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Bian Y, Zhang Y, Gong J, Jiang Y. Pathological Study of Light Cupula Syndrome on a Visual Bionic Semicircular Canal. J Biomech Eng 2023; 145:121001. [PMID: 37616055 DOI: 10.1115/1.4063221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 08/09/2023] [Indexed: 08/25/2023]
Abstract
A type of persistent direction-changing positional nystagmus with a null point during head position deflection is known as light cupula syndrome (LCS) in the clinic. To date, the pathogenesis and biomechanical response of human semicircular canals with light cupula syndrome (LCS) (HSCs-LCS) are still unclear. In this study, based on the anatomical structure and size of the one-dimensional human semicircular canal (HSC) and imitating the pathological changes of the endolymph in HSC with LCS, a visual bionic semicircular canal (BSC) with LCS was fabricated using three-dimensional printing technology, hydrogel modification, and target tracking technology. Through theoretical derivation, mathematical models of the HSC-LCS perception process were established. By conducting in vitro experiments on the bionic model, the biomechanical response process of HSC-LCS was studied, and the mathematical models were validated. The results of pulse acceleration stimulation showed that the pathological changes in the density and viscosity of the endolymph could reduce the deformation of the cupula of the BSC-LCS and increase the time constant. The results of the sinusoidal acceleration stimulation showed that the amplitude-frequency gain of the BSC-LCS decreased and the phase difference increased. The BSC-LCS can be used as a tool for pathological research of the HSC-LCS. The results of this study can provide a theoretical basis for clinical diagnosis.
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Affiliation(s)
- Yixiang Bian
- School of Mechanical Engineering, Yangzhou University, Huayang Road 196 Yangzhou, Jiangsu 225000, China
| | - Yu Zhang
- School of Mechanical Engineering, Yangzhou University, Huayang Road 196 Yangzhou, Jiangsu 225000, China
| | - Junjie Gong
- School of Mechanical Engineering, Yangzhou University, Huayang Road 196 Yangzhou, Jiangsu 225000, China
| | - Yani Jiang
- School of Mechanical Engineering, Yangzhou University, Huayang Road 196 Yangzhou, Jiangsu 225000, China
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Li X, Zhu Z, Yin H, Zhao P, Lv H, Tang R, Qin Y, Zhuo L, Wang Z. Labyrinth morphological modeling and its application on unreferenced segmentation assessment. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2023.104891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
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Chen K, Zhang Z, Jiang J, Wang J, Wang J, Sun Y, Xu X, Guo C. Prediction of condylar movement envelope surface based on facial morphology. Heliyon 2023; 9:e17769. [PMID: 37483714 PMCID: PMC10362184 DOI: 10.1016/j.heliyon.2023.e17769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/24/2023] [Accepted: 06/27/2023] [Indexed: 07/25/2023] Open
Abstract
The present study aimed to predict the envelope surfaces from facial morphology. Condylar envelope surfaces for 34 healthy adults were formed and simplified as sagittal section curves. Cephalometric and maximum mandibular moving distances measurement were performed on the participants. There was no statistically significant difference (p = 0.763) between the left and right maximum lateral movements. There was a statistically significant difference in the mandibular body length between the sexes. The envelope surfaces were divided into type 1 with Hp2 ≥ 1/3 Hp1 and type 2 with Hp2 < 1/3 × Hp1. SNA and SNB for type 2 were significantly greater than those for type 1 (p < 0.001). Therefore, the participants were divided into four groups based on gender and envelope surface morphology. The curves could be fitted using the second-order Fourier function (R-square ≥0.95). Six facial parameters were selected and a matrix was used to map facial morphology to the envelope surface. Individual sagittal curves were predicted using the matrix and facial parameters, and the envelope surface was predicted using the curve and the condyle model. Deviation analysis for the predicted envelope surface using the actual envelope as a reference was carried out (root mean square = 0.9970 mm ± 0.2918 mm). This method may lay a foundation for the geometric design of artificial fossa components of temporomandibular joint replacement systems. It may improve prosthesis design without flexible tissue repair and guide the movement of the artificial joint head.
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Affiliation(s)
- Kenan Chen
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing Key Laboratory of Digital Stomatology, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, NMPA Key Laboratory for Dental Materials, Beijing, PR China
| | - Zhehao Zhang
- State Key Laboratory of Tribology, Tsinghua University, Beijing, 100084, PR China
| | - Junqi Jiang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing Key Laboratory of Digital Stomatology, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, NMPA Key Laboratory for Dental Materials, Beijing, PR China
| | - Junlin Wang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing Key Laboratory of Digital Stomatology, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, NMPA Key Laboratory for Dental Materials, Beijing, PR China
| | - Jing Wang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing Key Laboratory of Digital Stomatology, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, NMPA Key Laboratory for Dental Materials, Beijing, PR China
| | - Yuchun Sun
- Center of Digital Dentistry, Faculty of Prosthodontics, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing Key Laboratory for Dental Materials, Beijing, PR China
| | - Xiangliang Xu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing Key Laboratory of Digital Stomatology, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, NMPA Key Laboratory for Dental Materials, Beijing, PR China
| | - Chuanbin Guo
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing Key Laboratory of Digital Stomatology, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, NMPA Key Laboratory for Dental Materials, Beijing, PR China
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Golabbakhsh M, Wang X, MacDougall D, Farrell J, Landry T, Funnell WRJ, Adamson R. Finite-Element Modelling Based on Optical Coherence Tomography and Corresponding X-ray MicroCT Data for Three Human Middle Ears. J Assoc Res Otolaryngol 2023:10.1007/s10162-023-00899-x. [PMID: 37165211 DOI: 10.1007/s10162-023-00899-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 04/11/2023] [Indexed: 05/12/2023] Open
Abstract
PURPOSE Optical coherence tomography (OCT) is an emerging imaging modality which is non-invasive, can be employed in vivo, and can record both anatomy and vibrations. The purpose here is to explore the application of finite-element (FE) modelling to OCT data. METHODS We recorded vibrations for three human cadaver middle ears using OCT. We also have X-ray microCT images from the same ears. Three FE models were built based on geometries obtained from the microCT images. The material properties and boundary conditions of the models were obtained from previously reported studies. RESULTS Tympanic-membrane (TM) vibration patterns were computed for the three models and compared with the patterns measured using OCT. Frequency responses were also computed for all three models for several locations in the middle ear and compared with the OCT displacements and with the literature. The three models were compared with each other in terms of geometry and function. Parameter sensitivity analyses were done and the results were compared among the models and with the literature. The simulated TM displacement patterns are qualitatively similar to the OCT results. The simulated displacements are closer to the OCT results for 500 Hz and 1 kHz but the differences are greater at 2 kHz. CONCLUSION This study provides an initial look at the combined use of OCT measurements and FE modelling based on subject-specific anatomy. The geometries and parameters of the existing FE models could be modified for individual patients in the future to help identify abnormalities in the middle ear.
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Affiliation(s)
- Marzieh Golabbakhsh
- Department of BioMedical Engineering, McGill University, Montréal, QC, Canada
| | - Xuan Wang
- Department of BioMedical Engineering, McGill University, Montréal, QC, Canada
| | - Dan MacDougall
- School of Biomedical Engineering, Dalhousie University, Halifax, NS, Canada
| | - Joshua Farrell
- School of Biomedical Engineering, Dalhousie University, Halifax, NS, Canada
| | - Thomas Landry
- School of Biomedical Engineering, Dalhousie University, Halifax, NS, Canada
| | - W Robert J Funnell
- Department of BioMedical Engineering, McGill University, Montréal, QC, Canada.
- Department of Otolaryngology - Head & Neck Surgery, McGill University, Montréal, QC, Canada.
| | - Robert Adamson
- School of Biomedical Engineering, Dalhousie University, Halifax, NS, Canada
- Electrical and Computer Engineering Department, Dalhousie University, Halifax, NS, Canada
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Smith CM, Curthoys IS, Laitman JT. First evidence of the link between internal and external structure of the human inner ear otolith system using 3D morphometric modeling. Sci Rep 2023; 13:4840. [PMID: 36964237 PMCID: PMC10039035 DOI: 10.1038/s41598-023-31235-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/08/2023] [Indexed: 03/26/2023] Open
Abstract
Our sense of balance is among the most central of our sensory systems, particularly in the evolution of human positional behavior. The peripheral vestibular system (PVS) comprises the organs responsible for this sense; the semicircular canals (detecting angular acceleration) and otolith organs (utricle and saccule; detecting linear acceleration, vibration, and head tilt). Reconstructing vestibular evolution in the human lineage, however, is problematic. In contrast to considerable study of the canals, relationships between external bone and internal membranous otolith organs (otolith system) remain largely unexplored. This limits our understanding of vestibular functional morphology. This study combines spherical harmonic modeling and landmark-based shape analyses to model the configuration of the human otolith system. Our approach serves two aims: (1) test the hypothesis that bony form covaries with internal membranous anatomy; and (2) create a 3D morphometric model visualizing bony and membranous structure. Results demonstrate significant associations between bony and membranous tissues of the otolith system. These data provide the first evidence that external structure of the human otolith system is directly related to internal anatomy, suggesting a basic biological relationship. Our results visualize this structural relationship, offering new avenues into vestibular biomechanical modeling and assessing the evolution of the human balance system.
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Affiliation(s)
- Christopher M Smith
- Department of Anthropology, The Graduate Center, City University of New York, New York, NY, 10016, USA.
- Center for Anatomy and Functional Morphology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
- New York Consortium in Evolutionary Primatology, New York, NY, 10016, USA.
| | - Ian S Curthoys
- Vestibular Research Laboratory, School of Psychology, University of Sydney, Sydney, NSW, 2006, Australia
| | - Jeffrey T Laitman
- Department of Anthropology, The Graduate Center, City University of New York, New York, NY, 10016, USA
- Center for Anatomy and Functional Morphology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- New York Consortium in Evolutionary Primatology, New York, NY, 10016, USA
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
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Curthoys IS, McGarvie LA, MacDougall HG, Burgess AM, Halmagyi GM, Rey-Martinez J, Dlugaiczyk J. A review of the geometrical basis and the principles underlying the use and interpretation of the video head impulse test (vHIT) in clinical vestibular testing. Front Neurol 2023; 14:1147253. [PMID: 37114229 PMCID: PMC10126377 DOI: 10.3389/fneur.2023.1147253] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/20/2023] [Indexed: 04/29/2023] Open
Abstract
This paper is concerned mainly with the assumptions underpinning the actual testing procedure, measurement, and interpretation of the video head impulse test-vHIT. Other papers have reported in detail the artifacts which can interfere with obtaining accurate eye movement results, but here we focus not on artifacts, but on the basic questions about the assumptions and geometrical considerations by which vHIT works. These matters are crucial in understanding and appropriately interpreting the results obtained, especially as vHIT is now being applied to central disorders. The interpretation of the eye velocity responses relies on thorough knowledge of the factors which can affect the response-for example the orientation of the goggles on the head, the head pitch, and the contribution of vertical canals to the horizontal canal response. We highlight some of these issues and point to future developments and improvements. The paper assumes knowledge of how vHIT testing is conducted.
