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Tahir E, Kan EK, Uştu EK, Küçüköner A. Assessment of hearing and balance functions in patients with acromegaly by the use of an audiovestibular test battery: a cross-sectional study. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-09009-w. [PMID: 39356356 DOI: 10.1007/s00405-024-09009-w] [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: 07/17/2024] [Accepted: 09/23/2024] [Indexed: 10/03/2024]
Abstract
PURPOSE Patients with acromegaly may have abnormalities in their hearing and balance as a result of modifications in body composition and involvement of the temporal bone. The objective of this study is to examine if there are any changes in the auditory and vestibular systems in individuals with acromegaly by using audiogram and vestibular function tests. METHODS This prospective study included 33 healthy controls and 33 acromegaly patients who were matched for age and gender distribution. A pure-tone audiometry test was conducted, including frequencies ranging from 250 Hz to 8000 Hz. Videonystagmography (VNG) was employed to assess nystagmus, an essential parameter used for assessing vestibular functions. The Video Head Impulse Test (v-HIT) was used to assess the vestibulo-ocular reflex (VOR). The Dizziness Handicap Inventory (DHI) was applied to evaluate the subjective complaints of the participants. RESULTS The acromegaly patients had significantly elevated hearing thresholds at all frequencies (250, 500, 1000, 2000, 4000, and 6000 Hz) compared to the control group (p < 0.005). The VNG tests, including gaze horizontal, gaze vertical, saccade, spontaneous nystagmus, optokinetic, smooth pursuit, and positioning tests, did not show any statistically significant difference between the two groups (p values > 0.05). The patient group demonstrated reduced VOR gains compared to the control group in the anterior and posterior channels (p < 0.005). There was no statistically significant difference between the two groups for the occurrence of aberrant eye movements (p values > 0.05). The patient group had a total DHI score of 6.6 ± 3.2, while the control group had a score of 3.2 ± 2.6 (independent samples t-test; p < 0.001). Therefore, The patient group exhibited significantly greater subjective vestibular symptoms. CONCLUSIONS Patients with acromegaly experience impaired auditory function. The central vestibular system remains unaffected, while the gains of the vestibulo-ocular reflex (VOR) in the posterior and anterior semicircular canals are decreased. Additionally, these patients report experiencing subjective dizziness. Screening for hearing and balance in patients with acromegaly may improve the quality of life of patients and prevent problems related to balance disorders at an early stage.
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Affiliation(s)
- Emel Tahir
- Department of Otolaryngology, School of Medicine, Ondokuz Mayıs University, Kurupelit Cove, Atakum, Samsun, Turkey.
| | - Elif Kılıç Kan
- Department of Endocrinology, School of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Esra Kavaz Uştu
- Department of Otolaryngology, School of Medicine, Ondokuz Mayıs University, Kurupelit Cove, Atakum, Samsun, Turkey
| | - Asuman Küçüköner
- Department of Otolaryngology, School of Medicine, Ondokuz Mayıs University, Kurupelit Cove, Atakum, Samsun, Turkey
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Dikici O, Aslanci ME, Ekim B. Refractive Error Impact on Video Head Impulse Test Outcomes. Laryngoscope 2024. [PMID: 39158011 DOI: 10.1002/lary.31715] [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: 04/23/2024] [Revised: 07/29/2024] [Accepted: 08/06/2024] [Indexed: 08/20/2024]
Abstract
OBJECTIVE The objective of this study is to investigate the potential influence of refractive error on Video Head Impulse Test outcomes. MATERIAL AND METHODS Eighty-two patients were included in the study, and all patients underwent video head impulse testing. Patients were divided into four groups according to their refractive error: myopia, myopia-astigmatism, astigmatism, and emmetropia as control. RESULTS Patients with myopia are younger than patients with astigmatism and controls; similarly, patients with myopia-astigmatism are younger than patients with astigmatism. The right and left lateral, anterior, and posterior gain values were statistically significantly lower in the control group compared with myopia and myopia-astigmatism patients (p < 0.05). There was a statistically significant relationship between the right and left lateral, anterior, and posterior gain values and the degree of myopia in the patients (p < 0.05). CONCLUSION The results of the Video Head Impulse Test gain in myopia patients are higher than that in patients without refractive error. In addition, age may have an effect on gain values. It is important to consider this factor when evaluating the results of the Video Head Impulse Test in patients, and corrections should be made if necessary. LEVEL OF EVIDENCE Level 3 Laryngoscope, 2024.
