Journal of Vestibular Research - Volume 34, issue 2-3

Authors: Cisneros-Gimeno, A.I. | Garcia-Barrios, A. | Fraile, J. | Alarcia, E. | Whyte, J.

Article Type: Research Article

Abstract: In December 1923, a twelve-day course took place at the University of Zaragoza, specifically at the Faculty of Medicine, given by Professor Róbert Bárány, who was awarded the Nobel Prize for Medicine in 1914 for his discoveries on the vestibular apparatus. Professor Robert Bárány came to the faculty at the invitation of Professor Victor Fairén through the University Exchange programme. This course consisted of four lectures and twelve lessons a day in which he presented his knowledge of the physiopathology of the vestibule and cerebellum, as well as practical demonstrations of the physical examination of nystagmus and cerebellar pathology. …Lorente de Nó, a doctorate student of medicine, was one of the most outstanding students on the course. His intellect was already outstanding in those years, which helped him to discuss the physiopathology of nystagmus with Professor Bárány. The relationship he forged with the Nobel laureate in Zaragoza would be decisive for his future as a researcher. The aim of this work is to compile and integrate the available information on the course that Professor Bárány took in the city of Zaragoza, consulting official documents from the university and the city, articles, books and the press of the time. Show more

Keywords: Robert Bárány, Faculty of Medicine (University of Zaragoza), course on vestibular and cerebellum pathology, neuro-otology

DOI: 10.3233/VES-230011

Citation: Journal of Vestibular Research, vol. 34, no. 2-3, pp. 75-81, 2024

Authors: Geno, Olivia | Critelli, Kyle | Arduino, Cesar | Crane, Benjamin T. | Anson, Eric R.

Article Type: Research Article

Abstract: BACKGROUND: Inertial self-motion perception is thought to depend primarily on otolith cues. Recent evidence demonstrated that vestibular perceptual thresholds (including inertial heading) are adaptable, suggesting novel clinical approaches for treating perceptual impairments resulting from vestibular disease. OBJECTIVE: Little is known about the psychometric properties of perceptual estimates of inertial heading like test-retest reliability. Here we investigate the psychometric properties of a passive inertial heading perceptual test. METHODS: Forty-seven healthy subjects participated across two visits, performing in an inertial heading discrimination task. The point of subjective equality (PSE) and thresholds for heading discrimination were …identified for the same day and across day tests. Paired t -tests determined if the PSE or thresholds significantly changed and a mixed interclass correlation coefficient (ICC) model examined test-retest reliability. Minimum detectable change (MDC) was calculated for PSE and threshold for heading discrimination. RESULTS: Within a testing session, the heading discrimination PSE score test-retest reliability was good (ICC = 0. 80) and did not change (t (1,36) = –1.23, p  = 0.23). Heading discrimination thresholds were moderately reliable (ICC = 0.67) and also stable (t (1,36) = 0.10, p  = 0.92). Across testing sessions, heading direction PSE scores were moderately correlated (ICC = 0.59) and stable (t (1,46) = –0.44, p  = 0.66). Heading direction thresholds had poor reliability (ICC = 0.03) and were significantly smaller at the second visit (t (1,46) = 2.8, p  = 0.008). MDC for heading direction PSE ranged from 6–9 degrees across tests. CONCLUSION: The current results indicate moderate reliability for heading perception PSE and provide clinical context for interpreting change in inertial vestibular self-motion perception over time or after an intervention. Show more

