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Schöne CG, Vibert D, Mast FW. Executive functions in patients with bilateral and unilateral peripheral vestibular dysfunction. J Neurol 2024; 271:3291-3308. [PMID: 38466421 PMCID: PMC11136862 DOI: 10.1007/s00415-024-12267-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/16/2024] [Accepted: 02/17/2024] [Indexed: 03/13/2024]
Abstract
Previous research suggests that patients with peripheral vestibular dysfunction (PVD) suffer from nonspatial cognitive problems, including executive impairments. However, previous studies that assessed executive functions are conflicting, limited to single executive components, and assessments are confounded by other cognitive functions. We compared performance in a comprehensive executive test battery in a large sample of 83 patients with several conditions of PVD (34 bilateral, 29 chronic unilateral, 20 acute unilateral) to healthy controls who were pairwise matched to patients regarding age, sex, and education. We assessed basic and complex executive functions with validated neuropsychological tests. Patients with bilateral PVD performed worse than controls in verbal initiation and working memory span, while other executive functions were preserved. Patients with chronic unilateral PVD had equal executive performance as controls. Patients with acute unilateral PVD performed worse than controls in the exact same tests as patients with bilateral PVD (verbal initiation, working memory span); however, this effect in patients with acute PVD diminished after correcting for multiple comparisons. Hearing loss and affective disorders did not influence our results. Vestibular related variables (disease duration, symptoms, dizziness handicap, deafferentation degree, and compensation) did not predict verbal initiation or working memory span in patients with bilateral PVD. The results suggest that bilateral PVD not only manifests in difficulties when solving spatial tasks but leads to more general neurocognitive deficits. This understanding is important for multidisciplinary workgroups (e.g., neurotologists, neurologists, audiologists) that are involved in diagnosing and treating patients with PVD. We recommend screening patients with PVD for executive impairments and if indicated providing them with cognitive training or psychoeducational support.
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Affiliation(s)
- Corina G Schöne
- Department of Psychology, University of Bern, Bern, Switzerland.
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
| | - Dominique Vibert
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Fred W Mast
- Department of Psychology, University of Bern, Bern, Switzerland
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Licameli GR, Wang A, Zhou G, Faller D, Kenna M, Poe D, Shearer E, Oster L, Brodsky JR. Vestibular Preservation in Pediatric Cochlear Implantation. Laryngoscope 2024; 134:1913-1918. [PMID: 37584403 DOI: 10.1002/lary.30978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/20/2023] [Accepted: 08/03/2023] [Indexed: 08/17/2023]
Abstract
OBJECTIVES Evaluate the rate of preserved vestibular function in pediatric cochlear implant surgery. STUDY DESIGN Retrospective case review. METHODS Pre- and post-operative vestibular tests were compared in children who underwent cochlear implantation at a tertiary level pediatric hospital over a 4-year period. RESULTS Data from 59 implanted ears in 44 children was included. Median age was 2.8 years at initial testing (range 7 months - 21 years) with 1:1 male/female ratio. Implant surgeries were 26 unilateral, 13 bilateral simultaneous, and 5 bilateral sequential. The majority were implanted with slim, non-styletted electrodes (86.4%) via a round window approach (91.5%). Normal pre-operative results were preserved post-operatively on rotary chair testing in 75% (21/28) of patients, cervical vestibular evoked myogenic potential testing in (75%) 30/40 of ears tested, ocular vestibular evoked myogenic potential testing in 85.7% (6/7) of ears tested, video head impulse testing in 100% (9/9) of ears tested, and computerized dynamic posturography in 100% (5/5) of patients tested. Overall, 62.5% of patients had no new deficits on any vestibular test performed post-operatively. CONCLUSIONS Preservation rates of vestibular function following cochlear implant surgery were higher in this cohort than what has been reported in many earlier studies. Contemporary, less traumatic electrodes and insertion techniques may be a significant factor. The risk of causing a new, severe bilateral vestibular loss with long-term functional impacts appears to be low. Further study is warranted on the impacts of different cochlear implant electrode designs and insertion approaches on post-operative vestibular preservation. LEVEL OF EVIDENCE 4, Case Series Laryngoscope, 134:1913-1918, 2024.
