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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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2
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Pace A, Milani A, Rossetti V, Iannella G, Maniaci A, Cocuzza S, Alunni Fegatelli D, Vestri A, Magliulo G. Evaluation of Vestibular Function in Patients Affected by Obstructive Sleep Apnea Performing Functional Head Impulse Test (fHIT). Nat Sci Sleep 2022; 14:475-482. [PMID: 35321358 PMCID: PMC8937310 DOI: 10.2147/nss.s346241] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 02/18/2022] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Obstructive sleep apnoea (OSA) is a common disease with significantly related complications. Since a connection between the vestibular nucleus and sleep regulator pathways has been demonstrated, vestibular evaluation in OSA patients was partially studied and none used functional head impulse test (fHIT) for this purpose. This paper aimed at evaluating the vestibular function in patients affected by OSA using fHIT, selecting patients who did not present any other related to cardiovascular, neurological, or metabolic diseases. PATIENTS AND METHODS Patients enrolled had a diagnosis of OSA by polysomnography type III and were cataloged according to American Association of Sleep Medicine criteria. Each patient underwent fHIT. Statistical significance was set at 0.05. RESULTS A total of 85 patients were enrolled in the study of which 50 had a diagnosis of OSA and were included in the case group, while 35 belonged to the control group. In 88.6% of subjects of the case group was evidenced a vestibular impairment with a substantial difference between the two study groups (p<0.05). CONCLUSION The results show that the incidence of vestibular lesions in patients with obstructive sleep apnoea is underestimated and that fHIT can identify these lesions early.
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Affiliation(s)
- Annalisa Pace
- Organi di Senso Department, Sapienza University, Rome, Italy.,Scienze Chirurgiche Department, Sapienza University, Rome, Italy
| | | | | | - Giannicola Iannella
- Organi di Senso Department, Sapienza University, Rome, Italy.,Scienze Chirurgiche Department, Sapienza University, Rome, Italy.,Department of Head-Neck Surgery, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Antonino Maniaci
- Otorinolaringoiatria Department, University of Catania, Catania, Italy
| | - Salvatore Cocuzza
- Otorinolaringoiatria Department, University of Catania, Catania, Italy
| | | | - Annarita Vestri
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
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Millar JL, Schubert MC. Report of oscillopsia in ataxia patients correlates with activity, not vestibular ocular reflex gain. J Vestib Res 2021; 32:381-388. [PMID: 34897108 DOI: 10.3233/ves-210106] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Patients with cerebellar ataxia report oscillopsia, "bouncy vision" during activity, yet little is known how this impacts daily function. The purpose of this study was to quantify the magnitude of oscillopsia and investigate its relation to vestibulo-ocular reflex (VOR) function and daily activity in cerebellar ataxia. METHODS 19 patients diagnosed with cerebellar ataxia and reports of oscillopsia with activity were examined using the video head impulse test (vHIT), Oscillopsia Functional Index (OFI), and clinical gait measures. Video head impulse data was compared against 40 healthy controls. RESULTS OFI scores in ataxia patients were severe and inversely correlated with gait velocity (r = -0.55, p < 0.05), but did not correlate with VOR gains. The mean VOR gain in the ataxic patients was significantly reduced and more varied compared with healthy controls. All patients had abnormal VOR gains and eye/head movement patterns in at least one semicircular canal during VHIT with passive head rotation. CONCLUSIONS Patients with cerebellar ataxia and oscillopsia have impaired VOR gains, yet severity of oscillopsia and VOR gains are not correlated. Patients with cerebellar ataxia have abnormal oculomotor behavior during passive head rotation that is correlated with gait velocity, but not magnitude of oscillopsia.
