1
|
Kirbac A, Kaya E, Incesulu SA, Carman KB, Yarar C, Ozen H, Pinarbasli MO, Gurbuz MK. Differentiation of peripheral and non-peripheral etiologies in children with vertigo/dizziness: The video-head impulse test and suppression head impulse paradigm. Int J Pediatr Otorhinolaryngol 2024; 179:111935. [PMID: 38574650 DOI: 10.1016/j.ijporl.2024.111935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/14/2024] [Accepted: 03/26/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVES To identify the etiology of vertigo/dizziness and determine the effectiveness of the video-head impulse test (vHIT) and the suppression head impulse paradigm (SHIMP) tests in distinguishing between peripheral and non-peripheral etiologies in children who presented to the otolaryngology department with complaints of vertigo/dizziness. METHODS The vHIT and SHIMP tests were applied to the children. The vestibulo-ocular reflex (VOR) gain and saccade parameters were compared. RESULTS In 27 children presenting with vertigo/dizziness, the most common etiological factor was inner ear malformation (IEM) (n = 6/27, 22.2%), followed by cochlear implant surgery (11.1%) and migraine (11.1%). Vestibular hypofunction was indicated by the vHIT results at a rate of 60% (9/15 children) and SHIMP results at 73.3% (11/15 children) among the children with a peripheral etiology, while these rates were 8.3% (1/12 children) and 25% (3/12 children), respectively, in the non-peripheral etiology group. SHIMP-VOR and vHIT-VOR gain values had a moderate positive correlation (p = 0.01, r = 0.349). While there were overt/covert saccades in the vHIT, anti-compensatory saccade (ACSs) were not observed in the SHIMP test (p = 0.041). The rates of abnormal vHIT-VOR gain (p = 0.001), over/covert saccades (p = 0.019), abnormal vHIT response (p = 0.014), ACSs (p = 0.001), and abnormal SHIMP response (p = 0.035) were significantly higher in the peripheral etiology group. CONCLUSIONS IEM was the most common etiological cause, and the rate of vestibular hypofunction was higher in these children with peripheral vertigo. vHIT and SHIMP are effective and useful vestibular tests for distinguishing peripheral etiology from non-peripheral etiology in the pediatric population with vertigo/dizziness. These tests can be used together or alone, but the first choice should be the SHIMP test, considering its short application time (approximately 4-5 min) and simplicity.
Collapse
Affiliation(s)
- Arzu Kirbac
- Eskişehir Osmangazi University, Faculty of Health Sciences, Department of Audiology, 26480, Eskisehir, Turkiye.
| | - Ercan Kaya
- Eskişehir Osmangazi University, Faculty of Medicine, Department of Otolaryngology, 26480, Eskisehir, Turkiye
| | - Saziye Armagan Incesulu
- Eskişehir Osmangazi University, Faculty of Medicine, Department of Otolaryngology, 26480, Eskisehir, Turkiye
| | - Kursat Bora Carman
- Eskişehir Osmangazi University, Faculty of Medicine, Department of Pediatric Neurology, 26480, Eskisehir, Turkiye
| | - Coskun Yarar
- Eskişehir Osmangazi University, Faculty of Medicine, Department of Pediatric Neurology, 26480, Eskisehir, Turkiye
| | - Hulya Ozen
- University of Health Sciences, Gulhane Faculty of Medicine, Department of Medical Informatics, 06018 Ankara, Turkiye
| | - Mehmet Ozgur Pinarbasli
- Eskişehir Osmangazi University, Faculty of Medicine, Department of Otolaryngology, 26480, Eskisehir, Turkiye
| | - Melek Kezban Gurbuz
- Eskişehir Osmangazi University, Faculty of Medicine, Department of Otolaryngology, 26480, Eskisehir, Turkiye
| |
Collapse
|
2
|
Manzari L, Perez-Fernandez N, Tramontano M. Editorial: Gaze and postural stability rehabilitation. Front Neurol 2022; 13:1034012. [PMID: 36341124 PMCID: PMC9635923 DOI: 10.3389/fneur.2022.1034012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 09/26/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Leonardo Manzari
- MSA ENT Academy Center, Cassino, Italy
