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Bozdemir K, Çallıoğlu EE, İslamoğlu Y, Ercan MK, Eser F, Özdem B, Kıraç A, Bayazıt D, Güner R, Babademez MA. Evaluation of the effects of Covid-19 on cochleovestibular system with audiovestibular tests. Ear Nose Throat J 2024; 103:NP267-NP271. [PMID: 34991362 DOI: 10.1177/01455613211069916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The purpose of the present study was to investigate the effects of COVID-19 on audiovestibular system with Transiently Evoked Distortion Otoacoustic Emissions (TOAE), Distortion Product Otoacoustic Emissions (DPOAE), video head impulse test (vHIT) and caloric test. METHODS Audiovestibular findings of 24 patients with moderate/severe COVID-19 and 24 healthy controls were compared using pure tone audiometry, tympanometry, TOAE, DPOAE, caloric test, and vHIT. RESULTS On audiometry, the pure tone averages of the COVID-19 patients were higher than the controls (P = .038). The TEOAE amplitudes at 4000 and 5000 Hz (P = .006 and P < .01), and DPOAE amplitudes at 3000, 6000, and 8000 Hz (P < .001, P = .003 and P < .001) were significantly lower in COVID-19 patients compared to the controls. On vestibular tests, there was no significant difference between the caloric test results of the patients and the controls (P > .05). On vHIT testing, amplitudes of right semicircular canal was found to be significantly lower in COVID-19 group compared to the control group (P = .008). CONCLUSION COVID-19 may affect inner ear functions causing a subtle damage in the outer hair cells and lateral semicircular canals. It must be kept in mind that COVID-19 may cause cochleovestibular problems.
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Affiliation(s)
- Kazım Bozdemir
- Department of Otolaryngology-Head and Neck Surgery, Yıldırım Beyazıt University, Ankara, Turkey
| | - Elif Ersoy Çallıoğlu
- Department of Otolaryngology-Head and Neck Surgery, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Yüce İslamoğlu
- Department of Otolaryngology-Head and Neck Surgery, Ankara Bilkent City Hospital, Ankara, Turkey
| | | | - Fatma Eser
- Department of İnfectious Diseases and Microbiology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Birsen Özdem
- Department of İnfectious Diseases and Microbiology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Arda Kıraç
- Department of Otolaryngology-Head and Neck Surgery, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Dilara Bayazıt
- Deparment of Audiology, İstanbul Medipol University, İstanbul, Turkey
| | - Rahmet Güner
- Department of İnfectious Diseases and Microbiology, Yıldırım Beyazıt University, Ankara, Turkey
| | - Mehmet Ali Babademez
- Department of Otolaryngology-Head and Neck Surgery, Yıldırım Beyazıt University, Ankara, Turkey
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Hepkarsi S, Kaya I, Kirazli T. Vestibular function assessment in Idiopathic sudden sensorineural hearing loss: a prospective study. Eur Arch Otorhinolaryngol 2024; 281:2365-2372. [PMID: 38095708 DOI: 10.1007/s00405-023-08361-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 11/17/2023] [Indexed: 04/18/2024]
Abstract
PURPOSE Idiopathic sudden sensorineural hearing loss (ISSHL) can cause acute damage not only to the auditory function, but also to the vestibular function in addition to damage to the hearing function. The aim of this study was to perform vestibular assessment using caloric test and video head impulse test in patients with idiopathic sudden sensorineural hearing loss. In addition, to evaluate the relationship of dizziness with vestibular tests and post-treatment responses of vestibular tests. METHODS This is an observational, longitudinal and prospective study, including patients diagnosed with idiopathic sudden sensorineural hearing. Patients were divided into two groups according to the presence of vestibular complaints at presentation: Group 1: Patients with vestibular complaints, Group 2: Patients without vestibular complaints. All subjects underwent pure tone audiometry (PTA) testing, cold caloric test and video head impulse test (vHIT) during their admission and on the 10th day, 3rd month, and 1st year of their follow-up outpatient clinic controls. A unilateral weakness (UW) in the caloric test response was quantified according to the Jongkees formula. RESULTS A positive and significant relationship was found between the degree of hearing loss according to the ASHA criteria pre-treatment and the level of improvement created according to Siegel criteria at the 10th day, 3rd month, 1st year after treatment (respectively p = 0.001, p = 0.001, p < 0.001). When both short-term and long-term results were evaluated after treatment, a positive improvement in the degree of hearing loss was observed. A statistically significant difference was observed between Groups 1 and 2 when the pre-treatment, at 10 days, 3 months and 1 year after treatment the caloric test UW value was compared (respectively p = 0.020, p = 0.004, p = 0.004, p = 0.004). A statistically significant difference was observed between Groups 1 and 2 when the pre-treatment, at 10 days, 3 months and 1 year after treatment vHIT lateral canal VOR value was compared (respectively p = 0.000, p = 0.001, p = 0.000, p = 0.004). When both short-term and long-term results were evaluated after treatment, a positive improvement was observed in both caloric test results and lateral vHIT VOR values. Pre-treatment, post-treatment 10th day, 3rd month, 1st year vHIT anterior and posterior canal VOR values were found to be VOR˃0.8 in all patients. No difference was observed in anterior and posterior canal VOR values. CONCLUSION Vertigo in patients with ISSHL "as objectively confirmed through caloric testing and vHIT" can be considered a sign of severe cochlear damage. Our study demonstrated a significantly increased risk of vestibular affect in patients with ISSHL, especially in the presence of vertigo. Thus, we conclude that the focus in ISSHL should not only be on the cochlea but also on the vestibular system.
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Affiliation(s)
- Sevinc Hepkarsi
- Department of Otolaryngology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey.
| | - Isa Kaya
- Department of Otolaryngology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Tayfun Kirazli
- Department of Otolaryngology, Faculty of Medicine, Ege University, Izmir, Turkey
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Kirbac A, Kaya E, Incesulu SA, Carman KB, Yarar C, Ozen H, Pinarbasli MO, Gurbuz MK. Differentiation of peripheral and non-peripheral etiologies in children with vertigo/dizziness: The video-head impulse test and suppression head impulse paradigm. Int J Pediatr Otorhinolaryngol 2024; 179:111935. [PMID: 38574650 DOI: 10.1016/j.ijporl.2024.111935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/14/2024] [Accepted: 03/26/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVES To identify the etiology of vertigo/dizziness and determine the effectiveness of the video-head impulse test (vHIT) and the suppression head impulse paradigm (SHIMP) tests in distinguishing between peripheral and non-peripheral etiologies in children who presented to the otolaryngology department with complaints of vertigo/dizziness. METHODS The vHIT and SHIMP tests were applied to the children. The vestibulo-ocular reflex (VOR) gain and saccade parameters were compared. RESULTS In 27 children presenting with vertigo/dizziness, the most common etiological factor was inner ear malformation (IEM) (n = 6/27, 22.2%), followed by cochlear implant surgery (11.1%) and migraine (11.1%). Vestibular hypofunction was indicated by the vHIT results at a rate of 60% (9/15 children) and SHIMP results at 73.3% (11/15 children) among the children with a peripheral etiology, while these rates were 8.3% (1/12 children) and 25% (3/12 children), respectively, in the non-peripheral etiology group. SHIMP-VOR and vHIT-VOR gain values had a moderate positive correlation (p = 0.01, r = 0.349). While there were overt/covert saccades in the vHIT, anti-compensatory saccade (ACSs) were not observed in the SHIMP test (p = 0.041). The rates of abnormal vHIT-VOR gain (p = 0.001), over/covert saccades (p = 0.019), abnormal vHIT response (p = 0.014), ACSs (p = 0.001), and abnormal SHIMP response (p = 0.035) were significantly higher in the peripheral etiology group. CONCLUSIONS IEM was the most common etiological cause, and the rate of vestibular hypofunction was higher in these children with peripheral vertigo. vHIT and SHIMP are effective and useful vestibular tests for distinguishing peripheral etiology from non-peripheral etiology in the pediatric population with vertigo/dizziness. These tests can be used together or alone, but the first choice should be the SHIMP test, considering its short application time (approximately 4-5 min) and simplicity.
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Affiliation(s)
- Arzu Kirbac
- Eskişehir Osmangazi University, Faculty of Health Sciences, Department of Audiology, 26480, Eskisehir, Turkiye.
| | - Ercan Kaya
- Eskişehir Osmangazi University, Faculty of Medicine, Department of Otolaryngology, 26480, Eskisehir, Turkiye
| | - Saziye Armagan Incesulu
- Eskişehir Osmangazi University, Faculty of Medicine, Department of Otolaryngology, 26480, Eskisehir, Turkiye
| | - Kursat Bora Carman
- Eskişehir Osmangazi University, Faculty of Medicine, Department of Pediatric Neurology, 26480, Eskisehir, Turkiye
| | - Coskun Yarar
- Eskişehir Osmangazi University, Faculty of Medicine, Department of Pediatric Neurology, 26480, Eskisehir, Turkiye
| | - Hulya Ozen
- University of Health Sciences, Gulhane Faculty of Medicine, Department of Medical Informatics, 06018 Ankara, Turkiye
| | - Mehmet Ozgur Pinarbasli
- Eskişehir Osmangazi University, Faculty of Medicine, Department of Otolaryngology, 26480, Eskisehir, Turkiye
| | - Melek Kezban Gurbuz
- Eskişehir Osmangazi University, Faculty of Medicine, Department of Otolaryngology, 26480, Eskisehir, Turkiye
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Fukushima M, Kadowaki S, Nakatani S, Waki S, Matsumoto K, Okamoto H. Impact of endolymphatic hydrops on the function of the horizontal canal during caloric stimulation in Ménière's disease. Eur Arch Otorhinolaryngol 2024; 281:1701-1708. [PMID: 37804352 DOI: 10.1007/s00405-023-08272-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 10/02/2023] [Indexed: 10/09/2023]
Abstract
PURPOSE When a dizzy patient with episodic vertigo has an abnormal caloric and a normal video head impulse test (vHIT), this caloric-vHIT dissociation provides vital information for a diagnosis of Ménière's disease (MD). Endolymphatic hydrops (EH), a histological marker of MD, is hypothesized to be involved in the caloric-vHIT dissociation in MD through hydropic duct distension of the horizontal semicircular canal (SC). This study was designed to determine the impact of EH on the function of horizontal SC during caloric stimulation. METHODS Caloric test and vHIT were used to evaluate the function of horizontal SC every six months, annual magnetic resonance imaging (MRI) was used to evaluate the degree of EH size in the vestibule, and monthly vertigo and hearing evaluation was done for 12 months. EH shrinkage was defined as the size change of vestibular EH from significant to none. RESULTS Among 133 MD patients evaluated for eligibility, 67 patients with caloric-vHIT dissociation entered the study. Fifteen participants had EH shrinkage (G-I), while 52 participants had no remarkable EH change (G-II). Average values (IQR) of the maximum slow phase velocity in G-I and G-II were 29.6 (13.0-34.0) and 25.9 (17.3-31.3), respectively, at baseline, 26.1 (9.0-38.0) and 23.6 (18.0-28.3) at 12 months. Two-factor repeated-measures ANOVA showed no significant differences between the groups (P = 0.486). The values of vestibulo-ocular reflex gain of the horizontal SC in G-I and G-II remained above 0.8 during the study period. CONCLUSIONS EH detected by MRI shows limited correlation with caloric stimulation results.
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Affiliation(s)
- Munehisa Fukushima
- Department of Otolaryngology, Adachi Medical Center, Tokyo Women's Medical University, 4-33-1 Kohoku, Adachi-Ku, Tokyo, 123-8558, Japan.
- Department of Otolaryngology and Head and Neck Surgery, Kansai Rosai Hospital, Hyogo, Japan.
| | - Seiichi Kadowaki
- Department of Otolaryngology, Adachi Medical Center, Tokyo Women's Medical University, 4-33-1 Kohoku, Adachi-Ku, Tokyo, 123-8558, Japan
- Department of Physiology, School of Medicine, International University of Health and Welfare, Chiba, Japan
| | - Saho Nakatani
- Department of Otolaryngology and Head and Neck Surgery, Kansai Rosai Hospital, Hyogo, Japan
| | - Sadanori Waki
- Department of Otolaryngology and Head and Neck Surgery, Kansai Rosai Hospital, Hyogo, Japan
| | - Ken Matsumoto
- Department of Otolaryngology and Head and Neck Surgery, Kansai Rosai Hospital, Hyogo, Japan
| | - Hidehiko Okamoto
- Department of Physiology, School of Medicine, International University of Health and Welfare, Chiba, Japan
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Nakamichi N, Shiozaki T, Sakagami M, Kitahara T. Differences in semicircular canal function in the video head impulse test in patients in the chronic stage of sudden sensorineural hearing loss with vertigo and vestibular neuritis. Acta Otolaryngol 2024; 144:123-129. [PMID: 38546396 DOI: 10.1080/00016489.2024.2330680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/10/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Sudden sensorineural hearing loss with vertigo (SHLV) and vestibular neuritis (VN) can result in prolonged dizziness. OBJECTIVES This study aimed to compare the video head impulse test (vHIT) of patients with SHLV and VN. METHODS Fifteen patients with SHLV and 21 patients with VN who visited the Vertigo/Dizziness Center of our hospital between December 2016 and February 2023 were included. vHIT was performed at the time of admission, and the VOR gain and catch up saccade (CUS) in the three types of semicircular canals (SCCs) were analyzed. RESULTS Pathologic vHIT results were observed most frequently in the posterior SCC (73%), followed by lateral (53%) and anterior (13%) SCCs in the SHLV group. In contrast, pathologic vHIT results were observed most frequently in the lateral SCC (100%), followed by the anterior (43%) and posterior SCC (24%) SCCs in the VN group. Pathological vHIT results in the lateral and posterior SCC showed significant differences between the two groups, but for anterior SCC, no significant differences were found. CONCLUSIONS AND SIGNIFICANCE Comparison of the two vHIT results revealed differences in the SCC dysfunction patterns. This may be due to the different pathophysiological mechanisms of the two vestibular disorders, which may result in prolonged vertigo.
