Journal of Vestibular Research - Volume 28, issue 5-6

Authors: Passamonti, Luca | Riccelli, Roberta | Lacquaniti, Francesco | Staab, Jeffrey P. | Indovina, Iole

Article Type: Research Article

Abstract: OBJECTIVE: Persistent postural perceptual dizziness (PPPD) is a common vestibular disorder of persistent dizziness and unsteadiness, exacerbated by upright posture, self-motion, and exposure to complex or moving visual stimuli. Previous functional magnetic resonance imaging (fMRI) studies found dysfunctional activity in the visual-vestibular cortices in patients with PPPD. Clinical studies showed that the anxiety-related personality traits of neuroticism and introversion may predispose individuals to PPPD. However, the effects of these traits on brain function in patients with PPPD versus healthy controls (HCs) have not been studied. METHODS: To investigate potential differential effects of neuroticism and introversion on functioning of …their visuo-vestibular networks, 15 patients with PPPD and 15 HCs matched for demographics and motion sickness susceptibility underwent fMRI during virtual reality simulation of a rollercoaster ride in vertical and horizontal directions. RESULTS: Neuroticism positively correlated with activity in the inferior frontal gyrus (IFg), and enhanced connectivity between the IFg and occipital regions in patients with PPPD relative to HCs during vertical versus horizontal motion comparison. CONCLUSIONS: In patients with PPPD, neuroticism increased the activity and connectivity of neural networks that mediate attention to visual motion cues during vertical motion. This mechanism may mediate visual control of balance in neurotic patients with PPPD. Show more

Keywords: Rollercoaster simulation, vestibular, visual motion stimulation, fMRI, persistent postural-perceptual dizziness

DOI: 10.3233/VES-190653

Citation: Journal of Vestibular Research, vol. 28, no. 5-6, pp. 369-378, 2018

Authors: Yao, Qingxiu | Wang, Hui | Song, Qiang | Shi, Haibo | Yu, Dongzhen

Article Type: Research Article

Abstract: BACKGROUND: Benign paroxysmal positional vertigo (BPPV) is the most common vestibular disorder affecting about 20% of dizzy patients. Early diagnosis and treatment can improve the quality of life for patients. OBJECTIVE: We reviewed the classifications of different subtypes of benign paroxysmal positional vertigo and the problems we encountered using the diagnostic criteria of the Bárány Society. METHODS: Both the Dix–Hallpike maneuver and supine roll test were performed on 568 patients, and diagnoses were made based on patient history and the type of provoked nystagmus (if any). Next, the numbers of patients with each subtype and other …parameters, including age and sex, were analyzed. RESULTS: Posterior semicircular canal BPPV (pc-BPPV) accounted for the largest proportion, followed by horizontal semicircular canal BPPV (hc-BPPV). Both anterior canal BPPV and multiple canal lithiasis BPPV were rare, and no patient was diagnosed with cupulolithiasis of the posterior canal. CONCLUSIONS: pc-BPPV, hc-BPPV, and cupulolithiasis of the horizontal canal (hc-BPPV-cu) were the three major subtypes that could be definitively diagnosed, whereas the diagnoses of possible benign paroxysmal positional vertigo (pBPPV) and probable benign paroxysmal positional vertigo [spontaneously resolved] (pBPPVsr) require further investigation, with special attention being paid to appropriate differentiation and repositioning maneuvers. Show more

Keywords: Benign paroxysmal positional vertigo, classification, canalithiasis, cupulolithiasis

DOI: 10.3233/VES-190648

Citation: Journal of Vestibular Research, vol. 28, no. 5-6, pp. 379-384, 2018

Authors: Lee, Seung Jae | Lee, Se A | Kim, Bo Gyung | Hong, Hyun Sook | Lee, Ji Ye | Lee, Jong Dae

Article Type: Research Article

Abstract: BACKGROUND: Isolated acute audiovestibular loss is characterized by the sudden onset of unilateral hearing loss and prolonged vertigo. OBJECTIVE: The purpose of this study is aimed to identify the value of magnetic resonance imaging (MRI) for the evaluation of isolated acute audiovestibular loss. METHODS: We retrospectively enrolled 31 patients with isolated acute audiovestibular loss from March 2007 to December 2017. Specific medical records including initial and final pure tone audiometry (PTA), and canal paresis value were reviewed. Abbreviated MRI was performed in all patients. RESULTS: Fifteen patients showed increased signal of labyrinth on FLAIR …images and eleven revealed negative findings on MRI. Two patients showed an infarction in the anterior inferior cerebellar artery (AICA) territory and three exhibited vestibular schwannoma in the internal auditory canal. There were no significant differences in initial, final PTA, and hearing recovery between negative and labyrinthine abnormality groups on MRI. CONCLUSIONS: Our results show that isolated acute audiovestibular loss due to labyrinthitis is more common than other secondary causes including vestibular schwannoma or AICA infarction. However, MRI with a tailored, abbreviated protocol is strongly recommended in patients with isolated acute audiovestibular loss to identify the exact etiologies. Show more

