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Fujiwara K, Morita S, Motegi H, Yamaguchi S, Ishi Y, Hoshino K, Fukuda A, Kobayashi M, Nakamaru Y, Fujimura M, Homma A. Pre- and post-operative semicircular canal function evaluated by video head impulse test in patients with vestibular schwannoma. Auris Nasus Larynx 2024; 51:542-547. [PMID: 38537557 DOI: 10.1016/j.anl.2024.03.001] [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: 10/13/2023] [Revised: 02/09/2024] [Accepted: 03/06/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVES To evaluate pre- and post-operative semicircular canal function in patients with vestibular schwannoma (VS) by the video Head Impulse Test (vHIT). METHODS Nineteen patients with VS who underwent surgery were enrolled in this study. The gain in vestibulo-ocular reflex (VOR) and the degree of scatter in catch-up saccades were examined pre- and post-operatively for the semicircular canals in VS patients. RESULTS Ten of 19 cases (52.6 %) with VS were defined as demonstrating both superior vestibular nerve (SVN) and inferior vestibular nerve (IVN) impairment from the results of pre-operative vHIT. Hearing level and subjective vestibular symptoms showed significant correlations with pre-operative semicircular canal function. Compared to pre-operative vHIT results, VOR gains within 1 month after surgery were significantly reduced in all three canals; however, significant differences had disappeared in the anterior and posterior semicircular canals at 6 months after surgery. Cases of unknown origin had a significantly greater reduction in posterior semicircular canal function after surgery compared with those with disease of IVN origin. CONCLUSIONS As vHIT could evaluate pre-operative vestibular nerve impairment, post-operative VOR gain reduction and the degree of vestibular compensation, semicircular canal function evaluated by vHIT provides a good deal of useful information regarding VS patients undergoing surgery compared to caloric testing, and vHIT should be performed pre- and post-operatively for patients with VS.
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Affiliation(s)
- Keishi Fujiwara
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
| | - Shinya Morita
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroaki Motegi
- Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shigeru Yamaguchi
- Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yukitomo Ishi
- Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kimiko Hoshino
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Atsushi Fukuda
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Makoto Kobayashi
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yuji Nakamaru
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Miki Fujimura
- Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Akihiro Homma
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Alonso SM, Ayerve NA, Roca CM, Touma GC, de Dios JCDP, Gómez HS, Ruíz SSC, Caletrío ÁB. Use of Skull Vibration-Induced Nystagmus in the Follow-up of Patients With Ménière Disease Treated With Intratympanic Gentamicin. Clin Exp Otorhinolaryngol 2023; 16:236-243. [PMID: 37402470 PMCID: PMC10471906 DOI: 10.21053/ceo.2023.00129] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/27/2023] [Accepted: 06/24/2023] [Indexed: 07/06/2023] Open
Abstract
OBJECTIVES Ménière disease (MD) is an idiopathic disorder that affects hearing and inner ear balance. Intratympanic gentamicin (ITG) is recognized as an effective treatment for uncontrolled MD characterized by persistent vertigo attacks despite therapy. The video head impulse test (vHIT) and skull vibration-induced nystagmus (SVIN) are validated. METHODS for evaluating vestibular function. A progressive linear relationship has been identified between the slow-phase velocity (SPV) of SVIN determined using a 100-Hz skull vibrator and the gain difference (healthy ear/affected ear) measured by vHIT. The aim of this study was to ascertain whether the SPV of SVIN was associated with the recovery of vestibular function following ITG treatment. Consequently, we sought to determine whether SVIN could predict the onset of new vertigo attacks in patients with MD who were treated with ITG. METHODS A prospective longitudinal case-control study was conducted. Several variables were recorded post-ITG and throughout the follow-up period, followed by statistical analyses. Two groups were compared: patients who experienced vertigo attacks 6 months after ITG and those who did not. RESULTS The sample comprised 88 patients diagnosed with MD who underwent ITG treatment. Of the 18 patients who experienced recurring vertigo attacks, 15 demonstrated gain recovery in the affected ear. However, all 18 patients exhibited a decrease in the SPV of SVIN. CONCLUSION The SPV of SVIN may be more sensitive than vHIT in identifying the recovery of vestibular function following ITG administration. To our knowledge, this is the first study to illustrate the link between a reduction in SPV and the likelihood of vertigo episodes in patients with MD who have been treated with ITG.
