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Suh MW, Shim DB, Kim MB, Park MK, Moon IJ, Hong SK, Oh K, Kim Y, Kim H, Kim SH. Nationwide Prevalence of Video Head Impulse Test Abnormality and its Risk Factors in South Korea. Otolaryngol Head Neck Surg 2024. [PMID: 38881387 DOI: 10.1002/ohn.856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 05/16/2024] [Accepted: 05/26/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVE To identify the prevalence of and relevant information for video head impulse test (vHIT) abnormality in a large population. STUDY DESIGN A cross-sectional design. SETTING Korean National Health and Nutrition Examination Survey, 2021. METHODS The sample was representative of the Korean population, with 2237 participants aged ≥40 years. A vHIT was performed to evaluate vestibular function. The vestibulo-ocular reflex (VOR) gain and the presence of reproducible catch-up saccades was assessed in a vHIT. Participants also completed questionnaires for demographics, socioeconomic status, and basic information regarding systemic diseases and dizziness and underwent hearing tests with automated pure-tone audiometry. RESULTS The prevalence of vHIT abnormality was 22.5%, with unilateral (14.3%) being more common than bilateral (8.2%). The prevalence of vHIT abnormality increased significantly with age, with the highest rate observed in individuals aged >70 years (42.5%). Both hearing and VOR gain deteriorated with age, but the patterns of age-related progression were different. While hearing loss (HL) deteriorated gradually and progressively throughout adulthood, VOR gain deterioration was markedly evident after 70 years of age. CONCLUSION Considering the high prevalence of vHIT abnormality, appropriate social and medical policies are needed to prevent associated injuries and improve patients' quality of life. The distinct age-related changes in HL and objective findings of vestibular dysfunction indicate the need for different approaches to address these social problems in aging countries.
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Affiliation(s)
- Myung-Whan Suh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dae Bo Shim
- Department of Otorhinolaryngology Myongji Hospital, Hanyang University College of Medicine, Goyang-si, Republic of Korea
| | - Min-Beom Kim
- Department of Otorhinolaryngology-Head and Neck, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Moo Kyun Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Il Joon Moon
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Kwang Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Anyang-si, Republic of Korea
| | - Kyungwon Oh
- Division of Health and Nutrition Survey and Analysis, Bureau of Chronic Disease Prevention and Control, Korea Disease Control and Prevention Agency, Cheongju-si, Republic of Korea
| | - Yoonjung Kim
- Division of Health and Nutrition Survey and Analysis, Bureau of Chronic Disease Prevention and Control, Korea Disease Control and Prevention Agency, Cheongju-si, Republic of Korea
| | - Hyejin Kim
- Division of Health and Nutrition Survey and Analysis, Bureau of Chronic Disease Prevention and Control, Korea Disease Control and Prevention Agency, Cheongju-si, Republic of Korea
| | - Sung Huhn Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
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Jasinska-Nowacka A, Niemczyk K. Application of a Video Head Impulse Test in the Diagnosis of Vestibular Neuritis. Life (Basel) 2024; 14:757. [PMID: 38929740 PMCID: PMC11204878 DOI: 10.3390/life14060757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/08/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Abstract
In patients presenting in the emergency department with acute vertigo, a rapid and accurate differential diagnosis is crucial, as posterior circulation strokes can mimic acute vestibular losses, leading to inappropriate treatment. The diagnosis of vestibular neuritis is made based on the clinical manifestation and a bedside otoneurological assessment. In the clinical examination, an evaluation of the vestibulo-ocular reflex is the key element; however, the accuracy of the bedside head impulse test depends on the clinician's experience. Thus, new diagnostic methods are needed to objectify and facilitate such rapid vestibular evaluations. The aim of our paper is to provide a comprehensive review of the video head impulse test's application in the diagnosis of vestibular neuritis. Numerous studies have reported advantages that make this method helpful in detailed otoneurological evaluations; in contrast to the bedside head impulse test, it enables an analysis of all six semicircular canals function and records the covert corrective saccades, which are invisible to the naked eye. As a portable and easy diagnostic tool, it is known to improve the diagnostic accuracy in patients with acute vertigo presenting in the emergency department. Moreover, as it evaluates the vestibulo-ocular reflex across different frequencies, as compared to caloric tests, it can be used as an additional test that is complementary to videonystagmography. Recently, several papers have described the application of the video head impulse test in follow-up and recovery evaluations in patients with vestibular neuritis.
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Affiliation(s)
- Agnieszka Jasinska-Nowacka
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Warsaw, 02-091 Warszawa, Poland;
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Wenyan X, Lifeng Y, Jing W, Hui J. Vestibular function in cases of posterior semicircular canal canalolithiasis and cupulolithiasis. Front Neurol 2024; 15:1369193. [PMID: 38487330 PMCID: PMC10937546 DOI: 10.3389/fneur.2024.1369193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/19/2024] [Indexed: 03/17/2024] Open
Abstract
Objective To analyze and compare the vestibular function of posterior canal cupulolithiasis and canalolithiasis. Methods The results of posterior cupulolithiasis in 45 cases, posterior canalolithiasis in 122 cases and 19 healthy controls were analyzed retrospectively. Results The abnormal rates of vHIT in the canalolithiasis group and the cupulolithiasis group were 42.6 and 37.8%, respectively, both higher than those in the control group (both p < 0.05); there was no statistically significant difference between two BPPV groups (p = 0.573). The abnormal vHIT in 76.9% of the canalolithiasis cases and 82.4% of the cupulolithiasis cases showed normal gain with saccades, with no difference between the groups (p = 0.859). The lesion location of vHIT in the two groups did not show a correlation with the affected side of BPPV (both p > 0.05). 84.4% of canalolithiasis and 65.0% of cupulolithiasis had abnormal VEMP results, with no significant differences in abnormality rates or sides (both p > 0.05). Abnormal results of VEMPs did not show any correlation with side (p > 0.05). The results of pc-ca and pc-cu were both abnormal in 14 cases and 7 cases, and there was no correlation between the site and side of the injury (all p > 0.05). Conclusion The results of vHIT and VEMP in pc-cu and pc-ca were partially abnormal, but they did not show any correlation with side of BPPV. It can be considered that there are scattered vestibular peripheral organ damage in both groups.