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Affiliation(s)
- Ian S. Curthoys
- Vestibular Research Laboratory, School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia
- *Correspondence: Ian S. Curthoys
| | - Leigh A. McGarvie
- Neurology Department, Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Hamish G. MacDougall
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Ann M. Burgess
- Vestibular Research Laboratory, School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia
| | - Gabor M. Halmagyi
- Neurology Department, Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Jorge Rey-Martinez
- Neurotology Unit, Department of Otorhinolaryngology Head and Neck Surgery, Donostia University Hospital, Donostia-San Sebastian, Spain
- Biodonostia Health Research Institute, Otorhinolaryngology Area, Osakidetza Basque Health Service, Donostia-San Sebastian, Spain
| | - Julia Dlugaiczyk
- Department of Otorhinolaryngology, Head and Neck Surgery and Interdisciplinary Center of Vertigo, Balance and Ocular Motor Disorders, University Hospital Zurich (USZ), University of Zurich (UZH), Zurich, Switzerland
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Cleworth TW, Kessler P, Honegger F, Carpenter MG, Allum JHJ. Vestibulo-ocular reflex gain improvements at peak head acceleration and velocity following onset of unilateral vestibular neuritis: Insights into neural compensation mechanisms. J Vestib Res 2022; 32:517-527. [PMID: 35147572 DOI: 10.3233/ves-210153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIMS An acute unilateral peripheral vestibular deficit (aUPVD) due to vestibular neuritis causes deficient yaw axis vestibular ocular reflex (VOR) gains. Using video head impulse tests (vHITs), we examined phasic and tonic velocity gains of the VOR over time to determine if these differed at onset and during subsequent improvement. METHODS The VOR responses of 61 patients were examined within 5 days of aUPVD onset, and 3 and 7 weeks later using vHIT with mean peak yaw angular velocities of 177°/s (sd 45°/s) and mean peak accelerations of 3660°/s2 (sd 1300°/s2). The phasic velocity or acceleration gain (aG) was computed as the ratio of eye to head velocity around peak head acceleration, and the tonic velocity gain (vG) was calculated as the same ratio around peak head velocity. RESULTS aG increased ipsi-deficit from 0.45 at onset to 0.67 at 3 weeks and 7 weeks later, and vG increased ipsi-deficit from 0.29 to 0.51 and 0.53, respectively, yielding a significant time effect (p < 0.001). Deficit side aG was significantly greater (p < 0.001) than vG at all time points. Deficit side gain improvements in aG and vG were similar. Contra-deficit aG increased from 0.86 to 0.95 and 0.94 at 3 weeks and 7 weeks, and vG contra-deficit increased from 0.84, to 0.89 and 0.87, respectively, also yielding a significant time effect (p = 0.004). Contra-deficit aG and vG were normal at 3 weeks. Mean canal paresis values improved from 91% to 67% over the 7 weeks. CONCLUSIONS Acceleration and velocity VOR gains on the deficit side are reduced by aUPVD and improve most in the first 3 weeks after aUPVD onset. Deficit side aG is consistently higher than deficit side vG following an aUPVD, suggesting that acceleration rather than velocity sensitive compensatory neural mechanisms are predominant during the compensation process for aUPVD.
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Affiliation(s)
- Taylor W Cleworth
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Canada.,Center for Vision Research, York University, Toronto, Canada
| | - Paul Kessler
- Department of ORL, Cantonal Hospital of Basel-Land, Liestal, Switzerland
| | - Flurin Honegger
- Department of ORL, University of Basel Hospital, Basel, Switzerland
| | - Mark G Carpenter
- School of Kinesiology, University of British Columbia, Vancouver, Canada
| | - John H J Allum
- Department of ORL, University of Basel Hospital, Basel, Switzerland
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Helminski JO. Case report: Atypical patterns of nystagmus suggest posterior canal cupulolithiasis and short-arm canalithiasis. Front Neurol 2022; 13:982191. [PMID: 36299265 PMCID: PMC9588913 DOI: 10.3389/fneur.2022.982191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/26/2022] [Indexed: 12/03/2022] Open
Abstract
Background Atypical posterior canal (PC) positional nystagmus may be due to the changes in cupular response dynamics from cupulolithiasis (cu), canalithiasis of the short arm (ca-sa), or a partial/complete obstruction—jam. Factors that change the dynamics are the position of the head in the pitch plane, individual variability in the location of the PC attachment to the utricle and the position of the cupula within the ampulla, and the location of debris within the short arm and on the cupula. The clinical presentation of PC-BPPV-cu is DBN with torsion towards the contralateral side in the DH positions and SHHP or no nystagmus in the ipsilateral DH position and no nystagmus upon return to sitting from each position. The clinical presentation of PC-BPPV-ca-sa is no nystagmus in the DH position and upbeat nystagmus (UBN) with torsion lateralized to the involved side upon return to sitting from each position. Case description A 68-year-old woman, diagnosed with BPPV, presented with DBN associated with vertigo in both DH positions and without nystagmus or symptoms on sitting up. In the straight head hanging position (SHHP), the findings of a transient burst of UBN with left torsion associated with vertigo suggested ipsicanal conversion from the left PC-BPPV-cu to canalithiasis. Treatment included a modified canalith repositioning procedure (CRP), which resulted in complete resolution. BPPV recurred 17 days later. Clinical presentation of BPPV included no nystagmus/symptoms in both the contralateral DH position and SHHP, DBN in the ipsilateral DH position without symptoms, and UBN with left torsion associated with severe truncal retropulsion and nausea on sitting up from provoking position. The findings suggested the left PC-BPPV-cu-sa and PC-BPPV-ca-sa. Treatment included neck extension, a modified CRP, and demi-Semont before complete resolution. Conclusion An understanding of the biomechanics of the vestibular system is necessary to differentially diagnose atypical PC-BPPV. DH test (DHT) findings suggest that PC-BPPV-cu presents with DBN or no nystagmus in one or two DH positions and sometimes SHHP and without nystagmus or no reversal/reversal of nystagmus on sitting up. The findings suggest PC-BPPV-ca-sa has no nystagmus in DH positions or DBN in the ipsilateral DH position and UBN with torsion lateralized to the involved side on sitting up.
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Wang Z, Lu S, Wang X, Chen Y, Gong J, Jiang Y, Bian Y. Development of Bionic Semicircular Canals and the Sensation of Angular Acceleration. Bioengineering (Basel) 2022; 9:180. [PMID: 35621458 PMCID: PMC9138073 DOI: 10.3390/bioengineering9050180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 11/16/2022] Open
Abstract
To study the sensing process of the human semicircular canals (HSCs) during head rotation, which is difficult to directly measure due to physiological reasons. A 1-BSC (one-dimensional bionic semicircular canal) and 3-BSC were prepared with soft SMPFs (symmetric electrode metal core polyvinylidene difluoride fibers), which could sense deformations similar to human sensory cells. Based on these models, experiments were carried out to study the principle of the HSCs. Deformations of the bionic ampulla (BA) depended on the angular acceleration. Gravity had a strong influence on the deformation of the BA in the vertical plane. When the 3-BSC was subjected to angular acceleration around one of its centerlines, the three BAs all deformed. The deformation of the BAs was linearly related to the angular acceleration. The deformation of the BA in the main semicircular canal was exactly three times that of the other two BAs.
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Pogson JM, Taylor RL, Bradshaw AP, Mcgarvie L, D'souza M, Flanagan S, Kong J, Biggs N, Shivalingam B, Greenberg S, Croxson G, Michael Halmagyi G, Welgampola MS. The human vestibulo-ocular reflex and compensatory saccades in schwannoma patients before and after vestibular nerve section. Clin Neurophysiol 2022. [DOI: 10.1016/j.clinph.2022.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 01/25/2022] [Accepted: 02/13/2022] [Indexed: 11/19/2022]
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Liu W, Chen G, Xie J, Liang T, Zhang C, Liao X, Liao W, Song L, Zhang X. A New Coordinate System for Magnetic Resonance Imaging of the Vestibular System. Front Neurol 2022; 12:789887. [PMID: 35069419 PMCID: PMC8766740 DOI: 10.3389/fneur.2021.789887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/06/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: To develop and evaluate a new coordinate system for MRI of the vestibular system. Methods: In this study, 53 internal auditory canal MRI and 78 temporal bone CT datasets were analyzed. Mimics Medical software version 21.0 was used to visualize and three-dimensionally reconstruct the image data. We established a new coordinate system, named W–X, based on the center of the bilateral eyeballs and vertex of the bilateral superior semicircular canals. Using the W–X coordinate system and Reid's coordinate system, we measured the orientations of the planes of the anterior semicircular canal (ASCC), the lateral semicircular canal (LSCC), and the posterior semicircular canal (PSCC). Results: No significant differences between the angles measured using CT and MRI were found for any of the semicircular canal planes (p > 0.05). No statistical differences were found between the angles measured using Reid's coordinate system (CT) and the W–X coordinate system (MRI). The mean values of ∠ASCC & LSCC, ∠ASCC & PSCC, and ∠LSCC & PSCC were 84.67 ± 5.76, 94.21 ± 3.81, and 91.79 ± 5.22 degrees, respectively. The angle between the LSCC plane and the horizontal imaging plane was 15.64 ± 3.92 degrees, and the angle between the PSCC plane and the sagittal imaging plane was 48.79 ± 4.46 degrees. Conclusion: A new W–X coordinate system was developed for MRI studies of the vestibular system and can be used to measure the orientations of the semicircular canals.
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Affiliation(s)
- Weixing Liu
- State Key Laboratory of Respiratory Disease, Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Gui Chen
- State Key Laboratory of Respiratory Disease, Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Junyang Xie
- State Key Laboratory of Respiratory Disease, Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Tianhao Liang
- State Key Laboratory of Respiratory Disease, Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chunyi Zhang
- State Key Laboratory of Respiratory Disease, Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiao Liao
- State Key Laboratory of Respiratory Disease, Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wenjing Liao
- State Key Laboratory of Respiratory Disease, Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Lijuan Song
- State Key Laboratory of Respiratory Disease, Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaowen Zhang
- State Key Laboratory of Respiratory Disease, Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Harmat K, Tamás LT, Schubert MC, Gerlinger I, Komoly S, Büki B. Prevalence of and Theoretical Explanation for Type 2 Benign Paroxysmal Positional Vertigo. J Neurol Phys Ther 2022. [PMID: 35081081 DOI: 10.1097/NPT.0000000000000383] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE A variant of benign paroxysmal positional vertigo (BPPV) involves the subjective report of vertigo without the coinciding nystagmus. This presentation includes truncal retropulsion when sitting up from the ipsilesional provocative test (ie, Dix-Hallpike), which we term type 2 BPPV. The primary objective of this study is to prospectively determine the prevalence and describe the clinical course of type 2 BPPV. We offer a theoretical explanation for the absence of nystagmus. METHODS Prospective, observational study carried out in 2 tertiary hospitals. One hundred eighty patients (134 women, 46 men) met the inclusion criteria and were included between January 10, 2018, and October 30, 2019. Efficacy of physical therapy maneuvers was determined at 1-week follow-up. Three-dimensional reconstructions of the planes of the semicircular canal cupula from histological preparations are offered as evidence for the theoretical explanation. RESULTS One-third of the patients met the criteria for type 2 BPPV; the remainder had typical posterior or horizontal semicircular canal involvement. Symptoms from type 2 BPPV were longer in duration yet responded favorably to physical therapy maneuvers. Upon repeat testing, 19 patients treated for posterior canalithiasis developed a slight, persistent positional downbeat nystagmus in the Dix-Hallpike position that we propose as evidence the otoconia entered the short arm of the posterior semicircular canal. DISCUSSION AND CONCLUSIONS Our data and 3-dimensional rendering suggest the report of vertigo, yet absent nystagmus in type 2 BPPV is from otoconia aligning with the gravitoinertial vector during provocative testing that precludes cupular stimulation. Type 2 BPPV appears to be a common and treatable form of vertigo.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A372).
