Worldwide survey on laboratory testing of vestibular function

BackgroundThe function of the peripheral vestibular system can nowadays be quantified. The video head impulse test (vHIT) and caloric irrigation are used for the semicircular canals, cervical vestibular evoked myogenic potentials (cVEMP) for the sacculus, and ocular vestibular evoked myogenic potentials (oVEMP) for the utriculus. Because there is no agreement on normal and pathologic values, we performed a worldwide survey.MethodsA web-based standardized survey questionnaire was used to collect data on “reference values” and “cutoff” values. Thirty-eight centers from all continents (except Africa) replied.Results“Reference values”: vHIT: mean for the vestibulo-ocular reflex gain of the left horizontal canal 0.91 (range: 0.7–1.01) and of the left horizontal canal 0.92 (0.7–1.05); side difference 0.15 (0.25–0.3). Caloric irrigation: mean peak slow phase velocity of caloric-induced nystagmus for warm (44°C) water 18.65°/s (12–30°/s); cold (30°C) water 18.21°/s (10–25°/s). cVEMP: P13-N23 amplitude mean for the lower limit 28.67 μV (16–50 μV); upper limit 200 μV (50–350 μV). “Cutoff values”: vHIT: side difference 0.26 (0.1–0.4), bilateral vestibulopathy <0.61 (0.3–0.8); unilateral vestibulopathy (UVP) <0.68 (0.4–0.8). Caloric irrigation pathologic side difference mean 25.93% (17.7%–40%) or 12°/sec (5–30°/s); side difference UVP 26.73% (20%–40%) or 29.8°/s (5–100°/s). cVEMP: P13/N23 amplitude mean lower cutoff 32.5 μV (15–50 μV), mean upper cutoff 125 μV (50–200 μV), asymmetry 36.08 μV (20–50 μV).ConclusionThis worldwide survey showed a large variability in terms of reference and pathologic cutoff values in the 38 centers included. Therefore, standardization of how to achieve these values and agreement on which values should be used is highly warranted to guarantee a high quality of vestibular testing and interpretation of clinical and scientific results.

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Skull Vibration-Induced Nystagmus Test in a Human Model of Horizontal Canal Plugging

Audiology Research ◽

10.3390/audiolres11030028 ◽

2021 ◽

Vol 11 (3) ◽

pp. 301-312

Author(s):

Georges Dumas ◽

Christol Fabre ◽

Anne Charpiot ◽

Lea Fath ◽

Hella Chaney-Vuong ◽

...

Keyword(s):

Semicircular Canal ◽

Vestibular Function ◽

Human Model ◽

Vestibular Evoked Myogenic Potentials ◽

Head Impulse Test ◽

Slow Phase ◽

Caloric Test ◽

Horizontal Semicircular Canal ◽

Horizontal Canal ◽

Tertiary Referral Center

Background/Aim: the aim of this study was to assess the skull vibration-induced nystagmus test (SVINT) results and vestibular residual function after horizontal semicircular canal (HSCC) plugging. Methods: In this retrospective chart review performed in a tertiary referral center, 11 patients who underwent unilateral horizontal semicircular canal plugging (uHSCCP) for disabling Menière’s disease (MD) were included. The skull vibration-induced nystagmus (SVIN) slow-phase velocity (SPV) was compared with the results of the caloric test (CaT), video head impulse test (VHIT), and cervical vestibular-evoked myogenic potentials (cVEMP) performed on the same day. Results: Overall, 10 patients had a strong SVIN beating toward the intact side (Horizontal SVIN-SPV: 8.8°/s ± 5.6°/s), 10 had a significant or severe ipsilateral CaT hypofunction, 10 had an ipsilateral horizontal VHIT gain impairment, and 3 had altered cVEMP on the operated side. Five had sensorineural hearing worsening. SVIN-positive results were correlated with CaT and horizontal VHIT (HVHIT) results (p < 0.05) but not with cVEMP. SVIN-SPV was correlated with CaT hypofunction in % (p < 0.05). Comparison of pre- and postoperative CaT % hypofunction showed a significant worsening (p = 0.028). Conclusion: SVINT results in a human model of horizontal canal plugging are well correlated with vestibular tests exploring horizontal canal function, but not with cVEMP. SVINT always showed a strong lesional nystagmus beating away from the lesion side. SVIN acts as a good marker of HSCC function. This surgical technique showed invasiveness regarding horizontal canal vestibular function.