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Affiliation(s)
- Xu Wenyan
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yue Lifeng
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Wu Jing
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jiang Hui
- Department of Otolaryngology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
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Li Z, Miao L, Zhang T, Li X. Objective Neurological Testing Methods Used to Follow Up Vestibular Neuritis Depending on Different Factors. Int J Gen Med 2023; 16:4991-5002. [PMID: 37933252 PMCID: PMC10625780 DOI: 10.2147/ijgm.s436206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/20/2023] [Indexed: 11/08/2023] Open
Abstract
Purpose We analyze the impact of different factors on clinical performance and prognosis in vestibular neuritis (VN) and explore indicators that could accurately reflect changes in patients' symptoms at different stages. Methods We observed patients with VN during the acute and recovery phases. Clinical symptoms, vertigo-related scales, neurological examination, vestibular function tests (caloric test, video head impulse test (vHIT), vestibular evoked myogenic potential (VEMP)), and the history of disease (underlying diseases, glucocorticoid therapy) were recorded at onset and at 4 and 12 weeks after onset in VN patients. Multiple linear regression analysis was used to identify vestibular function tests that had a linear regression relationship with the subjective quantitative results. Results At 4 weeks after onset, the group without underlying disease had better improvement in EEV, gain, and UW than the group with underlying disease (P < 0.05). There was a significant difference in the change in DHI, EEV, gain of the affected horizontal semicircular canal in the vHIT and unilateral weakness (UW) between the glucocorticoid treatment group and the no glucocorticoid treatment group (P < 0.05), and glucocorticoid treatment group was better. The change value in the gain of horizontal canals in the vHIT was mainly positively and linearly correlated with the EEV scores (P<0.001). Possible dynamic correlation between vHIT results and vestibular symptoms. Conclusion The absence of underlying disease and the receipt of glucocorticoid therapy significantly contributed to the improvement of objective vestibular function tests in the short term, while the improvement of subjective vertigo may correlate with the different objective measures and questionnaire. We believe that the improvement of the affected horizontal semicircular canal gain value in the vHIT can be used as a reference indicator of the degree of improvement of vestibular symptoms with superior vestibular neuritis.
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Affiliation(s)
- Zidong Li
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, People’s Republic of China
| | - Lu Miao
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, People’s Republic of China
| | - Tianyi Zhang
- School of Basic Medical Sciences, Shandong University, Jinan, 250000, People’s Republic of China
| | - Xinyi Li
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, People’s Republic of China
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Ha SH, Lee DK, Park G, Kim BJ, Chang JY, Kang DW, Kwon SU, Kim JS, Park HJ, Lee EJ. Prospective analysis of video head impulse tests in patients with acute posterior circulation stroke. Front Neurol 2023; 14:1256826. [PMID: 37808489 PMCID: PMC10557255 DOI: 10.3389/fneur.2023.1256826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/05/2023] [Indexed: 10/10/2023] Open
Abstract
Background Video head impulse tests (vHITs), assessing the vestibulo-ocular reflex (VOR), may be helpful in the differential diagnosis of acute dizziness. We aimed to investigate vHITs in patients with acute posterior circulation stroke (PCS) to examine whether these findings could exhibit significant abnormalities based on lesion locations, and to evaluate diagnostic value of vHIT in differentiating dizziness between PCS and vestibular neuritis (VN). Methods We prospectively recruited consecutive 80 patients with acute PCS and analyzed vHIT findings according to the presence of dorsal brainstem stroke (DBS). We also compared vHIT findings between PCS patients with dizziness and a previously studied VN group (n = 29). Receiver operating characteristic (ROC) analysis was performed to assess the performance of VOR gain and its asymmetry in distinguishing dizziness between PCS and VN. Results Patients with PCS underwent vHIT within a median of 2 days from stroke onset. Mean horizontal VOR gain was 0.97, and there was no significant difference between PCS patients with DBS (n = 15) and without (n = 65). None exhibited pathologic overt corrective saccades. When comparing the PCS group with dizziness (n = 40) to the VN group (n = 29), patients with VN demonstrated significantly lower mean VOR gains in the ipsilesional horizontal canals (1.00 vs. 0.57, p < 0.001). VOR gain and their asymmetry effectively differentiated dizziness in the PCS from VN groups, with an area under the ROC curve of 0.86 (95% CI 0.74-0.98) and 0.91 (95% CI 0.83-0.99, p < 0.001), respectively. Conclusion Significantly abnormal vHIT results were rare in patients with acute PCS, even in the presence of DBS. Moreover, vHIT effectively differentiated dizziness between PCS and VN, highlighting its potential for aiding differential diagnosis of acute dizziness.
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Affiliation(s)
- Sang Hee Ha
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Department of Neurology, Gil Medical Center, Gachon University, Incheon, Republic of Korea
| | - Dong Kyu Lee
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Gayoung Park
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jun Young Chang
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong-Wha Kang
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sun U. Kwon
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong S. Kim
- Department of Neurology, Gangneung Asan Hospital, University of Ulsan, Gangneung, Gangwon-do, Republic of Korea
| | - Hong Ju Park
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Eun-Jae Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Liu Y, Leng Y, Zhou R, Liu J, Wang H, Xia K, Liu B, Xiao H. Discrepancies of video head impulse test results in patients with idiopathic sudden sensorineural hearing loss with vertigo and vestibular neuritis. Front Neurosci 2023; 17:1102512. [PMID: 37139518 PMCID: PMC10150120 DOI: 10.3389/fnins.2023.1102512] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/13/2023] [Indexed: 05/05/2023] Open
Abstract
Objective Sudden sensorineural hearing loss with vertigo (SHLV) and vestibular neuritis (VN) remain frequent causes of acute vestibular syndrome (AVS). The aim of study was to compare the results of video head impulse test (vHIT) in patients with SHLV and VN. The characteristics of high-frequency vestibule-ocular reflex (VOR) and the differences of the pathophysiological mechanisms underlying these two AVS were explored. Methods Fifty-seven SHLV patients and 31 VN patients were enrolled. vHIT was conducted at the initial presentation. The VOR gains and occurrence of corrective saccades (CSs) of anterior, horizontal, and posterior semicircular canals (SCCs) in two groups were analyzed. Pathological vHIT results refer to impaired VOR gains and presence of CSs. Results In SHLV group, pathological vHIT results was most prevalent in the posterior SCC on the affected side (30/57, 52.63%), followed by horizontal (12/57, 21.05%) and anterior SCC (3/57, 5.26%). In VN group, pathological vHIT preferentially affected horizontal SCC (24/31, 77.42%), followed by anterior (10/31, 32.26%) and posterior SCC (9/31, 29.03%) on the affected side. As for anterior and horizontal SCC on the affected side, the incidences of pathological vHIT results in VN group were significantly higher than those in SHLV group (β = 2.905, p < 0.01; β = 2.183, p < 0.001). There were no significant differences in the incidence of pathological vHIT result in posterior SCC between two groups. Conclusion Comparison of vHIT results in patients with SHLV and VN revealed discrepancies in the pattern of SCCs impairments, which may be explained by different pathophysiological mechanisms underlying these two vestibular disorders presenting as AVS.
