1
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Zhang L, Ouyang S, Chen L, Huang H, Ou Y, Tang X. Evaluation of subjective visual vertical and horizontal in patients with acoustic neuroma based on virtual reality. Front Neurosci 2023; 17:1264585. [PMID: 37954872 PMCID: PMC10639117 DOI: 10.3389/fnins.2023.1264585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/16/2023] [Indexed: 11/14/2023] Open
Abstract
Objective To investigate potential differences in absolute deviation values of subjective visual vertical and horizontal between unilateral acoustic neuroma patients and healthy young adults under varying degrees of static head tilt, as well as the impact of proprioception on these values, with the aim of determining the effect of acoustic neuroma on gravity sensory pathway function in patients. Methods We recruited 22 patients diagnosed with unilateral acoustic neuroma and 25 healthy young adults and employed virtual reality technology to assess the absolute deviation values of subjective visual vertical (SVV) and subjective visual horizontal (SVH) under eight different static tilted head positions (Head centered (0° tilt), PdP, Head tilt 15°, 30°, 45° to the left and right), then compare and analyze intergroup differences. Results In the Head-centered position, both SVV and SVH absolute deviated values were significantly higher in the AN group compared to healthy young adults. The AN group exhibited significantly higher absolute deviation values of SVV compared to the healthy group when tilting their head 30° left and right. Additionally, when tilting their heads to the right at 15° and 45° the AN group showed significant increases in SVH absolute deviated values compared to healthy adults. The SVV and SVH absolute deviation values of LAN and SAN groups did not reach statistical significance. The results of the SVV test for PDP position did not show any significant differences among all groups. However, the SVH test revealed that the absolute deviation values of the LAN group was significantly higher than that of healthy individuals. Conclusion Our study shows that the gravity sensing function of patients with unilateral acoustic neuroma is affected to different degrees, however, the degree of gravity sensing function damage of patients has little relationship with tumor size. When acoustic neuroma is larger than 2 cm, the effect of proprioception on patients' SVH outcome is noteworthy. So, we should pay attention to the postoperative follow-up of patients with acoustic neuroma and the evaluation of vestibular rehabilitation effect. Meanwhile, for patients opting for conservative treatment, it is imperative to monitor the dynamic changes in vestibular function and seize timely opportunities for intervention.
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Affiliation(s)
- Lin Zhang
- Department of Otorhinolaryngology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shunlin Ouyang
- Department of Otorhinolaryngology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ling Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Institute of Hearing and Speech-Language Science, Sun Yat-Sen University, Guangzhou, China
| | - Hemei Huang
- The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Yongkang Ou
- Department of Otorhinolaryngology, Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Institute of Hearing and Speech-Language Science, Sun Yat-Sen University, Guangzhou, China
| | - Xiaowu Tang
- Department of Otorhinolaryngology, Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Institute of Hearing and Speech-Language Science, Sun Yat-Sen University, Guangzhou, China
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2
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Grove CR, Klatt BN, Wagner AR, Anson ER. Vestibular perceptual testing from lab to clinic: a review. Front Neurol 2023; 14:1265889. [PMID: 37859653 PMCID: PMC10583719 DOI: 10.3389/fneur.2023.1265889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
Not all dizziness presents as vertigo, suggesting other perceptual symptoms for individuals with vestibular disease. These non-specific perceptual complaints of dizziness have led to a recent resurgence in literature examining vestibular perceptual testing with the aim to enhance clinical diagnostics and therapeutics. Recent evidence supports incorporating rehabilitation methods to retrain vestibular perception. This review describes the current field of vestibular perceptual testing from scientific laboratory techniques that may not be clinic friendly to some low-tech options that may be more clinic friendly. Limitations are highlighted suggesting directions for additional research.