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Affiliation(s)
- Greg R Licameli
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Alicia Wang
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Guangwei Zhou
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - David Faller
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Margaret Kenna
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Dennis Poe
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Eliot Shearer
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Linda Oster
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Jacob R Brodsky
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
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Zhu M, van Stiphout L, Karabulut M, Pérez Fornos A, Guinand N, Meijer K, van de Berg R, McCrum C. Assessing balance in people with bilateral vestibulopathy using the Mini-Balance Evaluation Systems Test (Mini-BESTest): feasibility and comparison with healthy control data. J Neurol 2023; 270:4423-4433. [PMID: 37269353 PMCID: PMC10421784 DOI: 10.1007/s00415-023-11795-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Bilateral vestibulopathy (BVP) leads to unsteadiness when walking, which worsens in darkness or on uneven ground, as well as falls. Since simple balance tests struggle to distinguish between BVP and healthy participants, we aimed (1) to test if the Mini-BESTest is feasible in BVP, (2) how people with BVP perform on the Mini-BESTest and (3) to compare these scores with healthy reference data. METHODS Fifty participants with BVP completed the Mini-BESTest. 12-month falls incidence was obtained by questionnaire. To compare the overall and sub-scores between our participants with BVP and those of healthy participants from the literature (n = 327; obtained via PubMed searches), Mann-Whitney U tests were used. Sub scores within the BVP group were also compared. Spearman correlations were used to investigate the relationships between Mini-BESTest score and age. RESULTS No floor or ceiling effects were observed. Participants with BVP had significantly lower Mini-BESTest total scores than the healthy group. Anticipatory, reactive postural control and sensory orientation sub scores of the Mini-BESTest were significantly lower in BVP, while dynamic gait sub scores were not significantly different. A stronger negative correlation between age and Mini-BESTest total score was found in BVP than in the healthy group. Scores did not differ between patients with different falls history. CONCLUSION The Mini-BESTest is feasible in BVP. Our results confirm the commonly reported balance deficits in BVP. The stronger negative association between age and balance in BVP might reflect the age-related decline in the remaining sensory systems with which people with BVP compensate.
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Affiliation(s)
- Meichan Zhu
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands.
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
- Department of Otorhinolaryngology, Guangzhou Twelfth People's Hospital (Guangzhou Otolarynology-Head and Neck Surgery Hospital), No. 1 Tianqiang Road, Tianhe District, Guangzhou, 510620, Guangdong, China.
| | - Lisa van Stiphout
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Mustafa Karabulut
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Angélica Pérez Fornos
- Service of Otorhinolaryngology and Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Nils Guinand
- Service of Otorhinolaryngology and Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Kenneth Meijer
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Raymond van de Berg
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Christopher McCrum
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
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Zhiznevskiy DV, Zamergrad MV, Levin OS, Azimova AA. [Bilateral peripheral vestibulopathy]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:24-30. [PMID: 37084361 DOI: 10.17116/jnevro202312304124] [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: 04/23/2023]
Abstract
Bilateral vestibulopathy is a relatively widespread and at the same time rarely diagnosed cause of chronic postural instability. Numerous toxic factors, dysmetabolic, autoimmune and neurodegenerative processes can lead to this condition. The main clinical manifestations of bilateral vestibulopathy are balance disorders and visual disturbances (oscillopsia), which can significantly increase the risks of falls in such patients. In addition, cognitive and affective disorders, which also reduce the quality of life in patients with bilateral vestibulopathy, have been described and actively studied in recent years. The diagnosis of bilateral vestibulopathy is based on the results of a clinical neurovestibular study, including a dynamic visual acuity test and a Halmagyi test. A video head impulse test, a bithermal caloric test and a sinusoidal rotation test are used as instrumental methods confirming the dysfunction of the peripheral vestibular system. However, they are still not widespread in neurological practice. Treatment of bilateral vestibulopathy is reduced to vestibular rehabilitation. Encouraging results have been obtained in a number of studies using galvanic vestibular stimulation and the use of vestibular implants. In addition, cognitive rehabilitation methods are currently being developed, which presumably can also improve compensation for bilateral vestibular loss.
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Affiliation(s)
- D V Zhiznevskiy
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - M V Zamergrad
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
- Russian Gerontology Clinical Research Center of Pirogov Russian National Research Medical University, Moscow, Russian
| | - O S Levin
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - A A Azimova
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
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Abstract
PURPOSE OF REVIEW The current review covers recent advances in bilateral vestibulopathy (BVP) in terms of its etiology, diagnosis, and treatments. RECENT FINDINGS The etiology of BVP depends on its clinical course and associated findings, and genetic abnormalities are increasingly recognized in isolated as well as complicated form of BVP. Recent developments in evaluation of the vestibular function have greatly enhanced the detection of BVP, and introduction of the consensus diagnostic criteria by Barany Society has facilitated research on BVP. Vestibular prosthesis may improve vestibular function, posture, gait and quality of life in patients with BVP and would expand the therapeutic options for BVP in near future. SUMMARY Genetics is expanding its role in identifying the causes of BVP of hitherto unknown etiology. The detection and investigation of BVP have been greatly enhanced by introduction of consensus diagnostic criteria and recent developments in methodology evaluating the vestibular function. Vestibular prothesis appears promising in managing BVP. VIDEO ABSTRACT http://links.lww.com/CONR/A59.