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Affiliation(s)
| | | | | | | | | | | | - Bo Liu
- *Correspondence: Bo Liu, ; Hongjun Xiao,
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Alfarghal M, Algarni MA, Sinha SK, Nagarajan A. VOR gain of lateral semicircular canal using video head impulse test in acute unilateral vestibular hypofunction: A systematic review. Front Neurol 2022; 13:948462. [PMID: 36570452 PMCID: PMC9773140 DOI: 10.3389/fneur.2022.948462] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 11/11/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction Acute unilateral vestibular hypofunction is characterized by sudden onset of vertigo or dizziness, vomiting/nausea, gait instability, and nystagmus. This is commonly described as an acute vestibular syndrome and usually attributed to vestibular neuritis; however, up to 25% of acute vestibular syndrome is caused by a stroke of posterior circulations. The video head impulse test is a recent tool in the vestibular test battery that assesses the vestibule-ocular reflex by measuring the VOR gain and recording overt and covert saccades, these findings have been found to be helpful in the diagnosis of various vestibular disorders. Method A literature search was conducted in databases, including PubMed Central, PubMed, and Web of Science. All the articles that define video head impulse test (vHIT), acute vestibular hypofunction, and vestibular neuritis were considered for the preliminary search. No limits were placed on the date of publication. The searches were limited to studies with full-text availability, published in English, and including human subjects. Search words such as "head impulse test," "video head impulse test," "vestibular ocular reflex," "acute vestibular syndrome," "acute vestibular hypofunction," "vestibular neuritis," and "vHIT in central vestibular disorders" were entered into different databases in different combinations using boolean operators such as AND, OR, and NOT. Results Searches across different databases, including Web of Science, PubMed Central, and PubMed, resulted in a total of 1,790 articles. Title screening was done for all the articles. Out of the 1,790 articles, we found that 245 articles were related to vestibular hypofunction i.e., 1,545 articles were removed at this stage. A further 56 duplicate articles were removed. This led to a final screening of 189 articles. The exclusion criteria included unavailability of full text, studies reported in languages other than English, case reports, reviews, and articles including participants having other comorbid conditions. This final screening led to 133 articles being excluded, which led to the full-text screening of 56 articles. After screening the full-text articles as per the eligibility criteria, 21 articles were found to be eligible for the systematic review. Among the remaining studies, six articles were excluded due to different specific reasons. A total of 15 articles were included in this systematic review. The mean VOR gain for the patients with vestibular neuritis was 0.48 ± 0.14 for the ipsilesional ear, whereas the mean VOR gain was > 0.80 in the contralesional ear for all the patients with acute vestibular neuritis. In patients with PICA lesions, the VOR gain for the ipsilesional ear was 0.90 (range 0.87-0.94) and for the contralesional ear was 0.88 (range 0.84-0.93). In patients with AICA lesions, the mean VOR gain was variable. Based on the above mean VOR gain findings, the authors propose the following adjective description scale of VOR of the lateral canal using vHIT: normal VOR gain above 0.80, mild VOR gain loss for 0.70-0.79, moderate loss for 0.69-0.4, severe loss for 0.39-0.2, and profound loss for < 0.2.
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Affiliation(s)
- Mohamad Alfarghal
- Otorhinolaryngology - Head and Neck Section, Surgery Department, King Abdulaziz Medical City, Jeddah, Saudi Arabia,*Correspondence: Mohamad Alfarghal
| | - Mohammed Abdullah Algarni
- Otorhinolaryngology - Head and Neck Section, Surgery Department, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Sujeet Kumar Sinha
- Department of Audiology, All India Institute of Speech and Hearing, Mysore, India
| | - Aishwarya Nagarajan
- Department of Audiology, All India Institute of Speech and Hearing, Mysore, India
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Yetiser S, Ince D. Videonystagmography (VNG) and video head impulse test (vHIT) analysis of patients with migraine who had first episode of vertigo. HEARING, BALANCE AND COMMUNICATION 2022. [DOI: 10.1080/21695717.2022.2142382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Sertac Yetiser
- Department of ORL & HNS, Anadolu Medical Center, Gebze, Turkey
| | - Dilay Ince
- Department of ORL & HNS, Anadolu Medical Center, Gebze, Turkey
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Kwon H, Kwon E, Kim H, Choi J, Kim J. Vestibular syncope: clinical characteristics and mechanism. Ann Clin Transl Neurol 2022; 9:1616-1625. [PMID: 36056529 PMCID: PMC9539380 DOI: 10.1002/acn3.51661] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/14/2022] [Accepted: 08/16/2022] [Indexed: 12/19/2022] Open
Abstract
Background and Objectives Vestibular syncope is a condition in which vertigo‐induced hemodynamic changes cause syncope. This study investigated the clinical and laboratory findings of vestibular syncope and tried to refine our knowledge of the mechanism underlying this newly recognized entity. Methods This study retrospectively analyzed 53 patients (33 women, median age = 63 years [interquartile range = 54–71 years]) with vestibular syncope from January 2017 to December 2021. To explain the mechanism of vestibular syncope, we incorporated a velocity‐storage model into the dual reflex pathways comprising the vestibulo‐sympathetic reflex and baroreflex and predicted the cardiovascular responses. Results Twenty (37.7%) patients had multiple episodes of vestibular syncope, and seven (13.2%) had potentially life‐threatening injuries. Meniere's disease (20.8%) and benign paroxysmal positional vertigo (9.4%) were the most common underlying vestibular disorders. Abnormal vestibular function tests included impaired cervical vestibular‐evoked myogenic potentials (57.5%) and positive head impulse tests (31.0%). Orthostatic hypotension was found in 19.5% of patients. Dyslipidemia (30.2%) and hypertension (28.3%) were common medical comorbidities. The dual reflex pathways incorporating the function of the velocity‐storage circuit in the brainstem and cerebellum suggest that vestibular syncope is a neurally mediated reflex syncope associated with a sudden hemodynamic change during vertigo. This change can be arterial hypertension triggered by a false downward inertial cue, as suggested previously, or hypotension driven by a false upward inertial cue. Conclusions Vestibular syncope is associated with various vestibular disorders and requires careful evaluation and intervention to prevent recurrent falls and significant injuries.
