Journal of Vestibular Research-Equilibrium & Orientation最新文献

Aim: To comprehensively evaluate the dynamic change of vestibular function during long-term follow-up of vestibular neuritis, as well as the co-relationship with the outcomes of vestibular neuritis (VN), which provides the recommendations for vestibular function tests during the course of VN.

Methods: A prospective cohort study was conducted on 16 patients with acute VN. Caloric test, vHIT, rotatory chair tests, VEMP, dizziness handicap inventory (DHI) score, and dynamic dizzy scales (VAS-DD) was first performed within 7 days of neuritis onset, which were further re-evaluated during the 6-12 months of follow-up. The dynamic changes on multiple objective vestibular examinations were analyzed during the acute and recovery stage of VN. We further evaluated the co-relationship between the vestibular dysfunction scales and the prognosis of VN.

Results: In more than 6 months of follow-up, 44% of the ultralow frequency, 94% of the low-to-mid frequency, and 44% of the high-frequency function of the horizontal semicircular canal returned to normal (p < 0.05). The change degree in symmetry of the rotatory chair test was correlated with the gain of the horizontal semicircular canal on the vHIT and the unilateral weakness (UW) value on the caloric test (p < 0.05). The change in DHI score was correlated with the phase; change in VAS-DD level correlated with the symmetry and TC of the rotatory chair test at VN recovery stage (p < 0.05). There was no significant correlation between the change in DHI score or change in VAS-DD and the degree of vestibular function recovery (p > 0.05).

Conclusion: In general, vestibular function improved during the course of VN. The rotatory chair test can be used to evaluate the overall function of the vestibular system and the compensatory state in patients with VN.

Objective/background: Though sleep problems (apnea, insomnia) and related daytime symptoms (fatigue, anxiety, depression) have been associated with vestibular problems (falls, dizziness), it is not well known which particular sleep features relate to vestibular problems. We thus assessed symptoms of vestibular problems in patients visiting a sleep clinic and evaluated how they were associated with objective sleep parameters derived from polysomnography and relevant daytime symptoms.

Patients/methods: The polysomnography data of thirty-one patients (61% female, between 20 and 79 years of age) who were referred for clinical sleep assessment was collated with subjective measures of symptoms linked to vestibular problems (rated on the Situational Characteristics Questionnaire), as well as fatigue, anxiety and depression symptoms. Multiple linear regression was used to identify factors associated with vestibular symptoms, including analyses adjusted for age, sex, medication use and total sleep time.

Results: A higher percentage of REM sleep and more severe anxiety symptoms were independently associated with more severe vestibular symptoms, which survived adjusted analyses. Other sleep stages, as well as as sleep efficiency, apnea-hypopnea index and oxygen saturation were not significantly related to vestibular symptoms.

Conclusions: These results point at vestibular symptoms as possible important and overlooked correlates of variations in sleep architecture in individuals with sleep complaints. Though replication is needed to confirm findings from this limited sample, the results highlight the importance of assessing vestibular symptoms in people with sleep complaints. In particular, further investigations will need to address the potential implication of REM sleep for vestibular functions and the directionality of this relation.

Background: Cognitive deficits have been defined in patients with bilateral and unilateral vestibular loss.

Objective: To investigate cognitive functions in patients with episodic vestibular disorders.

Methods: Nineteen patients with Meniere's disease (MD), 19 patients with vestibular migraine (VM) and 21 age and education matched healthy controls were studied. Mini Mental State Examination assessing global mental status, Reading Span Test and the Stroop Test evaluating working memory, cognitive processing, reading comprehension and attention, Trail Making Test and Benton's Judgment of Line Orientation Test investigating visual processing, visuospatial skills, processing speed were used. Beck depression and anxiety inventories were given to evaluate the emotional status.

Results: Cognitive test results of the MD and VM patients were not significantly different from the healthy controls (p > 0.05) as well as Beck depression scores (p = 0.14). Beck anxiety scores showed significant difference (p = 0.003). VM patients had significantly higher scores than the healthy controls (p = 0.002) on pairwise comparisons. The scores of the MD patients did not reach statistical significance (p = 0.15).