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Affiliation(s)
- Colin R. Grove
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Division of Physical Therapy, Department of Physical Medicine and Rehabilitation School of Medicine, Emory University, Atlanta, GA, United States
| | - Brooke N. Klatt
- Physical Therapy Department, University of Pittsburgh, Pittsburgh, PA, United States
| | - Andrew R. Wagner
- Department of Otolaryngology—Head and Neck Surgery, Ohio State University Wexner Medical Center, Columbus, OH, United States
- School of Health and Rehabilitation Sciences, Ohio State University, Columbus, OH, United States
| | - Eric R. Anson
- Department of Otolaryngology, University of Rochester, Rochester, NY, United States
- Physical Therapy Department, University of Rochester, Rochester, NY, United States
- Department of Neuroscience, University of Rochester, Rochester, NY, United States
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3
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Riera-Tur L, Antúnez-Estudillo E, Montesinos-González JM, Martín-Mateos AJ, Lechuga-Sancho AM. Test-retest of the Subjective Visual Vertical Test performed using a mobile application with the smartphone anchored to a turntable. Eur Arch Otorhinolaryngol 2023; 280:613-621. [PMID: 35838781 DOI: 10.1007/s00405-022-07512-6] [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: 04/19/2022] [Accepted: 06/14/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE The alterations of the Subjective visual vertical test are related to vestibular pathology. Our previously validated method to distinguish between healthy and pathological individuals measures the deviation from the Subjective visual vertical using a mobile application installed on a smartphone fixed to a turntable anchored to the wall. The aim of this study was evaluating the intra-observer reliability of our method in individuals with or without vestibular pathology. METHODS Participants were recruited consecutively. In each individual two measurements with an interval of 2 h were made. Both tests were performed by the same examiner. A total of 91 patients were included in this study, of which 25 were healthy and 66 diseased. Intra-observer reliability was evaluated using the intraclass correlation coefficient (ICC). To assess the clinical accuracy of the measurement, we calculated the standard error of the measurement (SEM) and the minimum detectable change (MDC) with a 95% confidence interval. RESULTS Intra-observer reliability was excellent with an ICC 0.95 (0.92-0.97) in the whole sample, in healthy patients 0.91 (0.80-0.96) and in pathological patients 0.92 (0.87-0.95). The SEM was calculated to be 0.59 for the whole sample (0.26 in the "healthy" group, and 0.67 in the pathological group). Likewise, the sample's MDC was 1.16, being 0.52 and 1.36 for the healthy and the pathological group, respectively. CONCLUSIONS Considering the results, our method presents an excellent intraobserver reliability. Furthermore, changes in deviation greater than 0.52 in healthy individuals and 1.36 in pathological individuals can be considered a real change in deviation.
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Affiliation(s)
- Laura Riera-Tur
- Department of Otolaryngology, Puerta del Mar University Hospital, Av. Ana de Viya 21, 11009, Cádiz, Spain. .,Department of Child and Mother Health and Radiology, Medical School, University of Cádiz, Cádiz, Spain. .,Biomedical Research and Innovation Institute of Cádiz (INiBICA), Cádiz, Spain.
| | - Encarnación Antúnez-Estudillo
- Department of Otolaryngology, Puerta del Mar University Hospital, Av. Ana de Viya 21, 11009, Cádiz, Spain.,Department of Child and Mother Health and Radiology, Medical School, University of Cádiz, Cádiz, Spain.,Biomedical Research and Innovation Institute of Cádiz (INiBICA), Cádiz, Spain
| | - Juan M Montesinos-González
- Department of Otolaryngology, Puerta del Mar University Hospital, Av. Ana de Viya 21, 11009, Cádiz, Spain.,Department of Child and Mother Health and Radiology, Medical School, University of Cádiz, Cádiz, Spain.,Biomedical Research and Innovation Institute of Cádiz (INiBICA), Cádiz, Spain
| | - Antonio J Martín-Mateos
- Department of Otolaryngology, Puerta del Mar University Hospital, Av. Ana de Viya 21, 11009, Cádiz, Spain.,Department of Child and Mother Health and Radiology, Medical School, University of Cádiz, Cádiz, Spain.,Biomedical Research and Innovation Institute of Cádiz (INiBICA), Cádiz, Spain
| | - Alfonso M Lechuga-Sancho
- Department of Otolaryngology, Puerta del Mar University Hospital, Av. Ana de Viya 21, 11009, Cádiz, Spain.,Department of Child and Mother Health and Radiology, Medical School, University of Cádiz, Cádiz, Spain.,Biomedical Research and Innovation Institute of Cádiz (INiBICA), Cádiz, Spain
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4
