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Fattahi CB, Zaro C, Chung JJ, Lewis RF, Chari DA. Comparative utility of vestibular function tests in patients with peripheral and central vestibular dysfunction. J Otol 2024; 19:5-9. [PMID: 38313756 PMCID: PMC10837540 DOI: 10.1016/j.joto.2023.10.002] [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: 08/15/2023] [Accepted: 10/31/2023] [Indexed: 02/06/2024] Open
Abstract
Background Bithermal caloric irrigation, video head impulse test (vHIT), and rotational testing are commonly used to assess peripheral vestibular function, but the relative clinical utility of each test in differentiating patients with peripheral vestibulopathy is debated. Objectives To determine whether (1) the combination of two or more vestibular tests enhances diagnostic utility over a single test; (2) abnormal test results on vestibular tests correlate with one another. Methods Retrospective analysis of data collected from multidisciplinary vestibular clinics at two academic medical centers from 2016 to 2022. Results 150 patients (54.10 ± 15.09 years, 88 females) were included. No individual test was significantly better at predicting the presence of peripheral vestibular damage (p > 0.05). vHIT test results improved significantly when combined with either the caloric test (p = 0.007) or rotary chair test (p = 0.039). Caloric and rotational testing had high sensitivity (74.65% and 76.06%, respectively) and specificity (83.54% and 78.48%, respectively). vHIT demonstrated excellent specificity (89.87%) but poor sensitivity (47.89%). Caloric, vHIT, and rotary chair tests results did not correlate with one another (p > 0.05). Conclusions Vestibular function tests have comparable diagnostic utility, yet each offers unique advantages. Caloric and rotational testing may be best suited for screening peripheral damage and vHIT may function ideally as a confirmatory test.
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Affiliation(s)
- Cameron B. Fattahi
- Department of Otolaryngology – Head and Neck Surgery, UMASS Memorial Medical Center, University of Massachusetts Chan Medical School, Worcester, MA, USA
- Jenks Vestibular Physiology Laboratory, Massachusetts Eye and Ear, Boston, MA, USA
| | - Christopher Zaro
- Department of Otolaryngology – Head and Neck Surgery, UMASS Memorial Medical Center, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Janice J. Chung
- Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Richard F. Lewis
- Jenks Vestibular Physiology Laboratory, Massachusetts Eye and Ear, Boston, MA, USA
- Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Divya A. Chari
- Department of Otolaryngology – Head and Neck Surgery, UMASS Memorial Medical Center, University of Massachusetts Chan Medical School, Worcester, MA, USA
- Jenks Vestibular Physiology Laboratory, Massachusetts Eye and Ear, Boston, MA, USA
- Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
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Wittmeyer Cedervall L, Magnusson M, Karlberg M, Fransson PA, Nyström A, Tjernström F. vHIT Testing of Vertical Semicircular Canals With Goggles Yield Different Results Depending on Which Canal Plane Being Tested. Front Neurol 2021; 12:692196. [PMID: 34385970 PMCID: PMC8353365 DOI: 10.3389/fneur.2021.692196] [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: 04/07/2021] [Accepted: 06/24/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: The use of goggles to assess vertical semicircular canal function has become a standard method in vestibular testing, both in clinic and in research, but there are different methods and apparatus in use. The aim of this study was to determine what the cause of the systematic differences is between gain values in testing of the vertical semicircular canals with two different video head impulse test (vHIT) equipment in subjects with normal vestibular function. Study Design: Retrospective analysis of gain values on patients with clinically deemed normal vestibular function (absence of a corrective eye saccade), tested with either Interacoustics or Otometrics system. Prospective testing of subjects with normal vestibular function with the camera records the eye movements of both eyes. Finally, 3D sensors were placed on different positions on the goggles measuring the actual vertical movement in the different semicircular planes. Results: In the clinical cohorts, the gain depended on which side and semicircular canal was tested (p < 0.001). In the prospective design, the combination between the stimulated side, semicircular canal, and position of the recording device (right/left eye) highly influenced the derived gain (p < 0.001). The different parts of the goggles also moved differently in a vertical direction during vertical semicircular canal testing. Conclusion: The gain values when testing the function of the vertical semicircular canals seem to depend upon which eye is recorded and which semicircular plane is tested and suggests caution when interpreting and comparing results when different systems are used both clinically as well as in research. The results also imply that further research and development are needed to obtain accurate vertical semicircular canal testing, in regard to both methodology and equipment design.