- *Correspondence: Leonardo Manzari
| | | | - Marco Tramontano
- Fondazione Santa Lucia IRCCS, Rome, Italy
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Rome, Italy
| |
Collapse
|
3
|
Manzari L, Orejel Bustos AS, Princi AA, Tramontano M. Video Suppression Head Impulses and Head Impulses Paradigms in Patients with Vestibular Neuritis: A Comparative Study. Healthcare (Basel) 2022; 10:healthcare10101926. [PMID: 36292373 PMCID: PMC9601449 DOI: 10.3390/healthcare10101926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/13/2022] [Accepted: 09/27/2022] [Indexed: 11/04/2022] Open
Abstract
Background: This study aims to explore the clinical relevance of the Suppression Head Impulse Paradigm (SHIMP) to better understand if it represents an additional clinical value compared to the Head Impulse Paradigm (HIMP) in patients with vestibular neuritis (VN) in different stages of the disease. Methods: From January 2020 to June 2022, patients with unilateral VN were found in a database of an ENT vestibular clinic. Clinical presentation, vestibular test outcomes, therapy, and recovery were examined in medical records. Results: A total of 42 patients (16 Females, mean age 51.06 ± 12.96; 26 Male, mean age 62.50 ± 9.82) met the inclusion criteria and were enrolled in the study. The means of the VOR gain for both paradigms were respectively 0.38 ± 0.12 (SHIMP) and 0.46 ± 0.13 (HIMP) at T0 and 0.55 ± 0.20 (SHIMP) and 0.64 ± 0.19 (HIMP) at T1 for the lesional side. For the HIMP, the gain value <0.76 identified the affected side of VN with 100% sensitivity (92−100) and 100% specificity (91−100). For the SHIMP, the gain value <0.66 identified the affected side of VN with 100% sensitivity (92−100) and 100% specificity (91−100) and an AUC of 1.0 (0.96−1.0, p < 0.0001). Conclusion: The SHIMP paradigm has a diagnostic accuracy equal to the classic HIMP paradigm in patients with VN. The assessment of VOR slow phase velocity and vestibulo-saccadic interaction in patients with VN could be easier with the use of the SHIMPs paradigm. SHIMPs paradigm provides helpful information about the evaluation of VOR slow phase velocity and vestibulo-saccadic interaction as new recovery strategies in patients with VN.
Collapse
Affiliation(s)
| | - Amaranta Soledad Orejel Bustos
- Fondazione Santa Lucia IRCCS, 00179 Rome, Italy
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy
| | | | - Marco Tramontano
- Fondazione Santa Lucia IRCCS, 00179 Rome, Italy
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy
| |
Collapse
|
4
|
The Clinical Use of the Suppression Head Impulse Paradigm in Patients with Vestibulopathy: A Systematic Review. Healthcare (Basel) 2022; 10:healthcare10071182. [PMID: 35885709 PMCID: PMC9320756 DOI: 10.3390/healthcare10071182] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/23/2022] [Accepted: 06/23/2022] [Indexed: 11/16/2022] Open
Abstract
Background: This review aims to explore the potential clinical application of the suppression head impulse paradigm (SHIMP) in patients with unilateral and bilateral vestibulopathy. Methods: An electronic search was conducted by two independent reviewers in the following databases: Embase, MEDLINE (PubMed), and Scopus. The screening of titles, abstracts, and full texts and data extraction were undertaken independently by pairs of reviewers. The included studies were quality appraised using a modified version of the Newcastle–Ottawa Scale. Results: The results were reported following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Our search yielded 935 unique records, of which 16 remained after screening titles and abstracts. A total of 11 studies were included, covering a total of 418 participants (230 patients and 188 healthy participants). Conclusion: SHIMP could be a useful tool to diagnose a VOR alteration in patients with vestibulopathy in both the acute and chronic phases of vestibulopathy.
