The Subjective Visual Vertical as a Clinical Parameter of Vestibular Function in Peripheral Vestibular Diseases

1995 ◽  
Vol 5 (1) ◽  
pp. 35-45
Author(s):  
Andreas Böhmer ◽  
Jürg Rickenmann
Keyword(s):  
Vestibular Function ◽  
Normal Subjects ◽  
Spontaneous Nystagmus ◽  
Otolith Organs ◽  
Subjective Visual Vertical ◽  
Eccentric Rotation ◽  
Vestibular Neurectomy ◽  
Vestibular Diseases ◽  
Ramsay Hunt Syndrome ◽  
Visual Vertical

The subjective visual vertical, SV, was measured in the upright and side positions in 25 normal subjects and in 73 patients with various peripheral vestibular disorders. Significant deviations of SV (toward the affected ear) were found in 100% of the patients with vestibular nerve section and with Ramsay Hunt syndrome, in 89% of the patients with vestibular neuritis, and in 0% of the patients with benign paroxysmal positional vertigo. The deviation of SV gradually disappeared within a few weeks of the onset of the disease in all patients except in those with total VIIth nerve resection. SV is a parameter of tonic afferent differences between the two labyrinths similar to vestibular spontaneous nystagmus but is mediated by other parts of the inner ear (probably the otolith organs) and thus provides additional information on the labyrinthine function. SV measured in 90° side positions, however, did not reveal asymmetric vestibular sensitivity, which is in contrast to SV tested during eccentric rotation in patients after vestibular neurectomy.

Subjective visual vertical in peripheral unilateral vestibular diseases*

1999 ◽  
Vol 9 (2) ◽  
pp. 145-152 ◽  
Author(s):  
D. Vibert ◽  
R. Häusler ◽  
A.B. Safran
Keyword(s):  
Eye Movements ◽  
Prospective Study ◽  
Vestibular Neuritis ◽  
Subjective Visual Vertical ◽  
Vestibular Loss ◽  
Vestibular Neurectomy ◽  
Vestibular Diseases ◽  
Vestibular Cues ◽  
Visual Vertical ◽  
Maddox Rod

In humans, the perception of vertical is provided by input from various sensorineural organs and pathways: vision, eye-movements, and proprioceptive and vestibular cues, particularly from the otolithic organs and graviceptive pathways. Well known in several types of brainstem lesions, subjective visual vertical (SVV) abnormalities may also be observed after peripheral vestibular lesions, such as surgical deafferentation, with a deviation directed toward the operated ear. Subjective visual vertical abnormalities are presumably related to a lesion of the otolithic organs and/or to changes in the afferent graviceptive pathways. The goal of this prospective study was to measure the SVV and to define the influence of the otolithic organs in patients suffering from various types of peripheral vestibular diseases: unilateral sudden cochleo-vestibular loss, so-called “viral labyrinthitis” (VL), sudden idiopathic unilateral peripheral vestibular loss, so-called “vestibular neuritis” (Ne). Data were compared with findings after unilateral surgical deafferentations such as vestibular neurectomy (VN) and labyrinthectomy (Lab). Subjective visual vertical was measured with a binocular test (vertical frame) and a monocular test (Maddox rod). In all patients, after VN and Lab, the SVV showed a 10 – 30 ∘ tilt with the vertical frame (N: 0 ± 2 ∘ ), 5 – 15 ∘ with the Maddox rod (N: 0 ± 4 ∘ ). With the vertical frame, SVV was tilted > 2 ∘ in VL (47%) VL (41%) Our results demonstrate that SVV is frequently tilted in acute peripheral vestibulopathies such as VL and Ne. These findings suggest that otolithic function is implicated in the deficit depending on the extent and/or the localisation of the peripheral vestibular lesion.

Chronic unilateral loss of otolith function revealed by the subjective visual vertical during off center yaw rotation

1999 ◽  
Vol 9 (6) ◽  
pp. 413-422
Author(s):  
Andreas Böhmer ◽  
Fred Mast
Keyword(s):  
Rotation Axis ◽  
Inertial Force ◽  
Normal Subjects ◽  
Clinical Test ◽  
Subjective Visual Vertical ◽  
Eccentric Rotation ◽  
Midsagittal Plane ◽  
Vestibular Loss ◽  
Visual Vertical ◽  
Set Up