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Affiliation(s)
- Oğuzhan Dikici
- Department of Otorlaryngology, Health Sciences University Bursa City Hospital, Bursa, Turkey
| | - Mehmet Emin Aslanci
- Ophthalmology Clinic, Health Sciences University Bursa City Hospital, Bursa, Turkey
| | - Buse Ekim
- Department of Otorlaryngology, Health Sciences University Bursa Yüksek Ihtisas Training and Research Hospital, Bursa, Turkey
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Mazloom M, Heravian Shandiz J, Jafarzadeh S, Jamali J, Momeni-Moghaddam H. Effect of Induced Myopia on the Vestibulo-ocular Reflex Evaluated by Ocular Vestibular Evoked Myogenic Potential. J Ophthalmic Vis Res 2024; 19:219-226. [PMID: 39055505 PMCID: PMC11267135 DOI: 10.18502/jovr.v19i2.10910] [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: 05/02/2022] [Accepted: 09/14/2023] [Indexed: 07/27/2024] Open
Abstract
Purpose The possible effects of refractive errors on vestibulo-ocular reflex (VOR) has been a conflicting issue. The aim of this study was to evaluate the effects of induced myopia on VOR using the ocular Vestibular Evoked Myogenic Potential (oVEMP). Methods In this cross-sectional quasi-experimental study, 35 emmetropic and normal subjects with the mean age of 23.89 ± 3.93 (range, 20-40 years) without any ocular, nervous system, and vestibular disorders, underwent the oVEMP test in the comprehensive rehabilitation center of Mashhad University of Medical Sciences. The oVEMP was performed under five different conditions of testing binocularly, monocularly, and when myopia was induced with the use of spherical lenses of +1.00, +3.00, and +5.00 diopters, respectively. There were 2 to 5 min of rest with closed eyes after each condition to avoid adaptation, fatigue, and any other sources of bias. Mean latencies of oVEMP waves (N1 and P1) and amplitudes of N1-P1 complex were measured. Results There was no significant difference between the right and left sides (P > 0.05). The induced myopia significantly increased the N1 and P1 latencies using lenses of +1.00, +3.00, and +5.00 diopters but the amplitudes of N1-P1 complex were not influenced by the different amounts of induced myopia. There was no significant difference among the different conditions of induced myopia either (P > 0.05). Conclusion Induced myopia could affect the VOR due to prolonging the latencies of oVEMP waves. However, the amplitudes were not affected and the effects of multiple degrees of induced myopia were not significantly different.
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Affiliation(s)
- Mahdi Mazloom
- Department of Optometry, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences,
Mashhad, Iran
| | - Javad Heravian Shandiz
- Department of Optometry, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences,
Mashhad, Iran
- Refractive Errors Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sadegh Jafarzadeh
- Department of Audiology, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences,
Mashhad, Iran
| | - Jamshid Jamali
- Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamed Momeni-Moghaddam
- Rehabilitation Sciences Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
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Money-Nolan LE, Flagge AG. Factors affecting variability in vestibulo-ocular reflex gain in the Video Head Impulse Test in individuals without vestibulopathy: A systematic review of literature. Front Neurol 2023; 14:1125951. [PMID: 36970532 PMCID: PMC10034038 DOI: 10.3389/fneur.2023.1125951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/20/2023] [Indexed: 03/11/2023] Open
Abstract
IntroductionThe purpose of this systematic review was to summarize and synthesize published evidence examining variations in vestibulo-ocular reflex (VOR) gain outcomes for the Video Head Impulse Test (vHIT) in healthy individuals without vestibulopathy in order to describe factors that may influence test outcomes.MethodsComputerized literature searches were performed from four search engines. The studies were selected based on relevant inclusion and exclusion criteria, and were required to examine VOR gain in healthy adults without vestibulopathy. The studies were screened using Covidence (Cochrane tool) and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards (PRISMA-2020).ResultsA total of 404 studies were initially retrieved, of which a total of 32 studies met inclusion criteria. Four major categories were identified which lead to significant variation in VOR gain outcomes: participant-based factors, tester/examiner-based factors, protocol-based factors, and equipment-based factors.DiscussionVarious subcategories are identified within each of these classifications and are discussed, including recommendations for decreasing VOR gain variability in clinical practice.
