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Zhou M, Mao J, Yang X. The spatial orientation of crista ampullaris: implications for BPPV diagnosis and treatment. Front Neurol 2024; 15:1401041. [PMID: 39026586 PMCID: PMC11256863 DOI: 10.3389/fneur.2024.1401041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 06/21/2024] [Indexed: 07/20/2024] Open
Abstract
Objective This study aimed to provide a comprehensive understanding of the spatial orientation of the crista ampullaris within the inner ear and its implications for the diagnosis and management of benign paroxysmal positional vertigo (BPPV). Methods Using high-resolution MRI scans of 55 normal inner ears, 3D models of the semicircular canals were segmented. These were complemented by detailed membrane labyrinth models from micro-CT scans of human temporal bones, accessed via the Comparative Ear Bank (www.earbank.org). A statistical shape model of inner ears and eyeballs was established, and a standardized 3D spatial coordinate system was created. The horizontal plane was defined using the top of the common crus and the bottom of the eyeballs. This calibrated reference system allowed for precise quantification of crista ampullaris orientations by calculating angles between the defined crista planes and coordinate planes. Results The plane of the ampulla and the corresponding semicircular canal plane are nearly perpendicular to each other. In the upright position, the posterior semicircular canal crista ampullaris formed an angle of 48.9° with the horizontal plane. The relative orientations of the crista ampullaris of the lateral and superior canals were also defined. Furthermore, we identified "zero-point planes" representing crista orientations perpendicular to gravity, which resulted in minimal ampullary stimulation. A 6.2° tilt to the left in the supine position resulted in the plane of the left lateral semicircular canal crista ampullaris being parallel to the direction of gravity. Conclusion This study elucidates the precise spatial orientation of the crista ampullaris, thereby providing an anatomical basis for understanding BPPV pathophysiology and improving the accuracy of diagnostic and therapeutic maneuvers. The findings have the potential to significantly enhance the management of BPPV and other inner ear disorders.
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Affiliation(s)
- Mi Zhou
- Wenzhou Key Laboratory of Intelligent Medicine for Neurodegenerative Diseases, Third Affiliated Hospital, School of Medicine, Shanghai University, Shanghai, China
- Wenzhou Key Laboratory of Intelligent Medicine for Neurodegenerative Diseases, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou, Zhejiang, China
- Wenzhou Key Laboratory of Intelligent Medicine for Neurodegenerative Diseases, Wenzhou People's Hospital, Wenzhou, Zhejiang, China
| | - Jiesheng Mao
- Wenzhou Key Laboratory of Intelligent Medicine for Neurodegenerative Diseases, Third Affiliated Hospital, School of Medicine, Shanghai University, Shanghai, China
- Wenzhou Key Laboratory of Intelligent Medicine for Neurodegenerative Diseases, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou, Zhejiang, China
- Wenzhou Key Laboratory of Intelligent Medicine for Neurodegenerative Diseases, Wenzhou People's Hospital, Wenzhou, Zhejiang, China
| | - Xiaokai Yang
- Wenzhou Key Laboratory of Intelligent Medicine for Neurodegenerative Diseases, Third Affiliated Hospital, School of Medicine, Shanghai University, Shanghai, China
- Wenzhou Key Laboratory of Intelligent Medicine for Neurodegenerative Diseases, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou, Zhejiang, China
- Wenzhou Key Laboratory of Intelligent Medicine for Neurodegenerative Diseases, Wenzhou People's Hospital, Wenzhou, Zhejiang, China
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La Scaleia B, Brunetti C, Lacquaniti F, Zago M. Head-centric computing for vestibular stimulation under head-free conditions. Front Bioeng Biotechnol 2023; 11:1296901. [PMID: 38130821 PMCID: PMC10734306 DOI: 10.3389/fbioe.2023.1296901] [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: 09/19/2023] [Accepted: 11/16/2023] [Indexed: 12/23/2023] Open
Abstract
Background: The vestibular end organs (semicircular canals, saccule and utricle) monitor head orientation and motion. Vestibular stimulation by means of controlled translations, rotations or tilts of the head represents a routine manoeuvre to test the vestibular apparatus in a laboratory or clinical setting. In diagnostics, it is used to assess oculomotor postural or perceptual responses, whose abnormalities can reveal subclinical vestibular dysfunctions due to pathology, aging or drugs. Objective: The assessment of the vestibular function requires the alignment of the motion stimuli as close as possible with reference axes of the head, for instance the cardinal axes naso-occipital, interaural, cranio-caudal. This is often achieved by using a head restraint, such as a helmet or strap holding the head tightly in a predefined posture that guarantees the alignment described above. However, such restraints may be quite uncomfortable, especially for elderly or claustrophobic patients. Moreover, it might be desirable to test the vestibular function under the more natural conditions in which the head is free to move, as when subjects are tracking a visual target or they are standing erect on the moving platform. Here, we document algorithms that allow delivering motion stimuli aligned with head-fixed axes under head-free conditions. Methods: We implemented and validated these algorithms using a MOOG-6DOF motion platform in two different conditions. 1) The participant kept the head in a resting, fully unrestrained posture, while inter-aural, naso-occipital or cranio-caudal translations were applied. 2) The participant moved the head continuously while a naso-occipital translation was applied. Head and platform motion were monitored in real-time using Vicon. Results: The results for both conditions showed excellent agreement between the theoretical spatio-temporal profile of the motion stimuli and the corresponding profile of actual motion as measured in real-time. Conclusion: We propose our approach as a safe, non-intrusive method to test the vestibular system under the natural head-free conditions required by the experiential perspective of the patients.