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Affiliation(s)
- Susana Marcos Alonso
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - Nicole Almeida Ayerve
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - Chiara Monopoli Roca
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - Guillermo Coronel Touma
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - Juan Carlos del Pozo de Dios
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - Hortensia Sánchez Gómez
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - Santiago Santa Cruz Ruíz
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - Ángel Batuecas Caletrío
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
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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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Riska KM, Bellucci J, Garrison D, Hall C. Relationship Between Corrective Saccades and Measures of Physical Function in Unilateral and Bilateral Vestibular Loss. Ear Hear 2021; 41:1568-1574. [PMID: 33136632 DOI: 10.1097/aud.0000000000000885] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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
OBJECTIVES Following the loss of vestibular function, some patients functionally improve and are minimally bothered by their loss of peripheral function while others remain more symptomatic and are unable to return to their activities of daily living. To date, the mechanisms for functional improvement remain poorly understood. The purpose of the present study was to examine the association between corrective saccades and measures of handicap, dynamic visual acuity, gait, and falls. DESIGN A retrospective chart review was performed to identify patients who were diagnosed with unilateral or bilateral vestibular hypofunction and who also completed a baseline vestibular rehabilitation evaluation. A total of 82 patients with unilateral vestibular hypofunction and 17 patients with bilateral vestibular hypofunction were identified. The video head impulse test results for each patient were grouped based on the type of presenting saccades. Specifically, the saccade grouping included the following: (1) covert, (2) overt, or (3) a combination of both types of saccades. RESULTS The results show that covert saccades are associated with better performance on measures of dynamic visual acuity, gait, and balance in patients with unilateral vestibular hypofunction. Patients exhibiting overt saccades or combination of both covert and overt saccades were more often found to have an abnormal gait speed and be characterized as being at risk for falls using the Dynamic Gait Index. We observed no differences in physical function for those patients with bilateral vestibular hypofunction as a function of saccade grouping. CONCLUSIONS When comparing saccade groups (covert, overt, or combination of both), patients with unilateral vestibular hypofunction and covert saccades demonstrated better performance on standard baseline physical therapy measures of dynamic visual acuity and gait and balance. We did not observe any significant associations between saccade group and physical function in patients with bilateral vestibular hypofunction; however, additional studies are needed with adequate sample sizes. Our findings may suggest that corrective saccade latency in patients with unilateral vestibular hypofunction is related to measures of physical function. The extent to which saccade latency has the potential to be a useful target for vestibular rehabilitation is still to be determined and may be promising target to improve functional outcomes.
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Affiliation(s)
- Kristal M Riska
- Department of Head and Neck Surgery & Communication Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Jordan Bellucci
- Department of Allied Health Sciences, Division of Speech and Hearing Sciences, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Doug Garrison
- Department of Head and Neck Surgery & Communication Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Courtney Hall
- Research Service, James H Quillen VAMC, Mountain Home, Tennessee, USA
- Department of Physical Therapy, East Tennessee State University, Johnson City, Tennessee, USA
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Denia-Lafuente A, Lombardero B. Vestibular Function Measured Using the Video Head Impulse Test in Congenital Nystagmus and Vertigo: A Case Report. Front Neurol 2021; 12:690402. [PMID: 34177790 PMCID: PMC8220896 DOI: 10.3389/fneur.2021.690402] [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: 04/02/2021] [Accepted: 05/17/2021] [Indexed: 11/13/2022] Open
Abstract
In patients with congenital nystagmus (CN), the study of vestibular function is complicated by many factors related to the measurement of the vestibulo-ocular reflex (VOR) by means of caloric testing and the video head impulse test (vHIT), and to date no such studies have successfully employed the vHIT to evaluate vestibular function in these patients. We present a case with CN and vertigo in which peripheral vestibular function was evaluated using the vHIT system, including head impulse testing and the suppression head impulse protocol. We show that it is possible (a) to identify lateral VOR changes such as abnormalities resembling those produced by bilateral vestibular lesions, though not necessarily related to the same mechanism; (b) to identify peripheral VOR lesions of the vertical semicircular canals (SCC); and (c) to document compensation and recovery subsequent to these peripheral lesions during follow-up of patients with CN. vHIT is a useful tool that should be used to study vestibular function in patients with CN and vertigo, which could constitute a new clinical application of this technique.
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Martin-Sanz E, Esteban-Sánchez J, González-Márquez R, Larrán-Jiménez A, Cuesta Á, Batuecas-Caletrio Á. Vibration-induced nystagmus and head impulse test screening for vestibular schwannoma. Acta Otolaryngol 2021; 141:340-347. [PMID: 33583327 DOI: 10.1080/00016489.2021.1872797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
LEVEL OF EVIDENCE II-2. BACKGROUND Vestibular schwannomas are benign tumors of the eight cranial nerve that may cause asymmetric sensorineural hearing loss (ASHL) and vestibular dysfunction. OBJECTIVE The aim of this study was to assess the role of the video head impulse test (vHIT) and vibration-induced nystagmus (VIN) test in diagnosing vestibular schwannoma in a population of patients with Asymmetric sensorineural hearing loss. MATERIAL AND METHODS For this prospective case-control study, 23 consecutive patients with ASHL and normal magnetic resonance were enrolled in the control group, and 33 consecutive patients with ASHL and vestibular schwannoma were enrolled in the case group. Gold standard was magnetic resonance imaging. Audiometry, vHIT, and VIN tests were performed for each patient. Significance of VIN and vHIT testing was determined by evaluation of their sensitivity, specificity, and correlation with vestibular function tests. RESULTS Regarding the vHIT, sensitivity and specificity were 45.5% and 82.6%, respectively, for horizontal canal gain, 60.6% and 87.6%, respectively, for posterior canal gain, and 45.5% and 78.3%, respectively, when analyzing superior canal gains. Regarding the VIN test, the sensitivity and specificity were 81.8% and 73.9%, respectively, when based on the presence of a VIN with any mastoid stimulation. CONCLUSIONS Our results suggest that using the VIN test may be an efficient approach to screen for vestibular schwannoma in patients with asymmetric sensorineural hearing loss. SIGNIFICANCE Our results suggest that using the VIN test may be an efficient approach to screen for vestibular schwannoma in patients with ASHL.