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Affiliation(s)
- Natsuko Nakamichi
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, Kashihara-city, Japan
| | - Tomoyuki Shiozaki
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, Kashihara-city, Japan
| | - Masaharu Sakagami
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, Kashihara-city, Japan
| | - Tadashi Kitahara
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, Kashihara-city, Japan
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Zhao D, Jiang Z, Li C. [Dynamic visual acuity screening test results analysis of 25 patients with peripheral vertigo]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2024; 38:146-149. [PMID: 38297869 DOI: 10.13201/j.issn.2096-7993.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Indexed: 02/02/2024]
Abstract
Objective:To observe the results of dynamic visual acuity screening tests in patients with peripheral vertigo and explore its clinical significance. Methods:The number of 48 healthy volunteers were enrolled as control group and 25 peripheral vertigo patients as experimental group. In the experimental group, there are 12 patients with vestibular neuritis, 1 patient with Hunt syndrome, 5 patients with sudden deafness with vertigo and 7 patients with bilateral vestibular dysfunction. Horizontal and vertical dynamic visual acuity screening tests were performed on them. The number of lost rows of horizontal and vertical dynamic visual acuity was compared between the control group and the experimental group to figure out if there is a statistical difference. The number of lost rows of horizontal and vertical dynamic visual acuity was compared within the experimental group to figure out if there is a statistical difference. The two groups of 18 cases of unilateral vestibular function decline and 7 cases of bilateral vestibular function decline in the experimental group were compared with the control group, and figure out if there is a statistical difference. Results:The median number of lost rows of horizontal dynamic visual acuity in 48 healthy volunteers was 1.5 and median number of lost rows of vertical dynamic visual acuity was 1.0 in the control group. The median number of lost rows of horizontal dynamic visual acuity of 26 healthy volunteers was 6 and median number of lost rows of vertical dynamic visual acuity was 5 in the experimental group. Compared to the experimental group, the number of lost rows both have statistical significance in horizontal and vertical dynamic visual acuity(P<0.01). The comparison of horizontal and vertical lost rows within the test group also have statistical significance(P<0.01). Twenty five patients with exceptional vestibular disease in the experimental group were divided into unilateral vestibular function reduction group(n=18) and bilateral vestibular function reduction group(n=7). Compared with the control group, there was significant differences in the number of horizontal and vertical lost rows(P<0.01) within the three groups. After pairwise comparison, the number of lost rows of horizontal and vertical in the control group was significantly lower than that in the unilateral vestibular function reduction group and the bilateral vestibular function reduction group(P<0.01). There was a highly significant correlation between the number of horizontally lost rows of DVA and the mean vHIT values of bilateral horizontal semicircular canals in 25 patients(P<0.01); and a highly significant correlation between the number of vertically lost rows of DVA and the mean vHIT values of vertical semicircular canals in 4 groups bilaterally(P<0.01). Conclusion:The Dynamic Visual Acuity Screening Test is a useful addition to existing tests of peripheral vestibular function, particularly the vHIT test, and provides a rapid assessment of the extent of 2 Hz VOR impairment in patients with reduced vestibular function.
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Affiliation(s)
- Dong Zhao
- Department of Otology,First Hospital of Qinhuangdao,Qinhuangdao,066000,China
| | - Zigang Jiang
- Department of Otology,First Hospital of Qinhuangdao,Qinhuangdao,066000,China
| | - Chunjiao Li
- Department of Otology,First Hospital of Qinhuangdao,Qinhuangdao,066000,China
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Hermann R, Robert C, Lagadec V, Dupre M, Pelisson D, Froment Tilikete C. Catch-Up Saccades in Vestibular Hypofunction: A Contribution of the Cerebellum? Cerebellum 2024; 23:136-143. [PMID: 36680705 PMCID: PMC10864466 DOI: 10.1007/s12311-023-01512-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/05/2023] [Indexed: 01/22/2023]
Abstract
Long-term deficits of the vestibulo-ocular reflex (VOR) elicited by head rotation can be partially compensated by catch-up saccades (CuS). These saccades are initially visually guided, but their latency can greatly decrease resulting in short latency CuS (SL-CuS). It is still unclear what triggers these CuS and what are the underlying neural circuits. In this study, we aimed at evaluating the impact of cerebellar pathology on CuS by comparing their characteristics between two groups of patients with bilateral vestibular hypofunction, with or without additional cerebellar dysfunction. We recruited 12 patients with both bilateral vestibular hypofunction and cerebellar dysfunction (BVH-CD group) and 12 patients with isolated bilateral vestibular hypofunction (BVH group). Both groups were matched for age and residual VOR gain. Subjects underwent video head impulse test recording of the horizontal semicircular canals responses as well as recording of visually guided saccades in the step, gap, and overlap paradigms. Latency and gain of the different saccades were calculated. The mean age for BVH-CD and BVH was, respectively, 67.8 and 67.2 years, and the mean residual VOR gain was, respectively, 0.24 and 0.26. The mean latency of the first catch-up saccade was significantly longer for the BVH-CD group than that for the BVH group (204 ms vs 145 ms, p < 0.05). There was no significant difference in the latency of visually guided saccades between the two groups, for none of the three paradigms. The gain of covert saccades tended to be lower in the BVH-CD group than in BVH group (t test; p = 0.06). The mean gain of the 12° or 20° visually guided saccades were not different in both groups. Our results suggest that the cerebellum plays a role in the generation of compensatory SL-CuS observed in BVH patients.
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Affiliation(s)
- Ruben Hermann
- Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, IMPACT, F-69500, Bron, France
- Lyon I University, Lyon, France
- Cervico-Facial Surgery and Audiophonology, Hospices Civils de Lyon, ENT, Hôpital Edouard Herriot, Lyon, France
| | - Camille Robert
- Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, IMPACT, F-69500, Bron, France
| | - Vincent Lagadec
- Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, IMPACT, F-69500, Bron, France
- French Vestibular Rehabilitation Society, Lyon, France
| | - Mathieu Dupre
- Neuro-Ophthalmology Unit, Hospices Civils de Lyon, Hopital Neurologique Et Neurochirurgical P Wertheimer, Lyon, France
| | - Denis Pelisson
- Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, IMPACT, F-69500, Bron, France
- Lyon I University, Lyon, France
| | - Caroline Froment Tilikete
- Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, IMPACT, F-69500, Bron, France.
- Lyon I University, Lyon, France.
- Neuro-Ophthalmology Unit, Hospices Civils de Lyon, Hopital Neurologique Et Neurochirurgical P Wertheimer, Lyon, France.
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Yoon HJ, Lee JH, Lee JH, Park E, Lee SU, Kim BJ, Kim JS. Effects of pupil size in video head-impulse tests. J Neurol 2024; 271:819-825. [PMID: 37805976 DOI: 10.1007/s00415-023-12026-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/10/2023]
Abstract
The results of video head impulse tests (video-HITs) may be confounded by data artifacts of various origins, including pupil size and eyelid obstruction of the pupil. This study aimed to determine the effect of these factors on the results of video-HITs. We simulated ptosis by adopting pharmacological dilatation of the pupil in 21 healthy participants (11 women; age 24-58 years). Each participant underwent video-HITs before and after pupillary dilatation using 0.5% tropicamide. We assessed the changes in the vestibulo-ocular reflex (VOR) gain, corrective saccade amplitude, and frequency of eyelid flicks. After pupillary dilatation, the VOR gain decreased for both right (RAC; 1.12 [Formula: see text] 0.12 vs. 1.01 [Formula: see text] 0.16, p = 0.011) and left anterior canals (LACs; 1.15 [Formula: see text] 0.13 vs. 0.96 [Formula: see text] 0.14, p < 0.001), and right posterior canal (RPC, 1.10 [Formula: see text] 0.13 vs. 0.98 [Formula: see text] 0.09, p = 0.001). The corrective saccade amplitudes also decreased significantly for all four vertical canals. The frequency of eyelid flicks, however, did not change. The changes of VOR gain were positively correlated with the lid excursion in RPC (r = 0.629, p = 0.002) and LPC (r = 0.549, p = 0.010). Our study indicates that eyelid position and pupil size should be considered when interpreting the results of video-HITs, especially for the vertical canals. Pupils should be shrunk in a very well-lit room, and artifacts should be prevented by taping or lifting the eyelids as required during video-HITs.
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Affiliation(s)
- Ho-Jin Yoon
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Jeong-Heon Lee
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
- Neurotology and Neuro-Ophthalmology Laboratory, Korea University Anam Hospital, Seoul, South Korea
| | - Joo-Hyeong Lee
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
- Neurotology and Neuro-Ophthalmology Laboratory, Korea University Anam Hospital, Seoul, South Korea
| | - Euyhyun Park
- Neurotology and Neuro-Ophthalmology Laboratory, Korea University Anam Hospital, Seoul, South Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea.
- Neurotology and Neuro-Ophthalmology Laboratory, Korea University Anam Hospital, Seoul, South Korea.
| | - Byung-Jo Kim
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
- BK21 FOUR Program in Learning Health Systems, Korea University, Seoul, South Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
- Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea
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David AP, Bolds C, Wu X, Sharon JD. Posterior Canal Fibrosis: A Case Series. Otol Neurotol 2024; 45:e36-e41. [PMID: 38013472 DOI: 10.1097/mao.0000000000004056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
OBJECTIVE To establish a case series where loss of magnetic resonance fluid signal intensity in the posterior semicircular canal (SCC) corresponded with a functional deficit on clinical and video head impulse testing, and most likely a result of canal fibrosis or obstruction. PATIENTS Three patients with an magnetic resonance imaging (MRI) showing loss of T2-weighted signal intensity in their posterior SCC corresponding to a vestibular weakness in that canal. INTERVENTIONS All patients underwent a comprehensive neuro-otologic examination. Vestibulo-ocular reflex was evaluated using clinical head impulse testing (cHIT) and quantified with video head impulse testing. MRI for all patients was obtained using clinical protocols for gadolinium-enhanced MRI of the internal auditory canal on 1.5 or 3 T scanners, which all included high-resolution, heavily T2-weighted imaging of the membranous labyrinth. MAIN OUTCOME MEASURE Correlation of MRI findings with vestibular weakness in the corresponding posterior SCC. RESULTS Subject 1 showed abnormal vHIT in the left lateral and left posterior SCCs. MRI showed loss of T2 signal intensity of the entire left posterior SCC as well as in the posterior limb of the superior SCC. Subject 2 showed isolated loss of function (cHIT) and low gain with catch-up saccade (vHIT) of the left posterior SCC. MRI showed loss of T2 signal intensity of the superior portion of the left posterior SCC, as well as in the posterior limb of the superior SCC. Subject 3 showed catch-up saccades of the left posterior SCC on cHIT and vHIT and loss of T2 signal intensity of the entire left posterior SCC and partial loss of bilateral lateral SCC on MRI. CONCLUSIONS In this case series, loss of posterior SCC function correlated with vestibular function testing and high-resolution, T2-weighted MRI findings, perhaps related to fibrosis of the posterior SCC.
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Affiliation(s)
- Abel P David
- Division of Otology, Neurotology, and Lateral Skull Base Surgery, Department of Otolaryngology-Head & Neck Surgery
| | | | - Xin Wu
- Neuroradiology Section, Department of Radiology, University of California, San Francisco, San Francisco, California
| | - Jeffrey D Sharon
- Division of Otology, Neurotology, and Lateral Skull Base Surgery, Department of Otolaryngology-Head & Neck Surgery
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10
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Elyoseph Z, Geisinger D, Zaltzman R, Mintz M, Gordon CR. The vestibular symptomatology of Machado-Joseph Disease. J Vestib Res 2024; 34:159-167. [PMID: 37661905 DOI: 10.3233/ves-230038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
BACKGROUND Machado Joseph Disease (MJD) is an autosomal dominant neurodegenerative disease. In previous studies, we described significant bilateral horizontal Vestibulo-Ocular Reflex (VOR) deficit within this population without any reference to the presence of vestibular symptomatology. OBJECTIVE To evaluate whether, beyond cerebellar ataxia complaints, MJD patients have typical vestibular symptomatology corresponding to the accepted diagnostic criteria of Bilateral Vestibulopathy (BVP) according to the definition of the International Barany Society of Neuro-Otology. METHODS Twenty-one MJD, 12 clinically stable chronic Unilateral Vestibulopathy (UVP), 15 clinically stable chronic BVP, and 22 healthy Controls underwent the video Head Impulse Test (vHIT) evaluating VOR gain and filled out the following questionnaires related to vestibular symptomatology: The Dizziness Handicap Inventory (DHI), the Activities-specific Balance Confidence Scale (ABC), the Vertigo Visual Scale (VVS) and the Beck Anxiety Inventory (BAI). RESULTS The MJD group demonstrated significant bilateral vestibular impairment with horizontal gain less than 0.6 in 71% of patients (0.54±0.17). Similar to UVP and BVP, MJD patients reported a significantly higher level of symptoms than Controls in the DHI, ABC, VVS, and BAI questionnaires. CONCLUSIONS MJD demonstrated significant VOR impairment and clinical symptoms typical of BVP. We suggest that in a future version of the International Classification of Vestibular Disorders (ICVD), MJD should be categorized under a separate section of central vestibulopathy with the heading of bilateral vestibulopathy. The present findings are of importance regarding the clinical diagnosis process and possible treatment based on vestibular rehabilitation.
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Affiliation(s)
- Zohar Elyoseph
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
- Department of Psychology and Educational Counseling, The Center for Psychobiological Research, Max Stern Yezreel Valley College, Jezreel Valley, Israel
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | | | - Roy Zaltzman
- Department of Neurology, Meir Medical Center, Kfar Saba, Israel
| | - Matti Mintz
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Department of Psychology, Ashkelon Academic College, Ashkelon, Israel
| | - Carlos R Gordon
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Neurology, Meir Medical Center, Kfar Saba, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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11
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Furman JM, Shirey I, Roxberg J, Kiderman A. The vertical computerized rotational head impulse test. J Vestib Res 2024; 34:29-38. [PMID: 38393869 PMCID: PMC10894580 DOI: 10.3233/ves-230121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/29/2023] [Indexed: 02/25/2024]
Abstract
The computerized rotational head impulse test (crHIT) uses a computer-controlled rotational chair to deliver whole-body rotational impulses to assess the semicircular canals. The crHIT has only been described for horizontal head plane rotations. The purpose of this study was to describe the crHIT for vertical head plane rotations. In this preliminary study, we assessed four patients with surgically confirmed unilateral peripheral vestibular abnormalities and two control subjects. Results indicated that the crHIT was well-tolerated for both horizontal head plane and vertical head plane stimuli. The crHIT successfully assessed each of the six semicircular canals. This study suggests that the crHIT has the potential to become a new laboratory-based vestibular test for both the horizontal and vertical semicircular canals.
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Affiliation(s)
- Joseph M. Furman
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Jillyn Roxberg
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA
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12
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Kirazli G, Erbek HS. A comparison of the video head impulse test and the functional head impulse test in chronic unilateral vestibular loss. J Laryngol Otol 2024; 138:43-51. [PMID: 37667906 PMCID: PMC10772026 DOI: 10.1017/s0022215123001536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 07/19/2023] [Accepted: 08/01/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE To examine the correlation of video head impulse test, functional head impulse test and Dizziness Handicap Inventory results in patients with chronic unilateral vestibular loss, and to compare the results with healthy controls. METHODS Forty-eight patients diagnosed with chronic unilateral vestibular loss and 35 healthy individuals, aged 18-65 years, were included. The video head impulse test, functional head impulse test and Dizziness Handicap Inventory were administered. RESULTS A significant positive correlation was found between functional head impulse test and video head impulse test results for the study group in all semicircular canals (p < 0.05). There was no significant correlation between Dizziness Handicap Inventory, functional head impulse test and video head impulse test results (p > 0.05). The functional head impulse test and video head impulse test results of the control group were significantly higher than those of the study group in all semicircular canals planes (p < 0.05). CONCLUSION In chronic unilateral vestibular loss patients, with high head accelerations, the functional head impulse test indicates deterioration in vestibulo-ocular reflex functionality. It would be beneficial to include the video head impulse test and functional head impulse test in clinical practice as complementary tests in vestibulo-ocular reflex evaluation.