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van Dooren T, Starkov D, Lucieer F, Dobbels B, Janssen M, Guinand N, Pérez Fornos A, Kingma H, Van Rompaey V, van de Berg R. Suppression Head Impulse Test (SHIMP) versus Head Impulse Test (HIMP) When Diagnosing Bilateral Vestibulopathy. J Clin Med 2022; 11:jcm11092444. [PMID: 35566570 PMCID: PMC9102589 DOI: 10.3390/jcm11092444] [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: 03/02/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 02/05/2023] Open
Abstract
The Suppression Head Impulse (SHIMP) test was introduced as an alternative to the Head Impulse Paradigm (HIMP) to overcome challenges in VOR gain calculation due to the interference of covert saccades. The objectives of this study were (1) to determine if SHIMP, compared to HIMP, reduces covert saccades in BV patients and (2) to define the agreement on diagnosing BV between SHIMP and HIMP. First, the number of covert saccades was compared between SHIMP and HIMP. Secondly, VOR gain was compared between SHIMP and HIMP. Lastly, the agreement between SHIMP and HIMP on identifying BV (horizontal VOR gain <0.6) was evaluated. A total of 98 BV patients were included. To our knowledge, this is the largest study population on SHIMP testing in BV patients. Covert saccades were significantly reduced, and a lower VOR gain was found during SHIMP compared to HIMP (p < 0.001). However, the clinical relevance of these statistically significant differences is small. In 93% of the patients, an agreement was found between the two paradigms regarding the diagnosis of BV, and both paradigms detect BV in the vast majority of patients.
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Affiliation(s)
- Tessa van Dooren
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands; (F.L.); (N.G.); (H.K.); (R.v.d.B.)
- Correspondence:
| | - Dmitrii Starkov
- Faculty of Physics, Tomsk State Research University, 634050 Tomsk, Russia;
| | - Florence Lucieer
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands; (F.L.); (N.G.); (H.K.); (R.v.d.B.)
| | - Bieke Dobbels
- Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerp, Belgium; (B.D.); (V.V.R.)
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, 2650 Edegem, Belgium
| | - Miranda Janssen
- Department of ENT/Audiology, School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands;
- Department of Methodology and Statistics, Care and Public Health Research Institute (CAPHRI), Maastricht University, 6211 LK Maastricht, The Netherlands
| | - Nils Guinand
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands; (F.L.); (N.G.); (H.K.); (R.v.d.B.)
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Geneva, Switzerland;
| | - Angelica Pérez Fornos
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Geneva, Switzerland;
| | - Herman Kingma
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands; (F.L.); (N.G.); (H.K.); (R.v.d.B.)
| | - Vincent Van Rompaey
- Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerp, Belgium; (B.D.); (V.V.R.)
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, 2650 Edegem, Belgium
| | - Raymond van de Berg
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands; (F.L.); (N.G.); (H.K.); (R.v.d.B.)
