scholarly journals Prevalence of Vestibular Disorders in Independent People Over 50 That Experience Dizziness

2021 ◽  
Vol 12 ◽  
Author(s):  
William V. C. Figtree ◽  
Jasmine C. Menant ◽  
Allan T. Chau ◽  
Patrick P. Hübner ◽  
Stephen R. Lord ◽  
...  
Keyword(s):  
Time Constant ◽  
High Frequency ◽  
Constant Velocity ◽  
Vestibular Function ◽  
Community Dwelling ◽  
Whole Body ◽  
Head Impulse Test ◽  
Vestibular Loss ◽  
Vestibulo Ocular Reflex ◽  
The Impact

People aged over 50 are the most likely to present to a physician for dizziness. It is important to identify the main cause of dizziness in order to develop the best treatment approach. Our goal was to determine the prevalence of benign paroxysmal positional vertigo (BPPV), and peripheral and central vestibular function in people that had experienced dizziness within the past year aged over 50. One hundred and ninety three community-dwelling participants aged 51–92 (68 ± 8.7 years; 117 females) were tested using the clinical and video head impulse test (cHIT and vHIT) to test high-frequency vestibular organ function; the head thrust dynamic visual acuity (htDVA) test to test high-frequency visual-stability; the dizziness handicap inventory (DHI) to measure the impact of dizziness; as well as sinusoidal and unidirectional rotational chair testing to test low- to mid-frequency peripheral and central vestibular function. From these assessments we computed the following measures: HIT gain; htDVA score; DHI score; sinusoidal (whole-body; 0.1–2 Hz with 30°/s peak-velocity) vestibulo-ocular reflex (VOR) gain and phase; transient (whole-body, 150°/s2 acceleration to 50°/s constant velocity) VOR gain and time constant; optokinetic nystagmus (OKN) gain and time constant (whole-body, 50°/s constant velocity rotation). Our study showed that BPPV, and peripheral or central vestibular hypofunction were present in 34% of participants, suggesting a vestibular cause to their dizziness. Over half (57%) of these with a likely vestibular cause had BPPV, which is more than twice the percentage reported in other dizzy clinic studies. Our findings suggest that the physical DHI score and VOR time constant were best at detecting those with non-BPPV vestibular loss, but should always be used in conjunction with cHIT or vHIT, and that the htDVA score and vHIT gain were best at detecting differences between ipsilesional and contralesional sides.

VOR gain calculation methods in video head impulse recordings

2020 ◽  
Vol 30 (4) ◽  
pp. 225-234
Author(s):  
Ewa Zamaro ◽  
Ali S. Saber Tehrani ◽  
Jorge C. Kattah ◽  
Karin Eibenberger ◽  
Cynthia I. Guede ◽  
...  
Keyword(s):  
Calculation Method ◽  
Vestibular Function ◽  
Head Impulse Test ◽  
Calculation Methods ◽  
Normal Range ◽  
International Consensus ◽  
Head Impulse ◽  
Acute Vestibular Syndrome ◽  
Vestibulo Ocular Reflex ◽  
The Impact

BACKGROUND: International consensus on best practices for calculating and reporting vestibular function is lacking. Quantitative vestibulo-ocular reflex (VOR) gain using a video head impulse test (HIT) device can be calculated by various methods. OBJECTIVE: To compare different gain calculation methods and to analyze interactions between artifacts and calculation methods. METHODS: We analyzed 1300 horizontal HIT traces from 26 patients with acute vestibular syndrome and calculated the ratio between eye and head velocity at specific time points (40 ms, 60 ms) after HIT onset (‘velocity gain’), ratio of velocity slopes (‘regression gain’), and ratio of area under the curves after de-saccading (‘position gain’). RESULTS: There was no mean difference between gain at 60 ms and position gain, both showing a significant correlation (r2 = 0.77, p < 0.001) for artifact-free recordings. All artifacts reduced high, normal-range gains modestly (range –0.06 to –0.11). The impact on abnormal, low gains was variable (depending on the artifact type) compared to artifact-free recordings. CONCLUSIONS: There is no clear superiority of a single gain calculation method for video HIT testing. Artifacts cause small but significant reductions of measured VOR gains in HITs with higher, normal-range gains, regardless of calculation method. Artifacts in abnormal HITs with low gain increased measurement noise. A larger number of HITs should be performed to confirm abnormal results, regardless of calculation method.

scholarly journals Importance of high-frequency vestibular function in the prognosis of bilateral vestibulopathy