Keywords: Sudden hearing loss, infarction, magnetic resonance imaging, acoustic neuroma

DOI: 10.3233/VES-190649

Citation: Journal of Vestibular Research, vol. 28, no. 5-6, pp. 385-391, 2018

Authors: Lubetzky, Anat V. | Hujsak, Bryan D.

Article Type: Research Article

Abstract: BACKGROUND: The contribution of visual information to standing balance in patients with vestibular dysfunction varies between patients. Sensitive tools to detect kinematic response to visual perturbation are needed to individualize treatment. OBJECTIVE: Using the Oculus Rift headset and sensors, we developed a novel virtual reality (VR) test of head stability (HST) in response to visual perturbation. During the test, head movements were tracked in six degrees-of-freedom. The purpose of this pilot study was to test the sensitivity of the VR_HST to differences between patients with vestibular dysfunction and controls. METHODS: Seventeen patients and 16 controls performed …static balance tasks with eyes closed (feet together or tandem on floor and foam) and observing ‘moving stars’ (amplitude 32 mm, frequency 0.2 Hz) via the Oculus (tandem). Directional Path and Root Mean Square Velocity were calculated for postural and head oscillations. RESULTS: Postural sway differed significantly between groups when standing on foam with feet together and on floor while observing the ‘moving stars’ task. Head oscillations were larger among patients, primarily in pitch, yaw, and roll rotation. CONCLUSIONS: The VR_HST was found to be sensitive to differences between small and diverse groups. Its clinical utility should be studied in larger samples of patients with vestibular dysfunction. Show more

Keywords: Sensory integration, postural control, virtual reality, oculus rift

DOI: 10.3233/VES-190650

Citation: Journal of Vestibular Research, vol. 28, no. 5-6, pp. 393-400, 2018

Authors: van Esch, B.F. | Abolhosseini, K. | Masius-Olthof, S. | van der Zaag-Loonen, H.J. | van Benthem, P.P.G. | Bruintjes, Tj.D.

Article Type: Research Article

Abstract: BACKGROUND: The video-head impulse test employs the vestibulo-ocular reflex (VOR) to assess vestibular function. To this day, no consensus has been reached among scientists in terms of whether or not vHIT results change in MD patients as the disease progresses. OBJECTIVE: To assess whether the vHIT is more often abnormal in later stages of MD compared to earlier stages. METHODS: We retrospectively analyzed patients with ‘definite’ MD who had undergone a vHIT and caloric test between 2012 and 2015. Patients were evaluated based on duration of disease in years (≤1, >1≤5, >5≤10, >10) and stage of disease (stage I …and II versus III and IV). For the vHIT, an abnormal vestibulo-ocular reflex was defined as a gain cut-off value of≤0.8 and presence of correction saccades including subanalyses using a cut-off value of≤0.9. RESULTS: In 89 definite MD patients (42 (47%) male, mean age 55±5 (SD)), data on both the caloric test and the vHIT were available. The risk of an abnormal vHIT was 25% in patients with a duration of disease over 10 years compared to 22% in the patients with a disease duration of 10 years or less (risk difference 3%, 95% CI:– 28% to 35%), p  = 0.82). The risk for an abnormal vHIT in the Stage I and Stage II was 17% compared to 26% in Stage III and IV (risk difference 9%, 95% CI:– 30% to 11%). When using a cut-off value of 0.9 we also did not demonstrate a relationship between the duration of disease and the proportion of abnormal vHIT test results. CONCLUSIONS: There is no relationship between the proportion of abnormal vHIT test results in patients with MD in either duration or stage of disease. Show more

Keywords: Video head impulse test, caloric testing, vestibular hypofunction, Meniere’s disease.

