Journal of Vestibular Research - Volume 31, issue 5

Authors: Cha, Yoon-Hee | Golding, John F. | Keshavarz, Behrang | Furman, Joseph | Kim, Ji-Soo | Lopez-Escamez, Jose A. | Magnusson, Måns | Yates, Bill J. | Lawson, Ben D. | Advisors:

Collaborators: Staab, Jeffrey P. | Bisdorff, Alexandre

Article Type: Research Article

Abstract: We present diagnostic criteria for motion sickness, visually induced motion sickness (VIMS), motion sickness disorder (MSD), and VIMS disorder (VIMSD) to be included in the International Classification of Vestibular Disorders. Motion sickness and VIMS are normal physiological responses that can be elicited in almost all people, but susceptibility and severity can be high enough for the response to be considered a disorder in some cases. This report provides guidelines for evaluating signs and symptoms caused by physical motion or visual motion and for diagnosing an individual as having a response that is severe enough to constitute a disorder.    The …diagnostic criteria for motion sickness and VIMS include adverse reactions elicited during exposure to physical motion or visual motion leading to observable signs or symptoms of greater than minimal severity in the following domains: nausea and/or gastrointestinal disturbance, thermoregulatory disruption, alterations in arousal, dizziness and/or vertigo, headache and/or ocular strain. These signs and/or symptoms occur during the motion exposure, build as the exposure is prolonged, and eventually stop after the motion ends. Motion sickness disorder and VIMSD are diagnosed when recurrent episodes of motion sickness or VIMS are reliably triggered by the same or similar stimuli, severity does not significantly decrease after repeated exposure, and signs/symptoms lead to activity modification, avoidance behavior, or aversive emotional responses.    Motion sickness/MSD and VIMS/VIMSD can occur separately or together. Severity of symptoms in reaction to physical motion or visual motion stimuli varies widely and can change within an individual due to aging, adaptation, and comorbid disorders. We discuss the main methods for measuring motion sickness symptoms, the situations conducive to motion sickness and VIMS, and the individual traits associated with increased susceptibility. These additional considerations will improve diagnosis by fostering accurate measurement and understanding of the situational and personal factors associated with MSD and VIMSD. Show more

DOI: 10.3233/VES-200005

Citation: Journal of Vestibular Research, vol. 31, no. 5, pp. 327-344, 2021

Authors: Meskers, Arjan J. H. | Houben, Mark M. J. | Pennings, Helena J. M. | Clément, Gilles | Groen, Eric L.

Article Type: Research Article

Abstract: BACKGROUND: During large angles of self-tilt in the roll plane on Earth, measurements of the subjective visual vertical (SVV) in the dark show a bias towards the longitudinal body axis, reflecting a systematic underestimation of self-tilt. OBJECTIVE: This study tested the hypothesis that self-tilt is underestimated in partial gravity conditions, and more so at lower gravity levels. METHODS: The SVV was measured in parabolic flight at three partial gravity levels: 0.25, 0.50, and 0.75 g. Self-tilt was varied amongst 0, 15, 30, and 45 deg, using a tiltable seat. The participants indicated their SVV by setting a …linear array of dots projected inside a head mounted display to the perceived vertical. The angles of participants’ body and head roll tilt relative to the gravito-inertial vertical were measured by two separate inertial measurement units. RESULTS: Data on six participants were collected. Per G-level, a regression analysis was performed with SVV setting as dependent variable and head tilt as independent variable. The latter was used instead of chair tilt, because not all the participants’ heads were aligned with their bodies. The estimated regression slopes significantly decreased with smaller G-levels, reflecting an increased bias of the SVV towards the longitudinal body axis. On average, the regression slopes were 0.95 (±0.38) at 0.75 g; 0.84 (±0.22) at 0.5 g; and 0.63 (±0.33) at 0.25 g. CONCLUSIONS: The results of this study show that reduced gravity conditions lead to increased underestimation of roll self-tilt. Show more

Keywords: Perception, orientation, A-effect, space, microgravity, subjective vertical