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Steinberg N, Elias G, Zeev A, Witchalls J, Waddington G. The Function of the Proprioceptive, Vestibular and Visual Systems Following Fatigue in Individuals With and Without Chronic Ankle Instability. Percept Mot Skills 2023; 130:239-259. [PMID: 36138519 DOI: 10.1177/00315125221128634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To maintain postural balance, the proprioceptive, vestibular, and visual systems continuously provide body position and movement data to the central nervous system. In this study, our main aim was to examine, for the first time, the influence of anaerobically or aerobically induced fatigue on these separate functions in persons with and without chronic ankle instability (CAI). We obtained assessments pre- and post-fatigue protocols from 60 physical education students (Mage = 24.3, SD = 3.4) Twenty-seven students had CAI, and 33 students did not have CAI). To measure proprioception, we used the AMEDA device; for vision, we used near point of convergence (NPC); and, for vestibular function, we used subjective visual vertical (SVV). We found a pre-post proprioception (AMEDA) effect in the aerobic group (p < .001), and a visual (NPC) effect in both anaerobic and aerobic participant groups (both p < .001). There were no visual system (NPC) fatigue effect differences among aerobic or anerobic participants who had or did not have CAI (p = .047); there was a significant aerobic fatigue effect on proprioception (AMEDA) (p = .010) that favored participants without CAI. There was a significant interaction effect between time of testing and CAI for visual (NPC) (p = .003) in the aerobic group only. In both the anaerobic and aerobic groups, post-fatigue vestibular function (AMEDA) was significantly lower for those with than those without CAI (anaerobic: p = .030; and aerobic: p =.016). Thus, post-fatigue, participants with CAI showed worse proprioceptive, visual, and vestibular function than those without CAI. Future investigators should further examine each movement sense system in individuals with CAI.
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Affiliation(s)
- Nili Steinberg
- Wingate College of Physical Education and Sports Sciences, 172890Wingate Institute, Netanya, Israel
| | - Gal Elias
- Wingate College of Physical Education and Sports Sciences, 172890Wingate Institute, Netanya, Israel
| | - Aviva Zeev
- Wingate College of Physical Education and Sports Sciences, 172890Wingate Institute, Netanya, Israel
| | - Jeremy Witchalls
- Research Institute for Sport and Exercise, 110446University of Canberra, Canberra, ACT, Australia
| | - Gordon Waddington
- Faculty of Health, 110446University of Canberra, Canberra, ACT, Australia
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5
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Zhao C, Yang Q, Song J. Dynamic changes of otolith organ function before and after repositioning in patients with benign paroxysmal positional vertigo detected by virtual reality auxiliary technology: A cohort study. Front Neurol 2022; 13:1007992. [PMID: 36425796 PMCID: PMC9679621 DOI: 10.3389/fneur.2022.1007992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/17/2022] [Indexed: 11/11/2022] Open
Abstract
Objectives To dynamically investigate otolith function in patients with benign paroxysmal positional vertigo (BPPV) before, after, and 1 month after repositioning, and explore the possible compensation mechanisms. Methods Thirty-six patients confirmed with BPPV (canal lithiasis) treated in our hospital between August 2020 and March 2021, as well as 36 health controls matched for age and gender (normal control group, NC group) were enrolled. For NC group, the virtual reality (VR) auxiliary static subjective visual vertical (SVV), subjective visual horizontal (SVH), and SVV of dynamic unilateral centrifugation (DUC), were measured at inclusion. For the BPPV group, visual analog scale (VAS) was used to assess the vertigo degree, while static SVV, SVH, and DUC were performed before, after, and 1 month after repositioning. First, we compare the deviations of SVV0/SVH0° when the subject's head is in the positive position, and SVV of DUC between BPPV and NC groups before repositioning, after which we compared the deviations in SVV45, SVV90, SVH45, SVH90°, and SVV of DUC between the affected and unaffected sides before repositioning. Finally, paired t-test was used to compare the VAS score, deviations in static SVV0, SVV45, SVV90, SVH0, SVH45, and SVH90°, and deviations in SVV of DUC before, after, and 1 month after repositioning. (Here, 0, 45, and 90° refer to the angle which the center axis of head deviates from the gravity line.) Results SVV0 SVH0°, and SVV of DUC at 120 and 180°/s 0 significantly differed between BPPV and NC group before repositioning. The deviations in SVV45, SVV90, SVH45, SVH90°, and SVV of DUC at 120°/s-2 and 180°/s-4.5 did not significantly differ between bilateral sides in BPPV patients before repositioning. The deviation in SVH90° was significantly lower after repositioning than before. The deviation in SVH45° was significantly higher 1 month after repositioning than before. The deviation angle of SVV of DUC at 180°/s-0 was significantly lower after repositioning than before. The vertigo VAS score of patient with BPPV continued to decrease after repositioning. Conclusion Before repositioning, the otolithic organ function of BPPV patients was obviously impaired, with no significant difference between the healthy and affected ear. After repositioning, there was a transient recovery of otolithic organ dysfunction followed by a sustained decline to similar levels to before repositioning.