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Affiliation(s)
- Eduardo Martin-Sanz
- Otoneurology Unit, ENT Department, University Hospital of Getafe, Madrid, Spain
| | | | | | - Alba Larrán-Jiménez
- Otoneurology Unit, ENT Department, University Hospital of Getafe, Madrid, Spain
| | - Ángela Cuesta
- Otoneurology Unit, ENT Department, University Hospital of Getafe, Madrid, Spain
| | - Ángel Batuecas-Caletrio
- Otoneurology Unit, ENT Department, University Hospital of Salamanca, IBSAL, Salamanca, Spain
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Zobeiri OA, Mischler GM, King SA, Lewis RF, Cullen KE. Effects of vestibular neurectomy and neural compensation on head movements in patients undergoing vestibular schwannoma resection. Sci Rep 2021; 11:517. [PMID: 33436776 PMCID: PMC7804855 DOI: 10.1038/s41598-020-79756-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 12/07/2020] [Indexed: 01/29/2023] Open
Abstract
The vestibular system is vital for maintaining balance and stabilizing gaze and vestibular damage causes impaired postural and gaze control. Here we examined the effects of vestibular loss and subsequent compensation on head motion kinematics during voluntary behavior. Head movements were measured in vestibular schwannoma patients before, and then 6 weeks and 6 months after surgical tumor removal, requiring sectioning of the involved vestibular nerve (vestibular neurectomy). Head movements were recorded in six dimensions using a small head-mounted sensor while patients performed the Functional Gait Assessment (FGA). Kinematic measures differed between patients (at all three time points) and normal subjects on several challenging FGA tasks, indicating that vestibular damage (caused by the tumor or neurectomy) alters head movements in a manner that is not normalized by central compensation. Kinematics measured at different time points relative to vestibular neurectomy differed substantially between pre-operative and 6-week post-operative states but changed little between 6-week and > 6-month post-operative states, demonstrating that compensation affecting head kinematics is relatively rapid. Our results indicate that quantifying head kinematics during self-generated gait tasks provides valuable information about vestibular damage and compensation, suggesting that early changes in patient head motion strategy may be maladaptive for long-term vestibular compensation.
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Affiliation(s)
- Omid A Zobeiri
- Department of Biomedical Engineering, McGill University, Montreal, QC, Canada
| | - Gavin M Mischler
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, USA
| | - Susan A King
- Jenks Vestibular Physiology Laboratory, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
- Departments of Otolaryngology and Neurology, Harvard Medical School, Boston, MA, USA
| | - Richard F Lewis
- Jenks Vestibular Physiology Laboratory, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
- Departments of Otolaryngology and Neurology, Harvard Medical School, Boston, MA, USA
| | - Kathleen E Cullen
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, USA.
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, USA.
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, USA.
- Kavli Neuroscience Discovery Institute, Johns Hopkins University, Baltimore, USA.
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Starkov D, Strupp M, Pleshkov M, Kingma H, van de Berg R. Diagnosing vestibular hypofunction: an update. J Neurol 2021; 268:377-385. [PMID: 32767115 PMCID: PMC7815536 DOI: 10.1007/s00415-020-10139-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/31/2020] [Accepted: 08/01/2020] [Indexed: 12/13/2022]
Abstract
Unilateral or bilateral vestibular hypofunction presents most commonly with symptoms of dizziness or postural imbalance and affects a large population. However, it is often missed because no quantitative testing of vestibular function is performed, or misdiagnosed due to a lack of standardization of vestibular testing. Therefore, this article reviews the current status of the most frequently used vestibular tests for canal and otolith function. This information can also be used to reach a consensus about the systematic diagnosis of vestibular hypofunction.
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Affiliation(s)
- Dmitrii Starkov
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
- Faculty of Physics, Tomsk State Research University, Tomsk, Russia.