DOI: 10.3233/VES-201512

Citation: Journal of Vestibular Research, vol. 31, no. 5, pp. 345-352, 2021

Authors: Micarelli, Alessandro | Viziano, Andrea | Micarelli, Beatrice | Di Fulvio, Giulia | Alessandrini, Marco

Article Type: Research Article

Abstract: BACKGROUND: Posturography power spectra (PS) implementation has been proven to discriminate between sensory inputs detriment of vestibular and proprioceptive origin. OBJECTIVE: To deepen the role of posturography testing in the diagnostic route of dizzy conditions, by comparing two groups of patients –93 affected by cervicogenic dizziness (CGD) and 72 by unilateral vestibular hypofunction (UVH) –with a group of 98 age- and gender-matched healthy subjects, serving as control group (CON). METHODS: All participants underwent otoneurological testing including video head impulse test (vHIT) and posturography testing with PS analysis. They also filled in Dizziness Handicap Inventory (DHI), Tampa …Scale for Kinesiophobia and Hospital Anxiety and Depression Scale questionnaires. RESULTS: UVH and CGD patients were found to have significant increase in vestibular- and proprioceptive-related PS values when compared with CON. Receiver operating characteristic curves found PS values to reliably discriminate both groups from CON. Positive and negative correlations were respectively found between vestibular-/proprioceptive-related PS domain and DHI in both groups and between PS and vHIT scores in UVH patients. CONCLUSIONS: PS analysis demonstrated to be useful in differentiating CGD and UVH patients each other and when compared to CON, to objectively represent perceived symptoms filled along the DHI scale and to corroborate the rate of vestibular deficit in UVH patients. Show more

Keywords: Posturography testing, cervicogenic dizziness, fast fourier transform, video-head impulse test, unilateral vestibular hypofunction

DOI: 10.3233/VES-190729

Citation: Journal of Vestibular Research, vol. 31, no. 5, pp. 353-364, 2021

Authors: Cochrane, Graham D. | Christy, Jennifer B. | Kicker, Ethan T. | Kailey, Ryan P. | England, Brandon K.

Article Type: Research Article

Abstract: BACKGROUND: Clinical vestibular technology is rapidly evolving to improve objective assessments of vestibular function. Understanding the reliability and expected score ranges of emerging clinical vestibular tools is important to gauge how these tools should be used as clinical endpoints. OBJECTIVE: The objective of this study was to evaluate inter-rater and test-retest reliability intraclass correlation coefficients (ICCs) of four vestibular tools and to determine expected ranges of scores through smallest real difference (SRD) measures. METHODS: Sixty healthy graduate students completed two 1-hour sessions, at most a week apart, consisting of two video head-impulse tests (vHIT), computerized dynamic …visual acuity (cDVA) tests, and a smartphone-assisted bucket test (SA-SVV). Thirty students were tested by different testers at each session (inter-rater) and 30 by the same tester (test-retest). ICCs and SRDs were calculated for both conditions. RESULTS: Most measures fell within the moderate ICC range (0.50–0.75). ICCs were higher for cDVA in the inter-rater subgroup and higher for vHITs in the test-retest subgroup. CONCLUSIONS: Measures from the four tools evaluated were moderately reliable. There may be a tester effect on reliabilities, specifically vHITs. Further research should repeat these analyses in a patient population and explore methodological differences between vHIT systems. Show more

Keywords: Clinical tools, reliability, vHIT, cDVA, subjective visual vertical

DOI: 10.3233/VES-201522

Citation: Journal of Vestibular Research, vol. 31, no. 5, pp. 365-373, 2021

Authors: Maheu, Maxime | Nooristani, Mujda | Kaci, Brahim | Moïn-Darbari, Karina | Bacon, Benoit-Antoine | Champoux, François

