment and the sense of self. We thus compared cardiac interoceptive accuracy, confidence in the performance, and general body awareness in 25 BVP patients and healthy controls using a heartbeat tracking task, self-reports about interoceptive awareness, as well as measures of self-localization and of self-body closeness. Results showed no difference between patients and controls regarding interoceptive accuracy, confidence and body awareness, suggesting that long-term BVP does not influence cardiac interoception. Patients and controls did not differ either regarding self-location and self-body closeness. However, in our overall sample of patients and controls, we found that interoceptive accuracy increased with perceived self-body closeness, suggesting that anchoring the self to the body is generally linked with better cardiac interoception. This result is in line with previous suggestions of an important contribution of interoception to the sense of embodiment.

Autonomic laterality in caloric vestibular stimulation

BACKGROUND

Caloric stimulation of the vestibular system is associated with autonomic response. The lateralization in the nervous system activities also involves the autonomic nervous system.

AIM

To compare the effect of the right and left ear caloric test on the cardiac sympathovagal tone in healthy persons.

METHODS

This self-control study was conducted on 12 healthy male volunteers. The minimal ice water caloric test was applied for vestibular stimulation. This was done by irrigating 1 milliliter of 4 ± 2 °C ice water into the external ear canal in 1 s. In each experiment, only one ear was stimulated. For each ear, the pessimum position was considered as sham control and the optimum position was set as caloric vestibular stimulation of horizontal semicircular channel. The order of right or left caloric vestibular stimulation and the sequence of optimum or pessimum head position in each set were random. The recovery time between each calorie test was 5 min. The short-term heart rate variability (HRV) was used for cardiac sympathovagal tone metrics. All variables were compared using the analysis of variance.

RESULTS

After caloric vestibular stimulation, the short-term time-domain and frequency-domain HRV indices as well as, the systolic and the diastolic arterial blood pressure, the respiratory rate and the respiratory amplitude, had no significant changes. These negative results were similar in the right and the left sides. Nystagmus duration of left caloric vestibular stimulations in the optimum and the pessimum positions had significant differences (e.g., 72.14 ± 39.06 vs 45.35 ± 35.65, P < 0.01). Nystagmus duration of right caloric vestibular stimulations in the optimum and the pessimum positions had also significant differences (e.g., 86.42 ± 67.20 vs 50.71 ± 29.73, P < 0.01). The time of the start of the nystagmus following caloric vestibular stimulation had no differences in both sides and both positions.

CONCLUSION

Minimal ice water caloric stimulation of the right and left vestibular system did not affect the cardiac sympathovagal balance according to HRV indices.

Influence of graviceptor stimulation initiated by off-vertical axis rotation on ventilation

NEW FINDINGS

What is the central question of this study? It is known that respiration is affected by graviceptors, but it remains unclear to what extent labyrinthine and non-labyrinthine graviceptors are involved in this process. What is the main finding and its importance? Our results suggest that the modulation of respiration is not a result of a simple reflex arc, but that it involves a higher integration of different types of receptors with variable contributions of either type of graviceptor among subjects.

ABSTRACT

It has been suggested that the otolith system is involved in the physiological response to changes in body orientation with respect to gravity. In studies on animals, an otolith-respiratory reflex has been observed, but data on humans are scarce and inconclusive, mainly because pure otolithic stimulation is difficult to produce in humans. To assess the otolithic-respiratory reflex in humans, we used an off-vertical axis rotation (OVAR) that produces periodic and pure stimulation of graviceptors. The inspiratory flow was measured during earth vertical axis rotation (EVAR, control conditions) and OVAR in 21 subjects. To distinguish the effects of the labyrinthine and non-labyrinthine graviceptors on ventilation, these measurements were repeated with two different static head positions: head turned leftward and rightward in yaw. The velocity of rotation was individually selected to match spontaneous breathing rate (mean 11.4 cycles min^-1 , 0.19 Hz). Average ventilatory flow was higher in OVAR than in EVAR, as was tidal volume. In OVAR, the transition between inspiration and expiration occurred mainly in the forward pitch position. The phase of this transition in most subjects was driven mostly by the body position rather than by the head position, suggesting that respiratory modifications during OVAR mainly involved non-labyrinthine receptors. However, the study demonstrated a high intersubject variability both in the ability of OVAR to synchronize breathing and in the influence of labyrinthine stimulation. We conclude that the respiratory response to changes in orientation of the body with respect to the vertical involves labyrinthine and non-labyrinthine stimulation, with the gain of each signal varying individually.