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Affiliation(s)
- Louise Wittmeyer Cedervall
- Department of Otorhinolaryngology, Head and Neck Surgery, Clinical Sciences, Lund Skåne University Hospital Lund, Lund, Sweden
| | - Måns Magnusson
- Department of Otorhinolaryngology, Head and Neck Surgery, Clinical Sciences, Lund Skåne University Hospital Lund, Lund, Sweden
| | - Mikael Karlberg
- Department of Otorhinolaryngology, Head and Neck Surgery, Clinical Sciences, Lund Skåne University Hospital Lund, Lund, Sweden
| | - Per-Anders Fransson
- Department of Otorhinolaryngology, Head and Neck Surgery, Clinical Sciences, Lund Skåne University Hospital Lund, Lund, Sweden
| | - Anastasia Nyström
- Department of Otorhinolaryngology, Head and Neck Surgery, Clinical Sciences, Lund Skåne University Hospital Lund, Lund, Sweden
| | - Fredrik Tjernström
- Department of Otorhinolaryngology, Head and Neck Surgery, Clinical Sciences, Lund Skåne University Hospital Lund, Lund, Sweden
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Relevance of Artifact Removal and Number of Stimuli for Video Head Impulse Test Examination. Ear Hear 2021; 41:1397-1406. [PMID: 32058350 DOI: 10.1097/aud.0000000000000849] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the effect of artifacts on the impulse and response recordings with the video head impulse test (VHIT) and determine how many stimuli are necessary for obtaining acceptably efficient measurements. METHODS One hundred fifty patients were examined using VHIT and their registries searched for artifacts. We compared several variations of the dataset. The first variation used only samples without artifacts, the second used all samples (with and without artifacts), and the rest used only samples with each type of artifact. We calculated the relative efficiency (RE) of evaluating an increasingly large number of samples (3 to 19 per side) when compared with the complete sample (20 impulses per side). RESULTS Overshoot was associated with significantly higher speed (p = 0.005), higher duration (p < 0.001) and lower amplitude of the impulses (p = 0.002), and consequent higher saccades' latency (p = 0.035) and lower amplitude (p = 0.025). Loss of track was associated with lower gain (p = 0.035). Blink was associated with a higher number of saccades (p < 0.001), and wrong way was associated with lower saccade latency (p = 0.012). The coefficient of quartile deviation escalated as the number of artifacts of any type rose, indicating an increment of variability. Overshoot increased the probability of the impulse to lay on the outlier range for gain and peak speed. Blink did so for the number of saccades, and wrong way for the saccade amplitude and speed. RE reached a tolerable level of 1.1 at 7 to 10 impulses for all measurements except the PR score. CONCLUSIONS Our results suggest the necessity of removing artifacts after collecting VHIT samples to improve the accuracy and precision of results. Ten impulses are sufficient for achieving acceptable RE for all measurements except the PR score.