Assessing the subjective visual vertical, SVV, in a static upright position is an easy clinical test in which a deviation of some 10 ∘ from true vertical indicates an acute loss of unilateral (otolithic) vestibular function on the side to which the SVV is tilted. Because this deviation of the SVV is compensated during the following months, patients with chronic unilateral vestibular loss do no longer differ from normal subjects. This study presents an experimental set-up that allows for clear detection of compensated chronic loss of unilateral otolithic function by testing the SVV. 21 normals and 17 unilaterally vestibular deafferentiated (UVD) patients (vestibular neurectomies) were first rotated on a human centrifuge about an earth vertical yaw axis through the midsagittal plane of the head ( 240 ∘ /s). This induced tilts of the gravito-inertial force (GIF) vectors, which differed at the two inner ears by 8 ∘ . During constant velocity rotation, the subjects were moved in pseudo-randomized steps laterally up to 16 cm apart from the rotation axis, inducing roll tilts of the GIF vectors up to 16 ∘ . Normal subjects set their SVV to pre-centrifugation values at positions with the midsagittal plane of their head close to the rotation axis, while chronic UVD patients indicated pre-centrifugation values during positions with the rotation axis 5.9 ± 2.5 cm paramedian on the side of the intact ear. Tilts of the GIF vectors shifted the SVV with a gain of 0.70 in normals and only 0.32 in UVD patients. Roll gains for laterally directed GIF vectors relative to the intact inner ear did not differ from medially directed roll gains in the UVD patients. The roll gains observed in this experimental set-up were lower than those observed with static body tilts or during eccentric rotation with a larger radius, which might be at least partially due to conflicting stimulation between otolithic and extra-vestibular cues.

Subjective visual vertical during eccentric rotation in patients with vestibular neuritis

2009 ◽  
Vol 267 (3) ◽  
pp. 357-361 ◽  
Author(s):  
Seok Min Hong ◽  
Seung Geun Yeo ◽  
Jae Yong Byun ◽  
Moon Suh Park ◽  
Chan Hum Park ◽  
...  
Keyword(s):  
Vestibular Neuritis ◽  
Subjective Visual Vertical ◽  
Eccentric Rotation ◽  
Visual Vertical

scholarly journals Gravity Dependence of Subjective Visual Vertical Variability

2009 ◽  
Vol 102 (3) ◽  
pp. 1657-1671 ◽  
Author(s):  
A. A. Tarnutzer ◽  
C. Bockisch ◽  
D. Straumann ◽  
I. Olasagasti
Keyword(s):  
Inertial Force ◽  
Semicircular Canals ◽  
The Body ◽  
Otolith Organs ◽  
Subjective Visual Vertical ◽  
Visual Vertical ◽  
Head Roll ◽  
Static Head ◽  
Experimental Findings ◽  
Vertical Variability

The brain integrates sensory input from the otolith organs, the semicircular canals, and the somatosensory and visual systems to determine self-orientation relative to gravity. Only the otoliths directly sense the gravito-inertial force vector and therefore provide the major input for perceiving static head-roll relative to gravity, as measured by the subjective visual vertical (SVV). Intraindividual SVV variability increases with head roll, which suggests that the effectiveness of the otolith signal is roll-angle dependent. We asked whether SVV variability reflects the spatial distribution of the otolithic sensors and the otolith-derived acceleration estimate. Subjects were placed in different roll orientations (0–360°, 15° steps) and asked to align an arrow with perceived vertical. Variability was minimal in upright, increased with head-roll peaking around 120–135°, and decreased to intermediate values at 180°. Otolith-dependent variability was modeled by taking into consideration the nonuniform distribution of the otolith afferents and their nonlinear firing rate. The otolith-derived estimate was combined with an internal bias shifting the estimated gravity-vector toward the body-longitudinal. Assuming an efficient otolith estimator at all roll angles, peak variability of the model matched our data; however, modeled variability in upside-down and upright positions was very similar, which is at odds with our findings. By decreasing the effectiveness of the otolith estimator with increasing roll, simulated variability matched our experimental findings better. We suggest that modulations of SVV precision in the roll plane are related to the properties of the otolith sensors and to central computational mechanisms that are not optimally tuned for roll-angles distant from upright.

scholarly journals The Value of Subjective Visual Vertical in Diagnosis of Vestibular Migraine

2021 ◽  
Vol 41 (4) ◽  
pp. 654-660
Author(s):  
Fei Li ◽  
Jin Xu ◽  
Gen-ru Li ◽  
Rui Gao ◽  
Chen-yong Shang ◽  
...  
Keyword(s):  
Normal Subjects ◽  
Diagnostic Value ◽  
Upright Position ◽  
Vestibular Migraine ◽  
Subjective Visual Vertical ◽  
Vestibular Evoked Myogenic Potential ◽  
Significant Difference ◽  
Visual Vertical ◽  
High Level ◽  
Sensitivity Specificity