- Maastricht University ENT Department, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| | - Michael Strupp
- German Center for Vertigo and Balance Disorders, Ludwig Maximilians University, Munich, Germany
- Department of Neurology, Ludwig Maximilians University, Munich, Germany
| | - Maksim Pleshkov
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- Faculty of Physics, Tomsk State Research University, Tomsk, Russia
| | - Herman Kingma
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- Faculty of Physics, Tomsk State Research University, Tomsk, Russia
| | - Raymond van de Berg
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- Faculty of Physics, Tomsk State Research University, Tomsk, Russia
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Constanzo F, Sens P, Teixeira BCDA, Ramina R. Video Head Impulse Test to Preoperatively Identify the Nerve of Origin of Vestibular Schwannomas. Oper Neurosurg (Hagerstown) 2020; 16:319-325. [PMID: 29750273 DOI: 10.1093/ons/opy103] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 04/04/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Identification of the nerve of origin in vestibular schwannoma (VS) is an important prognostic factor for hearing preservation surgery. Thus far, vestibular functional tests and magnetic resonance imaging have not yielded reliable results to preoperatively evaluate this information. The development of the video head impulse test (vHIT) has allowed a precise evaluation of each semicircular canal, and its localizing value has been tested for some peripheral vestibular diseases, but not for VS. OBJECTIVE To correlate patterns of semicircular canal alteration on vHIT to intraoperative identification of the nerve of origin of VSs. METHODS A total 31 patients with sporadic VSs were preoperatively evaluated with vHIT (gain of vestibule-ocular reflex, overt and covert saccades on each semicircular canal) and then the nerve of origin was surgically identified during surgical resection via retrosigmoid approach. vHIT results were classified as normal, isolated superior vestibular nerve (SVN) pattern, isolated inferior vestibular nerve (IVN) pattern, predominant SVN pattern, and predominant IVN pattern. Hannover classification, cystic component, and distance between the tumor and the end of the internal auditory canal were also considered for analysis. RESULTS Three patients had a normal vHIT, 12 had an isolated SVN pattern, 5 had an isolated IVN pattern, 7 had a predominant SVN pattern, and 4 had a predominant IVN pattern. vHIT was able to correctly identify the nerve of origin in 89.7% of cases (100% of altered exams). CONCLUSION The pattern of semicircular canal dysfunction on vHIT has a localizing value to identify the nerve of origin in VSs.
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Affiliation(s)
- Felipe Constanzo
- Department of Neurosurgery, Neurological Institute of Curitiba (INC), Curitiba, Paraná, Brazil
| | - Patricia Sens
- Department of Otolaryngology, Neurological Institute of Curitiba (INC), Curitiba, Paraná, Brazil
| | - Bernardo Corrêa de Almeida Teixeira
- Department of Neuroradiology, Neurological Institute of Curitiba (INC) and Centro de Diagnostico por Imagem (CETAC), Curitiba, Paraná, Brazil
| | - Ricardo Ramina
- Department of Neurosurgery, Neurological Institute of Curitiba (INC), Curitiba, Paraná, Brazil
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Valente P, Medeiros N, Larangeiro J, Castro E, Condé A. In Reference to A New and Faster Method to Assess Vestibular Compensation: A Cross-Sectional Study. Laryngoscope 2020; 131:E581. [PMID: 32356898 DOI: 10.1002/lary.28705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 02/13/2020] [Indexed: 11/12/2022]
Affiliation(s)
- Pedro Valente
- Department of Otorhinolaryngology, Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Nuno Medeiros
- Department of Otorhinolaryngology, Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - João Larangeiro
- Department of Otorhinolaryngology, Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Eugénia Castro
- Department of Otorhinolaryngology, Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Artur Condé
- Department of Otorhinolaryngology, Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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Guajardo-Vergara C, Pérez-Fernández N. In Response to A New and Faster Method to Assess Vestibular Compensation: A Cross-Sectional Study. Laryngoscope 2020; 131:E582. [PMID: 32356899 DOI: 10.1002/lary.28707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Carlos Guajardo-Vergara
