Journal of Vestibular Research - Volume 32, issue 5

Authors: Strupp, Michael | Bisdorff, Alexandre | Furman, Joseph | Hornibrook, Jeremy | Jahn, Klaus | Maire, Raphael | Newman-Toker, David | Magnusson, Måns

Article Type: Research Article

Abstract: This paper describes the diagnostic criteria for Acute Unilateral Vestibulopathy (AUVP), a synonym for vestibular neuritis, as defined by the Committee for the Classification of Vestibular Disorders of the Bárány Society. AUVP manifests as an acute vestibular syndrome due to an acute unilateral loss of peripheral vestibular function without evidence for acute central or acute audiological symptoms or signs. This implies that the diagnosis of AUVP is based on the patient history, bedside examination, and, if necessary, laboratory evaluation. The leading symptom is an acute or rarely subacute onset of spinning or non-spinning vertigo with unsteadiness, nausea/vomiting and/or oscillopsia. A …leading clinical sign is a spontaneous peripheral vestibular nystagmus, which is direction-fixed and enhanced by removal of visual fixation with a trajectory appropriate to the semicircular canal afferents involved (generally horizontal-torsional). The diagnostic criteria were classified by the committee for four categories: 1. “Acute Unilateral Vestibulopathy”, 2. “Acute Unilateral Vestibulopathy in Evolution”, 3. “Probable Acute Unilateral Vestibulopathy” and 4. “History of Acute Unilateral Vestibulopathy”. The specific diagnostic criteria for these are as follows: “Acute Unilateral Vestibulopathy”: A) Acute or subacute onset of sustained spinning or non-spinning vertigo (i.e., an acute vestibular syndrome) of moderate to severe intensity with symptoms lasting for at least 24 hours. B) Spontaneous peripheral vestibular nystagmus with a trajectory appropriate to the semicircular canal afferents involved, generally horizontal-torsional, direction-fixed, and enhanced by removal of visual fixation. C) Unambiguous evidence of reduced VOR function on the side opposite the direction of the fast phase of the spontaneous nystagmus. D) No evidence for acute central neurological, otological or audiological symptoms. E) No acute central neurological signs, namely no central ocular motor or central vestibular signs, in particular no pronounced skew deviation, no gaze-evoked nystagmus, and no acute audiologic or otological signs. F) Not better accounted for by another disease or disorder. “Acute Unilateral Vestibulopathy in Evolution”: A) Acute or subacute onset of sustained spinning or non-spinning vertigo with continuous symptoms for more than 3 hours, but not yet lasting for at least 24 h hours, when patient is seen; B) - F) as above. This category is useful for diagnostic reasons to differentiate from acute central vestibular syndromes, to initiate specific treatments, and for research to include patients in clinical studies. “Probable Acute Unilateral Vestibulopathy”: Identical to AUVP except that the unilateral VOR deficit is not clearly observed or documented. “History of acute unilateral vestibulopathy“: A) History of acute or subacute onset of vertigo lasting at least 24 hours and slowly decreasing in intensity. B) No history of simultaneous acute audiological or central neurological symptoms. C) Unambiguous evidence of unilaterally reduced VOR function. D) No history of simultaneous acute central neurological signs, namely no central ocular motor or central vestibular signs and no acute audiological or otological signs. E) Not better accounted for by another disease or disorder. This category allows a diagnosis in patients presenting with a unilateral peripheral vestibular deficit and a history of an acute vestibular syndrome who are examined well after the acute phase. It is important to note that there is no definite test for AUVP. Therefore, its diagnosis requires the exclusion of central lesions as well as a variety of other peripheral vestibular disorders. Finally, this consensus paper will discuss other aspects of AUVP such as etiology, pathophysiology and laboratory examinations if they are directly relevant to the classification criteria. Show more

Keywords: Acute unilateral vestibulopathy, vestibular neuritis, vestibular neuronitis, acute vestibular syndrome, international classification of vestibular disorders, bárány society

