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Fattahi CB, Zaro C, Chung JJ, Lewis RF, Chari DA. Comparative utility of vestibular function tests in patients with peripheral and central vestibular dysfunction. J Otol 2024; 19:5-9. [PMID: 38313756 PMCID: PMC10837540 DOI: 10.1016/j.joto.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/31/2023] [Indexed: 02/06/2024] Open
Abstract
Background Bithermal caloric irrigation, video head impulse test (vHIT), and rotational testing are commonly used to assess peripheral vestibular function, but the relative clinical utility of each test in differentiating patients with peripheral vestibulopathy is debated. Objectives To determine whether (1) the combination of two or more vestibular tests enhances diagnostic utility over a single test; (2) abnormal test results on vestibular tests correlate with one another. Methods Retrospective analysis of data collected from multidisciplinary vestibular clinics at two academic medical centers from 2016 to 2022. Results 150 patients (54.10 ± 15.09 years, 88 females) were included. No individual test was significantly better at predicting the presence of peripheral vestibular damage (p > 0.05). vHIT test results improved significantly when combined with either the caloric test (p = 0.007) or rotary chair test (p = 0.039). Caloric and rotational testing had high sensitivity (74.65% and 76.06%, respectively) and specificity (83.54% and 78.48%, respectively). vHIT demonstrated excellent specificity (89.87%) but poor sensitivity (47.89%). Caloric, vHIT, and rotary chair tests results did not correlate with one another (p > 0.05). Conclusions Vestibular function tests have comparable diagnostic utility, yet each offers unique advantages. Caloric and rotational testing may be best suited for screening peripheral damage and vHIT may function ideally as a confirmatory test.
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Affiliation(s)
- Cameron B. Fattahi
- Department of Otolaryngology – Head and Neck Surgery, UMASS Memorial Medical Center, University of Massachusetts Chan Medical School, Worcester, MA, USA
- Jenks Vestibular Physiology Laboratory, Massachusetts Eye and Ear, Boston, MA, USA
| | - Christopher Zaro
- Department of Otolaryngology – Head and Neck Surgery, UMASS Memorial Medical Center, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Janice J. Chung
- Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Richard F. Lewis
- Jenks Vestibular Physiology Laboratory, Massachusetts Eye and Ear, Boston, MA, USA
- Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Divya A. Chari
- Department of Otolaryngology – Head and Neck Surgery, UMASS Memorial Medical Center, University of Massachusetts Chan Medical School, Worcester, MA, USA
- Jenks Vestibular Physiology Laboratory, Massachusetts Eye and Ear, Boston, MA, USA
- Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
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Ghoraba N, Assal S, Elmoazen D. Aging effect and test-retest reliability of the sinusoidal harmonic acceleration test and velocity step test using nanotorque rotatory chair. J Otol 2023; 18:125-131. [PMID: 37497331 PMCID: PMC10366574 DOI: 10.1016/j.joto.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/06/2023] [Accepted: 05/10/2023] [Indexed: 07/28/2023] Open
Abstract
Introduction Rotatory chair testing has been used to evaluate horizontal canal function. Frequently used tests include sinusoidal harmonic acceleration test (SHAT) and velocity step test (VST). Objectives Assessment of age effect on the SHAT and VST and assessment of test-retest reliability of the parameters of those two tests. Methods A prospective study was performed on 100 subjects with no ear or vestibular complaints and normal vestibular evaluation. They were divided into two groups; Group A: below 50 years of age and Group B: 50 years of age or above. SHAT was presented at frequencies 0.02, 0.04, 0.08, 0.16, 0.32, 0.64 Hz with a peak velocity of 60°/s. VST was performed using a maximum velocity of 100°/s with acceleration and deceleration of 200°/s2. Thirty subjects were tested twice to assess reliability. Results Study participants ranged in age from 20 to 67 years. Regarding group A, the mean age was 30.92 ± 7.31 and 55.36 ± 4.61 for group B. No significant differences were found in SHAT parameters between the two groups. As well, there was no significant difference in VST per-rotatory time constant, however, post-rotatory time constant was significantly longer for Group B (P value < 0.05). Intraclass correlation coefficient (ICC) values showed moderate to good reliability (ICC 0.580-0.818) for SHAT parameters for the lower frequencies and indicated moderate reliability for VST time constant (ICC 0.509-0.652). Conclusions Age has no significant effect on the parameters of SHAT and VST. Test-retest reliability is generally good for both tests.
