Journal of Vestibular Research-Equilibrium & Orientation最新文献

PurposeTo estimate the prevalence of endolymphatic sac hypoplasia (EShp)-a proposed specific finding in Ménière's disease (MD) that defines an endophenotype characterized by bilateral involvement, male predominance, temporal bone abnormalities, and familial clustering-in individuals without MD, to assess its specificity for the condition.MethodsWe analyzed 956 temporal bone CT scans from individuals without MD to assess the prevalence of EShp using the Angular Trajectory of the Vestibular Aqueduct (ATVA) marker. ATVA distribution, reproducibility, and associations with clinical variables were also evaluated.ResultsEShp was identified in 6 ears from 4 individuals, yielding a prevalence of 0.6% per patient and 0.8% per ear. ATVA values had a median of 95.0° (IQR = 12.5°, range 65.9°-159.4°). Interobserver agreement was good (ICC = 0.75), with a mean bias of 6.2° ± 5.4° and 5.5% of ears outside the 95% limits of agreement. No significant associations were found between ATVA and sex, age, or clinical diagnosis.ConclusionsEShp is rare in individuals without MD, supporting its specificity and potential role in MD pathophysiology. The ATVA marker is reliable and reproducible and may serve as a CT biomarker for the hypoplastic MD endophenotype.

BackgroundMotion sickness (MS) occurs when the brain receives conflicting signals about body movement from the visual, vestibular, and proprioceptive systems. The otolith organs play a key role in perceiving verticality, and their function may be influenced by MS susceptibility.ObjectiveThis study aimed to investigate the effect of MS susceptibility on otolith-mediated verticality perception across different head positions.MethodsForty-seven participants were classified into two groups based on the Motion Sickness Susceptibility Questionnaire-Short Form (MSSQ-SF): an MS group (n = 24) and a control group (n = 23). All participants completed static Subjective Visual Vertical (SVV), dynamic Subjective Visual Vertical (DVV), and Rod-and-Frame Test (RFT) using a virtual reality system. Measurements were conducted in three head tilt (upright, 30° left, 30° right). The absolute deviation from true vertical was calculated for each test.ResultsWhile no significant differences were found in SVV performance between groups across head-tilt angles, the MS group exhibited significantly greater deviations in DVV at all positions and in RFT during 30° head tilts. Higher MSSQ scores correlated with greater deviations in DVV and RFT under tilt conditions.ConclusionsAlthough static verticality perception remains intact, individuals with MS exhibit greater deviations under dynamic and visually misleading conditions, suggesting subtle vestibular-perceptual deficits.

ObjectiveThe study aims to assess the high-frequency Vestibulo-Ocular Reflex (VOR) gain across three pairs of semicircular canals using the EyeSeeCam device and to determine normative values.MethodsA total of 105 volunteers, aged 19 to 69 years with no history of vestibular disorders, were enrolled. This cohort included 50 males (mean age 41.11 ± 15.98) and 55 females (mean age 35.52 ± 15.07), with no statistically significant age difference between the genders (P = 0.078). Participants were categorized into six age brackets: 11-20, 21-30, 31-40, 41-50, 51-60, and 61-70. For each test, the recording device was consistently positioned on the left side of the goggles, and the tests were conducted by a right-handed operator.ResultsThe average regression gain for left anterior-right posterior canals (LARP) was 1.44 ± 0.19, significantly surpassing that of right anterior-left posterior canals (RALP) at 1.09 ± 0.13 (p < 0.001) and horizontal semicircular canals (HSC) at 1.11 ± 0.07 (p < 0.001). No significant difference was observed between the VOR gains of RALP and HSC (p = 0.1077). Additionally, VOR gain values did not show significant variation across different age groups. In a gender-based analysis, a marginally higher HSC gain was observed in females (1.13 ± 0.07) compared to males (1.11 ± 0.07; p = 0.042), while no significant gender disparity was noted for RALP gains (females: 1.09 ± 0.11; males: 1.10 ± 0.14; p = 0.641). Females exhibited significantly higher LARP gain values (1.49 ± 0.18) than males (1.41 ± 0.20; p = 0.002).ConclusionThis study underscores the stability of high-frequency VOR gain values across ages. However, it also reveals a significant asymmetry in vertical canal gains (LARP vs RALP), suggesting a possible vertical canals monocular directional preponderance. This finding highlights that normative values can be highly specific to the recording and testing protocol. Thus, laboratories should develop their own normative values, customized to their equipment and testing protocols.