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van Stiphout L, Pleshkov M, Lucieer F, Dobbels B, Mavrodiev V, Guinand N, Pérez Fornos A, Widdershoven J, Strupp M, Van Rompaey V, van de Berg R. Patterns of Vestibular Impairment in Bilateral Vestibulopathy and Its Relation to Etiology. Front Neurol 2022; 13:856472. [PMID: 35386413 PMCID: PMC8979031 DOI: 10.3389/fneur.2022.856472] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/17/2022] [Indexed: 11/23/2022] Open
Abstract
Objective This study aimed to investigate (1) the patterns of vestibular impairment in bilateral vestibulopathy (BVP) and subsequently, the implications regarding patient eligibility for vestibular implantation, and (2) whether this pattern and severity of vestibular impairment is etiology dependent. Methods A total of one hundred and seventy-three subjects from three tertiary referral centers in Europe were diagnosed with BVP according to the Bárány Society diagnostic criteria. The subjects underwent vestibular testing such as the caloric test, torsion swing test, video Head Impulse Test (vHIT) in horizontal and vertical planes, and cervical and/or ocular vestibular evoked myogenic potentials (c- and oVEMPs). The etiologies were split into idiopathic, genetic, ototoxicity, infectious, Menière's Disease, (head)trauma, auto-immune, neurodegenerative, congenital, and mixed etiology. Results The caloric test and horizontal vHIT more often indicated horizontal semicircular canal impairment than the torsion swing test. The vHIT results showed significantly higher gains for both anterior canals compared with the horizontal and posterior canals (p < 0.001). The rates of bilaterally absent oVEMP responses were higher compared to the bilaterally absent cVEMP responses (p = 0.010). A total of fifty-four percent of the patients diagnosed with BVP without missing data met all three Bárány Society diagnostic test criteria, whereas 76% of the patients were eligible for implantation according to the vestibular implantation criteria. Regarding etiology, only horizontal vHIT results were significantly lower for trauma, neurodegenerative, and genetic disorders, whereas the horizontal vHIT results were significantly higher for Menière's Disease, infectious and idiopathic BVP. The exploration with hierarchical cluster analysis showed no significant association between etiology and patterns of vestibular impairment. Conclusion This study showed that caloric testing and vHIT seem to be more sensitive for measuring vestibular impairment, whereas the torsion swing test is more suited for measuring residual vestibular function. In addition, no striking patterns of vestibular impairment in relation to etiology were found. Nevertheless, it was demonstrated that although the implantation criteria are stricter compared with the Bárány Society diagnostic criteria, still, 76% of patients with BVP were eligible for implantation based on the vestibular test criteria. It is advised to carefully examine every patient for their overall pattern of vestibular impairment in order to make well-informed and personalized therapeutic decisions.
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Affiliation(s)
- Lisa van Stiphout
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands
- *Correspondence: Lisa van Stiphout
| | - Maksim Pleshkov
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands
- Faculty of Physics, Tomsk State University, Tomsk, Russia
- Maksim Pleshkov
| | - Florence Lucieer
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands
| | - Bieke Dobbels
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine and Health Sciences, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Vergil Mavrodiev
- Department of Neurology and German Center for Vertigo, Ludwig-Maximilians University, Munich, Germany
| | - Nils Guinand
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Angelica Pérez Fornos
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Josine Widdershoven
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine and Health Sciences, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Michael Strupp
- Department of Neurology and German Center for Vertigo, Ludwig-Maximilians University, Munich, Germany
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine and Health Sciences, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Raymond van de Berg
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands
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Starkov D, Vermorken B, Van Dooren TS, Van Stiphout L, Janssen M, Pleshkov M, Guinand N, Pérez Fornos A, Van Rompaey V, Kingma H, Van de Berg R. The Effect of Different Head Movement Paradigms on Vestibulo-Ocular Reflex Gain and Saccadic Eye Responses in the Suppression Head Impulse Test in Healthy Adult Volunteers. Front Neurol 2021; 12:729081. [PMID: 34630303 PMCID: PMC8492894 DOI: 10.3389/fneur.2021.729081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/18/2021] [Indexed: 02/03/2023] Open
Abstract
Objective: This study aimed to identify differences in vestibulo-ocular reflex gain (VOR gain) and saccadic response in the suppression head impulse paradigm (SHIMP) between predictable and less predictable head movements, in a group of healthy subjects. It was hypothesized that higher prediction could lead to a lower VOR gain, a shorter saccadic latency, and higher grouping of saccades. Methods: Sixty-two healthy subjects were tested using the video head impulse test and SHIMPs in four conditions: active and passive head movements for both inward and outward directions. VOR gain, latency of the first saccade, and the level of saccade grouping (PR-score) were compared among conditions. Inward and active head movements were considered to be more predictable than outward and passive head movements. Results: After validation, results of 57 tested subjects were analyzed. Mean VOR gain was significantly lower for inward passive compared with outward passive head impulses (p < 0.001), and it was higher for active compared with passive head impulses (both inward and outward) (p ≤ 0.024). Mean latency of the first saccade was significantly shorter for inward active compared with inward passive (p ≤ 0.001) and for inward passive compared with outward passive head impulses (p = 0.012). Mean PR-score was only significantly higher in active outward than in active inward head impulses (p = 0.004). Conclusion: For SHIMP, a higher predictability in head movements lowered gain only in passive impulses and shortened latencies of compensatory saccades overall. For active impulses, gain calculation was affected by short-latency compensatory saccades, hindering reliable comparison with gains of passive impulses. Predictability did not substantially influence grouping of compensatory saccades.