DOI: 10.3233/VES-220201

Citation: Journal of Vestibular Research, vol. 32, no. 5, pp. 389-406, 2022

Authors: Babaee, Samar | Shaabani, Moslem | Vahedi, Mohsen

Article Type: Research Article

Abstract: BACKGROUND: Galvanic vestibular stimulation (GVS) is believed to be one of the most valuable tools for studying the vestibular system. In our opinion, its combined effect on posture and perception needs to be examined more. OBJECTIVE: The present study was conducted to investigate the effect of a 20 Hz sinusoidal Galvanic Vestibular Stimulation (sGVS) on the body sway and subjective visual vertical (SVV) deviation through two sets of electrode montages (bipolar binaural and double temple-mastoidal stimulation) during a three-stage experiment (baseline, threshold, and supra-threshold levels). METHODS: While the individuals (32 normal individuals, 10 males, the mean …age of 25.37±3.00 years) were standing on a posturography device and SVV goggles were put on, the parameters of the body sway and SVV deviation were measured simultaneously. Following the baseline stage (measuring without stimulation), the parameters were investigated during the threshold and supra-threshold stages (1 mA above the threshold) for 20 seconds. This was done separately for each electrode montage. Then, the results were compared between the three experimental stages and the two electrode montages. RESULTS: In both electrode montages, “the maximum amplitude” of the mediolateral (ML) and anteroposterior (AP) body sway decreased and increased in the threshold and supra-threshold stages, respectively, compared to the baseline stage. Comparison of the amount of  “amplitude change” caused by each electrode montages showed that the double temple-mastoidal stimulation induced a significantly greater amplitude change in body sway during both threshold and supra-threshold stages (relative to the baseline stage). The absolute mean values of the SVV deviation were significantly different between the baseline and supra-threshold levels in both electrode montages. The SVV deviation in double temple-mastoidal stimulation was a bit greater than that in the bipolar binaural stimulation. CONCLUSION: Double temple-mastoidal stimulation has induced greater amount of change in the body sway and SVV deviation. This may be due to the more effective stimulation of the otoliths than semicircular canals. Show more

Keywords: Galvanic vestibular stimulation, subjective visual vertical, postural sway, otolith

DOI: 10.3233/VES-210112

Citation: Journal of Vestibular Research, vol. 32, no. 5, pp. 407-421, 2022

Authors: Vereeck, Luc | Dunlap, Pamela M. | Vanspauwen, Robby | Hendriks, Erwin | Whitney, Susan L.

Article Type: Research Article

Abstract: BACKGROUND: Avoidance of activities that trigger dizziness in persons with vestibular disorders may inhibit dynamic vestibular compensation mechanisms. OBJECTIVE: To determine the reliability of the Vestibular Activities Avoidance Instrument (VAAI) 81 and 9 item tool and to compare the VAAI scores in Dutch-speaking healthy adults and in patients with vestibular disorders. METHODS: A prospective cohort study was conducted including 151 healthy participants and 106 participants with dizziness. All participants completed the 81-item VAAI. Within 7 days, the VAAI was completed a second time by 102 healthy adults and 43 persons with dizziness. RESULTS: The …average 81-item VAAI scores [54.8(47.1) vs. 228.1(78.3)] and 9-item VAAI scores [2.4(5.9) vs. 28.1(12)] were significantly different between healthy adults and participants with dizziness (p  < 0.001). In participants with dizziness the ICC for the 81-item VAAI was 0.95 (95% CI: 0.91, 0.97) and for the 9-item VAAI was 0.92 (95% CI: 0.85, 0.95). Cronbach’s alpha for the 81-item VAAI was 0.97 and 0.85 for the 9-item VAAI. The minimal detectable change was 47.8 for the 81-item VAAI and 8.9 for the 9-item VAAI. CONCLUSIONS: Persons with dizziness have a greater tendency to avoid movements. Both test-retest reliability and internal consistency of the Dutch version of the VAAI were excellent. Show more

Keywords: Dizziness, vertigo, fear avoidance

DOI: 10.3233/VES-210108

Citation: Journal of Vestibular Research, vol. 32, no. 5, pp. 423-431, 2022

Authors: Frank, Amanda J. | Hoppes, Carrie W. | Dunlap, Pamela M. | Costa, Cláudia M. | Whitney, Susan L.

Article Type: Research Article

Abstract: BACKGROUND: The Visual Vertigo Analogue Scale (VVAS) assesses visual vertigo. Instead of the original scoring methods (positive VVAS > 1), we propose categorizing patients as having No (0), Mild (0.1–40), Moderate (40.01–70), or Severe (70.01–100) symptoms. OBJECTIVE: Our primary aim was to validate an alternative interpretation of the VVAS by exploring the relationship between categories of visual vertigo symptoms and measures of activity and participation, dizziness handicap, anxiety, and depression. We aimed to describe the severity of visual vertigo reported by patients in different vestibular diagnostic categories. METHODS: Participants with vestibular disorders (n  = 250) completed the VVAS, Vestibular …Activities and Participation (VAP) Measure, Dizziness Handicap Inventory (DHI), and the Hospital Anxiety and Depression Scale (HADS). RESULTS: Patients with central disorders were more symptomatic than those with peripheral vestibular disorders. As evaluated by one-way ANOVA, the scores on the VAP, HADS, and DHI significantly differed among mild, moderate, severe, and no visual vertigo categories (p  < 0.001). As VVAS severity increased, activity and participation decreased (r  = 0.582, p  < 0.001); dizziness handicap increased (r  = 0.597, p  < 0.001, n  = 199); anxiety increased (r  = 0.405, p  < 0.001); and depression increased (r  = 0.521, p  < 0.001). CONCLUSIONS: The findings of this study support the use of an alternative VVAS interpretation method of categorizing symptoms as none, mild, moderate, and severe visual vertigo. Show more