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Affiliation(s)
- Jennifer L Millar
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, USA
| | - Michael C Schubert
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, USA.,Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
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4
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Starkov D, Vermorken B, Van Dooren TS, Van Stiphout L, Janssen M, Pleshkov M, Guinand N, Pérez Fornos A, Van Rompaey V, Kingma H, Van de Berg R. The Effect of Different Head Movement Paradigms on Vestibulo-Ocular Reflex Gain and Saccadic Eye Responses in the Suppression Head Impulse Test in Healthy Adult Volunteers. Front Neurol 2021; 12:729081. [PMID: 34630303 PMCID: PMC8492894 DOI: 10.3389/fneur.2021.729081] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/18/2021] [Indexed: 02/03/2023] Open
Abstract
Objective: This study aimed to identify differences in vestibulo-ocular reflex gain (VOR gain) and saccadic response in the suppression head impulse paradigm (SHIMP) between predictable and less predictable head movements, in a group of healthy subjects. It was hypothesized that higher prediction could lead to a lower VOR gain, a shorter saccadic latency, and higher grouping of saccades. Methods: Sixty-two healthy subjects were tested using the video head impulse test and SHIMPs in four conditions: active and passive head movements for both inward and outward directions. VOR gain, latency of the first saccade, and the level of saccade grouping (PR-score) were compared among conditions. Inward and active head movements were considered to be more predictable than outward and passive head movements. Results: After validation, results of 57 tested subjects were analyzed. Mean VOR gain was significantly lower for inward passive compared with outward passive head impulses (p < 0.001), and it was higher for active compared with passive head impulses (both inward and outward) (p ≤ 0.024). Mean latency of the first saccade was significantly shorter for inward active compared with inward passive (p ≤ 0.001) and for inward passive compared with outward passive head impulses (p = 0.012). Mean PR-score was only significantly higher in active outward than in active inward head impulses (p = 0.004). Conclusion: For SHIMP, a higher predictability in head movements lowered gain only in passive impulses and shortened latencies of compensatory saccades overall. For active impulses, gain calculation was affected by short-latency compensatory saccades, hindering reliable comparison with gains of passive impulses. Predictability did not substantially influence grouping of compensatory saccades.
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Affiliation(s)
- Dmitrii Starkov
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands.,Faculty of Physics, Tomsk State Research University, Tomsk, Russia
| | - Bernd Vermorken
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - T S Van Dooren
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Lisa Van Stiphout
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Miranda Janssen
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands.,Department of Methodology and Statistics, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Maksim Pleshkov
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands.,Faculty of Physics, Tomsk State Research University, Tomsk, Russia
| | - Nils Guinand
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands.,Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Angelica Pérez Fornos
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Vincent Van Rompaey
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Herman Kingma
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, 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 Center, Maastricht, Netherlands.,Faculty of Physics, Tomsk State Research University, Tomsk, Russia
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Jacobsen CL, Abrahamsen ER, Skals RK, Hougaard DD. Is regression gain or instantaneous gain the most reliable and reproducible gain value when performing video head impulse testing of the lateral semicircular canals? J Vestib Res 2021; 31:151-162. [PMID: 34057110 DOI: 10.3233/ves-180669] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Several different video Head Impulse Test (vHIT) systems exist. The function of each individual semicircular canal (SCC) may be determined by performing this test. All vHIT systems provide information about the function of the vestibular ocular reflex by means of two modalities: SACCADES and GAIN. However, different gain calculation methods exist. OBJECTIVE Primary endpoint:•Is instantaneous gain or regression gain the most reproducible and reliable gain value when performing vHIT with testing of the lateral SCCs?Secondary endpoints:•Comparison of each of the instantaneous gain values at 40, 60, and 80ms with the regression gain.•Examination of any intra- and inter examiner variability.•Mean instantaneous gain values, and at different velocities, compared with regression gain values of the lateral SCCs. METHODS 60 subjects between 18-65 years were included. All patients filled out the Dizziness Handicap Inventory (DHI) questionnaire and underwent four separate vHIT tests, two by an experienced neurotologist and two by an inexperienced examiner. RESULTS/CONCLUSIONS 240 datasets were obtained, displaying both regression and instantaneous gain values. Regression gain was more reproducible than instantaneous gain. The experienced examiner provided the most reproducible results.When comparing instantaneous gain, we found the gain at 40 ms to be the least reproducible. There was no significant difference between 60 ms and 80 ms.For both examiners no significant intra examiner variability was found.