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Affiliation(s)
- Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul
- Dizziness Center, Clinical Neuroscience Center, and Department of Neurology, Seoul National University Bundang Hospital, Seongnam
| | - Hyo-Jung Kim
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam, South Korea
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Mancino-Moreira F, Rueda A, Esteban-Sanchez J, Martin-Sanz E. Clinical Subtypes and vHIT Parameters in a Population With Bilateral Vestibulopathy. Front Neurol 2021; 12:673974. [PMID: 34163428 PMCID: PMC8216236 DOI: 10.3389/fneur.2021.673974] [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: 02/28/2021] [Accepted: 04/16/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To evaluate the different peripheral, neurological, genetic, and systemic etiologies of bilateral vestibulopathy (BVP) and the value of vHIT in the diagnostic process. Materials and methods: A retrospective case review was performed on 176 patients diagnosed with BVP in a tertiary referral center, between 2010 and 2020. Inclusion criteria comprised imbalance and/or oscillopsia during locomotion and horizontal angular VOR gain on both sides <0.8. We classified patients into different groups according to (1) their fulfillment of the Barany guideline for bilateral vestibulopathy (2) the definite etiology of BVP and (3) the four clinical subtypes distributed in our population (recurrent vertigo with BVP, rapidly progressive BVP, slowly progressive BVP, and slowly progressive BVP with ataxia). Medical history of vertigo, hypoacusis or migraine, and family background of imbalance and/or oscillopsia were assessed. Horizontal, posterior, and superior semicircular canal angular VOR gain was registered along with saccadic parameters such as velocity, and dispersion of the saccades' latency values. Results: Barany's Society diagnostic criteria for BVP was accomplished in 89 patients. Among our patients, 13.6% had migraines in their medical history and the idiopathic group accounted for 50% of the population. All four clinical subtypes were found in our population, slowly progressive bilateral vestibulopathy without vertigo was the most frequent one. A percentage of our population could not be categorized into any of the former subtypes, many of these patients were diagnosed with BVP after suffering a single vertigo episode. Lower vHIT gains were found in those patients with Barany's criteria for BVP and oscillopsia was significantly more prevalent in this group. Conclusions: Bilateral vestibulopathy manifests with very different patterns representing a very heterogeneous condition. The distribution of the clinical subtypes and Barany's criteria are a useful clinical tool to differentiate groups of patients. The vHIT can serve as an initial tool for identifying patients with BVP. The finding of bilateral vestibular involvement in a clinically suspected unilateral vestibulopathy should be considered in some patients.
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Affiliation(s)
| | - Almudena Rueda
- Department of Neurology, Getafe University Hospital, Madrid, Spain
| | | | - Eduardo Martin-Sanz
- Department of Otolaryngology, University Hospital of Getafe, Madrid, Spain.,Department of Medicine, School of Biomedical Sciences and Health, Universidad Europea de Madrid, Madrid, Spain
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Kim HJ, Lee JO, Kim JS. Protective Effects of Deferoxamine on Vestibulotoxicity in Gentamicin-Induced Bilateral Vestibulopathy Rat Model. Front Neurol 2021; 12:650752. [PMID: 33841317 PMCID: PMC8024619 DOI: 10.3389/fneur.2021.650752] [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: 01/07/2021] [Accepted: 02/15/2021] [Indexed: 12/28/2022] Open
Abstract
Introduction: Administration of aminoglycoside (AG) antibiotics is one of the most common causes of ototoxicity. This study aimed to determine the protective effects of deferoxamine, an iron-chelating agent, on vestibulotoxicity using an intratympanic gentamicin injection (ITGM)-induced bilateral vestibulopathy rat model. Methods: Fifteen Sprague-Dawley rats were randomly assigned to the ITGM only (n = 5), the ITGM combined with intramuscular deferoxamine (DFO) injection (ITGM+DFO, n = 5), or the intratympanic normal saline (control, n = 5) group. The rats in the ITGM+DFO group received intramuscular injection of 150 mg/kg of deferoxamine at 30, 90, and 150 min after the ITGM. The vestibular function was evaluated using the rotarod and open field test every 3 days after the injection until Day 16 when the rats were subjected to histological changes. Results: The rats in the ITGM only group began to show significantly impaired vestibular function 2 days after ITGM into both ears. In contrast, the vestibular function was maintained in the control and ITGM+DFO groups without a difference throughout the experiments. The rats in the ITGM only group showed a near-complete loss of the type I and II hair cells and a collapse of the sensory epithelium in both the saccule and utricle. In contrast, the rats in the ITGM+DFO and control groups showed a relatively well-preserved sensory epithelium including the hair cells, cilia, and otolith layer. Conclusion: This study provides experimental evidence for preventive effects of iron-chelating agents on AG-induced vestibulotoxicity. Simultaneous administration of iron-chelating agents may be considered when using ototoxic agents, especially in those considered to be vulnerable to toxic damage of the inner ear.
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Affiliation(s)
- Hyo-Jung Kim
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jin-Ok Lee
- Department of Biomedicine and Health Sciences, Graduate School, The Catholic University of Korea, Seoul, South Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Neurology, Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea
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Kim JG, Lee SU, Lee CN, Yu SW, Park KW, Kim JS. Bilateral vestibulopathy as an early manifestation of systemic lupus erythematosus. J Neurol 2020; 267:1855-1858. [DOI: 10.1007/s00415-020-09876-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 04/27/2020] [Accepted: 04/29/2020] [Indexed: 11/29/2022]
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