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Casani AP, Canelli R, Lazzerini F, Navari E. Prognosis after acute unilateral vestibulopathy: Usefulness of the suppression head impulse paradigm (SHIMP). J Vestib Res 2021; 31:531-540. [PMID: 33814480 DOI: 10.3233/ves-210038] [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] [Indexed: 01/12/2023]
Abstract
OBJECTIVES This cross-sectional study aims to describe the features of the suppression head impulse paradigm (SHIMP) in acute unilateral vestibulopathy (AUV) and to define its role in predicting the recovery of patients. METHODS Thirty patients diagnosed with AUV were retrospectively analyzed. The dizziness handicap inventory score and video head impulse test parameters performed 4-8 weeks from the AUV onset constituted the main outcome measures. Patients with a worse recovery (Group 1) and patients who recovered spontaneously (Group 2) were compared. RESULTS The SHIMP vestibulo-ocular reflex (VOR) gain was statistically significantly lower than the conventional head impulse paradigm (HIMP) VOR gain (P < 0.001). The SHIMP VOR gain was negatively correlated with the DHI (P < 0.001) and was positively correlated with the HIMP VOR gain (P < 0.001) and the SHIMP overt saccades (%) (P < 0.001). Patients with a worse recovery exhibited the following: higher DHI (P < 0.001), lower SHIMP and HIMP VOR gain (P < 0.001 and P = 0.007, respectively), and lower SHIMP and greater HIMP overt saccade prevalence values (P = 0.007 and P = 0.032, respectively). CONCLUSIONS The SHIMP and HIMP help in improving our approach to AUV. SHIMP appears to better identify the extent of the vestibular damage in patient suffering from AUV than HIMP and could provide interesting information about the course of the disease. Particularly, the analysis of SHIMP VOR gain and overt saccade prevalence would provide useful information about the recovery of patients.
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Affiliation(s)
- Augusto Pietro Casani
- Department of Surgical Pathology, Medical, Molecular and Critical Area, ENT Section, Pisa University Hospital, Pisa, Italy
| | - Rachele Canelli
- Department of Surgical Pathology, Medical, Molecular and Critical Area, ENT Section, Pisa University Hospital, Pisa, Italy
| | - Francesco Lazzerini
- Department of Surgical Pathology, Medical, Molecular and Critical Area, ENT Section, Pisa University Hospital, Pisa, Italy
| | - Elena Navari
- Department of Surgical Pathology, Medical, Molecular and Critical Area, ENT Section, Pisa University Hospital, Pisa, Italy
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Alexandru M, Courbebaisse M, Le Pajolec C, Ménage A, Papon JF, Vargas-Poussou R, Nevoux J, Blanchard A. Investigation of Vestibular Function in Adult Patients with Gitelman Syndrome: Results of an Observational Study. J Clin Med 2020; 9:jcm9113790. [PMID: 33238651 PMCID: PMC7700665 DOI: 10.3390/jcm9113790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/16/2020] [Accepted: 11/21/2020] [Indexed: 12/22/2022] Open
Abstract
Gitelman syndrome (GS) is a rare salt-losing tubulopathy caused by an inactivating mutation in the SLC12A3 gene, encoding the thiazide-sensitive sodium chloride cotransporter (NCC). Patients with GS frequently complain of vertigo, usually attributed to hypovolemia. Because NCC is also located in the endolymphatic sac, we hypothesized that patients with GS might have vestibular dysfunction. Between April 2013 and September 2016, 20 (22%) out of 90 patients followed at the reference center complained of vertigo in the absence of orthostatic hypotension. Sixteen of them were referred to an otology department for investigation of vestibular function. The vertigo was of short duration and triggered in half of them by head rotation. Seven patients (44%) had a vestibular syndrome. Vestibular syndrome was defined: (1) clinically, as nystagmus triggered by the head shaking test (n = 5); and/or (2) paraclinically, as an abnormal video head impulse test (n = 0), abnormal kinetic test (n = 4) and/or abnormal bithermal caloric test (n = 3). Five patients had associated auditory signs (tinnitus, aural fullness or hearing loss). In conclusion, we found a high frequency of vestibular disorder in GS patients suffering from vertigo, suggesting a role of NCC in the inner ear. Referent physicians of these patients should be aware of this extrarenal manifestation that requires specific investigations and treatment.
