Two conditions to fully recover dynamic canal function in unilateral peripheral vestibular hypofunction patients

BACKGROUND: The crucial role of early vestibular rehabilitation (VR) to recover a dynamic semicircular canal function was recently highlighted in patients with unilateral vestibular hypofunction (UVH). However, wide inter-individual differences were observed, suggesting that parameters other than early rehabilitation are involved. OBJECTIVE: The aim of the study was to determine to what extent the degree of vestibular loss assessed by the angular vestibulo-ocular reflex (aVOR) gain could be an additional parameter interfering with rehabilitation in the recovery process. And to examine whether different VR protocols have the same effectiveness with regard to the aVOR recovery. METHODS: The aVOR gain and the percentage of compensatory saccades were recorded in 81 UVH patients with the passive head impulse test before and after early VR (first two weeks after vertigo onset: N = 43) or late VR (third to sixth week after onset: N = 38) performed twice a week for four weeks. VR was performed either with the unidirectional rotation paradigm or gaze stability exercises. Supplementary outcomes were the dizziness handicap inventory (DHI) score, and the static and dynamic subjective visual vertical. RESULTS: The cluster analysis differentiated two distinct populations of UVH patients with pre-rehab aVOR gain values on the hypofunction side below 0.20 (N = 42) or above 0.20 (N = 39). The mean gain values were respectively 0.07±0.05 and 0.34±0.12 for the lateral canal (p < 0.0001), 0.09±0.06 and 0.44±0.19 for the anterior canal (p < 0.0001). Patients with aVOR gains above 0.20 and early rehab fully recovered dynamic horizontal canal function (0.84±0.14) and showed very few compensatory saccades (18.7% ±20.1%) while those with gains below 0.20 and late rehab did not improve their aVOR gain value (0.16±0.09) and showed compensatory saccades only (82.9% ±23.7%). Similar results were found for the anterior canal function. Recovery of the dynamic function of the lateral canal was found with both VR protocols while it was observed with the gaze stability exercises only for the anterior canal. All the patients reduced their DHI score, normalized their static SVV, and exhibited uncompensated dynamic SVV. CONCLUSIONS: Early rehab is a necessary but not sufficient condition to fully recover dynamic canal function. The degree of vestibular loss plays a crucial role too, and to be effective rehabilitation protocols must be carried out in the plane of the semicircular canals.

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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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Pre-habilitation Before Vestibular Schwannoma Surgery—Impact of Intratympanal Gentamicin Application on the Vestibulo-Ocular Reflex

Frontiers in Neurology ◽

10.3389/fneur.2021.633356 ◽

2021 ◽

Vol 12 ◽

Author(s):

Alexander A. Tarnutzer ◽

Christopher J. Bockisch ◽

Elena Buffone ◽

Alexander M. Huber ◽

Vincent G. Wettstein ◽

...

Keyword(s):