Article Type: Research Article

Abstract: BACKGROUND: Cervical Vestibular Evoked Myogenic Potentials (cVEMP) is an electromyogenic measure commonly used in clinic to assess saccule function. The main parameters are peak-peak amplitude and interaural asymmetry ratio (IAR). Several non-vestibular factors may influence these parameters. Notably, a greater EMG contraction level prior to stimulation leads to an increased amplitude. As aging impacts both vestibular structures and muscle propreties, it is still a matter of debate whether the decrease in cVEMP amplitude observed in normal aging is due to EMG differences prior to stimulation or to the effect of aging on the sacculo-collic reflex pathway. At the clinical level, …understanding the effect of aging on the relationship between EMG activity and cVEMP response (amplitude, asymmetry ratio) and the effect of normalization is crucial to improving the categorization of healthy versus pathological responses. OBJECTIVE: To investigate whether normalization modifies cVEMP amplitude and asymmetry ratios differently in younger and older heatlhy adults. METHOD: cVEMP recordings were conducted in 42 normal healthy participants divided in two age groups: younger (n  = 29): mean = 22.79 years old SD = 1.66; and older (n  = 13): mean = 69.00 years old SD = 3.61. Air-conducted cVEMP were recorded using Eclipse (Interacoustics, Denmark). The stimulus was a 95 dBnHL tone burst (500 Hz) with rise, plateau and fall time of 1 ms. cVEMP were recorded only when EMG levels were between 50μ V and 150μ V, using the Eclipse (Interacoustic, Denmark) monitoring system. RESULTS: No significant differences were observed for prestimulus EMG levels between younger and older participants (F(1,83) = 1.13, p  = 0.291). However, significant differences between groups were observed for raw cVEMP amplitude (F(1,83) = 14.78; p  < 0.001) and corrected cVEMP amplitude (F(1,83) = 21.85; p  < 0.0001). A significant positive linear relationship between prestimulus EMG contraction level (RMS) and raw cVEMP amplitude was observed in younger participants (r2  = 0.234; p  < 0.001), but not in older adults (r2  = –0.0144; p  = 0.056). Finally, no significant differences between younger and older participants were observed for raw amplitude asymmetry ratios (F(1,41) = 0.124, p  = 0.726) or normalized asymmetry ratios (F(1,41) = 0.726, p  = 0.508). CONCLUSION: Our results suggest that when EMG is monitored and activation of the SCM is sufficient, the observed decline in cVEMP amplitude with normal aging does not seem to be caused by EMG differences and is therefore likely due to the known histopathological modifications of the vestibular system that occurs with normal aging. Show more

Keywords: cVEMP, aging, vestibular, EMG, sternocleidomastoid muscle

DOI: 10.3233/VES-201515

Citation: Journal of Vestibular Research, vol. 31, no. 5, pp. 375-380, 2021

Authors: Gallus, Roberto | Melis, Andrea | Rizzo, Davide | Piras, Antonio | De Luca, Laura Maria | Tramaloni, Pierangela | Serra, Antonello | Longoni, Eleonora | Soro, Giovanni Maria | Bussu, Francesco

Article Type: Research Article

Abstract: BACKGROUND: since the beginning of COVID-19 outbreak a growing number of symptoms and deficits associated with the new pathology have emerged, among them cochlear damage in otherwise asymptomatic COVID-19 patients has been described. OBJECTIVE: to investigate general and audiovestibular symptoms and sequelae in healed patients, and to seek for any sign of residual or permanent hearing or vestibular loss. METHODS: we reviewed the data coming from 48 Covid-19 patients whose nasopharyngeal swabs have turned negative, all employed at our facility, that opted in for a free screening of audiovestibular symptoms offered by our hospital after the …aforementioned report was published. The screening included a tonal pure tone audiometry, a vHIT and SHIMP test, as well as a survey including known symptoms and audiovestibular symptoms. RESULTS: general symptoms as reported by our patients largely reflect what reported by others in the literature. 4 (8.3%) patients reported hearing loss, 2 (4.2%) tinnitus, 4 dizziness (8.3%), 1 spinning vertigo (2%), 1 dynamic imbalance (2%), 3 static imbalance (6.3%). Most audiovestibular symptoms have regressed. Thresholds at pure tone audiometry and vHIT gain were within normality range in all post-Covid-19 patients. CONCLUSIONS: even if some patients suffer from audiovestibular symptoms, these are mostly transitory and there is no clear evidence of clinically relevant persistent cochlear or vestibular damage after recovery. Show more