- Department of Otorhinolaryngology, Clínica Universidad de Navarra, Pamplona, Spain.,Escuela de Fonoaudiología, Universidad Austral de Chile, Sede Puerto Montt, Chile
| | - Nicolas Pérez-Fernández
- Department of Otorhinolaryngology, Clínica Universidad de Navarra, Madrid, Spain.,Research Group Interdisciplinar Theragnosis and Radiosomics, University of Navarra, Madrid, Spain
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12
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Guajardo‐Vergara C, Perez‐Fernandez N. A New and Faster Method to Assess Vestibular Compensation: A Cross‐Sectional Study. Laryngoscope 2020; 130:E911-E917. [DOI: 10.1002/lary.28505] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 12/27/2019] [Accepted: 12/30/2019] [Indexed: 01/03/2023]
Affiliation(s)
- Carlos Guajardo‐Vergara
- Department of Otorhinolaryngology Clínica Universidad de Navarra Pamplona Spain
- Escuela de Fonoaudiología, Universidad Austral de Chile Sede Puerto Montt Chile
| | - Nicolas Perez‐Fernandez
- Department of Otorhinolaryngology Clínica Universidad de Navarra Madrid Spain
- Research Group Interdisciplinar Theragnosis and Radiosomics, University of Navarra Madrid Spain
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Brown CS, Cooper MW, Peskoe SB, Risoli T, Kaylie DM. Associations of Vestibular Tests With Penn Acoustic Neuroma Quality of Life Scores After Resection of Vestibular Schwannoma. Otol Neurotol 2020; 41:e241-9. [DOI: 10.1097/mao.0000000000002462] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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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Pogson JM, Taylor RL, McGarvie LA, Bradshaw AP, D’Souza M, Flanagan S, Kong J, Halmagyi GM, Welgampola MS. Head impulse compensatory saccades: Visual dependence is most evident in bilateral vestibular loss. PLoS One 2020; 15:e0227406. [PMID: 31940394 PMCID: PMC6961882 DOI: 10.1371/journal.pone.0227406] [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: 03/20/2019] [Accepted: 12/18/2019] [Indexed: 11/19/2022] Open
Abstract
The normal vestibulo-ocular reflex (VOR) generates almost perfectly compensatory smooth eye movements during a 'head-impulse' rotation. An imperfect VOR gain provokes additional compensatory saccades to re-acquire an earth-fixed target. In the present study, we investigated vestibular and visual contributions on saccade production. Eye position and velocity during horizontal and vertical canal-plane head-impulses were recorded in the light and dark from 16 controls, 22 subjects after complete surgical unilateral vestibular deafferentation (UVD), eight subjects with idiopathic bilateral vestibular loss (BVL), and one subject after complete bilateral vestibular deafferentation (BVD). When impulses were delivered in the horizontal-canal plane, in complete darkness compared with light, first saccade frequency mean(SEM) reduced from 96.6(1.3)-62.3(8.9) % in BVL but only 98.3(0.6)-92.0(2.3) % in UVD; saccade amplitudes reduced from 7.0(0.5)-3.6(0.4) ° in BVL but were unchanged 6.2(0.3)-5.5(0.6) ° in UVD. In the dark, saccade latencies were prolonged in lesioned ears, from 168(8.4)-240(24.5) ms in BVL and 177(5.2)-196(5.7) ms in UVD; saccades became less clustered. In BVD, saccades were not completely abolished in the dark, but their amplitudes decreased from 7.3-3.0 ° and latencies became more variable. For unlesioned ears (controls and unlesioned ears of UVD), saccade frequency also reduced in the dark, but their small amplitudes slightly increased, while latency and clustering remained unchanged. First and second saccade frequencies were 75.3(4.5) % and 20.3(4.1) %; without visual fixation they dropped to 32.2(5.0) % and 3.8(1.2) %. The VOR gain was affected by vision only in unlesioned ears of UVD; gains for the horizontal-plane rose slightly, and the vertical-planes reduced slightly. All head-impulse compensatory saccades have a visual contribution, the magnitude of which depends on the symmetry of vestibular-function and saccade latency: BVL is more profoundly affected by vision than UVD, and second saccades more than first saccades. Saccades after UVD are probably triggered by contralateral vestibular function.
