Journal of Vestibular Research - Volume 32, issue 2

Authors: Furman, Joseph M.

Article Type: Editorial

DOI: 10.3233/VES-210168

Citation: Journal of Vestibular Research, vol. 32, no. 2, pp. 87-87, 2022

Authors: van de Berg, R. | Murdin, L. | Whitney, S.L. | Holmberg, J. | Bisdorff, A.

Article Type: Research Article

Abstract: This document presents the initiative of the Bárány Society to improve diagnosis and care of patients presenting with vestibular symptoms worldwide. The Vestibular Medicine (VestMed) concept embraces a wide approach to the potential causes of vestibular symptoms, acknowledging that vertigo, dizziness, and unsteadiness are non-specific symptoms that may arise from a broad spectrum of disorders, spanning from the inner ear to the brainstem, cerebellum and supratentorial cerebral networks, to many disorders beyond these structures. The Bárány Society Vestibular Medicine Curriculum (BS-VestMed-Cur) is based on the concept that VestMed is practiced by different physician specialties and non-physician allied health …professionals. Each profession has its characteristic disciplinary role and profile, but all work in overlapping areas. Each discipline requires good awareness of the variety of disorders that can present with vestibular symptoms, their underlying mechanisms and etiologies, diagnostic criteria and treatment options. Similarly, all disciplines require an understanding of their own limitations, the contribution to patient care from other professionals and when to involve other members of the VestMed community. Therefore, the BS-VestMed-Cur is the same for all health professionals involved, the overlaps and differences of the various relevant professions being defined by different levels of detail and depth of knowledge and skills. The BS-VestMed-Cur defines a Basic and an Expert Level Curriculum. The Basic Level Curriculum covers the VestMed topics in less detail and depth, yet still conveys the concept of the wide net approach. It is designed for health professionals as an introduction to, and first step toward, VestMed expertise. The Expert Level Curriculum defines a Focused and Broad Expert. It covers the VestMed spectrum in high detail and requires a high level of understanding. In the Basic and Expert Level Curricula, the range of topics is the same and runs from anatomy, physiology and physics of the vestibular system, to vestibular symptoms, history taking, bedside examination, ancillary testing, the various vestibular disorders, their treatment and professional attitudes. Additionally, research topics relevant to clinical practice are included in the Expert Level Curriculum. For Focused Expert proficiency, the Basic Level Curriculum is required to ensure a broad overview and additionally requires an expansion of knowledge and skills in one or a few specific topics related to the focused expertise, e.g. inner ear surgery. Broad Expert proficiency targets professionals who deal with all sorts of patients presenting with vestibular symptoms (e.g. otorhinolaryngologists, neurologists, audiovestibular physicians, physical therapists), requiring a high level of VestMed expertise across the whole spectrum. For the Broad Expert, the Expert Level Curriculum is required in which the minimum attainment targets for all the topics go beyond the Basic Level Curriculum. The minimum requirements regarding knowledge and skills vary between Broad Experts, since they are tuned to the activity profile and underlying specialty of the expert.   The BS-VestMed-Cur aims to provide a basis for current and future teaching and training programs for physicians and non-physicians. The Basic Level Curriculum could also serve as a resource for inspiration for teaching VestMed to students, postgraduate generalists such as primary care physicians and undergraduate health professionals, or anybody wishing to enter VestMed.   VestMed is considered a set of competences related to an area of practice of established physician specialties and non-physician health professions rather than a separate clinical specialty. This curriculum does not aim to define a new single clinical specialty.   The BS-VestMed-Cur should also integrate with, facilitate and encourage translational research in the vestibular field. Show more