Lightheadedness After Concussion: Not All Dizziness is Vertigo

OBJECTIVE

To characterize the presence and degree of postconcussion lightheadedness in relation to postconcussion vertigo and dizziness, and to determine whether lightheadedness influences overall symptom duration.

DESIGN

Prospective, cohort design.

SETTING

Nationwide Children's Hospital, Sports Concussion Clinic.

PARTICIPANTS

Five hundred ten patients (9-19 years of age) within 30 days of concussion injury.

MAIN OUTCOME MEASURES

Patient ratings (scale 0-6) of multiple postconcussion symptoms including lightheadedness, vertigo, and dizziness, reported from the day of clinic evaluation and recalled from the day of concussion.

RESULTS

Postconcussion lightheadedness occurred commonly relative to vertigo. Lightheadedness was recalled more than vertigo (70.8% vs 48.6%, P < 0.001) on concussion day and reported more than vertigo (47.1% vs 24.1%, P < 0.001) on the day of clinic evaluation. Principal component analysis demonstrated strong correlations among lightheadedness, vertigo, balance difficulties, difficulty concentrating, mental fogginess, and difficulty remembering, relative to other postconcussion symptoms. When present on the day of clinic evaluation, these highly correlated symptoms predicted prolonged concussion recovery [P = 0.028; Hazard Ratio (HR) = 1.2]. Female sex (P = 0.04; HR = 1.23), emotional symptoms recalled from the day of concussion (P = 0.007; HR = 1.23), and cephalalgic symptoms (P < 0.001; HR = 1.34) reported on the day of clinic evaluation also predicted prolonged concussion recovery.

CONCLUSIONS

Not all postconcussion dizziness is vertigo. Postconcussion lightheadedness is common and, when present at the time of clinic evaluation, can influence concussion recovery.

CLINICAL RELEVANCE

Distinguishing postconcussion lightheadedness from vertigo may help to inform clinical treatment and concussion research design. This study adds to the growing body of evidence that supports an association between concussion and autonomic dysfunction.

Distinct activation of the sympathetic adreno-medullar system and hypothalamus pituitary adrenal axis following the caloric vestibular test in healthy subjects

INTRODUCTION

The vestibular acute stress induces reversible alert-like reactions that involve the sympathetic adrenal-medullar system and hypothalamic-pituitary-adrenal axis responses. The present study aimed to evaluate salivary α-amylase and salivary cortisol production in relation with cardiovascular reactivity induced by acute stress in healthy subjects.

MATERIAL AND METHODS

Forty-eight young healthy male volunteers were examined under basal conditions and at various times after reaching the maximal nystagmic reaction following air caloric vestibular test. Heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were recorded at the same time as measurement of the salivary α-amylase and salivary cortisol. At the end of the caloric vestibular test session, perceived stress scale questionnaires were administered to measure the self-perceived stress impact induced by the task, and individual scores were compared with those measured on the enrollment day.

RESULTS

Following caloric vestibular test-evoked vertigo, salivary α-amylase and cortisol showed distinct trends in their production after acute stress: Student's t-test was used to compare the α-amylase vs cortisol slopes of the respective interpolated regression lines, and the difference was significant (t = -3.283; p<0.001); an increase in salivary cortisol production corresponded with a decrease in the salivary α-amylase concentration. In addition, salivary biomarker modifications were associated with consistent changes in the heart rate, systolic blood pressure and mean arterial pressure.

CONCLUSIONS

Using the air caloric vestibular test task as a stressor, the present study demonstrated a connection between the acute hormonal stress response to vestibular stimulation and cardiovascular output. However, further research is needed before we can define the potential importance of the consistent cardiovascular activity changes evoked by vestibular stimulation and the possible functional consequences for cardiovascular regulation and orthostatic tolerance in humans.