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Affiliation(s)
- Barbara La Scaleia
- Laboratory of Visuomotor Control and Gravitational Physiology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Claudia Brunetti
- Laboratory of Visuomotor Control and Gravitational Physiology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Francesco Lacquaniti
- Laboratory of Neuromotor Physiology, Istituto di Ricovero e Cura a Carattere Scientifico—Scientific Institute for Research, Hospitalization and Healthcare, Santa Lucia Foundation, Rome, Italy
- Department of Systems Medicine and Centre of Space Bio-medicine, University of Rome Tor Vergata, Rome, Italy
| | - Myrka Zago
- Laboratory of Visuomotor Control and Gravitational Physiology, IRCCS Santa Lucia Foundation, Rome, Italy
- Department of Systems Medicine and Centre of Space Bio-medicine, University of Rome Tor Vergata, Rome, Italy
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Yu FF, Feltrin FS, Bathla G, Raj K, Agarwal A, Lee WC, Booth T, Singh A. Imaging Guide to Inner Ear Malformations: An Illustrative Review. Curr Probl Diagn Radiol 2023; 52:576-585. [PMID: 37500297 DOI: 10.1067/j.cpradiol.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/29/2023]
Abstract
Inner ear malformation (IEM) with associated sensoryneural hearing loss (SNHL) is a major cause of childhood disability. Computed tomography (CT) and magnetic resonance imaging (MRI) imaging play important and often complementary roles in diagnosing underlying structural abnormalities and surgical planning allows for direct visualization of the cochlear nerve and is the preferred imaging modality prior to cochlear implantation. CT is helpful to assess osseous anatomy and when evaluating children with mixed hearing loss or syndromic associations. When reviewing these cases, it is important for the radiologist to be familiar with the key imaging features. In this article, we will present the imaging findings associated with different inner ear malformations associated with congenital sensorineural hearing loss.
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Affiliation(s)
- Fang Frank Yu
- Department of Radiology, University of Texas Southwestern, Dallas, TX
| | | | - Girish Bathla
- Department of Radiology, University of Iowa Hospital and Clinics, Iowa City, IA
| | - Karuna Raj
- Department of Radiology, University of Texas Southwestern, Dallas, TX
| | - Amit Agarwal
- Department of Radiology, University of Texas Southwestern, Dallas, TX
| | - Wan-Ching Lee
- Department of Emergency Medicine, University of Texas Southwestern, Dallas, TX
| | - Timothy Booth
- Department of Radiology, Children's Hospital, University of Texas Southwestern, Dallas, TX
| | - Achint Singh
- Department of Radiology, University of Texas Health Science Center at San Antonio, Dallas, TX
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Li X, Zhu Z, Yin H, Zhao P, Lv H, Tang R, Qin Y, Zhuo L, Wang Z. Labyrinth morphological modeling and its application on unreferenced segmentation assessment. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2023.104891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
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Li Y, Yang X. Design and analysis of HSC-BPPV diagnostic maneuver based on virtual simulation. Front Neurol 2023; 14:1132343. [PMID: 36873445 PMCID: PMC9981954 DOI: 10.3389/fneur.2023.1132343] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 01/31/2023] [Indexed: 02/19/2023] Open
Abstract
Background The preferred supine roll test for the diagnosis of horizontal semicircular canal BPPV has several disadvantages, including difficulty in locating the affected ear, inconsistent nystagmus performance on repeated testing, and lack of a typical latency period, resulting in insensitive diagnosis. Objectives To investigate novel diagnostic techniques with more scientific design, more accessible application, and better diagnostic sensitivity and specificity. Materials and methods Based on clinical microscopic CT data, we created a virtual simulation model of BPPV using Unity software. The physical simulation of the traditional supine roll test was performed to observe and analyse the movement of the otoliths, whose initial position was the typical stable position. In addition, the normal vectors of the plane and crista ampullaris of the horizontal semicircular canal were measured using 3D Slicer software. Based on this, we analyzed the critical steps for designing diagnostic maneuvers for BPPV in the horizontal semicircular canal. For a more accurate diagnosis of horizontal semicircular canal BPPV, it is critical to rotate the horizontal semicircular canal to be parallel to gravity. It is also necessary to move the otolith by swinging the head. As a result, we developed two diagnostic maneuvers: the 60° roll test and the prone roll test. We also performed simulations to observe otolith movement and predict nystagmus performance. Conclusions The 60° roll test and the prone roll test can complement the supine roll test. Compared to the supine roll test, they not only effectively differentiate canalolithiasis from cupulolithiasis, but also make it easier to determine the position of the otoliths, and the characteristics of the nystagmus are more pronounced. Significant diagnostic features have significant potential benefits for home and telemedicine.
