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Mutlu B, Cesur S, Mutlu A, Kalcioglu MT. Vestibulo-Ocular Reflex in the Aging Population. SISLI ETFAL HASTANESI TIP BULTENI 2024; 58:45-54. [PMID: 38808050 PMCID: PMC11128693 DOI: 10.14744/semb.2023.31967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/13/2023] [Accepted: 11/01/2023] [Indexed: 05/30/2024]
Abstract
Objectives The aim of this study was to evaluate vestibulo-ocular reflex (VOR) of individuals over 60 years of age who have not been diagnosed with a specific vestibular pathology. Methods Bilateral six-semicircular canal video head impulse test (vHIT), Dizziness Handicap Inventory and European Evaluation of Vertigo scales were applied to participants. Results In total, 103 participants were included in the study (75 male, 28 female), and the mean age was 69.35 ± 7.41 years. The mean age of 7th decade group was 64.32±3.12 (59 participants; 38 male, 21 female), and the mean age of 8th decade and older group was 76.11±5.93 (44 participants; 37 male, 7 female). No significant differences were found between the VOR gains of the lateral or vertical semicircular canals between the 7th decade and 8th decade and older groups (p>0.05). In the 8th decade and older group, the presence of right lateral semicircular canal corrective saccade and left posterior semicircular canal corrective saccade showed a positively moderate correlation with VOR gains of the same semicircular canals (r=0.455, p=0.002, and r=0.518, p=0.001, respectively). No significant correlation was found between age and VOR gain in the 7th decade group, however, there was a negatively weak correlation between age and left lateral semicircular canal VOR gain (r=-0.366, p=0.017) in the 8th decade and older group. Conclusion While assessing the age-related changes in VOR using vHIT, it must be considered that the changes related to aging of the vestibular system begin to emerge in the population over 70 years of age, and corrective saccade findings may be more informative than VOR gains in revealing these changes.
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Affiliation(s)
- Basak Mutlu
- Department of Audiology, Istanbul Medeniyet University Faculty of Health Sciences, Istanbul, Türkiye
| | - Sidika Cesur
- Department of Audiology, Istanbul Medeniyet University Faculty of Health Sciences, Istanbul, Türkiye
| | - Ahmet Mutlu
- Department of Otorhinolaryngology, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Türkiye
- Department of Otorhinolaryngology, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Türkiye
| | - Mahmut Tayyar Kalcioglu
- Department of Otorhinolaryngology, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Türkiye
- Department of Otorhinolaryngology, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Türkiye
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Du Y, Liu X, Ren L, Wang Y, Ji F, Guo W, Wu Z. Saccades of video head impulse test in Meniere's disease and Vestibular Migraine: What can we learn from? J Otol 2023; 18:79-84. [PMID: 37153704 PMCID: PMC10159756 DOI: 10.1016/j.joto.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/09/2023] Open
Abstract
Background Saccades are often observed on video head impulse tests (vHIT) in patients with Meniere's Disease (MD) and Vestibular Migraine (VM). However, their saccadic features are not fully described. Objective This study aims to identify the saccades characteristics of MD and VM. Methods 75 VM patients and 103 definite unilateral MD patients were enrolled in this study. First raw saccades were exported and analyzed. The VM patients were divided into left and right based on their ears, while the MD patients were separated into affected and unaffected subgroups based on their audiograms and symptoms. Results The MD patients have more saccades on the affected side (85% vs. 69%), and saccade velocity is more consistent than the contralateral side (shown by the coefficient of variation). The saccades occurrence rates on both sides are similar in VM (77% vs. 76%), as are other saccadic parameters. The MD patients have more significant inter-aural differences than the VM patients, manifested in higher velocity (p-value 0.000), earlier arriving (p-value 0.010), and more time-domain gathered (p-value 0.003) on the affected side. Conclusions Bilateral saccades are commonly observed in MD and VM. In contrast to MD, saccades on VM are subtle, scattered, and late-arrived. Furthermore, the MD patients showed inconsistent saccadic distribution with more velocity-uniform saccades on the affected side.