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6
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Cheng Y, Zhang Y, Chen F, Chen Z, Xue T, Zhang Q, Xu M. Virtual reality for the measurement of SVV and SVH during static head tilt in healthy adults: a novel vestibular test. Acta Otolaryngol 2022; 142:291-297. [PMID: 35382691 DOI: 10.1080/00016489.2022.2058082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND AND OBJECTIVE Few previous studies have used virtual-reality (VR) technology to measure subjective visual vertical (SVV) and subjective visual horizontal (SVH) during static head tilt (0°, 30°, 45°, 60° and 90°). We propose a novel vestibular test for measuring the normal range of SVV and SVH during static head tilt in healthy adults. METHODS Eighty healthy adults were included in the study. SVV and SVH were calculated in nine head positions. RESULTS With head tilt 90° to the right, SVV skewed to the right, and SVH skewed upward. With head tilt 90° to the left, SVV skewed to the left, and SVH skewed downward. SVV was asymmetrical only at a head tilt of 90°. SVV and SVH were similar at all degrees of head tilt, except for 30° to the right, 45° to the left, and 0°. CONCLUSIONS VR measurements showed that SVV and SVH differed at various degrees of static head tilt. The standardized protocol proposed here may be used to establish a reference range for utricle function when evaluating acute, unilateral vestibular lesions.
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Affiliation(s)
- Ying Cheng
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi’an, China
| | - Yuzhong Zhang
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi’an, China
| | - Feiyun Chen
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi’an, China
| | - Zichen Chen
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi’an, China
| | - Tingting Xue
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi’an, China
| | - Qing Zhang
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi’an, China
- Xinhua Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Xu
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi’an, China
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7
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Truong M, Bester C, Orimoto K, Vartanyan M, Phyland D, MacDougall H, Tari S, Rousset A, Curthoys I, O'Leary S. Cochlear implant surgery and perioperative dizziness is associated with utricular hyperfunction. J Vestib Res 2021; 32:295-304. [PMID: 34459428 DOI: 10.3233/ves-210053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Dizziness is a common perioperative complication after cochlear implantation (CI). To date, the exact cause behind this phenomenon remains unclear. There is recent evidence to suggest that otolith function, specifically utricular, may be affected shortly after CI surgery, however whether these changes are related to patient symptoms has not yet been investigated. OBJECTIVE To determine whether CI surgery and perioperative dizziness is associated with changes on utricular function. METHODS We performed an observational study on patients undergoing routine CI surgery. Utricular function was assessed using the Subjective Visual Vertical (SVV), and perioperative dizziness was determined using a questionnaire. The study followed patients before surgery and then again 1-day, 1-week and 6-weeks after implantation. RESULTS Forty-one adult CI recipients participated in the study. The SVV deviated away from the operated ear by an average of 2.17° a day after implantation, 0.889° 1 week and -0.25° 6 weeks after surgery. Dizziness contributed to a tilt of 0.5° away from the implanted ear. These deviations were statistically significant. CONCLUSIONS CI surgery causes utricular hyperfunction in the operated ear that resolves over 6 weeks. SVV tilts were greater in participants experiencing dizziness, suggesting that utricular hyperfunction may contribute to the dizziness.