Collapse
|
5
|
The feasibility of SHIMP for judging subjective vertigo and recovery in patients with vestibular neuritis. Eur Arch Otorhinolaryngol 2022; 279:3211-3217. [PMID: 35296947 DOI: 10.1007/s00405-022-07299-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 02/03/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE We aimed to study the results of the head impulse paradigm (HIMP) and the suppression head impulse paradigm (SHIMP) in patients with acute vestibular neuritis (AVN) to compare dizziness handicap inventory (DHI) scores before and after treatment. We also wanted to investigate the correlation between the HIMP, SHIMP and DHI score and to analyze the factors that affect the recovery with AVN in the short term. METHODS The HIMP, SHIMP, and DHI score were assessed in 20 patients with AVN before (T0) and after treatment (T1). We collected the following indicators: T0, T1-HIMP VOR gain; T0, T1-SHIMP VOR gain; the percentage of the anti-compensatory saccades of T0-SHIMP and T1-SHIMP on the affected side; T0-DHI score, T1-DHI score; and efficacy index (EI). The correlation between HIMP and SHIMP parameters with the DHI score and EI was analyzed, and the factors that affect the recovery of patients with AVN were assessed. RESULTS T0-SHIMP anti-compensatory saccades (%),T1-SHIMP VOR gain, and T1-SHIMP anti-compensatory saccades (%) were significantly correlated with the corresponding DHI score and EI (P < 0.05). T0, T1-HIMP VOR gain and T0-SHIMP VOR gain had no correlation with the corresponding DHI score and EI (P > 0.05). T0-SHIMP anti-compensatory saccades (%) significantly affect EI (P < 0.05). CONCLUSION Both HIMP and SHIMP can assess the current vestibular function and recovery of AVN patients, but SHIMP can more accurately reflect the degree of subjective vertigo. At the same time, T0-SHIMP anti-compensatory saccades (%) can be used as a good index to evaluate the short-term recovery of AVN patients.
Collapse
|
6
|
The clinical course of vestibular neuritis from the point of view of the ocular vestibular evoked myogenic potential. The Journal of Laryngology & Otology 2022; 136:129-136. [DOI: 10.1017/s0022215122000081] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackgroundStudying otolith functions after unilateral vestibular neuritis using ocular vestibular-evoked myogenic potentials and subjective visual vertical tests could give different results.MethodA total of 39 patients underwent a vestibular assessment that included the Dizziness Handicap Inventory and horizontal and vertical semicircular canal function testing with video head impulse testing, ocular vestibular-evoked myogenic potential testing, cervical vestibular-evoked myogenic potentials and subjective visual vertical testing.ResultsAll patients showed a significant alteration (asymmetry ratio more than 40 per cent) for ocular vestibular-evoked myogenic potentials as well as for subjective visual vertical testing (more than −2° to more than +2°) during the acute phase, whereas after 72 hours from the acute vertigo attack normal values (asymmetry ratio less than 40 per cent) were found in 6 out of 39 patients for ocular vestibular-evoked myogenic potentials and 36 out of 39 for the subjective visual vertical (less than −2° to less than +2°).ConclusionOcular vestibular-evoked myogenic potentials are the most suitable test to evaluate otolith functions in patients with unilateral vestibular neuritis in the acute and sub-acute phase.
Collapse
|
7
|
Maheu M, Nooristani M, Hullar TE, Peterka RJ. Influence of predictability on saccade timing in a head impulse VOR suppression task. Exp Brain Res 2022; 240:601-610. [PMID: 34989814 DOI: 10.1007/s00221-021-06302-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/29/2021] [Indexed: 11/26/2022]
Abstract
Gaze stabilization performance has been shown to be influenced differently when the head is either passively or actively moved in normal healthy participants. However, for a visual fixation suppression task, it remains unknown if the pattern of coordinated head and eye movement is influenced differently by passive or active head movements. We used a suppression head impulse paradigm (SHIMP), where the subject's goal was to maintain gaze stabilized on a visual target that moved with the head during rapid impulsive head movements, to evaluate gaze fixation performance in three conditions: (1) passive-unpredictable where the examiner applied impulsive head yaw rotations with random timing and direction, (2) passive-predictable where the direction of head rotation was announced and then the examiner repeatedly applied impulses in the same direction, and (3) active where the test subject self-generated their head movements. Thirteen young healthy adults performed all three conditions to assess the percentage of early saccades that initiated the gaze shift toward the final visual target position and the latency of first saccades. Early saccades were defined as those occurring within the duration of the head impulse. Results showed that active head impulses generated the greatest percentage of early saccades, followed by predictable and unpredictable. Among the two passive conditions, predictability shortened the first saccade onset latencies. Active condition onset latencies were shorter than in either of the passive conditions, showing a consistent head-leads-eye pattern defining a specific behavioral pattern that could vary across patient groups leading to insights into central neural mechanisms that control eye-head coordination.