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Affiliation(s)
- Gulce Kirazli
- Department of Audiology, Faculty of Health Sciences, Ege University, Izmir, Turkey
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13
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Soriano-Reixach MM, Rey-Martínez JA, Garcia-Martin M, Trinidad-Ruiz G, Altuna X. A New Method for Gain Calculation in Quantified Visuo-vestibular Interaction Test. Laryngoscope 2023; 133:3554-3563. [PMID: 37114648 DOI: 10.1002/lary.30722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/10/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVE To develop a new method to quantify visually-enhanced vestibulo-ocular reflex (VVOR) gain, in patients with vestibular function loss, that is mathematically suitable given the nature of the test, and determine the reliability of the method by comparing results with those of the gold standard, the video head impulse test (vHIT). MATERIALS AND METHODS We developed a new method for VVOR gain quantification and conducted a cross-sectional study in patients diagnosed with vestibular function loss and controls, all participants undergoing both a VVOR test and a vHIT. We measured VVOR gain with three different methods: area under the curve (AUC), slope regression, and a Fourier method (VVORAUC , VVORSP , and VVORFR , respectively); and compared these gain values with vHIT gain calculated using the AUC method. RESULTS Overall, 111 patients were included: 29 healthy subjects and 82 patients with vestibular function loss. Intraclass correlation coefficients (ICC(1,1)) between gain from the gold standard and each of the VVOR gain methods were: 0.68 (CI: 0.61-0.75) for VVORAUC , 0.66 (CI: 0.58-0.73) for VVORSP and 0.71 (CI: 0.64-0.77) for VVORFR . No interference was found between VVOR gain calculation methods and potentially influential variables considered (p ≥ 0.98). CONCLUSION The new method for quantifying VVOR gain showed good concordance with the vHIT method. LEVEL OF EVIDENCE 2: Individual cross-sectional studies with consistently applied reference standard and blinding (Diagnosis) Laryngoscope, 133:3554-3563, 2023.
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Affiliation(s)
- Maria M Soriano-Reixach
- Neurotology & Cochlear Implants Unit, Department of Otorhinolaryngology Head and Neck Surgery, Hospital Universitario Donostia, Donostia-San Sebastian, Spain
- Biodonostia Health Research Institute, Otorhinolaryngology Area, Osakidetza Basque Health Service, Donostia-San Sebastian, Spain
| | - Jorge A Rey-Martínez
- Neurotology & Cochlear Implants Unit, Department of Otorhinolaryngology Head and Neck Surgery, Hospital Universitario Donostia, Donostia-San Sebastian, Spain
- Biodonostia Health Research Institute, Otorhinolaryngology Area, Osakidetza Basque Health Service, Donostia-San Sebastian, Spain
| | - Mikel Garcia-Martin
- Neurotology Unit, Department of Otorhinolaryngology Head and Neck Surgery, Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain
| | - Gabriel Trinidad-Ruiz
- Neurotology Unit, Department of Otorhinolaryngology Head and Neck Surgery, Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain
| | - Xabier Altuna
- Neurotology & Cochlear Implants Unit, Department of Otorhinolaryngology Head and Neck Surgery, Hospital Universitario Donostia, Donostia-San Sebastian, Spain
- Biodonostia Health Research Institute, Otorhinolaryngology Area, Osakidetza Basque Health Service, Donostia-San Sebastian, Spain
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14
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Kirazli G, Emekci T, Inceoglu F, Pistav Akmese P, Celebisoy N. An evaluation of the test-retest reliability of the functional head impulse test in healthy young adults. Eur Arch Otorhinolaryngol 2023; 280:5339-5343. [PMID: 37341762 DOI: 10.1007/s00405-023-08063-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/09/2023] [Indexed: 06/22/2023]
Abstract
AIM To determine the test and retest reliability of the functional head impulse test (fHIT) in healthy young adults. MATERIALS AND METHODS Thirty-three healthy participants (17 women, 16 men) aged 18-30 years were included in the study. Each participant underwent the fHIT twice, 1 week apart, by the same experienced clinician. Intraclass correlation coefficients (ICCs) were used to determine test-retest reliability. RESULTS There was no statistically significant difference between the results of total percentage of correct answer (CA%) of the fHIT obtained in session 1 and session 2 measurements in the lateral, anterior, and posterior semicircular canals (SCCs) (p > 0.05). ICC values for test-retest reliability were found to range from 0.619 to 0.665 for the three semicircular canals (SCCs). CONCLUSION The test-retest reliability of the fHIT device was moderate. Attention, cognition, and fatigue may be the factors reducing reliability. In the diagnosis, follow-up, and rehabilitation processes of vestibular diseases in clinics, changes in the fHIT CA% can be used to assess vestibulo-ocular reflex (VOR) functionality.
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Affiliation(s)
- Gulce Kirazli
- Department of Audiology, Faculty of Health Sciences, Ege University, Izmir, Turkey
| | - Tugba Emekci
- Department of Audiology, Faculty of Health Sciences, Gülhane University of Health Sciences, Ankara, Turkey
| | - Feyza Inceoglu
- Department of Biostatistics, Faculty of Medicine, Malatya Turgut Ozal University, Malatya, Turkey
| | - Pelin Pistav Akmese
- Department of Audiology, Faculty of Health Sciences, Ege University, Izmir, Turkey.
| | - Nese Celebisoy
- Department of Neurology, Faculty of Medicine, Ege University, Izmir, Turkey
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15
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Evangelista ASDL, Diniz J, Costa APM, Dourado MET, Mantello EB. Neurological and vestibular findings in three cases of Multiple Sclerosis. Codas 2023; 35:e20210153. [PMID: 37991027 PMCID: PMC10702714 DOI: 10.1590/2317-1782/20232021153en] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/26/2022] [Indexed: 03/29/2024] Open
Abstract
Multiple sclerosis (MS) is a chronic and inflammatory autoimmune disease that affects the central nervous system (CNS). Dysfunction of body balance is also a common symptom and may be related to neurological injuries resulting from this disease. The aim of this study was to characterize the neurological and vestibular findings of three clinical cases diagnosed with MS. Data on the neurological evaluation and the magnetic resonance imaging of the skull were collected from the medical records. The patients responded to an initial interview and underwent clinical assessment of body balance and Video Head Impulse Test (vHIT). Vestibular symptoms and alterations were observed in at least one of the clinical tests of body balance and cerebellar function. In vHIT, changes were obtained in oculomotor tests, such as the presence of semi-spontaneous nystagmus and in parameters of the saccade test, and reduced gain in one or more vertical channels. Lesions were found on MRI of the skull in central areas that process vestibular information, such as the cerebellum and brainstem. The association of these findings suggests the presence of central vestibular dysfunction, compatible with the lesions detected in imaging exams.
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Affiliation(s)
| | - José Diniz
- Departamento de Cirurgia, Universidade Federal do Rio Grande do Norte – UFRN – Natal (RN), Brasil.
| | - Ana Paula Machado Costa
- Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte – UFRN – Natal (RN), Brasil.
| | | | - Erika Barioni Mantello
- Programa Associado de Pós-graduação em Fonoaudiologia, Universidade Federal do Rio Grande do Norte – UFRN – Natal (RN), Brasil.
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Evangelista ASDL, Diniz Júnior J, Costa APM, Dourado Júnior MET, Mantello EB. Neurological and vestibular findings in three cases of Multiple Sclerosis. Codas 2023; 35:e20210153. [PMID: 37991027 DOI: 10.1590/2317-1782/20232021153pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/26/2022] [Indexed: 11/23/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic and inflammatory autoimmune disease that affects the central nervous system (CNS). Dysfunction of body balance is also a common symptom and may be related to neurological injuries resulting from this disease. The aim of this study was to characterize the neurological and vestibular findings of three clinical cases diagnosed with MS. Data on the neurological evaluation and the magnetic resonance imaging of the skull were collected from the medical records. The patients responded to an initial interview and underwent clinical assessment of body balance and Video Head Impulse Test (vHIT). Vestibular symptoms and alterations were observed in at least one of the clinical tests of body balance and cerebellar function. In vHIT, changes were obtained in oculomotor tests, such as the presence of semi-spontaneous nystagmus and in parameters of the saccade test, and reduced gain in one or more vertical channels. Lesions were found on MRI of the skull in central areas that process vestibular information, such as the cerebellum and brainstem. The association of these findings suggests the presence of central vestibular dysfunction, compatible with the lesions detected in imaging exams.
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Affiliation(s)
| | - José Diniz Júnior
- Departamento de Cirurgia, Universidade Federal do Rio Grande do Norte - UFRN - Natal (RN), Brasil
| | - Ana Paula Machado Costa
- Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte - UFRN - Natal (RN), Brasil
| | | | - Erika Barioni Mantello
- Programa Associado de Pós-graduação em Fonoaudiologia, Universidade Federal do Rio Grande do Norte - UFRN - Natal (RN), Brasil
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17
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Karababa E, Sonkaya AR, Satar B, Korkmaz H. Role of the functional head impulse test in evaluating vestibulo-ocular reflex abnormalities in individuals with Parkinson's disease. Clin Otolaryngol 2023; 48:881-887. [PMID: 37496430 DOI: 10.1111/coa.14087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 05/24/2023] [Accepted: 07/02/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE To assess vestibular-ocular reflex (VOR) function in patients with Parkinson's disease (PD) using a new method called functional head impulse test (fHIT). STUDY DESIGN Case-control study. SETTING Tertiary medical center. PARTICIPANTS Twenty individuals with PD were recruited for PD group, and twenty healthy individuals for the control group. Ages of both groups ranged from 47 to 76 years. MAIN OUTCOME MEASURES According to the modified Hoehn-Yahr score, PD group was classified as an early stage with a range of 1-2.5 and a mid-late stage with a range of 3-5. Percentage of correct answers (%CA) was calculated using fHIT for lateral, anterior and posterior semicircular canal (SCC) planes. RESULTS PD group had statistically lower fHIT %CA in the right lateral, left lateral, and left posterior SCC planes compared to control group (p < .05). There was no statistical difference between two PD severity groups and functional VOR abnormality. CONCLUSION It was concluded that the functional VOR in the right lateral and left lateral and left posterior SCC plane was affected in individuals with PD. Our results show that impaired VOR and reduced dynamic visual acuity should be considered in individuals with PD for vestibular rehabilitation exercises.
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Affiliation(s)
- Ercan Karababa
- Department of Audiology, University of Health Sciences, Ankara, Turkey
| | - Ali Rıza Sonkaya
- Gulhane Faculty of Medicine, Department of Neurology, University of Health Sciences, Ankara, Turkey
| | - Bülent Satar
- Gulhane Faculty of Medicine, Department of Ear Nose Throat, University of Health Sciences, Ankara, Turkey
| | - Hanifi Korkmaz
- Vocational School of Health Services, Turgut Ozal University, Malatya, Turkey
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18
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Nilsen KS, Nordahl SHG, Berge JE, Dhayalan D, Goplen FK. Vestibular Tests Related to Tumor Volume in 137 Patients With Small to Medium-Sized Vestibular Schwannoma. Otolaryngol Head Neck Surg 2023; 169:1268-1275. [PMID: 37337472 DOI: 10.1002/ohn.399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/06/2023] [Accepted: 05/20/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVE The video head impulse test (vHIT) and cervical and ocular vestibular evoked myogenic potentials (cVEMP and oVEMP) are new methods for measuring peripheral vestibular function. The objectives of this study were to compare these tests and the traditionally used caloric test in patients with small and medium-sized untreated vestibular schwannoma (VS) and to measure the correlation between the tests' results and tumor volume. STUDY DESIGN National cross-sectional study. SETTING Tertiary university clinic. METHODS Prevalence of abnormal cVEMP, oVEMP, caloric test, and 6-canal vHIT results on the tumor side and the nontumor side were compared and related to tumor volume with regression analyses in 137 consecutive VS patients assigned to a wait-and-scan protocol in the period 2017 to 2019. RESULTS The sensitivity of 6-canal vHIT, caloric test, cVEMP, and oVEMP to detect vestibulopathy in VS patients was 51%, 47%, 39%, and 25%, respectively. Normal tests were found in 21% of the patients. The results of vHIT and caloric test were related to tumor volume, but this was not found for cVEMP and oVEMP. CONCLUSION The caloric test and 6-canal vHIT showed the highest sensitivity in detecting vestibulopathy in untreated VS patients. vHIT, and particularly the posterior canal, was limited with a high prevalence of abnormal results on the nontumor side. A combination of cVEMP and caloric test was favorable in terms of a relatively high sensitivity and low prevalence of abnormal results on the nontumor side. Larger tumors had a higher rate of pathology on caloric testing and vHIT.
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Affiliation(s)
- Kathrin Skorpa Nilsen
- Department of Head and Neck Surgery, Haukeland University Hospital, Norwegian National Advisory Network on Vestibular Disorders, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Norway
| | - Stein Helge Glad Nordahl
- Department of Head and Neck Surgery, Haukeland University Hospital, Norwegian National Advisory Network on Vestibular Disorders, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Norway
| | - Jan Erik Berge
- Department of Head and Neck Surgery, Haukeland University Hospital, Norwegian National Advisory Network on Vestibular Disorders, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Norway
| | - Dhanushan Dhayalan
- Department of Clinical Medicine, University of Bergen, Norway
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
| | - Frederik Kragerud Goplen
- Department of Head and Neck Surgery, Haukeland University Hospital, Norwegian National Advisory Network on Vestibular Disorders, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Norway
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Ojanperä OAI, Salonen JN, Haavisto L, Sarin J. Ethanol-Induced Vestibular Dysfunction as a Model for Bilateral Vestibular Syndrome: Similarities in Video Head Impulse Test and Video-Oculography Data. J Int Adv Otol 2023; 19:388-395. [PMID: 37789625 PMCID: PMC10661903 DOI: 10.5152/iao.2023.231030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/14/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND The goal of this study was to compare video head impulse test, video-oculography, and clinical balance test changes induced by ethanol consumption, in order to acquire a model for acute bilateral vestibular syndrome. METHODS Four healthy adult men and 5 healthy adult women were recruited as volunteers in the study. Initial video head impulse test, videooculography, and clinical balance test examinations were made. Participants proceeded to drink standard alcohol doses until a maximum of 1.2‰ breath alcohol concentration was reached. Video head impulse test and clinical balance tests were repeated at every 0.2‰ breath alcohol concentration interval and at the final 1.0-1.2‰ breath alcohol concentration range. Video-oculography examinations were repeated at 1.0- 1.2‰ breath alcohol concentration. RESULTS Decrease in mean vestibulo-ocular gain at 60 ms between the 0‰ and 1.0-1.2‰ was 0.16 on the left side (P < .05) and 0.16 on the right side (P < .05). A borderline abnormality (mean 0.79/0.82) (left/right) was observed in vestibulo-ocular gain at the highest breath alcohol concentration. Corrective saccades increased significantly in amplitude and latency. There was a statistically significant, symmetrical decrease in video-oculography smooth pursuit gain. Saccade latency increased but statistically significantly only with right-sided cycles. Saccade accuracy remained constant. Optokinetic reflex gain showed significant decrease. Romberg's test was performed with normal results initially and at 1.0-1- 2‰ breath alcohol concentration. CONCLUSION Ethanol produces a symmetrical loss in vestibulo-ocular gain measured by video head impulse test. Ethanol also decreases smooth eye pursuit gain and increases pro-saccade latency. Similar findings can be made in vestibular disorders as well as in cerebellar dysfunction. Central pathology should be ruled out in acute bilateral vestibular syndrome.