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Affiliation(s)
- Jacob M. Pogson
- Royal Prince Alfred Hospital, Institute of Clinical Neuroscience, Camperdown, New South Wales, Australia
- Faculty of Health and Medicine, Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia
| | - Rachael L. Taylor
- Royal Prince Alfred Hospital, Institute of Clinical Neuroscience, Camperdown, New South Wales, Australia
- Faculty of Health and Medicine, Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia
| | - Leigh A. McGarvie
- Royal Prince Alfred Hospital, Institute of Clinical Neuroscience, Camperdown, New South Wales, Australia
- Department of Psychology, Faculty of Science, The University of Sydney, Camperdown, New South Wales, Australia
| | - Andrew P. Bradshaw
- Royal Prince Alfred Hospital, Institute of Clinical Neuroscience, Camperdown, New South Wales, Australia
| | - Mario D’Souza
- Department of Clinical Research, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Sean Flanagan
- Otolaryngology, Head and Neck and Skull Base Surgery, St Vincent’s Hospital, Darlinghurst, New South Wales, Australia
- Faculty of Medicine, University of NSW, Kensington, New South Wales, Australia
| | - Jonathan Kong
- Faculty of Health and Medicine, Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia
- Department of Neurosurgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Department of Otolaryngology, Head & Neck Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - G. Michael Halmagyi
- Royal Prince Alfred Hospital, Institute of Clinical Neuroscience, Camperdown, New South Wales, Australia
- Faculty of Health and Medicine, Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia
| | - Miriam S. Welgampola
- Royal Prince Alfred Hospital, Institute of Clinical Neuroscience, Camperdown, New South Wales, Australia
- Faculty of Health and Medicine, Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia
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15
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Kjærsgaard JB, Szeremet M, Hougaard DD. Vestibular Deficits Correlating to Dizziness Handicap Inventory Score, Hearing Loss, and Tumor Size in a Danish Cohort of Vestibular Schwannoma Patients. Otol Neurotol 2019; 40:813-9. [DOI: 10.1097/mao.0000000000002236] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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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Pogson JM, Taylor RL, Bradshaw AP, McGarvie L, D’Souza M, Halmagyi GM, Welgampola MS. The human vestibulo-ocular reflex and saccades: normal subjects and the effect of age. J Neurophysiol 2019; 122:336-349. [DOI: 10.1152/jn.00847.2018] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Here we characterize in 80 normal subjects (16–84 yr (means ± SD, 47 ± 19 yr) the vestibulo-ocular reflex (VOR) and saccades in response to three-dimensional head impulses with a monocular video head impulse test (vHIT) of the right eye. Impulses toward the right lateral, right anterior, and left posterior canals (means: 0.98, 0.91, 0.79) had slightly higher mean gains compared with their counterparts (0.95, 0.86, 0.76). In the older age group (>60 yr), gains of the left posterior canal dropped 0.09 and left anterior canals rose 0.09 resulting in symmetry. All canal gains reduced with increasing head velocity (0.02–0.13 per 100°/s). Comparison of lateral canal gains calculated using five published algorithms yielded lower values (~0.80) when a narrow detection window was used. Low-amplitude refixation saccades (amplitude: 1.11 ± 0.98°, peak velocity: 63.9 ± 34.0°/s at 262.0 ± 93.9 ms) were observed among all age groups (frequency: 40.2 ± 23.4%), increasing in amplitude, peak velocity, and frequency in older subjects. Impulses toward anterior canals showed the least frequent saccades and lateral and posterior canals were similar, but lateral canal impulses showed the smallest saccades and the posterior canal showed the largest saccades. Saccade peak-velocity approximate amplitude “main sequence” slope was steeper for the horizontal canals compared with the vertical planes (60 vs. <40°/s per 1°). In summary, we found small but significant asymmetries in monocular vHIT gain that changed with age. Healthy subjects commonly have minuscule refixation saccades that are moderately to strongly correlated with vHIT gain. NEW & NOTEWORTHY Gaze fixation is normally stabilized during rapid “head-impulse” movements by the bisynaptic vestibulo-ocular reflex (VOR), but earlier studies of normal subjects also report small amplitude saccades. We found that with increased age of the subject the vertical VOR became more variable, while in all semicircular canal directions the saccade frequency, amplitude, and peak velocity increased. We also found that the VOR gain algorithm significantly influences values.
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Affiliation(s)
- Jacob M. Pogson
- Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia
- Institute of Clinical Neuroscience, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Rachael L. Taylor
- Institute of Clinical Neuroscience, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Andrew P. Bradshaw
- Institute of Clinical Neuroscience, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Leigh McGarvie
- Psychology Department, The University of Sydney, Camperdown, New South Wales, Australia
- Institute of Clinical Neuroscience, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Mario D’Souza
- Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia
- Clinical Research Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - G. Michael Halmagyi
- Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia
- Institute of Clinical Neuroscience, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Miriam S. Welgampola
- Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia
- Institute of Clinical Neuroscience, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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Affiliation(s)
- Jose A Lopez-Escamez
- Department of Otolaryngology, Instituto de Investigación Biosanitaria Ibs. GRANADA, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO Centre for Genomics and Oncological Research, Pfizer/University of Granada/Andalusian Regional Government, PTS Granada, Granada, Spain
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18
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Jay DR, Cane D, Howe S. Age Is a Greater Influence on Small Saccades Than Target Size in Normal Subjects on the Horizontal Video Head Impulse Test. Front Neurol 2019; 10:328. [PMID: 31040813 PMCID: PMC6476940 DOI: 10.3389/fneur.2019.00328] [Citation(s) in RCA: 5] [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: 12/21/2018] [Accepted: 03/18/2019] [Indexed: 12/01/2022] Open
Abstract
Objective: This study sought to investigate whether the size of the target used in the horizontal vHIT has an effect on the saccade profile of healthy subjects, and to expand upon previous work linking age to the existence of small vHIT saccades. Methods: Forty eight participants were recruited between 18 and 77 years of age, with no history of vestibular, oculomotor or neurological conditions and a visual acuity of at least 0.3 LogMAR. Participants underwent four consecutive horizontal vHIT trials using the standard target size and three smaller targets. VOR gain and metrics for saccadic incidence, peak eye velocity and latency were then extracted from results. Results: Target size was a statistically significant influence on saccade metrics. As target size increased, saccadic incidence decreased while peak eye velocity and latency increased. However, a potential order effect was also discovered, and once this was corrected for the remaining effect of target size was small and is likely clinically insignificant. The effect of age was much stronger than target size; increasing age was strongly positively correlated with saccadic incidence and showed a medium size correlation with peak velocity, though not with saccadic latency. Conclusion: While this study suggests that target size may have a statistically significant impact on the vHIT saccade profile of normal subjects, age has a greater influence on the incidence and size of small vHIT saccades.