Vestibular Schwannoma ◽

Vestibular Function ◽

Loss Of Function ◽

Saccadic Amplitude ◽

Vestibular Loss ◽

Horizontal Canal ◽

Ocular Reflex ◽

Intratympanic Gentamicin ◽

Vestibulo Ocular Reflex ◽

Anterior Canal

Background: Patients with vestibular schwannoma that show residual peripheral-vestibular function before surgery may experience sudden and substantial vestibular loss of function after surgical resection. To alleviate the sudden loss of peripheral-vestibular function after vestibular-schwannoma (VS) resection, pre-surgical intratympanic gentamicin application was proposed.Objective: We hypothesized that this approach allows for a controlled reduction of peripheral-vestibular function before surgery but that resulting peripheral-vestibular deficits may be canal-specific with anterior-canal sparing as observed previously in systemic gentamicin application.Methods: Thirty-four patients (age-range = 27–70 y) with unilateral VS (size = 2–50 mm) were included in this retrospective single-center trial. The angular vestibulo-ocular reflex (aVOR) was quantified before and after (29.7 ± 18.7 d, mean ± 1SD) a single or two sequential intratympanic gentamicin applications by use of video-head-impulse testing. Both aVOR gains, cumulative saccadic amplitudes, and overall aVOR function were retrieved. Statistical analysis was done using a generalized linear model.Results: At baseline, loss of function of the horizontal (20/34) and posterior (21/34) canal was significantly (p < 0.001) more frequent than that of the anterior canal (5/34). After gentamicin application, loss of function of the horizontal (32/34) or posterior (31/34) canal remained significantly (p ≤ 0.003) more frequent than that of the anterior canal (18/34). For all ipsilesional canals, significant aVOR-gain reductions and cumulative-saccadic-amplitude increases were noted after gentamicin. For the horizontal canal, loss of function was significantly larger (increase in cumulative-saccadic-amplitude: 1.6 ± 2.0 vs. 0.8 ± 1.2, p = 0.007) or showed a trend to larger changes (decrease in aVOR-gain: 0.24 ± 0.22 vs. 0.13 ± 0.29, p = 0.069) than for the anterior canal.Conclusions: Intratympanic gentamicin application resulted in a substantial reduction in peripheral-vestibular function in all three ipsilesional canals. Relative sparing of anterior-canal function noted at baseline was preserved after gentamicin treatment. Thus, pre-surgical intratympanic gentamicin is a suitable preparatory procedure for reducing the drop in peripheral-vestibular function after VS-resection. The reasons for relative sparing of the anterior canal remain unclear.

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Case Report: Could Hennebert's Sign Be Evoked Despite Global Vestibular Impairment on Video Head Impulse Test? Considerations Upon Pathomechanisms Underlying Pressure-Induced Nystagmus due to Labyrinthine Fistula

Frontiers in Neurology ◽

10.3389/fneur.2021.634782 ◽

2021 ◽

Vol 12 ◽

Author(s):

Andrea Castellucci ◽

Cecilia Botti ◽

Margherita Bettini ◽

Ignacio Javier Fernandez ◽

Pasquale Malara ◽

...

Keyword(s):

Relevant Literature ◽

Case Series ◽

Head Impulse Test ◽

Video Head Impulse Test ◽

Low Velocity ◽

Vestibular Loss ◽

Horizontal Canal ◽

Head Impulse ◽

Labyrinthine Fistula ◽

Middle Ear Cholesteatoma

We describe a case series of labyrinthine fistula, characterized by Hennebert's sign (HS) elicited by tragal compression despite global hypofunction of semicircular canals (SCs) on a video-head impulse test (vHIT), and review the relevant literature. All three patients presented with different amounts of cochleo-vestibular loss, consistent with labyrinthitis likely induced by labyrinthine fistula due to different temporal bone pathologies (squamous cell carcinoma involving the external auditory canal in one case and middle ear cholesteatoma in two cases). Despite global hypofunction on vHIT proving impaired function for each SC for high accelerations, all patients developed pressure-induced nystagmus, presumably through spared and/or recovered activity for low-velocity canal afferents. In particular, two patients with isolated horizontal SC fistula developed HS with ipsilesional horizontal nystagmus due to resulting excitatory ampullopetal endolymphatic flows within horizontal canals. Conversely, the last patient with bony erosion involving all SCs developed mainly torsional nystagmus directed contralaterally due to additional inhibitory ampullopetal flows within vertical canals. Moreover, despite impaired measurements on vHIT, we found simultaneous direction-changing positional nystagmus likely due to a buoyancy mechanism within the affected horizontal canal in a case and benign paroxysmal positional vertigo involving the dehiscent posterior canal in another case. Based on our findings, we might suggest a functional dissociation between high (impaired) and low (spared/recovered) accelerations for SCs. Therefore, it could be hypothesized that HS in labyrinthine fistula might be due to the activation of regular ampullary fibers encoding low-velocity inputs, as pressure-induced nystagmus is perfectly aligned with the planes of dehiscent SCs in accordance with Ewald's laws, despite global vestibular impairment on vHIT. Moreover, we showed how pressure-induced nystagmus could present in a rare case of labyrinthine fistulas involving all canals simultaneously. Nevertheless, definite conclusions on the genesis of pressure-induced nystagmus in our patients are prevented due to the lack of objective measurements of both low-acceleration canal responses and otolith function.