Distinct activation of the sympathetic adreno-medullar system and hypothalamus pituitary adrenal axis following the caloric vestibular test in healthy subjects

INTRODUCTION

The vestibular acute stress induces reversible alert-like reactions that involve the sympathetic adrenal-medullar system and hypothalamic-pituitary-adrenal axis responses. The present study aimed to evaluate salivary α-amylase and salivary cortisol production in relation with cardiovascular reactivity induced by acute stress in healthy subjects.

MATERIAL AND METHODS

Forty-eight young healthy male volunteers were examined under basal conditions and at various times after reaching the maximal nystagmic reaction following air caloric vestibular test. Heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were recorded at the same time as measurement of the salivary α-amylase and salivary cortisol. At the end of the caloric vestibular test session, perceived stress scale questionnaires were administered to measure the self-perceived stress impact induced by the task, and individual scores were compared with those measured on the enrollment day.

RESULTS

Following caloric vestibular test-evoked vertigo, salivary α-amylase and cortisol showed distinct trends in their production after acute stress: Student's t-test was used to compare the α-amylase vs cortisol slopes of the respective interpolated regression lines, and the difference was significant (t = -3.283; p<0.001); an increase in salivary cortisol production corresponded with a decrease in the salivary α-amylase concentration. In addition, salivary biomarker modifications were associated with consistent changes in the heart rate, systolic blood pressure and mean arterial pressure.

CONCLUSIONS

Using the air caloric vestibular test task as a stressor, the present study demonstrated a connection between the acute hormonal stress response to vestibular stimulation and cardiovascular output. However, further research is needed before we can define the potential importance of the consistent cardiovascular activity changes evoked by vestibular stimulation and the possible functional consequences for cardiovascular regulation and orthostatic tolerance in humans.

Caloric vestibular stimulation modulates nociceptive evoked potentials

Vestibular stimulation has been reported to alleviate central pain. Clinical and physiological studies confirm pervasive interactions between vestibular signals and somatosensory circuits, including nociception. However, the neural mechanisms underlying vestibular-induced analgesia remain unclear, and previous clinical studies cannot rule out explanations based on alternative, non-specific effects such as distraction or placebo. To investigate how vestibular inputs influence nociception, we combined caloric vestibular stimulation (CVS) with psychophysical and electrocortical responses elicited by nociceptive-specific laser stimulation in humans (laser-evoked potentials, LEPs). Cold water CVS applied to the left ear resulted in significantly lower subjective pain intensity for experimental laser pain to the left hand immediately after CVS, relative both to before CVS and to 1 h after CVS. This transient reduction in pain perception was associated with reduced amplitude of all LEP components, including the early N1 wave reflecting the first arrival of nociceptive input to primary somatosensory cortex. We conclude that cold left ear CVS elicits a modulation of both nociceptive processing and pain perception. The analgesic effect induced by CVS could be mediated either by subcortical gating of the ascending nociceptive input, or by direct modulation of the primary somatosensory cortex.

Heart rate and blood pressure effects during caloric vestibular testing

OBJECTIVES

To determine whether the caloric vestibular test causes significant changes in heart rate and mean arterial blood pressure.

MATERIALS AND METHODS

Changes in heart rate and mean arterial blood pressure before and after caloric irrigation were compared with the degree of nystagmus (as measured by maximum slow phase velocity) and the patient's subjective dizziness (scored from 0 to 10). A cardiologist reviewed each patient's heart rate and mean arterial blood pressure changes. Patients' anxiety levels were also assessed.

RESULTS

Eighteen patients were recruited. There were no adverse events in any patient. There were no overall significant differences between the heart rate and mean arterial pressure before and after each irrigation. There was a significant correlation between the maximum slow phase velocity and patients' subjective dizziness scores.

CONCLUSION

Heart rate and mean arterial blood pressure are not significantly influenced by the caloric vestibular test. This preliminary study will enable patients with stable cardiovascular disease to be recruited for further risk determination.

