The Clinical Significance of the Failure to Perceive Vertigo in the Postcaloric Period Despite a Robust Caloric Response

Erin G. Piker; Gary P. Jacobson; Daniel Romero; Ye Wang; Kaylee Smith

doi:10.1044/2019_aja-19-00036

The Clinical Significance of the Failure to Perceive Vertigo in the Postcaloric Period Despite a Robust Caloric Response

American Journal of Audiology ◽

10.1044/2019_aja-19-00036 ◽

2020 ◽

Vol 29 (1) ◽

pp. 50-58

Author(s):

Erin G. Piker ◽

Gary P. Jacobson ◽

Daniel Romero ◽

Ye Wang ◽

Kaylee Smith

Keyword(s):

Working Memory ◽

Motion Perception ◽

Postural Stability ◽

Vestibular Function ◽

Slow Phase ◽

Visuospatial Memory ◽

Visuospatial Working Memory ◽

Dynamic Posturography ◽

Caloric Testing ◽

Caloric Response

Purpose The purpose of this project was to explore the association between the perception of motion during caloric testing and two tasks associated with central vestibular processing: postural stability and visuospatial memory. Method This was a prospective study of 25 patients who were found to have nonvestibular etiologies of their symptoms and normal vestibular function test results and who underwent caloric testing with a mean maximum slow phase eye velocity for each irrigation of 15° or greater. Following each caloric irrigation, patients were asked whether they had any sensation of movement. Patients were grouped based on the presence or absence of motion during the caloric exam (motion perception vs. absent perception). Postural stability was assessed using computerized dynamic posturography, and visuospatial memory was assessed using a memory match card game application. Results There were no significant differences between groups on any measures of peripheral vestibular function. However, the Absent Perception Group showed greater postural instability during Condition 5 of posturography and performed significantly worse on a task of visuospatial working memory. Both age and absence of motion perception predicted abnormal performance on measures of postural stability and visuospatial working memory. Conclusions There appears to be clinical implications to a lack of motion perception during the caloric exam in patients with an otherwise normal peripheral vestibular system. Based on the current findings, we are unable to determine whether differences in postural stability and visuospatial memory were due to age or a central vestibular processing deficit.

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Vestibular Preservation After Cochlear Implantation Using the Round Window Approach

Frontiers in Neurology ◽

10.3389/fneur.2021.656592 ◽

2021 ◽

Vol 12 ◽

Author(s):

Keita Tsukada ◽

Shin-ichi Usami

Keyword(s):

Cochlear Implantation ◽

Round Window ◽

Surgical Techniques ◽

Vestibular Function ◽

Vestibular Evoked Myogenic Potential ◽

Flexible Electrodes ◽

Caloric Testing ◽

Before And After ◽

Window Approach ◽

Caloric Response

Background: The development of less traumatic surgical techniques, such as the round window approach (RWA), as well as the use of flexible electrodes and post-operative steroid administration have enabled the preservation of residual hearing after cochlear implantation (CI) surgery. However, consideration must still be given to the complications that can accompany CI. One such potential complication is the impairment of vestibular function with resulting vertigo symptoms. The aim of our current study was to examine the changes in vestibular function after implantation in patients who received CI using less traumatic surgery, particularly the RWA technique.Methods: Sixty-six patients who received CI in our center were examined by caloric testing, cervical vestibular evoked myogenic potential (cVEMP) and ocular VEMP (oVEMP) before or after implantation, or both, to obtain data on semicircular canal, saccular and utricular function, respectively. Less traumatic CI surgery was performed by the use of the RWA and insertion of flexible electrodes such as MED-EL FLEX soft, FLEX 28, and FLEX 24 (Innsbruck, Austria).Results: Caloric response and the asymmetry ratio of cVEMP and oVEMP were examined before and after implantation using less traumatic surgical techniques. Compared with before implantation, 93.9, 82.4, and 92.5% of the patients showed preserved vestibular function after implantation based on caloric testing, cVEMP and oVEMP results, respectively. We also examined the results for vestibular function by a comparison of the 66 patients using the RWA and flexible electrodes, and 17 patients who underwent cochleostomy and insertion of conventional or hard electrodes. We measured responses using caloric testing, cVEMP and oVEMP in patients after CI. There were no differences in the frequencies of abnormal caloric and oVEMP results in the implanted ears between the RWA and cochleostomy. On the other hand, the frequency of abnormal cVEMP responses in the implanted ears in the patients who received implantation by cochleostomy was significantly higher than that in the patients undergoing surgery using the RWA.Conclusion: Patients receiving CI using less traumatic surgical techniques such as RWA and flexible electrodes have reduced risk of damage to vestibular function.