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Affiliation(s)
- Dmitrii Starkov
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands.,Faculty of Physics, Tomsk State Research University, Tomsk, Russia
| | - Bernd Vermorken
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - T S Van Dooren
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Lisa Van Stiphout
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Miranda Janssen
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands.,Department of Methodology and Statistics, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Maksim Pleshkov
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands.,Faculty of Physics, Tomsk State Research University, Tomsk, Russia
| | - Nils Guinand
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands.,Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Angelica Pérez Fornos
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Vincent Van Rompaey
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Herman Kingma
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands.,Faculty of Physics, Tomsk State Research University, Tomsk, Russia
| | - Raymond Van de Berg
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands.,Faculty of Physics, Tomsk State Research University, Tomsk, Russia
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van Stiphout L, Lucieer F, Pleshkov M, Van Rompaey V, Widdershoven J, Guinand N, Pérez Fornos A, Kingma H, van de Berg R. Bilateral vestibulopathy decreases self-motion perception. J Neurol 2021; 269:5216-5228. [PMID: 34263351 PMCID: PMC9467944 DOI: 10.1007/s00415-021-10695-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 03/19/2021] [Accepted: 06/29/2021] [Indexed: 11/25/2022]
Abstract
Objective Current diagnostic criteria for bilateral vestibulopathy (BV) primarily involve measurements of vestibular reflexes. Perceptual self-motion thresholds however, are not routinely measured and their clinical value in this specific population is not yet fully determined. Objectives of this study were (1) to compare perceptual self-motion thresholds between BV patients and control subjects, and (2) to explore patterns of self-motion perception performance and vestibular function in BV patients. Methods Thirty-seven BV patients and 34 control subjects were included in this study. Perceptual self-motion thresholds were measured in both groups using a CAREN platform (Motek Medical BV, Amsterdam, The Netherlands). Vestibular function was evaluated (only in BV patients) by the caloric test, torsion swing test, video head impulse test of all semicircular canals, and cervical- and ocular vestibular-evoked myogenic potentials. Differences in thresholds between both groups were analyzed. Hierarchical cluster analysis was performed to visualize patterns between self-motion perception and vestibular function within the group of BV patients. Results Perceptual self-motion thresholds were significantly higher in BV patients compared to control subjects, regarding nearly all rotations and translations (depending on the age group) (p ≤ 0.001). Cluster analysis showed that within the group of BV patients, higher perceptual self-motion thresholds were generally associated with lower vestibular test results (significant for yaw rotation, caloric test, torsion swing test, and video head impulse test (p ≤ 0.001)). Conclusion Self-motion perception is significantly decreased in BV patients compared to control subjects regarding nearly all rotations and translations. Furthermore, decreased self-motion perception is generally associated with lower residual vestibular function in BV patients. Trial registration Trial registration number NL52768.068.15/METC Supplementary Information The online version contains supplementary material available at 10.1007/s00415-021-10695-3.
