Journal of Vestibular Research-Equilibrium & Orientation最新文献

BackgroundMilitary duty may place Service members and Veterans at an increased risk of experiencing dizziness. Individuals with dizziness report poor sleep quality as well as abnormal sleep duration, which is associated with increased risk of falling and worse quality of life. The overall pooled prevalence of poor sleep quality in Service members and Veterans was 69%, but it is not known if Service members and Veterans with self-reported dizziness report poorer sleep quality than their counterparts without dizziness.ObjectiveThe purpose of this research study was to evaluate the sleep quality of Service members and Veterans with and without reports of dizziness.MethodsDescriptive statistics were used to explore the prevalence of self-reported dizziness among Service members and Veterans by demographic characteristics. Descriptive statistics were also used to describe the prevalence of participants' dizziness symptoms and the mean age participants first noticed dizziness. Models (unadjusted and adjusted) were created by regressing sleep disorders and daytime sleepiness on dizziness frequency. Potential confounders were chosen a priori through a theoretical framework. Military status (Service member vs Veteran) was explored as an interaction term. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated, with statistical significance determined by the 95% CI.ResultsDizziness was reported by 22.4% of Service members (n = 171 of 763) and 31.7% of Veterans (n = 241 of 761). Service members and Veterans with dizziness were 1.7 times more likely to have a sleep disorder than Service members and Veterans without dizziness.ConclusionsService members and Veterans with dizziness were more likely to have poor sleep quality than those without dizziness. Medical providers should screen for sleep disturbances, evaluate for obstructive sleep apnea, treat chronic insomnia disorder, and consider referral for vestibular rehabilitation in Service members and Veterans presenting with dizziness.

Background and PurposePrevious studies on benign paroxysmal positional vertigo (BPPV) have primarily been performed in referral-based clinics. This study aimed to explore the clinical characteristics of BPPV and its variant (light cupula) in a primary care setting.MethodsWe retrospectively analyzed the clinical data of 1126 patients who visited a primary care neurology clinic due to dizziness or vertigo between March 2023 and February 2024. We collected information on age, sex, affected ear, symptom duration at the first evaluation, BPPV subtypes (including the variant), duration of positional nystagmus (transient: <1 min vs persistent: ≥1 min), and the number of canalith repositioning procedures (CRPs) required for treatment.ResultsA total of 308 patients (27.4%) were diagnosed with BPPV or its variant. Subtypes included posterior canal (PC) type in 183 (59.4%), geotropic horizontal canal (HC) type in 73 (23.7%), apogeotropic HC type in 43 (14.0%), anterior canal type in 4 (1.3%), and mixed type in 5 (1.6%). The proportion of PC type increased with a longer duration of symptoms (p = 0.012). In multinomial regression, only the duration of positional nystagmus was significantly associated with the number of CRPs (p < 0.001), as patients with persistent nystagmus required more CRPs than those with transient nystagmus.ConclusionsIn primary care, the proportion of each subtype of BPPV and its variant differs according to symptom duration. Furthermore, patients with positional nystagmus lasting more than 1 minute tend to be more refractory to CRPs.