2020 ◽  
Author(s):  
Seonghoon Bae ◽  
Gi Sung Nam ◽  
Sang Hyun Kwak ◽  
Sung Huhn Kim
Keyword(s):  
High Frequency ◽  
Vestibular Function ◽  
Vestibular Rehabilitation ◽  
Composite Score ◽  
Head Impulse Test ◽  
Caloric Test ◽  
Bilateral Vestibulopathy ◽  
Dynamic Posturography ◽  
Vestibulo Ocular Reflex

Objective: To investigate whether preserved vestibular function in the high-frequency range influences the prognosis after vestibular rehabilitation in patients with BVP.Methods: Twenty-four patients followed up with vestibular rehabilitation were recruited. Enrolled patients were divided into two groups according to the preservation of high-frequency vestibulo-ocular reflex (VOR) based on the video head impulse test (vHIT). The results on the computerized dynamic posturography (CDP) and dizziness handicap inventory (DHI) survey collected at baseline and at the 6-month follow-up with vestibular rehabilitation therapy were analysed. Results: Both groups showed significantly increased composite and DHI scores after follow up with vestibular rehabilitation. The high-frequency VOR preserved group showed a better composite score (p = 0.064) and vestibular score (p = 0.008) than the high-frequency VOR loss group at the 6-month follow up. The DHI score was significantly decreased only in the high-frequency VOR loss group (p = 0.047). Among the three vestibular function tests (caloric test, rotary chair test, vHIT) used to diagnose BVP, only vHIT showed a significant correlation (p = 0.015) with favourable prognosis (composite score

Vestibular semicircular canal function as detected by video Head Impulse Test (vHIT) is essentially unchanged in people with Parkinson’s disease compared to healthy controls

2021 ◽  
pp. 1-9
Author(s):  
Kim E. Hawkins ◽  
Elodie Chiarovano ◽  
Serene S. Paul ◽  
Ann M Burgess ◽  
Hamish G. MacDougall ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Semicircular Canal ◽  
Neurodegenerative Disorder ◽  
Vestibular Function ◽  
Head Impulse Test ◽  
Healthy Controls ◽  
Video Head Impulse Test ◽  
Head Impulse ◽  
Vestibulo Ocular Reflex

BACKGROUND: Parkinson’s disease (PD) is a common multi-system neurodegenerative disorder with possible vestibular system dysfunction, but prior vestibular function test findings are equivocal. OBJECTIVE: To report and compare vestibulo-ocular reflex (VOR) gain as measured by the video head impulse test (vHIT) in participants with PD, including tremor dominant and postural instability/gait dysfunction phenotypes, with healthy controls (HC). METHODS: Forty participants with PD and 40 age- and gender-matched HC had their vestibular function assessed. Lateral and vertical semicircular canal VOR gains were measured with vHIT. VOR canal gains between PD participants and HC were compared with independent samples t-tests. Two distinct PD phenotypes were compared to HC using Tukey’s ANOVA. The relationship of VOR gain with PD duration, phenotype, severity and age were investigated using logistic regression. RESULTS: There were no significant differences between groups in vHIT VOR gain for lateral or vertical canals. There was no evidence of an effect of PD severity, phenotype or age on VOR gains in the PD group. CONCLUSION: The impulsive angular VOR pathways are not significantly affected by the pathophysiological changes associated with mild to moderate PD.

scholarly journals Finding a Balance: A Systematic Review of the Biomechanical Effects of Vestibular Prostheses on Stability in Humans

2020 ◽  
Vol 5 (2) ◽  
pp. 23
Author(s):  
Felix Haxby ◽  
Mohammad Akrami ◽  
Reza Zamani
Keyword(s):  
Vestibular System ◽  
Postural Sway ◽  
Vestibular Function ◽  
Vestibular Stimulation ◽  
Significant Heterogeneity ◽  
Vestibular Loss ◽  
Ocular Reflex ◽  
Gait Characteristics ◽  
Vestibulo Ocular Reflex ◽  
Meta Analyses

The vestibular system is located in the inner ear and is responsible for maintaining balance in humans. Bilateral vestibular dysfunction (BVD) is a disorder that adversely affects vestibular function. This results in symptoms such as postural imbalance and vertigo, increasing the incidence of falls and worsening quality of life. Current therapeutic options are often ineffective, with a focus on symptom management. Artificial stimulation of the vestibular system, via a vestibular prosthesis, is a technique being explored to restore vestibular function. This review systematically searched for literature that reported the effect of artificial vestibular stimulation on human behaviours related to balance, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) technique. A total of 21 papers matched the inclusion criteria of the literature search conducted using the PubMed and Web of Science databases (February 2019). The populations for these studies included both healthy adults and patients with BVD. In every paper, artificial vestibular stimulation caused an improvement in certain behaviours related to balance, although the extent of the effect varied greatly. Various behaviours were measured such as the vestibulo-ocular reflex, postural sway and certain gait characteristics. Two classes of prosthesis were evaluated and both showed a significant improvement in at least one aspect of balance-related behaviour in every paper included. No adverse effects were reported for prostheses using noisy galvanic vestibular stimulation, however, prosthetic implantation sometimes caused hearing or vestibular loss. Significant heterogeneity in methodology, study population and disease aetiology were observed. The present study confirms the feasibility of vestibular implants in humans for restoring balance in controlled conditions, but more research needs to be conducted to determine their effects on balance in non-clinical settings.