DOI: 10.3233/VES-190654

Citation: Journal of Vestibular Research, vol. 28, no. 5-6, pp. 401-407, 2018

Authors: Rosiak, Oskar | Krajewski, Krzysztof | Woszczak, Marek | Jozefowicz-Korczynska, Magdalena

Article Type: Research Article

Abstract: BACKGROUND: Recently, two types of movement sensors have been introduced into Virtual Reality (VR) therapy: motion trackers and force-plate platforms. Combining these two methods could produce better rehabilitation outcomes. Such devices, encompassing motion trackers and force platforms, are referred to as “hybrid” VR units. OBJECTIVE: To assess the effectiveness of a low-cost hybrid VR based vestibular rehabilitation program METHODS: A prospective, non-randomized, controlled group study comparing training using a hybrid VR unit (Group 1 n  = 25) vs. static posturography with visual feedback (Group 2 n  = 25) in patients with peripheral vestibular dysfunction was …conducted. The subjects underwent 10 training sessions over 10 days (30 minute sessions). All were examined on a posturography platform at the start and 1 month after rehabilitation and completed the Vertigo Symptom Scale – Short Form (VSS-SF) questionnaire. RESULTS: Both groups demonstrated improvement in posturographic parameters, which were statistically significant, but when comparing results between both groups there were no differences. The patients reported improvement in their subjective perception of symptoms on the VSS-SF scale, which were statistically significant in both groups, but greater in the VR group. CONCLUSIONS: Both methods reduce postural sway, however subjective reduction of symptoms was greater in the VR group. Show more

Keywords: Vertigo, vestibular rehabilitation, Virtual Reality

DOI: 10.3233/VES-180647

Citation: Journal of Vestibular Research, vol. 28, no. 5-6, pp. 409-415, 2018

Authors: Ismail, Elshahat Ibrahem | Morgan, Ashraf Elsayed | Abdel Rahman, Akram Mohamed

Article Type: Research Article

Abstract: BACKGROUND: The management strategy for functional recovery after vestibular neuritis (VN) has not yet been established. Therapeutic choices involve corticosteroids, vestibular rehabilitation therapy (VRT) and the combination of corticosteroids with VRT. OBJECTIVE: The present study aimed to compare the efficacy of corticosteroids, vestibular rehabilitation, and combination of them in terms of subjective and objective improvement in patients with VN. METHODS: A prospective randomized study was conducted on 60 patients with acute vestibular neuritis within 3 days after symptom onset. The patients were divided into three groups; steroid group treated with corticosteroids (n  = 20), VRT group (n … = 20) managed with vestibular rehabilitation exercises and combination group (n  = 20) received combined (corticosteroids and vestibular exercises). Groups were compared by caloric lateralization, vestibular myogenic potential amplitude asymmetry and Dizziness Handicap Inventory scores, both at presentation and up to 12 months. RESULTS: The study found no statistically significant difference between the three groups of the study at the end of the follow up period. CONCLUSION: Corticosteroids and VRT seem to be equivalently effective in patients with VN. The study proposes that corticosteroids may accelerate the recovery of VN, with no more beneficial role in the long-term prognosis of the disease. Show more

Keywords: Corticosteroids, vestibular rehabilitation therapy, vestibular neuritis

DOI: 10.3233/VES-180645

Citation: Journal of Vestibular Research, vol. 28, no. 5-6, pp. 417-424, 2018

Authors: Chen (Lu), Chien-Ming

Article Type: Research Article

Abstract: BACKGROUND: There are some variations of barbecue rotation to treat canalithiasis of horizontal semicircular canal (HSC-canalithiasis). But a 540° approach has never been reported. OBJECTIVE: To compare a modified 540° to a traditional 360° barbecue rotation for treatment of HSC-canalithiasis. METHODS: Sixty consecutive patients with HSC-canalithiasis were prospectively allocated to two groups of log roll treatment, either 540° or 360° barbecue rotation (Br540 or Br360). Only one application was allowed in each visit, with weekly repetitions until the resolution of positional nystagmus and vertigo. RESULTS: In each group, 2 patients …were lost to follow-up so that 28 were analyzed. With “multi-canal sufferers” or “canal switchers” included, 25, 2, and 1 patients in the Br540 needed 1, 2 and 4 canalith repositioning procedures (CRP) respectively to cure the HSC-canalithiasis, while 17, 6, 5 in the Br360 required 1, 2 and 3 CRPs (p  = 0.011). With “multiple canal sufferers” and “canal switchers” excluded from analysis, 19, 1, and 1 patients in the Br540 needed 1, 2 and 4 CRPs respectively, while 16, 6, 4 in the Br360 required 1, 2 and 3 CRPs (p  = 0.027). The success rate with one application was higher in the 540° group than the 360° group, about 90% versus 61% (P  < 0.05 in both analyses). CONCLUSION: A 540° barbecue rotation is probably superior to 360° for treatment of HSC-canalithiasis. Show more

Keywords: HSC-canalithiasis, barbecue rotation

DOI: 10.3233/VES-180644

Citation: Journal of Vestibular Research, vol. 28, no. 5-6, pp. 425-429, 2018