Keywords: Vestibular, visual vertigo, assessment, classification, dizziness, vertigo, rehabilitation, physical therapy

DOI: 10.3233/VES-210131

Citation: Journal of Vestibular Research, vol. 32, no. 5, pp. 433-441, 2022

Authors: Soriano-Reixach, Maria Montserrat | Rey-Martínez, Jorge | Altuna, Xabier | Perez-Fernandez, Nicolas

Article Type: Research Article

Abstract: OBJECTIVE: Main objectives for this study were to develop a quantification method to obtain a Perez-Rey (PR) score adapted to the VVOR test and to evaluate the correlation of the PR score obtained with quantified VVOR with the PR score of the vHIT test. METHODS: A new PR score calculation method for quantified VVOR test was developed using the MATLAB computational software based on saccadic response time latency variability between each head oscillation cycle of the VVOR test. Retrospective correlation between PR scores in VVOR and vHIT tests, performed in the same vHIT testing session for patients with …vestibular neuritis and vestibular neurectomy, was performed to correlate new PR (VVOR) score with the classic PR (vHIT) score. RESULTS: Thirty patients were included: 11 post-neurectomy and 19 subacute vestibular neuritis. Pearson’s correlation coefficient (R2 ) for the overall sample was 0.92 (p  < 0.001) and 95% confidence interval was 0.85 –0.96. In the linear mixed-effects statistical model developed, only PRVHIT and PRVVOR scores showed statistical association in Wald X2 test (p  = 0.008). CONCLUSION: The new developed PR score for synchronization measurement of saccadic responses in VVOR testing is a valid method that outputs synchronization values and highly correlates with PR score in vHIT test. Show more

Keywords: VVOR, vHIT, VOR, gain, PR score, saccade

DOI: 10.3233/VES-210127

Citation: Journal of Vestibular Research, vol. 32, no. 5, pp. 443-451, 2022

Authors: Chae, Ricky | Krauter, Roseanne | Pasquesi, Lauren L. | Sharon, Jeffrey D.

Article Type: Research Article

Abstract: BACKGROUND: Current Bárány Society criteria for vestibular migraine (VM) include only episodic symptoms. Anecdotal observations suggest that some patients have episodic forms and others have chronic forms of VM, with interplay and evolution of both subtypes over time. OBJECTIVE: To better understand VM subtypes and evaluate a more inclusive diagnostic schema. METHODS: Four VM groups were studied: definite episodic (dVM), probable episodic (pVM), definite chronic (dCVM), and probable chronic (pCVM). Chronic VM was defined as having more than 15 dizzy days per month. Sociodemographic and clinical characteristics were analyzed, along with Dizziness Handicap Inventory (DHI) and …Vestibular Migraine Patient Assessment Tool and Handicap Inventory (VM-PATHI) scores. RESULTS: 54 adults with a mean age of 47.0 years (SD 13.7) were enrolled. 10 met criteria for dVM, 11 pVM, 22 dCVM, and 11 pCVM. Overall, there were strong similarities in clinical characteristics between dVM, pVM, dCVM, and pCVM. Compared to subjects with episodic VM, those with chronic VM had a higher average number of VM triggers (8.7 vs. 6.4, P  = 0.019), including motion (93.9% vs. 66.7%, P  = 0.009), scrolling on a screen (78.8% vs. 47.6%, P  = 0.018), skipped meal (57.6% vs. 23.8%, P  = 0.015), and air travel (57.6% vs. 23.8%, P  = 0.015). They also had higher symptom severity (DHI = 53.3, P  = 0.194) and burden of disease (VM-PATHI = 48.2, P  = 0.030) scores. CONCLUSIONS: Many patients do not meet current Bárány Society criteria for VM based on their duration of vestibular symptoms. Yet, these patients with chronic VM endorse several indistinguishable symptoms from those who do meet criteria. A more inclusive diagnostic schema should be adopted where patients with vestibular symptoms shorter than 5 minutes or longer than 72 hours are also recognized as having VM. Show more