DOI: 10.3233/VES-210095

Citation: Journal of Vestibular Research, vol. 32, no. 2, pp. 89-98, 2022

Authors: Mohammadi, Midya | Enayati, Zakaria | Shaabani, Moslem | Vahedi, Mohsen

Article Type: Research Article

Abstract: BACKGROUND: Auditory cues might play a role in postural control. OBJECTIVE: The primary aim of this study was to investigate the association between white noise and head-shake (HS) related changes in postural sway. METHODS: Fifty healthy adults underwent Synapsys Posturography System (SPS) evaluation. The posturography (PG) evaluation consisted of two protocols: sensory organization test (SOT) and SOT with head-shake (HS) (HS-SOT). The standard SOT protocol of SPS involves a battery of six postural conditions. In the current study, participants underwent only four SOT conditions. The participants were asked to stand barefoot on the SPS platform (static …platform and foam). The SOT standing conditions were as follow: (1) firm surface (force platform only) with eyes open (SOT1); (2) firm surface with eyes closed (SOT2); (3) foam surface (which was positioned on the force platform) with eyes open (SOT4); and (4) foam surface with eyes closed (SOT5). For the HS-SOT protocol, we asked the participants to move their heads left and right (i.e., yaw head rotation) in the mentioned SOT conditions. Each postural condition was 10 seconds long. Both SOT and HS-SOT postural conditions were conducted across the two hearing modes of silence and noise. To achieve our aims, comparison of sway parameters between SOT and HS-SOT, and between hearing modes were considered. RESULTS: White noise was associated with a reduction in postural sway. The reduction observed in sway area, sway amplitude, and sway frequency. Moreover, HS significantly increased postural sway in all HS-SOT conditions compared to their SOT equivalents (i.e., HS-SOT1 compared to SOT1, etc.). The presence of white noise was associated with a decrease in the HS-related increase in postural sway. CONCLUSIONS: Considering the results, this study adds to the body of literature suggesting that white noise contributes to postural control, and the implications of this for rehabilitation need to be further investigated. Show more

Keywords: Postural control, auditory cues, white noise, sensory organization test, head-shake

DOI: 10.3233/VES-201616

Citation: Journal of Vestibular Research, vol. 32, no. 2, pp. 99-112, 2022

Authors: Pomante, A. | Selen, L.P.J. | Romano, F. | Bockisch, C.J. | Tarnutzer, A.A. | Bertolini, G. | Medendorp, W.P.

Article Type: Research Article

Abstract: The percept of vertical, which mainly relies on vestibular and visual cues, is known to be affected after sustained whole-body roll tilt, mostly at roll positions adjacent to the position of adaptation. Here we ask whether the viewing of panoramic visual cues during the adaptation further influences the percept of the visual vertical. Participants were rotated in the frontal plane to a 90° clockwise tilt position, which was maintained for 4-minutes. During this period, the subject was either kept in darkness, or viewed panoramic pictures that were either veridical (aligned with gravity) or oriented along the body longitudinal axis. Errors …of the subsequent subjective visual vertical (SVV), measured at various tilt angles, showed that the adaptation effect of panoramic cues is local, i.e. for a narrow range of tilts in the direction of the adaptation angle. This distortion was found irrespective of the orientation of the panoramic cues. We conclude that sustained exposure to panoramic and vestibular cues does not adapt the subsequent percept of vertical to the direction of the panoramic cue. Rather, our results suggest that sustained panoramic cues affect the SVV by an indirect effect on head orientation, with a 90° periodicity, that interacts with a vestibular cue to determine the percept of vertical. Show more

Keywords: perception, panoramic, gravity, adaptation, subjective visual vertical

DOI: 10.3233/VES-210051

Citation: Journal of Vestibular Research, vol. 32, no. 2, pp. 113-121, 2022

Authors: Emekci, Tuğba | Erbek, Hatice Seyra

Article Type: Research Article

Abstract: BACKGROUND: fHIT is an easily applicable test battery that indirectly evaluates the vestibulo-ocular reflex (VOR) from a functional perspective. AIMS/OBJECTIVES: The aim of this study was to Individuals determine the correlation between age and the percentage of correct answers (%CA) obtained in the functional head impulse test (fHIT) in healthy individuals. MATERIAL AND METHODS: A total of 105 volunteers, 50 males and 55 females, between the ages of 18 and 70 years, participated in the study. A Beon Solution fHIT system (Zero Branco (TV), Italy) was used in the study. RESULTS: In our study, …a decrease in the mean %CA was observed in all semicircular canals (SCCs) with increasing age. Between age and mean %CA, a significant negative moderate (–0.311) correlation was observed in lateral SCCs, and a significant negative low (–0.257) correlation was observed in posterior SCCs (p  < 0.05). In anterior SCCs, there was no statistically significant relationship between age and mean %CA (p  > 0.05). CONCLUSIONS: The present study performed in a healthy population will be helpful in terms of making comparisons in studies to be conducted in various vestibular diseases. It will also be a guide for identifying pathological consequences in vestibular diseases. Show more

