Off-center yaw rotation: effect of naso-occipital linear acceleration on the nystagmus response of normal human subjects and patients after unilateral vestibular loss

Low-intensity ultrasound activates vestibular otolith organs through acoustic radiation force

The present study examined the efficacy of 5 MHz low-intensity focused ultrasound (LiFU) as a stimulus to remotely activate inner ear vestibular otolith organs. The otolith organs are the primary sensory apparati responsible for detecting orientation of the head relative to gravity and linear acceleration in three-dimensional space. These organs also respond to loud sounds and vibration of the temporal bone. The oyster toadfish, Opsanus tau, was used to facilitate unobstructed acoustic access to the otolith organs in vivo. Single-unit responses to amplitude-modulated LiFU were recorded in afferent neurons identified as innervating the utricle or the saccule. Neural responses were equivalent to direct mechanical stimulation, and arose from the nonlinear acoustic radiation force acting on the otolithic mass. The magnitude of the acoustic radiation force acting on the otolith was measured ex vivo. Results demonstrate that LiFU stimuli can be tuned to mimic directional forces occurring naturally during physiological movements of the head, loud air conducted sound, or bone conducted vibration.

Clinical Characteristics of Patients With Abnormal Ocular/Cervical Vestibular Evoked Myogenic Potentials in the Presence of Normal Caloric Responses

Objective:

To investigate the clinical features and vestibular symptoms of patients with abnormal ocular vestibular evoked myogenic potentials (oVEMPs) and/or cervical VEMPs (cVEMPs) in the presence of normal caloric responses.

Study Design:

Retrospective chart review.

Setting:

Tertiary referral center.

Methods:

One thousand five hundred twenty-one consecutive patients with balance problems who underwent the caloric, cVEMP, and oVEMP tests were included, and patients who showed abnormal oVEMPs and/or cVEMPs in the presence of normal caloric responses were selected. Clinical characteristics, diagnoses, and vestibular symptoms of the patients were analyzed.

Results:

Of the 1521 patients, 227 (15%) were found to have abnormal oVEMPs and/or cVEMP responses with normal caloric responses. Benign paroxysmal positional vertigo (BBPV), Meniere’s disease, and vestibular migraine were the common diagnoses of these patients. Eighty-one patients (36%) could not be diagnosed with a recognizable disease. Multiple episodes of spinning vertigo with a duration of seconds to hours were their most common vestibular symptoms.

Conclusion:

BPPV, Meniere’s disease, and vestibular migraine are the most frequent diagnoses showing abnormal oVEMP and/or cVEMPs without canal paresis. Apart from these clinical entities, a portion of undiagnosed patients with multiple episodes of vertigo might have a disease that involves the otolith organs only.

Perception of tilt and ocular torsion of vestibular patients during eccentric rotation

Four patients following unilateral vestibular loss and four patients complaining of otolith-dependent vertigo were tested during eccentric yaw rotation generating 1 x g centripetal acceleration directed along the interaural axis. Perception of body tilt in roll and in pitch was recorded in darkness using a somatosensory plate that the subjects maintained parallel to the perceived horizon. Ocular torsion was recorded by a video camera. Unilateral vestibular-defective patients underestimated the magnitude of the roll tilt and had a smaller torsion when the centrifugal force was towards the operated ear compared to the intact ear and healthy subjects. Patients with otolithic-dependent vertigo overestimated the magnitude of roll tilt in both directions of eccentric rotation relative to healthy subjects, and their ocular torsion was smaller than in healthy subjects. Eccentric rotation is a promising tool for the evaluation of vestibular dysfunction in patients. Eye torsion and perception of tilt during this stimulation are objective and subjective measurements, which could be used to determine alterations in spatial processing in the CNS.

Bayesian processing of vestibular information

Complex self-motion stimulations in the dark can be powerfully disorienting and can create illusory motion percepts. In the absence of visual cues, the brain has to use angular and linear acceleration information provided by the vestibular canals and the otoliths, respectively. However, these sensors are inaccurate and ambiguous. We propose that the brain processes these signals in a statistically optimal fashion, reproducing the rules of Bayesian inference. We also suggest that this processing is related to the statistics of natural head movements. This would create a perceptual bias in favour of low velocity and acceleration. We have constructed a Bayesian model of self-motion perception based on these assumptions. Using this model, we have simulated perceptual responses to centrifugation and off-vertical axis rotation and obtained close agreement with experimental findings. This demonstrates how Bayesian inference allows to make a quantitative link between sensor noise and ambiguities, statistics of head movement, and the perception of self-motion.