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Vestibular and Cardiovascular Responses After Long-Duration Spaceflight

Aerospace Medicine and Human Performance ◽

10.3357/amhp.5502.2020 ◽

2020 ◽

Vol 91 (8) ◽

pp. 621-627

Author(s):

Nandini Deshpande ◽

Steven S. Laurie ◽

Stuart M. C. Lee ◽

Chris A. Miller ◽

Ajitkumar P. Mulavara ◽

...

Keyword(s):

Heart Rate ◽

Postural Stability ◽

Cardiovascular Response ◽

Space Station ◽

Vestibular Function ◽

Cardiovascular Responses ◽

Dynamic Posturography ◽

Arterial Blood ◽

Dynamic Head ◽

Long Duration

BACKGROUND: The vestibulo-sympathetic reflex operates during orthostatically challenging movements to initiate cardiovascular responses in advance of a baroreceptor-mediated response. The objective of this study was to determine whether there was an association between changes in vestibular function and cardiovascular responses during a prone-to-stand movement in astronauts after return from long-duration spaceflight.METHODS: Thirteen crewmembers who participated in International Space Station missions were tested before spaceflight and 1 d after landing. Vestibular function was evaluated by computerized dynamic posturography while their head was erect and while they performed dynamic head tilts. Heart rate and mean arterial blood pressure were measured while the subjects were in prone and standing positions.RESULTS: The 21.4% increase in the astronauts’ heart rate during the prone to stand maneuver after spaceflight correlated significantly with their spaceflight-induced 48.7% decrease in postural stability during dynamic head tilts. The larger mean arterial pressure in the prone position after spaceflight compared to preflight (+7%) also correlated with the postflight decrease in postural stability during dynamic head tilts.CONCLUSION: These results indicate that an appropriate vestibular function is important to evoke optimum vestibulo-sympathetic response during orthostatically challenging voluntary movements performed after spaceflight. They also suggest that there may be a greater need to generate an anticipatory cardiovascular response after spaceflight.Deshpande N, Laurie SS, Lee SMC, Miller CA, Mulavara AP, Peters BT,Reschke MF, Stenger MB, Taylor LC, Wood SJ, Clément GR, Bloomberg JJ. Vestibular and cardiovascular responses after long-duration spaceflight. Aerosp Med Hum Perform. 2020; 91(8):621–627.

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Caloric response does not decline with age

Journal of Vestibular Research ◽

10.3233/ves-2004-14505 ◽

2004 ◽

Vol 14 (5) ◽

pp. 393-396

Author(s):

A.I. Mallinson ◽

N.S. Longridge

Keyword(s):

Vestibular System ◽

Vestibular Function ◽

The Elderly ◽

Slow Phase ◽

Balance System ◽

Age Related ◽

Dependent Change ◽

Physiologic Function ◽

Caloric Response ◽

Anatomical Evidence

Complaints of imbalance in the elderly are commonly heard by clinicians, and pathology of the vestibular system may play an important role in these complaints. While there is solid anatomical evidence for age related decline of some vestibular structures, a corresponding deterioration in physiologic function has not been convincingly demonstrated. Vestibular function is traditionally measured with caloric irrigations. Although there has been some age dependent change in caloric response shown, there is no good parallel between caloric response and imbalance in the elderly patient. Our experiment confirms that slow phase velocity of caloric responses does not decline with age. Calorics measure only one part of the vestibular system, and so should not be regarded as representative of balance system function. As a result, measured caloric response does not parallel documented anatomic age-related decline of the vestibular system.