ObjectivesBenign paroxysmal positional vertigo (BPPV) is a prevalent triggers of persistent postural-perceptual dizziness (PPPD). The maladaptation of brain function may be one of the pathophysiology in PPPD. This study aims to identify brain functional neuroimaging features and establish prediction models to predict PPPD after BPPV.MethodsThe diagnosis of BPPV and PPPD was based on the criteria established by the Bárány Society. Patients with posterior semicircular canal BPPV were treated using the Epley maneuver. Patients with geotropic lateral canal BPPV were treated with the barbecue rotation maneuver, while those with apogeotropic lateral canal BPPV were treated using the Gufoni maneuver. After successful canalith repositioning maneuver treatment, the patient underwent resting-state functional magnetic resonance imaging (fMRI) scan. Using feature selection and extraction techniques, six machine learning algorithms were implemented to predict PPPD. The models were trained with 5-fold cross-validation, and performance was evaluated using the receiver operating characteristic curve (AUC), accuracy, precision, recall, and F1 score (F1).ResultsA total of 101 patients were included in the final analysis, comprising 64 patients without PPPD (non-PPPD) and 37 patients with PPPD (PPPD). A total of 22 functional neuroimaging features were identified to be closely associated with PPPD after BPPV. Among the six machine learning algorithms, the Multilayer Perceptron model exhibited superior performance, with an AUC of 0.93, a recall of 0.82, a precision of 0.83, an accuracy of 0.82, and an F1 score of 0.82. SHAP analysis identified the most influential resting-state fMRI features in this model. For the top 10 important resting-state fMRI features, 3 features overlapped in all six machine learning algorithms. These features include FC between the vermis 3 and the superior frontal gyrus, orbital part, DC in the cerebellum 7b, left, and FC between the Heschl gyrus, left, and the caudate, right.ConclusionsThese findings provide brain functional neuroimaging features which may be closely associated with the transition from BPPV to PPPD, thereby offering a valuable tool for the early detection of PPPD.

IntroductionIn the early years following the development of the caloric test, one of the parameters used to quantify vestibular function was nystagmus duration. A common finding in patients with Meniere's disease (MD) is the presence of unilateral caloric weakness, despite normal results on the video head impulse test (vHIT). It has been proposed that the apparent caloric loss could be due to the creation of local flow facilitated by canal distention. If the nystagmus duration is linked to the hydrostatic effect, one could hypothesize that MD patients would demonstrate shorter slow-phase velocity (SPV) duration.ObjectiveThe aim of the study was to examine SPV and the duration of nystagmus following caloric testing in MD patients.Method24 participants (12 controls; 12 MD) were assessed using bithermal, bilateral caloric stimulation. To control for possible side differences, two subgroups were analyzed: MD-ipsilateral (affected ear); MD-contralateral (unaffected ears). Ears in the control group were side matched with ears in the MD groups and the terminology control-ipsilateral or control-contralateral was used to represent this matching.ResultsSignificant differences were observed for SPV between controls-contralateral and MD-ipsilateral ears (cold: p ≤ 0.001; warm: p = 0.02) and between controls-ipsilateral and MD-ipsilateral ears (cold: p ≤ 0.001; warm: p = 0.04). Significant SPV differences were observed between MD-contralateral and MD-ipsilateral ears (cold: p ≤ 0.001; warm: p = 0.03). However, no differences were found between groups in the duration of nystagmus following cold or warm irrigation (cold: p = 0.2; warm: p = 0.33).ConclusionResults support previous literature suggesting SPV can be affected in patients with MD even if vHIT gain is normal. However, mechanisms that influence the SPV seem to differ from those for the nystagmus duration. Indeed, nystagmus duration seems to remain unaffected in MD patients with vHIT-caloric dissociation, suggesting that it may be controlled by other factors.

BackgroundPositional downbeat nystagmus (pDBN) may have multiple etiologies.ObjectivesDescription of a case series and further considerations about pDBN characteristics, pathogenesis, and differential diagnosis.MethodsDescriptive study concerning 153 consecutive patients with pDBN of presumed peripheral origin that were recruited and observed. They were treated only with Brandt-Daroff Exercises.Results56% reported symptoms of "typical positional vertigo," 44% described postural instability during head movements or a continuous sense of dizziness. 40% of patients were symptom- and nystagmus-free after 1 week and almost 60% after 2 weeks 5% were still affected by pDBN after 1 month. Several pathogenetic hypotheses have been advanced: otoconia in the anterior canal, an apogeotropic variant of posterior canal, or in the short arm of the posterior canal.ConclusionDown-beat nystagmus arising from the semicircular canals must contain a torsional component and be in "canal-plane" - presenting more torsional when gaze is towards the affected canal, and more purely vertical when directed away, whereas central causes of DBN may be "pure" down-beat. Peripheral pDBN is fatigable, often no nystagmus when returning in sitting position and, highly relevantly, it is self-limiting (95% disappears with only Brandt-Daroff Exercises), with no central signs. Patients may complain of long-term dizziness, trunk oscillation, and prolonged motion sickness. New guidelines may consider the term of Down-Beating BPPV or Down-Beating peripheral positional vertigo, even if the otoconia's exact position is still uncertain: in our opinion pDBN might be considered as an "apogeotropic variant of PC-BPPV".