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Affiliation(s)
- Michelle Truong
- Department of Surgery, Otolaryngology, University of Melbourne.,Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University
| | - Christo Bester
- Department of Surgery, Otolaryngology, University of Melbourne
| | - Kumiko Orimoto
- Department of Surgery, Otolaryngology, University of Melbourne.,Royal Victorian Eye and Ear Hospital, Melbourne
| | | | - Debra Phyland
- Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University
| | | | - Sylvia Tari
- Royal Victorian Eye and Ear Hospital, Melbourne
| | | | | | - Stephen O'Leary
- Department of Surgery, Otolaryngology, University of Melbourne.,Royal Victorian Eye and Ear Hospital, Melbourne
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8
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Subjective Visual Vertical Evaluation by a Smartphone-based Test-Taking the Phone Out of the Bucket. Otol Neurotol 2021; 42:455-460. [PMID: 33555757 DOI: 10.1097/mao.0000000000002944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To measure the subjective visual vertical (SVV) in patients suffering from peripheral vestibular disorders versus controls, using a smartphone-based test designed to simulate the bucket test, in order to validate it as an available tool for the clinician. STUDY DESIGN Prospective cohort study. SETTING Academic tertiary medical center. PATIENTS Forty-five adult patients were recruited to the study, 25 had vestibular disorders, and 20 did not (controls). INTERVENTION All patients underwent conventional bucket-SVV (b-SVV) and smartphone-based SVV (s-SVV) testing. MAIN OUTCOME MEASURES Correlation and agreement of b-SVV and s-SVV scores in patients with peripheral vestibular disorders compared to controls. RESULTS SVV score in the vestibular disorders group was significantly higher compared to controls in both testing methods (p < 0.001 for b-SVV and p = 0.01 for s-SVV, effect size d = 1.7 for both testing methods). Intragroup correlation was excellent within the study group. Spearman's rank correlation coefficient between b-SVV and s-SVV was 0.902 (p = 0.01). Agreement measurements suggested a greater sensitivity for the b-SVV test, showing a mean difference of 1.088 degree (SD ± 1.77); directionality, however, was preserved. CONCLUSION The smartphone-based test is a valid, simple, and efficient in-office screening tool for assisting in the diagnosis of vestibular disorders.
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9
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Cochrane GD, Christy JB, Kicker ET, Kailey RP, England BK. Inter-rater and test-retest reliability of computerized clinical vestibular tools. J Vestib Res 2021; 31:365-373. [PMID: 33646190 DOI: 10.3233/ves-201522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Clinical vestibular technology is rapidly evolving to improve objective assessments of vestibular function. Understanding the reliability and expected score ranges of emerging clinical vestibular tools is important to gauge how these tools should be used as clinical endpoints. OBJECTIVE The objective of this study was to evaluate inter-rater and test-retest reliability intraclass correlation coefficients (ICCs) of four vestibular tools and to determine expected ranges of scores through smallest real difference (SRD) measures. METHODS Sixty healthy graduate students completed two 1-hour sessions, at most a week apart, consisting of two video head-impulse tests (vHIT), computerized dynamic visual acuity (cDVA) tests, and a smartphone-assisted bucket test (SA-SVV). Thirty students were tested by different testers at each session (inter-rater) and 30 by the same tester (test-retest). ICCs and SRDs were calculated for both conditions. RESULTS Most measures fell within the moderate ICC range (0.50-0.75). ICCs were higher for cDVA in the inter-rater subgroup and higher for vHITs in the test-retest subgroup. CONCLUSIONS Measures from the four tools evaluated were moderately reliable. There may be a tester effect on reliabilities, specifically vHITs. Further research should repeat these analyses in a patient population and explore methodological differences between vHIT systems.