Collapse
Affiliation(s)
- Maxime Maheu
- Faculty of Medicine, School of Speech-Language and Audiology, University of Montreal, Succursale Centre-Ville, 7077 Avenue du Parc, bureau 3001-42, C.P. 6128, Montreal, QC, H3C 3J7, Canada.
- Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal (IURDPM), Pavillon Laurier, CIUSSS du Centre-Sud-de-L'Île-de-Montréal, Montréal, Canada.
| | - Mujda Nooristani
- Faculty of Medicine, School of Speech-Language and Audiology, University of Montreal, Succursale Centre-Ville, 7077 Avenue du Parc, bureau 3001-42, C.P. 6128, Montreal, QC, H3C 3J7, Canada
- Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal (IURDPM), Pavillon Laurier, CIUSSS du Centre-Sud-de-L'Île-de-Montréal, Montréal, Canada
| | - Timothy E Hullar
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR, 97239, USA
- National Center for Rehabilitative Auditory Research-VA Portland Health Care System, Portland, OR, 97239, USA
| | - Robert J Peterka
- Department of Neurology, Oregon Health and Science University, Portland, OR, 97239, USA
- National Center for Rehabilitative Auditory Research-VA Portland Health Care System, Portland, OR, 97239, USA
| |
Collapse
|
8
|
Chen F, Chen Z, Zhang Y, Wei X, Zhao H, Hu J, Cheng Y, Ren X, Zhang Q. Association Analysis of HIMP and SHIMP Quantitative Parameters in Patients With Vestibular Neuritis and Healthy Participants. Front Neurol 2021; 12:748990. [PMID: 34777221 PMCID: PMC8579954 DOI: 10.3389/fneur.2021.748990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The Head Impulse Paradigm (HIMP) and Suppression Head Impulse Paradigm (SHIMP) are objective, quantitative methods that directly test the vestibulo-ocular reflex (VOR) and are increasingly becoming a standard in evaluating patients with vestibular disorders. Objective: The main objective was to assess the correlations between HIMP and SHIMP parameters in patients with superior vestibular neuritis (VN) and healthy participants. Additionally, the correlations between the parameters of each method were analyzed. Methods: A retrospective cohort, non-randomized study was designed. HIMP and SHIMP were performed on 40 patients with VN and 20 healthy participants (40 ears). HIMP and SHIMP parameters were measured and calculated. Pearson's or Spearson's correlations were used to establish the associations among them. Results: A strong positive correlation was found between HIMP and SHIMP gain (Pearson's r = 0.957, p = 0.000), while strong negative correlations were detected between HIMP and SHIMP saccade amplitudes (r = -0.637, p = 0.000) and percentages of overt saccades (r = -0.631, p = 0.000). In HIMP, strong and moderate positive correlations were identified between gain and saccade amplitude (R 2 = 0.726, p = 0.000) and gain and saccade percentage (R 2 = 0.558, p = 0.000), respectively. By contrast, an extremely weak positive correlation was observed between gain and latency (R 2 = 0.053, p = 0.040). In SHIMP, strong and moderate positive correlations were found between gain and saccade percentage (R 2 = 0.723, p = 0.000) and gain and saccade amplitude (R 2 = 0.525, p = 0.000), respectively, but no correlation was detected between gain and latency (R 2 = 0.006, p = 0.490). Conclusions: HIMP and SHIMP-related parameters were highly correlated (inter-method). Within each method (intra-method), moderate to strong correlations in VOR assessment were observed. These results further contribute to our understanding of the relationship between HIMP and SHIMP as well as to the diagnosis.