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Harada T, Sugawara T, Ito T, Wada Y, Fukunaga M, Sadato N, Larroque SK, Demertzi A, Laureys S, Sakai H. Vestibular Morphological Asymmetry Associated With Motion Sickness Susceptibility. Front Neurosci 2021; 15:763040. [PMID: 34803595 PMCID: PMC8600179 DOI: 10.3389/fnins.2021.763040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/14/2021] [Indexed: 01/24/2023] Open
Abstract
Sensory conflicts leading to motion sickness can occur not only between but also within sensory modalities. The vestibular organs are located in both left and right inner ears, and their misalignment can be a source of self-motion related sensory conflicts. In the current study, using inner ear magnetic resonance imaging, we examined whether morphological asymmetry of the bilateral vestibular organs was associated with motion sickness susceptibility. The results showed a larger position asymmetry of bilateral vestibular organs in individuals with high rather than low susceptibility. In addition, vestibular position asymmetry was associated with reciprocal interaction (negative resting state functional connectivity) between vestibular and visuocortical regions in lowly, but not highly, susceptible individuals. In conclusion, these findings suggest that vestibular morphological asymmetry can be a source of sensory conflicts in individuals with dysfunctional reciprocal visuo-vestibular interactions, a putative neural mechanism for resolving sensory conflicts.
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Affiliation(s)
| | | | - Taeko Ito
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, Kashihara, Japan
| | - Yoshiro Wada
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, Kashihara, Japan
| | - Masaki Fukunaga
- Division of Cerebral Integration, Department of System Neuroscience, National Institute for Physiological Sciences, Okazaki, Japan
| | - Norihiro Sadato
- Division of Cerebral Integration, Department of System Neuroscience, National Institute for Physiological Sciences, Okazaki, Japan
| | - Stephen K. Larroque
- Coma Science Group, GIGA-Consciousness, GIGA Institute, University of Liège, Liege, Belgium
| | - Athena Demertzi
- Physiology of Cognition Research Lab, GIGA-Consciousness, GIGA Institute, University of Liège, Liege, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, GIGA Institute, University of Liège, Liege, Belgium
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14
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Abstract
Located deep in the temporal bone, the semicircular canal is a subtle structure that requires a spatial coordinate system for measurement and observation. In this study, 55 semicircular canal and eyeball models were obtained by segmentation of MRI data. The spatial coordinate system was established by taking the top of the common crus and the bottom of the eyeball as the horizontal plane. First, the plane equation was established according to the centerline of the semicircular canals. Then, according to the parameters of the plane equation, the plane normal vectors were obtained. Finally, the average unit normal vector of each semicircular canal plane was obtained by calculating the average value of the vectors. The standard normal vectors of the and left posterior semicircular canal, superior semicircular canal and lateral semicircular canal were [−0.651, 0.702, 0.287], [0.749, 0.577, 0.324], [−0.017, −0.299, 0.954], [0.660, 0.702, 0.266], [−0.739, 0.588, 0.329], [0.025, −0.279, 0.960]. The different angles for the different ways of calculating the standard normal vectors of the right and left posterior semicircular canal, superior semicircular canal and lateral semicircular canal were 0.011, 0.028, 0.008, 0.011, 0.024, and 0.006 degrees. The technology for measuring the semicircular canal spatial attitudes in this study are reliable, and the measurement results can guide vestibular function examinations and help with guiding the diagnosis and treatment of BPPV.
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Affiliation(s)
- Shuzhi Wu
- Neurology Department, Third Affiliated Hospital of Shanghai University, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou People's Hospital, Wenzhou, China
| | - Ping Lin
- Neurology Department, Third Affiliated Hospital of Shanghai University, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou People's Hospital, Wenzhou, China
| | - Yanyan Zheng
- Neurology Department, Third Affiliated Hospital of Shanghai University, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou People's Hospital, Wenzhou, China
| | - Yifei Zhou
- ENT Department, Third Affiliated Hospital of Shanghai University, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou People's Hospital, Wenzhou, China
| | - Zhaobang Liu
- Department of Medical Imaging, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Xiaokai Yang
- Neurology Department, Third Affiliated Hospital of Shanghai University, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou People's Hospital, Wenzhou, China
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15
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Bhandari A, Bhandari R, Kingma H, Zuma E Maia F, Strupp M. Three-dimensional simulations of six treatment maneuvers for horizontal canal benign paroxysmal positional vertigo canalithiasis. Eur J Neurol 2021; 28:4178-4183. [PMID: 34339551 DOI: 10.1111/ene.15044] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Horizontal canal benign paroxysmal positional vertigo (BPPV) is the second most common variant of BPPV after posterior canal BPPV. Various liberatory maneuvers are recommended for the treatment of horizontal canal BPPV canalithiasis (hc-BPPV-ca). The aim of this study was to show how three-dimensional (3D) dynamic simulation models visualize the movement of the clot of otoconia within the canal for a better understanding of the theoretical efficacy. METHODS Based on reconstructed magnetic resonance imaging and fluid dynamics, a 3D dynamic simulation model (as a function of time) was developed and applied. Thereby, six treatment maneuvers for hc-BPPV-ca were simulated: two types of the roll maneuver (the original 270° and the modified 360°) as well as two Gufoni and Zuma maneuvers (for geotropic and apogeotropic nystagmus). RESULTS The simulations showed that the 360° roll maneuver and Zuma maneuver are effective treatment options for hc-BPPV-ca for debris in all locations within the canal. However, the original 270° roll maneuver will not be effective if the clot is in the ampullary arm of the horizontal canal. The Gufoni maneuver for geotropic hc-BPPV-ca is effective, whereas for apogeotropic hc-BPPV-ca there is a risk of treatment failure due to insufficient repositioning of the debris. CONCLUSIONS The 3D simulations for movement of the otoconia clots can be used to test the mechanism of action and the theoretical efficacy of existing maneuvers for the different BPPV variants. For hc-BPPV-ca, the modified 360° roll maneuver and Zuma maneuver are theoretically efficient for all subtypes, whereas Gufoni maneuver is effective for geotropic nystagmus only.
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Affiliation(s)
| | | | - Herman Kingma
- Department of Ear Nose Throat, Maastricht University, Maastricht, Netherlands.,Faculty of Physics, Tomsk State National Research University, Tomsk, Russia.,Department of Ear Nose Throat, Aalborg University, Aalborg, Denmark
| | - Francisco Zuma E Maia
- Department of Otorhinolaryngology and Instituto de Cerebro, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Michael Strupp
- Department of Neurology and German Center for Vertigo and Balance Disorders, Hospital of Ludwig Maximilian University of Munich, Munich, Germany
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16
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Moroz M, Choy M, Lee CW, Hadfield H, Lasenby J, Stone T, Bance M. Evaluating the Epley Canalolith Repositioning Procedure With and Without a Visual Assistive Device. Otol Neurotol 2021; 42:765-773. [PMID: 33492058 DOI: 10.1097/mao.0000000000003017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
HYPOTHESIS The primary goal of this study was to examine how accuracy is affected when we employ a guidance device to assist with the execution of the Epley canalolith repositioning procedure. BACKGROUND Benign paroxysmal positional vertigo is a common cause of vestibular vertigo. Treatment is noninvasive and generally effective when performed correctly. Deficiencies in clinical application result in unnecessary failures in response for those affected. METHODS Ten participants were each taken through six iterations of the Epley canalolith repositioning procedure. Iterations were divided evenly between those conducted with and without the use of a guidance device. One clinician performed all 60 procedures. Head movements were recorded using motion capture cameras and strategically placed motion tracking markers. RESULTS Results showed that the guidance device significantly improved the latter phase maneuver accuracy. Rotation error was significantly reduced for hold3 with-device (M = 20.23°, SD = 12.08°) versus without-device (M = 40.13°, SD = 14.62°, p = 0.001). Maximal rotation error during rotation4 of the maneuver demonstrated a similar reduction of error with-device (M = 24.44°, SD = 10.43°) versus without-device (M = 41.36°, SD = 12.89°, p = 0.002). CONCLUSION A simple visual guidance device can increase the execution accuracy of canalith repositioning procedures. Further research is required to show how such improvements influence treatment efficacy.
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Affiliation(s)
| | - Matthew Choy
- School of Clinical Medicine, University of Cambridge
| | - Chang Woo Lee
- Department of ENT, Royal Surrey County Hospital, Guildford
| | | | - Joan Lasenby
- Department of Engineering, University of Cambridge
| | - Thomas Stone
- Department of Clinical Engineering, Addenbrooke's Hospital, Cambridge, UK
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17
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Smith CM, Curthoys IS, Mukherjee P, Wong C, Laitman JT. Three-dimensional visualization of the human membranous labyrinth: The membrana limitans and its role in vestibular form. Anat Rec (Hoboken) 2021; 305:1037-1050. [PMID: 34021723 DOI: 10.1002/ar.24675] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/16/2021] [Accepted: 04/18/2021] [Indexed: 11/06/2022]
Abstract
The inner ear contains the end organs for balance (vestibular labyrinth) and hearing (cochlea). The vestibular labyrinth is comprised of the semicircular canals (detecting angular acceleration) and otolith organs (utricle and saccule, which detect linear acceleration and head tilt relative to gravity). Lying just inferior to the utricle is the membranous membrana limitans (ML). Acting as a keystone to vestibular geometry, the ML provides support for the utricular macula and acts as a structural boundary between the superior (pars superior) and inferior (pars inferior) portions of the vestibular labyrinth. Given its importance in vestibular form, understanding ML morphology is valuable in establishing the spatial organization of other vestibular structures, particularly the utricular macula. Knowledge of the 3D structure and variation of the ML, however, remain elusive. Our study addresses this knowledge gap by visualizing, in 3D, the ML and surrounding structures using micro-CT data. By doing so, we attempt to clarify: (a) the variation of ML shape; (b) the reliability of ML attachment sites; and (c) the spatial relationship of the ML to the stapes footplate using landmark-based Generalized Procrustes, Principal Component and covariance analyses. Results indicate a consistent configuration of three distinct bony ML attachments including an anterolateral, medial, and posterior attachment which all covary with bony structure. Our results set the stage for further understanding into vestibular and more specifically, utricular macula spatial configuration within the human head, offering the potential to aid in clinical and evolutionary studies which rely on a 3D understanding of vestibular spatial configuration.