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Affiliation(s)
- Graham D Cochrane
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham AL, USA
| | - Jennifer B Christy
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham AL, USA
| | - Ethan T Kicker
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham AL, USA
| | - Ryan P Kailey
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham AL, USA
| | - Brandon K England
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham AL, USA
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10
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Zabaneh SI, Voss LJ, Szczepek AJ, Olze H, Stölzel K. Methods for Testing the Subjective Visual Vertical during the Chronic Phase of Menière's Disease. Diagnostics (Basel) 2021; 11:diagnostics11020249. [PMID: 33562708 PMCID: PMC7915072 DOI: 10.3390/diagnostics11020249] [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: 01/11/2021] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 12/25/2022] Open
Abstract
The subjective visual vertical (SVV) evaluates the function of the utricle, which, in patients with Menière’s disease (MD), can be affected by endolymphatic hydrops. This study aimed to determine the SVV in MD patients during the chronic phase of illness compared to healthy participants. The second aim was to compare the SVV measurement tools: the analog bucket test, digital bucket test, and C-SVV© goggles. The SVV scores differed significantly between MD patients and the control group for the analog bucket test (p < 0.001) and the C-SVV® goggles (p = 0.028), but no significance was shown when using the digital bucket test (p = 0.062). When comparing the analog bucket test and the C-SVV® goggles applying the calculated threshold (1.125° in analog bucket test, 2.5° in C-SVV® goggles), the bucket test showed higher accuracy (bucket test 73.84%, C-SVV® goggles 69.23%). When examining the influence of betahistine on SVV scores, there were no statistically significant differences in both the analog bucket test and C-SVV© goggles. We conclude that SVV test can be used as an additional tool to evaluate utricle function during the chronic phase of MD and that the analog bucket test produces the most reliable results. The intake of betahistine does not influence the perception of SVV.
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Affiliation(s)
- Samira Ira Zabaneh
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität, Berlin Humboldt Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte, Chariteplatz 1, 10117 Berlin, Germany; (S.I.Z.); (A.J.S.); (H.O.)
| | - Linda Josephine Voss
- Department of Audiology and Phoniatrics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität, Berlin Humboldt Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte, Chariteplatz 1, 10117 Berlin, Germany;
| | - Agnieszka J. Szczepek
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität, Berlin Humboldt Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte, Chariteplatz 1, 10117 Berlin, Germany; (S.I.Z.); (A.J.S.); (H.O.)
| | - Heidi Olze
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität, Berlin Humboldt Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte, Chariteplatz 1, 10117 Berlin, Germany; (S.I.Z.); (A.J.S.); (H.O.)
| | - Katharina Stölzel
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität, Berlin Humboldt Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte, Chariteplatz 1, 10117 Berlin, Germany; (S.I.Z.); (A.J.S.); (H.O.)
- Correspondence:
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11
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Wang CH, Winnick AA, Ko YH, Wang Z, Chang TP. Test-retest reliability of subjective visual vertical measurements with lateral head tilt in virtual reality goggles. Tzu Chi Med J 2021; 33:294-300. [PMID: 34386369 PMCID: PMC8323649 DOI: 10.4103/tcmj.tcmj_207_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/25/2020] [Accepted: 10/07/2020] [Indexed: 11/29/2022] Open
Abstract
Objective: The objective is to investigate the test-retest reliability of subjective visual vertical (SVV) in the upright position and with lateral head tilts through a computerized SVV measuring system using virtual reality (VR) goggles. Materials and Methods: Thirty healthy controls underwent SVV test in upright position, with the head tilted to the right 30°, and with the head tilted to the left 30°. Subjects wore SVV VR goggles, which contained a gyroscope for monitoring the angle of head tilt. Each subject completed 10 adjustments in each head position. The mean value of SVV deviations and SVV imprecision (the intra-individual variability of SVV deviations from the 10 adjustments) were recorded and compared across different head positions. The participants then repeated the same SVV protocol at least 1 week later. The test-retest reliability of SVV deviation and SVV imprecision were analyzed. Results: The SVV deviation (mean ± standard deviation) was 0.22° ± 1.56° in upright position, −9.64° ± 5.91° in right head tilt, and 7.20° ± 6.36° in left head tilt. The test-retest reliability of SVV deviation was excellent in upright position (intra-class correlation coefficient [ICC] = 0.77, P < 0.001), right head tilt (ICC = 0.83, P < 0.001) and left head tilt (ICC = 0.84, P < 0.001). The SVV values from the 10 adjustments made during right and left head tilts were less precise than when measured at upright (P < 0.001). The test-retest reliability of SVV imprecision was poor at upright (ICC = 0.21, P = 0.26) but fair-to-good in right head tilt (ICC = 0.72, P < 0.001) and left head tilt (ICC = 0.44, P = 0.04). Conclusion: The test-retest reliability of SVV deviation during lateral head tilts via VR goggles is excellent, which supports further research into the diagnostic value of head-tilt SVV in various vestibular disorders. In addition, the degree of SVV imprecision during head tilt has fair-to-good test-retest reliability, which suggests SVV imprecision may have clinical applicability.