Test order effects of computerized dynamic posturography and calorics

PURPOSE

To determine whether there is a test order effect of the caloric subtest of videonystagmography on the Sensory Organization Test (SOT) of computerized dynamic posturography, and to assess the learning effect of multiple posturography test sessions on the SOT score.

METHOD

Scores on the 6 SOT conditions before and after caloric testing were compared for 10 participants age 18-36 years. Four SOT sessions were completed prior to caloric testing to assess the presence of a learning effect and establish precaloric baseline SOT scores. All participants had normal vestibular systems with no history of dizziness or imbalance.

RESULTS

Caloric testing had a significant effect on the equilibrium score for only 1 of 6 test conditions. While meeting statistical significance, the actual change in score for this condition was very small. Equilibrium scores improved for the more difficult test conditions between the 1st and 2nd SOT sessions.

CONCLUSION

Results indicate that there are minimal test order effects of calorics on the SOT. Results confirm that a significant improvement in score for more challenging test conditions occurs between SOT Sessions 1 and 2 as a result of learning. Therefore, clinicians must be cautious when using posturography to monitor patient improvement.

Strong galvanic vestibular stimulation obscures arterial pressure response to gravitational change in conscious rats

Galvanic vestibular stimulation (GVS) is known to create an imbalance in the vestibular inputs; thus it is possible that the simultaneously applied GVS obscures adequate gravity-based inputs to the vestibular organs or modifies an input-output relationship of the vestibular system and then impairs the vestibular-mediated response. To examine this, arterial pressure (AP) response to gravitational change was examined in conscious rats with and without GVS. Free drop-induced microgravity and centrifugation-induced hypergravity were employed to elicit vestibular-mediated AP response. GVS itself induced pressor response in an intensity-dependent manner. This pressor response was completely abolished by vestibular lesion, suggesting that the GVS-induced response was mediated by the vestibular system. The pressor response to microgravity (35 +/- 3 mmHg) was significantly reduced by simultaneously applied GVS (19 +/- 1 mmHg), and pressor response to 3-G load was also significantly reduced by GVS. However, GVS had no effect on air jet-induced pressor response. The effects of GVS on pressor response to gravitational change were qualitatively and quantitatively similar to that caused by the vestibular lesion, effects of which were demonstrated in our previous studies (Gotoh TM, Fujiki N, Matsuda T, Gao S, Morita H. Am J Physiol Regul Integr Comp Physiol 286: R25-R30, 2004; Matsuda T, Gotoh TM, Tanaka K, Gao S, Morita H. Brain Res 1028: 140-147, 2004; Tanaka K, Gotoh TM, Awazu C, Morita H. Neurosci Lett 397: 40-43, 2006). These results indicate that GVS reduced the vestibular-mediated pressor response to gravitational change but has no effect on the non-vestibular-mediated pressor response. Thus GVS might be employed for the acute interruption of the AP response to gravitational change.

Consequences of postural changes and removal of vestibular inputs on the movement of air in and out of the lungs of conscious felines

A variety of experimental approaches in human subjects and animal models established that the vestibular system contributes to regulation of respiration. In cats, the surgical elimination of labyrinthine signals produced changes in the spontaneous activity and posturally related responses of a number of respiratory muscles. However, these effects were complex and sometimes varied between muscle compartments, such that the physiological role of vestibulo-respiratory responses is unclear. The present study determined the functional significance of vestibulo-respiratory influences by examining the consequences of a bilateral labyrinthectomy on breathing rate and the pressure, volume, and flow rate of air exchanged during inspiration and expiration as body orientation with respect to gravity was altered. Data were collected from conscious adult cats acclimated to breathing through a facemask connected to a pneuomotach during 60 degrees head-up pitch and ear-down roll body rotations. Removal of vestibular inputs resulted in a 15% reduction in breathing rate, a 13% decrease in minute ventilation, a 16% decrease in maximal inspiratory airflow rate, and a 14% decrease in the maximal expiratory airflow rate measured when the animals were in the prone position. However, the lesions did not appreciably affect phasic changes in airflow parameters related to alterations in posture. These results suggest that the role of the vestibular system in the control of breathing is to modify baseline respiratory parameters in proportion to the general intensity of ongoing movements, and not to rapidly alter ventilation in accordance with body position.