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

2017 ◽  
Vol 28 (09) ◽  
pp. 778-785 ◽  
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.

Recovery of vestibulo-ocular reflex-function in subjects with an acute unilateral peripheral vestibular deficit

1999 ◽  
Vol 9 (2) ◽  
pp. 135-144 ◽  
Author(s):  
J.H.J. Allum ◽  
T. Ledin
Keyword(s):  
Low Frequency ◽  
Vestibular Function ◽  
Vertical Axis ◽  
Whole Body ◽  
Horizontal Semicircular Canal ◽  
Ocular Reflex ◽  
Vestibulo Ocular Reflex ◽  
Central Compensation ◽  
Head Rotations ◽  
Vestibular Deficit

The centrally controlled compensation for a reduced horizontal vestibulo-ocular reflex (VOR) gain caused by a unilateral afferent deficit is usually studied following a selective surgical procedure which completely lesions the vestibular nerve or blocks the horizontal semicircular canal. The more common, unilateral, vestibular deficit encountered clinically, is a partial loss of peripheral vestibular function, following which peripheral recovery and/or central compensation may occur. We investigated changes of the VOR gain in response to a sudden, idiopathic, unilateral vestibular deficit in 64 subjects by examining the responses to low-frequency, whole-body, rotations about an earth vertical axis with different accelerations (5, 20 and 40 deg / sec 2 ) during in- and out-patient visits separated by 4 months in an attempt to identify changes brought about by peripheral recovery and by central compensation processes. Peripheral function was assumed to be measured by the response to caloric irrigation. It improved some 30% between the two visits. VOR responses for rotations towards the deficit side also improved between the two visits. Most improvement occurred for 20 deg / sec 2 accelerations. However, the correlation coefficient between rotation and caloric responses was always less than 0.6. Unlike caloric responses which improved over time, responses for rotations to the intact side did not change between the visits. For this reason, the majority of observed VOR rotation responses were nearly symmetrical at the time of the second visit, despite being below normal levels. These findings suggest that both peripheral recovery and central compensation processes help restore symmetrical VOR function for head rotations after a partial unilateral vestibular deficit. However the improvement of VOR response symmetry, particularly to slow ( < 40 deg / sec 2 ) accelerations, is largely independent of the recovery of peripheral sensitivity.

scholarly journals Quantifying the Vestibulo-Ocular Reflex with Video-Oculography: Nature and Frequency of Artifacts

2014 ◽  
Vol 20 (1) ◽  
pp. 39-50 ◽  
Author(s):  
Georgios Mantokoudis ◽  
Ali S. Saber Tehrani ◽  
Jorge C. Kattah ◽  
Karin Eibenberger ◽  
Cynthia I. Guede ◽  
...  
Keyword(s):  
Head Impulse Test ◽  
Head Impulse ◽  
Video Oculography ◽  
Ocular Reflex ◽  
Acute Vestibular Syndrome ◽  
Vestibulo Ocular Reflex ◽  
Corrective Saccades ◽  
Coding Manual ◽  
A Prospective Study ◽  
The Impact

Video-oculography devices are now used to quantify the vestibulo-ocular reflex (VOR) at the bedside using the head impulse test (HIT). Little is known about the impact of disruptive phenomena (e.g. corrective saccades, nystagmus, fixation losses, eye-blink artifacts) on quantitative VOR assessment in acute vertigo. This study systematically characterized the frequency, nature, and impact of artifacts on HIT VOR measures. From a prospective study of 26 patients with acute vestibular syndrome (16 vestibular neuritis, 10 stroke), we classified findings using a structured coding manual. Of 1,358 individual HIT traces, 72% had abnormal disruptive saccades, 44% had at least one artifact, and 42% were uninterpretable. Physicians using quantitative recording devices to measure head impulse VOR responses for clinical diagnosis should be aware of the potential impact of disruptive eye movements and measurement artifacts. i 2014 S. Karger AG, Basel

Clinical-pathologic correlation in a patient with selective loss of hair cells in the vestibular endorgans