Keywords: Barany society, chronic, dizziness, vertigo, vestibular migraine

DOI: 10.3233/VES-210117

Citation: Journal of Vestibular Research, vol. 32, no. 5, pp. 453-463, 2022

Authors: Smith, Laura | Tresh, Miriam | Surenthiran, S.S. | Wilkinson, David

Article Type: Research Article

Abstract: BACKGROUND: People with vestibular disorders experience symptoms which put them at risk of reduced wellbeing during the Covid-19 pandemic. OBJECTIVE: To assess the impact of the Covid-19 pandemic on vestibular symptoms, access to healthcare and daily activities amongst people living with a vestibular disorder. METHODS: An online survey was completed by 124 people in the UK with a vestibular disorder. The survey incorporated the Vertigo Symptom Scale-Short Form and questions regarding health status, healthcare received, daily activities and employment during Covid-19. RESULTS: The Covid-19 pandemic affected perceptions of wellbeing. 54.1% rated their health as …worse now than before the pandemic. Vertigo, unsteadiness, dizziness, tinnitus, loss of concentration/memory, and headaches were the most exacerbated symptoms. Respondents reported changes to their daily activities including reduced social contact (83%) and exercise (54.3%). Some experienced healthcare delays or received a remote appointment. Remote care was perceived as convenient, but barriers included difficulty communicating, trouble concentrating and perceived unsuitability for initial appointments. Unintended benefits of the pandemic included less social pressure, avoiding busy environments, and engaging in self-care. CONCLUSION: The effects of the Covid-19 pandemic are diverse. Clinical services should be mindful that Covid-19 can exacerbate vestibular and allied neuropsychiatric symptoms that require acute, multi-disciplinary intervention, but not lose sight of the potential benefit and cost saving associated with promoting self-management and delivering remote care, especially post-diagnosis. Show more

Keywords: Covid-19, vestibular, activities of daily living, healthcare, psychological symptoms

DOI: 10.3233/VES-210119

Citation: Journal of Vestibular Research, vol. 32, no. 5, pp. 465-477, 2022

Authors: Hassannia, Fatemeh | Misale, Priyanka | Sulway, Shaleen | Olmos, Gabriela Vergara | Dabiri, Sasan | Ranalli, Paul | Rutka, John Alexander

Article Type: Research Article

Abstract: OBJECTIVE: To evaluate the benefit of vestibular rehabilitation therapy (VRT) in the management of patients with idiopathic cerebellar ataxia with bilateral vestibulopathy (iCABV). BACKGROUND: iCABV is a hindbrain degenerative disorder with impairment of both central and peripheral vestibular pathways. There is combined failure of four compensatory eye movement systems including the vestibulo-ocular reflex (VOR), optokinetic reflex, smooth pursuit and the visually enhanced vestibulo-ocular reflex (VVOR). Phenotypic presentation includes postural and gait instability, oscillopsia and dizziness with active head movement. The benefit of VRT in iCABV patients has not been established. METHODS: A retrospective review was performed …on a cohort of twelve patients diagnosed with iCABV in a multidisciplinary neuro-otology clinic. All participated in VRT and completed their suggested course of VRT. The following clinical measures were assessed before starting and after finishing VRT: 1) Dizziness Handicap Inventory (DHI), 2) Activities-Specific Balance Confidence (ABC) Scale, 3) Catastrophization scale, 4) Positive Affective Negative Affective Score (PANAS), 5) Dynamic Gait Index (DGI) and 6) Modified Clinical Test of Sensory Interaction in Balance (mCTSIB). The number of falls historically was recorded in addition to gait speed (ft./sec). RESULTS: Following VRT, patients were found to have improved balance on mCTSIB (condition 4 : 7 vs 18 seconds, P  = 0.04) and a better postural stability with a reduced number of falls (p  = 0.01). No statistically significant improvement was seen in the DHI, ABC, Catastrophization scale, DGI, PANAS and gait speed (p  > 0.05). CONCLUSIONS: iCABV patients who underwent VRT were found to have a better postural stability and reduced risk of falls. VRT was not found to significantly improve patients’ overall subjective perception of their symptoms or their psychological status. Show more

Keywords: Cerebellar ataxia with bilateral vestibulopathy, vestibular rehabilitation, vestibular loss, cerebellar degeneration

DOI: 10.3233/VES-210058

Citation: Journal of Vestibular Research, vol. 32, no. 5, pp. 479-485, 2022