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Affiliation(s)
- Mihaela Alexandru
- AP-HP, Université Paris Saclay, Hôpital Bicêtre, Service d’Oto-Rhino-Laryngologie, 94270 Le Kremlin-Bicêtre, France; (M.A.); (C.L.P.); (A.M.); (J.-F.P.)
| | - Marie Courbebaisse
- AP-HP, Centre—Université de Paris, Hôpital Européen Georges-Pompidou, Service de Physiologie-Exploration Fonctionnelles Rénales, 75015 Paris, France;
- Faculté de Médecine Paris Descartes, Université de Paris, 75006 Paris, France
- INSERM, U1151-CNRS UMR8253, 75015 Paris, France
| | - Christine Le Pajolec
- AP-HP, Université Paris Saclay, Hôpital Bicêtre, Service d’Oto-Rhino-Laryngologie, 94270 Le Kremlin-Bicêtre, France; (M.A.); (C.L.P.); (A.M.); (J.-F.P.)
| | - Adeline Ménage
- AP-HP, Université Paris Saclay, Hôpital Bicêtre, Service d’Oto-Rhino-Laryngologie, 94270 Le Kremlin-Bicêtre, France; (M.A.); (C.L.P.); (A.M.); (J.-F.P.)
| | - Jean-François Papon
- AP-HP, Université Paris Saclay, Hôpital Bicêtre, Service d’Oto-Rhino-Laryngologie, 94270 Le Kremlin-Bicêtre, France; (M.A.); (C.L.P.); (A.M.); (J.-F.P.)
- Faculté de Médecine, Université Paris-Saclay, F-94275 Le Kremlin-Bicêtre, France
| | - Rosa Vargas-Poussou
- AP-HP, Centre—Université de Paris, Hôpital Européen Georges-Pompidou, Département de Génétique et Biologie Moléculaire, 75015 Paris, France;
- INSERM, UMRS 1138, Centre de Recherche des Cordeliers, 75006 Paris, France
- Centre de Référence des Maladies Rénales Héréditaires de l’Enfant et de l’Adulte (MARHEA), Hôpital Européen Georges-Pompidou, 75015 Paris, France
| | - Jérôme Nevoux
- AP-HP, Université Paris Saclay, Hôpital Bicêtre, Service d’Oto-Rhino-Laryngologie, 94270 Le Kremlin-Bicêtre, France; (M.A.); (C.L.P.); (A.M.); (J.-F.P.)
- Faculté de Médecine, Université Paris-Saclay, F-94275 Le Kremlin-Bicêtre, France
- INSERM, U1120, Institut Pasteur, 75724 Paris CEDEX 15, France
- Correspondence: (J.N.); (A.B.); Tel.: +33-1-4521-3688 (J.N.); +33-1-5609-2913 (A.B.)
| | - Anne Blanchard
- Faculté de Médecine Paris Descartes, Université de Paris, 75006 Paris, France
- INSERM, UMRS 1138, Centre de Recherche des Cordeliers, 75006 Paris, France
- Centre de Référence des Maladies Rénales Héréditaires de l’Enfant et de l’Adulte (MARHEA), Hôpital Européen Georges-Pompidou, 75015 Paris, France
- AP-HP, Hôpital Européen Georges-Pompidou, Centre d’Investigation Clinique 1418, 75015 Paris, France
- Correspondence: (J.N.); (A.B.); Tel.: +33-1-4521-3688 (J.N.); +33-1-5609-2913 (A.B.)