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Affiliation(s)
- Christopher M Smith
- Department of Anthropology, The Graduate Center, City University of New York, New York City, New York, USA.,Center for Anatomy and Functional Morphology, Icahn School of Medicine at Mount Sinai., New York City, New York, USA.,New York Consortium in Evolutionary Primatology, New York City, New York, USA
| | - Ian S Curthoys
- Vestibular Research Laboratory, School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Payal Mukherjee
- RPA Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Christopher Wong
- Vestibular Research Laboratory, School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Jeffrey T Laitman
- Department of Anthropology, The Graduate Center, City University of New York, New York City, New York, USA.,Center for Anatomy and Functional Morphology, Icahn School of Medicine at Mount Sinai., New York City, New York, USA.,New York Consortium in Evolutionary Primatology, New York City, New York, USA.,Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
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18
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Bhandari A, Kingma H, Bhandari R. BPPV Simulation: A Powerful Tool to Understand and Optimize the Diagnostics and Treatment of all Possible Variants of BPPV. Front Neurol 2021; 12:632286. [PMID: 33841305 PMCID: PMC8032929 DOI: 10.3389/fneur.2021.632286] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 03/03/2021] [Indexed: 11/13/2022] Open
Abstract
BPPV is a mechanical disorder caused by the displacement of otolith debris into the semicircular canals. The treatment involves different repositioning maneuvers to bring the debris back into the utricle. This study aims to show how dynamic simulation models based on fluid dynamics and MRI, can help to visualize and understand the movement of the debris within the canals during head movement in 3D as a function of time. The user can define the rotation angle and plane at each step of the maneuver and then the model visualizes the canal and the otoconial movement in 3D. The simulation developed also allows alteration of various parameters like the rotational head acceleration, the duration of each step of the maneuver, the initial position of the otoconial debris in the canal, the size and the number of the particles and fluid dynamics of endolymph. The clod movement is visualized in such a way that it allows a better understanding of the impact and efficacy of various liberation maneuvers and why certain maneuvers might fail when not applied properly in the clinic. The model allows simulation of multi-canal BPPV. In this paper we demonstrate the power of the model applied on the maneuvers of Semont and Yacovino when executed in different ways. The model aims to provide a visual explanation for the need of specific maneuvers for each type of BPPV. The simulator presented here can be used to test the efficacy of existing maneuvers and help in the development of new maneuvers to treat different BPPV variants.
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Affiliation(s)
| | - Herman Kingma
- Department of Ear Nose Throat, Maastricht University, Maastricht, Netherlands.,Faculty of Physics, Tomsk State National Research University, Tomsk, Russia.,Department of Ear Nose Throat, Aalborg University, Aalborg, Denmark
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19
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Kwon C, Ku Y, Seo S, Jang E, Kong HJ, Suh MW, Kim HC. Quantitative assessment of self-treated canalith repositioning procedures using inertial measurement unit sensors. J Vestib Res 2021; 31:423-431. [PMID: 33646186 DOI: 10.3233/ves-190747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Low success and high recurrence of benign paroxysmal positional vertigo (BPPV) after home-based self-treated Epley and Barbeque (BBQ) roll maneuvers is an important issue. OBJECTIVE To quantify the cause of low success rate of self-treated Epley and BBQ roll maneuvers and provide a clinically acceptable criterion to guide self-treatment head rotations. METHODS Twenty-five participants without active BPPV wore a custom head-mount rotation monitoring device for objective measurements. Self-treatment and specialist-assisted maneuvers were compared for head rotation accuracy. Absolute differences between the head rotation evaluation criteria (American Academy of Otolaryngology guidelines) and measured rotation angles were considered as errors. Self-treatment and specialist-treated errors in maneuvers were compared. Between-trial variations and age effects were evaluated. RESULTS A significantly large error and between-trial variation occurred in step 4 of the self-treated Epley maneuver, with a considerable error in the second trial. The cumulative error of all steps of self-treated BBQ roll maneuver was significantly large. Age effect occurred only in the self-treated BBQ roll maneuver. Errors in specialist-treated maneuvers ranged from 10 to 20 degrees. CONCLUSIONS Real-time feedback of head movements during simultaneous head-body rotations could increase success rates of self-treatments. Specialist-treated maneuvers can be used as permissible rotation margin criteria.
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Affiliation(s)
- Chiheon Kwon
- Institute of Medical & Biological Engineering, Medical Research Center, Seoul National University, Seoul, Korea
| | - Yunseo Ku
- Department of Biomedical Engineering, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Shinhye Seo
- Department of Biomedical Engineering, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Eunsook Jang
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Hyoun-Joong Kong
- Department of Biomedical Engineering, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Myung-Whan Suh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Hee Chan Kim
- Institute of Medical & Biological Engineering, Medical Research Center, Seoul National University, Seoul, Korea.,Interdisciplinary Program in Bioengineering, Graduate School, Seoul National University, Seoul, Korea.,Department of Biomedical Engineering, College of Medicine, Seoul National University, Seoul, Korea
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20
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Stam D, Pernu J. Novel Treatment of Subjective BPPV in the Medically Complex Geriatric Patient. Journal of Acute Care Physical Therapy 2020; 11:120-126. [DOI: 10.1097/jat.0000000000000131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Abstract
BACKGROUND AND PURPOSE Downbeat nystagmus (DBN) during the Dix-Hallpike test (DHT) suggests excitation of the anterior canal (AC) or inhibition of the posterior canal (PC) underlying benign paroxysmal positional vertigo (BPPV). This case series describes 2 individuals presenting with DBN in positional testing suggestive of a PC BPPV variant termed apogeotropic PC-BPPV and due to inhibition of the PC. CASE DESCRIPTIONS Case 1 illustrates a DBN during positional testing (PC inhibition) that changes to an upbeating nystagmus (PC excitation) representing the otoconial material changing location and direction of movement within the PC. Case 2 describes a canal jam in the nonampullary segment of the PC. DIFFERENTIAL DIAGNOSIS Apogeotropic PC-BPPV can cause DBN due to inhibition of the vestibular afferent. Apogeotropic PC-BPPV may be due to a canal jam of debris within the nonampullary segment or cupulolithiasis with debris attached to the inferior-most aspect of the cupula within the PC. It can be difficult to differentiate AC-BPPV from the apogeotropic PC-BPPV variant. In both forms, the affected canal may be provoked in 1 or both positions of the DHT and straight head hanging position. However, in AC-BPPV there may only be a slight or absent torsional component toward the involved ear. In apogeotropic PC-BPPV, a strong torsion away from the involved ear is typically observed. The straight head hanging position may resolve AC-BPPV or convert apogeotropic PC-BPPV to typical PC-BPPV. SUMMARY These 2 cases illustrate atypical variants of BPPV that clinicians must consider in their interpretation of DBN during positional testing, particularly in the absence of other neurological signs.
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22
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Carry PM, Duke VR, Brazell CJ, Stence N, Scholes M, Rousie DL, Hadley Miller N. Lateral semi-circular canal asymmetry in females with idiopathic scoliosis. PLoS One 2020; 15:e0232417. [PMID: 32349123 PMCID: PMC7190182 DOI: 10.1371/journal.pone.0232417] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 04/14/2020] [Indexed: 01/09/2023] Open
Abstract
Purpose Adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal structural deformity that occurs in otherwise normal individuals. Although curve progression and severity vary amongst individuals, AIS can lead to significant cosmetic and functional deformity. AIS etiology has been determined to be genetic, however, exact genetic and biological processes underlying this disorder remain unknown. Vestibular structure and function have potentially been related to the etiopathogenesis of AIS. Here, we aimed to characterize the anatomy of the semicircular canals (SCC) within the vestibular system through a novel approach utilizing T2-weighted magnetic resonance images (MRI). Methods Three dimensional, MRI-based models of the SCCs were generated from AIS subjects (n = 20) and healthy control subjects (n = 19). Linear mixed models were used to compare SCC morphological measurements in the two groups. We compared side-to-side differences in the SCC measurements between groups (group*side interaction). Results Side-to-side differences in the lateral SCC were different between the two groups [false discovery rate adjusted p-value: 0.0107]. Orientation of right versus left lateral SCC was significantly different in the AIS group compared to the control group [mean side-to-side difference: -4.1°, 95% CI: -6.4° to -1.7°]. Overall, among subjects in the AIS group, the left lateral SCC tended to be oriented in a more horizontal position than subjects in the control group. Significance Asymmetry within the SCCs of the vestibular system of individuals with AIS potentially results in abnormal efferent activity to postural muscles. Consequences of this muscular activity during periods of rapid growth, which often coincides with AIS onset and progression, warrant consideration.
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Affiliation(s)
- Patrick M. Carry
- Department of Orthopaedic Surgery, Musculoskeletal Research Center, Children’s Hospital Colorado, Aurora, Colorado, United States of America
| | - Victoria R. Duke
- Department of Orthopaedic Surgery, Musculoskeletal Research Center, Children’s Hospital Colorado, Aurora, Colorado, United States of America
| | - Christopher J. Brazell
- Department of Orthopaedic Surgery, Musculoskeletal Research Center, Children’s Hospital Colorado, Aurora, Colorado, United States of America
| | - Nicholas Stence
- Department of Radiology, Children’s Hospital Colorado, Aurora, Colorado, United States of America
| | - Melissa Scholes
- Department of Otolaryngology, Children’s Hospital Colorado, Aurora, Colorado, United States of America
| | | | - Nancy Hadley Miller
- Department of Orthopaedic Surgery, Musculoskeletal Research Center, Children’s Hospital Colorado, Aurora, Colorado, United States of America
- * E-mail:
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23
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Yılmazer R, Topçuoğlu OM. Three-Dimensional Reconstruction of the Semicircular Canals with a Two-Hands Model. Turk Arch Otorhinolaryngol 2020; 57:176-181. [PMID: 32128514 DOI: 10.5152/tao.2019.4412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 09/24/2019] [Indexed: 11/22/2022] Open
Abstract
Objective To help understand the anatomy and the diseases of the semicircular canals (SCCs) by defining the three-dimensional reconstruction of the SCCs in a model reconstructed using the two hands (two-hands model) and to determine the three-dimensional configuration of the two hands by measuring the angle between the SCCs and the sagittal plane. Methods Patients older than 18 years of age with computed tomography (CT) scans of the temporal bones taken between 2017 and 2018 at the Yeditepe University Hospital were included in the study. CT images were evaluated by a radiologist. The angles between every SCC and the sagittal plane were measured with the MIMICS 12.1 program. Mean angles between the SCCs and the sagittal plane were measured. These angles were demonstrated on the two-hands model of the SCCs by means of a goniometer and photographed. Results Thirty patients and 60 temporal bones were included in the study. Mean angles between the superior, the posterior, and the horizontal SCCs and the sagittal plane were found as 37.1±3.3°, 50.4±4.1°, and 89.5±4.7°, respectively. Conclusion This is the first study to define the three-dimensional representation of the SCCs with a two-hands model. This may allow for a better understanding and the better teaching of the anatomy and diseases of SCCs.