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Affiliation(s)
- Nourhan Ghoraba
- Corresponding author. Audiovestibular Medicine Unit, Otorhinolaryngology Department, Faculty of Medicine, Alexandria University, Champollion street, El Azareeta Medical Campus, Alexandria, Egypt.
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Molnár A, Maihoub S, Tamás L, Szirmai Á. Comparison between caloric and video-head impulse tests in Ménière's disease and vestibular neuritis. Int J Audiol 2022; 62:393-399. [PMID: 35439091 DOI: 10.1080/14992027.2022.2059711] [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: 11/05/2022]
Abstract
OBJECTIVE To compare the diagnostic accuracies of air caloric testing with electronystagmography and the vHIT (video-head impulse test). DESIGN Prospective, controlled study. STUDY SAMPLE MD (Ménière's disease), 26; vestibular neuritis, 27; control, 56. RESULTS In MD, CP (canal paresis) was pathological in 88.5%, the GA (gain asymmetry) on vHIT was pathological in 65.3%, and the gain was abnormal in only one patient. The GA and CP, were significantly higher in the MD group than in the control group, indicating hypofunction of the horizontal canals in MD, whereas a hyperfunction may also occur. No correlation was observed between the results of the two tests for evaluating MD, suggesting that pathological outcomes of one test do not guarantee abnormalities on the other test. For vestibular neuritis, significantly higher CP (96.3%), GA (81.5%), and gain (51.9%) values were detected. A correlation was identified between the two tests for vestibular neuritis, indicating a similar diagnostic efficiency. The higher percentage of pathological GA versus pathological gain values indicates that the asymmetry may be more informative. CONCLUSIONS The vHIT showed a higher specificity, whereas the caloric test a higher sensitivity. No correlation between the two methods was observed; therefore, the tests appear to provide complementary information.
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Affiliation(s)
- András Molnár
- Faculty of Medicine, Department of Otolaryngology and Head and Neck Surgery, Semmelweis University, Budapest, Hungary
| | - Stefani Maihoub
- Faculty of Medicine, Department of Otolaryngology and Head and Neck Surgery, Semmelweis University, Budapest, Hungary
| | - László Tamás
- Faculty of Medicine, Department of Otolaryngology and Head and Neck Surgery, Semmelweis University, Budapest, Hungary
| | - Ágnes Szirmai
- Faculty of Medicine, Department of Otolaryngology and Head and Neck Surgery, Semmelweis University, Budapest, Hungary
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Chua KWD, Yuen HW, Low DYM, Kamath SH. The prevalence of isolated otolith dysfunction in a local tertiary hospital. J Otol 2022; 17:5-12. [PMID: 35140753 PMCID: PMC8811395 DOI: 10.1016/j.joto.2021.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Patients with dizziness may present with symptoms of tilting, swaying, rocking, floating or with disequilibrium. This may be suggestive of an isolated otolithic dysfunction yet, there is little emphasis on this emerging clinical entity. To characterize and describe the prevalence of isolated otolith dysfunction in a local tertiary hospital and correlate them with clinical diagnosis. METHODOLOGY Retrospective medical chart review of patients who presented with dizziness to the specialist outpatient Otolaryngology clinic, who required vestibular laboratory investigation. RESULTS Of the 206 patients, more than half of them (52.4%) fulfilled the criteria for either probable or definite isolated otolith dysfunction. When there are clinical symptoms of otolith dysfunction reported, there is a 1.62 odds of a remarkable laboratory otolith finding. The most common clinical finding was "no clear diagnosis" (65.5%) followed by Vestibular Migraine (13.6%). CONCLUSION The prevalence of isolated otolith dysfunction is quite high. Laboratory tests of otolith function should be performed more routinely. This can be done in a sequential way to optimize cost effectiveness in countries with no insurance reimbursement. Prospective cohort studies on isolated otolith dysfunction, will lay the groundwork for achieving diagnostic consensus and formulating rehabilitation plans to aid this group of patients.