Prediction of vestibulo-autonomic symptoms during the caloric test: evaluation of autonomic activity by spectral analysis of the electrocardiographic R-R interval

CONCLUSION

If the high-frequency (HF) component of the R-R interval spectrum of the electrocardiogram (ECG) increases after the first stimulation during a bithermal caloric test, subsequent repeated stimulations may be likely to induce autonomic symptoms such as nausea.

OBJECTIVE

Nausea often occurs as a vestibulo-autonomic symptom during the caloric test. However, there have been only a few clinical studies of autonomic activity during this test. To determine whether certain factors can predict the development of nausea, we performed an autonomic function test by means of R-R interval spectral analysis of the ECG during caloric testing.

MATERIAL AND METHODS

The study subjects were 53 healthy volunteers aged 22-39 years (41 males, 12 females; mean age 25.3 years) and a 35-year-old male patient with a labyrinthine defect. The caloric test was performed in 43 subjects using an air caloric apparatus with bithermal stimulation of alternate ears. After each stimulation, the subjects were asked about autonomic symptoms. Serial ECG records were obtained and R-R interval spectral analysis was performed.

RESULTS

Severe nausea was observed in 12 subjects (28%). In the group with severe nausea, the HF component of the R-R interval spectrum increased after the first caloric stimulation when autonomic symptoms had not yet become marked.

Benign paroxysmal positional vertigo can interfere with the cardiac response to head-down tilt

OBJECTIVE

To assess the pulse rate and the respiratory rate responses to head-down tilt of the whole body in the plane of the posterior canals in healthy subjects and in patients with benign paroxysmal positional vertigo (BPPV).

BACKGROUND

Although BPPV attacks are usually accompanied by autonomic symptoms, there are no studies assessing autonomic responses during triggering maneuvers for BPPV, neither in healthy subjects nor in patients.

METHODS

We evaluated nine healthy subjects and four BPPV patients (3 unilateral and 1 bilateral). Using a two-axis rotator, from an upright position they were rotated 135 degrees backwards to head-down tilt, either in the plane of the right or the left posterior canal.

RESULTS

In healthy subjects, head-down tilt always induced a significant decrease of the pulse rate, which was similar after rotation to the right and to the left posterior canals. This response was observed in patients with unilateral BPPV only when they were rotated toward the nonaffected side, and it was not evident when they were rotated toward the affected side (p < 0.025). In the patient with bilateral BPPV, no change of the pulse rate was observed after rotation toward the right or to the left posterior canal. Although, in all the patients, the respiratory rate increased during the tilt, a similar increase was observed in two healthy subjects.

CONCLUSION

After rotation in the plane of the affected semicircular canal, BPPV can interfere with the cardiac response to head-down tilt of the whole body.

Vestibular influence on the cardiorespiratory responses to whole-body oscillation after standing

We assessed the influence of vestibular stimulation by whole-body oscillation in the yaw plane on the cardiorespiratory responses after a change of posture from sitting to standing. Eighteen healthy subjects (21-70 years old) and six patients with bilateral vestibular loss (46-59 years old) were tested. For comparison, a subgroup, age matched to the patients, was created from the healthy group. After a 10-min rest, subjects who were sitting, back unsupported, stood on a platform affording en bloc head and body support. The platform was either static or oscillated at 0.1 Hz and 0.5 Hz (20 degrees amplitude) for 2 min. Presentation of the three conditions was counterbalanced. Respiration, ECG, blood pressure and head position were recorded. During oscillation at 0.5 Hz, the respiratory responses were different between groups; healthy subjects showed a significant increase of the respiratory frequency (1.75+/-2.1 breaths/min), which was not observed in the patients (0.16+/-0.7 breaths/min) ( p<0.05, ANOVA). Absolute changes of heart rate and blood pressure were similar for the three conditions in all the subjects. However, healthy subjects showed a decrease of power spectrum density of the high-frequency ('respiratory') component of heart rate variability on standing during all three conditions. This response was variable among the patients and the age-matched group. The study shows that semicircular canal activation influences the respiratory rhythm during movements in the yaw plane in standing subjects. In addition, we observed that changes of the respiratory influence on heart rate variability during orthostatic stress are not affected by yaw oscillation or chronic vestibular loss, but may be affected by factors related to age.