Keywords: vHIT, pure tone audiometry, covid-19, audiovestibular symptoms, general symptoms

DOI: 10.3233/VES-201505

Citation: Journal of Vestibular Research, vol. 31, no. 5, pp. 381-387, 2021

Authors: Pyykkö, Ilmari | Pyykkö, Nora | Manchaiah, Vinaya

Article Type: Research Article

Abstract: The aim of the present study was to evaluate the severity of vestibular drop attack (VDA) in Ménière’s disease (MD) and to examine the association between VDA severity and other MD-related complaints. The study used a cross-sectional survey design using an electronic questionnaire. The mean age of participants was 56.7 years, and the mean duration of MD was 12.4 years. Four categories of VDA were identified based on level of severity. VDA occurred in 305 (50.7%) of the 602 patients. Of these, 133 patients (22%) experienced mild VDA (i.e., associated with tripping); 80 (13%) experienced moderate VDA (i.e., associated with …fall threat unless they had been able to grab support); and 92 (15%) experienced severe VDA (i.e., patients fell to the ground, as in a classical Tumarkin attack). In 70%of participants, VDA occurred less than once a week. VDA lasted for only a few seconds in 90%of participants. 87%reported single attacks, whereas 13%experienced VDA in clusters. VDA was associated with visual auras, reduced quality of life, poor postural control, and fatigue. Approximately half of MD patients experience VDA with varying degrees of severity. If VDA causes falls or near-falls, the attacks should be appropriately treated. Show more

Keywords: Ménière’s disease, vestibular drop attacks, tumarkin attacks, vestibular migraine, migraine, headache

DOI: 10.3233/VES-201502

Citation: Journal of Vestibular Research, vol. 31, no. 5, pp. 389-399, 2021

Authors: Bery, Anand K. | Azzi, Jayson Lee | Le, Andre | Spitale, Naomi S. | Leech, Judith | Lelli, Daniel A. | Tse, Darren

Article Type: Research Article

Abstract: BACKGROUND: Obstructive sleep apnea (OSA) has been linked to vestibular dysfunction, but no prior studies have investigated the relationship between Persistent Postural-Perceptual Dizziness (PPPD), a common cause of chronic dizziness, and OSA. OBJECTIVE AND METHODS: We determined the frequency of OSA in an uncontrolled group of PPPD patients from a tertiary dizziness clinic based on polysomnogram (PSG). We then assessed the sensitivity and specificity of common OSA questionnaires in this population. RESULTS: Twenty-five patients with PPPD underwent PSG (mean age 47, 60% female, mean BMI 29.5). A majority, or 56%, of patients were diagnosed with OSA, …and in most, the OSA was severe. OSA patients were older (56 years versus 40 years, p  = 0.0006) and had higher BMI (32 versus 26, p  = 0.0078), but there was no clear gender bias (56% versus 64% female, p  = 1.00). The mean sensitivity and specificity of the STOP BANG questionnaire for detecting OSA was 86% and 55%, respectively. Sensitivity and specificity of the Berlin Questionnaire was 79% and 45%, respectively. CONCLUSIONS: The prevalence of OSA was much higher in our small PPPD group than in the general population. Screening questionnaires appear to demonstrate good sensitivity to detect PPPD patients at risk of OSA in this small study. Future studies should confirm these findings and determine whether treatment of OSA improves symptoms in PPPD. Show more