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Affiliation(s)
- Lisa van Stiphout
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, School for Mental Health and Neuroscience, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| | - Florence Lucieer
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, School for Mental Health and Neuroscience, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Maksim Pleshkov
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, School for Mental Health and Neuroscience, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.,Faculty of Physics, Tomsk State Research University, Tomsk, Russian Federation
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine and Health Sciences, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Josine Widdershoven
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, School for Mental Health and Neuroscience, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.,Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine and Health Sciences, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Nils Guinand
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Angélica Pérez Fornos
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Herman Kingma
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, School for Mental Health and Neuroscience, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.,Faculty of Physics, Tomsk State Research University, Tomsk, Russian Federation
| | - Raymond van de Berg
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, School for Mental Health and Neuroscience, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.,Faculty of Physics, Tomsk State Research University, Tomsk, Russian Federation
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9
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Lucieer FMP, Van Hecke R, van Stiphout L, Duijn S, Perez-Fornos A, Guinand N, Van Rompaey V, Kingma H, Joore M, van de Berg R. Bilateral vestibulopathy: beyond imbalance and oscillopsia. J Neurol 2020; 267:241-255. [PMID: 33030608 PMCID: PMC7718190 DOI: 10.1007/s00415-020-10243-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 09/20/2020] [Accepted: 09/22/2020] [Indexed: 01/04/2023]
Abstract
Objective To optimize the current diagnostic and treatment procedures for patients with bilateral vestibulopathy (BV), this study aimed to determine the complete spectrum of symptoms associated with BV. Method A prospective mixed-method study design was used. Qualitative data were collected by performing semi-structured interviews about symptoms, context, and behavior. The interviews were recorded and transcribed until no new information was obtained. Transcriptions were analyzed in consensus by two independent researchers. In comparison to the qualitative results, quantitative data were collected using the Dizziness Handicap Inventory (DHI), Hospital Anxiety and Depression Scale (HADS) and a health-related quality of life questionnaire (EQ-5D-5L). Results Eighteen interviews were transcribed. Reported symptoms were divided into fourteen physical symptoms, four cognitive symptoms, and six emotions. Symptoms increased in many situations, such as darkness (100%), uneven ground (61%), cycling (94%) or driving a car (56%). These symptoms associated with BV often resulted in behavioral changes: activities were performed more slowly, with greater attention, or were avoided. The DHI showed a mean score of severe handicap (54.67). The HADS questionnaire showed on average normal results (anxiety = 7.67, depression = 6.22). The EQ-5D-5L demonstrated a mean index value of 0.680, which is lower compared to the Dutch age-adjusted reference 0.839 (60–70 years). Conclusion BV frequently leads to physical, cognitive, and emotional complaints, which often results in a diminished quality of life. Importantly, this wide range of symptoms is currently underrated in literature and should be taken into consideration during the development of candidacy criteria and/or outcome measures for therapeutic interventions such as the vestibular implant. Electronic supplementary material The online version of this article (10.1007/s00415-020-10243-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- F M P Lucieer
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - R Van Hecke
- Department of Rehabilitation Sciences, University of Ghent, Ghent, Belgium
| | - L van Stiphout
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - S Duijn
- Faculty of Health, Medicine and life Sciences, University of Maastricht, Maastricht, The Netherlands
| | - A Perez-Fornos
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences,, Geneva University Hospitals, Geneva, Switzerland
| | - N Guinand
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences,, Geneva University Hospitals, Geneva, Switzerland
| | - V Van Rompaey
- Faculty of Physics, Tomsk State Research University, Tomsk, Russian Federation
| | - H Kingma
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - M Joore
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Care and Public Health Research Institute (CAPHRI) of the Faculty of Health, Medicine and Life Sciences of Maastricht University (FHML), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - R van de Berg
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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10