Keywords: Age, functional head impulse test (fHIT), semicircular canal, VOR

DOI: 10.3233/VES-210040

Citation: Journal of Vestibular Research, vol. 32, no. 2, pp. 123-134, 2022

Authors: Gedik-Soyuyuce, Ozlem | Yalinay-Dikmen, Pinar | Korkut, Nazim

Article Type: Research Article

Abstract: BACKGROUND: The caloric vestibular test (CVT) may evoke headache and vestibular symptoms in susceptible people. Patients with migraines have higher susceptibility to motion sickness. In migraines, impaired habituation to repetitive stimuli is a well-known interictal abnormality. OBJECTIVE: This study is aimed at evaluating CVT-evoked headache, nausea, vomiting, and imbalance in patients with and without migraine and/or motion sickness. METHODS: A retrospective data analysis was performed on 554 patients with a complaint of dizziness who underwent bithermal CVT at a tertiary referral center. The occurrences of CVT-evoked headache, nausea, vomiting, and imbalance were observed in four groups: …patients with only migraine (MG; n  = 94), those with only motion sickness (MSG; n  = 89), those with migraine and motion sickness (MMSG; n  = 122), and those without migraine and motion sickness (non-MMSG; n  = 146). The differences between the groups were assessed. RESULTS: The mean ages of groups were similar (p  = 0.534). The proportions of females were higher in the MG, MSG, and MMSG (p  = 0.001). The severity of nausea and headache for each gender was higher in the MG, MSG, and MMSG (p  < 0.001). Vomiting was more common in MMSG among males (p  = 0.003), while there was no difference between groups among females (p  = 0.099). Imbalance was more common in MMSG among females (p  < 0.001). A relationship was detected between age and imbalance (p  < 0.001), where an increased risk for imbalance was evident with greater age. Three patients in the MMSG needed hospitalization after CVT. CONCLUSIONS: Special caution is needed when performing caloric testing for patients with migraines or MS since CVT-evoked symptoms may occur with higher incidence and intensity, which might be related to a lack of habituation in neuronal information processing after robust sensory stimuli like CVT. Show more

Keywords: Caloric tests, dizziness, headache, migraine, motion sickness

DOI: 10.3233/VES-210046

Citation: Journal of Vestibular Research, vol. 32, no. 2, pp. 135-144, 2022

Authors: Lin, Yufeng | Mukherjee, Mukul | Stergiou, Nicholas | Chien, Jung Hung

Article Type: Research Article

Abstract: BACKGROUND: The mastoid vibration (MV) has been used to investigate unilateral vestibular dysfunction by inducing nystagmus. Additionally, this MV can be used to quantify the effect of deterioration by aging on the vestibular system during walking. Could such MV be used to assess the uni/bilateral vestibular deterioration by aging during standing? OBJECTIVE: This study attempted to determine the feasibility of using MV for identifying the uni/bilateral vestibular deterioration by aging during standing. METHODS: Fifteen young and ten old adults’ balance control patterns were assessed by three random MV conditions: 1) No MV; 2) Unilateral MV; 3) …Bilateral MV. The dependent variables were the 95% confidence ellipse areas and the sample entropy values, which were calculated based on the center of gravity displacement within each condition. RESULTS: Significant main effects of MV and aging were found on all outcome variables. A significant interaction between aging and different MV types was observed in the 95% confidence ellipse area (p  = 0.002) and the length of the short axis (anterior-posterior direction, p  = 0.001). CONCLUSIONS: We concluded that the MV could be used to identify different vestibular dysfunctions, specifically in old adults. Show more

Keywords: Mastoid vibration, balance control, aging

DOI: 10.3233/VES-210042

Citation: Journal of Vestibular Research, vol. 32, no. 2, pp. 145-154, 2022

Authors: Byun, Hayoung | Chung, Jae Ho | Jeong, Jin Hyeok | Ryu, Jiin | Lee, Seung Hwan