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Affiliation(s)
- Chia-Han Wang
- Department of Chinese Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Ariel A Winnick
- Soroka University Hospital and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,School of Optometry, University of California, Berkeley, Berkeley, CA, USA
| | - Yu-Hung Ko
- Department of Research, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Zheyu Wang
- Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tzu-Pu Chang
- Department of Neurology, Neuro-Medical Scientific Center, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan.,Department of Neurology, School of Medicine, Tzu Chi University, Hualien, Taiwan
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The Bucket Test Improves Detection of Stroke in Patients With Acute Dizziness. J Emerg Med 2020; 60:485-494. [PMID: 33308916 DOI: 10.1016/j.jemermed.2020.10.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 10/17/2020] [Accepted: 10/22/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND It is challenging to detect posterior circulation strokes in patients presenting to the emergency department (ED) with acute dizziness. The current approach uses a combinatorial head-impulse, nystagmus, and test-of-skew method and is sensitive enough to differentiate central causes from peripheral ones. However, it is difficult to perform and underused. Further, magnetic resonance imaging (MRI) of the brain is not always available and can have low sensitivity for detecting posterior circulation strokes. OBJECTIVES We evaluated the feasibility and utility of the bucket test (BT), which measures the difference between patient's subjective perception of the visual vertical and the true vertical, as a screening tool for stroke in patients presenting to the ED with acute dizziness. METHODS In this work, we prospectively enrolled 81 patients that presented to our academic medical center ED with dizziness as their chief complaint. The BT was performed 3 times for every patient. RESULTS Seventy-one patients met the study criteria and were included in the analysis. Ten patients were excluded because of a history of drug-seeking behavior. There were no reported difficulties performing the BT. Six patients (8%) were diagnosed with ischemic stroke on MRI and 1 additional patient was diagnosed with transient ischemic attack and found to have a stroke on subsequent MRI. All 7 patients with dizziness attributed to cerebrovascular etiology had an abnormal BT, resulting in a sensitivity of 100% (95% confidence interval [CI] 59-100%). The specificity of the BT was 38% (95% CI 24-52%). The positive predictive value of the BT for detecting stroke was 18% (95% CI 15-21%). CONCLUSIONS The BT is an easy, cheap, safe, and quick test that is feasible and sensitive to screen acutely dizzy patients for stroke in the ED.
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ARDIÇ FN, ŞENTÜRK M, ÇİL T. The effect of head roll and soft surface on Virtual SVV in healthy subjects: A normalization study. ENT UPDATES 2020. [DOI: 10.32448/entupdates.743714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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da Costa Monsanto R, Kasemodel ALP, Tomaz A, de Oliveira Penido N. Subjective Visual Vertical Testing in Patients With Chronic Suppurative Otitis Media. Otolaryngol Head Neck Surg 2020; 163:1018-1024. [PMID: 32571144 DOI: 10.1177/0194599820931491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To analyze the results of the subjective visual vertical test using the "bucket method" in patients with chronic suppurative otitis media (CSOM). STUDY DESIGN Cross-sectional, controlled study. SETTING Outpatient otology clinic in a tertiary care hospital. SUBJECTS AND METHODS Patients had CSOM, defined as the presence of chronic infection or inflammation of the middle ear cleft, associated with a perforation of the tympanic membrane, frequent or intractable middle ear suppuration, with or without cholesteatoma. Controls were selected using a nonprobability, purposive sampling method. We excluded patients with neurologic or metabolic diseases, cognitive deficits, otosclerosis, vestibular migraine, Ménière's disease, past use of ototoxic medication, or head and neck cancer. The volunteers were subjected to the subjective visual vertical test using the "bucket method." The results obtained in our study and control groups were analyzed using nonparametric tests. RESULTS Our study comprised 51 patients with CSOM and 50 controls. In the CSOM group, we observed that 72.5% of the patients had vestibular symptoms in the past year, and 70.5% had abnormalities identified in at least 1 vestibular function test. The subjective visual vertical test revealed that patients with CSOM (with and without cholesteatoma) had significantly higher deviations of the true vertical as compared with controls (CSOM, 3.66°; controls, 0.76°; P < .001). CONCLUSION Our results revealed that CSOM was associated with high rates of vestibular symptoms, abnormal vestibular function tests, and abnormal subjective vertical visual results.