Neurology ◽  
1997 ◽  
Vol 49 (5) ◽  
pp. 1377-1382 ◽  
Author(s):  
R. W. Baloh ◽  
I. Lopez ◽  
K. Beykirch ◽  
A. Ishiyama ◽  
V. Honrubia
Keyword(s):  
Time Constant ◽  
Hair Cells ◽  
Vestibular Function ◽  
Cochlear Hair Cells ◽  
Vestibular Hair Cells ◽  
Selective Loss ◽  
Ocular Reflex ◽  
Hearing Function ◽  
Vestibulo Ocular Reflex ◽  
Vestibular Endorgans

We found a selective loss of vestibular hair cells in a patient followed for more than 10 years with imbalance and oscillopsia due to idiopathic progressive loss of vestibular function. Hearing function and cochlear hair cells were normal. The vestibulo-ocular reflex (VOR) gain at high frequencies was relatively maintained despite marked shortening of the dominant VOR time constant (to less than 500 ms). Ultrastructural examination of remaining hair cells showed mitochondrial abnormalities. The ultrashort VOR time constant probably resulted from changes in firing patterns of the primary afferent nerves due to loss of hair cells and impaired energy metabolism in remaining hair cells.

Study of Pursuit and Vestibulo-Ocular Cancellation

1986 ◽  
Vol 95 (5) ◽  
pp. 589-591 ◽  
Author(s):  
M. Mai ◽  
V.S. Dayal ◽  
R.D. Tomlinson ◽  
J. Farkashidy
Keyword(s):  
Single Dose ◽  
High Frequency ◽  
Vestibular Function ◽  
Sedative Effect ◽  
Drug Intake ◽  
Ocular Reflex ◽  
Vestibulo Ocular Reflex ◽  
Analysis Of Results ◽  
Time Courses

This present study, a follow-up of our earlier investigation, further examines the time courses of recovery of oculomotor and vestibular function while patients are under the sedative effect of a single dose of secobarbital (Seconal). The assessment included tests for saccade and smooth pursuit, and the vestibulo-ocular reflex and its cancellation, as evaluated by sinusoidal and pseudorandom rotation in a high-frequency hydraulic chair (up to 5 Hz). Analysis of results showed that the vestibulo-ocular reflex (VOR) gain, depressed soon after drug intake, recovered substantially after a few hours. Changes in VOR gain were more pronounced with higher frequencies of rotation at 2 and 3 Hz, and greater with pseudorandom than sinusoidal stimulation. Under barbiturate influence, pursuit and VOR cancellation followed distinctly different time courses of recovery. This dissociation between VOR cancellation and pursuit supports the theory that these two systems are subserved by different mechanisms. Saccadic hypermetria was also observed after drug intake.

scholarly journals Prevalence of Peripheral Vestibular Impairment in Adults with Human Immunodeficiency Virus

2021 ◽  
Vol 25 (1) ◽  
pp. 36-42
Author(s):  
Alison Millar ◽  
Karin Joubert ◽  
Alida Naude
Keyword(s):  
Human Immunodeficiency Virus ◽  
Vestibular Function ◽  
Head Impulse Test ◽  
Hiv Positive ◽  
Positive Group ◽  
Head Impulse ◽  
Immunodeficiency Virus ◽  
Central Compensation ◽  
The Impact ◽  
Hiv Negative

Background and Objectives: Globally, the human immunodeficiency virus (HIV) is responsible for one of the most serious pandemics to date. The vulnerability of the vestibular system in individuals with HIV has been confirmed, and central vestibular impairments have been frequently reported. However, there are disagreements on the impact of HIV on peripheral vestibular function. Thus, the current study aimed to determine the prevalence of peripheral vestibular impairment, specifically related to the semi-circular canals (SCCs), in HIV-positive individuals receiving antiretroviral (ARV) treatment.Subjects and Methods: A total of 92 adults between the ages of 18 and 50 years (divided into two groups) participated in the study. The first group comprised HIV-positive individuals receiving ARV treatment (n1=60), and the second group comprised HIV-negative participants (n2=32). The video head impulse test was used to conduct the head impulse paradigm (HIMP).Results: Bilateral normal HIMP results were obtained in 95% of the HIV-positive participants and all HIV-negative participants. The gain of the left posterior SCCs was significantly lower in the HIV-positive group, while the gains of all other canals between the two groups were comparable.Conclusions: The prevalence of peripheral vestibular impairment in the HIV-positive group was not significantly different from that of the HIV-negative group. The reduced prevalence in the current study may be attributed to participant characteristics, the test battery employed, and the central compensation of the vestibular dysfunctions at the later stages of infection.

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