Journal of Vestibular Research-Equilibrium & Orientation最新文献

Background: The International Classification of Vestibular Disorders defines probable vestibular migraine (PVM) as an episodic vestibular disorder with either a history of migraine (criterion B) or migraine features during vestibular episodes (criterion C).

Objective: The purpose of this study is to investigate the clinical characteristics of PVM, focusing on items in the diagnostic criteria.

Methods: We retrospectively reviewed the medical records of 30 consecutive PVM patients diagnosed according to the Barany classification. The PVM patients were divided into two groups: those who fulfilled the criterion B (pre-existing migraine group) and those who fulfilled the criterion C (migraine features group).

Results: Twenty-four patients (80%) were in the pre-existing migraine group and the remaining 6 patients (20%) were in the migraine features group. All patients in the migraine features group had headache episodes. There were no significant differences between the two groups with regard to prevalence of migraine features listed in the criterion C and abnormal testing results.

Conclusions: The diagnosis of PVM was based on a history of migraine in most patients and on migraine features during vestibular episodes only in a few. All patients with migraine features during vestibular episodes had also headache episodes.

Objective: This study aims to investigate the effect of camera positioning (left-sided vs right-sided) on the vestibulo-ocular reflex (VOR) gain values of normal subjects during the video head impulse test (vHIT), thereby providing valuable reference data for otology clinical practice.

Methods: Thirty healthy adults (60 ears) were recruited and examined by vHIT for the three pairs of semicircular canals (SCs). During the examination, we meticulously recorded and compared the VOR gain values in the six canal planes-right lateral (RL), left lateral (LL), right anterior-left posterior (RALP), and left anterior-right posterior (LARP)-with the camera positioned on the left side first, followed by repositioning on the right side. We evaluated instantaneous gain (40 ms, 60 ms, and 80 ms), 0-100 ms median gain, and regression gain in 0-100 ms for all SCs.

Results: For horizontal canals, higher VOR gain values were recorded when the camera was positioned on the same side as the canal being tested. The gain value in LARP was higher when the camera was on the left side than on the right side, while the gain value in RALP was higher when the camera was on the right side than on the left side.

Conclusion: This study underscores the importance of camera positioning on VOR gain values for both lateral and vertical canals during vHIT. To mitigate the effects of these variables, standardization of operational procedures and equipment settings is crucial.

Background: Cervical VEMP elicited by air-conducted acoustic stimuli (AC cVEMP) is considered as a valuable test for assessment of saccular function. The dominant component of this response, which is composed of a biphasic positive-negative deflexion, can be recorded from the tensed ipsilateral sternocleidomastoid muscle. It is conveyed by inhibitory connections from the irregular saccular afferents. The contralateral response, which has opposite polarity, is in general not studied in clinical practice. It probably reflects excitatory influences conveyed from irregular afferents of the utricle.

Objective: The purpose of this study was to ascertain whether this contralateral response has any clinical value.

Methods: AC cVEMPs of 117 control subjects and 353 patients with balance problems and/or BPPV were subjected to retrospective analysis. The contribution of the contralateral excitatory response to the whole response (i.e., amplitudes of the contralateral plus ipsilateral responses) was expressed in percentages calculated according to Jongkee's formula.

Results: There was statistically significant increase in the contribution of the contralateral excitatory component to the whole response in patients.

Conclusions: This may imply somewhat lower vulnerability of the contralateral utricular response to various disease processes and/or aging.

Background: Individuals with dizziness often face balance issues and anxiety, which can result in reduced physical activity levels and decreased participation in their daily activities. Few studies have evaluated physical activity levels in individuals with chronic dizziness, and none have specifically focused on the two most prevalent types: vestibular migraine (VM) and persistent postural perceptual dizziness (PPPD).

Objective: Evaluate self-reported physical activity levels in individuals diagnosed with PPPD and VM who are awaiting vestibular rehabilitation.

Methods: In a retrospective cross-sectional study, we extracted data from the electronic healthcare records involving 121 individuals presenting either VM or PPPD, referred for vestibular rehabilitation at National Hospital for Neurology and Neurosurgery, University College London. Data on IPAQ (International Physical Activity Questionnaire) and DHI (dizziness handicap inventory) questionnaires were analysed across groups.