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Affiliation(s)
- Chris L Jacobsen
- Department of Otolaryngology, Head & Neck Surgery and Audiology, Aalborg University Hospital, Aalborg, Denmark
| | - Emil R Abrahamsen
- Department of Otolaryngology, Head & Neck Surgery and Audiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Regitze K Skals
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Dan D Hougaard
- Department of Otolaryngology, Head & Neck Surgery and Audiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
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Pal'chun VT, Guseva AL, Baybakova EV, Makoeva AA. [Recovery of vestibulo-ocular reflex in vestibular neuronitis depending on severity of vestibulo-ocular reflex damage]. Vestn Otorinolaringol 2020; 84:33-37. [PMID: 32027320 DOI: 10.17116/otorino20198406133] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 11/18/2022]
Abstract
AIM The aim of this study is to evaluate clinical symptoms and recovery of vestibule-ocular reflex (VOR) in patients with vestibular neuronitis (VN) in dependence on severity of VOR damage according to video head impulse test (vHIT). PATIENTS AND METHODS 45 patients with VN and superior or both superior and inferior vestibular nerves involvement were recruited and horizontal gain was measured with vHIT. According to gain asymmetry the patients were divided in three groups: 11 patients with 8-19% gain asymmetry, 10 patients with 20-39% gain asymmetry and 24 patients with more than 40% gain asymmetry. RESULTS Coexisting chronic heart and endocrinological diseases could contribute to greater damage of VOR in VN. In patients with less gain asymmetry the full recovery of gain on the affected side was more often. When gain asymmetry was more than 40%, only 10% of patients demonstrated full recovery of gain in 8-12 months. Dynamic visual acuity (DVA) could normalize in patients with clinically significant gain asymmetry. DVA stays decreased more often in patients with in the most gain asymmetry even after vestibular rehabilitation. Benign paroxysmal positional vertigo appeared in 8.9% of patients with VN and had no correlation with VOR asymmetry. Steroid treatment didn't show significant impact on VOR recovery in patients with VN.
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Affiliation(s)
- V T Pal'chun
- N.I. Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Moscow, Russia, 117997; Sverzhevsky Research Institute of Clinical Otorhinolaryngology, Moscow, Russia, 117152
| | - A L Guseva
- N.I. Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Moscow, Russia, 117997
| | - E V Baybakova
- Sverzhevsky Research Institute of Clinical Otorhinolaryngology, Moscow, Russia, 117152
| | - A A Makoeva
- N.I. Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Moscow, Russia, 117997
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7
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Ramaioli C, Cuturi LF, Ramat S, Lehnen N, MacNeilage PR. Vestibulo-Ocular Responses and Dynamic Visual Acuity During Horizontal Rotation and Translation. Front Neurol 2019; 10:321. [PMID: 31024422 PMCID: PMC6467074 DOI: 10.3389/fneur.2019.00321] [Citation(s) in RCA: 11] [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: 10/31/2018] [Accepted: 03/14/2019] [Indexed: 11/13/2022] Open
Abstract
Dynamic visual acuity (DVA) provides an overall functional measure of visual stabilization performance that depends on the vestibulo-ocular reflex (VOR), but also on other processes, including catch-up saccades and likely visual motion processing. Capturing the efficiency of gaze stabilization against head movement as a whole, it is potentially valuable in the clinical context where assessment of overall patient performance provides an important indication of factors impacting patient participation and quality of life. DVA during head rotation (rDVA) has been assessed previously, but to our knowledge, DVA during horizontal translation (tDVA) has not been measured. tDVA can provide a valuable measure of how otolith, rather than canal, function impacts visual acuity. In addition, comparison of DVA during rotation and translation can shed light on whether common factors are limiting DVA performance in both cases. We therefore measured and compared DVA during both passive head rotations (head impulse test) and translations in the same set of healthy subjects (n = 7). In addition to DVA, we computed average VOR gain and retinal slip within and across subjects. We observed that during translation, VOR gain was reduced (VOR during rotation, mean ± SD: position gain = 1.05 ± 0.04, velocity gain = 0.97 ± 0.07; VOR during translation, mean ± SD: position gain = 0.21 ± 0.08, velocity gain = 0.51 ± 0.16), retinal slip was increased, and tDVA was worse than during rotation (average rDVA = 0.32 ± 0.15 logMAR; average tDVA = 0.56 ± 0.09 logMAR, p = 0.02). This suggests that reduced VOR gain leads to worse tDVA, as expected. We conclude with speculation about non-oculomotor factors that could vary across individuals and affect performance similarly during both rotation and translation.