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Abrahamsen ER, Skals RK, Hougaard DD. Are gain values significantly altered by manual data selection when performing the video Head Impulse Test (v-HIT) on all six semicircular canals with two different v-HIT systems. J Vestib Res 2020; 30:305-317. [PMID: 33044206 DOI: 10.3233/ves-200717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND It has not yet been tested whether averaged gain values and the presence of pathological saccades are significantly altered by manual data selection or if data selection only done by the incorporated software detection algorithms provides a reliable data set following v-HIT testing. OBJECTIVE The primary endpoint was to evaluate whether the averaged gain values of all six SCCs are significantly altered by manual data selection with two different v-HIT systems. METHOD 120 subjects with previously neither vestibular nor neurological disorders underwent four separate tests of all six SCCs with either EyeSeeCam® or ICS Impulse®. All v-HIT test reports underwent manual data selection by an experienced ENT Specialist with deletion of any noise and/or artifacts. Generalized estimating equations were used to compare averaged gain values based on unsorted data with averaged gain values based on the sorted data. RESULTS EyeSeeCam®: Horizontal SCCs: The estimate and the p-value (shown in parenthesis) for the right lateral SCC and the left lateral SCC were 0.00004 (0.95) and 0.00087 (0.70) respectively. Vertical SCCs: The estimate varied from -0.00858 to 0.00634 with p-values ranging from 0.31 to 0.78. ICS Impulse®: Horizontal SCCs: The estimate and the p-value for the right lateral SCC and the left lateral SCC were 0.00159 (0.18) and 0.00071 (0.38) respectively. Vertical SCCs: The estimate varied from 0.00217 to 0.01357 with p-values ranging from 0.00 to 0.17. Based upon the averaged gain value from the individual SCC being tested, 148 tests before and 127 after manual data selection were considered pathological. CONCLUSION None of the two v-HIT systems revealed any clinically important effects of manual data selection. However, 21 fewer tests were considered pathological after manual data selection.
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Affiliation(s)
- Emil Riis Abrahamsen
- Department of Otolaryngology, Head & Neck Surgery and Audiology, Aalborg University Hospital, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Regitze Kuhr Skals
- Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Dan Dupont Hougaard
- Department of Otolaryngology, Head & Neck Surgery and Audiology, Aalborg University Hospital, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Swanenburg J, Büchi F, Straumann D, Weber KP, de Bruin ED. Exergaming With Integrated Head Turn Tasks Improves Compensatory Saccade Pattern in Some Patients With Chronic Peripheral Unilateral Vestibular Hypofunction. Front Neurol 2020; 11:601. [PMID: 32714269 PMCID: PMC7344241 DOI: 10.3389/fneur.2020.00601] [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: 03/17/2020] [Accepted: 05/25/2020] [Indexed: 11/13/2022] Open
Abstract
Background: This study aimed to determine whether vestibular rehabilitation using active video games (Exergames), including promoted head turns and unsupported locomotion, may facilitate vestibular compensation and gait in subjects with one-sided chronic peripheral vestibular hypofunction (cPVH). Methods: 12 patients with cPVH (mean age of 65 ± 12 years, 8 male) were recruited for this study. The study consisted of a four-week baseline control period T1-T2 followed by a four-week intervention period T2-T3. The intervention included exergames that required physical tasks such as steps, weight shifts or balance control to cognitive challenges, in a virtual environment to play the game. The subjects participated in a total of 176 min of exergaming in eight sessions. Because of the changing projection direction of the game to the wall, the subjects had to turn their heads constantly while playing the game. Dynamic visual acuity (DVA) was assessed. Vestibulo-Ocular reflex (VOR) gain deficit and cumulative overt saccade amplitude (COSA) were measured with the video head-impulse test. Additionally, the functional gait assessment (FGA), Extended Timed Get-Up-and-Go (ETGUG), and the Dizziness handicap inventory (DHI), were assessed. Results: DVA showed no significant group level change (p = 0.475, z = -0.714, d = 0.295) with a small effect size and improvements in five out of 12 subjects. Ipsilesional VOR gain did not improve (p = 0.157, z = -1.414, d = 0.481) on group level while there was an intermediate effect size and improvements in six out of 12 subjects. COSA got significant smaller (p = 0.006, z = -2.746, d = 1.354) with improvements in seven out of 12 subjects. The contralesional sides did not change. The FGA for the group significantly improved with an intermediate effect size (p < 0.001, z = -3.08, d = 1.617) and five individuals showed clinically relevant improvements. The ETGUG group value improved significantly with a strong effect size (p < 0.001, z = -2.67, d = 1.030), with seven individuals contributing to this change. The DHI showed no change (p = 0.172, z = -1.381, d = 0.592) neither on the group nor on the individuals' level. The game scores of the subjects improved during the intervention period of the intervention for every game. Conclusion: The results of this study demonstrate that exergaming with promoted head turns facilitates vestibular compensation in some subjects with cPVH. This is the first study that shows an improvement in cumulative overt saccade amplitude after exergaming in chronic vestibular subjects.