Keywords: Heading, perception, inertia, vestibular, psychometrics

DOI: 10.3233/VES-230077

Citation: Journal of Vestibular Research, vol. 34, no. 2-3, pp. 83-92, 2024

Authors: Anton, Kristina | Ernst, Arne | Basta, Dietmar

Article Type: Research Article

Abstract: BACKGROUND: Patients with vestibular impairment often suffer from postural instability. This could be compensated by other sensory systems such as the auditory system. OBJECTIVE: The aim of this study was to investigate whether auditory input improves postural stability in patients with abnormal subjective haptic vertical (SHV). METHODS: Participants (n  = 13) with normal hearing and vision, but abnormal SHV participated. Participants performed standing on firm ground and foam support (eyes open/closed) and Tandem Romberg test (eyes closed) in quiet (reference), noise and with plugged ears. All tasks were conducted in a soundproofed and reverberant room. Postural stability …was recorded close to the body’s center of gravity. Reference conditions were compared with a control group. RESULTS: In only two tasks sway increased significantly when noise was presented during challenging tasks in the soundproofed room. Sway of the reference conditions did not differ significantly between control and study group. CONCLUSIONS: This study shows no influence of applied auditory stimulation on posture in participants with abnormal SHV in a reverberant room, but an adverse effect on balance during difficult tasks in the soundproofed room. Noise possibly masked auditory information that was helpful in improving posture in the quiet condition. Futhermore, noise might have distracted participants from maintaining balance. Show more

Keywords: Auditory influence, postural control, abnormal subjective haptic vertical, body sway, spatial cues

DOI: 10.3233/VES-230079

Citation: Journal of Vestibular Research, vol. 34, no. 2-3, pp. 93-102, 2024

Authors: Han, Jae Sang | Lee, Dong-Hee | Park, Shi Nae | Park, Kyoung Ho | Kim, Tae Ho | Han, Jae Hong | Kang, Min Ju | Kim, So-Hyun | Seo, Jae-Hyun

Article Type: Research Article

Abstract: BACKGROUND: The upright head roll test (UHRT) is a recently introduced diagnostic maneuver for lateral semicircular canal benign paroxysmal positional vertigo (LSC-BPPV). OBJECTIVE: This study aimed to evaluate the reliability and validity of the UHRT. METHODS: Two separate studies were conducted. Study 1 analyzed 827 results of videonystagmography (VNG) to assess UHRT reliability, and Study 2 analyzed 130 LSC-BPPV cases to evaluate UHRT validity. RESULTS: The inter-test reliability between UHRT and the supine head roll test (SHRT) showed substantial agreement (Cohen’s kappa = 0.753) in direction-changing positional nystagmus (DCPN) and almost perfect …agreement (Cohen’s kappa = 0.836) in distinguishing the direction of DCPN. The validity assessment of UHRT showed high accuracy in diagnosing LSC-BPPV (80.0%) and in differentiating the variant types (74.6%). UHRT was highly accurate in diagnosing the canalolithiasis type in LSC-BPPV patients (Cohen’s kappa = 0.835); however, it showed only moderate accuracy in diagnosing the cupulolithiasis type (Cohen’s kappa = 0.415). The intensity of nystagmus in UHRT was relatively weaker than that in SHRT (P  < 0.05). CONCLUSION: UHRT is a reliable test for diagnosing LSC-BPPV and distinguishing subtypes. However, UHRT has a limitation in discriminating the affected side owing to a weaker intensity of nystagmus than SHRT. Show more

Keywords: Semicircular canal, benign paroxysmal positional vertigo, dizziness

DOI: 10.3233/VES-230127

Citation: Journal of Vestibular Research, vol. 34, no. 2-3, pp. 103-112, 2024

Authors: Moore, Alexander I.G. | Golding, John F. | Alenova, Anastasia | Castro, Patricia | Bronstein, Adolfo M.

Article Type: Research Article

Abstract: BACKGROUND: Our sense of direction (SOD) ability relies on the sensory integration of both visual information and self-motion cues from the proprioceptive and vestibular systems. Here, we assess how dysfunction of the vestibular system impacts perceived SOD in varying vestibular disorders, and secondly, we explore the effects of dizziness, migraine and psychological symptoms on SOD ability in patient and control groups. METHODS: 87 patients with vestibular disorder and 69 control subjects were assessed with validated symptom and SOD questionnaires (Santa Barbara Sense of Direction scale and the Object Perspective test). RESULTS: While patients with vestibular disorders …performed significantly worse than controls at the group level, only central and functional disorders (vestibular migraine and persistent postural perceptual dizziness), not peripheral disorders (benign-paroxysmal positional vertigo, bilateral vestibular failure and Meniere’s disease) showed significant differences compared to controls on the level of individual vestibular groups. Additionally, orientational abilities associated strongly with spatial anxiety and showed clear separation from general dizziness and psychological factors in both patient and control groups. CONCLUSIONS: SOD appears to be less affected by peripheral vestibular dysfunction than by functional and/or central diagnoses, indicating that higher level disruptions to central vestibular processing networks may impact SOD more than reductions in sensory peripheral inputs. Additionally, spatial anxiety is highly associated with orientational abilities in both patients and control subjects. Show more