Testing utricular function by means of on-axis rotation

CONCLUSIONS

Subjective visual vertical (SVV) estimation during on-axis rotation provides an efficient screening test of utricle function. The survey demonstrates that isolated disorders of peripheral utricular function can occur while SCC function appears normal.

OBJECTIVE

The present study aimed to investigate estimation of SVV during constant velocity yaw rotation (with the head held on-axis--to enhance any asymmetry between right and left utricular responses), as a useful screening test.

MATERIALS AND METHODS

In all, 230 patients were recruited from the dizziness clinic. For each patient, the SVV was estimated (a) while held stationary, and (b) during constant angular velocity (240 degrees/s), with the head centred on-axis. Bithermal caloric testing was also performed in 201 of the patients.

RESULTS

Of those patients with normal SVV results during stationary testing, 18.3% were pathological during rotation testing. In those cases with pathological SVV during stationary testing, a significantly greater deviation from the norm was observed during rotation (p<0.001). Of those patients with normal caloric responses, 44.4% showed pathological SVV estimates; this increased to 54.3% for cases with unilateral weakness, and 56.5% for unilateral loss. No clear correlation was found between reports of tilt illusion and pathological SVV, respectively, between rotatory vertigo and pathological caloric responses.

Short latency responses in the averaged electro-oculogram elicited by vibrational impulse stimuli applied to the skull: could they reflect vestibulo-ocular reflex function?

OBJECTIVES

To investigate whether vibrational impulse stimuli applied to the skull can be used to evoke the vestibulo-ocular reflex (VOR) and detect vestibular lesions.

METHODS

Twenty four patients with unilateral vestibular loss (UVD), five with bilateral vestibular loss, two with ocular palsies, and 10 healthy subjects participated. Vibrations of the skull were induced with head taps and with a single period of 160 Hz tone burst on the inion, vertex, and the mastoids while the patients viewed a distant target. Several patients were also examined while viewing a near target, with eccentric gaze and in tilted postures. Responses were recorded by EOG.

RESULTS

Responses occurred between 5 ms and 20 ms and seemed to be compensatory to the second phase of the sine wave of vibration impulse and were greatly diminished/absent in patients with bilateral VD and ocular palsies. The patients with UVD had asymmetrical responses in the vertical EOG with stimuli applied on the inion and vertex, with enhancement of the response amplitude on the side of vestibular loss and/or diminution on the healthy side. The asymmetry ratios between the healthy subjects and patients with UVD, and among patients with UVD were statistically significant. Some gaze and positional influences could be demonstrated consistent with otolithic reflexes.

CONCLUSION

If the asymmetric responses to skull vibration in UVD result from passive oscillatory movements of the orbital tissues they may reflect the otolith mediated sustained skew torsion. Conversely, if generated by active eye movements, their likely origin is a phasic VOR.

Centrifugation as a countermeasure during actual and simulated microgravity: a review

This paper summarizes what has been learned from studies of the effects of artificial gravity generated by centrifugation in actual and simulated weightless conditions. The experience of artificial gravity during actual space flight in animals and humans are discussed. Studies using intermittent centrifugation during bed rest and water immersion, as a way to maintain orthostatic tolerance and exercise capacity, are reviewed; their results indicate that intermittent centrifugation is a potential countermeasure for maintaining the integrity of these physiological functions in extended space missions. These results can help set guidelines for future experiments aimed at validating the regimes of centrifugation as a countermeasure for space missions. Current and future research projects using artificial gravity conditions in humans are discussed.

Otolith function: basis for modern testing

The major challenge in developing a robust test of otolith function, particularly with regard to linear vestibulo-ocular reflex (LVOR) and perceptual measures, is to find a way in which graded lesions are reflected in graded response properties and abnormalities. The ability of the vestibulo-ocular reflex (VOR) to compensate and adapt to dysfunction and pathology presents formidable challenges for registering localizing clinical findings, whether in the angular vestibulo-ocular reflex (AVOR), the LVOR, or both. Based on a variety of considerations, various forms of eccentric rotation seem to provide the most convenient, and potentially the most useful, means to generate motion profiles from which otolith function can be directly assessed. Both translational and tilt responses can be recorded depending on the stimulus profile. The near-centric version is particularly enticing because of the ability to study one labyrinth at a time, much like calorics. In that case and in others in which the tilt-LVOR is prominent, measures of the perceived visual vertical are useful and by all accounts similar to ocular torsion. The latter does hold the important advantage of being an objective measure, requiring no intervention on the part of the patient. The translational-LVOR can be derived from eccentric rotation responses with the head displaced forward as well as backward, while viewing near targets in hopes of generating a large addition or subtraction (even inversion) of an otherwise AVOR-driven reflex. These considerations provide an impetus to pursue improved methods of quantifying otolith function in a clinical population. The sobering caveat is that the diagnosis of total unilateral vestibular loss presents little challenge either clinically or by classic testing (e.g., calorics), and yet most of our efforts in developing quantifiable measures of dysfunction over the years have yielded results that are modest and hardly compelling.