Collapse
Affiliation(s)
- Feiyun Chen
- Department of Otorhinolaryngology Head and Neck Surgery, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zichen Chen
- Department of Otorhinolaryngology Head and Neck Surgery, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yuzhong Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xinyu Wei
- Department of Otorhinolaryngology Head and Neck Surgery, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Huandi Zhao
- Department of Otorhinolaryngology Head and Neck Surgery, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Juan Hu
- Department of Otorhinolaryngology Head and Neck Surgery, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ying Cheng
- Department of Otorhinolaryngology Head and Neck Surgery, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiaoyong Ren
- Department of Otorhinolaryngology Head and Neck Surgery, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qing Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Otorhinolaryngology Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| |
Collapse
|
9
|
Tramontano M, Princi AA, De Angelis S, Indovina I, Manzari L. Vestibular rehabilitation in patients with persistent postural-perceptual dizziness: a scoping review. HEARING, BALANCE AND COMMUNICATION 2021. [DOI: 10.1080/21695717.2021.1975986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Marco Tramontano
- Fondazione Santa Lucia IRCCS, Rome, Italy
- Department of Movement, Human and Health Sciences, Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, University of Rome ‘Foro Italico’, Roma, Italy
| | | | | | - Iole Indovina
- Fondazione Santa Lucia IRCCS, Rome, Italy
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | | |
Collapse
|
10
|
Milkov M. Recent advances in the diagnosis of some common vestibular disorders. SCRIPTA SCIENTIFICA MEDICA 2021; 53:21. [DOI: 10.14748/ssm.v0i0.7999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
|
11
|
Manzari L, Princi AA, De Angelis S, Tramontano M. Clinical value of the video head impulse test in patients with vestibular neuritis: a systematic review. Eur Arch Otorhinolaryngol 2021; 278:4155-4167. [PMID: 33893851 DOI: 10.1007/s00405-021-06803-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 04/07/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE The aim of this systematic review was to evaluate the clinical application potential of the video head impulse test (vHIT) in diagnosing vestibular neuritis (VN). METHODS An electronic search was conducted in the following databases: Embase, MEDLINE, ScienceDirect, Google scholar, and the Cochrane Database of Systematic Reviews. Clinical studies were included in which an evaluation was made using vHIT either alone or in combination with other tests or bedside algorithms. Evaluations that were carried out using unvalidated tools were excluded. Only studies of patients with VN (superior, inferior, or in toto) were included. Screening of titles, abstracts, full texts, and data extraction were undertaken independently by pairs of reviewers. Included studies were quality appraised using a modified version of the Newcastle-Ottawa scale. RESULTS Results were reported according to the preferred reporting items for systematic reviews and meta-analyses. Our search yielded 1309 unique records, 21 of which remained after screening titles and abstracts. Sixteen studies were included, i.e., for a total of 933 patients including 474 patients with a diagnosis of VN. CONCLUSIONS The diagnostic value of vHIT is high for VN, as it is a high-frequency measurement tool. vHIT is a useful complement or alternative to caloric and rotational tests as an indicator of lesions of vestibular canal functioning, especially at the time of onset. This tool can provide useful clues about the clinical progress of recovery from the lesion through the value of the vestibulo ocular reflex gain and the consequent evolution of the saccade pattern, which allows the patient to stabilize vision on the retina.
Collapse
Affiliation(s)
| | | | | | - Marco Tramontano
- Fondazione Santa Lucia IRCCS, Rome, Italy.,Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| |
Collapse
|
12
|
Casani AP, Canelli R, Lazzerini F, Navari E. Prognosis after acute unilateral vestibulopathy: Usefulness of the suppression head impulse paradigm (SHIMP). J Vestib Res 2021; 31:531-540. [PMID: 33814480 DOI: 10.3233/ves-210038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES This cross-sectional study aims to describe the features of the suppression head impulse paradigm (SHIMP) in acute unilateral vestibulopathy (AUV) and to define its role in predicting the recovery of patients. METHODS Thirty patients diagnosed with AUV were retrospectively analyzed. The dizziness handicap inventory score and video head impulse test parameters performed 4-8 weeks from the AUV onset constituted the main outcome measures. Patients with a worse recovery (Group 1) and patients who recovered spontaneously (Group 2) were compared. RESULTS The SHIMP vestibulo-ocular reflex (VOR) gain was statistically significantly lower than the conventional head impulse paradigm (HIMP) VOR gain (P < 0.001). The SHIMP VOR gain was negatively correlated with the DHI (P < 0.001) and was positively correlated with the HIMP VOR gain (P < 0.001) and the SHIMP overt saccades (%) (P < 0.001). Patients with a worse recovery exhibited the following: higher DHI (P < 0.001), lower SHIMP and HIMP VOR gain (P < 0.001 and P = 0.007, respectively), and lower SHIMP and greater HIMP overt saccade prevalence values (P = 0.007 and P = 0.032, respectively). CONCLUSIONS The SHIMP and HIMP help in improving our approach to AUV. SHIMP appears to better identify the extent of the vestibular damage in patient suffering from AUV than HIMP and could provide interesting information about the course of the disease. Particularly, the analysis of SHIMP VOR gain and overt saccade prevalence would provide useful information about the recovery of patients.