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Affiliation(s)
- Jaap Swanenburg
- Physiotherapy and Occupational Therapy Research Center, Directorate of Research and Education, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Chiropractic Medicine, Integrative Spinal Research ISR, Balgrist University Hospital, Zurich, Switzerland
| | - Fabienne Büchi
- Physiotherapy and Occupational Therapy Research Center, Directorate of Research and Education, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Dominik Straumann
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Konrad P Weber
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Eling D de Bruin
- Department Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
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Pérez-Fernández N, Alvarez-Gomez L, Manrique-Huarte R. Bilateral Vestibular Hypofunction in the Time of the Video Head Impulse Test. Audiol Neurootol 2019; 25:72-78. [PMID: 31825921 DOI: 10.1159/000504286] [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: 08/15/2019] [Accepted: 10/21/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Bilateral vestibulopathy is a clinical syndrome in which laboratory testing plays a crucial diagnostic role. We aimed to establish the frequency of detection of that finding in a tertiary level hospital considering the new methods of laboratory vestibular examination nowadays in use, with respect to the conventional caloric and rotatory chair test approaches. DESIGN Two similar time periods (5 years) were retrospectively evaluated, and the demographic, clinical data and test results from 4,576 patients were reviewed. In the first period, the diagnosis was based on caloric and rotatory chair tests and, in the second, on the video head impulse test. RESULTS Of the patients included, 3.77% in the first period and 4.58% in the second met the criteria for bilateral vestibular hypofunction; there was no significant difference between both periods. CONCLUSIONS The functional vestibular evaluation to detect bilateral deficiency makes no significant difference to the number of patients diagnosed with a bilateral vestibulopathy. New diagnostic categories probably depend not only on the availability and accessibility of complete vestibular and visual-vestibular evaluation, but also on recent advances in defining vestibular disorders. Bilateral vestibular hypofunction manifests with very different patterns. Progress in more detailed definition (clinical and laboratory) is needed, in particular when all 6 semicircular canals and both maculae are available for testing.
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Affiliation(s)
| | - Laura Alvarez-Gomez
- Department of Otorhinolaryngology, Clínica Universidad de Navarra, Pamplona, Spain
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Intra- and Interexaminer Variability of Two Separate Video Head Impulse Test Systems Assessing All Six Semicircular Canals. Otol Neurotol 2019; 39:e113-e122. [PMID: 29315187 DOI: 10.1097/mao.0000000000001665] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate intra- and interexaminer variability of the video Head Impulse Test (v-HIT) when assessing all six semicircular canals (SCCs) of two separate v-HIT systems. STUDY DESIGN Prospective study. SETTING Department of Otolaryngology, Head and Neck Surgery, Aalborg University Hospital, Denmark. PATIENTS One hundred twenty healthy subjects. INTERVENTION Four separate tests of all six SCCs with either system A or system B. Two examiners tested all subjects twice. Pretest randomization included type of v-HIT system, order of paired SCC testing, as well as initial examiner. MAIN OUTCOME MEASURE Gain values and the presence of pathological saccades were registered. Ninety-five percent limits of agreement (LOAs) were calculated for both intra- and interexaminer variability. Adding or subtracting the value from the mean difference achieves the upper and lower bound LOA. Ninety-five percent of the differences lie within these limits. RESULTS Interexaminer reliability: System A: LOAs between 0.13 and 0.24 for the horizontal SCCs and between 0.42 and 0.74 for the vertical SCCs. System B: LOAs between 0.09 and 0.13 for the horizontal SCCs and between 0.13 and 0.20 for the vertical SCCs. Intraexaminer reliability: System A: LOAs were 0.19 and 0.14 for the horizontal SCCs and varied from 0.43 to 0.53 for the vertical SCCs. System B: LOAs were 0.14 for the horizontal SCCs and varied from 0.13 to 0.22 for the vertical SCCs. CONCLUSION Horizontal SCC testing: both v-HIT systems displayed good intra- and interexaminer variability. Vertical SCC testing: System B displayed good intra- and interexaminer variability whereas the opposite was true with system A.