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Affiliation(s)
- Ossi Antti Ilari Ojanperä
- Department of Otorhinolaryngology – Head and Neck Surgery, Turku University Hospital and University of Turku, Turku, Finland
| | - Jaakko Nikolai Salonen
- Department of Otorhinolaryngology – Head and Neck Surgery, Turku University Hospital and University of Turku, Turku, Finland
| | - Lotta Haavisto
- Department of Otorhinolaryngology – Head and Neck Surgery, Turku University Hospital and University of Turku, Turku, Finland
| | - Jussi Sarin
- Department of Otorhinolaryngology – Head and Neck Surgery, Turku University Hospital and University of Turku, Turku, Finland
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Karpeta N, Asp F, Edholm K, Bonnard Å, Wales J, Karltorp E, Duan M, Verrecchia L. Vestibular function in children with vestibulocochlear nerve aplasia/hypoplasia. Acta Otolaryngol 2023; 143:861-866. [PMID: 38063358 DOI: 10.1080/00016489.2023.2285453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/13/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Infants and young children with vestibulocochlear nerve (VCN) hypoplasia/aplasia present with severe hearing loss and are candidates for cochlear implantation (CI). It is unknown whether vestibular function is related to CI outcome and if vestibular tests can guide the operation decision. AIMS/OBJECTIVES Our aim was to describe the vestibular function in patients with VCN hypoplasia/aplasia before a possible CI. MATERIALS AND METHODS Forty-two ears in 23 patients were tested between 2019 and 2022 with bone-conducted cervical vestibular evoked myogenic potentials (BCcVEMP), video head impulse test (vHIT) and miniice-water caloric test (mIWC). RESULTS All ears could be tested with at least one vestibular test and 83% could be tested with more than one method. Twenty-nine ears (61%) showed normal function with at least one method. The presence of a normal response to any test doubled the likelihood of a measured hearing threshold after CI, the best predictors being the BCcVEMP and vHIT (p < 0.05). CONCLUSION Canal function may represent a predictor of auditive pathway integrity with a possible favourable audiological outcome after CI operation. SIGNIFICANCE Our results demonstrate high vestibular response rates suggesting a functioning pathway despite the radiological diagnosis.
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Affiliation(s)
- Niki Karpeta
- Division of Ear, Nose and Throat Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
- Karolinska Ear and Hearing, Karolinska University Hospital, Stockholm, Sweden
| | - Filip Asp
- Division of Ear, Nose and Throat Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
- Karolinska Ear and Hearing, Karolinska University Hospital, Stockholm, Sweden
| | - Kaijsa Edholm
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Åsa Bonnard
- Division of Ear, Nose and Throat Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
- Karolinska Ear and Hearing, Karolinska University Hospital, Stockholm, Sweden
| | - Jeremy Wales
- Division of Ear, Nose and Throat Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
- Karolinska Ear and Hearing, Karolinska University Hospital, Stockholm, Sweden
| | - Eva Karltorp
- Division of Ear, Nose and Throat Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
- Karolinska Ear and Hearing, Karolinska University Hospital, Stockholm, Sweden
| | - Maoli Duan
- Division of Ear, Nose and Throat Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
- Karolinska Ear and Hearing, Karolinska University Hospital, Stockholm, Sweden
| | - Luca Verrecchia
- Division of Ear, Nose and Throat Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
- Karolinska Ear and Hearing, Karolinska University Hospital, Stockholm, Sweden
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21
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Özçelik P, Koçoğlu K, Halmágyi GM, Akdal G. Video head impulse and suppression head impulse test in vestibular migraine. Acta Otolaryngol 2023; 143:856-860. [PMID: 38071651 DOI: 10.1080/00016489.2023.2284877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/08/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Vestibular Migraine (VM) is a frequent cause of recurrent spontaneous vertigo. While some report a normal Video Head Impulse Test (vHIT) in VM, others observed abnormal results on this test. Whether or not methodological discrepancies could be the cause of these differences is not known. There are 2 vHIT methods: subjects fixating an earth-fixed target (HIMP paradigm) or a head-fixed target, the suppression head impulse test (SHIMP paradigm). OBJECTIVES The present study aimed to compare VM patients against healthy controls on both HIMP and SHIMP in order to unravel any differences between them. METHODS Forty-eight VM patients and 27 healthy controls tested with both the HIMP and SHIMP paradigm. Results: Our 48 VM patients showed mean VOR normal range gains in both the HIMP and SHIMP paradigms, although there were some VOR impairments in individual semicircular SCCs. VM patients with motion sickness had lower horizontal VOR gain than those without motion sickness, with the HIMP, but not the SHIMP paradigm. CONCLUSION VM patients have normal VOR gain with either vHIT paradigm. SIGNIFICANCE The clinical significance of this observation is that a definitely abnormal vHIT with either method is unlikely to be due to vestibular migraine and an alternative diagnosis should be sought.
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Affiliation(s)
- Pınar Özçelik
- Institute of Health Sciences, Department of Neurosciences, Dokuz Eylül University, Izmir, Türkiye
- Faculty of Medicine, Department of Neurology, Bezmialem Vakif University, Istanbul, Türkiye
| | - Koray Koçoğlu
- Institute of Health Sciences, Department of Neurosciences, Dokuz Eylül University, Izmir, Türkiye
| | - Gábor M Halmágyi
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia
- Central Clinical School, University of Sydney, Sydney, Australia
| | - Gülden Akdal
- Institute of Health Sciences, Department of Neurosciences, Dokuz Eylül University, Izmir, Türkiye
- Faculty of Medicine, Department of Neurology, Dokuz Eylül University, Izmir, Türkiye
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赵 东, 姜 子. [A comparative study of detection methods for assessing superior and inferior vestibular nerve damages in patients with vestibular neuritis]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2023; 37:829-831;836. [PMID: 37828889 PMCID: PMC10803235 DOI: 10.13201/j.issn.2096-7993.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Indexed: 10/14/2023]
Abstract
Objective:This study aims to compare the examination results of the vestibular evoked myogenic potential(VEMP) and video head impulse testing(vHIT) in patients with vestibular neuritis(VN), thus exploring the methods to distinguish superior and inferior vestibular nerve damages in VN patients, and their feasibility. Methods:A total of 25 patients with unilateral VN treated in the Otology Department of the First Hospital of Qinhuangdao from May 2018 to July 2021 were recruited. They were respectively tested for ocular VEMP(oVEMP), cervical VEMP(cVEMP) and vHIT, and the examination results were analyzed. Results:Examination results of oVEMP showed that 96%(24/25) patients had one-ear abnormalities with the amplitude decline or no waveform introduced, and 4%(1/25) patient had no waveform introduced of both ears. The overall abnormal rate examined by oVEMP was 100%(26/26). Examination results of cVEMP showed that 36%(9/25) patients had one-ear abnormalities with the amplitude decline or no waveform introduced, and 4%(1/25) patients had no waveform introduced of both ears. The overall abnormal rate examined by cVEMP was 40%(10/25), and 60%(15/25) patients had normal waveforms of both ears. Examination results of vHIT showed that 100%(25/25) patients had semicircular canal gain decline of one side, 92%(23/25) had anterior Semicircular canal decline of one side, and 36%(9/25) had posterior semicircular canal decline of one side. VEMP and vHIT results were compared. Examination results of VEMP showed that 60%(15/25) VN patients had superior vestibular nerve damage, and 40%(10/25) had both superior and inferior vestibular nerve damages. Examination results of vHIT showed that 64%(16/25) VN patients had superior vestibular nerve damage, and 36%(9/25) had both superior and inferior vestibular nerve damages. There was no significant difference in the ratio of VN patients with superior and inferior vestibular nerve damages examined by VEMP or vHIT(χ²=0.085, P>0.05). The matching ratio of VEMP and vHIT results was 80%(20/25), and the non-matching ratio was 20%(5/25). Conclusion:Consistent results obtained from both VEMP and vHIT can preliminarily identify the type of vestibular nerve damage. If their results are not consistent, it is recommended not to identify the scope of the vestibular nerve damage.
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Affiliation(s)
- 东 赵
- 秦皇岛市第一医院耳科(河北秦皇岛,066000)Department of Otology, Qinghuangdao First Hospital, Qinghuangdao, 066000, China
| | - 子刚 姜
- 秦皇岛市第一医院耳科(河北秦皇岛,066000)Department of Otology, Qinghuangdao First Hospital, Qinghuangdao, 066000, China
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Fujiwara Y, Fujiwara K, Motegi H, Ishi Y, Morita S, Hoshino K, Fukuda A, Nakamaru Y, Homma A. Quantitative Evaluations of Vestibular Function in Patients With Petrous Apex Cholesterol Granulomas Treated With an Endoscopic Transsphenoidal Approach: A Report of Two Cases. Otol Neurotol 2023; 44:809-812. [PMID: 37464454 DOI: 10.1097/mao.0000000000003961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
OBJECTIVE We report two cases of petrous apex cholesterol granuloma (PACG) treated with an endoscopic transsphenoidal approach. Vestibular functions of the two patients were evaluated quantitatively by video Head Impulse Test (vHIT) and/or vestibular evoked myogenic potentials (VEMPs). PATIENTS Two patients with PACG who experienced episodes of dizziness are presented. INTERVENTION An endoscopic transsphenoidal approach to PACG. MAIN OUTCOME MEASURE The preoperative and postoperative vestibular functions as evaluated by vHIT and VEMP. RESULTS Two cases of PACG were treated by a transsphenoidal approach. The internal auditory canal was compressed by the PACG in both cases. The patients both experienced episodes of dizziness before surgery and preoperative vestibular testing including vHIT and VEMP indicated dysfunction of vestibular nerves. After surgery, their symptoms were completely resolved, and the vestibular testing results were improved. CONCLUSIONS This article is noteworthy for being the first to publish quantitative vestibular function testing for patients with PACG with vestibular dysfunction. PACG may show various symptoms, with dizziness being one of the most common symptoms. In cases in which the internal auditory canal is compressed by the PACG, vestibular functions should be evaluated by vHIT and VEMP. In the present cases, dizziness was found to be resolved by surgery to release the compression on internal auditory canal. Based on the present cases, the transsphenoidal approach is considered to be both safe and effective.
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Affiliation(s)
- Yuuki Fujiwara
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Keishi Fujiwara
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Hiroaki Motegi
- Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Yukitomo Ishi
- Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Shinya Morita
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Kimiko Hoshino
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Atsushi Fukuda
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Yuji Nakamaru
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Akihiro Homma
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
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Pathirana MB, Szmulewicz DJ. Machine Learning Based Diagnosis of Vertigo using Video Head Impulse Test. Annu Int Conf IEEE Eng Med Biol Soc 2023; 2023:1-5. [PMID: 38082826 DOI: 10.1109/embc40787.2023.10340475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
This work utilises the strength of state space based dynamic modelling and the ability of machine learning based segmentation of SRM standard descriptors to reach superior diagnostic capabilities. Dynamic modelling ensured vHIT input-output characteristics generated SRM standard descriptors, which were consequently used in formation of ML classification models.The best ML model was Linear SVM when built on left and right sided data with the SRM standard descriptors: rise time, settling time, settling minimum, settling maximum, overshoot and undershoot. The model was able to classify individuals to patient or control groups with an accuracy of 100% and a sensitivity and specificity of 1.Clinical Relevance- Dizziness is one of the most common presentations to family physicians and emergency departments. It is associated with significant medical complications such as falls as well as economic costs to both the individual and the community. Vestibular diseases comprise the bulk of dizzy disorders and are often associated with dysfunction of the vestibular or inner ear balance apparatus. This is most commonly the result of hypo-function of the semi-circular canals. Clinically, the most commonly employed objective test of semicircular function is the video Head Impulse Test (vHIT). Here we provide a machine learning approach to a more comprehensible and accurate interpretation of the results obtained by the vHIT to more robustly establish the presence and severity of VOR dysfunction, and ultimately aid in the diagnosis of vestibular disorders.