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Influence of Tasking During Vestibular Testing

American Journal of Audiology ◽

10.1044/2021_aja-20-00227 ◽

2021 ◽

pp. 1-6

Author(s):

Kathryn Makowiec ◽

Kaylee Smith ◽

Ashley Deeb ◽

Erica Bennett ◽

Jenni Sis

Keyword(s):

Statistical Significance ◽

Vestibular Function ◽

Slow Phase ◽

Vestibular Disorder ◽

Caloric Testing ◽

Significant Difference ◽

Verbal Tasks ◽

History Of ◽

Age Range ◽

Sinusoidal Harmonic Acceleration

Purpose The purpose of this study was to investigate the effectiveness of different types of tasking on the measurement of peak slow phase velocity (SPV) for caloric testing and rotary chair testing. Method This study evaluated the peak SPV response for caloric testing and rotary chair across five conditions. Three verbal, one tactile, and one condition without tasking were used for both caloric testing and rotary chair. The subjects consisted of 20 young adults (age range: 22–33 years, M = 26.65, SD = 3.72; seven male, 13 female) with normal vestibular function and no history of ear surgery or vestibular disorder. Study participation consisted of two visits with 24 hr minimum between each, one for caloric testing and one for rotary chair testing. The test completed at each visit was counterbalanced. Caloric Testing : The caloric irrigations were performed 5 times, with the ears randomized and tasking conditions randomized. Rotary Chair Testing : Rotary chair sinusoidal harmonic acceleration testing was performed 5 times at 0.08 Hz with the tasking conditions randomized. Results Tasking of any kind resulted in significantly larger peak SPV responses when compared to the no tasking condition for rotary chair testing. When comparing each type of tasking, no significant differences were noted. No significant difference was noted when comparing the conditions with tasking to the no tasking condition for caloric testing. Conclusions Clinically, either mental or tactile tasking can be utilized as a method to reduce VOR suppression during rotary chair testing. As no difference was found when comparing different verbal tasks to each other, the type of tasking can be catered to the patient. If verbal tasking cannot be completed, the braiding tactile task is a valid substitution. Caloric results varied widely across subjects and did not reach statistical significance, so conclusions on the need for tasking cannot be drawn.

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Do Children With Developmental Language Disorder (DLD) Have Difficulties With Interference Control, Visuospatial Working Memory, and Selective Attention? Developmental Patterns and the Role of Severity and Persistence of DLD

Journal of Speech Language and Hearing Research ◽

10.1044/2020_jslhr-20-00012 ◽

2020 ◽

Vol 63 (9) ◽

pp. 3036-3050

Author(s):

Elma Blom ◽

Tessel Boerma

Keyword(s):

Working Memory ◽

Selective Attention ◽

Language Disorder ◽

Typically Developing ◽

Developmental Language Disorder ◽

Visuospatial Working Memory ◽

Interference Control ◽

Developmental Patterns ◽

Search Tasks ◽

The Impact

Purpose Many children with developmental language disorder (DLD) have weaknesses in executive functioning (EF), specifically in tasks testing interference control and working memory. It is unknown how EF develops in children with DLD, if EF abilities are related to DLD severity and persistence, and if EF weaknesses expand to selective attention. This study aimed to address these gaps. Method Data from 78 children with DLD and 39 typically developing (TD) children were collected at three times with 1-year intervals. At Time 1, the children were 5 or 6 years old. Flanker, Dot Matrix, and Sky Search tasks tested interference control, visuospatial working memory, and selective attention, respectively. DLD severity was based on children's language ability. DLD persistence was based on stability of the DLD diagnosis. Results Performance on all tasks improved in both groups. TD children outperformed children with DLD on interference control. No differences were found for visuospatial working memory and selective attention. An interference control gap between the DLD and TD groups emerged between Time 1 and Time 2. Severity and persistence of DLD were related to interference control and working memory; the impact on working memory was stronger. Selective attention was unrelated to DLD severity and persistence. Conclusions Age and DLD severity and persistence determine whether or not children with DLD show EF weaknesses. Interference control is most clearly impaired in children with DLD who are 6 years and older. Visuospatial working memory is impaired in children with severe and persistent DLD. Selective attention is spared.