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Affiliation(s)
- Yanjun Li
- Department of Research Center, Third Affiliated Hospital of Shanghai University, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou People's Hospital, Wenzhou, China
| | - Xiaokai Yang
- Department of Research Center, Third Affiliated Hospital of Shanghai University, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou People's Hospital, Wenzhou, China
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Wu S, Li J, Zhou M, Yang X. Simulation Study of Canal Switching in BPPV. Front Neurol 2022; 13:944703. [PMID: 35911897 PMCID: PMC9326062 DOI: 10.3389/fneur.2022.944703] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 07/17/2022] [Indexed: 11/13/2022] Open
Abstract
The objective of this research was to investigate the mechanism of canal switching in benign paroxysmal positional vertigo through a virtual simulation model. Using Unity 3D software and a built-in NVIDIA Physx physics engine, the virtual simulation software is developed using a browser-server architecture, and different models are imported. Based on the benign paroxysmal positional vertigo virtual simulation model, we constructed five different virtual reality scenes of diagnosis and treatment, set otoliths in different positions of the semicircular canals, and analyzed the effects of diagnostic and therapeutic procedures on otolith location. Through the analysis of otolith movement in five virtual scenes, we found that canal switching may be caused by otoliths in the utricle entering the semicircular canal in the supine position. Then, we used different methods to reposition the otolith, improved the repositioning maneuver, and explored in depth the mechanism of the canal switching. The results showed that the main reason for the canal switch is that in the supine position, the otolith in the utricle enters the semicircular canal. The repositioning maneuvers, including the Epley maneuver and Barbecue maneuver, will not directly lead to the canal switch in the ipsilateral inner ear. The supine roll maneuver leads to the otolith in the utricle entering the posterior or lateral semicircular canal, which is the most likely mechanism for canal switching.
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Affiliation(s)
- Shuzhi Wu
- Neurology Department, Third Affiliated Hospital of Shanghai University, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou People's Hospital, Wenzhou, China
| | - Jianxin Li
- Third Affiliated Hospital of Shanghai University, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou People's Hospital, Wenzhou, China
| | - Mi Zhou
- Neurology Department, Third Affiliated Hospital of Shanghai University, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou People's Hospital, Wenzhou, China
| | - Xiaokai Yang
- Neurology Department, Third Affiliated Hospital of Shanghai University, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou People's Hospital, Wenzhou, China
- *Correspondence: Xiaokai Yang
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Abstract
To analyze the mechanism and clinical significance of Benign paroxysmal positional vertigo (BPPV) fatigability and discuss how to eliminate BPPV fatigability. A physical simulation model of BPPV was developed to observe the effect of the Dix-Hallpike test on otolith location and explore strategies to eliminate fatigability. Dix-Hallpike test can keep the otoliths in the lower arm of the posterior semicircular canal away from the ampulla. When the head is tilted 30° forward, the otolith slides to the lower arm near the ampulla, which is sufficient to ensure that the starting position of the otolith is consistent when the Dix-Hallpike test is repeated. When the head is tilted 60° forward, the otolith can enter the ampulla and reach the bottom of the crista ampullaris, which leads to long latency because the otolith sliding in the ampulla does not cause an obvious hydrodynamic effect during the Dix-Hallpike test. The otoliths located on the short arm side of the posterior semicircular canal will break away from the short arm side and enter the utricle when the head is tilted 120° forward. The stable and consistent nystagmus induced by the improved diagnostic test may be a more important feature of BPPV.
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Affiliation(s)
- Xiaokai Yang
- Neurology Department, Third Affiliated Hospital of Shanghai University, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou People's Hospital, Wenzhou, China
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