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Affiliation(s)
- David R Jay
- Manchester Head and Neck Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Debbie Cane
- Manchester Centre for Audiology and Deafness, The University of Manchester, Manchester, United Kingdom
| | - Simon Howe
- Manchester Centre for Audiology and Deafness, The University of Manchester, Manchester, United Kingdom.,Department of Audiology, The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom
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Brown CS, Peskoe SB, Risoli T, Garrison DB, Kaylie DM. Associations of Video Head Impulse Test and Caloric Testing among Patients with Vestibular Schwannoma. Otolaryngol Head Neck Surg 2019; 161:324-329. [PMID: 30909803 DOI: 10.1177/0194599819837244] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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
OBJECTIVE To determine relationships between caloric testing (CT) and video head impulse testing (vHIT) among patients with unilateral vestibular schwannoma (VS). To describe the distribution of CT and vHIT measurements and assess associations with tumor size and self-perceived handicapping effects. STUDY DESIGN Retrospective review. SETTING Tertiary referral hospital. SUBJECTS AND METHODS Subjects were adults with presumed unilateral VS between 2014 and 2017. Interventions were CT and vHIT. Primary outcomes were vHIT value (abnormal <0.8) and CT value (abnormal >25%). Secondary outcomes were tumor size and Dizziness Handicap Inventory scores. RESULTS Fifty-one individuals had complete data for CT and vHIT. The odds of abnormal gain increases by 2.18 for every 10% increase in unilateral weakness on CT (range, 1.44-3.34; P < .001). A significant negative correlation between CT and gain exists (rs = -0.64, P < .001). Odds of observing saccades increased by 2.68 for every 10% increase in unilateral weakness (range, 1.48-4.85; P = .001). This association was larger in magnitude for overt than covert saccades (odds ratios, 2.48 and 1.59, respectively). Tumor size was significantly associated with an increase in caloric weakness (β = 0.135, P < .001). With every 10-mm increase of tumor size, odds of abnormal gain on vHIT increased 4.13 (range, 1.46-11.66; P = .007). Mean Dizziness Handicap Inventory score was 19.7 (σ = 22), without association to caloric weakness, gain, or tumor size. CONCLUSION CT and vHIT both effectively assess vestibular function for patients with VS and correlate to tumor size. These findings are important as vHIT has a lower overall cost, improved patient tolerance, and demonstrated reliability.
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Affiliation(s)
- C Scott Brown
- 1 Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Sarah B Peskoe
- 2 Biostatistics Core, Department of Biostatistics and Bioinformatics, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Thomas Risoli
- 2 Biostatistics Core, Department of Biostatistics and Bioinformatics, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Douglas B Garrison
- 1 Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - David M Kaylie
- 1 Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
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Paul SS, Dibble LE, Walther RG, Shelton C, Gurgel RK, Lester ME. Characterization of Head-Trunk Coordination Deficits After Unilateral Vestibular Hypofunction Using Wearable Sensors. JAMA Otolaryngol Head Neck Surg 2017; 143:1008-1014. [PMID: 28859201 DOI: 10.1001/jamaoto.2017.1443] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance Individuals with vestibular hypofunction acutely restrict head motion to reduce symptoms of dizziness and nausea. This restriction results in abnormal decoupling of head motion from trunk motion, but the character, magnitude, and persistence of these deficits are unclear. Objective To use wearable inertial sensors to quantify the extent of head and trunk kinematic abnormalities in the subacute stage after resection of vestibular schwannoma (VS) and the particular areas of deficit in head-trunk motion. Design, Setting, and Participants This cross-sectional observational study included a convenience sample of 20 healthy adults without vestibular impairment and a referred sample of 14 adults 4 to 8 weeks after resection of a unilateral VS at a university and a university hospital outpatient clinic. Data were collected from November 12, 2015, through November 17, 2016. Exposures Functional gait activities requiring angular head movements, including items from the Functional Gait Assessment (FGA; range, 1-30, with higher scores indicating better performance), the Timed Up & Go test (TUG; measured in seconds), and a 2-minute walk test (2MWT; measured in meters). Main Outcomes and Measures Primary outcomes included peak head rotation amplitude (in degrees), peak head rotation velocity (in degrees per second), and percentage of head-trunk coupling. Secondary outcomes were activity and participation measures including gait speed, FGA score, TUG time, 2MWT