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Affiliation(s)
- Cecilia Ramaioli
- German Center for Vertigo and Balance Disorders, University Hospital Munich, Munich, Germany.,Institute of Medical Technology, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Luigi F Cuturi
- Unit for Visually Impaired People, Italian Institute of Technology, Genoa, Italy
| | - Stefano Ramat
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Nadine Lehnen
- German Center for Vertigo and Balance Disorders, University Hospital Munich, Munich, Germany.,Institute of Medical Technology, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Paul R MacNeilage
- Department of Psychology, Cognitive and Brain Sciences, University of Nevada, Reno, NV, United States
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Kaga K, Kimura Y, Minami S. Development of vestibular ocular reflex and gross motor function in infants with common cavity deformity as a type of inner ear malformation. Acta Otolaryngol 2019; 139:361-366. [PMID: 30762456 DOI: 10.1080/00016489.2018.1548777] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 10/27/2022]
Abstract
Background: The function of common cavity deformity demonstrated by temporal bone CT and MRI has been unknown. AIM/OBJECTIVE To investigate the developmental changes of vestibular ocular reflex and acquisition of postural control in infants with common cavity deformity. MATERIAL AND METHODS Eight infants who were congenitally deaf complicated by common cavity deformity were studied. The damped rotational chair test was carried out to evaluate vestibular ocular reflex. Acquisition of head control and independent walking in these infants was compared with that in normal infant's milestones of gross motor development. RESULTS All of the eight infants with common cavity deformity did not show per-rotatory nystagmus in the damped rotational chair test around the first year of life. However, a normal number of beats and a longer duration of per-rotatory nystagmus for their age were recorded at around three or four years of age. CONCLUSIONS AND SIGNIFICANCE In the eight infants with common cavity deformity, vestibular ocular reflex was not present around the first year of life, but appeared after three or four years probably because of some vestibular sensory cells. Head control and independent walking were delayed but eventually acquired by the central vestibular compensation.
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Affiliation(s)
- Kimitaka Kaga
- National Tokyo Medical Center, National Institute of Sensory Organs, Tokyo, Japan
| | - Yusuke Kimura
- National Tokyo Medical Center, National Institute of Sensory Organs, Tokyo, Japan
| | - Shujiro Minami
- NHO Tokyo Medical Center, Department of Otolaryngology, Tokyo, Japan
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Bittar RSM, Sato ES, Silva-Ribeiro DJ, Oiticica J, Mezzalira R, Tsuji RK, Bento RF. Caloric test and video head impulse test sensitivity as vestibular impairment predictors before cochlear implant surgery. Clinics (Sao Paulo) 2019; 74:e786. [PMID: 30892418 PMCID: PMC6404384 DOI: 10.6061/clinics/2019/e786] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 11/26/2018] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Currently, cochlear implant procedures are becoming increasingly broad and have greatly expanded. Bilateral cochlear implants and cochlear implants are more frequently applied in children. Our hypothesis is that the video head impulse test may be more sensitive than the caloric test in detecting abnormal vestibular function before cochlear implant surgery. The objective of this study was to compare the video head impulse test and caloric test results of patients selected for cochlear implant procedures before surgery. METHODS The patients selected for cochlear implant surgery were submitted to a bithermal caloric test and video head impulse test. RESULTS By comparing angular slow phase velocity values below 5° in the bithermal caloric test (hypofunction) and video head impulse test with a gain lower than 0.8, we identified 37 (64.9%) patients with vestibular hypofunction or canal paresis and 21 (36.8%) patients with abnormal video head impulse test gain before the cochlear implant procedure. Of the 37 patients with caloric test vestibular hypofunction, 20 (54%) patients exhibited an abnormal gain in the video head impulse test. CONCLUSION The caloric test is more sensitive than the video head impulse test (Fisher's exact test, p=0.0002) in detecting the impaired ear before cochlear implant delivery. The proportion of caloric test/video head impulse test positive identification of abnormal vestibular function or caloric test/video head impulse test sensitivity was 1.8:1.