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Walther LE, Löhler J, Agrawal Y, Motschall E, Schubach F, Meerpohl JJ, Schmucker C. Evaluating the Diagnostic Accuracy of the Head-Impulse Test: A Scoping Review. JAMA Otolaryngol Head Neck Surg 2019; 145:550-560. [PMID: 31021380 DOI: 10.1001/jamaoto.2019.0243] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Vestibular symptoms rank among the most common complaints in medicine worldwide. Underlying disorders manifested by these symptoms are generally associated with an impairment of the vestibular-ocular reflex and can be assessed with different diagnostic procedures. In recent years, an increasing number of diagnostic test accuracy studies comparing various head-impulse test (HIT) methods with other diagnostic procedures have been published but not systematically reviewed. Objective To conduct a scoping review and describe key characteristics of the growing number of diagnostic studies in patients presenting with vestibular symptoms. Evidence Review In April 2017, published studies were identified through searches of 4 bibliographic databases: Medline, Science Citation Index Expanded, the Cochrane Library, and ScienceDirect. Studies were included if they provided diagnostic accuracy data (sensitivity and specificity) for any HIT method with reference to any other vestibular test or clinical diagnosis in patients with vestibular symptoms. Study key characteristics were extracted, and the current literature was described narratively. All analysis took place between June 2017 and July 2018. Findings We identified a total of 27 diagnostic studies (including 3821 participants). There were disagreements between diagnostic test accuracy data both within and between studies when different HIT methods were compared with other diagnostic procedures. The proportion of correctly identified people having the disease (sensitivity) ranged between 0% and 100% (median, 41%), whereas the proportion of correctly identified people without the disease (specificity) was higher and ranged between 56% and 100% (median, 94%). Conclusions and Relevance Based on the studies included in this review, sensitivity, specificity, and, more importantly, the risk of misdiagnosis and associated undertreatment or overtreatment cannot be reliably estimated by HIT methods for patients with vestibular symptoms. We recommend that further diagnostic studies consider (1) multiple possible underlying causes of vestibular symptoms and multiple test thresholds, (2) a representative sample of patients with and without the disease, and (3) reporting guidelines for diagnostic test accuracy studies.
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Affiliation(s)
- Leif Erik Walther
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jan Löhler
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Schleswig-Holstein, Lübeck, Germany
| | - Yuri Agrawal
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Edith Motschall
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center-University of Freiburg, Freiburg, Germany
| | - Fabian Schubach
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Jörg J Meerpohl
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center-University of Freiburg, Freiburg, Germany
| | - Christine Schmucker
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center-University of Freiburg, Freiburg, Germany
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Inpatient Treatment of Patients Admitted for Dizziness: A Population-Based Healthcare Research Study on Epidemiology, Diagnosis, Treatment, and Outcome. Otol Neurotol 2018; 38:e460-e469. [PMID: 28938275 DOI: 10.1097/mao.0000000000001568] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To determine inpatient treatment rates of patients with dizziness with focus on diagnostics, treatment and outcome. STUDY DESIGN Retrospective population-based study. SETTING Inpatients in the federal state Thuringia in 2014. PATIENTS All 1,262 inpatients (62% females, median age: 61 yr) treated for inpatient dizziness were included. MAIN OUTCOME MEASURES The association between analyzed parameters and probability of improvement and recovery was tested using univariable and multivariable statistics. RESULTS Final diagnosis at demission was peripheral vestibular disorder (PVD), central vestibular disorder (CVD), cardiovascular syndrome, somatoform syndrome, and unclassified disease in 75, 9, 3, 0.6, and 13%, respectively. The most frequent diseases were acute vestibular neuritis (28%) and benign paroxysmal positional vertigo (22%). The follow-up time was 38 ± 98 days. 88.5% of patients showed at least an improvement of complaints and 31.4% a complete recovery. The probability for no improvement from inpatient dizziness was higher if the patient had a history of ear/vestibular disease (hazard ratio [HR] = 1.506; 95% confidence interval [CI] = 1.301-1.742), and was taking more than two drugs for comorbidity (HR = 1.163; CI = 1.032-1.310). Compared with final diagnosis of cardiovascular syndrome, patients with PVD (HR = 1.715; CI = 1.219-2.415) and CVD (HR = 1.587; CI = 1.076-2.341) had a worse outcome. CONCLUSIONS Inpatient treatment of dizziness was highly variable in daily practice. The population-based recovery rate was worse than reported in clinical trials. We need better ways to implement clinical trial findings for inpatients with dizziness.