ObjectiveTo explore the incidence, risk factors, and comorbidities of persistent postural-perceptual dizziness (PPPD) after stroke.MethodsPatients with acute stroke and vestibular symptoms were enrolled prospectively and continuously. Baseline information, risk factors, imaging materials, and diagnosis were collected. PPPD, anxiety, depression, and quality of life were followed up in 6 months after stroke. Binary logistic regression was used to identify the risk factors of PPPD.ResultsIn this study, 284 patients (82.0% of males) were enrolled, with a mean age of 56.33 ± 11.87 years. Thirty-five patients (12.3%) had PPPD in 6-month follow-up. Patients with PPPD had a higher proportion of clinically significant anxiety and clinically significant depression and a lower three-level five-dimension EuroQol (EQ-5D-3L) index. Binary logistic regression analysis identified medulla oblongata stroke (OR, 5.549; p < .001), cerebellar stroke in posterior inferior cerebellar artery (PICA) territory (OR, 2.449; p = .026), and clinically significant anxiety at discharge (OR, 5.030; p < .001) were significant predictors for PPPD.ConclusionsAbout 12.3% of stroke patients with vestibular symptoms developed PPPD at 6 months after stroke, with a higher prevalence of psychological comorbidities and decreased quality of life. Medulla oblongata lesion, cerebellar (PICA territory) lesion, and clinically significant anxiety at discharge were independent risk factors for PPPD.

ObjectiveSome patients with benign paroxysmal positional vertigo (BPPV) do not improve with a single maneuver and may require multiple maneuvers. This study aims to utilize machine learning (ML) to identify parameters predisposing multiple CRMs, thus enhancing the predictability of treatment requirements in BPPV patients.Study designRetrospective study.SettingHospital.PatientsThis study included 520 participants diagnosed with BPPV between 2018 and 2023, with a mean age of 56.2 ± 14.0 years.InterventionsAge, BPPV type, comorbid diseases, gender, and number of maneuvers that the patients recovered with were determined. The target outcome-"number of maneuvers"-was dichotomized as either one (0) or more than one (1). The models' success was evaluated using metrics such as precision, F1-score, accuracy, balanced accuracy, recall, area under the Receiver Operating Characteristic (ROC), and area under the curve (AUC).ResultsThe applied maneuver number to treat BPPV was 188 (36%) in one maneuver and 332 (67%) in more than one maneuvers. Gradient Boosting Machine (GBM) had the best AUC in maneuver number estimation. Also, logistic regression resulted the best precision score; XGBoost showed the best F1 and recall score while support vector classifier showed the best accuracy and balanced accuracy scores.ConclusionsMachine learning models with high predictive capabilities can help identify patients likely to need multiple maneuvers, allowing for more efficient treatment planning and enhanced patient outcomes.

BackgroundDizziness is an unpleasant symptom which can cause anxiety and fear of movement (kinesiophobia) which may lead to avoidance of physical activity. There are no reliable and valid questionnaires available to detect kinesiophobia in patients with peripheral vestibular dizziness.ObjectiveTo adapt the Tampa Scale for Kinesiophobia (TSK-SV) to TSK-SV Dizziness and to investigate the questionnaire´s reliability and validity.MethodsThe TSK-SV was adapted to TSK-SV Dizziness in patients with peripheral vestibular disorder. Test-retest reliability and internal consistency was calculated. Face and content validity construct and a confirmatory factor analysis were performed. Concurrent validity was assessed in relation to Hospital anxiety and depression scale (HADS-A, HADS-D), Dizziness Handicap Inventory (DHI), Short form-36, Self-reported physical activity, assessment of dynamic and static balance function.ResultsTSK-SV dizziness showed excellent test-retest reliability (intraclass correlation coefficient 0.91) and excellent internal consistentcy (Cronbach's alpha 0.76). Confirmatory factor analysis provided acceptable model fit for the modified second-order factor model. In concurrent validity moderate to large associations between TSK-SV dizziness, HADS-A, HADS-D and DHI total sum.ConclusionsThis study supports the reliability and validity of the TSK-SV dizziness questionnaire for clinical use in patients with peripheral vestibular dizziness.