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Affiliation(s)
- Rasim Yılmazer
- Department of Otorhinolaryngology, Demiroğlu Bilim University School of Medicine, İstanbul, Turkey
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Tang X, Tang J, Gong L, Ke R, Tan S, Tang A. Adverse effects of semicircular circle angles variation on Epley repositioning procedure: a study on reconstruction of Micro-CT images 3D. Acta Otolaryngol 2020; 140:99-104. [PMID: 31876219 DOI: 10.1080/00016489.2019.1699953] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: For patients with posterior semicircular canal (PSC) BPPV, Epley re-position maneuver and some improvement methods are the most efficient treatment methods. But there were still 9.43% patients who were not benefit from Epley re-position maneuver.Objective: To measure the angles of semicircular canals and evaluate its effect on Epley maneuver.Methods: Fifteen skull specimens, containing 30 temporal bone specimens were included. After Micro-CT scanning, 3D reconstruction was loaded with the CT image. The angles between each semicircular canal and each standard skull plane were measured. Furthermore, the angles' effect on Epley maneuver was evaluated according to the three-dimension (3D) model.Results: Angles of PSC plane: Frankfurt plane was 71.54 ± 6.51, sagittal plane was 53.77 ± 5.36°, and the coronal plane was 43.33 ± 3.56°. Angles between PSC and the sagittal plane of skulls had an adverse effect on Epley maneuver, when it was less than 45°.Conclusion: 1. Variation could be found in angles between the semicircular canals and the standard planes of skulls, which meant variation of semicircular canals' location existing in skulls. 2. The variation of angles between PSC and sagittal plane could have an adverse effect on the Epley maneuver when the angle was less than 45°, which may cause the Epley maneuver to be invalid.
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Affiliation(s)
- Xianglong Tang
- Department of Otorhinolaryngology-Head andNeck Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jie Tang
- Department of Otorhinolaryngology-Head andNeck Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Li Gong
- Department of Otorhinolaryngology-Head andNeck Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Rongdan Ke
- Department of Otorhinolaryngology-Head andNeck Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Songhua Tan
- Department of Otorhinolaryngology-Head andNeck Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Anzhou Tang
- Department of Otorhinolaryngology-Head andNeck Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Choi B, Nahm H, Shin JE, Kim CH. Comorbid Cupulolithiasis Is Rare in Patients With Horizontal Semicircular Canal Canalolithiasis. Otol Neurotol 2020; 41:e357-62. [PMID: 31868781 DOI: 10.1097/MAO.0000000000002540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Considering that otolith particles pass through the canal until attaching to the cupula in the canal-side horizontal semicircular canal (HSCC) cupulolithiasis, comorbidity of HSCC canalolithiasis and cupulolithiasis may occur. We aimed to investigate the incidence of comorbidity of cupulolithiasis in patients with HSCC canalolithiasis and to improve treatment efficacy. STUDY DESIGN Retrospective study. SETTING Tertiary referral academic center. PATIENTS Ninety-seven consecutive patients with HSCC canalolithiasis between March 2017 and March 2019 were included. MAIN OUTCOME MEASURES Coexistence of HSCC cupulolithiasis was hierarchically investigated. 1) Spontaneous reversal of initial nystagmus is observed bilaterally in a head-roll test (HRT), 2) nystagmus is in the same direction at each of the three times the supine position was tested, and 3) both bowing and leaning nystagmus with opposite direction are observed. RESULTS Of 97 patients with HSCC canalolithiasis, 2 patients (2%) had comorbid HSCC cupulolithiasis. CONCLUSIONS Although coexistence of HSCC canalolithiasis and cupulolithiasis should be considered when spontaneous reversal of nystagmus direction is observed without position change during a HRT, the incidence of coexistence is very low. However, canalith repositioning maneuvers for both canalolithiasis and cupulolithiasis should be performed in cases with comorbidity.
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Cortés-domínguez I, Fernández-seara MA, Pérez-fernández N, Burguete J. Systematic Method for Morphological Reconstruction of the Semicircular Canals Using a Fully Automatic Skeletonization Process. Applied Sciences 2019; 9:4904. [DOI: 10.3390/app9224904] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We present a novel method to characterize the morphology of semicircular canals of the inner ear. Previous experimental works have a common nexus, the human-operator subjectivity. Although these methods are mostly automatic, they rely on a human decision to determine some particular anatomical positions. We implement a systematic analysis where there is no human subjectivity. Our approach is based on a specific magnetic resonance study done in a group of 20 volunteers. From the raw data, the proposed method defines the centerline of all three semicircular canals through a skeletonization process and computes the angle of the functional pair and other geometrical parameters. This approach allows us to assess the inter-operator effect on other methods. From our results, we conclude that, although an average geometry can be defined, the inner ear anatomy cannot be reduced to a single geometry as seen in previous experimental works. We observed a relevant variability of the geometrical parameters in our cohort of volunteers that hinders this usual simplification.
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Pérez-Vázquez P, Franco-Gutiérrez V, Soto-Varela A, Amor-Dorado JC, Martín-Sanz E, Oliva-Domínguez M, Lopez-Escamez JA. Practice Guidelines for the Diagnosis and Management of Benign Paroxysmal Positional Vertigo Otoneurology Committee of Spanish Otorhinolaryngology and Head and Neck Surgery Consensus Document. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.otoeng.2018.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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van den Boogert T, van Hoof M, Handschuh S, Glueckert R, Guinand N, Guyot JP, Kingma H, Perez-Fornos A, Seppen B, Johnson Chacko L, Schrott-Fischer A, van de Berg R. Optimization of 3D-Visualization of Micro-Anatomical Structures of the Human Inner Ear in Osmium Tetroxide Contrast Enhanced Micro-CT Scans. Front Neuroanat 2018; 12:41. [PMID: 29872380 PMCID: PMC5972190 DOI: 10.3389/fnana.2018.00041] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 04/27/2018] [Indexed: 11/30/2022] Open
Abstract
Introduction: Knowledge of the neuro-anatomical architecture of the inner ear contributes to the improvement and development of cochlear and vestibular implants. The present knowledge is mainly based on two-dimensional images (histology) or derived models that simplify the complexity of this architecture. This study investigated the feasibility of visualizing relevant neuro-anatomical structures of the inner ear in a dynamic three-dimensional reproduction, using a combination of staining, micro-CT imaging and an image processing algorithm. Methods: Four fresh cadaveric temporal bones were postfixed with osmium tetroxide (OsO4) and decalcified with EDTA. Micro-CT was used for scanning at 10 μm (4 scans) and 5.5 μm (1 scan) voxel resolution. A new image processing algorithm was developed and the scans were visualized in open source software. Results: OsO4 enhanced the contrast in all scans and the visualization was substantially improved by the image processing algorithm. The three-dimensional renderings provided detailed visualization of the whole inner ear. Details were visible up to the size of individual neurons, nerve crossings and the specific neuro-anatomical structures such as the tunnel of Corti. Conclusion: The combination of OsO4, micro-CT and the proposed image processing algorithm provides an accurate and detailed visualization of the three-dimensional micro-anatomy of the human inner ear.
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Affiliation(s)
- Thomas van den Boogert
- Division of Balance Disorders, Department of Otorhinolaryngology, Head, and Neck Surgery, Faculty of Health Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Marc van Hoof
- Division of Balance Disorders, Department of Otorhinolaryngology, Head, and Neck Surgery, Faculty of Health Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Stephan Handschuh
- VetCore Facility for Research, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Rudolf Glueckert
- Department of Otorhinolaryngology, Medical University Innsbruck, Innsbruck, Austria
| | - Nils Guinand
- Department of Clinical Neurosciences, Service of Otorhinolaryngology, Head, and Neck Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-Philippe Guyot
- Department of Clinical Neurosciences, Service of Otorhinolaryngology, Head, and Neck Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Herman Kingma
- Division of Balance Disorders, Department of Otorhinolaryngology, Head, and Neck Surgery, Faculty of Health Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, Netherlands
- Vestibular Laboratory, Faculty of Physics, Tomsk State National Research University, Tomsk, Russia
| | - Angelica Perez-Fornos
- Department of Clinical Neurosciences, Service of Otorhinolaryngology, Head, and Neck Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Bart Seppen
- Division of Balance Disorders, Department of Otorhinolaryngology, Head, and Neck Surgery, Faculty of Health Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Lejo Johnson Chacko
- Department of Otorhinolaryngology, Medical University Innsbruck, Innsbruck, Austria
| | | | - Raymond van de Berg
- Division of Balance Disorders, Department of Otorhinolaryngology, Head, and Neck Surgery, Faculty of Health Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, Netherlands
- Vestibular Laboratory, Faculty of Physics, Tomsk State National Research University, Tomsk, Russia
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Demkin VP, Udut VV, Shchetinin PP, Svetlik MV, Mel'nichuk SV, Shchetinina AP, Pleshkov MO, Starkov DN, Demkin OV, Kingma H. Electrophysiological Properties of Rat Vestibular Labyrinth and Their Effect on Parameters of Transmitted Voltage Pulses. Bull Exp Biol Med 2018; 164:707-11. [PMID: 29658089 DOI: 10.1007/s10517-018-4063-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Indexed: 10/17/2022]
Abstract
We propose a new approach to optimization of electrical stimulation of the vestibular nerve and improving the transfer function of vestibular implant. A mathematical model of the vestibular organ is developed based on its anatomy, the model premises, 3D-analysis of MRI and CT images, and mathematical description of physical processes underlying propagation of alternating electric current across the tissues of vestibular labyrinth. This approach was tested in vitro on the rat vestibular apparatus and had been examined anatomically prior to the development of its mathematical model and equivalent electrical circuit. The experimental and theoretical values of changes of the gain-phase characteristics of vestibular tissues in relation to location of the reference electrode obtained in this study can be used to optimize the electrical stimulation of vestibular nerve.