Collapse
Affiliation(s)
- Augusto Pietro Casani
- Department of Surgical Pathology, Medical, Molecular and Critical Area, ENT Section, Pisa University Hospital, Pisa, Italy
| | - Rachele Canelli
- Department of Surgical Pathology, Medical, Molecular and Critical Area, ENT Section, Pisa University Hospital, Pisa, Italy
| | - Francesco Lazzerini
- Department of Surgical Pathology, Medical, Molecular and Critical Area, ENT Section, Pisa University Hospital, Pisa, Italy
| | - Elena Navari
- Department of Surgical Pathology, Medical, Molecular and Critical Area, ENT Section, Pisa University Hospital, Pisa, Italy
| |
Collapse
|
13
|
Manzari L, Koch G, Tramontano M. Selective Asymmetry of Ocular Vestibular-Evoked Myogenic Potential in Patients with Acute Utricular Macula Loss. J Int Adv Otol 2021; 17:58-63. [PMID: 33605223 PMCID: PMC7901419 DOI: 10.5152/iao.2020.18012020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 11/02/2020] [Accepted: 11/05/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES We retrospectively evaluated a chart review of 3,525 patients evaluated for any acute disturbance. A total of 1,504 patients with acute vestibular syndrome (AVS) received an instrumental vestibular assessment within 72 h from the onset of the symptoms evaluated using simultaneously a combination of ocular vestibular-evoked myogenic potential (oVEMPs), cervical vestibular-evoked myogenic potential (cVEMPs), video head-impulse test (vHIT), and subjective visual vertical (SVV) were included in this study. MATERIALS AND METHODS A total of 41 patients with AVS that showed a normal horizontal canal function tested with vHIT, a normal cVEMP function, unilaterally reduced or absent oVEMP n10, and an altered SVV were enrolled. RESULTS We found that although these patients referred acute vertigo and presented spontaneous nystagmus, they showed physiological values of vHIT and a normal saccular function, as shown by symmetrical cVEMPs. CONCLUSION Our findings support the hypothesis that a percentage of patients evaluated during an AVS using an instrumental vestibular assessment could present selective utricular macula dysfunction.
Collapse
Affiliation(s)
| | - Giacomo Koch
- Fondazione Santa Lucia IRCCS, Rome, Italy;Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | | |
Collapse
|
14
|
Manzari L, Graziano D, Tramontano M. The Different Stages of Vestibular Neuritis from the Point of View of the Video Head Impulse Test. Audiol Res 2020; 10:31-38. [PMID: 33704148 PMCID: PMC7768365 DOI: 10.4081/audiores.2020.248] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 09/22/2019] [Indexed: 11/22/2022] Open
Abstract
Vestibular neuritis (VN) is one of the most common causes of acute vestibular syndrome (AVS). Quantifying the vestibulo-ocular reflex (VOR) gain by the video Head Impulse Test (vHIT) could provide useful information to diagnose VN. This study aims to retrospectively evaluate the VOR gain values during the acute and subacute stages of the VN and to correlate these values with the patients’ dizziness-related handicap. Medical record of 28 patients with VN were reviewed. Patients were assigned to two groups according to the time since the acute vestibular syndrome (AVS). One group with patients assessed within seventy-two hours since the AVS (AVSg) and one group with patients evaluated from four days to six weeks since the AVS (PAVSg). VOR gain was evaluated in all selected patients and correlated to Dizziness Handicap Inventory (DHI). Significant differences were found in the between-subjects analysis in DHI score (p = 0.000) and in the ipsilesional hVOR gain values (p = 0.001). The correlation analysis showed significant results (p = 0.017) between DHI score (40 ± 16.08) and ipsilesional VOR gain (0.54 ± 0.09) in the PAVSg. Patients evaluated within 72 h since the AVS showed anticompensatory saccades (AcS) turning the head toward the contralesional side. Patients with unilateral Superior VN (SVN) could have dissimilar hVOR gain values and DHI score according to the damage of the VIII pair of cranial nerves. AcS in the contralesional side is a sign of acute phase in patients with unilateral SVN.
Collapse
Affiliation(s)
| | | | - Marco Tramontano
- IRCCS Santa Lucia Foundation, Rome, Italy.,Department of Movement, Human and Health Sciences, University of Rome "Foro Italico",Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, P.zza Lauro de Bosis 15, 00135 Roma, Italy
| |
Collapse
|