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Tamanini JB, Mezzalira R, Vallim MGB, Gabriel GP, Stoler G, Chone CT. Dissociation between video head impulse test and caloric test: a marker of menière's disease? - A systematic review and meta-analysis. Braz J Otorhinolaryngol 2023; 89:101279. [PMID: 37354884 PMCID: PMC10331280 DOI: 10.1016/j.bjorl.2023.101279] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 03/02/2023] [Accepted: 05/25/2023] [Indexed: 06/26/2023] Open
Abstract
OBJECTIVE To analyze, by means of a systematic review and meta-analysis, the proportion of patients with Meniere's disease who have altered caloric test and vHIT, as well as to determine the prevalence of altered caloric test and normal vHIT dissociation in the diagnosis of Meniere's disease. METHODS The literature search had no restriction regarding the period of publication on the following indexed data platforms: PubMed, PubMed PMC, BVS-Bireme, Web of Science, Embase and Cochrane Library. Articles that evaluated patients with Meniere's disease who underwent caloric test and vHIT were included. Two researchers independently conducted the analysis of the articles, promoting the selection and capture of data, following the recommendations of the PRISMA method, and complying with the criteria for articles inclusion and exclusion defined in the research protocol. In case of disagreement during the selection process, a third researcher was included for analysis. RESULTS From a total of 427 initial studies, the researchers selected 12 articles, published between 2014 and 2021, with a total of 708 patients evaluated, with a mean age of 52.72 years old. The prevalence of patients with Meniere's disease with altered caloric reflex test was 64% (95% CI 57%‒71%), while the prevalence of altered vHIT was only 28% (95% CI 16%-40%). The prevalence of the altered caloric test + normal vHIT dissociation was 47% (95% CI 37%-57%). CONCLUSION The video head impulse test and the caloric test are valuable tools for vestibular assessment. The dissociation of findings between these two tests in patients with Meniere's disease was more prevalent in this meta-analysis and may be a result of the tonotopy of specialized hair cells in the ampullary crest. The prevalence of altered caloric test was 64% and anormal vHIT was 28%. The dissociation caloric asymmetry and normal vHIT was observed in 47% of the patients. LEVEL OF EVIDENCE: 1
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Affiliation(s)
- Jonas Belchior Tamanini
- Universidade Estadual de Campinas (UNICAMP), Departamento de Otorrinolaringologia, Campinas, SP, Brazil.
| | - Raquel Mezzalira
- Universidade Estadual de Campinas (UNICAMP), Departamento de Otorrinolaringologia, Campinas, SP, Brazil
| | | | - Guilherme Paiva Gabriel
- Universidade Estadual de Campinas (UNICAMP), Departamento de Otorrinolaringologia, Campinas, SP, Brazil
| | - Guita Stoler
- Universidade Estadual de Campinas (UNICAMP), Departamento de Otorrinolaringologia, Campinas, SP, Brazil
| | - Carlos Takahiro Chone
- Universidade Estadual de Campinas (UNICAMP), Departamento de Otorrinolaringologia, Campinas, SP, Brazil
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Nham B, Wang C, Reid N, Calic Z, Kwok BYC, Black DA, Bradshaw A, Halmagyi GM, Welgampola MS. Modern vestibular tests can accurately separate stroke and vestibular neuritis. J Neurol 2023; 270:2031-2041. [PMID: 36566345 DOI: 10.1007/s00415-022-11473-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To separate posterior-circulation stroke (PCS) and vestibular-neuritis (VN) using quantitative vestibular tests. METHODS Patients were prospectively recruited from the emergency room within 72 h of presentation. Video-nystagmography (VNG), three-dimensional video head-impulse testing (vHIT), vestibular-evoked myogenic potentials (VEMPs), and subjective visual-horizontal (SVH) were performed. RESULTS There were 128 PCS and 134 VN patients. Common stroke-territories were: posterior-inferior cerebellar artery, basilar-perforators, multi-territory and anterior-inferior cerebellar artery (41.4%, 21.1%, 14.1%, 7.8%). VN included superior, inferior and pan-neuritis (53.3%, 4.2%, and 41.5%). Most VN and stroke patients presented with acute vestibular syndrome (96.6%, 61.7%). In VN, we recorded horizontal (98.5%) or vertical/torsional spontaneous nystagmus (1.5%) and in PCS, absent-nystagmus (53.9%), horizontal (32%) or vertical/torsional (14.1%) nystagmus. The mean slow-phase velocity of horizontal nystagmus was faster in VN than PCS (11.8 ± 7.2 and 5.2 ± 3.0°/s, p < 0.01). Ipsilesional horizontal-canal (HC) vHIT-gain was lower in VN than in stroke (0.47 ± 0.24, 0.92 ± 0.20, p < 0.001). Ipsilesional catch-up saccades occurred earlier, and their amplitude, prevalence, and velocity were greater in VN than PCS (p < 0.01). Ipsilesional SVH deviation > 2.5° occurred more often in VN than in stroke (97.6% and 24.3%, p < 0.01). Abnormal bone-conducted ocular-VEMP asymmetry ratio was more common in VN than PCS (50% and 14.4%, p < 0.01). Using the ten best discriminators (VNG, vHIT, SVH, and oVEMP metrics), VN was separated from PCS with a sensitivity of 92.9% and specificity of 89.8%. Adding VNG and vHIT to the bedside head-impulse-nystagmus-and-test-of-skew (HINTS) test enhanced sensitivity and specificity from 95.3% and 63.4% to 96.5% and 80.6%. CONCLUSION Quantitative vestibular testing helps separate stroke from vestibular neuritis and, when used, could improve diagnostic accuracy in the emergency room.
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Affiliation(s)
- Benjamin Nham
- Department of Neurology, The Sutherland Hospital, Sydney, Australia
- Central Clinical School, The University of Sydney, Sydney, Australia
| | - Chao Wang
- Central Clinical School, The University of Sydney, Sydney, Australia
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia
| | - Nicole Reid
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia
| | - Zeljka Calic
- Department of Neurology, Liverpool Hospital, Sydney, Australia
| | - Belinda Y C Kwok
- Central Clinical School, The University of Sydney, Sydney, Australia
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia
| | - Deborah A Black
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Andrew Bradshaw
- Central Clinical School, The University of Sydney, Sydney, Australia
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia
| | - GMichael Halmagyi
- Central Clinical School, The University of Sydney, Sydney, Australia
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia
| | - Miriam S Welgampola
- Central Clinical School, The University of Sydney, Sydney, Australia.
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia.
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何 风, 韩 军, 白 雅, 王 圆, 魏 东, 石 瑛, 安 星, 付 炜. [Application of vestibular function examination in the analysis of damaged site in patients with acute vestibular neuritis]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2023; 37:263-267. [PMID: 36987955 PMCID: PMC10406585 DOI: 10.13201/j.issn.2096-7993.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Indexed: 03/30/2023]
Abstract
Objective:To analyze the site of vestibular nerve damaged in patients with acute vestibular neuritis. Methods:Fifty-seven patients with acute vestibular neuritis were recruited, and each patient underwent caloric irrigation test, video head impulse test(vHIT) and vestibular evoked myogenic potentials(VEMPs). The results were further analyzed. Results:Analysis of abnormal rates of different vestibular function tests: the abnormal rate of caloric irrigation test, horizontal semicircular canal vHIT, anterior semicircular canal vHIT, and posterior semicircular canal vHIT were 92.98%, 92.98%, 92.98%, and 52.63%, respectively. The abnormal rate of cervical vestibular evoked myogenic potentials(cVEMP) and ocular vestibular evoked myogenic potentials(oVEMP) were 52.63% and 89.47%. The abnormal rate of caloric irrigation test, horizontal semicircular canal vHIT, anterior semicircular canal vHIT, and oVEMP were significantly higher than posterior semicircular canal vHIT and cVEMP(P<0.01). Combination analysis of different vestibular function tests: there are twenty-six patients(45.61%, superior and inferior vestibular nerve) with abnormal caloric irrigation test, video head impulse test, and VEMPs. There are twenty-five patients(43.86%, superior vestibular nerve) with abnormal caloric irrigation test, horizontal semicircular canal vHIT, anterior semicircular canal vHIT, and oVEMP. There are 4 patients(7.02%, inferior vestibular nerve) with abnormal posterior semicircular canal vHIT and cVEMP. There are two patients(3.51%, ampullary vestibular nerve) with abnormal caloric irrigation test, horizontal semicircular canal vHIT, and anterior semicircular canal vHIT. The rate of superior and inferior vestibular neuritis and superior vestibular neuritis were significantly higher than inferior vestibular neuritis and ampullary vestibular neuritis(P<0.01). Conclusion:Acute vestibular neuritis subtypes can be divided into four categories: superior and inferior vestibular neuritis, superior vestibular neuritis, inferior vestibular neuritis, and ampullary vestibular neuritis. Video head impulse test can accurately assess the site of vestibular nerve damage in patients with acute vestibular neuritis. In addition, vHIT combined with VEMPs can provide objective evidence for the diagnosis of ampullary vestibular neuritis.
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Affiliation(s)
- 风 何
- 空军军医大学第一附属医院神经内科(西安,710032)Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - 军良 韩
- 空军军医大学第一附属医院神经内科(西安,710032)Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - 雅 白
- 空军军医大学第一附属医院神经内科(西安,710032)Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - 圆圆 王
- 空军军医大学第一附属医院神经内科(西安,710032)Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - 东 魏
- 空军军医大学第一附属医院神经内科(西安,710032)Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - 瑛 石
- 空军军医大学第一附属医院神经内科(西安,710032)Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - 星月 安
- 空军军医大学第一附属医院神经内科(西安,710032)Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - 炜 付
- 空军军医大学第一附属医院老年病科Department of Geriatrics, Xijing Hospital, Fourth Military Medical University
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Martens S, Dhooge I, Dhondt C, Vanaudenaerde S, Sucaet M, Rombaut L, Maes L. Pediatric Vestibular Assessment: Clinical Framework. Ear Hear 2023; 44:423-436. [PMID: 36534710 DOI: 10.1097/aud.0000000000001303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Although vestibular deficits can have severe repercussions on the early motor development in children, vestibular assessment in young children has not yet been routinely integrated in clinical practice and clear diagnostic criteria to detect early vestibular deficits are lacking. In young children, specific adjustments of the test protocol are needed, and normative data are age-dependent as the vestibular pathways mature through childhood. Therefore, this study aims to demonstrate the feasibility of an extensive age-dependent vestibular test battery, to provide pediatric normative data with the concurrent age trends, and to offer a clinical framework for pediatric vestibular testing. DESIGN This normative study included 133 healthy children below the age of 4 years (mean: 22 mo, standard deviation: 12.3 mo, range: 5-47 mo) without history of hearing loss or vestibular symptoms. Children were divided into four age categories: 38 children younger than 1 year old, 37 one-year olds, 33 two-year olds, and 25 three-year olds. Children younger than 3 years of age were examined with the video Head Impulse Test (vHIT) of the horizontal semicircular canals, cervical vestibular evoked myogenic potentials (cVEMP) with bone conduction stimuli, and the rotatory test at 0.16, 0.04, and 0.01 Hz. In 3-year old children, the vHIT of the vertical semicircular canals and ocular vestibular evoked myogenic potentials (oVEMP) using a minishaker were added to the protocol. RESULTS The horizontal vHIT appeared to be the most feasible test across age categories, except for children younger than 1-year old in which the success rate was the highest for the cVEMP. Success rates of the rotatory test varied the most across age categories. Age trends were found for the vHIT as the mean vestibulo-ocular reflex (VOR) gain increased significantly with age (r = 0.446, p < 0.001). Concerning the cVEMP, a significant increase with age was found for latency P1 (r = 0.420, p < 0.001), rectified interpeak amplitude P1-N1 (r = 0.574, p < 0.001), and averaged electromyographic (EMG) activity (r = 0.430, p < 0.001), whereas age trends for the latency N1 were less pronounced (r = 0.264, p = 0.004). Overall, the response parameters of the rotatory test did not show significant age effects ( p > 0.01), except for the phase at 0.01 Hz (r = 0.578, p < 0.001). Based on the reported success rates and age-dependent normative vestibular data, straightforward cutoff criteria were proposed (vHIT VOR gain < 0.7, cVEMP rectified interpeak amplitude < 1.3, oVEMP interpeak amplitude < 10 µV) with accompanying clinical recommendations to diagnose early vestibular impairment. CONCLUSIONS In this large cohort of typically developing children below the age of 4 years, the vHIT and cVEMP were the most feasible vestibular tests. Moreover, the age-dependent normative vestibular data could specify age trends in this group of young children. Finally, based on the current results and clinical experience of more than ten years at the Ghent University Hospital (Belgium), a clinical framework to diagnose early vestibular deficits in young patients is proposed.
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Affiliation(s)
- Sarie Martens
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Ingeborg Dhooge
- Department of Head and Skin, Ghent University, Ghent, Belgium
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Cleo Dhondt
- Department of Head and Skin, Ghent University, Ghent, Belgium
| | | | - Marieke Sucaet
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Lotte Rombaut
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Leen Maes
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
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Martens S, Maes L, Dhondt C, Vanaudenaerde S, Sucaet M, De Leenheer E, Van Hoecke H, Van Hecke R, Rombaut L, Dhooge I. Vestibular Infant Screening-Flanders: What is the Most Appropriate Vestibular Screening Tool in Hearing-Impaired Children? Ear Hear 2023; 44:385-398. [PMID: 36534644 DOI: 10.1097/aud.0000000000001290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES As children with sensorineural hearing loss have an increased risk for vestibular impairment, the Vestibular Infant Screening-Flanders project implemented a vestibular screening by means of cervical vestibular evoked myogenic potentials (cVEMP) at the age of 6 months for each child with hearing loss in Flanders (Belgium). Given that vestibular deficits can affect the child's development, this vestibular screening should allow early detection and intervention. However, less is currently known about which screening tool would be the most ideal and how vestibular impairment can evolve. Therefore, this study aimed to determine the most appropriate tool to screen for vestibular deficits, to assess the necessity of vestibular follow-up, and to set clinical guidelines for vestibular screening in children with hearing loss. DESIGN In total, 71 children with congenital or early-onset sensorineural hearing loss were enrolled (mean age at first appointment = 6.7 months). Follow-up was provided at 6 months, 1, 2, and 3 years of age. Below three years of age, the video Head Impulse Test (vHIT) of the horizontal semicircular canals (SCC), the cVEMP, and the rotatory test at 0.16, 0.04, and 0.01 Hz were applied. At 3 years of age, the vHIT of the vertical SCC and ocular vestibular evoked myogenic potentials (oVEMP) were added. To evaluate early motor development, the Alberta Infant Motor Scale (AIMS) results at 6 months and 1-year old were included. RESULTS At 6 months of age, the highest success rate was obtained with the cVEMP (90.0%) compared to the vHIT (70.0%) and the rotatory test (34.3-72.9%). Overall, vestibular deficits were found in 20.0% of the children, consisting of 13.9% with both SCC and otolith deficits (bilateral: 9.3%, unilateral: 4.6%), and 6.1% with unilateral isolated SCC (4.6%) or otolith (1.5%) deficits. Thus, vestibular deficits would not have been detected in 4.6% of the children by only using the cVEMP, whereas 1.5% would have been missed when only using the vHIT. Although vestibular deficits were more frequently found in severe to profound hearing loss (28.6%), characteristics of vestibular function were highly dependent on the underlying etiology. The AIMS results showed significantly weaker early motor development in children with bilateral vestibular deficits ( p = 0.001), but could not differentiate children with bilateral normal vestibular function from those with unilateral vestibular deficits ( p > 0.05). Progressive or delayed-onset vestibular dysfunction was only found in a few cases (age range: 12-36 months), in which the hearing loss was mainly caused by congenital cytomegalovirus (cCMV). CONCLUSIONS The cVEMP is the most feasible screening tool to assess vestibular function in 6-months-old children with hearing loss. Although the majority of children with vestibular deficits are detected with the cVEMP, the vHIT seems even more sensitive as isolated SCC deficits are associated with specific etiologies of hearing loss. As a result, the cVEMP is an appropriate vestibular screening tool, which is advised at least in severe to profound hearing loss, but certain etiologies require the addition of the vHIT (i.e., cCMV, meningitis, cochleovestibular anomalies with or without syndromic hearing loss).