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Cohen HS, Stitz J, Sangi-Haghpeykar H, Williams SP, Mulavara AP, Peters BT, Bloomberg JJ. Utility of quick oculomotor tests for screening the vestibular system in the subacute and chronic populations. Acta Otolaryngol 2018; 138:382-386. [PMID: 29141478 DOI: 10.1080/00016489.2017.1398838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The goal of this study was to determine the sensitivity and specificity of some widely used, easily administered clinical tests. BACKGROUND Simple tests of oculomotor function have become widely used for clinical screening of patients suspected of having vestibular disorders despite a paucity of evidence showing good statistical support for their use in this highly variable population. METHODS Healthy controls with no history of otologic or neurologic disorders (n = 291) were compared to patients with known vestibular disorders (n = 62). All subjects performed passive and active head shaking, un-instrumented head impulse tests (HT), and video head impulse tests (vHIT) recorded with infrared video-oculography. RESULTS For both passive and active head shaking, using presence/absence of vertigo and of nystagmus, sensitivity was low (<0.40). Sensitivity of presence/absence of saccades on HT was even lower (<0.15). On vHIT, gains were all approximately = 1.0, so sensitivity was very low (approximately 0.15-0.35). Sensitivity and specificity for presence/absence of saccades were moderately poor (less than 0.70). CONCLUSION None of these tests are adequate for screening patients in the out-patient clinic for vestibular disorders or for screening people in epidemiologic studies to determine the prevalence of vestibular disorders.
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Affiliation(s)
- Helen S. Cohen
- Bobby R Alford Department of Otolaryngology–Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Jasmine Stitz
- Department of Medical Engineering, University of Applied Sciences/Upper Austria, Linz, Austria
| | | | - Susan P. Williams
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | | | - Jacob J. Bloomberg
- NASA/Johnson Space Center, Neuroscience Research Laboratories, Houston, TX, USA
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Does spectacle use lead to vestibular suppression? The Journal of Laryngology & Otology 2016; 130:1033-1038. [PMID: 27748202 DOI: 10.1017/s0022215116009051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Laboratory experiments indicate that changes in retinal image size result in adaptive recalibration or suppression of the vestibulo-ocular reflex. Myopia correction with spectacles or contact lenses also leads to retinal image size changes, and may bring about similar vestibulo-ocular reflex alterations. METHODS A hypothesis-generating preliminary investigation was conducted. In this cross-sectional study, findings of electronystagmography including bithermal caloric testing were compared between 17 volunteer myopes using spectacles or contact lenses and 17 volunteer emmetropes (with no refractive error). RESULTS Bilateral hypoactive caloric responses were demonstrated in 6 of 11 spectacle users, in 1 of 6 contact lens users and in 1 of 17 emmetropes. Hypoactive caloric responses were significantly more likely in spectacle users than in emmetropes (p < 0.01; relative risk = 9.3). CONCLUSION A significant proportion of myopes using spectacles have vestibulo-ocular reflex suppression, as demonstrated by the caloric test. This has implications for the interpretation of electronystagmography and videonystagmography results, and highlights spectacle use as a possible cause of vestibular impairment. Further corroboration of these findings is warranted, with more precise and direct vestibulo-ocular reflex tests such as rotational tests and the head impulse test.
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