Journal of Vestibular Research-Equilibrium & Orientation最新文献

We report a case of paroxysmal downbeat nystagmus, ataxia, and dysarthria in the context of a delirium in a patient with severe hypomagnesemia. Extensive workup did not provide alternative explanations. Her attacks subsided within 48 h after the start of magnesium substitution and the patient remained confused and ataxic with a gradual but full recovery over 6 weeks. Hypomagnesemia resulted most probably from long-term proton-pump inhibitor (PPI) intake. Paroxysmal downbeat nystagmus is rare and has so far only been consistently described in association with hypomagnesemia of various causes.

PurposeBalance and vestibular disorders have a profound impact on quality of life. Anxiety (ANX) and depression (DEP) are common with dizziness, vertigo, or imbalance. It is unclear whether self-reported anxiety or depression depends on perceived physical function for individuals participating in vestibular rehabilitation (VPT). We hypothesized that individuals with worse physical function would be more likely to report abnormally high anxiety and/or depression levels.Participants170 individuals referred for vestibular rehabilitation (113 female, 57 males, and age 63.7 (21)).MethodsA retrospective chart review extracted age, Patient-Reported Outcome Measurement Information System (PROMIS) scores (ANX, DEP, physical function) and primary diagnoses [benign paroxysmal positional vertigo (n = 42), unilateral vestibular hypofunction (n = 39), bilateral vestibular hypofunction (n = 14), concussion/head injury (n = 7), dizziness/vertigo (n = 37), and imbalance (n = 31)]. Average PROMIS scores and percentage of abnormal scores were calculated for physical function, ANX, and DEP scores and reported using descriptive statistics. Logistic regression was performed to separately examine the odds of abnormal ANX and DEP based on abnormal physical function while controlling for age and sex, on the entire dataset and on diagnosis subgroups.ResultsIndividuals referred to vestibular physical therapy with self-reported abnormal physical function were more likely to have abnormal ANX (OR 5.1, p < 0.001) or DEP (OR 3.10, p = 0.002). Older adults were less likely to have abnormal ANX (OR = 0.96, p = 0.002). For individuals experiencing BPPV (n = 42), those with abnormal physical function are more likely to report ANX (OR 9.9, p = 0.009). For individuals with UVH (n = 39), those with abnormal physical function were more likely to report ANX (OR 10.1, p = 0.008) or DEP (OR 9.9, p = 0.010).ConclusionSelf-reported abnormal physical function corresponds to a higher incidence of abnormal ANX and DEP for individuals referred to VPT. Individuals with benign proximal positional vertigo and unilateral vestibular hypofunction were approximately 10 times more likely to experience abnormally high ANX or DEP compared to all other primary diagnosis. Clinicians seeing patients in VPT should be screening for anxiety and depression especially for those with self-reports of impaired physical function.

BackgroundPeople with vestibular hypofunction (PwVH) often demonstrate abnormal gait and increased fall risk. An analysis of the strategies used for maintaining walking balance is lacking in PwVH.ObjectiveThe purpose of this study was to examine how PwVH use recovery strategies and maintain stability following perturbations.MethodsPwVH and healthy controls were perturbed during walking with mediolateral ground shifts while kinematic responses were recorded.ResultsAs a group, PwVH (n = 9, unilateral loss) responded similarly to healthy participants (n = 15) with changes in foot placement, ankle inversion, ankle push-off, and trunk sway. However, responses in PwVH depended on the vestibular lesion side and functional compensation as assessed by the Functional Gait Assessment (FGA). PwVH had larger changes in stability when perturbations caused body movement toward the side of the lesion and more effective trunk responses when perturbations caused body movement away from the lesion. Additionally, PwVH who performed poorly on the FGA showed worse stability and overactive ankle and trunk responses following medial perturbations.ConclusionsThese findings demonstrate kinematic differences in balance recovery in PwVH and suggest that PwVH are more susceptible to instability when falling toward the lesion.