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Affiliation(s)
- Kenneth Wei De Chua
- Department of Otorhinolaryngology-Head and Neck Surgery, Changi General Hospital, Singapore
- The American Institute of Balance (AIB), Largo, FL, USA
| | - Heng Wai Yuen
- Department of Otorhinolaryngology-Head and Neck Surgery, Changi General Hospital, Singapore
| | - David Yong Ming Low
- Department of Otorhinolaryngology-Head and Neck Surgery, Changi General Hospital, Singapore
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Kullmann A, Ashmore RC, Braverman A, Mazur C, Snapp H, Williams E, Szczupak M, Murphy S, Marshall K, Crawford J, Balaban CD, Hoffer M, Kiderman A. Normative data for ages 18-45 for ocular motor and vestibular testing using eye tracking. Laryngoscope Investig Otolaryngol 2021; 6:1116-1127. [PMID: 34667856 PMCID: PMC8513422 DOI: 10.1002/lio2.632] [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: 04/12/2021] [Revised: 06/26/2021] [Accepted: 07/29/2021] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE Eye tracking technology has been employed in assessing ocular motor and vestibular function following vestibular and neurologic conditions, including traumatic brain injury (TBI). Assessments include tests that provide visual and motion (rotation) stimuli while recording horizontal, vertical, and torsional eye movements. While some of these tests have shown diagnostic promise in previous studies, their use in clinical practice is limited by the lack of normative data. The goal of this study was to construct normative reference ranges to be used when comparing patients' results. METHODS Optokinetic response, subjective visual horizontal and vertical, and rotation tests were administered to male and female volunteers, ages 18-45, who were free from neurological, vestibular disorders, or other head injuries. Tests were administered using either a rotatory chair or a portable virtual reality-like goggle equipped with video-oculography. RESULTS Reference values for eye movements in response to different patterns of stimuli were analyzed from 290 to 449 participants. Analysis of gender (self-reported) or age when grouped as pediatric (late adolescent; 18-21 years of age) and adult (21-45 years of age) revealed no effects on the test metrics. Data were pooled and presented for each test metric as the 95% reference interval (RI) with 90% confidence intervals (CI) on upper and lower limits of the RI. CONCLUSIONS This normative database can serve as a tool to aid in diagnosis, treatment, and/or rehabilitation protocols for vestibular and neurological conditions, including mild TBI (mTBI). This database has been cleared by the FDA for use in clinical practice (K192186). LEVEL OF EVIDENCE 2b.
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Affiliation(s)
- Aura Kullmann
- Neurolign USA LLC, A Subsidiary of Neurolign Technologies Inc. (formerly Neuro Kinetics, Inc.)PittsburghPennsylvaniaUSA
| | - Robin C. Ashmore
- Neurolign USA LLC, A Subsidiary of Neurolign Technologies Inc. (formerly Neuro Kinetics, Inc.)PittsburghPennsylvaniaUSA
| | | | - Christian Mazur
- Neurolign USA LLC, A Subsidiary of Neurolign Technologies Inc. (formerly Neuro Kinetics, Inc.)PittsburghPennsylvaniaUSA
| | - Hillary Snapp
- Department of OtolaryngologyMiller School of Medicine, University of MiamiMiamiFloridaUSA
| | - Erin Williams
- Department of OtolaryngologyMiller School of Medicine, University of MiamiMiamiFloridaUSA
| | - Mikhaylo Szczupak
- Department of OtolaryngologyMiller School of Medicine, University of MiamiMiamiFloridaUSA
| | - Sara Murphy
- Naval Medical CenterSan DiegoCaliforniaUSA
- Department of DefenseHearing Center of ExcellenceSan AntonioTexasUSA
| | - Kathryn Marshall
- Department of DefenseHearing Center of ExcellenceSan AntonioTexasUSA
- Madigan Army Medical CenterTacomaWashingtonUSA
| | | | - Carey D. Balaban
- Department of OtolaryngologyUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Michael Hoffer
- Department of OtolaryngologyMiller School of Medicine, University of MiamiMiamiFloridaUSA
- Department of Neurological SurgeryMiller School of Medicine, University of MiamiMiamiFloridaUSA
| | - Alexander Kiderman
- Neurolign USA LLC, A Subsidiary of Neurolign Technologies Inc. (formerly Neuro Kinetics, Inc.)PittsburghPennsylvaniaUSA
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Huang S, Zhou H, Zhou E, Zhang J, Feng Y, Yu D, Shi H, Wang J, Wang H, Yin S. A New Proposal for Severity Evaluation of Menière's Disease by Using the Evidence From a Comprehensive Battery of Auditory and Vestibular Tests. Front Neurol 2020; 11:785. [PMID: 33013611 PMCID: PMC7461919 DOI: 10.3389/fneur.2020.00785] [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: 04/15/2020] [Accepted: 06/25/2020] [Indexed: 12/18/2022] Open
Abstract