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Affiliation(s)
| | - Eduardo Setsuo Sato
- Departamento de Otorrinolaringologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | | | - Jeanne Oiticica
- Departamento de Otorrinolaringologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Raquel Mezzalira
- Departamento de Otorrinolaringologia, Universidade Estadual de Campinas, Campinas, SP, BR
- Corresponding author. E-mail:
| | - Robinson Koji Tsuji
- Departamento de Otorrinolaringologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Ricardo Ferreira Bento
- Departamento de Otorrinolaringologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
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10
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Mezzalira R, Bittar RSM, do Carmo Bilécki-Stipsky MM, Brugnera C, Grasel SS. Sensitivity of caloric test and video head impulse as screening test for chronic vestibular complaints. Clinics (Sao Paulo) 2017; 72:469-473. [PMID: 28954005 PMCID: PMC5577631 DOI: 10.6061/clinics/2017(08)03] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 04/07/2017] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE: This study compared the results of the caloric test with those of the video head impulse test obtained during the same session and evaluated whether the former can be used to screen for non-acute vestibular dysfunction. METHODS: A total of 157 participants complaining of dizziness with vestibular characteristics of varying durations and clinical courses completed the caloric test and video head impulse test. RESULTS: Significantly more caloric test results than video head impulse test results were abnormal. CONCLUSIONS: The results of the caloric test and video head impulse test are distinct but complement each other. Within our sample, the caloric test was more sensitive for vestibular dysfunction. Therefore, the video head impulse test is not a suitable screening tool of the vestibular system in patients with chronic complaints.
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Affiliation(s)
- Raquel Mezzalira
- Departamento de Otorrinolaringologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Clínica de Otorrinolaringologia do Instituto Penido Burnier, Campinas, SP, BR
- *Corresponding author. E-mail:
| | | | - Marcia Maria do Carmo Bilécki-Stipsky
- Departamento de Otorrinolaringologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Clínica de Otorrinolaringologia do Instituto Penido Burnier, Campinas, SP, BR
| | - Cibele Brugnera
- Departamento de Otorrinolaringologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Signe Schuster Grasel
- Departamento de Otorrinolaringologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
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11
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Xu KX, Chen TS, Wang W, Li SS, Wen C, Liu Q, Han X, Lin P. [The characteristic of vestibular ocular reflex in patients with vestibular migraine]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2017; 31:1075-1077. [PMID: 29798243 DOI: 10.13201/j.issn.1001-1781.2017.14.005] [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] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Indexed: 11/12/2022]
Abstract
Objective:Analysis of vestibular ocular reflex (VOR) in patients with vestibular migraine (VM) by vestibular autorotation test (VAT). To explore the clinical value of VAT technology in the diagnosis of vestibular migraine.Method:Sixty-nine patients with VM, 73 patients with posterior circulation (PCI) vertigo and 65 normal people were examined by VAT test. The characteristics of vestibular ocular reflex were analyzed by using VAT gain, phase and asymmetry among them.Result:①Among the 69 cases of VM patients,54 cases (78.3%) were horizontal or vertical gain abnormalities, 66 cases (95.7%) were horizontal or/and vertical phase delay, and 13 cases (18.8%) were asymmetric abnormalities. ②Among the 54 (78.3%) cases of abnormal gain, 46 (66.7%) cases demonstrated high gain, 42 had high gain combined with high phase, and 36 cases were simple horizontal high gain (and mainly concentrated at 2-4 Hz, 26 cases), 8 cases (11.6%) showed low gain. ③VAT characteristics in PCI group:47 cases (64.4%) were high gain, and 11 cases (15.1%) were low gain. There was no significant difference in high gain and low gain between PCI group and VM group (χ² was 0.07 and 0.37, P>0.05). Both VM group and PCI group are high-gain, but there was significant difference in the phase delay and asymmetric indicators. ④VAT characteristics in normal people group: The four indices have low abnormally positive rates. There were statistically significant differences of the high gain and the low gain between the normal people group and VM group(χ² were 56.17 and 97.57, P<0.01).Conclusion:The vestibular ocular reflex of VM is high-gain based and was mostly in the 2-4 Hz frequency,and accompanied by phase delay. Vestibular central system was mainly involved in VM. VAT detection can provide a clue for VM diagnostics.