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Affiliation(s)
- Hanim Kwon
- Department of NeurologyKorea University Ansan HospitalAnsanSouth Korea
| | - Eunjin Kwon
- Department of NeurologyChungnam National University HospitalDaejeonSouth Korea
| | - Hyo‐Jung Kim
- Research Administration TeamSeoul National University Bundang HospitalSeongnamSouth Korea
| | - Jeong‐Yoon Choi
- Dizziness Center, Clinical Neuroscience Center, and Department of NeurologySeoul National University Bundang HospitalSeongnamSouth Korea
- Department of NeurologySeoul National University College of MedicineSeoulSouth Korea
| | - Ji‐Soo Kim
- Dizziness Center, Clinical Neuroscience Center, and Department of NeurologySeoul National University Bundang HospitalSeongnamSouth Korea
- Department of NeurologySeoul National University College of MedicineSeoulSouth Korea
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Li X, Ling X, Li Z, Song N, Ba X, Yang B, Yang X, Sui R. Clinical characteristics of patients with dizziness/vertigo showing a dissociation between caloric and video head impulse test results. EAR, NOSE & THROAT JOURNAL 2022:1455613221113790. [PMID: 35817592 DOI: 10.1177/01455613221113790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To explore the clinical characteristics of patients with dizziness/vertigo who showed a dissociation between the results of the caloric test and video head impulse test (vHIT). METHODS A total of 327 patients who complained of dizziness/vertigo were continuously included. All patients underwent both the horizontal vHIT (h-vHIT) and caloric tests. Of the 327 patients, 69 patients showed a dissociation between the results of the two tests, 4 patients were excluded because the interval between the two tests exceeded 7 days. Finally, 65 patients were included in the analysis. RESULTS Among the 65 patients, 55 (84.6%) patients showed a positive caloric test (+) with a negative h-vHIT (-), and 10 (15.4%) patients showed a negative caloric test (-) with a positive h-vHIT (+). Peripheral and central lesions were identified in 50 (90.9%) and 5 (9.1%) patients, respectively, in the caloric test (+)/h-vHIT (-) group; and central lesions were found in 6 (60%) patients in caloric test (-)/h-vHIT (+) group. The etiologies were unilateral peripheral vestibular dysfunction (n = 25), Meniere's disease (MD, n = 10), sudden hearing loss with vertigo (SHLV, n = 7), benign paroxysmal positional vertigo (n = 5), vestibular neuritis (n = 2), autoimmune inner ear disease (n = 1), vestibular migraine (VM, n = 3), multiple sclerosis (n = 1), and multiple system atrophy (n = 1) in the caloric test (+)/h-vHIT (-) group, which were SHLV (n = 3), MD (n = 1), VM (n = 1), episodic ataxia type 2 (n = 1), cerebellopontine angle tumor (N = 1), Parkinson's disease (n = 1), Persistent postural perceptual dizziness (n = 1), and posterior circulation ischemia (n = 1) in the caloric test (-)/h-vHIT (+) group. CONCLUSION Dissociation between the results of caloric test and h-vHIT is not uncommon. A positive caloric test with a negative h-vHIT occurred more frequently, and these patients mostly had peripheral vestibular lesions; while a negative caloric test with a positive h-vHIT was unusual, these patients had both peripheral and central lesions.
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Affiliation(s)
- Xiang Li
- Department of Neurology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Xia Ling
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Zheyuan Li
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Ning Song
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Xiahong Ba
- Department of Neurology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Bo Yang
- Department of Neurology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Xu Yang
- Department of Neurology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Rubo Sui
- Department of Neurology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
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Long-Term Evolution of Vestibular Compensation, Postural Control, and Perceived Disability in a Population of Patients with Vestibular Neuritis. J Clin Med 2022; 11:jcm11143941. [PMID: 35887704 PMCID: PMC9324005 DOI: 10.3390/jcm11143941] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/28/2022] [Accepted: 07/01/2022] [Indexed: 12/10/2022] Open
Abstract
Objectives. The aim was to analyze and compare the compensatory process, vestibular dysfunction, postural control, and perceived disability in a population of patients with vestibular neuritis (VN). Material and Methods. This is a prospective and longitudinal study of 67 patients diagnosed with VN. Inclusion criteria were sudden onset of vertigo, unidirectional spontaneous horizontal nystagmus, and impairment in vestibular test. Exclusion criteria were imaging or clinical findings of any neurotologic disorder. All vestibular tests were performed; vHIT, vestibular evoked myogenic potentials (VEMPs), caloric test and computerized dynamic posturography (CDP), dizziness handicap inventory (DHI), and visual analogue scale (VAS) were also performed at every follow up. Results. We observed a correlation between the composite score of CDP and baseline vestibular function elicited either by caloric test, VEMPs, or vHIT. There was a significant correlation between baseline vestibular function and first visit questionnaire scores. The main gain recovery for the horizontal canal was 0.1 ± 0.04 for the first three months. After that, the gain recovery significantly decreased. The presence of covert and overt saccades’, latency and amplitude decreased, respectively, after the 6-month period, when compared to the baseline results. We also observed a decrease in the PR score from 3 months after the vestibular insult until the last follow up. We observed a significant decrease in DHI and VAS from the first visit until the last one. Those patients with an initial HC gain below 0.5 had significantly higher DHI and VAS scores at every follow up. Conclusions. There are different measurements that could become a complete measurement of the state of compensation, postural control, and disability of the patients. There is a time window in which the vestibular restoration could give us clinical insights regarding the management of VN patients.
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Schmid MB, Bächinger D, Pangalu A, Straumann D, Dlugaiczyk J. Acute Unilateral Peripheral Vestibulopathy After COVID-19 Vaccination: Initial Experience in a Tertiary Neurotology Center. Front Neurol 2022; 13:917845. [PMID: 35847228 PMCID: PMC9283640 DOI: 10.3389/fneur.2022.917845] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/06/2022] [Indexed: 01/14/2023] Open
Abstract
ObjectiveThe aim of the present study was to identify patients who developed acute unilateral peripheral vestibulopathy (AUPVP) after COVID-19 vaccination.MethodsFor this single-center, retrospective study, we screened the medical records of our tertiary interdisciplinary neurotology center for patients who had presented with AUPVP within 30 days after COVID-19 vaccination (study period: 1 June−31 December 2021). The initial diagnosis of AUPVP was based on a comprehensive bedside neurotological examination. Laboratory vestibular testing (video head impulse test, cervical and ocular vestibular evoked myogenic potentials, dynamic visual acuity, subjective visual vertical, video-oculography, caloric testing) was performed 1–5 months later.ResultsTwenty-six patients were diagnosed with AUPVP within the study period. Of those, n = 8 (31%) had developed acute vestibular symptoms within 30 days after COVID-19 vaccination (mean interval: 11.9 days, SD: 4.8, range: 6–20) and were thus included in the study. The mean age of the patients (two females, six males) was 46 years (SD: 11.7). Seven patients had received the Moderna mRNA vaccine and one the Pfizer/BioNTech mRNA vaccine. All patients displayed a horizontal(-torsional) spontaneous nystagmus toward the unaffected ear and a pathological clinical head impulse test toward the affected ear on initial clinical examination. Receptor-specific laboratory vestibular testing performed 1–5 months later revealed recovery of vestibular function in two patients, and heterogeneous lesion patterns of vestibular endorgans in the remaining six patients.Discussion and ConclusionsThe present study should raise clinicians' awareness for AUPVP after COVID-19 vaccination. The relatively high fraction of such cases among our AUPVP patients may be due to a certain selection bias at a tertiary neurotology center. Patients presenting with acute vestibular symptoms should be questioned about their vaccination status and the date of the last vaccination dose. Furthermore, cases of AUPVP occurring shortly after a COVID-19 vaccination should be reported to the health authorities to help determining a possible causal relationship.