To date, no widely accepted criteria exist to quantify the severity of Menière's disease (MD) by using vestibular tests. This study aimed to compare association of hearing loss and vertigo severity with association of accurate assessments of vestibular function and the vertigo severity. The severity of vertigo was documented by a comprehensive medical history with number of vertigo attacks in the past 6 months and a Dizziness Handicap Inventory (DHI) questionnaire. The involvement of vestibular organs was verified by audio-vestibular tests in 80 definite MD patients. Correlations between DHI scores, number of vertigo attacks in the past 6 months, audio-vestibular function, and the number of involved vestibular end organs were evaluated. We show that there are no significant differences in either severity of vertigo or laboratory results across the degree of hearing loss. Furthermore, the number of involved vestibular end organs was significantly correlated with vestibulo-ocular reflex gain in anterior and posterior canal video head impulse test (vHIT), interaural asymmetry ratio in vestibular-evoked myogenic potentials (VEMPs), and number of vertigo attacks in the past 6 months and DHI score. The vestibulo-ocular reflex gain in the rotatory chair test (RCT) was significantly correlated with the DHI Physical scores and number of involved vestibular end organs at 0.08 Hz. These results indicate that hearing loss is a poor indicator of vertigo severity in MD whereas the number of involved vestibular end organs may serve as an objective measure for MD progress. A battery of vestibular tests targeting different sensor organs is a complementary method for evaluating inner ear deficits and may aid in "grading" the severity of MD.
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Affiliation(s)
- Shujian Huang
- Department of Otorhinolaryngology-Head and Neck Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Huiqun Zhou
- Department of Otorhinolaryngology-Head and Neck Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Enhui Zhou
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Gongli Hospital, The Second Military Medical University, Shanghai, China
| | - Jiajia Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Yanmei Feng
- Department of Otorhinolaryngology-Head and Neck Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Dongzhen Yu
- Department of Otorhinolaryngology-Head and Neck Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Haibo Shi
- Department of Otorhinolaryngology-Head and Neck Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Jian Wang
- School of Communication Science and Disorders, Dalhousie University, Halifax, NS, Canada
| | - Hui Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Shankai Yin
- Department of Otorhinolaryngology-Head and Neck Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
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7
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Verbecque E, Wuyts FL, Vanspauwen R, Van Rompaey V, Van de Heyning P, Vereeck L. The Antwerp Vestibular Compensation Index (AVeCI): an index for vestibular compensation estimation, based on functional balance performance. Eur Arch Otorhinolaryngol 2020; 278:1755-1763. [PMID: 32757037 PMCID: PMC8131278 DOI: 10.1007/s00405-020-06192-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 07/04/2020] [Indexed: 01/21/2023]
Abstract
PURPOSE To create an index that is a measure of the amount of vestibular compensation and for which only functional balance performance is needed. METHODS The medical charts of 62 eligible peripheral vestibular dysfunction (PVD) patients were analyzed retrospectively. To be included, the following vestibulo-ocular reflex (VOR) and balance performance data had to be available: (1) caloric and sinusoidal harmonic acceleration test (SHA) and (2) standing balance sum-eyes closed (SBS-EC), Timed Up and Go Test and Dynamic Gait Index. Patients were divided into three groups: normal caloric- and SHA test (group 1), abnormal caloric- and normal SHA test (group 2, PVD compensated) and abnormal caloric- and SHA test (group 3, PVD uncompensated). Next to the use of non-parametric tests to study the VOR and balance variables, logistic regression was used to identify the balance measures that predict whether PVD patients were compensated or uncompensated. This resulted also in the construction of a continuous measure representing the degree of compensation. RESULTS Logistic regression identified SBS-EC and age to classify uncompensated from compensated patients with sensitivity of 83.9% and specificity of 72.4%. Then an index was created, called the Antwerp Vestibular Compensation Index, AVeCI = - 50 + age × 0.486 + SBS-EC × 0.421. A patient belongs to the uncompensated group when AVeCI < 0 and to the compensated group when AVeCI > 0, with respective group means of - 5 and 5. CONCLUSION AVeCI stages the degree of compensation of PVD patients and can serve to evaluate rehabilitation effects.