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Affiliation(s)
- Yi Du
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, 28 Fuxing Road, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
- State Key Lab of Hearing Science, Ministry of Education, Beijing, China
- Beijing Key Lab of Hearing Impairment Prevention and Treatment, Beijing, China
| | - Xingjian Liu
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, 28 Fuxing Road, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
- State Key Lab of Hearing Science, Ministry of Education, Beijing, China
- Beijing Key Lab of Hearing Impairment Prevention and Treatment, Beijing, China
| | - Lili Ren
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, 28 Fuxing Road, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
- State Key Lab of Hearing Science, Ministry of Education, Beijing, China
- Beijing Key Lab of Hearing Impairment Prevention and Treatment, Beijing, China
| | - Yu Wang
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, 28 Fuxing Road, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
- State Key Lab of Hearing Science, Ministry of Education, Beijing, China
- Beijing Key Lab of Hearing Impairment Prevention and Treatment, Beijing, China
| | - Fei Ji
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, 28 Fuxing Road, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
- State Key Lab of Hearing Science, Ministry of Education, Beijing, China
- Beijing Key Lab of Hearing Impairment Prevention and Treatment, Beijing, China
| | - Weiwei Guo
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, 28 Fuxing Road, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
- State Key Lab of Hearing Science, Ministry of Education, Beijing, China
- Beijing Key Lab of Hearing Impairment Prevention and Treatment, Beijing, China
| | - Ziming Wu
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, 28 Fuxing Road, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
- State Key Lab of Hearing Science, Ministry of Education, Beijing, China
- Beijing Key Lab of Hearing Impairment Prevention and Treatment, Beijing, China
- Corresponding author. College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China.
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Wagner AR, Akinsola O, Chaudhari AMW, Bigelow KE, Merfeld DM. Measuring Vestibular Contributions to Age-Related Balance Impairment: A Review. Front Neurol 2021; 12:635305. [PMID: 33633678 PMCID: PMC7900546 DOI: 10.3389/fneur.2021.635305] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/18/2021] [Indexed: 12/16/2022] Open
Abstract
Aging is associated with progressive declines in both the vestibular and human balance systems. While vestibular lesions certainly contribute to imbalance, the specific contributions of age-related vestibular declines to age-related balance impairment is poorly understood. This gap in knowledge results from the absence of a standardized method for measuring age-related changes to the vestibular balance pathways. The purpose of this manuscript is to provide an overview of the existing body of literature as it pertains to the methods currently used to infer vestibular contributions to age-related imbalance.
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Affiliation(s)
- Andrew R. Wagner
- School of Health and Rehabilitation Science, The Ohio State University, Columbus, OH, United States
- Department of Otolaryngology—Head and Neck Surgery, The Ohio State University, Columbus, OH, United States
| | - Olaoluwa Akinsola
- Department of Mechanical and Aerospace Engineering, The Ohio State University, Columbus, OH, United States
| | - Ajit M. W. Chaudhari
- School of Health and Rehabilitation Science, The Ohio State University, Columbus, OH, United States
- Department of Mechanical and Aerospace Engineering, The Ohio State University, Columbus, OH, United States
| | - Kimberly E. Bigelow
- Department of Mechanical and Aerospace Engineering, University of Dayton, Dayton, OH, United States
| | - Daniel M. Merfeld
- School of Health and Rehabilitation Science, The Ohio State University, Columbus, OH, United States
- Department of Otolaryngology—Head and Neck Surgery, The Ohio State University, Columbus, OH, United States
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, United States
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Comparison of three video head impulse test systems for the diagnosis of bilateral vestibulopathy. J Neurol 2020; 267:256-264. [PMID: 32719974 PMCID: PMC7718202 DOI: 10.1007/s00415-020-10060-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/15/2020] [Accepted: 07/06/2020] [Indexed: 10/26/2022]
Abstract
INTRODUCTION A horizontal vestibulo-ocular reflex gain (VOR gain) of < 0.6, measured by the video head impulse test (VHIT), is one of the diagnostic criteria for bilateral vestibulopathy (BV) according to the Báràny Society. Several VHIT systems are commercially available, each with different techniques of tracking head and eye movements and different methods of gain calculation. This study compared three different VHIT systems in patients diagnosed with BV. METHODS This study comprised 46 BV patients (diagnosed according to the Báràny criteria), tested with three commercial VHIT systems (Interacoustics, Otometrics and Synapsys) in random order. Main outcome parameter was VOR gain as calculated by the system, and the agreement on BV diagnosis (VOR gain < 0.6) between the VHIT systems. Peak head velocities, the order effect and covert saccades were analysed separately, to determine whether these parameters could have influenced differences in outcome between VHIT systems. RESULTS VOR gain in the Synapsys system differed significantly from VOR gain in the other two systems [F(1.256, 33.916) = 35.681, p < 0.000]. The VHIT systems agreed in 83% of the patients on the BV diagnosis. Peak head velocities, the order effect and covert saccades were not likely to have influenced the above mentioned results. CONCLUSION To conclude, using different VHIT systems in the same BV patient can lead to clinically significant differences in VOR gain, when using a cut-off value of 0.6. This might hinder proper diagnosis of BV patients. It would, therefore, be preferred that VHIT systems are standardised regarding eye and head tracking methods, and VOR gain calculation algorithms. Until then, it is advised to not only take the VOR gain in consideration when assessing a VHIT trial, but also look at the raw traces and the compensatory saccades.