ObjectiveTo assess whether preoperative vestibular rehabilitation and/or intratympanic gentamicin (ITG) improve vestibular compensation and postoperative functional outcomes in patients undergoing vestibular schwannoma surgery.DesignSystematic review conducted in accordance with the PRISMA 2020 statement.Study sampleTwelve original studies were identified through PubMed, Web of Science, and Google Scholar. Eligible designs included clinical trials, cohort, case-control, and case-series studies evaluating preoperative vestibular rehabilitation and/or ITG before surgery. Methodological quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklists and the RoB 2 tool.ResultsThree studies implemented ITG alone, whereas nine integrated ITG and/or structured vestibular rehabilitation within multimodal prehabilitation protocols. Rehabilitation components ranged from supervised physiotherapy to home-based or hybrid programs. A Bayesian random-effects meta-analysis of three studies evaluating hospital length of stay (LOS) yielded a small-to-moderate pooled effect favouring prehabilitation (μ = 0.28; 95% CrI -0.37 to 1.00), with moderate heterogeneity and wide uncertainty. Other outcomes such as posturography and dizziness handicap could not be meta-analysed due to methodological heterogeneity. Overall risk of bias was moderate-to-high.ConclusionsPreoperative prehabilitation may support postoperative recovery, particularly when tailored to residual vestibular function and delivered through supervised or hybrid formats. Larger, high-quality randomized trials using standardized outcomes are warranted.

BackgroundMénière's disease (MD) impairs cognitive function, yet the dynamics of cognitive-motor interference are not well understood. This study investigated dual-task performance in MD, hypothesizing a greater performance cost for patients compared to healthy controls under combined cognitive and postural loads.MethodTwenty-nine patients with MD and 29 healthy controls participated in a dual-task paradigm that combined computerized dynamic posturography (CDP) with a cognitive battery assessing visuospatial, executive, and working memory functions. Performance was measured across Sensory Organization Test (SOT) conditions of increasing difficulty and analyzed using mixed-effects models.ResultsSignificant dual-task interference was found in the MD group only for reaction times on two cognitive tasks (Mental Rotation and Shifting Attention), where increasing postural difficulty disproportionately slowed performance relative to controls. No dual-task effects were found in the other four cognitive tasks (Visual Stroop Task, Backward Digit Span Task, Corsi Block Task, and Symbol Digit Coding Task). Importantly, concurrent cognitive tasks did not significantly impair postural stability in either group. Patients also exhibited baseline deficits specifically on visuospatial working memory tasks.ConclusionIndividuals with MD demonstrate selective cognitive-motor interference in demanding visuospatial and executive tasks, without concomitant deterioration in postural control under dual-task conditions. This suggests a posture first strategy and highlights a quantifiable, task-specific cognitive burden that is a clinically relevant feature of the disorder. Dual-task paradigms provide a sensitive method for assessing this impact, with clear implications for comprehensive patient evaluation and management.

ObjectiveThe present study aimed to identify blood-based inflammatory biomarkers that would help investigate the underlying pathogenesis in vestibular neuritis (VN) using a proximity extension assay (PEA).MethodsIn this single-center prospective study, we enrolled both a cross-sectional (acute VN vs normal controls) and a longitudinal (acute phase vs recovery phase) cohorts. We quantified 92 plasma inflammatory proteins using the Olink PEA and identified differentially expressed proteins (DEPs) in each cohort using t-tests. The clinical utility and predictive value of each DEP were evaluated using the Pearson correlation test and receiver operating characteristic (ROC) curve analysis, respectively.ResultsIn the cross-sectional cohort, there were 17 DEPs identified between acute VN (n = 35) and normal controls (n = 35), of which Flt3L was the only downregulated DEP that showed longitudinal changes congruent with clinical disease activity in the longitudinal cohort (n = 18). The correlation analysis revealed that the expression level of CXCL5 was significantly related to the absolute gain and gain asymmetry of the horizontal vestibulo-ocular reflex, while five DEPs (OSM, Flt3L, IFN-γ, MCP-1, and uPA) were negatively correlated with the hospitalization period. ROC curves showed that CXCL1 and Flt3L were upregulated and downregulated DEPs with high predictive values, respectively.ConclusionsThis study shows that the high-throughput PEA technology can be used to identify blood-based inflammatory biomarkers for VN. Our findings highlight the potential value of Flt3L and CXCL1/CXCL5 as objective VN markers that may correlate with disease activity.

The vestibular disorders, which generally manifest themselves as nausea, vomiting, and dizziness or vertigo, have troubled many people. Increasing evidence suggests that certain vestibular disorders are hereditary, and gene variants contribute to the onset and susceptibility of these disorders. This review summarizes the latest research progress, especially the molecular and genetic aspects of several common vestibular disorders, including Meniere's disease, vestibular migraine, benign paroxysmal positional vertigo, and motion sickness, with the aim of encouraging more fundamental research and enhancing our understanding of the molecular and genetic mechanisms underlying vestibular disorders.