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Affiliation(s)
- Evi Verbecque
- Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium.,Rehabilitation Research Centre (REVAL), Rehabilitation Sciences and Physiotherapy, Hasselt University, Agoralaan Building A, 3590, Diepenbeek, Belgium
| | - Floris L Wuyts
- Lab for Equilibrium Investigations and Aerospace (LEIA), University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium. .,European Institute for Otorhinolaryngology, GZA Hospitals Antwerp, Wilrijk, Belgium.
| | - Robby Vanspauwen
- European Institute for Otorhinolaryngology, GZA Hospitals Antwerp, Wilrijk, Belgium
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, Campus Drie Eiken, 2610, Wilrijk, Belgium
| | - Paul Van de Heyning
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, Campus Drie Eiken, 2610, Wilrijk, Belgium
| | - Luc Vereeck
- Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium.,Multidisciplinary Motor Centre Antwerp (M2OCEAN), University of Antwerp, Universiteitsplein 1, Campus Drie Eiken, D.R.311, 2610, Wilrijk, Belgium
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Rambold HA, Barthold D, Ramat S. Value of passive whole-body rotation: a model-based approach. J Neurol 2019; 266:123-125. [DOI: 10.1007/s00415-019-09422-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 06/04/2019] [Accepted: 06/06/2019] [Indexed: 11/24/2022]
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10
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Leyssens L, Heinze B, Vinck B, Van Ombergen A, Vanspauwen R, Wuyts FL, Maes LK. 'Standard' versus 'nose reference' electrode placement for measuring oVEMPs with air-conducted sound: Test-retest reliability and preliminary patient results. Clin Neurophysiol 2016; 128:312-322. [PMID: 28042997 DOI: 10.1016/j.clinph.2016.11.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 11/21/2016] [Accepted: 11/25/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVES This study compared two electrode placements ('standard' versus 'nose reference' placement) for measuring oVEMPs, elicited by air-conducted 500Hz tone bursts. The test-retest reliability of both positions was evaluated and additionally both electrode placements were applied on a group of vestibular patients. METHODS Eighteen healthy volunteers (range of 20-25years) participated in the first part and were retested after one week for evaluation of the test-retest reliability. Eleven patients (range of 41-74years) with a variety of vestibular pathologies were tested once. RESULTS In the normal group, the nose reference electrode placement resulted in significantly larger peak-to-peak amplitudes (p<0.001), shorter n10 (p=0.001) and p15 (p<0.001) latencies and smaller 95% prediction intervals for the Inter-Ocular Ratio (IOR) ([-68, 68] for the standard position versus [-32, 32] for the nose reference position). Furthermore, an excellent amplitude and IOR test-retest reliability was observed with the nose reference configuration, as shown by the intraclass correlation coefficient (ICC), the coefficient of variation of the method error (CVME) and the minimal detectable differences (MDD). In the patient group, the same significant amplitude difference was found. Moreover, three patients presented with absent oVEMPs when recorded with the standard placement, whereas the nose reference placement could evoke a detectable oVEMP response. CONCLUSIONS This study demonstrated that a nose reference electrode position results in larger oVEMP amplitudes and achieves a better reliability for the most important clinical parameters (amplitude and IOR). Our patient data substantiate the possible clinical benefit of this position, but further systematic patient verification is required. SIGNIFICANCE The nose reference electrode position facilitates the detection of generally very small oVEMP responses and shows a high test-retest reliability, showing promising potential for future use in the vestibular clinic.