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Clinical dynamic visual acuity in patients with cerebellar ataxia and vestibulopathy

PLoS ONE ◽

10.1371/journal.pone.0255299 ◽

2021 ◽

Vol 16 (7) ◽

pp. e0255299

Author(s):

Michaela Dankova ◽

Jaroslav Jerabek ◽

Dylan J. Jester ◽

Alena Zumrova ◽

Jaroslava Paulasova Schwabova ◽

...

Keyword(s):

Visual Acuity ◽

Vestibular Function ◽

Head Impulse Test ◽

Dynamic Visual Acuity ◽

Bilateral Vestibulopathy ◽

Caloric Irrigation ◽

Ocular Reflex ◽

Vestibulo Ocular Reflex ◽

Cerebellar Ataxias ◽

Central Adaptation

Deterioration of dynamic visual acuity (DVA) as a result of impaired vestibulo-ocular reflex (VOR) has been well described in peripheral vestibulopathies, however, changes in DVA in patients with degenerative cerebellar ataxias (CA) and its relation to VOR impairment in these patients has not yet been evaluated. Our aim was to assess the alterations of DVA in CA and to evaluate its relation to vestibular function. 32 patients with CA and 3 control groups: 13 patients with unilateral and 13 with bilateral vestibulopathy and 21 age matched healthy volunteers were examined by clinical DVA test, VOR was assessed by video Head Impulse Test and caloric irrigation. The severity of ataxia in CA was assessed by Scale for the assessment and rating of ataxia (SARA). Relationship between DVA and vestibular function in CA patients was examined by linear regressions. DVA impairment was highly prevalent in CA patients (84%) and its severity did not differ between CA and bilateral vestibulopathy patients. The severity of DVA impairment in CA was linked mainly to VOR impairment and only marginally to the degree of ataxia. However, DVA impairment was present also in CA patients without significant vestibular lesion showing that central mechanisms such as impairment of central adaptation of VOR are involved. We suggest that the evaluation of DVA should be a standard part of clinical evaluation in patients with progressive CA, as this information can help to target vestibular and oculomotor rehabilitation.

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The walking speed-dependency of gait variability in bilateral vestibulopathy and its association with clinical tests of vestibular function

Scientific Reports ◽

10.1038/s41598-019-54605-0 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 3

Author(s):

Christopher McCrum ◽

Florence Lucieer ◽

Raymond van de Berg ◽

Paul Willems ◽

Angélica Pérez Fornos ◽

...

Keyword(s):

Walking Speed ◽

Assessment Tool ◽

Clinical Care ◽

Vestibular Function ◽

Step Length ◽

Gait Variability ◽

Vestibular Evoked Myogenic Potentials ◽

Head Impulse Test ◽

Step Width ◽

Bilateral Vestibulopathy

AbstractUnderstanding balance and gait deficits in vestibulopathy may help improve clinical care and our knowledge of the vestibular contributions to balance. Here, we examined walking speed effects on gait variability in healthy adults and in adults with bilateral vestibulopathy (BVP). Forty-four people with BVP, 12 healthy young adults and 12 healthy older adults walked at 0.4 m/s to 1.6 m/s in 0.2 m/s increments on a dual belt, instrumented treadmill. Using motion capture and kinematic data, the means and coefficients of variation for step length, time, width and double support time were calculated. The BVP group also completed a video head impulse test and examinations of ocular and cervical vestibular evoked myogenic potentials and dynamic visual acuity. Walking speed significantly affected all gait parameters. Step length variability at slower speeds and step width variability at faster speeds were the most distinguishing parameters between the healthy participants and people with BVP, and among people with BVP with different locomotor capacities. Step width variability, specifically, indicated an apparent persistent importance of vestibular function at increasing speeds. Gait variability was not associated with the clinical vestibular tests. Our results indicate that gait variability at multiple walking speeds has potential as an assessment tool for vestibular interventions.