Keywords: Sense of direction, spatial orientation, vestibular disorders, dizziness, migraine, central disorders, functional disorders, anxiety, depression, spatial anxiety

DOI: 10.3233/VES-230082

Citation: Journal of Vestibular Research, vol. 34, no. 2-3, pp. 113-123, 2024

Authors: Li, Xiao-Xiao | Yu, Hai-Yun | Li, Jing-Jing | Liu, Xiao-Long | Zheng, Hang-Yu | Li, Yan-Fei | Li, Qi | Liu, Si-Yuan

Article Type: Research Article

Abstract: BACKGROUND: Visual vertigo (VV) is a disease characterized by various visual signal-induced discomforts, including dizziness, unsteady balance, activity avoiding, and so forth. Distinguishing it from other kinds of dizziness is important because it needs the combination of visual training and vestibular rehabilitation together. However, there is no appropriate tool to diagnose VV in China, thus we would like to introduce an effective tool to China. OBJECTIVE: The aim of this study was to establish the reliability and validity of the Chinese version of visual vertigo analogue scale (VVAS-CH) and to achieve its cross-cultural adaptation in order …to promote its further usage in China. METHODS: A total of 1681 patients complaining of vertigo or dizziness were enrolled and they were asked to complete the VVAS-CH. The cross-cultural adaptation, reliability and construct validity of the VVAS-CH were determined. RESULTS: Split-half reliability was 0.939, showing a good reliability. Factor analysis identified only one common factor for the nine items that explained 64.83% of the total variance. Most fit indices reached acceptable levels, proving the good fit of the VVAS-CH model. CONCLUSIONS: The VVAS-CH validated in this study can be used as an effective tool for diagnosing and evaluating VV in patients whose native language is Chinese. Show more

Keywords: Visual vertigo, dizziness, scale, validity, common factor

DOI: 10.3233/VES-220102

Citation: Journal of Vestibular Research, vol. 34, no. 2-3, pp. 125-132, 2024

Authors: Ichijo, Kentaro | Oka, Mineko | Koda, Kento | Kamogashira, Teru | Kinoshita, Makoto | Kawahara, Takuya | Takashima, Ikumi | Demura, Shinichi | Yamasoba, Tatsuya | Fujimoto, Chisato

Article Type: Research Article

Abstract: BACKGROUND/OBJECTIVE: Persistent postural-perceptual dizziness (PPPD) is worsened in a standing posture, or by body movement, or visual stimulation. We aimed to evaluate postural stability in PPPD patients using foam posturography and to investigate the dependence on visual and somatosensory input in the standing posture. METHODS: Foam posturography was performed on 53 PPPD patients, and data from the PPPD patients were compared with the data from an age- and sex-matched healthy controls. The PPPD patients were divided into four groups based on the findings of vestibular function tests and the effect of vestibular function on posturographic data was examined. …RESULTS: Romberg’s ratios were significantly higher in PPPD patients than in controls. The median Romberg’s ratios in PPPD patients with normal vestibular function were also higher than those in controls. However, foam ratio was significantly lower in PPPD patients than in controls. The median foam ratios in PPPD patients with vestibular dysfunction were also lower than those in controls. CONCLUSIONS: In a standing posture, PPPD patients may be more dependent on visual input and less dependent on somatosensory input than healthy subjects. Higher dependence on visual and lower dependence on somatosensory input in PPPD may be a feature unaffected by vestibular function. Show more

Keywords: Dizziness, posture, vestibular evoked myogenic potentials, vestibular function tests

DOI: 10.3233/VES-230034

Citation: Journal of Vestibular Research, vol. 34, no. 2-3, pp. 133-144, 2024

Authors: Weston, Angela R. | Dibble, Leland E. | Fino, Peter | Lisonbee, Rich | Hoppes, Carrie | Loyd, Brian J.