BackgroundSensory impairments such as hearing loss and vestibular disorders can affect spatial cognition.ObjectiveThis study assessed the spatial cognitive abilities of cochlear implant (CI) users with hearing loss and compared them based on otolith functions.MethodsThe study has a control group and two subgroups. The first study group had 19 CI users with otolith dysfunction, and the second had 21 without. The control group had 20 healthy, age-, gender-, and education-matched volunteers. The triangle completion task (TCT), the spatial orientation test (SOT), and the four mountains test assessed spatial ability.ResultsResearch indicates that CI users with otolith dysfunction had significantly larger deviation angles and distances in TCT compared to healthy controls (p < .001). Statistically significant differences in SOT were found between groups (p < .001). Healthy controls had the lowest SOT score, whereas CI users with otolith dysfunction had the highest. In 4 MT, CI users with and without otolith dysfunction had more mistakes than controls (p < .05).ConclusionsResearch shows that otolith information is important for path integration and spatial navigation, and hearing loss worsens spatial memory degradation. These impairments impede spatial skills, which are essential for daily tasks like shopping and driving and for spatial memory, learning, and navigation.

ObjectivesPeripheral vestibular hypofunction (PVH) affects a significant portion of the population and impairs visual acuity during head motion (dynamic visual acuity, DVA). This study compared the effectiveness of a novel gaze stability training called Incremental VOR Adaptation (IVA) versus traditional vestibular physical therapy (VPT) for improving DVA.MethodsThe Incremental Velocity Error as a New Treatment in Vestibular Rehabilitation (INVENT) trial is a randomized, controlled, cross-over study involving 24 participants with chronic unilateral or bilateral PVH. Participants underwent either IVA or VPT for 3 weeks, followed by a washout period and then the alternate intervention (IVA-VPT or VPT-IVA). DVA was measured at baseline, after each intervention, at the completion of the washout period, and at 6-month follow-up.ResultsThere was a significant main effect of treatment Group, F (1,19) = 7.75, p = 0.012, with (IVA-VPT) consistently demonstrating lower DVA scores than VPT-IVA. A significant main effect of Side was also observed, F (1,19) = 13.35, p = 0.0017, indicating lower DVA scores for contralesional compared to ipsilesional head rotation. We found no effect of Time (F (4,76) = 1.44, p = 0.23), suggesting that scores remained stable from baseline through the 6-months follow-up. There were no significant interactions, including Group × Side (F (1,19) = 0.11, p = 0.74), Group × Time (F (4,76) = 1.33, p = 0.27), or Group × Side × Time (F (4,76) = 0.59, p = 0.67).ConclusionDVA scores were consistently better at all time points after participants completed IVA. Using an intent to treat analysis, with no baseline demographic differences between groups, our data support that exposure to the first gaze stability training type exerts a stable influence on DVA that persisted to 6-month follow-up. Clinically, this implies that once DVA improvements are established through either IVA or VPT, they tend to remain stable over 6 months.Level of EvidenceLevel 2.