Aging attenuates the vestibulorespiratory reflex in humans

Activation of the vestibular system changes ventilation in humans. The purpose of the present study was to investigate whether aging alters the vestibulorespiratory reflex in humans. Because aging attenuates the vestibulosympathetic reflex, it was hypothesized that aging would attenuate the vestibulorespiratory reflex. Changes in ventilation during engagement of the semicircular canals and/or the otolith organs were measured in fourteen young (26 +/- 1 years) and twelve older subjects (66 +/- 1 years). In young subjects, natural engagement of the semicircular canals and the otolith organs by head rotation increased breathing frequency during dynamic upright pitch at 0.25 Hz (15 cycles min-1) and 0.5 Hz (30 cycles min-1) (delta2 +/- 1 and delta4 +/- 1 breaths min-1, respectively; P < 0.05) and during dynamic upright roll (delta2 +/- 1 and delta4 +/- 1, respectively; P < 0.05). In older subjects, the only significant changes in breathing frequency occurred during dynamic pitch and roll at 0.5 Hz (delta2 +/- 1 and delta2 +/- 1 for pitch and roll, respectively). Stimulation of the horizontal semicircular canals by yaw rotation increased minute ventilation in young but not older subjects. Selective engagement of the otolith organs during static head-down rotation did not alter breathing frequency in either the young or older subjects. The results of this study indicate that the vestibulorespiratory reflex is attenuated in older humans, with greater vestibular stimulation needed to activate the reflex.

Influence of vestibular activation on respiration in humans

The purpose of this study was to determine the effects of the semicircular canals and otolith organs on respiration in humans. On the basis of animal studies, we hypothesized that vestibular activation would elicit a vestibulorespiratory reflex. To test this hypothesis, respiratory measures, arterial blood pressure, and heart rate were measured during engagement of semicircular canals and/or otolith organs. Dynamic upright pitch and roll (15 cycles/min), which activate the otolith organs and semicircular canals, increased respiratory rate (Delta2 +/- 1 and Delta3 +/- 1 breaths/min, respectively; P < 0.05). Dynamic yaw and lateral pitch (15 cycles/min), which activate the semicircular canals, increased respiration similarly (Delta3 +/- 1 and Delta2 +/- 1, respectively; P < 0.05). Dynamic chair rotation (15 cycles/min), which mimics dynamic yaw but eliminates neck muscle afferent, increased respiration (Delta3 +/- 1; P < 0.05) comparable to dynamic yaw (15 cycles/min). Increases in respiratory rate were graded as greater responses occurred during upright (Delta5 +/- 2 breaths/min) and lateral pitch (Delta4 +/- 1) and roll (Delta5 +/- 1) performed at 30 cycles/min. Increases in breathing frequency resulted in increases in minute ventilation during most interventions. Static head-down rotation, which activates otolith organs, did not alter respiratory rate (Delta1 +/- 1 breaths/min). Collectively, these data indicate that semicircular canals, but not otolith organs or neck muscle afferents, mediate increased ventilation in humans and support the concept that vestibular activation alters respiration in humans.

Respiratory responses of normal and vestibular defective human subjects to rotation in the yaw and pitch planes

We evaluated the contribution of the semicircular canals to autonomic responses to rotation in 12 normal subjects and three labyrinthine defective patients. Respiration, heart rate, arterial blood pressure and blood flow in the finger were recorded during 60 degrees /s steps of constant velocity rotation. Rotation was performed in the dark about a vertical axis: (I) with head upright for yaw stimulation of horizontal canals; (II) head tilted chin down and rotated laterally to stimulate the vertical canals in both face-forwards and backwards directions. In normal subjects, rotation in the pitch plane elicited an increase in respiratory frequency due to a shortening of the time for expiration, whilst patients had inconsistent responses. We conclude that vertical semicircular canal activity exerts a regulatory drive on respiration in human subjects.