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Affiliation(s)
- Sarie Martens
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- These authors contributed equally to this work
| | - Leen Maes
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
- These authors contributed equally to this work
| | - Cleo Dhondt
- Department of Head and Skin, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | | | - Marieke Sucaet
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Els De Leenheer
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
- Department of Head and Skin, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Helen Van Hoecke
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
- Department of Head and Skin, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Ruth Van Hecke
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Lotte Rombaut
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Ingeborg Dhooge
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
- Department of Head and Skin, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Karabin MJ, Harrell RG, Sparto PJ, Furman JM, Redfern MS. Head and vestibular kinematics during vertical semicircular canal impulses. J Vestib Res 2023; 33:367-376. [PMID: 37574748 PMCID: PMC10789328 DOI: 10.3233/ves-230010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 07/17/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND The video head impulse test (vHIT) is a common assessment of semicircular canal function during high-speed impulses. Reliability of the vHIT for assessing vertical semicircular canals is uncertain. Vertical head impulses require a complex head movement, making it difficult to isolate a single semicircular canal and interpret resulting eye rotations. OBJECTIVE The purpose of this study was to provide descriptive head kinematics and vestibular stimuli during vertical plane impulses to ultimately improve impulse delivery and interpretation of vHIT results for vertical semicircular canals. METHODS Six participants received right anterior (RA) and left posterior (LP) semicircular canal impulses. Linear displacements, rotational displacements, and rotational velocities of the head were measured. Peak velocities in semicircular canal planes and peak-to-peak gravitoinertial accelerations at the otolith organs were derived from head kinematics. RESULTS The largest rotational velocities occurred in the target semicircular canal plane, with non-negligible velocities occurring in non-target planes. Larger vertical displacements and accelerations occurred on the right side of the head compared to the left for RA and LP impulses. CONCLUSIONS These results provide a foundation for designing protocols to optimize stimulation applied to a singular vertical semicircular canal and for interpreting results from the vHIT for vertical semicircular canals.
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Affiliation(s)
- Michelle J. Karabin
- Department of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, PA, USA
| | - Regan G. Harrell
- Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, PA, USA
| | - Patrick J. Sparto
- Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, PA, USA
| | - Joseph M. Furman
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Eye & Ear Institute, Pittsburgh, PA, USA
| | - Mark S. Redfern
- Department of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, PA, USA
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Emekci T, Dündar MA, Kirazlı G, İnceoğlu F, Cengiz DU, Kilinç FM, Karababa E, Muzaç S, Kaya Ş, Arbağ H. vHIT results with the synapsis system according to clinicians' dominant hand use. J Vestib Res 2023; 33:105-113. [PMID: 36776084 DOI: 10.3233/ves-220073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
BACKGROUND/OBJECTIVE There exists limited information in the literature on dominant hand preference in relation with vHIT applications. The present study aimed to examine the relationship between the clinician's dominant use of right- or left-hand and vHIT results. METHODS A Synapsys vHIT Ulmer device was used in the study. The tests were administered by 3 clinicians experienced in vHIT, 2 of whom were right-handed and 1 left-handed. The test was applied to the 94 participants three times, one week apart. RESULTS In this study, the correlation between right-handed clinicians and left-handed clinicians was examined, and in all SCCs, namely RA, LA, RL, LL, RP and LP, a moderate positive significant correlation was found between right-handed1 and right-handed2, between right-handed1 and left-handed, and between right-handed2 and left-handed. CONCLUSIONS In this study, these findings suggested that measures were reliable across test sessions regardless of hand dominancy (right or left). Based on the vHIT results we obtained with three different right- or left-handed clinicians, the clinician should evaluate the results according to the dominant side.
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Affiliation(s)
- Tuğba Emekci
- Necmettin Erbakan University, Faculty of Medicine ENT Clinic, Konya, Turkey
| | - Mehmet Akif Dündar
- Necmettin Erbakan University, Faculty of Medicine ENT Clinic, Konya, Turkey
| | - Gülce Kirazlı
- Ege University, Faculty of Health Sciences, Department of Audiology, Izmir, Turkey
| | - Feyza İnceoğlu
- Malatya Turgut Ozal University, Faculty of Medicine, Department of Biostatistics, Malatya, Turkey
| | - Deniz Uğur Cengiz
- İnönü University, Faculty of Health Science, Department of Audiology, Malatya, Turkey
| | - Fatma Men Kilinç
- Hamidiye University of Health Sciences, Audiology, Ankara, Turkey
| | - Ercan Karababa
- Gülhane University of Health Sciences, Audiology, Ankara, Turkey
| | - Seray Muzaç
- Necmettin Erbakan University, Faculty of Medicine ENT Clinic, Konya, Turkey
| | - Şeyda Kaya
- Necmettin Erbakan University, Faculty of Medicine ENT Clinic, Konya, Turkey
| | - Hamdi Arbağ
- Necmettin Erbakan University, Faculty of Medicine ENT Clinic, Konya, Turkey
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Koohi N, Mendis S, Lennox A, Whelan D, Kaski D. Video head impulse testing: Pitfalls in neurological patients. J Neurol Sci 2022; 442:120417. [PMID: 36209570 DOI: 10.1016/j.jns.2022.120417] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 11/18/2022]
Abstract
The video head impulse test (vHIT) assesses the vestibulo-ocular reflex (VOR) during a rapid high-velocity low amplitude (10°-20°) head rotation. Patients with peripheral vestibulopathy have a reduced VOR gain with corrective catch-up saccades during the head turn. There are several pitfalls, mainly technical, which may interfere with interpretation of vHIT data. In addition, intrusive eye movement disorders such as spontaneous nystagmus that affect normal eye position and tracking can affect the vHIT results. To date there has been little study of neurological saccadic eye movements that may interfere with the interpretation of vHIT data. Here, in ten patients with a range of central neurological disorders, we describe oculomotor abnormalities on vHIT in the presence of normal range VOR gain values, recorded at a tertiary vestibular neurology service.
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Affiliation(s)
- Nehzat Koohi
- Centre for Vestibular and Behavioural Neurosciences, Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London, Queen Square, London, UK; The Ear Institute, University College London, London, UK
| | - Surangi Mendis
- Department of Neuro-otology, Royal national ENT and Eastman Dental Hospitals, University College London Hospitals, London, UK
| | | | - Darren Whelan
- Department of Neuro-otology, Royal national ENT and Eastman Dental Hospitals, University College London Hospitals, London, UK
| | - Diego Kaski
- Centre for Vestibular and Behavioural Neurosciences, Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London, Queen Square, London, UK; The Ear Institute, University College London, London, UK; Department of Neuro-otology, Royal national ENT and Eastman Dental Hospitals, University College London Hospitals, London, UK.
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Ooi S, Phillips G, Tang T, Chen L, Fok A, Ly J, Ma H, Phan TG. Meta-Analysis of the Use of Head Impulse Test and Head Impulse Test with Direction Changing Nystagmus and Test of Skew Deviation in the Diagnosis of Peripheral Vertigo and Stroke. Cerebrovasc Dis 2022; 52:184-193. [PMID: 36088909 DOI: 10.1159/000526331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 07/27/2022] [Indexed: 11/19/2022] Open
Abstract
<b><i>Introduction:</i></b> The head impulse test (HIT) and HIT combined with direction-changing Nystagmus-Test of Skew deviation (HINTS) have been proposed as bedside tests to differentiate between peripheral and central causes of vertigo in the emergency department (ED). We conducted a meta-analysis of the HIT and HINTS tests to diagnose peripheral vertigo (PV) and central vertigo. <b><i>Methods:</i></b> Pubmed, Google Scholar, EmBase, and articles references published in English up to July 2021 were searched for keywords “vertigo” or “acute vestibular syndrome” or “dizziness” and “head impulse” and “stroke.” The bivariate method for meta-analysis was used to calculate positive (PLR) and negative likelihood ratios (NLR) and summary receiver operating characteristics area under the curve (AUC). <b><i>Results:</i></b> A total of 11 studies were included analysing both HIT (8 studies, <i>N</i> = 417) and HINTS (6 studies, <i>N</i> = 405). HIT and HINTS were performed within 24 h in 4 of 11 studies. PLR and NLR for HIT in PV was 4.85 (95% CI: 2.83–8.08) and 0.19 (95% CI: 0.12–0.29, <i>I</i><sup>2</sup> 63.25%), respectively. The AUC for HIT the diagnosis of PV and stroke was 0.90 and 0.92, respectively. PLR and NLR for a negative HIT in stroke was 5.85 (95% CI: 3.07–10.6) and 0.17 (95% CI: 0.08–0.30), respectively. PLR and NLR for peripheral HINTS pattern for PV was 17.3 (95% CI: 8.38–32.1) and 0.15 (95% CI: 0.07–0.26), respectively. PLR and NLR for central HINTS pattern for stroke: 5.61 (95% CI: 4.19–7.7) and 0.06 (95% CI: 0.03–0.12). In all included studies, HIT and HINTS exams were administered by neurology residents or neurology specialists with additional neuro-otology or neuro-ophthalmology subspeciality experience, and two studies included ED physicians. Raters reported high degree of bias and high concern regarding applicability in most domains of the quality assessment of diagnostic accuracy studies (QUADAS-2) tool. Meta-regression did not demonstrate a statistically significant effect of publication year, time to test, and type of assessor on sensitivity or false positive rate. <b><i>Conclusion:</i></b> The HIT and HINTS exams appear to be moderately good discriminators of central and PV. However, in most papers, the tests were administered by neurologists and were evaluated beyond 24 h, which may limit utility in the ED setting.
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Affiliation(s)
- Suyi Ooi
- Department of Neurology, Monash Health, Melbourne, Victoria, Australia,
| | - Grace Phillips
- Monash University, Faculty of Medicine, Nursing and Health Sciences, Melbourne, Victoria, Australia
| | - Tanya Tang
- Department of Neurology, Peninsula Health, Melbourne, Victoria, Australia
| | - Luke Chen
- Department of Neurology, Monash Health, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Anthony Fok
- Department of Neurology, Monash Health, Melbourne, Victoria, Australia
| | - John Ly
- Department of Neurology, Monash Health, Melbourne, Victoria, Australia
| | - Henry Ma
- Department of Neurology, Monash Health, Melbourne, Victoria, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Thanh G Phan
- Department of Neurology, Monash Health, Melbourne, Victoria, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
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Kim HS, Oh EH, Kim JY, Choi SY, Choi KD, Choi JH. Discordant vestibulo-ocular reflex function according to the frequency and mode of stimulation. J Neurol 2022; 269:4742-4752. [PMID: 35394171 DOI: 10.1007/s00415-022-11105-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/24/2022] [Accepted: 03/24/2022] [Indexed: 11/26/2022]
Abstract
This study aimed to determine the incidence, pattern, and etiology of dissociated vestibulo-ocular reflex (VOR) function according to the stimulus frequency in dizzy patients. We retrospectively evaluated the results of bithermal caloric tests and video-head impulse tests (vHITs) in 1022 patients with dizziness or vertigo between July 2016 and April 2021. Patients were classified into concordant group (normal or abnormal results on both tests) and discordant group (dissociated results between two tests). Of 1022 patients, discordant group had 159 (16%), comprising abnormal horizontal vHITs with normal caloric responses (n = 36, 23%) and abnormal caloric tests with normal horizontal vHITs (n = 123, 77%). The former group showed similar frequency of peripheral (44%) and central (42%) causes, and more common involvement of bilateral horizontal semicircular canals in central than peripheral causes (86.7 vs 37.5%, p = 0.005). The most common peripheral causes were Meniere's disease and chronic vestibular neuritis, while central causes were variable, but mainly affecting the cerebellum. In the latter group, peripheral causes were common (67%), with the main etiologies being Meniere's disease and vestibular neuritis, whereas central causes were found in only 5%. The degree of canal paresis did not differ significantly between patients with central and peripheral causes. Discordant VOR function according to the stimulus frequency was not uncommon in dizzy patients. Specific patterns of VOR dissociation according to the disease etiologies may offer insight into underlying pathophysiology.
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Affiliation(s)
- Hyun Sung Kim
- Department of Neurology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Kumo-ro 20, Beomo-ri, Mulgum-eup, Yangsan, Gyeongnam, 50612, South Korea
| | - Eun Hye Oh
- Department of Neurology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Kumo-ro 20, Beomo-ri, Mulgum-eup, Yangsan, Gyeongnam, 50612, South Korea
| | - Jeong-Yeon Kim
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan, South Korea
| | - Seo Young Choi
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan, South Korea
| | - Kwang-Dong Choi
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan, South Korea
| | - Jae-Hwan Choi
- Department of Neurology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Kumo-ro 20, Beomo-ri, Mulgum-eup, Yangsan, Gyeongnam, 50612, South Korea.
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Salah M, Moyaert J, Vanderveken O, Schepers S, Termote B, Van Rompaey V, Janssens de Varebeke S. Does Vestibulo-Ocular Reflex (VOR) Gain Correlate With Radiological Findings in the Semi-Circular Canals in Patients Carrying the p.Pro51Ser (P51S) COCH Variant Causing DFNA9? Relationship Between the Three-Dimensional Video Head Impulse Test (vHIT) and MR/CT Imaging. Otol Neurotol 2022; 43:e348-e354. [PMID: 35020687 DOI: 10.1097/mao.0000000000003434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The primary aim was to determine whether 3D video-head-impulse-test vestibulo-ocular reflex (vHIT VOR)-gains correlate with computed tomography (CT) and magnetic resonance (MR) lesions in a series of carriers of the p.(Pro51Ser)-variant (P51S) in the COCH-gene (DFNA9). Secondary aim was to compare routine imaging with second peer review radiologic lecture. STUDY DESIGN Analytical cross-sectional study. SETTING Secondary referral center. PATIENTS Twenty-four p.P51S carriers with MR and CT images. Eighteen carriers were selected of whom both 3D-vHIT and imaging data were available within a time interval of 24 months. INTERVENTIONS All imaging data were reassessed by two independent neuroradiologists. vHIT VOR-gains were correlated with semi-circular canal (SCC) lesions. MAIN OUTCOME MEASURES Correlation between vHIT VOR-gains and SCC lesions, and additional lesions detected during scientific lecture of imaging data. RESULTS The average gain of the ipsilateral labyrinth was significantly lower when positive CT (0.3215; p = 0.0122) and MR results (0.3215; p = 0.0134).92% of ears presented MR lesions on at least one SCC, whereas this was 75% on CT. The posterior SCC is the most frequently affected on MR and CT. Second lecture led to nine additional MR and 16 CT lesions. CONCLUSIONS Significant correlation was observed between radiological lesions at any SCC and lower average gain of the three ipsilateral SCC. The substantially larger number of lesions during scientific assessment stresses the need to fully inform radiologists concerning differential diagnosis to facilitate accurate diagnosis when planning imaging. Focal sclerosis and narrowing of SCC in DFNA9 represent a possible biomarker of advanced stages of otovestibular deterioration.