Article Type: Research Article

Abstract: BACKGROUND: Obstructive sleep apnea (OSA) could influence peripheral vestibular function adversely via intermittent hypoxia and its consequences. OBJECTIVE: This study aimed to evaluate the risk of peripheral vestibular disorders in OSA using a nationwide population-based retrospective cohort study. METHODS: The National Health Insurance Service–National Sample Cohort represents the entire Korean population from 2002 to 2015. OSA was defined as individuals who had used medical services twice or more under a diagnosis of OSA(G47.33 in ICD-10). A comparison cohort consisted of socio-demographically matched non-OSA subjects in a ratio of 1:4. The incidences of benign paroxysmal positional vertigo(BPPV), …Meniere’s disease, and vestibular neuritis were evaluated in each cohort. RESULTS: A total of 2,082 individuals with OSA and 8,328 matched non-OSA subjects were identified. The incidence rates(IRs) of peripheral vertigo in OSA and non-OSA were 149.86 and 23.88 per 10,000 persons, respectively (Ratio of IR, IRR = 6.28, 95%CI 4.89 to 8.08). In multivariable analysis, the risk of peripheral vertigo was significantly higher in OSA(adjusted HR = 6.64, 95%CI 5.20 to 8.47), old age(adjusted HR = 1.03, 95%CI 1.02 to 1.04), female sex(adjusted HR = 1.92, 95%CI 1.48 to 2.50), and comorbidities(adjusted HR = 1.09, 95%CI 1.003 to 1.19). The IRRs of each vestibular disorder in the two groups were 7.32(95%CI 4.80 to 11.33) for BPPV, 3.61(95%CI 2.24 to 5.81) for Meniere’s disease, and 9.51(95%CI 3.97 to 25.11) for vestibular neuritis. CONCLUSIONS: Subjects diagnosed with OSA had a higher incidence of peripheral vestibular disorders than those without OSA, according to national administrative claims data. It is recommended to take peripheral vertigo into account when counseling OSA. Show more

Keywords: Dizziness, vertigo, BPPV, Meniere’s disease, vestibular neuritis, vestibulopathy

DOI: 10.3233/VES-210012

Citation: Journal of Vestibular Research, vol. 32, no. 2, pp. 155-162, 2022

Authors: Alharbi, Ahmad A. | Johnson, Eric G. | Albalwi, Abdulaziz A. | Ambode, Oluwaseun I. | Cordett, Tim K. | Alshehri, Fahad H. | Daher, Noha S.

Article Type: Research Article

Abstract: BACKGROUND: Chronic motion sensitivity (CMS) is a combination of autonomic symptoms provoked by exposure to motion. The correlation between anxiety and CMS is not yet well understood. OBJECTIVES: 1) To compare median anxiety levels between young adults with and without CMS. 2) To examine the effect of anxiety on postural stability with immersion virtual reality. 3) To compare anxiety levels between sexes. METHODS: Participants included 60 adults (20–40 years), with and without CMS. After determining their current and general anxiety levels, postural stability was measured. RESULTS: There were significant differences in median (minimum, maximum) …state- and trait-anxiety scores between participants with and without CMS, but no significant differences in median state- and trait-anxiety scores between males and females with CMS. There was a significant inverse relationship between state- and trait-anxiety scores and postural stability (ρ = –0.28, p  = 0.03, and ρ = –0.32, p  = 0.01, respectively). The stepwise regression analysis showed the Motion Sickness Susceptibility Questionnaire-Short Form score to be the only variable contributing significantly to postural stability (R2  = 26.2%; t  = –4.5, p  < 0.001). CONCLUSIONS: Young adults with CMS are more anxious, although anxiety does not contribute to postural stability in this group. Anxiety levels do not appear to differ between young adult males and females with CMS. Show more

Keywords: Motion sickness, anxiety, postural stability

DOI: 10.3233/VES-201625

Citation: Journal of Vestibular Research, vol. 32, no. 2, pp. 163-170, 2022

Authors: Kutlubaev, Mansur A. | Xu, Ying | Manchaiah, Vinaya | Zou, Jing | Pyykkö, Ilmari

Article Type: Research Article

Abstract: BACKGROUND: Vestibular drop attacks (VDA), also called Tumarkin otolith crises as a complication of Ménière’s disease (MD) were first described in 1936. Nevertheless, a clearer understanding of their prevalence and manifestations is needed. THE OBJECTIVE: of this review is to determine the frequency, correlates and consequences of VDA in MD. METHOD: Three databases were searched (i.e., MEDLINE, PubMed and Google Academia). A total of 1,791 references were identified, of which 18 studies were considered eligible. There was a large variation in the definition of VDA used in the studies. RESULTS: The frequency of VDA …in MD leading to a fall to the ground varied from 3 to 19% in 9 hospital-based studies. In studies where a less restrictive definition of VDA included attacks with postural perturbation, tripping and near-to-fall situations was used the prevalence ranged from 50 to 72%. The pooled frequency of VDA leading to fall to the ground was 8% (95% CI 4 to 12%) in hospital-based studies. In these studies, VDA often occurred in severe and advanced MD whereas in cohort studies such connection was not found. Co-morbidity with migraine increased the likelihood of VDA occurrence in MD. In 3 studies syncope was recorded in connection to VDA with falls. In terms of clinical manifestation, audiometry, MRI, vestibular evoked muscle response measures indicated endolymphatic hydrops with involvement of the otolith system. The hearing loss was more pronounced, and balance was worse in MD patients with VDA than in those without. Injury associated with VDA was reported in only one study. CONCLUSIONS: VDA is a common phenomenon in MD, occurring even in mild MD and complicated with syncope. Some preliminary evidence suggests that VDA may lead to severe injuries. Show more