BackgroundImpaired vestibulo-ocular reflex (VOR) can be compensated by catch-up saccades and/or increased residual VOR. Prediction and intention seem able to potentiate both responses, but how do these effects combine, particularly in individuals with bilateral vestibulopathy (BVP), remains largely unknown.ObjectiveTo compare the impact of passive, predictive and voluntary conditions of head impulse tests (HIT) on global oculomotor compensatory responses in individual with BVP.MethodsHIT were performed in Passive(P)-Random, Passive(P)-Cued and Active head movement conditions. VOR gain and latency and gain of the 1^st catch up saccades were calculated for the 32 tested ears. Among the 1^st catch up saccade, a separate analysis of covert saccades was performed.ResultsLatency of covert saccades was shorter in the Active compared to P-Random and P-Cued. First saccades showed shorter latency and greater gain in the P-Cued condition versus P-Random. VOR gain was significantly higher in the Active condition compared to P-Random and P-Cued. Most individuals enhanced catch-up saccades and VOR gain simultaneously while others either boosted VOR gain while reducing saccade efficiency, or enhanced saccade efficiency while decreasing VOR gain.ConclusionsPrediction and intention improve gaze during HIT in individuals with BVP by optimising existent oculomotor responses. During active movements, these effects combined according to subjects' individual strategies.

BackgroundDespite the role attributed to cervical proprioception in balance control, the impact of cervical dysfunction on patients with dizziness remains largely elusive.ObjectiveTo investigate the effects of cervical abnormalities on the quality of life and balance control of patients with unilateral peripheral vestibulopathy.MethodsThis was an observational cross-sectional study. Sixty-one patients with dizziness of peripheral origin were enrolled. They filled out clinical questionnaires, the Dizziness Handicap Inventory (DHI), and the Neck Disability Index (NDI). Twenty-four individuals without vestibular or neck complaints were used as controls. The participants underwent the Cervical Joint Position Error Test (CJPT) and a static posturography.ResultsPatients with dizziness showed worse CJPT results (p = 0.0003). During conditions 1 and 3 of posturography, patients with cervical symptoms performed particularly worse compared to those without them. Also, their mean DHI was higher (p = 0.014). DHI and the CJPT results correlated in the case group (r = 0.32; p = 0.012). In the subgroup with cervical complaints, the NDI and DHI scores showed a moderate correlation (r = 0.540; p = 0.0001).ConclusionCervical proprioception correlated with the DHI scores in patients with dizziness. Patients with vestibular disorders with cervical complaints showed poorer results in balance control. Among them, the scores of self-perceived handicap of cervical complaints and dizziness correlated.

BackgroundSense of direction (SOD) can be affected in patients with vestibular dysfunction.ObjectiveTo record differences in self-perceived sense of direction using the Santa Barbara Sense of Direction scale (SBSOD) in persons with dizziness and balance disorders over time. To determine relationships between self-perceived sense of direction and the Dizziness Handicap Inventory (DHI), Activities-specific Balance Confidence (ABC) scale, and Gait Disorientation Test (GDT).MethodsIn this prospective cohort study, 56 participants completed the SBSOD at three time points: self-recalled SOD before dizziness onset (pre-dizziness), SOD at initial evaluation (SBSOD-Eval), and SOD 3 months post-evaluation (SBSOD-3M). Participants completed DHI, ABC, and GDT at baseline. Repeated measures ANOVA and Spearman's correlation were used for analysis.ResultsMean SBSOD scores were 4.8 (SD ± 1.1) pre-dizziness; 4.6 (SD ± 1.1) at evaluation; and 4.5 (SD ± 1.2) at 3 months. Significant differences were found between pre-dizziness versus evaluation (p = .03) and pre-dizziness versus three months (p = .02). SBSOD-Eval had significant negative correlation with DHI total score (r = -0.3, p = .019), significant positive correlation with ABC score (r = 0.4, p < .001), and no correlation with GDT.ConclusionsOn average, participants reported that their sense of direction was worse after the onset of dizziness. A better SBSOD was significantly correlated with higher disability levels and better balance confidence.

BackgroundVestibular evoked myogenic potentials (VEMPs) are widely used to assess the otolith organs; however, the clinical significance of otolith organ dysfunction is unclear.ObjectiveThe primary purpose was to determine the functional consequences of otolith dysfunction on postural stability and quality of life in U.S. Veterans.MethodsA prospective case-control design was used, and 124 participants (21-84 years) were grouped based on comprehensive vestibular testing. Caloric and vertical canal video head impulse testing were used to determine semicircular canal function. Cervical and ocular VEMP testing determined otolith organ function. Three vestibular site-of-lesion groups (Otolith Only, Otolith + Canal, and Canal Only) and two control groups (Dizzy Control and Non-Dizzy Control) completed measures of quality of life and multiple measures of postural control.ResultsANCOVAs indicated significant group differences for measures of quality of life and postural stability. All vestibular groups (Otolith Only, Otolith + Canal, and Canal Only) reported significantly worse quality of life than Non-Dizzy Controls. The Otolith + Canal group performed significantly worse than the Otolith Only group and both control groups on the functional gait assessment and preferred gait speed.ConclusionsSimilar to isolated semicircular canal dysfunction, isolated otolith dysfunction may negatively impact quality of life, and in conjunction with semicircular canal dysfunction, may also negatively impact postural stability.