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Affiliation(s)
- Rafael da Costa Monsanto
- Department of Otolaryngology Head & Neck Surgery, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, SP, Brazil
| | - Ana Luiza Papi Kasemodel
- Department of Otolaryngology Head & Neck Surgery, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, SP, Brazil
| | - Andreza Tomaz
- Department of Otolaryngology Head & Neck Surgery, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, SP, Brazil
| | - Norma de Oliveira Penido
- Department of Otolaryngology Head & Neck Surgery, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, SP, Brazil
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Mueller AL, Liebmann LB, Petrak MR, Bahner CM, Weberling LM, Weiss AD, Matsuoka AJ. Evaluation of the utricular function with the virtual-subject visual vertical system: comparison with ocular vestibular-evoked myogenic potentials. Acta Otolaryngol 2020; 140:366-372. [PMID: 32022613 DOI: 10.1080/00016489.2020.1718202] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: The subjective visual vertical (SVV) is the most frequently assessed modality of verticality perception and has been measured in a variety of clinical situations, including peripheral vestibular lesions.Aim: The main objectives are (1) to collect normative data of Virtual SVV™ from healthy subjects, and (2) to study the correlation between Virtual SVV™ and ocular vestibular-evoked myogenic potentials (o-VEMP) on healthy subjects.Materials and methods: Forty-three healthy subjects were recruited. Air conduction (AC)-elicited oVEMPs and bone conduction (BC)-elicited oVEMPs were measured. BC stimuli were produced with a RadioEar B-81 High Output Bone Transducer. Virtual SVV™ were also measured.Results: Virtual SVV™ data from our healthy subjects were consistent with previously published normative SVV data. Normal Virtual SVV™ data did not correlate with normal AC-elicited and BC-elicited oVEMPs.Conclusions: Virtual SVV™ data from our healthy subjects were consistent with previously published normative SVV data. Virtual SVV™ data from our 43 health subjects only had weak correlation with c-VEMP, AC-elicited and BC-elicited oVEMPs. These data serve as a baseline for a future study of patients with unilateral utricular dysfunction.Significance: The Virtual SVV™ can be an attractive substitute for traditional SVV in clinical settings.
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Affiliation(s)
- Amanda L. Mueller
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Northwestern University, Evanston, IL, USA
| | - Lara B. Liebmann
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Northwestern University, Evanston, IL, USA
| | | | | | | | | | - Akihiro J. Matsuoka
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Northwestern University, Evanston, IL, USA
- Northwestern Medicine, Chicago, IL, USA
- Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Hugh Knowles Hearing Centre, Evanston, IL, USA
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Cohen HS. A review on screening tests for vestibular disorders. J Neurophysiol 2019; 122:81-92. [PMID: 30995137 PMCID: PMC6689777 DOI: 10.1152/jn.00819.2018] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 04/12/2019] [Accepted: 04/13/2019] [Indexed: 01/08/2023] Open
Abstract
Although many studies have reported on tests of the vestibular system a valid and reliable, evidence-based screening battery for easy clinical use remains elusive. Many screening tests attempt to assess the vestibulo-ocular reflex. Therefore, head shaking, the Dix-Hallpike maneuver, the supine roll test, and head impulse tests are discussed. Other tests address the spatial orientation functions of the vestibular system, such as the Bucket Test and the Fukuda Stepping test. Still, other tests are based on the known correlates with balance skills, both static and dynamic, such as tandem walking and the modern variation of the Romberg test, the modified Clinical Test of Sensory Interaction and Balance. This review provides a critical overview of the literature on some of these tests and their value for clinical use and in epidemiological studies.
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Affiliation(s)
- Helen S Cohen
- Bobby R. Alford Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine , Houston, Texas
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