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Vestibular function assessment of Susac syndrome patients by the video head impulse test and cervical vestibular-evoked myogenic potentials

Journal of Vestibular Research ◽

10.3233/ves-200007 ◽

2020 ◽

Vol 30 (6) ◽

pp. 393-399

Author(s):

Yahav Oron ◽

Ophir Handzel ◽

Zohar Habot-Wilner ◽

Keren Regev ◽

Arnon Karni ◽

...

Keyword(s):

Hearing Loss ◽

Sensorineural Hearing Loss ◽

Vestibular Function ◽

Pure Tone Audiometry ◽

Sensorineural Hearing ◽

Vestibular Evoked Myogenic Potentials ◽

Head Impulse Test ◽

Video Head Impulse Test ◽

Head Impulse ◽

Susac Syndrome

BACKGROUND: Susac syndrome (retino-cochleo-cerebral vasculopathy, SuS) is an autoimmune endotheliopathy characterized by the clinical triad of encephalopathy, branch retinal artery occlusions and sensorineural hearing loss. In contrast to data regarding auditory function, data measuring vestibular function is sparse and the cervical vestibular-evoked myogenic potentials (cVEMPs). OBJECTIVE: To determine whether the video head impulse test (vHIT) can serve as a confirmatory assessment of vestibulocochlear dysfunction in cases of suspected SuS. METHODS: Seven patients diagnosed with SuS underwent pure tone audiometry, a word recognition test, cVEMPs and the vHIT. RESULTS: Five patients were diagnosed with definite SuS, and two with probable SuS. Two patients were asymptomatic for hearing loss or tinnitus, and no sensorineural hearing loss was detected by audiograms. Four patients complained of tinnitus, and three patients reported experiencing vertigo. Three patients had abnormal cVEMPs results. All seven patients’ vHIT results were normal, except for patient #2, who was one of the three who complained of vertigo. The calculated gain of her left anterior semicircular canal was 0.5, without saccades. CONCLUSIONS: This is the first study to describe the results of the vHIT and cVEMPs among a group of patients with SuS. The results suggest that the vHIT should not be the only exam used to assess the function of the vestibular system of SuS patients.

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A case series shows independent vestibular labyrinthine function after major surgical trauma to the human cochlea

Communications Medicine ◽

10.1038/s43856-021-00036-w ◽

2021 ◽

Vol 1 (1) ◽

Author(s):

Stefan K. Plontke ◽

Torsten Rahne ◽

Ian S. Curthoys ◽

Bo Håkansson ◽

Laura Fröhlich

Keyword(s):

Case Series ◽

Vestibular Function ◽

Semicircular Canals ◽

Vestibular Evoked Myogenic Potentials ◽

Head Impulse Test ◽

Surgical Trauma ◽

Cochlear Function ◽

Receptor System ◽

Tertiary Referral Center ◽

Significant Difference

Abstract Background The receptors for hearing and balance are housed together in the labyrinth of the inner ear and share the same fluids. Surgical damage to either receptor system was widely believed to cause certain permanent loss of the receptor function of the other. That principle, however, has been called into question because there have been anecdotal reports in individual patients of at least partial preservation of cochlear function after major surgical damage to the vestibular division and vice versa. Methods We performed specific objective vestibular function tests before and after surgical trauma (partial or subtotal cochlear removal) for treatment of intracochlear tumors in 27 consecutive patients in a tertiary referral center. Vestibular function was assessed by calorics (low-frequency response of the lateral semicircular canal), vestibulo-ocular reflex by video head impulse test (vHIT) of the three semicircular canals, cervical and ocular vestibular evoked myogenic potentials (cVEMP, saccule and oVEMP, utricle). Preoperative and postoperative distributions were compared with paired t-tests. Results Here we show that there was no significant difference between pre- and post-operative measures for all tests of the five vestibular organs, and that after major surgical cochlear trauma, the vestibular receptors continue to function independently. Conclusions These surprising observations have important implications for our understanding of the function and the surgery of the peripheral auditory and vestibular system in general and open up new possibilities for the development, construction and evaluation of neural interfaces for electrical or optical stimulation of the peripheral auditory and vestibular nervous system.