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Affiliation(s)
- K X Xu
- Department of Otorhinolaryngology Head and Neck Surgery, Tianjin First Central Hospital, Tianjin, 300192, China
| | - T S Chen
- Department of Otorhinolaryngology Head and Neck Surgery, Tianjin First Central Hospital, Tianjin, 300192, China
| | - W Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Tianjin First Central Hospital, Tianjin, 300192, China
| | - S S Li
- Department of Otorhinolaryngology Head and Neck Surgery, Tianjin First Central Hospital, Tianjin, 300192, China
| | - C Wen
- Department of Otorhinolaryngology Head and Neck Surgery, Tianjin First Central Hospital, Tianjin, 300192, China
| | - Q Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Tianjin First Central Hospital, Tianjin, 300192, China
| | - X Han
- Department of Otorhinolaryngology Head and Neck Surgery, Tianjin First Central Hospital, Tianjin, 300192, China
| | - P Lin
- Department of Otorhinolaryngology Head and Neck Surgery, Tianjin First Central Hospital, Tianjin, 300192, China
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12
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Dai C, Lehar M, Sun DQ, Rvt LS, Carey JP, MacLachlan T, Brough D, Staecker H, Della Santina AM, Hullar TE, Della Santina CC. Rhesus Cochlear and Vestibular Functions Are Preserved After Inner Ear Injection of Saline Volume Sufficient for Gene Therapy Delivery. J Assoc Res Otolaryngol 2017. [PMID: 28646272 DOI: 10.1007/s10162-017-0628-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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] Open
Abstract
Sensorineural losses of hearing and vestibular sensation due to hair cell dysfunction are among the most common disabilities. Recent preclinical research demonstrates that treatment of the inner ear with a variety of compounds, including gene therapy agents, may elicit regeneration and/or repair of hair cells in animals exposed to ototoxic medications or other insults to the inner ear. Delivery of gene therapy may also offer a means for treatment of hereditary hearing loss. However, injection of a fluid volume sufficient to deliver an adequate dose of a pharmacologic agent could, in theory, cause inner ear trauma that compromises functional outcome. The primary goal of the present study was to assess that risk in rhesus monkeys, which closely approximates humans with regard to middle and inner ear anatomy. Secondary goals were to identify the best delivery route into the primate ear from among two common surgical approaches (i.e., via an oval window stapedotomy and via the round window) and to determine the relative volumes of rhesus, rodent, and human labyrinths for extrapolation of results to other species. We measured hearing and vestibular functions before and 2, 4, and 8 weeks after unilateral injection of phosphate-buffered saline vehicle (PBSV) into the perilymphatic space of normal rhesus monkeys at volumes sufficient to deliver an atoh1 gene therapy vector. To isolate effects of injection, PBSV without vector was used. Assays included behavioral observation, auditory brainstem responses, distortion product otoacoustic emissions, and scleral coil measurement of vestibulo-ocular reflexes during whole-body rotation in darkness. Three groups (N = 3 each) were studied. Group A received a 10 μL transmastoid/trans-stapes injection via a laser stapedotomy. Group B received a 10 μL transmastoid/trans-round window injection. Group C received a 30 μL transmastoid/trans-round window injection. We also measured inner ear fluid space volume via 3D reconstruction of computed tomography (CT) images of adult C57BL6 mouse, rat, rhesus macaque, and human temporal bones (N = 3 each). Injection was well tolerated by all animals, with eight of nine exhibiting no signs of disequilibrium and one animal exhibiting transient disequilibrium that resolved spontaneously by 24 h after surgery. Physiologic results at the final, 8-week post-injection measurement showed that injection was well tolerated. Compared to its pretreatment values, no treated ear's ABR threshold had worsened by more than 5 dB at any stimulus frequency; distortion product otoacoustic emissions remained detectable above the noise floor for every treated ear (mean, SD and maximum deviation from baseline: -1.3, 9.0, and -18 dB, respectively); and no animal exhibited a reduction of more than 3 % in vestibulo-ocular reflex gain during high-acceleration, whole-body, passive yaw rotations in darkness toward the treated side. All control ears and all operated ears with definite histologic evidence of injection through the intended site showed similar findings, with intact hair cells in all five inner ear sensory epithelia and intact auditory/vestibular neurons. The relative volumes of mouse, rat, rhesus, and human inner ears as measured by CT were (mean ± SD) 2.5 ± 0.1, 5.5 ± 0.4, 59.4 ± 4.7 and 191.1 ± 4.7 μL. These results indicate that injection of PBSV at volumes sufficient for gene therapy delivery can be accomplished without destruction of inner ear structures required for hearing and vestibular sensation.