Abstract Objective To study the value of the subjective visual vertical (SVV) in the diagnosis of vestibular migraine (VM). Methods This study recruited 128 VM patients and 64 age-matched normal subjects. We detected the SVV during the interval between attacks in both groups, in sitting upright, and the head tilted at 45° to the left or right. We then examined the correlation between the SVV results with the vestibular evoked myogenic potential (VEMP) and canal paresis (CP). Results It was found there was a significant difference in SVV at the upright position between VM patients and normal controls (P=0.006) and no significant difference was found at the tilts of 45° to the left or right between the two groups. The SVV results at the upright position were significantly correlated with cervical VEMP (P=0.042) whereas not significantly correlated with CP and VEMP. There existed no significant difference in the conformity to the Müller effect (M effect) between the two groups. ROC analysis exhibited that the sensitivity, specificity of SVVs at the upright were 67.200% and 62.500% respectively. The diagnostic value of SVV at the upright position was significantly higher than that at tilts of 45° to the left and right (P=0.006). Nonetheless the diagnostic accuracy was relatively low. Conclusion Abnormality in SVV possibly stems from the lasting functional disorder of cerebellar or high-level cortical centers in VM patients or is linked to the vestibular compensation. The SVV is of low diagnostic value for VM and the value of SVV in VM warrants further study.

Subjective Visual Vertical Testing in Patients With Chronic Suppurative Otitis Media

2020 ◽  
Vol 163 (5) ◽  
pp. 1018-1024
Author(s):  
Rafael da Costa Monsanto ◽  
Ana Luiza Papi Kasemodel ◽  
Andreza Tomaz ◽  
Norma de Oliveira Penido
Keyword(s):  
Otitis Media ◽  
Middle Ear ◽  
Vestibular Function ◽  
Chronic Suppurative Otitis Media ◽  
Controlled Study ◽  
Subjective Visual Vertical ◽  
Suppurative Otitis Media ◽  
Visual Vertical ◽  
Vestibular Symptoms ◽  
Vertical Test

Objective To analyze the results of the subjective visual vertical test using the “bucket method” in patients with chronic suppurative otitis media (CSOM). Study Design Cross-sectional, controlled study. Setting Outpatient otology clinic in a tertiary care hospital. Subjects and Methods Patients had CSOM, defined as the presence of chronic infection or inflammation of the middle ear cleft, associated with a perforation of the tympanic membrane, frequent or intractable middle ear suppuration, with or without cholesteatoma. Controls were selected using a nonprobability, purposive sampling method. We excluded patients with neurologic or metabolic diseases, cognitive deficits, otosclerosis, vestibular migraine, Ménière’s disease, past use of ototoxic medication, or head and neck cancer. The volunteers were subjected to the subjective visual vertical test using the “bucket method.” The results obtained in our study and control groups were analyzed using nonparametric tests. Results Our study comprised 51 patients with CSOM and 50 controls. In the CSOM group, we observed that 72.5% of the patients had vestibular symptoms in the past year, and 70.5% had abnormalities identified in at least 1 vestibular function test. The subjective visual vertical test revealed that patients with CSOM (with and without cholesteatoma) had significantly higher deviations of the true vertical as compared with controls (CSOM, 3.66°; controls, 0.76°; P < .001). Conclusion Our results revealed that CSOM was associated with high rates of vestibular symptoms, abnormal vestibular function tests, and abnormal subjective vertical visual results.

scholarly journals Relative diagnostic value of ocular vestibular evoked potentials and the subjective visual vertical during tilt and eccentric rotation

2011 ◽  
Vol 122 (2) ◽  
pp. 398-404 ◽  
Author(s):  
Yulia Valko ◽  
Stefan C.A. Hegemann ◽  
Konrad P. Weber ◽  
Dominik Straumann ◽  
Christopher J. Bockisch
Keyword(s):  
Evoked Potentials ◽  
Diagnostic Value ◽  
Subjective Visual Vertical ◽  
Eccentric Rotation ◽  
Visual Vertical ◽  
Vestibular Evoked Potentials

Role of subjective visual vertical test during eccentric rotation in the recovery phase of vestibular neuritis

2010 ◽  
Vol 37 (5) ◽  
pp. 565-569 ◽  
Author(s):  
Jae Yong Byun ◽  
Seok Min Hong ◽  
Seung Geun Yeo ◽  
Sang Hoon Kim ◽  
Sung Wan Kim ◽  
...  
Keyword(s):  
Recovery Phase ◽  
Vestibular Neuritis ◽  
Subjective Visual Vertical ◽  
Eccentric Rotation ◽  
Visual Vertical ◽  
Vertical Test
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