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Benign Positional Paroxysmal Vertigo in Children

Audiology Research ◽

10.3390/audiolres11010006 ◽

2021 ◽

Vol 11 (1) ◽

pp. 47-54

Author(s):

Cristiano Balzanelli ◽

Daniele Spataro ◽

Luca Oscar Redaelli de Zinis

Keyword(s):

Daily Activities ◽

Clinical Parameters ◽

Pediatric Age ◽

Balance Disorders ◽

Horizontal Canal ◽

Posterior Canal ◽

Benign Positional Paroxysmal Vertigo ◽

Vestibular Assessment ◽

Anxiety And Fear ◽

Anterior Canal

The aim of this study was to assess the prevalence and analyze clinical parameters of benign positional paroxysmal vertigo (BPPV) in a pediatric age. A cohort of 423 children under the age of 15 (median age 11. interquartile range 9–13) was submitted to vestibular assessment for balance disorders. Dix-Hallpike and Roll-Supine tests were performed to look for positioning nystagmus using video-infrared goggles. BPPV was found in 43 of 423 children evaluated for balance disorders (10.2%). There were 28 females (65.1%) and 15 (34.9%) males. The posterior canal was involved in 79% of cases and the horizontal canal in 21% of cases. No apogeotropic bilateral or anterior canal form were seen. Thus, BPPV is not an infrequent type of vertigo in children and must be evaluated as soon as possible in order to plan the most appropriate maneuver and restore daily activities as soon as possible, avoiding anxiety and fear.

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Relationship of Semicircular Canal Size to Vestibular-Nerve Afferent Sensitivity in Mammals

Journal of Neurophysiology ◽

10.1152/jn.00798.2007 ◽

2007 ◽

Vol 98 (6) ◽

pp. 3197-3205 ◽

Cited By ~ 83

Author(s):

Aizhen Yang ◽

Timothy E. Hullar

Keyword(s):

Semicircular Canal ◽

High Frequency ◽

High Gain ◽

Vestibular Nerve ◽

Radius Of Curvature ◽

Horizontal Canal ◽

Vestibular Nerve Afferents ◽

The Relationship ◽

Irregular Afferents ◽

Anterior Canal

The relationship between semicircular canal radius of curvature and afferent sensitivity has not been experimentally determined. We characterized mouse semicircular canal afferent responses to sinusoidal head rotations to facilitate interspecies and intraspecies comparisons of canal size to sensitivity. The interspecies experiment compared the horizontal canal afferent responses among animals ranging in size from mouse to rhesus monkey. The intraspecies experiment compared afferent responses from the larger anterior canal to those from the smaller horizontal canal of mice. The responses of mouse vestibular-nerve afferents showed a low- and high-frequency phase lead and high-frequency gain enhancement. Regular horizontal-canal afferents showed a sensitivity to 0.5-Hz sinusoidal rotations of 0.10 ± 0.03 (SD) spike · s−1/deg · s−1 and high-gain irregular afferents showed a sensitivity of 0.25 ± 0.11 spike · s−1/deg · s−1. The interspecies comparison showed that the sensitivity of regular afferents was related to the radius of curvature R according to the formula Gr = 0.23R − 0.09 ( r2 = 0.86) and the sensitivity of irregular afferents was related to radius according to the formula Gi = 0.32R + 0.01 ( r2 = 0.67). The intraspecies comparison showed that regularly firing anterior canal afferents were significantly more sensitive than those from the relatively smaller horizontal canal, with Gr = 0.25R. This suggests that canal radius of curvature is closely related to afferent sensitivity both among and within species. If the relationship in humans is similar to that demonstrated here, the sensitivity of their regular vestibular-nerve afferents to 0.5-Hz rotations is likely to be about 0.67 spike · s−1/deg · s−1 and of their high-gain irregular afferents about 1.06 spikes · s−1/deg · s−1.