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Affiliation(s)
- Chenkai Dai
- Vestibular NeuroEngineering Lab, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, 720 Rutland Ave., Ross Bldg Rm 830, Baltimore, MD, 21205, USA. .,Department of Biomedical Engineering, Johns Hopkins University School of Medicine, 720 Rutland Ave., Ross Bldg Rm 830, Baltimore, MD, 21205, USA.
| | - Mohamed Lehar
- Vestibular NeuroEngineering Lab, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, 720 Rutland Ave., Ross Bldg Rm 830, Baltimore, MD, 21205, USA.,Department of Biomedical Engineering, Johns Hopkins University School of Medicine, 720 Rutland Ave., Ross Bldg Rm 830, Baltimore, MD, 21205, USA
| | - Daniel Q Sun
- Vestibular NeuroEngineering Lab, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, 720 Rutland Ave., Ross Bldg Rm 830, Baltimore, MD, 21205, USA.,Department of Biomedical Engineering, Johns Hopkins University School of Medicine, 720 Rutland Ave., Ross Bldg Rm 830, Baltimore, MD, 21205, USA
| | - Lani Swarthout Rvt
- Vestibular NeuroEngineering Lab, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, 720 Rutland Ave., Ross Bldg Rm 830, Baltimore, MD, 21205, USA.,Department of Biomedical Engineering, Johns Hopkins University School of Medicine, 720 Rutland Ave., Ross Bldg Rm 830, Baltimore, MD, 21205, USA
| | - John P Carey
- Vestibular NeuroEngineering Lab, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, 720 Rutland Ave., Ross Bldg Rm 830, Baltimore, MD, 21205, USA.,Department of Biomedical Engineering, Johns Hopkins University School of Medicine, 720 Rutland Ave., Ross Bldg Rm 830, Baltimore, MD, 21205, USA
| | - Tim MacLachlan
- Novartis Institutes for Biomedical Research, 250 Massachusetts Ave, Cambridge, MA, 02139, USA
| | - Doug Brough
- GenVec, 910 Clopper Rd #220n, Gaithersburg, MD, 20878, USA
| | - Hinrich Staecker
- Dept of Otolaryngology, Head & Neck Surgery, University of Kansas School of Medicine, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Alexandra M Della Santina
- Vestibular NeuroEngineering Lab, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, 720 Rutland Ave., Ross Bldg Rm 830, Baltimore, MD, 21205, USA.,Department of Biomedical Engineering, Johns Hopkins University School of Medicine, 720 Rutland Ave., Ross Bldg Rm 830, Baltimore, MD, 21205, USA
| | - Timothy E Hullar
- Department of Otolaryngology, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO, 63110, USA.,Department of Anatomy and Neurobiology, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO, 63110, USA.,Department of Audiology and Communication Sciences, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO, 63110, USA
| | - Charles C Della Santina
- Vestibular NeuroEngineering Lab, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, 720 Rutland Ave., Ross Bldg Rm 830, Baltimore, MD, 21205, USA.,Department of Biomedical Engineering, Johns Hopkins University School of Medicine, 720 Rutland Ave., Ross Bldg Rm 830, Baltimore, MD, 21205, USA
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13
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DiGiovanna J, Nguyen TAK, Guinand N, Pérez-Fornos A, Micera S. Neural Network Model of Vestibular Nuclei Reaction to Onset of Vestibular Prosthetic Stimulation. Front Bioeng Biotechnol 2016; 4:34. [PMID: 27148528 PMCID: PMC4837148 DOI: 10.3389/fbioe.2016.00034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 12/31/2015] [Accepted: 03/30/2016] [Indexed: 11/24/2022] Open
Abstract
The vestibular system incorporates multiple sensory pathways to provide crucial information about head and body motion. Damage to the semicircular canals, the peripheral vestibular organs that sense rotational velocities of the head, can severely degrade the ability to perform activities of daily life. Vestibular prosthetics address this problem by using stimulating electrodes that can trigger primary vestibular afferents to modulate their firing rates, thus encoding head movement. These prostheses have been demonstrated chronically in multiple animal models and acutely tested in short-duration trials within the clinic in humans. However, mainly, due to limited opportunities to fully characterize stimulation parameters, there is a lack of understanding of “optimal” stimulation configurations for humans. Here, we model possible adaptive plasticity in the vestibular pathway. Specifically, this model highlights the influence of adaptation of synaptic strengths and offsets in the vestibular nuclei to compensate for the initial activation of the prosthetic. By changing the synaptic strengths, the model is able to replicate the clinical observation that erroneous eye movements are attenuated within 30 minutes without any change to the prosthetic stimulation rate. Although our model was only built to match this time point, we further examined how it affected subsequent pulse rate modulation (PRM) and pulse amplitude modulation (PAM). PAM was more effective than PRM for nearly all stimulation configurations during these acute tests. Two non-intuitive relationships highlighted by our model explain this performance discrepancy. Specifically, the attenuation of synaptic strengths for afferents stimulated during baseline adaptation and the discontinuity between baseline and residual firing rates both disproportionally boost PAM. Comodulation of pulse rate and amplitude has been experimentally shown to induce both excitatory and inhibitory eye movements even at high baseline stimulation rates. We also modeled comodulation and found synergistic combinations of stimulation parameters to achieve equivalent output to only amplitude modulation. This may be an important strategy to reduce current spread and misalignment. The model outputs reflected observed trends in clinical testing and aspects of existing vestibular prosthetic literature. Importantly, the model provided insight to efficiently explore the stimulation parameter space, which was helpful, given limited available patient time.