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Vestibular Function and Motion Sickness Susceptibility: Videonystagmographic Evidence From Oculomotor and Caloric Tests

American Journal of Audiology ◽

10.1044/2020_aja-19-00050 ◽

2020 ◽

Vol 29 (2) ◽

pp. 188-198

Author(s):

Cynthia G. Fowler ◽

Margaret Dallapiazza ◽

Kathleen Talbot Hadsell

Keyword(s):

Phase Velocity ◽

Motion Sickness ◽

Repeated Measures ◽

Short Form ◽

Vestibular Function ◽

Slow Phase ◽

Test Results ◽

Normal Range ◽

Slow Phase Velocity ◽

Caloric Tests

Purpose Motion sickness (MS) is a common condition that affects millions of individuals. Although the condition is common and can be debilitating, little research has focused on the vestibular function associated with susceptibility to MS. One causal theory of MS is an asymmetry of vestibular function within or between ears. The purposes of this study, therefore, were (a) to determine if the vestibular system (oculomotor and caloric tests) in videonystagmography (VNG) is associated with susceptibility to MS and (b) to determine if these tests support the theory of an asymmetry between ears associated with MS susceptibility. Method VNG was used to measure oculomotor and caloric responses. Fifty young adults were recruited; 50 completed the oculomotor tests, and 31 completed the four caloric irrigations. MS susceptibility was evaluated with the Motion Sickness Susceptibility Questionnaire–Short Form; in this study, percent susceptibility ranged from 0% to 100% in the participants. Participants were divided into three susceptibility groups (Low, Mid, and High). Repeated-measures analyses of variance and pairwise comparisons determined significance among the groups on the VNG test results. Results Oculomotor test results revealed no significant differences among the MS susceptibility groups. Caloric stimuli elicited responses that were correlated positively with susceptibility to MS. Slow-phase velocity was slowest in the Low MS group compared to the Mid and High groups. There was no significant asymmetry between ears in any of the groups. Conclusions MS susceptibility was significantly and positively correlated with caloric slow-phase velocity. Although asymmetries between ears are purported to be associated with MS, asymmetries were not evident. Susceptibility to MS may contribute to interindividual variability of caloric responses within the normal range.

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Visual Search Facilitation in Repeated Displays Depends on Visuospatial Working Memory

Experimental Psychology (formerly Zeitschrift für Experimentelle Psychologie) ◽

10.1027/1618-3169/a000125 ◽

2012 ◽

Vol 59 (1) ◽

pp. 47-54 ◽

Cited By ~ 16

Author(s):

Angela A. Manginelli ◽

Franziska Geringswald ◽

Stefan Pollmann

Keyword(s):

Working Memory ◽

Visual Search ◽

Control Experiment ◽

Memory Load ◽

Contextual Cueing ◽

Long Term Memory ◽

Visuospatial Working Memory ◽

Working Memory Load ◽

Memory Resources

When distractor configurations are repeated over time, visual search becomes more efficient, even if participants are unaware of the repetition. This contextual cueing is a form of incidental, implicit learning. One might therefore expect that contextual cueing does not (or only minimally) rely on working memory resources. This, however, is debated in the literature. We investigated contextual cueing under either a visuospatial or a nonspatial (color) visual working memory load. We found that contextual cueing was disrupted by the concurrent visuospatial, but not by the color working memory load. A control experiment ruled out that unspecific attentional factors of the dual-task situation disrupted contextual cueing. Visuospatial working memory may be needed to match current display items with long-term memory traces of previously learned displays.

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