BackgroundPatients with persistent postural-perceptual dizziness (PPPD) suffer from symptoms of chronic dizziness that exacerbate in a moving environment. However, not much is known regarding gaze behavior in a static condition. The present study investigated gaze stability under static visual stimuli in patients with PPPD.MethodsThree groups of participants were recruited; 22 PPPD, 9 Ménière's disease (MD) and 19 healthy participants (HC). Participants were asked to undergo a free viewing test of emotionally neutral images through a virtual reality headset with a gaze-recording system. Bivariate Contour Ellipse Area (BCEA), a measure for gaze stability, and saliency values at points of gaze fixations were measured.ResultsPPPD showed smaller BCEA compared to MD and HC, with high anxiety state being a possible confounding factor. There was no difference in saliency values between all three groups.ConclusionsPPPD, MD, and HC all tended to fixate on salient parts of the images, but in PPPD, gaze was restricted to a smaller area compared to MD and HC. Considering that previously reported studies on PPPD patients showed gaze instability under dynamic stimuli, the gaze behavior from the present study, involving static stimuli, may reflect the opposite pole to that of dynamic stimuli.

BackgroundSubjective visual vertical (SVV) test is a key functional assessment tool that provides insights into vestibular imbalance. Mobile virtual reality SVV measurement system (MVR-SVV) has the potential to facilitate simple, low-cost, and reliable measurements.ObjectiveThis study aimed to verify the reliability and validity of MVR-SVV by comparing its data with the previously established bucket test (bucket-SVV).MethodsThirty-eight healthy adults completed both bucket-SVV and MVR-SVV tests. The reliability and validity of MVR-SVV were examined using intraclass correlation coefficients (ICCs), Pearson's correlation, Bland-Altman plots (BAP), and minimum detectable change (MDC).ResultsBAP results indicated that the limits of agreement for the SVV angles were 1.61 to -1.24°. No fixed errors were identified (p = 0.13), although a small proportional error was detected (y = -0.59x + 0.157, p < 0.001). Pearson's correlation coefficient between bucket-SVV and MVR-SVV was 0.716 (p < 0.001). Within-day reliability was poor for bucket-SVV, with ICC = 0.33-0.38, but moderate for MVR-SVV, with ICC = 0.70-0.71. Between-day reliability was poor for both methods, with ICC = 0.38 for MVR-SVV and ICC = 0.28 for bucket-SVV. MDC was 1.78° for bucket-SVV and 2.67° for MVR-SVV.ConclusionsOur findings suggest that MVR-SVV can be used for assessing SVV. Its portability, availability, and reliability make it a valuable tool for clinicians in clinical settings.

ObjectivesKinesiophobia is the condition in which the patient restricts their movements and activities because of the fear of being injured again after a painful experience. Numerous studies have found kinesiophobia in patients with vestibular disorders. This research study aimed to develop and measure the psychometric properties of the Tampa Scale of Kinesiophobia (TSK-11), for use in persons with dizziness (TSKd).MethodsAn observational validation study of questionnaires was carried out including 211 participants with dizziness. After adapting the TSK-11 items to the symptoms of dizziness, the construct validity was evaluated with principal component analysis (PCA), internal consistency with the calculation of Cronbach's alpha, test-retest reliability with the intraclass correlation coefficient (ICC), concurrent validity with Spearman correlation and predictive validity with ROC curve analysis.ResultsThe PCA retained 10 items from the original scale with a three-factor structure that mediates fear (TSKd_f), negative thoughts (TSKd_n) and avoidance (TSKd_a). Cronbach's alpha was 0.810 for the 10-item TSKd. Reproducibility was moderate to substantial, with ICCs between 0.69 and 0.84. The TSK showed strong correlations with the DHI, while correlations with other dizziness measures were moderate. A TSKd score >25 and TSKd_f score >9 showed good predictive capacity, with an area under the curve (AUC) ROC of 0.85 and a sensitivity and specificity between 0.85 and 0.70.ConclusionsThe TSKd is a tool available for measuring kinesiophobia in persons with dizziness. Both the 10-item TSKd and the 4-item TSKd_f scales have good psychometric properties.