The illusion of self-motion provoked by dynamic visual stimulation is known as vection and is a common phenomenon when using visual displays such as virtual reality, video games, or movie theatres. Vection has been historically linked to visually induced motion sickness (VIMS), a phenomenon similar to traditional motion sickness characterized by various symptoms including nausea, fatigue, or eyestrain. Many factors are associated with an individual's susceptibility to VIMS and vection, but their impact is not well understood. Here, we investigated how field dependence, biological sex, and age are linked to the occurrence of VIMS and vection. To achieve this, we combined the datasets from four independent experimental studies with a pooled sample size of N = 336, including 237 younger and 99 older adults. Our results demonstrated that younger adults experienced significantly more VIMS compared to older adults and that women reported more VIMS than men (although this effect was rather weak). Additionally, field dependence was positively correlated with vection in younger adults, but no relationship between field dependence and VIMS was found. Overall, the findings from this study suggest that field dependence is not a relevant factor related to VIMS. Interestingly, older adults seem to be at lower risk of experiencing VIMS, which is encouraging considering that many novel applications are tailored towards an ageing population for rehabilitation or training purposes.

Dizziness significantly impairs health-related quality of life, yet its specific impact remains underexplored. Gaining insight into this relationship is essential for providing optimal care. Thus, this study aimed to explore the impact of dizziness-related quality of life (DRQOL) and develop a conceptual framework to inform patient-centered care. Participants with documented complaints of dizziness, vertigo, or unsteadiness were identified via medical record review. Those with severe medical illness or disability were excluded. 30 adults (12 males and 18 females), diagnosed with vestibular (n = 10), neurological (n = 10), or nonspecific-related dizziness (n = 10) were recruited. Semi-structured interviews were conducted using Zoom to examine the effects of dizziness on daily life. Interviews were transcribed, de-identified, and analyzed using thematic content analysis. Findings revealed that dizziness and imbalance affect multiple domains, including physical health (functioning, symptoms, and vision), social health (impact and support), cognitive health, and mental health (both positive and negative). These impacts were consistent across all diagnostic subgroups. Despite challenges, many participants reported adaptive responses, including coping strategies and resilience. The study highlights the broad and debilitating effects of dizziness, while also recognizing the role of positive outcomes.

IntroductionThe advent and growth of social media platforms have dramatically altered the landscape of health information sharing, particularly for conditions like Meniere's disease. This study delves into the nature and impact of shared experiences and peer support concerning Meniere's disease on social media, underscoring the critical need for analyzing this content for its influence and accuracy. This study aims to analyze the portrayal of Meniere's disease across social media platforms, focusing on content accuracy and misinformation, to provide vestibular care professionals with insights for improving patient education and fostering more effective patient engagement.Materials and methodsEmploying a comprehensive qualitative approach, our study scrutinized 1108 social media posts about Meniere's disease from Facebook, Instagram, and TikTok-over 3 months. Analysis included authorship identification, examination of the subject matter, tone assessment, and evaluation of post popularity and engagement metrics.Results and analysisA significant portion of the analyzed posts were predominantly image-driven, with a majority authored by patients or their family members. Instagram was the most utilized for Meniere's disease discussions, followed by Facebook and then TikTok. The content analysis revealed that personal experiences comprised 40% of the posts, followed by informational posts, and queries or advice-seeking posts. Sentiment analysis showcased a diverse range of emotions: 45% of posts displayed a positive tone, 35% were neutral, and 20% expressed negative sentiments.DiscussionThe findings from this study highlight a significant demand for accurate and authoritative educational resources on social media regarding Meniere's disease. They offer vestibular care providers, including otolaryngologists, audiologists, physical therapists, speech-language pathologists, and others valuable insights into improving patient-centered care by developing and implementing effective communication strategies. Emphasizing patient empowerment, these strategies should cater to a patient population that is increasingly turning to social media for health-related information. The study also points to the necessity of addressing misinformation and guiding patients towards reliable sources of medical information online.