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Affiliation(s)
- Jack DiGiovanna
- Center for Neuroprosthetics, Bertarelli Foundation Chair in Translational Neuroengineering, École Polytechnique Fédérale de Lausanne , Lausanne , Switzerland
| | - T A K Nguyen
- Center for Neuroprosthetics, Bertarelli Foundation Chair in Translational Neuroengineering, École Polytechnique Fédérale de Lausanne , Lausanne , Switzerland
| | - Nils Guinand
- Cochlear Implant Center for French Speaking Switzerland, Service of Otorhinolaryngology - Head and Neck Surgery, Geneva University Hospitals , Geneva , Switzerland
| | - Angelica Pérez-Fornos
- Cochlear Implant Center for French Speaking Switzerland, Service of Otorhinolaryngology - Head and Neck Surgery, Geneva University Hospitals , Geneva , Switzerland
| | - Silvestro Micera
- Center for Neuroprosthetics, Bertarelli Foundation Chair in Translational Neuroengineering, École Polytechnique Fédérale de Lausanne , Lausanne , Switzerland
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14
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Abstract
Vestibular function laboratories utilize a multitude of diagnostic instruments to evaluate a dizzy patient. Caloric irrigators, oculomotor stimuli, and rotational chairs produce a stimulus whose accuracy is required for the patient response to be accurate. Careful attention to everything from cleanliness of equipment to threshold adjustments determine on a daily basis if patient data are going to be correct and useful. Instrumentation specifications that change with time such as speed and temperature must periodically be checked using calibrated instruments.
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Affiliation(s)
| | - David A Zapala
- Audiology Section, Department of Otorhinolaryngology, Mayo Clinic Florida; Mayo Clinic College of Medicine, Jacksonville, Florida
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15
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Huang YY, Tschopp M, Straumann D, Neuhauss SCF. Vestibular deficits do not underlie looping behavior in achiasmatic fish. Commun Integr Biol 2011; 3:379-81. [PMID: 20798832 DOI: 10.4161/cib.3.4.11975] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Accepted: 04/02/2010] [Indexed: 01/20/2023] Open
Abstract
Zebrafish belladonna (bel) mutants carry a mutation in the lhx2 gene that encodes a Lim domain homeobox transcription factor, leading to a defect in the retinotectal axon pathfinding. As a result, a large fraction of homozygous bel mutants is achiasmatic. Achiasmatic bel mutants display ocular motor instabilities, both reserved optokinetic response (OKR) and spontaneous eye oscillations, and an unstable swimming behavior, described as looping. All these unstable behaviors have been linked to the underlying optic nerve projection defect. Looping has been investigated under different visual stimuli and shown to be vision dependent and contrast sensitive. In addition, looping correlates perfectly with reversed OKR and the spontaneous oscillations of the eyes. Hence, it has been hypothesized that looping is a compensatory response to the perception of self-motion induced by the spontaneous eye oscillations. However, both ocular and postural instabilities could also be caused by a yet unidentified vestibular deficit. Here, we performed a preliminary test of the vestibular function in achiasmatic bel larval mutants in order to clarify the potential role of a vestibular deficit in looping. We found that the vestibular ocular reflex (VOR) is normally directed in both bel mutants and wild types and therefore exclude the possibility that nystagmus and looping in reverse to the rotating optokinetic drum can be attributed to an underlying vestibular deficit.
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