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Affiliation(s)
- Marc Basil Schmid
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - David Bächinger
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Athina Pangalu
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Dominik Straumann
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Julia Dlugaiczyk
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- *Correspondence: Julia Dlugaiczyk
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Psillas G, Petrou I, Printza A, Sfakianaki I, Binos P, Anastasiadou S, Constantinidis J. Video Head Impulse Test (vHIT): Value of Gain and Refixation Saccades in Unilateral Vestibular Neuritis. J Clin Med 2022; 11:jcm11123467. [PMID: 35743536 PMCID: PMC9224852 DOI: 10.3390/jcm11123467] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 06/10/2022] [Accepted: 06/14/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to evaluate gain and refixation saccades (covert and overt) using a video head impulse test (vHIT) in the horizontal and vertical planes in patients after the onset of unilateral acute vestibular neuritis (AVN). Thirty-five patients were examined in the acute stage of AVN and at follow-up (range, 6–30 months); a control group of 32 healthy subjects also participated. At onset, the mean gain was significantly lower on the affected side in all of the semi-circular canal planes, mainly in the horizontal canal plane, and saccades (covert and overt) were more prevalent in the horizontal compared to the vertical canal planes. Multi-canal affection occurred more frequently (80% for gain, 71% for saccades) than isolated canal affection. At follow-up, which ranged from 6 to 30 months, the gain was recovered in all of the canals (anterior in 50%, horizontal in 42.8%, and posterior canal in 41.1% of cases), while covert and overt saccades were reduced in the horizontal and vertical planes. However, covert saccades were still recorded in a greater proportion (69%) than overt saccades (57%) in the horizontal plane and at a lower rate in the vertical planes. The compensatory mechanisms after AVN mainly involve the horizontal canal, as the refixation saccades—especially covert ones—were more frequently recorded in the horizontal than vertical canals.
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Affiliation(s)
- George Psillas
- 1st Otolaryngology Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, Stilponos Kyriakidi St., 546 36 Thessaloniki, Greece; (I.P.); (A.P.); (I.S.); (S.A.); (J.C.)
- Correspondence: ; Tel.: +30-2310-994-762; Fax: +30-2310-994-916
| | - Ioanna Petrou
- 1st Otolaryngology Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, Stilponos Kyriakidi St., 546 36 Thessaloniki, Greece; (I.P.); (A.P.); (I.S.); (S.A.); (J.C.)
| | - Athanasia Printza
- 1st Otolaryngology Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, Stilponos Kyriakidi St., 546 36 Thessaloniki, Greece; (I.P.); (A.P.); (I.S.); (S.A.); (J.C.)
| | - Ioanna Sfakianaki
- 1st Otolaryngology Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, Stilponos Kyriakidi St., 546 36 Thessaloniki, Greece; (I.P.); (A.P.); (I.S.); (S.A.); (J.C.)
| | - Paris Binos
- Department of Rehabilitation Sciences, Cyprus University of Technology, Limassol 3036, Cyprus;
| | - Sofia Anastasiadou
- 1st Otolaryngology Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, Stilponos Kyriakidi St., 546 36 Thessaloniki, Greece; (I.P.); (A.P.); (I.S.); (S.A.); (J.C.)
| | - Jiannis Constantinidis
- 1st Otolaryngology Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, Stilponos Kyriakidi St., 546 36 Thessaloniki, Greece; (I.P.); (A.P.); (I.S.); (S.A.); (J.C.)
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Rosengren SM, Young AS, Taylor RL, Welgampola MS. Vestibular function testing in the 21st century: video head impulse test, vestibular evoked myogenic potential, video nystagmography; which tests will provide answers? Curr Opin Neurol 2022; 35:64-74. [PMID: 34889807 DOI: 10.1097/wco.0000000000001023] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To most neurologists, assessing the patient with vertigo is an unpleasant and worrisome task. A structured history and focused examination can be complemented by carefully selected laboratory tests, to reach an early and accurate diagnosis. We provide evidence-based recommendations for vestibular test selection. RECENT FINDINGS The video head impulse test (vHIT), cervical and ocular vestibular evoked myogenic potential (VEMP) and home-video nystagmography are four modern, noninvasive methods of assessing vestibular function, which are equally applicable in the hospital and office-practice. Collectively, they enable assessment of all five vestibular end-organs. The prevalence and patterns of test abnormalities are distinct for each vestibular disorder. We summarize typical abnormalities encountered in four common vestibular syndromes. SUMMARY In the context of acute vestibular syndrome, an abnormal vHIT with low gain and large amplitude refixation saccades and an asymmetric oVEMP separates innocuous vestibular neuritis from stroke. In episodic spontaneous vertigo, high-velocity ictal nystagmus and asymmetric cVEMP help separate Ménière's disease from vestibular migraine. In chronic imbalance, all three tests help detect unilateral or bilateral vestibular loss as the root cause. Recurrent positional vertigo requires no laboratory test and can be diagnosed and treated at the bedside, guided by video nystagmography.