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084 Separating stroke from vestibular neuritis by vestibular function test parameters

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2019-anzan.72 ◽

2019 ◽

Vol 90 (e7) ◽

pp. A27.1-A27

Author(s):

Zeljka Calic ◽

Benjamin Nham ◽

Rachel Taylor ◽

Allison Young ◽

Craig Anderson ◽

...

Keyword(s):

Three Dimensional ◽

Vestibular Function ◽

Vestibular Neuritis ◽

Vestibular Evoked Myogenic Potentials ◽

Head Impulse Test ◽

Saccade Amplitude ◽

Vestibular Tests ◽

Acute Vestibular Syndrome ◽

Significant Difference ◽

Catch Up

IntroductionVestibular neuritis (VN) and posterior circulation stroke (PCS) are the commonest causes of acute vestibular syndrome (AVS). We aim to identify discriminators of VN from PCS by testing all five vestibular end-organs in patients presenting with AVS.MethodsThree-dimensional video-head impulse test (v-HIT), cervical and ocular-vestibular evoked myogenic potentials (c-and oVEMP) and subjective visual horizontal (SVH) tests were performed in 22 patients with VN and 22 with PCS. Ipsilesional horizontal, anterior and posterior canal (HC, AC, PC) v-HIT gain and first catch-up saccade characteristics, VEMP amplitude asymmetry-ratios were compared.ResultsAll VN and 6 PCS patients had positive clinical HIT. Mean time to testing was 4.7 days for VN, 7.0 days for PCS. VN mean ipsilesional HC and AC first saccade amplitude was larger, peak-velocities faster and onset latencies earlier compared to PCS (p<0.05). No significant difference between VN and PCS in first saccade characteristics was found in PC. Ipsilesional first saccade amplitude, peak-velocity and duration were significantly different between PCS and controls for all canals (p<0.05). A gain <0.68 and first saccade amplitudes >2.2°separated VN from PCS with sensitivities of 95.5% and 86.4% and specificities of 72.7% and 63.6%. First saccade amplitude of >0.91°identified PCS from controls with sensitivity of 68.2% and specificity of 70%. Abnormality rates for AC cVEMP, BC oVEMP and SVH were 42.9%, 50% and 91% for VN and 38.1%, 9% 72% for PCS.Conclusion v-HIT gain and catch-up saccade metrics are useful separators of VN from PCS. Detailed saccade analysis complements existing vestibular tests.

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Chronic Electrical Stimulation of the Otolith Organ: Preliminary Results in Humans with Bilateral Vestibulopathy and Sensorineural Hearing Loss

Audiology and Neurotology ◽

10.1159/000503600 ◽

2019 ◽

Vol 25 (Suppl. 1-2) ◽

pp. 79-90 ◽

Cited By ~ 3

Author(s):

Angel Ramos Macias ◽

Angel Ramos de Miguel ◽

Isaura Rodriguez Montesdeoca ◽

Silvia Borkoski Barreiro ◽

Juan Carlos Falcón González

Keyword(s):