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Comparison of three video head impulse test systems for the diagnosis of bilateral vestibulopathy. J Neurol 2020; 267:256-264. [PMID: 32719974 PMCID: PMC7718202 DOI: 10.1007/s00415-020-10060-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/15/2020] [Accepted: 07/06/2020] [Indexed: 10/26/2022]
Abstract
INTRODUCTION A horizontal vestibulo-ocular reflex gain (VOR gain) of < 0.6, measured by the video head impulse test (VHIT), is one of the diagnostic criteria for bilateral vestibulopathy (BV) according to the Báràny Society. Several VHIT systems are commercially available, each with different techniques of tracking head and eye movements and different methods of gain calculation. This study compared three different VHIT systems in patients diagnosed with BV. METHODS This study comprised 46 BV patients (diagnosed according to the Báràny criteria), tested with three commercial VHIT systems (Interacoustics, Otometrics and Synapsys) in random order. Main outcome parameter was VOR gain as calculated by the system, and the agreement on BV diagnosis (VOR gain < 0.6) between the VHIT systems. Peak head velocities, the order effect and covert saccades were analysed separately, to determine whether these parameters could have influenced differences in outcome between VHIT systems. RESULTS VOR gain in the Synapsys system differed significantly from VOR gain in the other two systems [F(1.256, 33.916) = 35.681, p < 0.000]. The VHIT systems agreed in 83% of the patients on the BV diagnosis. Peak head velocities, the order effect and covert saccades were not likely to have influenced the above mentioned results. CONCLUSION To conclude, using different VHIT systems in the same BV patient can lead to clinically significant differences in VOR gain, when using a cut-off value of 0.6. This might hinder proper diagnosis of BV patients. It would, therefore, be preferred that VHIT systems are standardised regarding eye and head tracking methods, and VOR gain calculation algorithms. Until then, it is advised to not only take the VOR gain in consideration when assessing a VHIT trial, but also look at the raw traces and the compensatory saccades.
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11
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Effects of parameters of video head impulse testing on visually enhanced vestibulo-ocular reflex and vestibulo-ocular reflex suppression. Clin Neurophysiol 2020; 131:1839-1847. [PMID: 32570198 DOI: 10.1016/j.clinph.2020.04.169] [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] [Received: 12/12/2019] [Revised: 04/14/2020] [Accepted: 04/26/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To investigate the main effects of some testing and analysis variables on clinically quantified visually enhanced vestibulo-ocular reflex (VVOR) and vestibulo-ocular reflex suppression (VORS) results using video head impulse test. METHODS This prospective observational clinical study included 19 healthy participants who underwent the VVOR and VORS tests. The effect of demographic variables, head oscillation frequency, rotation direction, visual acuity and analysis time window width and location of the recorded tests on the quantified results of both VVOR and VORS were evaluated. And specifically, for the VORS test the effect of cognitive reinforcement of the participant during testing was evaluated. RESULTS A statistically significant difference was observed among the VVOR, non-reinforced VORS, and reinforced VORS tests for mean gain values of 0.91 ± 0.09, 0.6 ± 0.15, and 0.57 ± 0.16, respectively (p < 0.001). The optimized linear mixed-effect model showed a significant influence of frequency on the gain values for the reinforced and non-reinforced VORS tests (p = 0.01 and p = 0.004, respectively). Regarding the gain analysis method, statistically significant differences were found according to the short time interval sample location of the records for the initial location of the VVOR test (p < 0.006) and final location of the reinforced VORS test (p < 0.023). CONCLUSION Significant differences were observed in the gain values according to VVOR and VORS testing. Head oscillation frequency is a significant factor that affects the gain values, especially in VORS testing. Moreover, in VORS testing, participant concentration has a significant effect on the test for obtaining suppression gain values. When a short time interval sample is considered for VVOR and VORS testing, intermediate time samples appear the most adequate for both tests. SIGNIFICANCE The quantified visually enhanced vestibulo-ocular reflex (VVOR) and vestibulo-ocular reflex suppression (VORS) tests have recently been added to the assortment of available clinical vestibular tests. However, despite the clinical validity of these quantified tests that appear to be of increasing clinical interest, the effects of most of the clinical testing methods and mathematical variables are not well defined. In this research we describe what are the main collecting and analysis variables that could influence to the VVOR and VORS tests. Specially for VORS test, participant concentration on test tasks will have positive effect on the measured vestibulo-ocular reflex (VOR) suppression.