Keywords: Ménière’s disease, vestibular drop attack, tumarkin otolith crises, vestibular syncope, syncope

DOI: 10.3233/VES-201514

Citation: Journal of Vestibular Research, vol. 32, no. 2, pp. 171-182, 2022

Authors: Du, Yi | Liu, Xingjian | Ren, Lili | Wu, Nan | Guo, Weiwei | Wu, Ziming | Yang, Shiming

Article Type: Research Article

Abstract: BACKGROUND: Unapparent saccades in video head impulse test (vHIT) are usually present in Meniere’s disease (MD) patients but tend to be ignored by the clinician. The result of vHIT is constantly questioned in MD patients due to a lack of uniform metrics. A more effective indicator is needed for indicating MD’s pathological progress. OBJECTIVES: To get a comprehensive understanding of the nature and usability of saccades in different MD stages. METHODS: 118 patients diagnosed with unilateral MD were recruited in this study. Patient history, audiological examination, caloric test, vHIT were performed. We proposed ‘raw saccades’ to …represent all showed wave peaks behind the head peak and named saccades by their appearance sequence: 1st saccade, 2nd saccade and 3rd saccade. An exploratory saccade analysis was executed to investigate the effectiveness of saccade attributes in identifying MD stages. RESULTS: MD patients have greater detectable 1st saccade than PR score as well as 2nd saccade. The time and velocity of the 1st saccade show high interaural variability (p  = 0.028, p  = 0.000 respectively). No statistical difference concerning the vHIT gain, PR score and 2nd saccade among stages could be recognized on both affected and contralateral sides. Multiple comparisons show the affected 1st saccade velocity and affected 1st saccade absolute velocity have stage-difference. At late stages (3&4), the affected 1st saccade is manifested as a speed increase, and this measure shows a relatively high correlation with MD stages compared to other vestibular indicators. CONCLUSION: The 1st saccade velocity on the affected side could indicate the MD disease process and severity. Show more

Keywords: PR score, vHIT, Meniere’s disease, caloric test, saccades

DOI: 10.3233/VES-201642

Citation: Journal of Vestibular Research, vol. 32, no. 2, pp. 183-192, 2022

Authors: Faralli, Mario | Ori, Michele | Ricci, Giampietro | Roscini, Mauro | Panichi, Roberto | Pettorossi, Vito Enrico

Article Type: Research Article

Abstract: BACKGROUND: Self-motion misperception has been observed in vestibular patients during asymmetric body oscillations. This misperception is correlated with the patient’s vestibular discomfort. OBJECTIVE: To investigate whether or not self-motion misperception persists in post-ictal patients with Ménière’s disease (MD). METHODS: Twenty-eight MD patients were investigated while in the post-ictal interval. Self-motion perception was studied by examining the displacement of a memorized visual target after sequences of opposite directed fast-slow asymmetric whole body rotations in the dark. The difference in target representation was analyzed and correlated with the Dizziness Handicap Inventory (DHI) score. The vestibulo-ocular reflex (VOR) and …clinical tests for ocular reflex were also evaluated. RESULTS: All MD patients showed a noticeable difference in target representation after asymmetric rotation depending on the direction of the fast/slow rotations. This side difference suggests disruption of motion perception. The DHI score was correlated with the amount of motion misperception. In contrast, VOR and clinical trials were altered in only half of these patients. CONCLUSIONS: Asymmetric rotation reveals disruption of self-motion perception in MD patients during the post-ictal interval, even in the absence of ocular reflex impairment. Motion misperception may cause persistent vestibular discomfort in these patients. Show more

Keywords: Quality of life, ménière’s disease, vertigo, motion perception, rehabilitation

DOI: 10.3233/VES-201520

Citation: Journal of Vestibular Research, vol. 32, no. 2, pp. 193-203, 2022