Conclusion: Episodic vestibular disorders like MD and VM without inter-ictal vestibular deficits do not seem to be associated with cognitive impairment. Patients with VM have significantly higher anxiety scores than the healthy controls and MD patients.

Background: The management of dizziness and vertigo can be challenging in the emergency department (ED). It is important to rapidly diagnose vertebrobasilar stroke (VBS), as therapeutic options such as thrombolysis and anticoagulation require prompt decisions.

Objective: This study aims to assess the rate of misdiagnosis in patients with dizziness caused by VBS in the ED.

Methods and results: The cohort was comprised of 66 patients with a mean age 56 years; 48% were women and 52% men. Among dizzy patients, 14% had VBS. We used Cohen's kappa test to quantify the agreement between two raters -namely, emergency physicians and neurologists -regarding the causes of dizziness in the ED. The Kappa value was 0.27 regarding the final diagnosis of central vertigo disorders and VBS, thus showing the low agreement. We used the χi2 test to show the association between the presence of two or more cardiovascular risk factors and admission to the stroke unit (p = 0.015).

Conclusion: There is a substantial rate of misdiagnosis in patients with dizziness caused by VBS in the ED. To reduce the number of missing diagnoses of VBS in the future, there is a need to train emergency physicians in neurovestibular examinations, including the HINTS examination for acute vestibular syndrome (AVS) and the Dix-Hallpike (DH) maneuver for episodic vestibular syndrome. Using video head impulse test could help reduce the rate of misdiagnosis of VBS in the ED.

Background: Patients with vestibular loss have reduced wayfinding ability, but the association between vestibular loss and impaired steering spatial navigation is unclear.

Objective: To evaluate whether vestibular loss is associated with reduced steering navigation performance in a virtual reality (VR) environment containing obstacles.

Methods: 17 ambulatory adults with vestibular loss were age/sex-matched to healthy controls. Participants traversed a VR hallway with obstacles, and their navigation performance was compared using metrics such as collisions, time, total distance travelled, and speed in single and multivariate analysis.

Results: In univariate analysis there was no significant difference in collisions between vestibular patients and controls (1.84 vs. 2.24, p = 0.974). However, vestibular patients took more time, longer routes, and had lower speeds to complete the task (56.9 vs. 43.9 seconds, p < 0.001; 23.1 vs. 22.0 meters, p = 0.0312; 0.417 vs. 0.544 m/s, p < 0.001). These results were confirmed in multivariate analysis.

Conclusions: This study found that patients with vestibular loss displayed slower gait speeds and traveled longer distances, though did not make more collisions, during a VR steering navigation task. Beyond the known influence of vestibular function on gait speed, vestibular loss may also contribute to less efficient steering navigation through an obstacle-laden environment, through neural mechanisms that remain to be elucidated.

Background: Hypoxia influences standing balance and vestibular function.

Objective: The purpose here was to investigate the effect of hypoxia on the vestibular control of balance.

Methods: Twenty participants (10 males; 10 females) were tested over two days (normobaric hypoxia and normoxia). Participants stood on a force plate (head rotated leftward) and experienced random, continuous electrical vestibular stimulation (EVS) during trials of eyes open (EO) and closed (EC) at baseline (BL), after 5 (H1), 30 (H2) and 55-min (H3) of hypoxia, and 10-min into normoxic recovery (NR). Vestibular-evoked balance responses were quantified using cumulant density, coherence, and gain functions between EVS and anteroposterior forces.

Results: Oxyhemoglobin saturation, end-tidal oxygen and carbon dioxide decreased for H1-3 compared to BL; however, end-tidal carbon dioxide remained reduced at NR with EC (p≤0.003). EVS-AP force peak-to-peak amplitude was lower at H3 and NR than at BL (p≤0.01). At multiple frequencies, EVS-AP force coherence and gain estimates were lower at H3 and NR than BL for females; however, this was only observed for coherence for males.

Conclusions: Overall, vestibular-evoked balance responses are blunted following normobaric hypoxia >30 min, which persists into NR and may contribute to the reported increases in postural sway.