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Affiliation(s)
- Laura Leyssens
- Faculty of Medicine and Health Sciences, Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium.
| | - Barbara Heinze
- Faculty of Humanities, Department of Speech-Language Pathology and Audiology, Pretoria University, Pretoria, South Africa
| | - Bart Vinck
- Faculty of Medicine and Health Sciences, Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium; Faculty of Humanities, Department of Speech-Language Pathology and Audiology, Pretoria University, Pretoria, South Africa
| | - Angelique Van Ombergen
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Antwerp University Research Center for Equilibrium and Aerospace (AUREA), ENT Department, University Hospital Antwerp, Antwerp, Belgium; Faculty of Sciences, Department of Biomedical Physics, University of Antwerp, Antwerp, Belgium
| | - Robby Vanspauwen
- ENT Department, Sint-Augustinus Hospital Antwerp, European Institute for ORL-HNS, Antwerp, Belgium
| | - Floris L Wuyts
- Antwerp University Research Center for Equilibrium and Aerospace (AUREA), ENT Department, University Hospital Antwerp, Antwerp, Belgium; Faculty of Sciences, Department of Biomedical Physics, University of Antwerp, Antwerp, Belgium
| | - Leen K Maes
- Faculty of Medicine and Health Sciences, Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium; Faculty of Sciences, Department of Biomedical Physics, University of Antwerp, Antwerp, Belgium
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11
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Yetiser S, Ince D, Gul M. An Analysis of Vestibular Evoked Myogenic Potentials in Patients With Benign Paroxysmal Positional Vertigo. Ann Otol Rhinol Laryngol 2014; 123:686-95. [DOI: 10.1177/0003489414532778] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Vestibular evoked myogenic potentials (VEMPs) selectively test the vestibular end-organ. The aim of this study was to analyze how the site of the diseased canal, type of particulate deposition, duration of symptoms, severity of nystagmus, recurrence, and age affect the VEMP in patients with benign paroxysmal positional vertigo (BPPV). Methods: One hundred two patients were enrolled in the study between 2009 and 2012. There were 36 men and 66 women with ages ranging from 16 to 71 years (mean age, 42.28 ± 11.29 years). Patients with BPPV were tested with roll-on and head-hanging maneuvers under video-electronystagmography monitoring and with air conduction cervical VEMP testing. Patients were grouped for duration, severity, recurrence, age, site of canal involvement, and so on, and the results were compared in each subgroup. Kruskal–Wallis and Mann–Whitney U tests were used for the comparative analysis. Results: Twenty-four patients (23.5%) had a gross VEMP abnormality (absence of VEMP in 6 and greater than 25% depression of the amplitude in 18). Abnormality of VEMPs was not correlated with factors including age, severity of nystagmus, number of maneuvers applied, and the site of canal involvement ( P < .05). However, persistence or recurrence of symptoms has an effect on VEMP results ( P = .016). Conclusion: Vestibular evoked myogenic potential is a useful tool to study the otolithic function in patients with BPPV and should be included in the test battery.
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Affiliation(s)
- Sertac Yetiser
- Department of Otorhinolaryngology–Head and Neck Surgery, Anadolu Medical Center, Kocaeli, Turkey
| | - Dilay Ince
- Department of Otorhinolaryngology–Head and Neck Surgery, Anadolu Medical Center, Kocaeli, Turkey
| | - Murat Gul
- Department of Statistics, University of Giresun, Giresun, Turkey
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12
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De Kegel A, Maes L, Baetens T, Dhooge I, Van Waelvelde H. The influence of a vestibular dysfunction on the motor development of hearing-impaired children. Laryngoscope 2012; 122:2837-43. [DOI: 10.1002/lary.23529] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 05/02/2012] [Accepted: 05/29/2012] [Indexed: 11/09/2022]
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