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Affiliation(s)
- Sally M Rosengren
- Central Clinical School, Faculty of Medicine and Health, University of Sydney
- Neurology Department and Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia
| | - Allison S Young
- Neurology Department and Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia
| | - Rachael L Taylor
- Department of Physiology and Centre for Brain Research, The University of Auckland, Auckland, New Zealand
| | - Miriam S Welgampola
- Central Clinical School, Faculty of Medicine and Health, University of Sydney
- Neurology Department and Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia
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15
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Kim Y, Kang BC, Yoo MH, Park HJ. Differential Involvement of Lateral Semicircular Canal and Otolith Organs in Common Vestibular Disorders. Front Neurol 2022; 13:819385. [PMID: 35173674 PMCID: PMC8841591 DOI: 10.3389/fneur.2022.819385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
Semicircular canal and otolith functions came to be evaluated recently, but comprehensive and comparative analysis of canal and otolith dysfunction in common vestibular disorders is lacking. We aimed to analyze the abnormal rates of canal and otolith function in common vestibular disorders. We enrolled 302 patients who were managed for 2 months in a dizziness clinic. Results of caloric, video head impulse test (vHIT), and cervical and ocular vestibular evoked myogenic potential (cVEMP and oVEMP) tests were analyzed and compared among various diagnoses. Vestibular disorders diagnosed included recurrent vestibulopathy (RV, 27%), vestibular migraine (VM, 21%), benign paroxysmal positional vertigo (BPPV, 17%), Meniere's disease (MD, 11%), vestibular neuritis (VN, 10%), orthostatic dizziness (7%), and central lesions (3%). Lateral canal dysfunction was found most in VN (100%) and less commonly in definite MD (75%), RV (46%) and definite VM (29%). Abnormal caloric results were more common than abnormal vHIT in all disorders. Otolith dysfunction was found more frequently than lateral canal dysfunction in most vestibular disorders except VN. An abnormal cVEMP was more frequent in definite MD than the other disorders. Isolated otolith dysfunction without lateral canal dysfunction was the most found in BPPV, followed by definite VM, RV, and definite MD in decreasing order. Various patterns of involvement in canal and otoliths were revealed in vestibular disorders, suggesting different pathogenesis.
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Affiliation(s)
- Yehree Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Byung Chul Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Myung Hoon Yoo
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Hong Ju Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- *Correspondence: Hong Ju Park
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16
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Fuentealba Bassaletti C, van Esch BF, Briaire JJ, van Benthem PPG, Hensen EF, Frijns JHM. Saccades Matter: Reduced Need for Caloric Testing of Cochlear Implant Candidates by Joint Analysis of v-HIT Gain and Corrective Saccades. Front Neurol 2021; 12:676812. [PMID: 34262523 PMCID: PMC8273162 DOI: 10.3389/fneur.2021.676812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 06/03/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Video head impulse test (v-HIT) is a quick, non-invasive and relatively cheap test to evaluate vestibular function compared to the caloric test. The latter is, however, needed to decide on the optimal side to perform cochlear implantation to avoid the risk on inducing a bilateral vestibular areflexia. This study evaluates the effectiveness of using the v-HIT to select cochlear implant (CI) candidates who require subsequent caloric testing before implantation, in that way reducing costs and patient burden at the same time. Study Design: Retrospective study using clinical data from 83 adult CI-candidates, between 2015 and 2020 at the Leiden University Medical Center. Materials and Methods: We used the v-HIT mean gain, MinGain_LR, the gain asymmetry (GA) and a newly defined parameter, MGS (Minimal Gain & Saccades) as different models to detect the group of patients that would need the caloric test to decide on the ear of implantation. The continuous model MGS was defined as the MinGain_LR, except for the cases with normal gain (both sides ≥0.8) where no corrective saccades were present. In the latter case MGS was defined to be 1.0 (the ideal gain value). Results: The receiver operating characteristics curve showed a very good diagnostic accuracy with and area under the curve (AUC) of 0.81 for the model MGS. The v-HIT mean gain, the minimal gain and GA had a lower diagnostic capacity with an AUC of 0.70, 0.72, and 0.73, respectively. Using MGS, caloric testing could be avoided in 38 cases (a reduction of 46%), with a test sensitivity of 0.9 (i.e., missing 3 of 28 cases). Conclusions: The newly developed model MGS balances the sensitivity and specificity of the v-HIT better than the more commonly evaluated parameters such as mean gain, MinGain_LR and GA. Therefore, taking the presence of corrective saccades into account in the evaluation of the v-HIT gain can considerably reduce the proportion of CI-candidates requiring additional caloric testing.
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Affiliation(s)
| | - Babette F van Esch
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Jeroen J Briaire
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Peter Paul G van Benthem
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Erik F Hensen
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Johan H M Frijns
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden, Netherlands.,Leiden Institute for Brain and Cognition, Leiden, Netherlands
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Manzari L, Princi AA, De Angelis S, Tramontano M. Clinical value of the video head impulse test in patients with vestibular neuritis: a systematic review. Eur Arch Otorhinolaryngol 2021; 278:4155-4167. [PMID: 33893851 DOI: 10.1007/s00405-021-06803-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 04/07/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE The aim of this systematic review was to evaluate the clinical application potential of the video head impulse test (vHIT) in diagnosing vestibular neuritis (VN). METHODS An electronic search was conducted in the following databases: Embase, MEDLINE, ScienceDirect, Google scholar, and the Cochrane Database of Systematic Reviews. Clinical studies were included in which an evaluation was made using vHIT either alone or in combination with other tests or bedside algorithms. Evaluations that were carried out using unvalidated tools were excluded. Only studies of patients with VN (superior, inferior, or in toto) were included. Screening of titles, abstracts, full texts, and data extraction were undertaken independently by pairs of reviewers. Included studies were quality appraised using a modified version of the Newcastle-Ottawa scale. RESULTS Results were reported according to the preferred reporting items for systematic reviews and meta-analyses. Our search yielded 1309 unique records, 21 of which remained after screening titles and abstracts. Sixteen studies were included, i.e., for a total of 933 patients including 474 patients with a diagnosis of VN. CONCLUSIONS The diagnostic value of vHIT is high for VN, as it is a high-frequency measurement tool. vHIT is a useful complement or alternative to caloric and rotational tests as an indicator of lesions of vestibular canal functioning, especially at the time of onset. This tool can provide useful clues about the clinical progress of recovery from the lesion through the value of the vestibulo ocular reflex gain and the consequent evolution of the saccade pattern, which allows the patient to stabilize vision on the retina.
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Affiliation(s)
| | | | | | - Marco Tramontano
- Fondazione Santa Lucia IRCCS, Rome, Italy.,Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
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18
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Importance of Video Head Impulse Test Parameters for Recovery of Symptoms in Acute Vestibular Neuritis. Otol Neurotol 2021; 41:964-971. [PMID: 32658401 DOI: 10.1097/mao.0000000000002669] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the importance of video head impulse test parameter for recovery of symptoms in acute vestibular neuritis (AVN). STUDY DESIGN Prospective study. SETTING Tertiary referral hospital. PATIENTS/INTERVENTIONS Twenty-seven patients with AVN were enrolled. We divided patients into two groups according to both dizziness handicap inventory (DHI) score and visual analog scale (VAS) at 6 months: Group F (symptoms free), DHI = 0 and VAS = 0; Group R (symptoms residual), DHI more than zero or VAS more than zero. MAIN OUTCOME MEASURE All patients underwent video head impulse test paradigm (HIMP), and suppression head impulse test paradigm (SHIMP) initially and at 1 month. Patients were also asked to complete DHI and VAS initially, at 1 month and 6 months. We compared measured parameters between Group F and R. RESULTS In HIMP, Group F showed higher vestibular-ocular reflex (VOR) gain, higher occurrence of covert corrective saccade (CS), lower occurrence and peak velocity of overt CS, and lower PR score than Group R at 1 month. In SHIMP, Group F showed higher VOR gain, higher occurrence and peak velocity of anti-CS, and higher PR score than Group R at 1 month. CONCLUSIONS Above parameters of both HIMP and SHIMP at 1 month would be important factors to predict the residual symptoms in chronic phase of AVN.