Neural processing of gravitoinertial cues in humans. III. Modeling tilt and translation responses

All linear accelerometers measure gravitoinertial force, which is the sum of gravitational force (tilt) and inertial force due to linear acceleration (translation). Neural strategies must exist to elicit tilt and translation responses from this ambiguous cue. To investigate these neural processes, we developed a model of human responses and simulated a number of motion paradigms used to investigate this tilt/translation ambiguity. In this model, the separation of GIF into neural estimates of gravity and linear acceleration is accomplished via an internal model made up of three principal components: 1) the influence of rotational cues (e.g., semicircular canals) on the neural representation of gravity, 2) the resolution of gravitoinertial force into neural representations of gravity and linear acceleration, and 3) the neural representation of the dynamics of the semicircular canals. By combining these simple hypotheses within the internal model framework, the model mimics human responses to a number of different paradigms, ranging from simple paradigms, like roll tilt, to complex paradigms, like postrotational tilt and centrifugation. It is important to note that the exact same mechanisms can explain responses induced by simple movements as well as by more complex paradigms; no additional elements or hypotheses are needed to match the data obtained during more complex paradigms. Therefore these modeled response characteristics are consistent with available data and with the hypothesis that the nervous system uses internal models to estimate tilt and translation in the presence of ambiguous sensory cues.

Molecular mechanisms of recovery from vestibular damage in mammals: recent advances

The aim of this review is to summarise and critically evaluate studies of vestibular compensation published over the last 2 years, with emphasis on those concerned with the molecular mechanisms of this process of lesion-induced plasticity. Recent studies of vestibular compensation have confirmed and extended the previous findings that: (i) compensation of the static ocular motor and postural symptoms occurs relatively rapidly and completely compared to the dynamic symptoms, many of which either do not compensate substantially or else compensate variably due to sensory substitution and the development of sensori-motor strategies which suppress or minimize symptoms; (ii) static compensation is associated with, and may be at least partially caused by a substantial recovery of resting activity in the ipsilateral vestibular nucleus complex (VNC), which starts to develop very quickly following the unilateral vestibular deafferentation (UVD) but does not correlate perfectly with the development of some aspects of static compensation (e.g., postural compensation); and (iii) many complex biochemical changes are occurring in the VNC, cerebellum and even areas of the central nervous system like the hippocampus, following UVD. However, despite many recent studies which suggest the importance of excitatory amino acid receptors such as the N-methyl-D-aspartate receptor, expression of immediate early gene proteins, glucocorticoids, neurotrophins and nitric oxide in the vestibular compensation process, how these various factors are linked and which of them may have a causal relationship with the physiological changes underlying compensation, remains to be determined.

Dynamic asymmetry of the vestibulo-ocular reflex in unilateral peripheral vestibular and cochleovestibular loss

OBJECTIVE

Rotatory tests in the horizontal plane have shown various degrees of vestibulo-ocular reflex (VOR) asymmetry in patients after surgical deafferentation of one labyrinth. The purpose of this work was to characterize dynamic horizontal VOR responses among patients presenting with a unilateral peripheral labyrinthine deficit of nonsurgical origin and to compare results in isolated vestibular loss versus cochleovestibular loss.

STUDY DESIGN

This study included 40 patients who presented with an acute, spontaneous unilateral peripheral labyrinthine lesion. Twenty-two patients had vestibular loss alone (without associated hearing impairment) and 18 presented with a cochleovestibular deficit (sudden hearing loss with vertigo). The majority of these patients were part of a long-term protocol to evaluate vestibular compensation.

METHODS

All patients underwent both the clockwise test and the counterclockwise rotatory test in the horizontal plane, using brief impulses of moderate intensity. Results were analyzed by a simplified model of vestibular function, allowing a parametric estimation of the response.

RESULTS

A weak and transitory horizontal VOR asymmetry was observed in the 22 patients with vestibular loss. However, the 18 patients with cochleovestibular loss demonstrated a more severe and persistent asymmetry.

CONCLUSIONS

This study revealed a difference in the dynamic characteristics of the horizontal VOR between patients with vestibular loss and those with cochleovestibular loss. Our results support the presence of an extensive labyrinthine lesion in cochleovestibular deficit that involves the otolith organs. The implications of this involvement on the central mechanisms of otolith-canal interaction are discussed.