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McCrum C, Lucieer F, van de Berg R, Willems P, Pérez Fornos A, Guinand N, Karamanidis K, Kingma H, Meijer K. The walking speed-dependency of gait variability in bilateral vestibulopathy and its association with clinical tests of vestibular function. Sci Rep 2019; 9:18392. [PMID: 31804514 PMCID: PMC6895118 DOI: 10.1038/s41598-019-54605-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 11/13/2019] [Indexed: 11/09/2022] Open
Abstract
Understanding balance and gait deficits in vestibulopathy may help improve clinical care and our knowledge of the vestibular contributions to balance. Here, we examined walking speed effects on gait variability in healthy adults and in adults with bilateral vestibulopathy (BVP). Forty-four people with BVP, 12 healthy young adults and 12 healthy older adults walked at 0.4 m/s to 1.6 m/s in 0.2 m/s increments on a dual belt, instrumented treadmill. Using motion capture and kinematic data, the means and coefficients of variation for step length, time, width and double support time were calculated. The BVP group also completed a video head impulse test and examinations of ocular and cervical vestibular evoked myogenic potentials and dynamic visual acuity. Walking speed significantly affected all gait parameters. Step length variability at slower speeds and step width variability at faster speeds were the most distinguishing parameters between the healthy participants and people with BVP, and among people with BVP with different locomotor capacities. Step width variability, specifically, indicated an apparent persistent importance of vestibular function at increasing speeds. Gait variability was not associated with the clinical vestibular tests. Our results indicate that gait variability at multiple walking speeds has potential as an assessment tool for vestibular interventions.
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Affiliation(s)
- Christopher McCrum
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands.
- Institute of Movement and Sport Gerontology, German Sport University Cologne, Cologne, Germany.
| | - Florence Lucieer
- Division of Balance Disorders, Department of Otolaryngology, Head and Neck Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Raymond van de Berg
- Division of Balance Disorders, Department of Otolaryngology, Head and Neck Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Faculty of Physics, Tomsk State University, Tomsk, Russian Federation
| | - Paul Willems
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Angélica Pérez Fornos
- Service of Otorhinolaryngology and Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Nils Guinand
- Service of Otorhinolaryngology and Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Kiros Karamanidis
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, London, UK
| | - Herman Kingma
- Division of Balance Disorders, Department of Otolaryngology, Head and Neck Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Faculty of Physics, Tomsk State University, Tomsk, Russian Federation
| | - Kenneth Meijer
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
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Judge PD, Rodriguez AI, Barin K, Janky KL. Impact of Target Distance, Target Size, and Visual Acuity on the Video Head Impulse Test. Otolaryngol Head Neck Surg 2018; 159:739-742. [PMID: 29865935 DOI: 10.1177/0194599818779908] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The video head impulse test (vHIT) assesses the vestibulo-ocular reflex. Few have evaluated whether environmental factors or visual acuity influence the vHIT. The purpose of this study was to evaluate the influence of target distance, target size, and visual acuity on vHIT outcomes. Thirty-eight normal controls and 8 subjects with vestibular loss (VL) participated. vHIT was completed at 3 distances and with 3 target sizes. Normal controls were subdivided on the basis of visual acuity. Corrective saccade frequency, corrective saccade amplitude, and gain were tabulated. In the normal control group, there were no significant effects of target size or visual acuity for any vHIT outcome parameters; however, gain increased as target distance decreased. The VL group demonstrated higher corrective saccade frequency and amplitude and lower gain as compared with controls. In conclusion, decreasing target distance increases gain for normal controls but not subjects with VL. Preliminarily, visual acuity does not affect vHIT outcomes.
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Affiliation(s)
- Paul D Judge
- 1 University of Nebraska Medical Center, Omaha, Nebraska, USA
| | | | - Kamran Barin
- 3 Eye and Ear Institute, The Ohio State University, Columbus, Ohio, USA
| | - Kristen L Janky
- 2 Boys Town National Research Hospital, Omaha, Nebraska, USA
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