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Nam GS, Shin HJ, Kang JJ, Lee NR, Oh SY. Clinical Implication of Corrective Saccades in the Video Head Impulse Test for the Diagnosis of Posterior Inferior Cerebellar Artery Infarction. Front Neurol 2021; 12:605040. [PMID: 33679578 PMCID: PMC7930369 DOI: 10.3389/fneur.2021.605040] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 01/18/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: In the present study, we characterized the vestibulo-ocular reflex (VOR) gain and properties of corrective saccades (CS) in patients with posterior inferior cerebellar artery (PICA) stroke and determined the best parameter to differentiate PICA stroke from benign peripheral vestibular neuritis (VN). In particular, we studied CS amplitude and asymmetry in video head impulse tests (vHITs) to discriminate these two less-studied disease conditions. Methods: The vHITs were performed within 1 week from symptom onset in patients with PICA stroke (n = 17), patients with VN (n = 17), and healthy subjects (HS, n = 17). Results: PICA stroke patients had bilaterally reduced VOR gains in the horizontal semicircular canal (HC) and the posterior semicircular canal (PC) compared with HSs. When compared with VN patients, PICA stroke patients showed preserved gains in the HC and anterior semicircular canal (AC) bilaterally (i.e., symmetric VOR gain). Similar to VOR gain, smaller but bilaterally symmetric CS in the HC and AC were observed in PICA stroke patients compared with VN patients; the mean amplitude of CS for the ipsilesional HC was reduced (p < 0.001, Mann-Whitney U-test), but the mean amplitude of CS for the contralesional HC was increased (p < 0.03, Mann-Whitney U-test) in PICA stroke compared with VN. The receiver operating characteristic (ROC) curve showed that CS amplitude asymmetry (CSs) and VOR gain asymmetry (Gs) of HC are excellent parameters to distinguish PICA stroke from VN. Conclusion: In the current study, we quantitatively investigated the VOR gain and CS using vHITs for three semicircular canals in PICA stroke and VN patients. In addition to VOR gain, quantitative assessments of CS using vHITs can provide sensitive and objective parameters to distinguish between peripheral and central vestibulopathies.
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Affiliation(s)
- Gi-Sung Nam
- Department of Otorhinolaryngology - Head and Neck Surgery, Chosun University College of Medicine, Gwangju, South Korea.,Research Institute of Clinical Medicine, Jeonbuk National University Hospital-Biomedical Research Institute, Jeonbuk National University, Jeonju, South Korea
| | - Hyun-June Shin
- Department of Neurology, School of Medicine, Jeonbuk National University, Jeonju, South Korea
| | - Jin-Ju Kang
- Research Institute of Clinical Medicine, Jeonbuk National University Hospital-Biomedical Research Institute, Jeonbuk National University, Jeonju, South Korea.,Department of Neurology, School of Medicine, Jeonbuk National University, Jeonju, South Korea
| | - Na-Ri Lee
- Research Institute of Clinical Medicine, Jeonbuk National University Hospital-Biomedical Research Institute, Jeonbuk National University, Jeonju, South Korea.,Division of Oncology and Hematology, Department of Internal Medicine, School of Medicine, Jeonbuk National University, Jeonju, South Korea
| | - Sun-Young Oh
- Research Institute of Clinical Medicine, Jeonbuk National University Hospital-Biomedical Research Institute, Jeonbuk National University, Jeonju, South Korea.,Department of Neurology, School of Medicine, Jeonbuk National University, Jeonju, South Korea
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Li Z, Wang H, Wang H, Yu D. Quantitative Analysis of Saccade Gain in Video Head Impulse Testing. Otolaryngol Head Neck Surg 2020; 163:799-805. [PMID: 32513047 DOI: 10.1177/0194599820930669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To quantitatively analyze corrective saccade (CS) gain and further characterize the specific relationship between vestibulo-ocular reflex (VOR) gain and CS gain in patients with vestibular loss and healthy controls. STUDY DESIGN Prospective combined with retrospective study. SETTING Affiliated Sixth People's Hospital, Shanghai Jiao Tong University. SUBJECTS AND METHODS Forty patients with unilateral vestibular loss and 40 participants with normal vestibular function were subjected to video head impulse testing (vHIT). The analysis of the horizontal semicircular canal VOR and CS gains was based on individual head impulses. RESULTS The patient group had significantly higher CS gain and lower VOR gain than the control group (P < .001). While there was no significant correlation between VOR and CS gains in the control group after adjusting for age and sex (P = .689), VOR gain negatively correlated with CS gain in the patient group (r = -0.853, P < .001). The specific relationship between VOR and CS gains was characterized as y = -1.17x + 1.12 (x: VOR gain, y: CS gain; r 2 = 0.732, P < .001) in the patient group. CONCLUSIONS In healthy participants, CS was not correlated with VOR gain, suggesting that CS is not due to VOR hypofunction. In patients with unilateral vestibular loss, CS was closely associated with VOR gain and can almost correct gaze position errors required for visual stabilization. CS gain could be an important indicator to diagnose vestibular loss and help physicians identify abnormal vHIT curves caused by artifacts and irregular practices.
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Affiliation(s)
- Zhuangzhuang Li
- Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Haiyan Wang
- Eye and ENT Hospital of Fu Dan University, Shanghai, China
| | - Hui Wang
- Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Dongzhen Yu
- Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Key Laboratory of Sleep Disordered Breathing, Shanghai, China
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21
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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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Abstract
BACKGROUND: The vestibulo-ocular reflex (VOR) gain is the primary parameter for quantifying and interpreting the video head impulse test (vHIT). Yet, the relationship between the VOR gain and the extent of canal function is not clear. OBJECTIVE: The goal of this paper was to determine if the loss of canal function in vHIT can be estimated from the VOR gain. METHODS: A model of the VOR was developed that included linear components for the cupula and the velocity storage mechanism as well as nonlinear components for the vestibular nerve and the vestibular nuclei. Multiple simulations were carried out as the level of function for the right and left VOR pathways was varied systematically over their entire range. RESULTS: Simulation results were similar to the typical findings in normal individuals as well as in patients with unilateral and bilateral loss of canal function. Based on these simulations, a relationship between the canal function and the VOR gains was established. This relationship was surprisingly independent of most model parameters. CONCLUSIONS: The sum of right and left VOR gains (or 2 times the mean of VOR gains) at a given head velocity is an estimate of the total function of the involved canals. This simple formula can estimate the loss of canal function in purely unilateral lesions. For bilateral lesions, the same formula can estimate the total loss of bilateral function but contributions from individual canals cannot be determined without additional information.