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Wagner AR, Schubert MC. Evidence a shared mechanism mediates ipsi- and contralesional compensatory saccades and gait after unilateral vestibular deafferentation. J Neurophysiol 2020; 123:1486-1495. [DOI: 10.1152/jn.00585.2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The study objective was to understand how the contralesional labyrinth contributes to gaze and gait stability after unilateral vestibular deafferentation (UVD). Head impulse testing (vHIT) was completed in 37 individuals [22 women (59%); age 52.13 ± 11.59 yr, mean ± SD] with UVD from vestibular schwannoma resection. Compensatory saccades (CS) and vestibulo-ocular reflex (VOR) gain were analyzed for both ipsilesional and contralesional impulses. Gait speed (10-m walk test) and endurance (2-min walk test) were collected for 35 individuals. CS were recruited during contralesional head rotation regardless of VOR gain on either the ipsilesional [ρ = 0.21 (−0.14, 0.57); Spearman rank (95% confidence interval)] or contralesional side [ρ = −0.04 (−0.42, 0.35)]. Additionally, the latency of these CS (151.19 ± 52.41 ms) was similar to that of CS generated during ipsilesional rotation (165.65 ± 21.62 ms; P = 0.159). CS recruited during ipsilesional vHIT were of a higher velocity ( P < 0.001) and greater frequency ( P < 0.001) compared with contralesional CS. VOR gain asymmetry was significantly correlated with gait speed [ρ = −0.37 (−0.73, −0.01)], yet individual VOR gain was not correlated [ipsilesional: ρ = 0.17 (−0.20, 0.55); contralesional: ρ = −0.18 (−0.52, 0.15)]. Our data reveal CS are recruited at similar latencies without correlation to VOR gain or direction of head rotation, and that the central integration of ipsilesional and contralesional vestibular afference correlates with gait. Together, our data suggest the brain considers vestibular afference from both sides when generating related behavioral output after UVD. NEW & NOTEWORTHY After unilateral vestibular deafferentation, compensatory saccades (CS) have similar latencies regardless of the direction of head rotation, and those CS generated during contralesional head rotation are unrelated to extent of vestibular loss. Additionally, the extent of asymmetry in residual vestibular function, not the extent of vestibular loss, correlates with gait speed. Our data suggest a common mechanism is responsible for the generation of CS and restoration of gait speed in vestibular compensation.
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Affiliation(s)
- Andrew R. Wagner
- College of Medicine, School of Health and Rehabilitation Science, The Ohio State University, Columbus, Ohio
| | - Michael C. Schubert
- Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology - Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Physical Medicine and Rehabilitation, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Wenzel A, Hülse R, Thunsdorff C, Rotter N, Curthoys I. Reducing the number of impulses in video head impulse testing - It's the quality not the numbers. Int J Pediatr Otorhinolaryngol 2019; 125:206-211. [PMID: 31415955 DOI: 10.1016/j.ijporl.2019.07.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 07/14/2019] [Accepted: 07/14/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The video-Head-Impulse-Test (vHIT) is widely used to evaluate vestibular function. Nevertheless, there is no consensus on the necessary or ideal number of impulses performed for robust VOR gains. Therefore, the aim of our study is to analyze how many impulses are needed to receive reliable VOR gains in difficult testing situations like testing children younger than 48 months and in children with vestibular loss. METHODS A retrospective data analysis was performed in which existing vHIT results of 25 healthy children aged 5-48 months were included as well as vHIT results of 25 children with vestibular loss aged 2-16 years. Descriptive data analysis was performed and further statistical analysis was conducted to determine if the number of head impulses could be reduced using internal consistency (Cronbach's alpha) and paired t-test. RESULTS Median gain was 0.95 (±0.16) for impulses to the right and 0.97 (±0.16) for impulses to the left in healthy children and ranged from 0.01 (±0.11) to 0.75 (+/- 0.23) in children with vestibular hypfunction. Analyzing Cronbach's Alpha, a 99.6% (α = 0.996) true score variance was achieved when two impulses were performed to the right and 98,1% to the left in healthy children and 99.9% in children with impaired vestibular function. CONCLUSION These results indicate that two high velocity artifact-free impulses from an experienced tester are sufficient to evaluate vestibular function in difficult vHIT testing conditions like testing very young children. Further impulses do not improve test reliability.