Results: The total sample consisted of 94 (77.7%) women and 27 (22.3%) men with a median age of 56 years old, ranging from 17 to 81 years (P25 = 41 and P75 = 64). Regarding the total sample, a minority (9.1%) of the individuals scored a high activity level on the IPAQ. We observed a significant difference between VM and PPPD in IPAQ score distribution (p = 0.039, Mann-Whitney). Within the category of high physical activity, a larger proportion of individuals had VM compared to PPPD. An inverse correlation was found between DHI and IPAQ (the lower IPAQ, the higher DHI) in the PPPD group (p<0.003).

Conclusions: In a sample of individuals with PPPD and VM referred for vestibular rehabilitation, only a minority demonstrated high physical activity levels on the IPAQ, with PPPD exhibiting lower activity levels compared to those with VM.

Background: Ramsay Hunt syndrome with dizziness (RHSD), vestibular neuritis (VN), and idiopathic sudden sensorineural hearing loss with vertigo (SHLV) all present with acute vestibular symptoms, and no study has compared the semicircular canal (SCC) deficits among them.

Objective: This study aimed to use video head impulse test (vHIT) to compare the SCC injury patterns in RHSD, VN, and SHLV.

Methods: Twenty-three RHSD patients, 44 VN patients, and 70 SHLV patients were enrolled. The vestibulo-ocular reflex gain and incidence of corrective saccades of anterior, horizontal, and posterior SCC (ASCC, HSCC, and PSCC) were examined using vHIT. Pathological vHIT results referred to decreased VOR gain and presence of corrective saccades.

Results: (1) The pathological rate of each SCC in RHSD group was the highest. (2) Impairment pattern of SCCs can be divided into 7 types based on vHIT results. The pattern of ASCC + HSCC + PSCC disability was the most common in RHSD patients (12/23, 52.2%). In the VN group, the HSCC deficit alone was the most common (16/44, 36.4%), followed by HSCC + ASCC impairment (13/44, 29.5%). In SHLV patients, the most common type was the PSCC deficit alone (26/70, 37.1%). (3) The system cluster analysis revealed that the injury of all SCCs in RHSD patients, the deficit of HSCC alone in VN patients, and the impairment of PSCC alone in SHLV patients showed the farthest distance from other injury patterns.

Conclusion: SCCs deficit showed more severe and extensive vestibular impairment in RHSD compared with VN and SHLV, suggesting these three peripheral acute vestibular disorders may have different pathophysiologic mechanisms.

Background: Gait variability is increased in people with bilateral vestibulopathy (BVP). Since dedicated gait analysis can be resource-intensive, concurrent assessment with another vestibular function test, dynamic visual acuity (DVA), is worth consideration.

Objective: To assess comparability of results from a combined gait and DVA assessment with results from a previous dedicated gait analysis.

Methods: 15 participants (4 women) with BVP were analysed. The DVA test assessed visual acuity during stance and during treadmill walking at 2, 4 and 6 km/h. An 8-camera motion capture system measured spatiotemporal gait parameters (step length, step time, step width and double support time; means and coefficients of variation [CoV]). The walking speed effect was assessed by mixed-effects models, and results were visually compared to previous results.

Results: Walking speed affected the means of step length, step time and double support time (p < .0001) but not step width (p = .373) and significantly affected the CoV of all parameters (p < .01). These values, as well as speed-related changes, were comparable between contexts.

Conclusions: Concurrent DVA and gait assessment seems promising as an assessment method in people with BVP. Test-retest reliability, clinically feasible motion capture solutions and sensitivity to change following interventions should be further investigated.

In 2007, the Bárány Society embarked on a project to establish definitions of vestibular syndromes and disorders based on best available evidence, referred to as the International Classification of Vestibular Disorders (ICVD). Since then, numerous publications providing consensus-driven diagnostic criteria for vestibular symptoms, syndromes, and disorders have been published. Here, we reflect on the rationale for developing the ICVD as well as its subsequent achievements, challenges, and outlook. In this summary of the work of the ICVD to date, the authors will focus on practical aspects to help improve the utility and applicability of these diagnostic criteria moving forward.

Background: The ocular counter roll (OCR) is a component of the vestibulo-ocular reflex (VOR) characterized by torsional eye movements in the opposite direction of the head during head tilt.