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Affiliation(s)
- Kamran Barin
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, OH, USA
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Micarelli A, Viziano A, Panella M, Micarelli E, Alessandrini M. Power spectra prognostic aspects of impulsive eye movement traces in superior vestibular neuritis. Med Biol Eng Comput 2019; 57:1617-1627. [DOI: 10.1007/s11517-019-01982-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 04/08/2019] [Indexed: 12/01/2022]
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Fu W, He F, Wei D, Bai Y, Shi Y, Wang X, Han J. Recovery Pattern of High-Frequency Acceleration Vestibulo-Ocular Reflex in Unilateral Vestibular Neuritis: A Preliminary Study. Front Neurol 2019; 10:85. [PMID: 30930826 PMCID: PMC6423915 DOI: 10.3389/fneur.2019.00085] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 01/22/2019] [Indexed: 11/13/2022] Open
Abstract
Objective: To explore the recovery pattern of the high-frequency acceleration vestibulo-ocular reflex (VOR) function in unilateral vestibular neuritis (UVN). Methods: Forty-seven consecutive patients with UVN were recruited within 10 days of symptom onset for this study. The high-frequency acceleration horizontal VOR function was assessed using the video head impulse test (vHIT). Patients returned for follow-up evaluation at ~6 months after the onset of symptoms. According to the dizziness handicap inventory questionnaire (DHI), the patients were classified into the normal to mild dizziness group (DHI score ≤30) and moderate to severe dizziness group (DHI score >30) at the follow-up. All the obtained horizontal vHIT gains and corrective saccades parameters were analyzed. Results: vHIT results showed a significantly horizontal VOR gain recovery in UVN patients at the follow-up on the lesion side (p < 0.01). A significantly reduction in the occurrence of corrective saccades (overt and covert) and velocity of corrective saccades (overt and covert) were observed at the follow-up (p < 0.05). At the follow-up, the normal to mild dizziness group (DHI score ≤30) had a significantly higher normal rate of VOR gain, the mean vHIT gains and occurrence of isolated covert saccades (P < 0.05). Furthermore, the occurrence of mixed saccades and the mean velocity of covert saccades were significantly lower in normal to mild dizziness group (P < 0.05). Conclusion: Apart from the recovery of the VOR gain, recovery pattern of corrective saccades can play a key role in vestibular compensate.
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Affiliation(s)
- Wei Fu
- Department of Geriatrics, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Feng He
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Dong Wei
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Ya Bai
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Ying Shi
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Xiaoming Wang
- Department of Geriatrics, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Junliang Han
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
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Park JW, Kim TS, Cha EH, Kang BC, Park HJ. Differences in video head impulse test gains from right versus left or outward versus inward head impulses. Laryngoscope 2018; 129:1675-1679. [DOI: 10.1002/lary.27607] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2018] [Indexed: 01/04/2023]
Affiliation(s)
- Jun Woo Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center; University of Ulsan College of Medicine; Seoul Republic of Korea
| | - Tae Su Kim
- the Department of Otorhinolaryngology-Head and Neck Surgery; Kangwon National University School of Medicine; Chuncheon Republic of Korea
| | - Eun Hye Cha
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center; University of Ulsan College of Medicine; Seoul Republic of Korea
| | - Byung Chul Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Ulsan University Hospital; University of Ulsan College of Medicine; Ulsan Republic of Korea
| | - Hong Ju Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center; University of Ulsan College of Medicine; Seoul Republic of Korea
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Kim TS, Lim HW, Yang CJ, Kim YH, Choi WR, Kim YR, Park JW, Kang BC, Park HJ. Changes of video head impulse test results in lateral semicircular canal plane by different peak head velocities in patients with vestibular neuritis. Acta Otolaryngol 2018; 138:785-789. [PMID: 30016899 DOI: 10.1080/00016489.2018.1481523] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND The peak head velocity influences on the video head impulse test (vHIT) results, but it has been not known how much the difference is. AIMS To evaluate the clinical evidence for the superiority of high-velocity compared to low-velocity vHIT. MATERIAL AND METHODS vHIT was performed in 30 patients with vestibular neuritis using two peak head velocities (mean 80 vs. 240°/s). vHIT gains and parameters of corrective saccades (CSs) were compared. A vHIT gain of ≤0.8 or a peak CS velocity of ≥100°/s was considered pathologic. RESULTS The vHIT gains were significantly lower (mean 0.5 vs. 0.6), and GA was larger (35 vs. 25%) at high-velocity vHIT, compared to low-velocity vHIT. CSs were significantly more frequent (100 vs. 80%) and peak CS velocities were larger (252 vs. 112°/s) at high-velocity vHIT. The abnormal rates based on vHIT gains were higher (90% vs. 73%) and CSs occurred more frequently (100% vs. 80%) at high-velocity vHIT. The abnormal rates based on the peak CS velocity were significantly higher at high-velocity vHIT (100% vs. 57%). CONCLUSION High-velocity vHIT is superior to low-velocity vHIT with a difference of 17-20% based on pathologic vHIT gains and presence of CSs.
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Affiliation(s)
- Tae Su Kim
- Department of Otolaryngology, Kangwon National University, Chuncheon, Republic of Korea
| | - Hyun Woo Lim
- Department of Otolaryngology, Asan Medical Center, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| | - Chan Joo Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, Hanil General Hospital, Seoul, Republic of Korea
| | - Yong Han Kim
- Department of Otolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
| | - Woo Ri Choi
- Department of Otolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
| | - Yeh Ree Kim
- Department of Otolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
| | - Jun Woo Park
- Department of Otolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
| | - Byung Chul Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Hong Ju Park
- Department of Otolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
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Yang CJ, Park HJ. Advantages of Considering Gains and Corrective Saccades by Video Head Impulse for Patients with Vestibular Neuritis. Otolaryngol Head Neck Surg 2018; 159:400-401. [PMID: 30066618 DOI: 10.1177/0194599818779794] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Chan Joo Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, Hanil General Hospital, Seoul, Korea
| | - Hong Ju Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
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Sabour S. Diagnostic Value of Video Head Impulse Test in Vestibular Neuritis: Methodological Issues. Otolaryngol Head Neck Surg 2018; 159:400. [DOI: 10.1177/0194599818779792] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Siamak Sabour
- Safety Promotions and Injury Prevention Research Center and Department of Clinical Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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