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Affiliation(s)
- Angela Wenzel
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Mannheim, Germany.
| | - Roland Hülse
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Mannheim, Germany; SRH University, Heidelberg, Germany
| | | | - Nicole Rotter
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Mannheim, Germany
| | - Ian Curthoys
- Vestibular Research Laboratory, School of Psychology, The University of Sydney, Sydney, NSW, Australia
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Jay DR, Cane D, Howe S. Age Is a Greater Influence on Small Saccades Than Target Size in Normal Subjects on the Horizontal Video Head Impulse Test. Front Neurol 2019; 10:328. [PMID: 31040813 PMCID: PMC6476940 DOI: 10.3389/fneur.2019.00328] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 03/18/2019] [Indexed: 12/01/2022] Open
Abstract
Objective: This study sought to investigate whether the size of the target used in the horizontal vHIT has an effect on the saccade profile of healthy subjects, and to expand upon previous work linking age to the existence of small vHIT saccades. Methods: Forty eight participants were recruited between 18 and 77 years of age, with no history of vestibular, oculomotor or neurological conditions and a visual acuity of at least 0.3 LogMAR. Participants underwent four consecutive horizontal vHIT trials using the standard target size and three smaller targets. VOR gain and metrics for saccadic incidence, peak eye velocity and latency were then extracted from results. Results: Target size was a statistically significant influence on saccade metrics. As target size increased, saccadic incidence decreased while peak eye velocity and latency increased. However, a potential order effect was also discovered, and once this was corrected for the remaining effect of target size was small and is likely clinically insignificant. The effect of age was much stronger than target size; increasing age was strongly positively correlated with saccadic incidence and showed a medium size correlation with peak velocity, though not with saccadic latency. Conclusion: While this study suggests that target size may have a statistically significant impact on the vHIT saccade profile of normal subjects, age has a greater influence on the incidence and size of small vHIT saccades.
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Affiliation(s)
- David R Jay
- Manchester Head and Neck Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Debbie Cane
- Manchester Centre for Audiology and Deafness, The University of Manchester, Manchester, United Kingdom
| | - Simon Howe
- Manchester Centre for Audiology and Deafness, The University of Manchester, Manchester, United Kingdom.,Department of Audiology, The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom
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Abstract
PURPOSE OF REVIEW Individuals over the age of 60 are at an increased risk of falls, even if they do not have an isolated dysfunction of the vestibular system. The aim of this article is to review the various vestibular testing currently available and its usefulness in determining the presence of vestibular dysfunction in the elderly population. The primary vestibular tests to be reviewed include: balance function testing, vestibular evoked myogenic potentials (VEMPs), and video head impulse testing (vHIT). RECENT FINDINGS Balance function testing is important as it evaluates the integration of vestibular information along with sensory and visual information, which may also be impaired. VEMP testing provides a small diagnostic yield as most elderly patients have absent or reduced responses. vHIT gain is reduced in this population, but will still be within the normal range for individuals with normal balance function. SUMMARY The combination of various vestibular tests provides complimentary information instead of redundant information on the patient's balance function. Each test evaluates various aspects of the vestibular system which are all needed to determine stable balance in the elderly population.
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Judge PD, Rodriguez AI, Barin K, Janky KL. Impact of Target Distance, Target Size, and Visual Acuity on the Video Head Impulse Test. Otolaryngol Head Neck Surg 2018; 159:739-742. [PMID: 29865935 DOI: 10.1177/0194599818779908] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The video head impulse test (vHIT) assesses the vestibulo-ocular reflex. Few have evaluated whether environmental factors or visual acuity influence the vHIT. The purpose of this study was to evaluate the influence of target distance, target size, and visual acuity on vHIT outcomes. Thirty-eight normal controls and 8 subjects with vestibular loss (VL) participated. vHIT was completed at 3 distances and with 3 target sizes. Normal controls were subdivided on the basis of visual acuity. Corrective saccade frequency, corrective saccade amplitude, and gain were tabulated. In the normal control group, there were no significant effects of target size or visual acuity for any vHIT outcome parameters; however, gain increased as target distance decreased. The VL group demonstrated higher corrective saccade frequency and amplitude and lower gain as compared with controls. In conclusion, decreasing target distance increases gain for normal controls but not subjects with VL. Preliminarily, visual acuity does not affect vHIT outcomes.
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Affiliation(s)
- Paul D Judge
- 1 University of Nebraska Medical Center, Omaha, Nebraska, USA
| | | | - Kamran Barin
- 3 Eye and Ear Institute, The Ohio State University, Columbus, Ohio, USA
| | - Kristen L Janky
- 2 Boys Town National Research Hospital, Omaha, Nebraska, USA
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