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Isolated horizontal canal hypofunction differentiating a canalith jam from an acute peripheral vestibular loss

American Journal of Otolaryngology ◽

10.1016/j.amjoto.2018.12.005 ◽

2019 ◽

Vol 40 (2) ◽

pp. 319-322 ◽

Cited By ~ 7

Author(s):

Andrea Castellucci ◽

Pasquale Malara ◽

Cristina Brandolini ◽

Valeria Del Vecchio ◽

Davide Giordano ◽

...

Keyword(s):

Vestibular Loss ◽

Horizontal Canal

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Bilateral Vestibular Hypofunction in the Time of the Video Head Impulse Test

Audiology and Neurotology ◽

10.1159/000504286 ◽

2019 ◽

Vol 25 (Suppl. 1-2) ◽

pp. 72-78

Author(s):

Nicolás Pérez-Fernández ◽

Laura Alvarez-Gomez ◽

Raquel Manrique-Huarte

Keyword(s):

Head Impulse Test ◽

Video Head Impulse Test ◽

Test Results ◽

Bilateral Vestibulopathy ◽

Similar Time ◽

Head Impulse ◽

Vestibular Hypofunction ◽

Number Of Patients ◽

Significant Difference ◽

Bilateral Vestibular Hypofunction

Objectives: Bilateral vestibulopathy is a clinical syndrome in which laboratory testing plays a crucial diagnostic role. We aimed to establish the frequency of detection of that finding in a tertiary level hospital considering the new methods of laboratory vestibular examination nowadays in use, with respect to the conventional caloric and rotatory chair test approaches. Design: Two similar time periods (5 years) were retrospectively evaluated, and the demographic, clinical data and test results from 4,576 patients were reviewed. In the first period, the diagnosis was based on caloric and rotatory chair tests and, in the second, on the video head impulse test. Results: Of the patients included, 3.77% in the first period and 4.58% in the second met the criteria for bilateral vestibular hypofunction; there was no significant difference between both periods. Conclusions: The functional vestibular evaluation to detect bilateral deficiency makes no significant difference to the number of patients diagnosed with a bilateral vestibulopathy. New diagnostic categories probably depend not only on the availability and accessibility of complete vestibular and visual-vestibular evaluation, but also on recent advances in defining vestibular disorders. Bilateral vestibular hypofunction manifests with very different patterns. Progress in more detailed definition (clinical and laboratory) is needed, in particular when all 6 semicircular canals and both maculae are available for testing.

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Tai Chi and vestibular rehabilitation effects on gaze and whole-body stability

Journal of Vestibular Research ◽

10.3233/ves-2004-14605 ◽

2004 ◽

Vol 14 (6) ◽

pp. 467-478 ◽

Cited By ~ 3

Author(s):

Chris A. McGibbon ◽

David E. Krebs ◽

Steven L. Wolf ◽

Peter M. Wayne ◽

Donna Moxley Scarborough ◽

...

Keyword(s):

Significant Relationship ◽

Postural Stability ◽

Intervention Program ◽

Tai Chi ◽

Vestibular Rehabilitation ◽

Whole Body ◽

Gaze Control ◽

Gaze Stability ◽

Vestibular Hypofunction ◽

The Relationship

Tai Chi (TC) is a comparatively new intervention for peripheral vestibular hypofunction, which is often treated with vestibular rehabilitation (VR). We compared gaze stability (GZS), whole-body stability (WBS) and footfall stability (FFS) during locomotion among 26 people with vestibulopathy (VSP), randomized into two treatment arms (13 TC and 13 VR). Each intervention program was offered for 10 weeks. GZS improved more for VR than for TC, but WBS (and FFS) improved more for TC than for VR. There was a significant relationship between changes in GZS and WBS for the VR subjects (r = 0.60, p = 0.01), but not for TC subjects. There was a significant relationship between changes in WBS and FFS for both VR (r = 0.65, p < 0.01) and TC (r = 0.58, p = 0.02) groups; the relationship disappeared in the VR but not the TC group when controlling for GZS. These findings suggest that VR and TC both benefit patients with VSP but via differing mechanisms. Moreover, these data are the first to test the assumption that improving gaze control among patients with VSP perforce improves postural stability: it does not. We conclude that GZS is most improved in those who receive VR, but that TC improves WBS and FFS without improving GZS, suggesting patients with VSP can rely on non-gaze related mechanisms to improve postural control.