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Johnson Chacko L, Schmidbauer DT, Handschuh S, Reka A, Fritscher KD, Raudaschl P, Saba R, Handler M, Schier PP, Baumgarten D, Fischer N, Pechriggl EJ, Brenner E, Hoermann R, Glueckert R, Schrott-Fischer A. Analysis of Vestibular Labyrinthine Geometry and Variation in the Human Temporal Bone. Front Neurosci 2018. [PMID: 29535601 PMCID: PMC5834493 DOI: 10.3389/fnins.2018.00107] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Stable posture and body movement in humans is dictated by the precise functioning of the ampulla organs in the semi-circular canals. Statistical analysis of the interrelationship between bony and membranous compartments within the semi-circular canals is dependent on the visualization of soft tissue structures. Thirty-one human inner ears were prepared, post-fixed with osmium tetroxide and decalcified for soft tissue contrast enhancement. High resolution X-ray microtomography images at 15 μm voxel-size were manually segmented. This data served as templates for centerline generation and cross-sectional area extraction. Our estimates demonstrate the variability of individual specimens from averaged centerlines of both bony and membranous labyrinth. Centerline lengths and cross-sectional areas along these lines were identified from segmented data. Using centerlines weighted by the inverse squares of the cross-sectional areas, plane angles could be quantified. The fit planes indicate that the bony labyrinth resembles a Cartesian coordinate system more closely than the membranous labyrinth. A widening in the membranous labyrinth of the lateral semi-circular canal was observed in some of the specimens. Likewise, the cross-sectional areas in the perilymphatic spaces of the lateral canal differed from the other canals. For the first time we could precisely describe the geometry of the human membranous labyrinth based on a large sample size. Awareness of the variations in the canal geometry of the membranous and bony labyrinth would be a helpful reference in designing electrodes for future vestibular prosthesis and simulating fluid dynamics more precisely.
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Affiliation(s)
- Lejo Johnson Chacko
- Department of Otolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | - Dominik T Schmidbauer
- Department of Otolaryngology, Medical University of Innsbruck, Innsbruck, Austria.,Department of Biotechnology & Food Engineering, Management Center Innsbruck, Innsbruck, Austria
| | - Stephan Handschuh
- VetImaging, VetCore Facility for Research, University of Veterinary Medicine, Vienna, Austria
| | - Alen Reka
- Department of Otolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | - Karl D Fritscher
- Institute of Biomedical Image Analysis, UMIT, Hall in Tirol, Austria
| | - Patrik Raudaschl
- Institute of Biomedical Image Analysis, UMIT, Hall in Tirol, Austria
| | | | - Michael Handler
- Institute of Electrical and Biomedical Engineering, UMIT, Hall in Tirol, Austria
| | - Peter P Schier
- Institute of Electrical and Biomedical Engineering, UMIT, Hall in Tirol, Austria
| | - Daniel Baumgarten
- Institute of Electrical and Biomedical Engineering, UMIT, Hall in Tirol, Austria.,Institute of Biomedical Engineering and Informatics, Technische Universität Ilmenau, Ilmenau, Germany
| | - Natalie Fischer
- Department of Otolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elisabeth J Pechriggl
- Division of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Innsbruck, Austria
| | - Erich Brenner
- Division of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Innsbruck, Austria
| | - Romed Hoermann
- Division of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Innsbruck, Austria
| | - Rudolf Glueckert
- Department of Otolaryngology, Medical University of Innsbruck, Innsbruck, Austria.,University Clinics Innsbruck, Tirol Kliniken, Innsbruck, Austria
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Pérez-Vázquez P, Franco-Gutiérrez V, Soto-Varela A, Amor-Dorado JC, Martín-Sanz E, Oliva-Domínguez M, Lopez-Escamez JA. Practice Guidelines for the Diagnosis and Management of Benign Paroxysmal Positional Vertigo Otoneurology Committee of Spanish Otorhinolaryngology and Head and Neck Surgery Consensus Document. Acta Otorrinolaringol Esp (Engl Ed) 2018; 69:345-66. [PMID: 28826856 DOI: 10.1016/j.otorri.2017.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 05/04/2017] [Indexed: 11/21/2022]
Abstract
Benign Paroxysmal Positional Vertigo is the most frequent episodic vestibular disorder. The purpose of this guide, requested by the committee on otoneurology of the Spanish Society of Otolaryngology and Head and Neck Surgery, is to supply a consensus document providing practical guidance for the management of BPPV. It is based on the Barany Society criteria for the diagnosis of BPPV. This guideline provides recommendations on each variant of BPPV, with a description of the different diagnostic tests and the therapeutic manoeuvres. For this purpose, we have selected the tests and manoeuvres supported by evidence-based studies or extensive series. Finally, we have also included a chapter on differential diagnosis and a section relating to general aspects in the management of BPPV.
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Abstract
In 1988, we introduced impulsive testing of semicircular canal (SCC) function measured with scleral search coils and showed that it could accurately and reliably detect impaired function even of a single lateral canal. Later we showed that it was also possible to test individual vertical canal function in peripheral and also in central vestibular disorders and proposed a physiological mechanism for why this might be so. For the next 20 years, between 1988 and 2008, impulsive testing of individual SCC function could only be accurately done by a few aficionados with the time and money to support scleral search-coil systems—an expensive, complicated and cumbersome, semi-invasive technique that never made the transition from the research lab to the dizzy clinic. Then, in 2009 and 2013, we introduced a video method of testing function of each of the six canals individually. Since 2009, the method has been taken up by most dizzy clinics around the world, with now close to 100 refereed articles in PubMed. In many dizzy clinics around the world, video Head Impulse Testing has supplanted caloric testing as the initial and in some cases the final test of choice in patients with suspected vestibular disorders. Here, we consider seven current, interesting, and controversial aspects of video Head Impulse Testing: (1) introduction to the test; (2) the progress from the head impulse protocol (HIMPs) to the new variant—suppression head impulse protocol (SHIMPs); (3) the physiological basis for head impulse testing; (4) practical aspects and potential pitfalls of video head impulse testing; (5) problems of vestibulo-ocular reflex gain calculations; (6) head impulse testing in central vestibular disorders; and (7) to stay right up-to-date—new clinical disease patterns emerging from video head impulse testing. With thanks and appreciation we dedicate this article to our friend, colleague, and mentor, Dr Bernard Cohen of Mount Sinai Medical School, New York, who since his first article 55 years ago on compensatory eye movements induced by vertical SCC stimulation has become one of the giants of the vestibular world.
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Affiliation(s)
- G M Halmagyi
- Neurology Department, Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Luke Chen
- Neurology Department, Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Hamish G MacDougall
- Vestibular Research Laboratory, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Konrad P Weber
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Leigh A McGarvie
- Neurology Department, Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Ian S Curthoys
- Vestibular Research Laboratory, School of Psychology, The University of Sydney, Sydney, NSW, Australia
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Maxwell R, von Kirschbaum C, Jerin C, Lehnen N, Krause E, Gürkov R. Effect of Spatial Orientation of the Horizontal Semicircular Canal on the Vestibulo-Ocular Reflex. Otol Neurotol 2017; 38:239-43. [PMID: 27898608 DOI: 10.1097/MAO.0000000000001291] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine if an alignment of the horizontal semi-circular canal (hSCC) with the plane of rotation would enhance the vestibular-ocular reflex (VOR) gain result as it has been previously suggested. STUDY DESIGN Comparative study of a physiological vestibular function test in healthy subjects. SETTING Tertiary referral center for otology and neurotology. PATIENTS Twenty two healthy volunteers were recruited for this study. Their mean age was 25.6 years and the sex distribution was 14:8 (M:F). None of the subjects had a history of audiovestibular disorders. INTERVENTION The video Head Impulse Test (v-HIT) was performed with the hSCC in the conventional position (head upright, horizontal gaze) and also with the hSCC in-line with the earth horizontal. MAIN OUTCOME MEASURES depending on the alignment of the hSCC with the plane of head rotation. RESULTS There was no significant difference between the results, either for the VOR gain at 60 ms, or the regression slope gain, when the two alternative head positions were compared. CONCLUSIONS The data acquired in this study show that the VOR as measured by the v-HIT is not enhanced by aligning the plane of the hSCC with the plane of rotation during the testing procedure. Hence, we recommend that the positioning of the patient, with the head upright and a horizontal gaze direction should be routinely used in the clinical evaluation of the angular VOR by v-HIT.
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Obrist D, Nienhaus A, Zamaro E, Kalla R, Mantokoudis G, Strupp M. Determinants for a Successful Sémont Maneuver: An In vitro Study with a Semicircular Canal Model. Front Neurol 2016; 7:150. [PMID: 27695437 PMCID: PMC5025435 DOI: 10.3389/fneur.2016.00150] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 09/02/2016] [Indexed: 11/19/2022] Open
Abstract
Objective To evaluate the effect of time between the movements/steps, angle of body movements as well as the angular velocity of the maneuvers in an in vitro model of a semicircular canal (SCC) to improve the efficacy of the Sémont maneuver (SM) in benign paroxysmal positional vertigo. Materials and Methods Sémont maneuvers were performed on an in vitro SCC model. Otoconia trajectories were captured by a video camera. The effects of time between the movements, angles of motion (0°, 10°, 20°, and 30° below the horizontal line), different angular velocities (90, 135, 180°/s), and otoconia size (36 and 50 μm) on the final position of the otoconia in the SCC were tested. Results Without extension of the movements beyond the horizontal, the in vitro experiments (with particles corresponding to 50 μm diameter) did not yield successful canalith repositioning. If the movements were extended by 20° beyond the horizontal position, SM were successful with resting times of at least 16 s. For larger extension angles, the required time decreased. However, for smaller particles (36 μm), the required time doubled. The angular maneuver velocity (tested between 90 and 180°/s) did not have a major impact on the final position of the otoconia. Interpretation The two primary determinants for success of the SM are the time between the movements and the extension of the movements beyond the horizontal. The time between the movements should be at least 45 s. Angles of 20° or more below horizontal line (so-called Sémont+) should increase the success rate of SM.
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Affiliation(s)
- Dominik Obrist
- ARTORG Center for Biomedical Engineering Research, University of Bern , Bern , Switzerland
| | - Andrea Nienhaus
- ARTORG Center for Biomedical Engineering Research, University of Bern , Bern , Switzerland
| | - Ewa Zamaro
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Bern, Inselspital , Bern , Switzerland
| | - Roger Kalla
- Department of Neurology, Division of Cognitive and Restorative Neurology, University Hospital Bern, Inselspital , Bern , Switzerland
| | - Georgios Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Bern, Inselspital , Bern , Switzerland
| | - Michael Strupp
- Department of Neurology, German Center for Vertigo and Balance Disorders, University Hospital Munich , Munich , Germany
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David R, Stoessel A, Berthoz A, Spoor F, Bennequin D. Assessing morphology and function of the semicircular duct system: introducing new in-situ visualization and software toolbox. Sci Rep 2016; 6:32772. [PMID: 27604473 PMCID: PMC5015051 DOI: 10.1038/srep32772] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 08/15/2016] [Indexed: 11/12/2022] Open
Abstract
The semicircular duct system is part of the sensory organ of balance and essential for navigation and spatial awareness in vertebrates. Its function in detecting head rotations has been modelled with increasing sophistication, but the biomechanics of actual semicircular duct systems has rarely been analyzed, foremost because the fragile membranous structures in the inner ear are hard to visualize undistorted and in full. Here we present a new, easy-to-apply and non-invasive method for three-dimensional in-situ visualization and quantification of the semicircular duct system, using X-ray micro tomography and tissue staining with phosphotungstic acid. Moreover, we introduce Ariadne, a software toolbox which provides comprehensive and improved morphological and functional analysis of any visualized duct system. We demonstrate the potential of these methods by presenting results for the duct system of humans, the squirrel monkey and the rhesus macaque, making comparisons with past results from neurophysiological, oculometric and biomechanical studies. Ariadne is freely available at http://www.earbank.org.