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Affiliation(s)
- Mahadi Salah
- Department of Otorhinolaryngology & Head and Neck Surgery, Jessa Hospital, Hasselt
- Faculty of Medicine and Health Sciences, University of Antwerp
- Department of Otorhinolaryngology & Head and Neck Surgery, Antwerp University Hospital, Antwerp
| | - Julie Moyaert
- Department of Otorhinolaryngology & Head and Neck Surgery, Antwerp University Hospital, Antwerp
| | - Olivier Vanderveken
- Faculty of Medicine and Health Sciences, University of Antwerp
- Department of Otorhinolaryngology & Head and Neck Surgery, Antwerp University Hospital, Antwerp
| | | | - Bruno Termote
- Department of Radiology, Jessa Hospital, Hasselt, Belgium
| | - Vincent Van Rompaey
- Faculty of Medicine and Health Sciences, University of Antwerp
- Department of Otorhinolaryngology & Head and Neck Surgery, Antwerp University Hospital, Antwerp
| | - Sebastien Janssens de Varebeke
- Department of Otorhinolaryngology & Head and Neck Surgery, Jessa Hospital, Hasselt
- Faculty of Medicine and Health Sciences, University of Antwerp
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Kwok BYC, Rosengren SM, Kong JHK, Birman CS, Hoskisson E, Young AS, Argaet EC, Fratturo L, Rivas C, Greenberg SL, Saxby AJ, Welgampola MS. Impact of Cochlear Implantation on Canal and Otolith Function. Otol Neurotol 2022; 43:304-312. [PMID: 35061639 DOI: 10.1097/mao.0000000000003459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To quantify the impact of cochlear implantation (CI) on all five vestibular end-organs and on subjective ratings of post-CI dizziness. METHODS Seventy-two patients undergoing unilateral CI were recruited for the study. All participants completed pre- and post-CI three-dimensional video head-impulse tests (3D vHITs) to assess semicircular-canal (SC) function, air- and bone-conducted (AC and BC) cervical and ocular vestibular-evoked myogenic potentials (cVEMPs and oVEMPs) to assess otolith-function and the dizziness handicap inventory (DHI) to measure self-perceived disability. RESULTS Nineteen percent of patients reported new or worsened dizziness postsurgery. Post-CI abnormalities (new lesions and significant deteriorations) were seen in the AC cVEMP (48%), AC oVEMP (34%), BC cVEMP (10%), and BC oVEMP (7%); and lateral (L) (17%), posterior (P) (10%), and anterior (A) (13%) SC vHITs. CI surgery was more likely to affect the AC cVEMP compared with the other tests (χ2 test, p < 0.05). Fifty percent of patients reported no dizziness pre- and postsurgery. In the implanted ear, normal pre-CI vHIT gain was preserved in lateral semicircular canal (LSC) (69%), anterior semicircular canal (ASC) (74%), and posterior semicircular canal (PSC) (67%), and normal reflex amplitudes were found in AC cVEMP (25%), AC oVEMP (20%), BC cVEMP (59%), and BC oVEMP (74%). Statistically significant decreases were observed in LSC vHIT gain, AC cVEMP amplitude, and AC oVEMP amplitude postsurgery (p < 0.05). There was a significant moderate positive correlation between change in DHI scores and the summed vestibular deficit postsurgery (r(51) = 0.38, p < 0.05). CONCLUSION CI can impact tests that assess all five vestibular end-organs and subjective ratings of dizziness. These results support pre and post-surgical vestibular testing and assist preoperative counseling and candidate selection.
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Affiliation(s)
| | - Sally M Rosengren
- Central Clinical School, Faculty of Medicine and Health
- Department of Neurology and Institute of Clinical Neurosciences
| | - Jonathan H K Kong
- Department of Otolaryngology, Royal Prince Alfred Hospital
- Discipline of Surgery, Sydney Medical School
- Department of Otolaryngology, Head and Neck Surgery, Macquarie University, North Ryde
| | - Catherine S Birman
- Department of Otolaryngology, Royal Prince Alfred Hospital
- Faculty of Medicine and Health, University of Sydney, Camperdown
- Sydney Cochlear Implant Centre, Royal Institute of Deaf and Blind Children, Gladesville, NSW
- Department of Clinical Medicine, Macquarie University, North Ryde
| | - Emma Hoskisson
- Department of Neurology and Institute of Clinical Neurosciences
| | | | - Emma C Argaet
- Central Clinical School, Faculty of Medicine and Health
- The Balance Clinic and Laboratory, Sydney
| | | | | | - Simon L Greenberg
- Department of Otolaryngology, St George Hospital, Kogarah, Australia
| | - Alex J Saxby
- Discipline of Surgery, Sydney Medical School
- Department of Otolaryngology, Head and Neck Surgery, Macquarie University, North Ryde
| | - Miriam S Welgampola
- Central Clinical School, Faculty of Medicine and Health
- Department of Neurology and Institute of Clinical Neurosciences
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Kunelskaya NL, Manaenkova EA, Zaoeva ZO, Baybakova EV, Chugunova MA, Yanyushkina ES, Larionova EV, Nikitkina YY. [Dissociation of the results of caloric and video head impulse tests as a marker of Meniere's disease]. Vestn Otorinolaringol 2022; 87:39-42. [PMID: 36404689 DOI: 10.17116/otorino20228705139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The study of vestibular function in patients with Meniere's disease (MD) is an urgent task, since it influences the choice of treatment tactic. We evaluated the results of caloric and video head impulse (vHIT) tests in 76 patients who met the clinical criteria for significant Meniere's disease (AAO-HNS modified by the Barany Society, 2015). Dissociation of the results of caloric and vHIT tests is observed in the majority (74%) of patients with MD: at normal gain, according to vHIT data, hypofunction of peripheral vestibular structures is recorded according to the caloric test (KASL 47 ± 7.8%). In patients with MD, vestibular dysfunction is observed mainly at low frequencies (0.003 Hz), therefore vHIT, which allows assessing horizontal semicircular canal function at high frequencies (3-5 Hz), is not an optimal study for assessing the degree of vestibular dysfunction in patients with MD.
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Affiliation(s)
- N L Kunelskaya
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - E A Manaenkova
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - Z O Zaoeva
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - E V Baybakova
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - M A Chugunova
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - E S Yanyushkina
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - E V Larionova
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - Ya Yu Nikitkina
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
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Rahne T, Plontke SK, Fröhlich L, Strauss C. Optimized preoperative determination of nerve of origin in patients with vestibular schwannoma. Sci Rep 2021; 11:8608. [PMID: 33883565 PMCID: PMC8060325 DOI: 10.1038/s41598-021-87515-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/30/2021] [Indexed: 02/07/2023] Open
Abstract
In vestibular schwannoma (VS) patients hearing outcome and surgery related risks can vary and depend on the nerve of origin. Preoperative origin differentiation between inferior or superior vestibular nerve may influence the decision on treatment, and the selection of optimal treatment and counselling modalities. A novel scoring system based on functional tests was designed to predict the nerve of origin for VS and was applied to a large number of consecutive patients. A prospective, double blind, cohort study including 93 patients with suspected unilateral VS was conducted at a tertiary referral centre. Preoperatively before tumor resection a functional test battery [video head-impulse test (vHIT) of all semicircular canals (SCC)], air-conducted cervical/ocular vestibular evoked myogenic potential tests (cVEMP, oVEMP), pure-tone audiometry, and speech discrimination was applied. Sensitivity and specificity of prediction of intraoperative finding by a preoperative score based on vHIT gain, cVEMP and oVEMP amplitudes and asymmetry ratios was calculated. For the prediction of inferior vestibular nerve origin, sensitivity was 73% and specificity was 80%. For the prediction of superior vestibular nerve origin, sensitivity was 60% and specificity was 90%. Based on the trade-off between sensitivity and specificity, optimized cut-off values of - 0.32 for cVEMP and - 0.11 for oVEMP asymmetry ratios and vHIT gain thresholds of 0.77 (anterior SCC), 0.84 (lateral SCC) and 0.80 (posterior SCC) were identified by receiver operator characteristic curves. The scoring system based on preoperative functional tests improves prediction of nerve of origin and can be applied in clinical routine.
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Affiliation(s)
- Torsten Rahne
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Halle (Saale), Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
- Universitäts-HNO-Klinik, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany.
| | - Stefan K Plontke
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Halle (Saale), Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Laura Fröhlich
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Halle (Saale), Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Christian Strauss
- Department of Neurosurgery, University Hospital Halle (Saale), Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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Jorge A, Martins AI, Gouveia A, Lemos J. The Use of Video-Head Impulse Test in Different Head Positions in Vertical Nystagmus and Ataxia Associated with Probable Thiamine Deficiency. Cerebellum 2020; 19:611-615. [PMID: 32410095 DOI: 10.1007/s12311-020-01140-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Upward and downward bias of eye movement signals in the semicircular canals (SCC)- and/or otolith-related central pathways have been proposed to explain the occurrence of vertical nystagmus (downbeat nystagmus [DBN] and upbeat nystagmus [UBN]) and its frequent modulation with head position. Video-head impulse test (VHIT), usually performed in upright position, is a recent development for measuring SCC function. We performed longitudinal nystagmus and VHIT assessments in different head positions in a patient with probable thiamine deficiency, in order to explore a possible relationship between the positional behavior of vertical nystagmus and SCC function. Initially, UBN in upright position changed to DBN in prone position and remained relatively unchanged in supine position. This was associated with both anterior and posterior SCC hyperactive responses in upright position, and a relative enhancement of the anterior SCC responses in prone position and the posterior SCC responses in supine position. Over 1 year, in prone position, change from UBN to DBN and the enhancement of anterior SCC responses remained, while in supine position, UBN either decreased or changed to DBN, when compared to upright position. This was associated with a relative enhancement of the anterior SCC responses in supine position, albeit inconsistently, and the presence of posterior SCC hypoactive responses in all positions, including prone. While not contradicting a primary otolithic dysfunction in the genesis of UBN change to DBN with head position, we provide evidence for positional modulation of SCC function in thiamine deficiency and a possible relationship with nystagmus positional behavior.
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Affiliation(s)
- André Jorge
- Neurology Department, Coimbra University Hospital Centre, Praceta Mota Pinto, 3000-135, Coimbra, Portugal
| | - Ana Inês Martins
- Neurology Department, Coimbra University Hospital Centre, Praceta Mota Pinto, 3000-135, Coimbra, Portugal
| | - Ana Gouveia
- Neurology Department, Tondela-Viseu Hospital Centre, Viseu, Portugal
| | - João Lemos
- Neurology Department, Coimbra University Hospital Centre, Praceta Mota Pinto, 3000-135, Coimbra, Portugal.
- Faculty of Medicine, Coimbra University, Coimbra, Portugal.
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Verrecchia L, Galle Barrett K, Karltorp E. The feasibility, validity and reliability of a child friendly vestibular assessment in infants and children candidates to cochlear implant. Int J Pediatr Otorhinolaryngol 2020; 135:110093. [PMID: 32422368 DOI: 10.1016/j.ijporl.2020.110093] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 05/05/2020] [Accepted: 05/05/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The pediatric vestibular assessment has developed significantly in the past two decades, especially in terms of assessment of cochlear implant (CI) candidates. Different methods and test protocols have been applied, however without a general consensus. We present here the feasibility, validity and reliability of a child friendly vestibular testing in use at our department for the assessment of pediatric CI candidates. METHODS The test battery consisted of head impulse test (HIT), video head impulse test (vHIT), cervical evoked myogenic potentials (cVEMP) and mini ice water caloric test (mIWC), all adapted from previous methods, mentioned in literature. We defined specific criteria for test feasibility, for test validity and test positivity (i.e. indicating vestibular insufficiency). The reliability of the whole protocol was assessed with test agreement analysis. RESULTS Complete data from 35 children, all CI candidates, age ranging 4-79 months (67% under 2 years) and recruited over two years, were obtained. All but one child could complete at least one test with valid responses bilaterally, with the best compliance for HIT (97,1%) and least for cVEMP (68,6%). Feasibility did not appear to be affected by age or hearing loss etiology. Among the valid responses there was a substantial test agreement between HIT and vHIT, moderate agreement between vHIT/HIT and mIWC and no apparent agreement between the canal tests and cVEMP. Simple clinical guidelines were introduced to solve the tests' disagreement and to improve the protocol reliability: a) a pathological response had to be confirmed in at least two different canal tests and in at least three cVEMP trials; b) a canal/otolith disagreement was interpreted as a partial vestibular loss to be opposed to a complete vestibular insufficiency. CONCLUSIONS The search for vestibular insufficiency in infants and young children can be attained with an opportunely adapted vestibular assessment, such the test battery proposed here. That assessment resulted easy to conduct and to interpret in a representative sample of CI candidates in preschool age, the most of whom were younger than 2 years. This method appears to particularly suit the demands of a vestibular assessment in young children CI candidates.
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Affiliation(s)
- Luca Verrecchia
- Hearing and Balance Section, Ear Nose and Throat Department, Karolinska University Hospital, Sweden; ENT Section, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Sweden.
| | | | - Eva Karltorp
- Ear and Neck Surgery, Ear Nose and Throat Department, Karolinska University Hospital, Sweden; ENT Section, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Sweden
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Bittar RSM, Sato ES, Silva-Ribeiro DJ, Oiticica J, Mezzalira R, Tsuji RK, Bento RF. Caloric test and video head impulse test sensitivity as vestibular impairment predictors before cochlear implant surgery. Clinics (Sao Paulo) 2019; 74:e786. [PMID: 30892418 PMCID: PMC6404384 DOI: 10.6061/clinics/2019/e786] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 11/26/2018] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Currently, cochlear implant procedures are becoming increasingly broad and have greatly expanded. Bilateral cochlear implants and cochlear implants are more frequently applied in children. Our hypothesis is that the video head impulse test may be more sensitive than the caloric test in detecting abnormal vestibular function before cochlear implant surgery. The objective of this study was to compare the video head impulse test and caloric test results of patients selected for cochlear implant procedures before surgery. METHODS The patients selected for cochlear implant surgery were submitted to a bithermal caloric test and video head impulse test. RESULTS By comparing angular slow phase velocity values below 5° in the bithermal caloric test (hypofunction) and video head impulse test with a gain lower than 0.8, we identified 37 (64.9%) patients with vestibular hypofunction or canal paresis and 21 (36.8%) patients with abnormal video head impulse test gain before the cochlear implant procedure. Of the 37 patients with caloric test vestibular hypofunction, 20 (54%) patients exhibited an abnormal gain in the video head impulse test. CONCLUSION The caloric test is more sensitive than the video head impulse test (Fisher's exact test, p=0.0002) in detecting the impaired ear before cochlear implant delivery. The proportion of caloric test/video head impulse test positive identification of abnormal vestibular function or caloric test/video head impulse test sensitivity was 1.8:1.