Keywords: Dizziness, PPPD, sleep apnea, neuro-otology, sleep medicine

DOI: 10.3233/VES-201508

Citation: Journal of Vestibular Research, vol. 31, no. 5, pp. 401-406, 2021

Authors: Lacour, Michel | Thiry, Alain | Tardivet, Laurent

Article Type: Research Article

Abstract: BACKGROUND: The crucial role of early vestibular rehabilitation (VR) to recover a dynamic semicircular canal function was recently highlighted in patients with unilateral vestibular hypofunction (UVH). However, wide inter-individual differences were observed, suggesting that parameters other than early rehabilitation are involved. OBJECTIVE: The aim of the study was to determine to what extent the degree of vestibular loss assessed by the angular vestibulo-ocular reflex (aVOR) gain could be an additional parameter interfering with rehabilitation in the recovery process. And to examine whether different VR protocols have the same effectiveness with regard to the aVOR recovery. METHODS: …The aVOR gain and the percentage of compensatory saccades were recorded in 81 UVH patients with the passive head impulse test before and after early VR (first two weeks after vertigo onset: N = 43) or late VR (third to sixth week after onset: N = 38) performed twice a week for four weeks. VR was performed either with the unidirectional rotation paradigm or gaze stability exercises. Supplementary outcomes were the dizziness handicap inventory (DHI) score, and the static and dynamic subjective visual vertical. RESULTS: The cluster analysis differentiated two distinct populations of UVH patients with pre-rehab aVOR gain values on the hypofunction side below 0.20 (N = 42) or above 0.20 (N = 39). The mean gain values were respectively 0.07±0.05 and 0.34±0.12 for the lateral canal (p  < 0.0001), 0.09±0.06 and 0.44±0.19 for the anterior canal (p  < 0.0001). Patients with aVOR gains above 0.20 and early rehab fully recovered dynamic horizontal canal function (0.84±0.14) and showed very few compensatory saccades (18.7% ±20.1%) while those with gains below 0.20 and late rehab did not improve their aVOR gain value (0.16±0.09) and showed compensatory saccades only (82.9% ±23.7%). Similar results were found for the anterior canal function. Recovery of the dynamic function of the lateral canal was found with both VR protocols while it was observed with the gaze stability exercises only for the anterior canal. All the patients reduced their DHI score, normalized their static SVV, and exhibited uncompensated dynamic SVV. CONCLUSIONS: Early rehab is a necessary but not sufficient condition to fully recover dynamic canal function. The degree of vestibular loss plays a crucial role too, and to be effective rehabilitation protocols must be carried out in the plane of the semicircular canals. Show more

Keywords: Unilateral vestibular hypofunction, degree of vestibular loss, early vs late vestibular rehabilitation, vestibulo-ocular reflex gain, compensatory saccades

DOI: 10.3233/VES-201557

Citation: Journal of Vestibular Research, vol. 31, no. 5, pp. 407-421, 2021

Authors: Kwon, Chiheon | Ku, Yunseo | Seo, Shinhye | Jang, Eunsook | Kong, Hyoun-Joong | Suh, Myung-Whan | Kim, Hee Chan

Article Type: Research Article

Abstract: BACKGROUND: Low success and high recurrence of benign paroxysmal positional vertigo (BPPV) after home-based self-treated Epley and Barbeque (BBQ) roll maneuvers is an important issue. OBJECTIVE: To quantify the cause of low success rate of self-treated Epley and BBQ roll maneuvers and provide a clinically acceptable criterion to guide self-treatment head rotations. METHODS: Twenty-five participants without active BPPV wore a custom head-mount rotation monitoring device for objective measurements. Self-treatment and specialist-assisted maneuvers were compared for head rotation accuracy. Absolute differences between the head rotation evaluation criteria (American Academy of Otolaryngology guidelines) and measured rotation angles were …considered as errors. Self-treatment and specialist-treated errors in maneuvers were compared. Between-trial variations and age effects were evaluated. RESULTS: A significantly large error and between-trial variation occurred in step 4 of the self-treated Epley maneuver, with a considerable error in the second trial. The cumulative error of all steps of self-treated BBQ roll maneuver was significantly large. Age effect occurred only in the self-treated BBQ roll maneuver. Errors in specialist-treated maneuvers ranged from 10 to 20 degrees. CONCLUSIONS: Real-time feedback of head movements during simultaneous head-body rotations could increase success rates of self-treatments. Specialist-treated maneuvers can be used as permissible rotation margin criteria. Show more

Keywords: BPPV, dizziness, head motion tracking, Epley maneuver, Barbeque roll maneuver

DOI: 10.3233/VES-190747

Citation: Journal of Vestibular Research, vol. 31, no. 5, pp. 423-431, 2021