Journal of Vestibular Research-Equilibrium & Orientation最新文献

ObjectiveThis study aimed to translate and cross-culturally adapt the Niigata Persistent Postural-Perceptual Dizziness Questionnaire (NPQ) into Turkish and evaluate its psychometric properties, including reliability, validity, and diagnostic accuracy, in Turkish-speaking patients with Persistent Postural-Perceptual Dizziness (PPPD).MethodsThis prospective case-control study included 114 participants: 36 PPPD patients, 40 with other vestibular disorders, and 38 healthy controls. Participants completed the Turkish version of the NPQ (T-NPQ) and the Dizziness Handicap Inventory (DHI). Internal consistency was assessed using Cronbach's alpha, and test-retest reliability was evaluated over 14-30-day interval. Construct validity was tested through confirmatory factor analysis (CFA) to test the hypothesized three-factor structure (Upright Posture/Walking, Movement, and Visual Stimulation), while convergent validity was examined by correlating T-NPQ scores with DHI scores. Diagnostic accuracy was assessed using Receiver Operating Characteristic (ROC) curve analysis.ResultsThe T-NPQ demonstrated excellent internal consistency (Cronbach's α = 0.919) and strong test-retest reliability (r = 0.832, p < .001). CFA supported the hypothesized three-factor structure and showed good model fit (χ²/df = 1.47, CFI = 0.964, RMSEA = 0.064). T-NPQ total scores strongly correlated with DHI total scores (r = 0.709, p < .001). The T-NPQ discriminated PPPD patients from other vestibular patients with an Area Under the Curve (AUC) of 0.746. The optimal cut-off score of 27.5 showed sensitivity of 86.1% and specificity of 57.5%.ConclusionThe Turkish version of the NPQ is a reliable and valid tool that may be useful for assessing symptom severity in PPPD patients. It has the potential to be effective for screening and measuring outcomes in clinical practice and research in Turkey.

BackgroundIndividuals with vestibular disorders often describe symptoms of dizziness, disorientation, and impaired balance induced by visual stimuli, commonly referred to as visual vertigo.ObjectiveThe purpose of this study was to improve assessment of visually induced symptoms by modifying the original, nine-item Visual Vertigo Analogue Scale (VVAS) to produce a more robust, interpretable, and clinically useful measure of visual vertigo. We also aimed to establish a cut-off score for identifying patients with vestibular disorders and low- versus high-severity visual vertigo.MethodsPatients with vestibular disorders (n = 199) and controls (n = 107) completed the modified VVAS (mVVAS). Exploratory factor analysis was conducted to develop a shorter scale and internal consistency analyses were performed. A K-means cluster analysis was used to determine a cut-off score for identifying low- and high-severity groups.ResultsA reduced six-item scale (VVAS-6), which included three items from the VVAS and three items from the mVVAS, had excellent internal consistency (Cronbach's α = 0.93). We identified four concepts within the VVAS-6 (walking with visual stimulation, visual stimulation only, escalator, car). A cut-off score of 37 was able to identify patients with vestibular disorders and high severity of visual vertigo.ConclusionsThe use of a cut-off score of 37 for the VVAS-6 scale resulted in an improvement in correctly identifying patients with vestibular disorders and high severity of visual vertigo from controls.

BackgroundPersistent postural-perceptual dizziness (PPPD) and motion sickness (MS) are associated with disturbances in spatial orientation related to altered multisensory integration. Impaired perception of upright orientation during head tilt may therefore occur in these conditions. Subjective visual vertical (SVV) and subjective visual horizontal (SVH) testing under head-tilted conditions provide quantitative measures of such perceptual errors. We hypothesized that headtilt-induced perceptual errors would be associated with PPPD and with susceptibility to clinically significant MS during non-driving tasks.Methods80 participants were enrolled: 27 healthy controls, 36 individuals with high Motion Sickness Susceptibility Questionnaire scores who reported MS during real-world driving, and 17 patients with PPPD diagnosed according to the Bárány Society criteria. SVV and SVH were measured at ±30° and ±60° head-roll tilts in a virtual environment. Perceptual error was defined as the signed deviation from the true vertical or horizontal orientation. Diagnostic accuracy was assessed using receiver operating characteristic analysis.ResultsSVV and SVH errors under head-tilt conditions differed significantly between groups, with healthy controls showing contraversive deviations and both individuals with high-MS and patients with PPPD exhibiting ipsiversive deviations, particularly at ±60° roll tilts, whereas errors in the upright (0°) position were negligible. Several tilt conditions demonstrated excellent diagnostic accuracy (AUC ≥ 0.90). Real-world MS severity correlated with ipsiversive SVV errors but not with questionnaire-based susceptibility scores.ConclusionsBased on the present findings, further methodological refinement may allow head-tilt SVV/SVH testing to serve as a rapid and sensitive tool for detecting perceptual alterations underlying functional dizziness, with translational potential for MS risk screening in future autonomous vehicle environments.

BackgroundFalls remain a major healthcare burden from an individual to societal level. Vestibular disorders are recognised as a significant risk factor for falls in older adults, but identification and assessment of such conditions has only recently been included in national and international guidance. The extent to which National Health Service (NHS) falls services in England are including vestibular assessment is not well known.MethodA freedom-of-information request was sent to 117 Falls Services run by NHS Trusts in England to identify if they included vestibular assessment/management, if so which professions were providing this and whether Trusts planned to develop this aspect.Results115 out of the 117 identified Trusts replied. 39/115 (33.9%) of Trusts reported that their falls prevention services included staff trained to assess and treat vestibular dysfunction. Physiotherapists were the most common profession delivering this. Despite the lack of provision, just 23/115 (20%) of Trusts reported this was an area of their service they were planning to develop.DiscussionThese results show a significant lack of vestibular management in falls services. Accordingly, in their current offering, a majority of NHS Trust falls services will not be able to fully implement recently updated NICE guidance (NG249) or World Falls Guidelines for falls prevention. Given the extensive burden of falls in older adults, steps to close this gap would appear important.

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.