Article Type: Research Article

Abstract: BACKGROUND: Individuals after a vestibular schwannoma resection (VSR) experience significant vestibular symptoms that can be provoked with turning. Vestibular rehabilitation assists in recovery of function and symptom relief, however turning response is unknown. OBJECTIVE: Examine peak turning speed response to surgery and rehabilitation. METHODS: Eight participants with a vestibular schwannoma (PwVS) and five healthy controls (HC) participated in this study. Peak turning speed (PTS) was captured with inertial measurement units (IMU) at the head and/or trunk during turning tasks at a pre-operative, post-operative and post-treatment assessment. Vestibular rehabilitation was provided twice weekly for six weeks. Linear …mixed models were used to assess change in PTS across time points. RESULTS: PwVS performed slower PTS than HC prior to surgery. PTS was significantly slower post-operatively compared to pre-operative during walking with head turns (B  = –61.03, p  = 0.004), two-minute walk test (B  = –37.33, p  = 0.015), 360° turn (B range from 50.05 to –57.4, p  < 0.05) and complex turning course (CTC) at the trunk (B  = –18.63, p  = 0.009). Post-treatment PTS was significantly faster than pre-operative during CTC at the head (B  = 18.46, p  = 0.014) and trunk (B  = 15.99, p  = 0.023). CONCLUSION: PwVS may have turning deficits prior to surgical resection. PTS was significantly affected post-operatively, however improved with rehabilitation. Show more

Keywords: Vestibular schwannoma, vestibular rehabilitation, wearable sensors, turning, turn speed

DOI: 10.3233/VES-230097

Citation: Journal of Vestibular Research, vol. 34, no. 2-3, pp. 145-157, 2024

Authors: Elyoseph, Zohar | Geisinger, Dario | Zaltzman, Roy | Mintz, Matti | Gordon, Carlos R.

Article Type: Research Article

Abstract: BACKGROUND: Machado Joseph Disease (MJD) is an autosomal dominant neurodegenerative disease. In previous studies, we described significant bilateral horizontal Vestibulo-Ocular Reflex (VOR) deficit within this population without any reference to the presence of vestibular symptomatology. OBJECTIVE: To evaluate whether, beyond cerebellar ataxia complaints, MJD patients have typical vestibular symptomatology corresponding to the accepted diagnostic criteria of Bilateral Vestibulopathy (BVP) according to the definition of the International Barany Society of Neuro-Otology. METHODS: Twenty-one MJD, 12 clinically stable chronic Unilateral Vestibulopathy (UVP), 15 clinically stable chronic BVP, and 22 healthy Controls underwent the video Head Impulse Test (vHIT) …evaluating VOR gain and filled out the following questionnaires related to vestibular symptomatology: The Dizziness Handicap Inventory (DHI), the Activities-specific Balance Confidence Scale (ABC), the Vertigo Visual Scale (VVS) and the Beck Anxiety Inventory (BAI). RESULTS: The MJD group demonstrated significant bilateral vestibular impairment with horizontal gain less than 0.6 in 71% of patients (0.54±0.17). Similar to UVP and BVP, MJD patients reported a significantly higher level of symptoms than Controls in the DHI, ABC, VVS, and BAI questionnaires. CONCLUSIONS: MJD demonstrated significant VOR impairment and clinical symptoms typical of BVP. We suggest that in a future version of the International Classification of Vestibular Disorders (ICVD), MJD should be categorized under a separate section of central vestibulopathy with the heading of bilateral vestibulopathy. The present findings are of importance regarding the clinical diagnosis process and possible treatment based on vestibular rehabilitation. Show more

Keywords: Cerebellum, Machado-Joseph Disease, Spinocerebellar Ataxia type 3, Vestibular, Dizziness Handicap Inventory, Bilateral Vestibulopathy.

DOI: 10.3233/VES-230038

Citation: Journal of Vestibular Research, vol. 34, no. 2-3, pp. 159-167, 2024