Objective: This study aimed to determine the test-retest reliability of the video ocular counter-roll (vOCR) test, based on video-oculography (VOG) measurements, in assessing otolith function.

Methods: The study included 40 healthy participants (25 females and 15 males) aged 18-44 years. Each participant underwent the vOCR test twice in 300 lateral head tilt positions 1 week apart. Test-retest reliability was assessed using intraclass correlation coefficients (ICCs), and paired t-tests and Wilcoxon signed-rank tests were used to compare the mean values of the measurements.

Results: There were no significant differences between the initial and retest measurements (p>0.05). The ICC for left head tilt was 85.2%, and for right head tilt was 79.3%, both indicating excellent reliability (p<0.01). The ICC for vOCR asymmetry was 50.7%, indicating moderate reliability (p<0.05).

Conclusions: The vOCR test demonstrated high reliability for lateral head tilts and was found to be a reliable tool for evaluating otolith function, supporting its use in the diagnosis and treatment of vestibular disorders.

Background: Motion sickness (MS) is a clinical condition that causes autonomic symptoms as a result of a mismatch in sensory inputs with unusual body and environmental movements. Although the cause of MS is not clearly established, one widely accepted theory is otolith asymmetry and canal-otolith conflict. Masseteric vestibular evoked myogenic potentials (mVEMPs) are short latency inhibitory potentials recorded from the bilateral masseter muscle in response to bilateral or unilateral galvanic/acoustic stimuli. Studies have shown that mVEMP evaluates the integrity of the vestibulo-trigeminal pathway and the generator region is the saccule in common with cVEMP.

Objective: Our study aimed to evaluate the function of the otolith organ and vestibulo-trigeminal pathway in people with high susceptibility to MS via mVEMP.

Methods: According to the Motion Sickness Susceptibility Questionnaire-Short Form (MSSQ-SF), 21 people with 70-100% susceptibility (high susceptibility) and 20 people with 0-30% susceptibility (low susceptibility) were included in the study. Participants have normal hearing and do not have any additional disorders. All participants underwent mVEMP evaluation.

Results: There was no statistical difference in P1, N1 absolute latency, N1-P1 inter-wave latency, N1-P1 amplitude, interaural amplitude asymmetry ratios at 100 dB nHL, and mVEMP thresholds in the high and low susceptibility groups.

Conclusions: Our study obtained no findings suggesting saccule and vestibulo-trigeminal involvement in people high susceptible to motion sickness.

Background: The efficacy of corticosteroids for treating acute vestibular neuritis, or acute unilateral vestibulopathy (AUVP), remains controversial.

Objective: This study aimed to evaluate whether corticosteroids improve vestibular function and reduce symptoms in both acute and chronic phases of AUVP.

Methods: This randomized, placebo-controlled, double-blind trial included patients with AUVP (ages 18-80) from emergency departments at three sites in southern Sweden. Patients were randomly assigned to one of three groups: placebo, 3-day or 10-day corticosteroid treatment. The steroid groups received intravenous betamethasone followed by oral steroids, while the placebo group received intravenous saline followed by oral placebo. The primary outcome was canal paresis (%) after 12 months, measured via caloric testing. Secondary outcomes included vHIT gain, Diary Vertigo score, Dizziness Handicap Inventory, and Hospital Anxiety and Depression Scale. Analyses were conducted on an intention-to-treat basis. The trial was registered with the EU Clinical Trials Register (EudraCT Number: 2014-005484-32) and ClinicalTrials.gov (NCT00802529).

Results: From December 2015 to March 2021, 350 patients were screened, and 69 were included: 23 in the 10-day corticosteroid group, 22 in the 3-day corticosteroid group, and 24 in the placebo group. All groups showed significant improvement in caloric function over time (p = .002), with no significant differences between groups at any time point (p = .629). Change in caloric asymmetry from baseline to 12 months did not differ between the treatment groups and the placebo group: mean difference -8.34 (95% CI -25.93 to 9.26; p = .347) in the 10-day steroid group and -6.61 (-24.67 to 11.45; p = .467) in the 3-day steroid group, compared with placebo. Secondary outcomes showed no significant differences between groups. Corticosteroid treatments were well tolerated with no safety concerns.

Conclusions: Corticosteroid treatment does not significantly improve caloric recovery, vHIT gain recovery, or subjective well-being in patients with AUVP.