distance, and the Dizziness Handicap Inventory score (range, 0-100, with higher scores indicating worse performance). Results A total of 34 participants (14 men and 20 women; mean [SD] age, 39.3 [13.6] years) were included. Compared with the 20 healthy participants, the 14 individuals with vestibular hypofunction demonstrated mean (SD) reduced head turn amplitude (84.1° [15.5°] vs 113.2° [24.4°] for FGA-3), reduced head turn velocities (195.0°/s [75.9°/s] vs 358.9°/s [112.5°/s] for FGA-3), and increased head-trunk coupling (15.1% [6.5%] vs 5.9% [5.8%] for FGA-3) during gait tasks requiring angular head movements. Secondary outcomes were also worse in individuals after VS resection compared with healthy individuals, including gait speed (1.09 [0.27] m/s vs 1.47 [0.22] m/s), FGA score (20.5 [3.6] vs 30.0 [0.2]), TUG time (10.9 [1.7] s vs 7.1 [0.8] s), 2MWT (164.8 [37.6] m vs 222.6 [26.8] m), and Dizziness Handicap Inventory score (35.4 [20.7] vs 0.1 [0.4]). Conclusions and Relevance With use of wearable sensors, deficits in head-trunk kinematics were characterized along with a spectrum of disability in individuals in the subacute stage after VS surgery compared with healthy individuals. Future research is needed to fully understand how patterns of exposure to head-on-trunk movements influence the trajectory of recovery of head-trunk coordination during community mobility.
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Affiliation(s)
- Serene S Paul
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City.,Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Leland E Dibble
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City
| | - Raymond G Walther
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City
| | - Clough Shelton
- Otolaryngology Division, School of Medicine, University of Utah, Salt Lake City
| | | | - Mark E Lester
- Doctoral Program in Physical Therapy, US Army-Baylor University, Ft Sam Houston, Texas
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de Waele C, Shen Q, Magnani C, Curthoys IS. A Novel Saccadic Strategy Revealed by Suppression Head Impulse Testing of Patients with Bilateral Vestibular Loss. Front Neurol 2017; 8:419. [PMID: 28868046 PMCID: PMC5563306 DOI: 10.3389/fneur.2017.00419] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 05/26/2017] [Accepted: 08/02/2017] [Indexed: 11/16/2022] Open
Abstract
Objective We examined the eye movement response patterns of a group of patients with bilateral vestibular loss (BVL) during suppression head impulse testing. Some showed a new saccadic strategy that may have potential for explaining how patients use saccades to recover from vestibular loss. Methods Eight patients with severe BVL [vestibulo-ocular reflex (VOR) gains less than 0.35 and absent otolithic function] were tested. All patients were given the Dizziness Handicap Inventory and questioned about oscillopsia during abrupt head movements. Two paradigms of video head impulse testing of the horizontal VOR were used: (1) the classical head impulse paradigm [called head impulse test (HIMPs)]—fixating an earth-fixed target during the head impulse and (2) the new complementary test paradigm—fixating a head-fixed target during the head impulse (called SHIMPs). The VOR gain of HIMPs was quantified by two algorithms. Results During SHIMPs testing, some BVL patients consistently generated an inappropriate covert compensatory saccade during the head impulse that required a corresponding large anti-compensatory saccade at the end of the head impulse in order to obey the instructions to maintain gaze on the head-fixed target. By contrast, other BVL patients did not generate this inappropriate covert saccade and did not exhibit a corresponding anti-compensatory saccade. The latencies of the covert saccade in SHIMPs and HIMPs were similar. Conclusion The pattern of covert saccades during SHIMPs appears to be related to the reduction of oscillopsia during abrupt head movements. BVL patients who did not report oscillopsia showed this unusual saccadic pattern, whereas BVL patients who reported oscillopsia did not show this pattern. This inappropriate covert SHIMPs saccade may be an objective indicator of how some patients with vestibular loss have learned to trigger covert saccades during head movements in everyday life.
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Affiliation(s)
- Catherine de Waele
- CNRS UMR 8257, Cognition and Action Group, Centre Universitaire des Saints-Peres, Universite Paris Descartes, Paris, France.,ENT Department, Salpetriere Hospital, Paris, France
| | - Qiwen Shen
- CNRS UMR 8257, Cognition and Action Group, Centre Universitaire des Saints-Peres, Universite Paris Descartes, Paris, France
| | - Christophe Magnani
- CNRS UMR 8257, Cognition and Action Group, Centre Universitaire des Saints-Peres, Universite Paris Descartes, Paris, France
| | - Ian S Curthoys
- Vestibular Research Laboratory, School of Psychology, The University of Sydney, Sydney, NSW, Australia
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