Electrical Stimulation ◽

Vestibular Evoked Myogenic Potentials ◽

Head Impulse Test ◽

Clinical Test ◽

Otolith Organ ◽

Bilateral Vestibulopathy ◽

Vestibular Loss ◽

Bilateral Vestibular Loss ◽

Chronic Electrical Stimulation ◽

Stimulation Of

Introduction: Bilateral vestibulopathy is an important cause of imbalance that is misdiagnosed. The clinical management of patients with bilateral vestibular loss remains difficult as there is no clear evidence for an effective treatment. In this paper, we try to analyze the effect of chronic electrical stimulation and adaptation to electrical stimulation of the vestibular system in humans when stimulating the otolith organ with a constant pulse train to mitigate imbalance due to bilateral vestibular dysfunction (BVD). Methods: We included 2 patients in our study with BVD according to Criteria Consensus of the Classification Committee of the Bárány Society. Both cases were implanted by using a full-band straight electrode to stimulate the otoliths organs and simultaneously for the cochlear stimulation we use a perimodiolar electrode. Results: In both cases Vestibular and clinical test (video head impulse test, videonistagmography cervical vestibular evoked myogenic potentials, cVEMP and oVEMP), subjective visual vertical test, computerized dynamic posturography, dynamic gait index, Time UP and Go test and dizziness handicap index) were performed. Posture and gait metrics reveal important improvement if compare with preoperartive situation. Oscillopsia, unsteadiness, independence and quality of life improved to almost normal situation. Discussion/Conclusion: Prosthetic implantation of the otolith organ in humans is technically feasible. Electrical stimulation might have potential effects on balance and this is stable after 1 year follow-up. This research provides new possibilities for the development of vestibular implants to improve gravito-inertial acceleration sensation, in this case by the otoliths stimulation.

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Early Assessment of Vestibular Function after Unilateral Cochlear Implant Surgery

Audiology and Neurotology ◽

10.1159/000502252 ◽

2019 ◽

Vol 25 (Suppl. 1-2) ◽

pp. 50-59 ◽

Cited By ~ 1

Author(s):

Maurizio Barbara ◽

Rita Talamonti ◽

Anna Teresa Benincasa ◽

Silvia Tarentini ◽

Chiara Filippi ◽

...

Keyword(s):

Short Form ◽

Statistical Significance ◽

Round Window ◽

Vestibular Function ◽

Semicircular Canals ◽

Vestibular Evoked Myogenic Potentials ◽

Diagnostic Tools ◽

Head Impulse Test ◽

Early Assessment ◽

Window Approach

Introduction: Cochlear implantation (CI) has been reported to negatively affect vestibular function. The study of vestibular function has variably been conducted using different types of diagnostic tools. The combined use of modern, rapidly performing diagnostic tools could prove useful for standardization of the evaluation protocol. Methods: In a group of 28 subjects undergoing CI, the video head impulse test (vHIT), the cervical vestibular evoked myogenic potentials (cVEMP) and the short form of the Dizziness Handicap Inventory (DHI) questionnaire were investigated preoperatively and postoperatively (implant on and off) in both the implanted and the contralateral, nonimplanted ear. All surgeries were performed with a round window approach (RWA), except for 3 otosclerosis cases in which the extended RWA (eRWA) was used. Results: The vHIT of the lateral semicircular canal showed preoperative vestibular involvement in nearly 50% of the cases, while the 3 canals were contemporarily affected in only 14% of the cases. In all the hypofunctional subjects, cVEMP were absent. A low VOR gain in all of the investigated superior semicircular canals was found in 4 subjects (14%). In those subjects (21.7%) in whom cVEMP were preoperatively present and normal on the operated side, the absence of a response was postoperatively recorded. Discussion/Conclusion: The vestibular protocol applied in this study was found to be appropriate for distinguishing between the CI-operated ear and the nonoperated ear. In this regard, cVEMP was found to be more sensitive than vHIT for revealing a vestibular sufferance after CI, though without statistical significance. Finally, the use of RWA surgery apparently did not reduce the occurrence of signs of vestibular impairment.