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Affiliation(s)
- R David
- Department of Human Evolution, Max Planck Institute for Evolutionary Anthropology, Deutscher Platz 6, 04103 Leipzig, Germany.,Centre de Recherches sur la Paléobiodiversité et les Paléoenvironnements (CR2P, UMR 7207), Sorbonne Universités-MNHN, CNRS, UPMC-Paris6, Muséum national d'Histoire naturelle, CP38, 57 rue Cuvier, F-75005, Paris, France
| | - A Stoessel
- Department of Human Evolution, Max Planck Institute for Evolutionary Anthropology, Deutscher Platz 6, 04103 Leipzig, Germany
| | - A Berthoz
- Collège de France, 11 place Marcelin Berthelot, 75231 Paris, France
| | - F Spoor
- Department of Human Evolution, Max Planck Institute for Evolutionary Anthropology, Deutscher Platz 6, 04103 Leipzig, Germany.,Department of Cell and Developmental Biology, University College London, London WC1E 6BT, UK
| | - D Bennequin
- Université Paris Diderot-Paris 7, UFR de Mathématiques, Equipe Géométrie et Dynamique, Bâtiment Sophie Germain, 8 place Aurélie Nemours, 75013 Paris Cedex 13, France
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Hitier M, Sato G, Zhang YF, Zheng Y, Besnard S, Smith PF, Curthoys IS. Anatomy and surgical approach of rat’s vestibular sensors and nerves. J Neurosci Methods 2016; 270:1-8. [DOI: 10.1016/j.jneumeth.2016.05.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 05/14/2016] [Accepted: 05/16/2016] [Indexed: 11/25/2022]
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Lyu HY, Chen KG, Yin DM, Hong J, Yang L, Zhang TY, Dai PD. The Age-Related Orientational Changes of Human Semicircular Canals. Clin Exp Otorhinolaryngol 2016; 9:109-15. [PMID: 27090280 PMCID: PMC4881327 DOI: 10.21053/ceo.2014.02012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 03/13/2015] [Accepted: 06/10/2015] [Indexed: 11/22/2022] Open
Abstract
Objectives Some changes are found in the labyrinth anatomy during postnatal development. Although the spatial orientation of semicircular canals was thought to be stable after birth, we investigated the age-related orientational changes of human semicircular canals during development. Methods We retrospectively studied the computed tomography (CT) images of both ears of 76 subjects ranged from 1 to 70 years old. They were divided into 4 groups: group A (1–6 years), group B (7–12 years), group C (13–18 years), and group D (>18 years). The anatomical landmarks of the inner ear structures were determined from CT images. Their coordinates were imported into MATLAB software for calculating the semicircular canals orientation, angles between semicircular canal planes and the jugular bulb (JB) position. Differences between age groups were analyzed using multivariate statistics. Relationships between variables were analyzed using Pearson analysis. Results The angle between the anterior semicircular canal plane and the coronal plane, and the angle between the horizontal semicircular canal plane and the coronal plane were smaller in group D than those in group A (P<0.05). The JB position, especially the anteroposterior position of right JB, correlated to the semicircular canals orientation (P<0.05). However, no statistically significant differences in the angles between ipsilateral canal planes among different age groups were found. Conclusion The semicircular canals had tendencies to tilt anteriorly simultaneously as a whole with age. The JB position correlated to the spatial arrangement of semicircular canals, especially the right JB. Our calculation method helps detect developmental and pathological changes in vestibular anatomy.
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Affiliation(s)
- Hui-Ying Lyu
- Department of Otolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Ke-Guang Chen
- Department of Otolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Dong-Ming Yin
- Department of Otolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Juan Hong
- Department of Otolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Lin Yang
- Research Center, Eye and ENT Hospital, Fudan University, Shanghai, China.,Key Laboratory of Hearing Medicine, National Ministry of Public Health, Shanghai, China
| | - Tian-Yu Zhang
- Department of Otolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, China.,Key Laboratory of Hearing Medicine, National Ministry of Public Health, Shanghai, China
| | - Pei-Dong Dai
- Research Center, Eye and ENT Hospital, Fudan University, Shanghai, China.,Key Laboratory of Hearing Medicine, National Ministry of Public Health, Shanghai, China
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38
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Perier A, Lebrun R, Marivaux L. Different Level of Intraspecific Variation of the Bony Labyrinth Morphology in Slow- Versus Fast-Moving Primates. J MAMM EVOL 2016. [DOI: 10.1007/s10914-016-9323-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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39
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Abstract
Benign paroxysmal positional vertigo is a common labyrinthine disorder caused by a mechanic stimulation of the vestibular receptors within the semicircular canals. It is characterized by positional vertigo and positional nystagmus, both provoked by changes in the position of the head with respect to gravity. The social impact of the disease and its direct and indirect costs to healthcare systems are significant owing to impairment of daily activities and increased risk of falls. The first description of a patient with benign paroxysmal positional vertigo is from Robert Bárány in 1921, but the features of the syndrome and the diagnostic maneuver were well described by Dix and Hallpike in 1952. Since then, the gradually increasing interest of otolaryngologists and neurologists has led to a progressive advance in the knowledge of this labyrinthine disorder with regard to its epidemiologic, pathophysiologic, clinical, and therapeutic aspects. Despite the often effective diagnosis and treatment of most cases of benign paroxysmal positional vertigo, the physiopathologic explanations of the disease are mainly speculative. In this chapter, we describe the epidemiologic, pathophysiologic, clinical, and therapeutic aspects of benign paroxysmal positional vertigo.
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Affiliation(s)
- D Nuti
- Department of Otology and Skull Base Surgery, University of Siena, Siena, Italy.
| | - M Masini
- Department of Social, Political and Cognitive Sciences, University of Siena, Siena, Italy
| | - M Mandalà
- Department of Otology and Skull Base Surgery, University of Siena, Siena, Italy
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40
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Cuthbertson RS, Maddin HC, Holmes RB, Anderson JS. The Braincase and Endosseous Labyrinth of Plioplatecarpus peckensis (Mosasauridae, Plioplatecarpinae), With Functional Implications for Locomotor Behavior. Anat Rec (Hoboken) 2015; 298:1597-611. [PMID: 26052684 DOI: 10.1002/ar.23180] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 04/06/2015] [Accepted: 04/07/2015] [Indexed: 11/06/2022]
Abstract
Adaptations of mosasaurs to the aquatic realm have been extensively studied from the perspective of modifications to the post-cranial skeleton. In recent years, imaging techniques such as computed tomography have permitted the acquisition of anatomical data from previously inaccessible sources. An exquisitely preserved specimen of the plioplatecarpine mosasaur Plioplatecarpus peckensis presents an opportunity to examine the detailed structure of the braincase, as well as the form of the otic capsule endocast. These data elaborate upon previous descriptions of the braincase of Plioplatecarpus, and provide a detailed, three dimensional reconstruction of the osseous labyrinth for the first time. The otic capsule endocasts reveal that the size of the labyrinth relative to head size is comparable to that of other squamates, suggesting that labyrinth size was not a factor in increasing sensitivity. However, all three semicircular canals are tall and strongly arced to a degree comparable to, and even exceeding, that observed in arboreal and aquatic lizards. Comparison of the sensitivity of the canals in each of the three major axes of rotation suggests Plioplatecarpus peckensis may have been most sensitive to movements in the pitch axis. Although early mosasaurs were probably anguilliform swimmers, most are thought to have been subcarangiform to thunniform locomotors with a near-rigid body form and likely decreased maneuverability. The data from the labyrinth presented here add a potential new dimension to this model of locomotion for further consideration, wherein changes in orientation, such as pitch, may have been more common locomotor behaviors than previously thought.
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Affiliation(s)
- Robin S Cuthbertson
- Department of Biological Sciences, University of Calgary, Calgary, Alberta, Canada, T2N 1N4
| | - Hillary C Maddin
- Department of Earth Sciences, Carleton University, Ottawa, Ontario, Canada, K1S 5B6
| | - Robert B Holmes
- Department of Biological Sciences, University of Alberta, Edmonton, Alberta, Canada, T6G 2E9
| | - Jason S Anderson
- Department of Comparative Biology and Experimental Medicine, University of Calgary, Calgary, Alberta, Canada, T2N 4N1
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McGarvie LA, Martinez-Lopez M, Burgess AM, MacDougall HG, Curthoys IS. Horizontal Eye Position Affects Measured Vertical VOR Gain on the Video Head Impulse Test. Front Neurol 2015; 6:58. [PMID: 25852637 PMCID: PMC4362217 DOI: 10.3389/fneur.2015.00058] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 03/04/2015] [Indexed: 11/25/2022] Open
Abstract
Background/hypothesis: With the video head impulse test (vHIT), the vertical VOR gain is defined as (vertical eye velocity/vertical head velocity), but compensatory eye movements to vertical canal stimulation usually have a torsional component. To minimize the contribution of torsion to the eye movement measurement, the horizontal gaze direction should be directed 40° from straight ahead so it is in the plane of the stimulated canal plane pair. Hypothesis: as gaze is systematically moved horizontally away from canal plane alignment, the measured vertical VOR gain should decrease. Study design: Ten healthy subjects, with vHIT measuring vertical eye movement to head impulses in the plane of the left anterior-right posterior (LARP) canal plane, with gaze at one of five horizontal gaze positions [40°(aligned with the LARP plane), 20°, 0°, −20°, −40°]. Methods: Every head impulse was in the LARP plane. The compensatory eye movement was measured by the vHIT prototype system. The one operator delivered every impulse. Results: The canal stimulus remained identical across trials, but the measured vertical VOR gain decreased as horizontal gaze angle was shifted away from alignment with the LARP canal plane. Conclusion: In measuring vertical VOR gain with vHIT the horizontal gaze angle should be aligned with the canal plane under test.
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Affiliation(s)
- Leigh A McGarvie
- Department of Neurology, Institute of Clinical Neurosciences, Royal Prince Alfred Hospital , Camperdown, NSW , Australia
| | - Marta Martinez-Lopez
- Department of Otorhinolaryngology, Clinica Universidad de Navarra , Pamplona , Spain
| | - Ann M Burgess
- Vestibular Research Laboratory, School of Psychology, University of Sydney , Sydney, NSW , Australia
| | - Hamish G MacDougall
- Vestibular Research Laboratory, School of Psychology, University of Sydney , Sydney, NSW , Australia
| | - Ian S Curthoys
- Vestibular Research Laboratory, School of Psychology, University of Sydney , Sydney, NSW , Australia
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Kim DK, Kim DR, Jeong SH, Kim GJ, Chang KH, Jun BC. Analysis of the coplanarity of functional pairs of semicircular canals using three-dimensional images reconstructed from temporal bone magnetic resonance imaging. J Laryngol Otol. 2015;129:430-434. [PMID: 25731632 DOI: 10.1017/s0022215115000201] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES This study was conducted to investigate the angles and orientation of semicircular canals, and the coplanarity of functional canal pairs. METHODS Fluid signals in semicircular canals were reconstructed with three-dimensional reconstruction software using 20 temporal bone magnetic resonance images of normal subjects. The angles between each pair of semicircular canals were measured. RESULTS The mean angles between the anterior and horizontal semicircular canal plane, the horizontal and posterior semicircular canal plane, and the anterior and posterior semicircular canal plane were 83.7°, 82.5° and 88.4°, respectively. Pairs of contralateral synergistic canal planes were formed 15.1° between the right and left horizontal semicircular canal planes, 21.2° between the right anterior and left posterior semicircular canal, and 21.7° between the left anterior and right posterior semicircular canal. CONCLUSION Each semicircular canal makes an almost right angle with other canals, but synergistically acting functional canal pairs of both ears do not lie in exactly the same plane.