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Aquatic physiotherapy for vestibular rehabilitation in patients with unilateral vestibular hypofunction: Exploratory prospective study

Journal of Vestibular Research ◽

10.3233/ves-2008-182-307 ◽

2008 ◽

Vol 18 (2-3) ◽

pp. 139-146

Author(s):

Yeda P.L. Gabilan ◽

Mônica R. Perracini ◽

Mario S.L. Munhoz ◽

Fernando F. Gananç

Keyword(s):

Symptom Onset ◽

Stability Index ◽

Vestibular Rehabilitation ◽

Therapeutic Effects ◽

Self Perception ◽

Vestibular Loss ◽

Tertiary Referral Center ◽

Vestibular Hypofunction ◽

Computerized Posturography ◽

Stability Indexes

Purpose: To explore the effects of aquatic physiotherapy on individuals with unilateral vestibular hypofunction and examine the association of therapeutic effects with age, time since symptom onset and use of antivertigo medication. Study design: Exploratory study. Setting: Tertiary referral center. Patients: Twenty-one patients presenting chronic dizziness with uncompensated unilateral vestibular loss. Intervention: All patients underwent a regimen of 10 sessions of aquatic physiotherapy for vestibular rehabilitation. Main outcome measures: Patient evaluation prior to and following rehabilitation involved the application of the Brazilian version of the Dizziness Handicap Inventory (DHI), dynamic computerized posturography and the self-perception scale of dizziness intensity. Statistical analysis compared average variables prior to and following rehabilitation using the Student t test. Results: Brazilian DHI total scores were lower following rehabilitation (p = 0.001). Posturography revealed a reduction in the variation of body displacement following rehabilitation in the average stability and anterior/posterior stability indexes (p = 0.001) and in the average medial/lateral stability index (p = 0.003). Self-perception of dizziness intensity was lower following rehabilitation (p = 0.001). No association between age, time since symptom onset and use of antivertigo medication and rehabilitation therapeutic effects were found. Conclusion: Unilateral vestibular hypofunction patients undergoing aquatic physiotherapy for vestibular rehabilitation achieved an improvement in quality of life, body balance and self-perception of dizziness intensity, regardless of age, time since symptom onset, and use of antivertigo medication.

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Voluntary Upper-Extremity Movements in Patients With Unilateral Peripheral Vestibular Hypofunction

Physical Therapy ◽

10.1093/ptj/82.3.216 ◽

2002 ◽

Vol 82 (3) ◽

pp. 216-227

Author(s):

Diane F Borello-France ◽

Jere D Gallagher ◽

Joseph M Furman ◽

Mark S Redfern ◽

George E Carvell

Keyword(s):

Reaction Time ◽

Choice Reaction Time ◽

Arm Movements ◽

Arm Movement ◽

Upper Body ◽

Body Segment ◽

Motor Impairments ◽

Vestibular Loss ◽

Head Velocity ◽

Vestibular Hypofunction

Abstract Background and Purpose. People with peripheral vestibular pathology demonstrate motor impairments when responding and adapting to postural platform perturbations and during performance of sit-to-stand and locomotor tasks. This study investigated the influence of unilateral peripheral vestibular hypofunction on voluntary arm movement. Subjects and Methods. Subjects without known neurological impairments and subjects with vestibular impairments performed 3 voluntary arm movements: an overhead reach to a target, a sideward reach to a target, and a forward flexion movement through 90 degrees. Subjects performed these tasks under precued and choice reaction time conditions. During all tasks, body segment motion was measured. Head velocity measurements were calculated for the side task only. Results. Subjects with vestibular loss restricted upper body segment motion within the frontal and transverse planes for the 90-degree and overhead tasks. Average angular head velocity was lower for the group with vestibular hypofunction. Task uncertainty (the introduction of a choice reaction time paradigm) differentially influenced the groups regarding head velocity at target acquisition. Discussion and Conclusion. Individuals with vestibular loss altered their performance of voluntary arm movements. Such alterations may have served to minimize the functional consequences of gaze instability.

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