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Effects of Device on Video Head Impulse Test (vHIT) Gain

Journal of the American Academy of Audiology ◽

10.3766/jaaa.16138 ◽

2017 ◽

Vol 28 (09) ◽

pp. 778-785 ◽

Cited By ~ 15

Author(s):

Kristen L. Janky ◽

Jessie N. Patterson ◽

Neil T. Shepard ◽

Megan L. A. Thomas ◽

Julie A. Honaker

Keyword(s):

Normal Control ◽

Vestibular Function ◽

Head Impulse Test ◽

Video Head Impulse Test ◽

Vestibular Loss ◽

Directional Bias ◽

Horizontal Canal ◽

Head Impulse ◽

Control Subjects ◽

Bilateral Vestibular Loss

AbstractNumerous video head impulse test (vHIT) devices are available commercially; however, gain is not calculated uniformly. An evaluation of these devices/algorithms in healthy controls and patients with vestibular loss is necessary for comparing and synthesizing work that utilizes different devices and gain calculations.Using three commercially available vHIT devices/algorithms, the purpose of the present study was to compare: (1) horizontal canal vHIT gain among devices/algorithms in normal control subjects; (2) the effects of age on vHIT gain for each device/algorithm in normal control subjects; and (3) the clinical performance of horizontal canal vHIT gain between devices/algorithms for differentiating normal versus abnormal vestibular function.Prospective.Sixty-one normal control adult subjects (range 20–78) and eleven adults with unilateral or bilateral vestibular loss (range 32–79).vHIT was administered using three different devices/algorithms, randomized in order, for each subject on the same day: (1) Impulse (Otometrics, Schaumberg, IL; monocular eye recording, right eye only; using area under the curve gain), (2) EyeSeeCam (Interacoustics, Denmark; monocular eye recording, left eye only; using instantaneous gain), and (3) VisualEyes (MicroMedical, Chatham, IL, binocular eye recording; using position gain).There was a significant mean difference in vHIT gain among devices/algorithms for both the normal control and vestibular loss groups. vHIT gain was significantly larger in the ipsilateral direction of the eye used to measure gain; however, in spite of the significant mean differences in vHIT gain among devices/algorithms and the significant directional bias, classification of “normal” versus “abnormal” gain is consistent across all compared devices/algorithms, with the exception of instantaneous gain at 40 msec. There was not an effect of age on vHIT gain up to 78 years regardless of the device/algorithm.These findings support that vHIT gain is significantly different between devices/algorithms, suggesting that care should be taken when making direct comparisons of absolute gain values between devices/algorithms.

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Video Head Impulse Testing (vHIT) and the Assessment of Horizontal Semicircular Canal Function

Journal of the American Academy of Audiology ◽

10.3766/jaaa.14083 ◽

2015 ◽

Vol 26 (05) ◽

pp. 518-523 ◽

Cited By ~ 5

Author(s):

Kristal M. Riska ◽

Owen Murnane ◽

Faith W. Akin ◽

Courtney Hall

Keyword(s):

Semicircular Canal ◽

Objective Assessment ◽

Vestibular Function ◽

Vestibular Evoked Myogenic Potentials ◽

Head Impulse Test ◽

Clinical Test ◽

Horizontal Semicircular Canal ◽

Head Impulse ◽

New Instrument ◽

Qualitative Test

Background: Vestibular function (specifically, horizontal semicircular canal function) can be assessed across a broad frequency range using several different techniques. The head impulse test is a qualitative test of horizontal semicircular canal function that can be completed at bedside. Recently, a new instrument (video head impulse test [vHIT]) has been developed to provide an objective assessment to the clinical test. Questions persist regarding how this test may be used in the overall vestibular test battery. Purpose: The purpose of this case report is to describe vestibular test results (vHIT, rotational testing, vestibular evoked myogenic potentials, and balance and gait performance) in an individual with a 100% unilateral caloric weakness who was asymptomatic for dizziness, vertigo or imbalance. Data Collection and/or Analysis: Comprehensive assessment was completed to evaluate vestibular function. Caloric irrigations, rotary chair testing, vHIT, and vestibular evoked myogenic potentials were completed. Results: A 100% left-sided unilateral caloric weakness was observed in an asymptomatic individual. vHIT produced normal gain with covert saccades. Conclusions: This case demonstrates the clinical usefulness of vHIT as a diagnostic tool and indicator of vestibular compensation and functional status.

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