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Papathanasiou ES. The evidence is finally here: Ocular vestibular evoked myogenic potentials are mainly dependent on utricular pathway function. Clin Neurophysiol 2015; 126:1843-4. [PMID: 25703939 DOI: 10.1016/j.clinph.2015.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 01/13/2015] [Accepted: 01/16/2015] [Indexed: 10/24/2022]
Affiliation(s)
- Eleftherios S Papathanasiou
- Clinical Neurophysiology Laboratory, Clinic B, The Cyprus Institute of Neurology & Genetics, Nicosia, Cyprus.
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Billet G, de Muizon C, Schellhorn R, Ruf I, Ladevèze S, Bergqvist L. Petrosal and inner ear anatomy and allometry amongst specimens referred to Litopterna (Placentalia). Zool J Linn Soc 2015. [DOI: 10.1111/zoj.12219] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Guillaume Billet
- Steinmann-Institut für Geologie; Mineralogie und Paläontologie; Rheinische Friedrich-Wilhelms-Universität Bonn; Nussallee 8 53115 Bonn Germany
- CR2P - UMR 7207 CNRS; MNHN; Univ Paris 06 - Muséum national d'Histoire naturelle; 8 rue Buffon CP 38 75005 Paris France
| | - Christian de Muizon
- CR2P - UMR 7207 CNRS; MNHN; Univ Paris 06 - Muséum national d'Histoire naturelle; 8 rue Buffon CP 38 75005 Paris France
| | - Rico Schellhorn
- Steinmann-Institut für Geologie; Mineralogie und Paläontologie; Rheinische Friedrich-Wilhelms-Universität Bonn; Nussallee 8 53115 Bonn Germany
| | - Irina Ruf
- Steinmann-Institut für Geologie; Mineralogie und Paläontologie; Rheinische Friedrich-Wilhelms-Universität Bonn; Nussallee 8 53115 Bonn Germany
- Senckenberg Forschungsinstitut und Naturmuseum Frankfurt; Abteilung Paläoanthropologie und Messelforschung; Senckenberganlage 25 60325 Frankfurt am Main Germany
| | - Sandrine Ladevèze
- CR2P - UMR 7207 CNRS; MNHN; Univ Paris 06 - Muséum national d'Histoire naturelle; 8 rue Buffon CP 38 75005 Paris France
| | - Lilian Bergqvist
- Avenida Athos da Silveira Ramos; 274, bloco G; Centro de Ciências Matemáticas e da Natureza; Universidade Federal do Rio de Janeiro; Rio de Janeiro 21941-916 Brasil
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Abstract
The aim of this study was to measure the neutral position of direction-changing apogeotropic positional nystagmus (heavy cupula of the horizontal semicircular canal) and persistent direction-changing geotropic positional nystagmus (light cupula of the horizontal semicircular canal). We conducted a prospective case series study on 31 patients with heavy cupula (12 males, 19 females; mean age, 64.3 years) and 33 patients with light cupula (10 males, 23 females; mean age, 60.9 years). We measured the angle of the neutral position in patients with heavy cupula (θ 1) and that in patients with light cupula (θ 2) using a large protractor. The mean value and standard deviation of θ 1 was 31.6 ± 22.4°, minimum value was 5°, and maximum value was 89°. The mean value and standard deviation of θ 2 was 44.4 ± 20.5°, minimum value was 5°, and maximum value was 85°. θ 2 was significantly greater than θ 1 (p < 0.05). The neutral position varies widely. Some patients exhibit a great angle (more than 40°); therefore, examiners should make patients adopt a completely lateral position in the supine head roll test and should confirm the direction of nystagmus in order to avoid mistaking positional nystagmus for spontaneous nystagmus.
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Affiliation(s)
- Hiroaki Ichijo
- Ichijo Ear, Nose and Throat Clinic, 3-2-1, Ekimae, Hirosaki, 036-8002, Japan.
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Stam D, Village D, Olson L. Benign Paroxysmal Positional Vertigo in the Acute Hospital Setting: Review of a Novel Means for Examination and Intervention. Journal of Acute Care Physical Therapy 2014; 5:103-13. [DOI: 10.1097/jat.0000000000000007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mejdoubi M, Dedouit F, Mokrane FZ, Telmon N. Semicircular canal angulation during fetal life: a computed tomography study of 54 human fetuses. Otol Neurotol 2015; 36:701-4. [PMID: 25420083 DOI: 10.1097/MAO.0000000000000640] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE In humans, the inner ear reaches its final configuration and adult size during fetal life. According to the literature, this occurs between 18 and 25 weeks of amenorrhea (WA). The ossification of the otic capsule is believed to arrest any further configuration change. There have, however, been some observations of slight changes in the orientation of the semicircular canals (SCCs) occurring later in fetal life. The present study aim was to examine changes of angulations between bony SCCs during fetal life. PATIENTS Fifty-four human fetuses aged 22 to 40 WA. INTERVENTION Computed tomography scanner. MAIN OUTCOME MEASURE SCC angulation (in degrees) studied with Amira software. RESULTS We found mean angles between the lateral SCC and anterior SCC, the lateral SCC and posterior SCC, and the anterior SCC and posterior SCC of 88.67, 92.60, and 90.19 degrees, respectively. Inter-SCC angles did not change significantly between the different age groups (22 WA, 24 WA, 26 WA, 29-31 WA, 34-36 WA, 38-40 WA). There was no difference of angulation between males and females and no intraobserver or interobserver variability. CONCLUSION The absence of correlation of SCC angles with age in our sample of fetuses indicates that the three-dimensional configuration of the SCC has already reached its adult form at 22 WA. As often described in the literature, these angles are close to orthogonality, probably reflecting an optimal vestibular function configuration.
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Abstract
OBJECTIVE To review new clinical data and theories concerning atypical positional nystagmus in vertical canal benign paroxysmal positional vertigo (BPPV). DATA SOURCES Peer reviewed, clinical papers describing nystagmus provoked by positioning in cases with BPPV. STUDY SELECTION Basic scientific articles detailing 3D anatomical reconstructions of the inner ear. CONCLUSION In BPPV, it is hypothetically possible that otoconia become dislocated but do not fall into the common crus of the vertical canals or into the horizontal canal; in these cases, they may gravitate toward the most inferior part of the utriculus, the ampulla of the inferior canal. It is argued that in these cases, depending on their behavior (free-floating or sticking to the cupula) and the precise position of the inferior ampulla, either no nystagmus or a slow downbeat nystagmus should ensue when the patient is positioned from sitting to a Dix-Hallpike position. Such scenarios could hypothetically explain commonly seen clinical entities such as "subjective BPPV" and/or cases with a peripheral positional downbeat nystagmus.
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Schutz H, Jamniczky HA, Hallgrímsson B, Garland T. Shape-shift: semicircular canal morphology responds to selective breeding for increased locomotor activity. Evolution 2014; 68:3184-98. [PMID: 25130322 DOI: 10.1111/evo.12501] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 07/06/2014] [Indexed: 02/05/2023]
Abstract
Variation in semicircular canal morphology correlates with locomotor agility among species of mammals. An experimental evolutionary mouse model was used to test the hypotheses that semicircular canal morphology (1) evolves in response to selective breeding for increased locomotor activity, (2) exhibits phenotypic plasticity in response to early-onset chronic exercise, and (3) is unique in individuals possessing the minimuscle phenotype. We examined responses in canal morphology to prolonged wheel access and selection in laboratory mice from four replicate lines bred for high voluntary wheel-running (HR) and four nonselected control (C) lines. Linear measurements and a suite of 3D landmarks were obtained from 3D reconstructions of μCT-scanned mouse crania (μCT is microcomputed tomography). Body mass was smaller in HR than C mice and was a significant predictor of both radius of curvature and 3D canal shape. Controlling for body mass, radius of curvature did not differ statistically between HR and C mice, but semicircular canal shape did. Neither chronic wheel access nor minimuscle affected radius of curvature or canal shape These findings suggest that semicircular canal morphology is responsive to evolutionary changes in locomotor behavior, but the pattern of response is potentially different in small- versus large-bodied species.
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Affiliation(s)
- Heidi Schutz
- Biology Department, Pacific Lutheran University, Tacoma, Washington, 98477; Department of Biology, University of California, Riverside, California, 92521.
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Oliveira FPM, Faria DB, Tavares JMRS. Automated segmentation of the incus and malleus ossicles in conventional tri-dimensional computed tomography images. Proc Inst Mech Eng H 2014; 228:810-8. [PMID: 25085697 DOI: 10.1177/0954411914546123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article proposes a fully automated computational solution to segment the incus and malleus ear ossicles in conventional tri-dimensional X-ray computed tomography images. The solution uses a registration-based segmentation paradigm, followed by image segmentation refinement. It was tested against a dataset comprising 21 computed tomography volumetric images of the ear acquired using standard protocols and with resolutions varying from 0.162 × 0.162 × 0.6 to 0.166 × 0.166 × 1.0 mm(3). The images used were randomly selected from subjects who had had a computed tomography examination of the ear due to ear-related pathologies. Dice's coefficient and the Hausdorff distance were used to compare the results of the automated segmentation against those of a manual segmentation performed by two experts. The mean agreement between automated and manual segmentations was equal to 0.956 (Dice's coefficient), and the mean Hausdorff distance among the shapes obtained was 1.14 mm, which is approximately equal to the maximum distance between the neighbouring voxels in the dataset tested. The results confirm that the automated segmentation of the incus and malleus ossicles in tri-dimensional images acquired from patients with ear-related pathologies, using conventional computed tomography scanners and standard protocols, is feasible, robust and accurate. Thus, the solution developed can be employed efficiently in computed tomography ear examinations to help radiologists and otolaryngologists in the evaluation of bi-dimensional slices by providing the related tri-dimensional model.
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Affiliation(s)
- Francisco P M Oliveira
- Institute of Nuclear Sciences Applied to Health (ICNAS) and Institute for Biomedical Imaging and Life Sciences (IBILI), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Diogo Borges Faria
- HPP Medicina Molecular, SA., Faculdade de Engenharia, Universidade do Porto, Porto, Portugal
| | - João Manuel R S Tavares
- Instituto de Engenharia Mecânica e Gestão Industrial, Departamento de Engenharia Mecânica, Faculdade de Engenharia, Universidade do Porto, Porto, Portugal
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