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Affiliation(s)
| | - Eduardo Setsuo Sato
- Departamento de Otorrinolaringologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | | | - Jeanne Oiticica
- Departamento de Otorrinolaringologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Raquel Mezzalira
- Departamento de Otorrinolaringologia, Universidade Estadual de Campinas, Campinas, SP, BR
- Corresponding author. E-mail:
| | - Robinson Koji Tsuji
- Departamento de Otorrinolaringologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Ricardo Ferreira Bento
- Departamento de Otorrinolaringologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Yilmaz N, Ila K, Soylemez E, Ozdek A. Evaluation of vestibular system with vHIT in industrial workers with noise-induced hearing loss. Eur Arch Otorhinolaryngol 2018; 275:2659-2665. [PMID: 30218385 DOI: 10.1007/s00405-018-5125-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 09/10/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE Industrial workers are frequently exposed to noise and the noise can cause hearing loss. The relationship between vestibular abnormalities and long-term exposure to occupational noise has been reported. The aim of this study was to use vHIT (video head impulse test) to evaluate the semicircular canal's function in industrial workers with noise-induced hearing loss. METHODS In the present study, we included 36 male patients (aged 28-55 years, mean 44.4 ± 6.1 years) with hearing loss due to noise exposure from working in the steel and metal industry for at least 4 years, and a control group of 30 healthy men (aged 34-50 years, mean 41.1 ± 4.5 years) without hearing loss. The gain of the vestibulo-ocular reflex for all 6 semicircular canals was examined by vHIT in 66 patients. RESULTS Canal deficit was detected in 20 (55.5%) of 36 patients in the noise exposure hearing loss group and was detected in 2 (6.6%) of 30 participants in the control group. There was significant loss of capacity for VOR gain in patients with noise exposure hearing loss. CONCLUSIONS In the present study we found that exposure to noise can cause vestibular dysfunction. And the vHIT is easily applicable, quick and practical and can individually evaluate all semicircular channels. Therefore, to evaluate vestibular function with vHIT is quick and practical.
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Affiliation(s)
- Nihat Yilmaz
- Department of Otorhinolaryngology, Karabuk University Medical Faculty, Karabuk, Turkey.
| | - Kadri Ila
- Department of Otorhinolaryngology, Karabuk University Medical Faculty, Karabuk, Turkey
| | - Emre Soylemez
- Department of Otorhinolaryngology, Karabuk University Medical Faculty, Karabuk, Turkey
| | - Ali Ozdek
- Department of Otorhinolaryngology, Istinye University School of Health Sciences, Istanbul, Turkey
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Yacovino DA, Martin LA, Perez Akly M, Hain TC. Characteristics of vestibular corrective saccades in patients with slow visual saccades, vestibular disorders and controls: A descriptive analysis. PLoS One 2018; 13:e0197079. [PMID: 29847602 PMCID: PMC5976173 DOI: 10.1371/journal.pone.0197079] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 04/25/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Our aim was to determine whether overt catch up saccades (OS) provoked by vestibular stimuli, as observed in the video head impulse test (vHIT), have comparable metrics as visually triggered horizontal saccades (VS), indicating a common saccadic brainstem generator. METHODS Three groups of patients were studied: patients with neurological disorders causing slow saccades (group 1, n = 12), patients with peripheral vestibular lesions (group 2, n = 43), and normal controls (group 3, = 24). All patients underwent vHIT and Videooculographic testing. OS velocity, acceleration, amplitude and duration and VS velocity in this group was compared between the groups. RESULTS There was significant reduction in the velocity of visually guided saccades in group 1, as expected from the patient selection constraints of this study. Group 1 also exhibited saccades which were longer in duration and of reduced acceleration when compared to subjects without saccadic slowing to visual targets (Group 2 and 3). There were significant positive correlations between OS acceleration and amplitude in both normal saccade groups (2 and 3) which was not observed in the slow saccade group (1). CONCLUSIONS The metrics of overt saccades measured by the vHIT in patients with slow saccades and normal controls are similar to visually guided saccades. This supports the hypothesis that overt saccades associated with vestibular stimuli and visually triggered saccades share common circuitry that controls metrics.
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Affiliation(s)
- Dario Andres Yacovino
- Department of Neurology, Dr. Cesar Milstein Hospital, Buenos Aires, Argentina
- Memory and Balance Clinic, Buenos Aires, Argentina
- * E-mail:
| | | | - Manuel Perez Akly
- Department of Neurology, Dr. Cesar Milstein Hospital, Buenos Aires, Argentina
| | - Timothy Carl Hain
- Northwestern University, Chicago, Illinois, United States of America
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Stevens MN, Garrison DB, Kaylie DM. What is the potential clinical utility of vHIT when assessing adult patients with dizziness? Laryngoscope 2017; 127:2689-2690. [PMID: 28699192 PMCID: PMC5687996 DOI: 10.1002/lary.26774] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2017] [Indexed: 12/20/2022]
Affiliation(s)
| | - Douglas B. Garrison
- Duke University Medical Center, Division of Otolaryngology – Head and Neck Surgery, Durham, NC, USA
| | - David M. Kaylie
- Duke University Medical Center, Division of Otolaryngology – Head and Neck Surgery, Durham, NC, USA
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Mezzalira R, Bittar RSM, do Carmo Bilécki-Stipsky MM, Brugnera C, Grasel SS. Sensitivity of caloric test and video head impulse as screening test for chronic vestibular complaints. Clinics (Sao Paulo) 2017; 72:469-473. [PMID: 28954005 PMCID: PMC5577631 DOI: 10.6061/clinics/2017(08)03] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 04/07/2017] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE: This study compared the results of the caloric test with those of the video head impulse test obtained during the same session and evaluated whether the former can be used to screen for non-acute vestibular dysfunction. METHODS: A total of 157 participants complaining of dizziness with vestibular characteristics of varying durations and clinical courses completed the caloric test and video head impulse test. RESULTS: Significantly more caloric test results than video head impulse test results were abnormal. CONCLUSIONS: The results of the caloric test and video head impulse test are distinct but complement each other. Within our sample, the caloric test was more sensitive for vestibular dysfunction. Therefore, the video head impulse test is not a suitable screening tool of the vestibular system in patients with chronic complaints.
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Affiliation(s)
- Raquel Mezzalira
- Departamento de Otorrinolaringologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Clínica de Otorrinolaringologia do Instituto Penido Burnier, Campinas, SP, BR
- *Corresponding author. E-mail:
| | | | - Marcia Maria do Carmo Bilécki-Stipsky
- Departamento de Otorrinolaringologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Clínica de Otorrinolaringologia do Instituto Penido Burnier, Campinas, SP, BR
| | - Cibele Brugnera
- Departamento de Otorrinolaringologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Signe Schuster Grasel
- Departamento de Otorrinolaringologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Abstract
OBJECTIVE The objective of the study was to compare rotary chair and video head impulse test (vHIT) findings in patients with bilateral vestibular hypofunction (BVH) to determine whether vHIT can: 1) define severity of BVH and 2) accurately predict rotary chair findings in patients with BVH. STUDY DESIGN Retrospective chart review. SETTING Research hospital. PATIENTS Twenty subjects with bilateral vestibular hypofunction as assessed by rotary chair. INTERVENTION Rotary chair and vHIT. MAIN OUTCOME MEASURES The main outcome measures were rotary chair phase, gain, and symmetry and vHIT vestibulo-ocular reflex (VOR) gain. Rotary chair and vHIT results were assessed and subjects were stratified into groups according to the severity of their vestibular hypofunction. For rotary chair, subjects were classified as mild, moderate, or severe BVH. For vHIT, subjects were classified as normal, unilateral, or bilateral. RESULTS Average lateral canal vHIT VOR gain: 1) significantly increased as severity of BVH decreased, and 2) demonstrated a significant and positive, linear relationship with rotary chair gains. vHIT was in disagreement with rotary chair in the classification of five subjects, which could be due to right-left asymmetry of BVH. CONCLUSION vHIT can serve as an initial tool for identifying patients with BVH. Lower vHIT gains are consistent with having severe BVH. There was disagreement between vHIT and rotary chair, though not for any patients with severe BVH. Compared with rotary chair, the clinical gold standard for identifying BVH, vHIT possesses 100% sensitivity for excluding severe BVH when average vHIT gains are greater than 0.46.
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Affiliation(s)
- Paul D Judge
- *University of Nebraska Medical Center †Boys Town National Research Hospital, Omaha, Nebraska ‡The Ohio State University, Eye and Ear Institute, Columbus, Ohio
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Park P, Park JH, Kim JS, Koo JW. Role of video-head impulse test in lateralization of vestibulopathy: Comparative study with caloric test. Auris Nasus Larynx 2017; 44:648-654. [PMID: 28077250 DOI: 10.1016/j.anl.2016.12.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 11/21/2016] [Accepted: 12/19/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the lateralization value of video head-impulse test (vHIT) for the diagnosis of vestibulopathy and to analyze cases showing dissociated results with caloric test. METHODS In total, 19 healthy volunteers and 92 dizzy patients who underwent both a caloric test and a vHIT were enrolled. Patients were divided into two groups depending on their fluctuating pattern of vertigo. The vestibulo-ocular reflex (VOR) gain and gain asymmetry (GA) of a vHIT as well as unilateral weakness (UW) and the sum of the slow-phase velocities (SPVs) of warm and cold irrigation of the same side were compared. A cutoff value of VOR gain of a vHIT was also calculated using a receiver-operating characteristic curve. RESULTS A VOR gain in an affected ear and GA of a vHIT showed a statistically significant correlation with UW in a caloric test. The cutoff value of a vHIT was determined to be 0.875, derived under the assumption that UW of a caloric test ≤25% is normal. However, the parameters of the two tests were dissociated in 18%. CONCLUSION A VOR gain of vHIT is a valuable objective parameter with a lateralization value determining vestibular hypofunction. However, considering substantial dissociation between a vHIT and a caloric test, these tests can be complementary tools for the lateralization of vestibular impairment for the comprehensive evaluation of patients' VOR.
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Affiliation(s)
- Pona Park
- Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Joo Hyun Park
- Department of Otorhinolaryngology, Dongguk University Ilsan Hospital, Goyang, South Korea
| | - Ji Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ja-Won Koo
- Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
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Redondo-Martínez J, Bécares-Martínez C, Orts-Alborch M, García-Callejo FJ, Pérez-Carbonell T, Marco-Algarra J. Relationship between video head impulse test (vHIT) and caloric test in patients with vestibular neuritis. Acta Otorrinolaringol Esp 2015; 67:156-61. [PMID: 26611424 DOI: 10.1016/j.otorri.2015.07.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 07/27/2015] [Accepted: 07/31/2015] [Indexed: 11/18/2022]
Abstract
INTRODUCTION AND OBJECTIVES The caloric test is the gold standard for the loss of vestibular function diagnosis. The Video Head Impulse Test (vHIT) assesses the same reflex by using a video- assisted examination of the impulsive maneuver. We intend to compare the variation of results of the vHIT and the caloric test in patients with vestibular neuritis with respect to their initial condition at two different moments of their evolution and to check the level of correlation between them and with that of the DHI test METHODS We explored 20 patients with neuritis by using both vHIT and the caloric test on the same day. We assessed the correlation between these two tests and with the DHI test for each patient at two different moments of their evolution. RESULTS We calculated gain asymmetry and compared it with the canal paresis, but we found neither a linear correlation between them, nor a correlation between the DHI test or improvement of these two other tests. We conclude that the covert saccades maintain a similar speed whilst present in the VHIT, but the overts diminish their speed over time. CONCLUSIONS The VHIT and the caloric test show different responses of the vestibulo-ocular reflex, because they stimulate different frequencies of this reflex. No correlation was found between the VHIT, the caloric test and the DHI test. The tests appear to complement one another.
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Affiliation(s)
- Jaume Redondo-Martínez
- Servicio de ORL, Departamento de Cirugía, Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, España.
| | | | - Miguel Orts-Alborch
- Servicio de ORL, Departamento de Cirugía, Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, España
| | - Francisco Javier García-Callejo
- Servicio de ORL, Departamento de Cirugía, Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, España
| | - Tomás Pérez-Carbonell
- Servicio de ORL, Departamento de Cirugía, Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, España
| | - Jaime Marco-Algarra
- Servicio de ORL, Departamento de Cirugía, Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, España
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Abstract
CONCLUSION Additional research is needed to validate the importance of the video head impulse tests (vHIT), but it provides an important contribution to the evaluation of anterior and posterior semicircular canal disorders. OBJECTIVES To share observations of the vHIT test in clinical neurotology and to discuss the significance of the study findings. METHODS This study comprised 200 patients with a clinical history of vestibular disturbances who were submitted to a vHIT including all six semicircular canals. RESULTS Abnormal responses of the anterior and posterior canals were found in several patients, either alone or combined with altered responses in the lateral canals. A unilateral hypoactive response of a posterior canal was found in a patient with a small vestibular schwannoma.
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Blödow A, Heinze M, Bloching MB, von Brevern M, Radtke A, Lempert T. Caloric stimulation and video-head impulse testing in Ménière's disease and vestibular migraine. Acta Otolaryngol 2014; 134:1239-44. [PMID: 25399882 DOI: 10.3109/00016489.2014.939300] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Both the bithermal caloric test and the video-head impulse test (vHIT) were more often abnormal in Ménière's disease (MD) than in vestibular migraine (VM). Horizontal vestibulo-ocular reflex (hVOR) evaluation with caloric test (low-frequency test) was significantly more often abnormal than vHIT (high-frequency test). Therefore, both tests can be used in a complementary way for frequency-selective testing of peripheral vestibular function. OBJECTIVES To compare the results of caloric testing and vHIT in MD and VM and to determine which test is more sensitive to uncover peripheral vestibular hypofunction. METHODS Patients with MD (n=30) or VM (n=23) were examined with the caloric test and vHIT. The parameters analyzed were the canal paresis factor for the caloric test and the hVOR gain on both sides in vHIT. RESULTS The caloric test was abnormal in 67% of patients with MD and in 22% with VM (p=0.002), while the vHIT showed an hVOR deficit in 37% in MD and 9% in VM (p=0.025). In all, 28% of patients with an abnormal caloric test had a normal vHIT, whereas 6% of those with an abnormal vHIT had a normal caloric test. The sensitivity of vHIT compared with caloric testing was 55% for MD and 40% for VM. Neither the caloric test nor vHIT could detect significant differences between early (<5 years) or advanced stages (>5 years) of MD or VM.
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Affiliation(s)
- Alexander Blödow
- Department of Otorhinolaryngology, Head and Neck Surgery and Communication Disorders , HELIOS-Klinikum Berlin-Buch , Germany
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