Test Batteries and the Diagnostic Algorithm for Chronic Vestibular Syndromes

Objective: To develop a diagnostic algorithm for chronic vestibular syndromes by determining significant items that differ among diagnoses.Methods: Two hundred thirty-one patients with chronic vestibular syndromes lasting for >3 months were included. Full vestibular tests and questionnaire surveys were performed: bithermal caloric test, cervical and ocular vestibular-evoked myogenic potential assessment, video head impulse test (vHIT), posturography, rotatory chair test, dizziness handicap inventory, hospital anxiety and depression scale (HADS), and Niigata persistent postural-perceptual dizziness (PPPD) questionnaire (NPQ). Differences in each item of the vestibular tests/questionnaires/demographic data were tested among the diagnoses. A receiver operating characteristic (ROC) curve was created for the significant items. The value that provided the best combination of sensitivity/specificity on the ROC curve was adopted as a threshold for diagnosing the targeted disease. Multiple diagnostic algorithms were proposed, and their diagnostic accuracy was calculated.Results: There were 92 patients with PPPD, 44 with chronic dizziness due to anxiety (CDA), 31 with unilateral vestibular hypofunction (UVH), 37 with undifferentiated dizziness (UD), and 27 with other conditions. The top four diagnoses accounted for 88% of all chronic vestibular syndromes. Five significant items that differed among the four diseases were identified. The visual stimulation and total NPQ scores were significantly higher in the patients with PPPD than in those with UVH and UD. The percentage of canal paresis (CP %) was significantly higher in the patients with UVH than in those with PPPD, CDA, and UD. The patients with CDA were significantly younger and had higher anxiety scores on the HADS (HADS-A) than those with UVH and UD. Moreover, catch-up saccades (CUSs) in the vHIT were more frequently seen in the patients with UVH than in those with PPPD. The most useful algorithm that tested the total and visual stimulation NPQ scores for PPPD followed by the CP%/CUSs for UVH and HADS-A score/age for CDA showed an overall diagnostic accuracy of 72.8%.Conclusions: Among the full vestibular tests and questionnaires, the items useful for differentiating chronic vestibular syndromes were identified. We proposed a diagnostic algorithm for chronic vestibular syndromes composed of these items, which could be useful in clinical settings.

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Skull Vibration Induced Nystagmus Test: Correlations with Semicircular Canal and Otolith Asymmetries

Audiology Research ◽

10.3390/audiolres11040056 ◽

2021 ◽

Vol 11 (4) ◽

pp. 618-628

Author(s):

Christol Fabre ◽

Haoyue Tan ◽

Georges Dumas ◽

Ludovic Giraud ◽

Philippe Perrin ◽

...

Keyword(s):

Vertical Component ◽

Horizontal Component ◽

Positive Test ◽

Head Impulse Test ◽

Control Group ◽

Caloric Test ◽

3D Analysis ◽

Vestibular Evoked Myogenic Potential ◽

Myogenic Potential ◽

Vestibular Tests

Background: To establish in patients with peripheral vestibular disorders relations between skull vibration-induced nystagmus (SVIN) different components (horizontal, vertical, torsional) and the results of different structurally related vestibular tests. Methods: SVIN test, canal vestibular test (CVT: caloric test + video head impulse test: VHIT), otolithic vestibular test (OVT: ocular vestibular evoked myogenic potential oVEMP + cervical vestibular evoked myogenic potential cVEMP) performed on the same day in 52 patients with peripheral vestibular diseases (age < 65 years), and 11 control patients were analyzed. Mixed effects logistic regression analysis was performed to assert whether the presence of nystagmus in SVIN (3D analysis) have an association with the presence of peripheral vestibular dysfunction measured by vestibular explorations (CVT or OVT). Results: We obtained different groups: Group-Co (control group), Group-VNT (dizzy patients with no vestibular tests alterations), Group-O (OVT alterations only), Group-C (CVT alterations only), Group-M (mixed alterations). SVIN-SPV horizontal component was significantly higher in Group-M than in the other groups (p = 0.005) and correlated with alterations of lateral-VHIT (p < 0.001), caloric test (p = 0.002) and oVEMP (p = 0.006). SVIN-SPV vertical component was correlated with the anterior-VHIT and oVEMP alterations (p = 0.007; p = 0.017, respectively). SVIN-SPV torsional component was correlated with the anterior-VHIT positivity (p = 0.017). SVIN was the only positive test for 10% of patients (83% of Group-VNT). Conclusion: SVIN-SPV analysis in dizzy patients shows significant correlation to both CVT and OVT. SVIN horizontal component is mainly relevant to both vestibular tests exploring lateral canal and utricle responses. SVIN-SPV is significantly higher in patients with combined canal and otolith lesions. In some patients with dizziness, SVIN may be the only positive test.

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Acute Vertigo in a Patient with Long-Term Organic Solvent Exposure: Importance of a Comprehensive Audio-Vestibular Test Battery

Journal of the American Academy of Audiology ◽

10.3766/jaaa.19034 ◽

2020 ◽

Vol 31 (05) ◽

pp. 363-368

Author(s):

Maxime Maheu ◽

François Champoux ◽

Adrian Fuente

Keyword(s):

Organic Solvent ◽

Organic Solvents ◽

Vestibular System ◽

Semicircular Canals ◽

Vestibular Evoked Myogenic Potentials ◽

Head Impulse Test ◽

Solvent Exposure ◽

Vestibular Evoked Myogenic Potential ◽

Vestibular Tests ◽

Organic Solvent Exposure

Abstract Background Ototoxicity induced by organic solvents has been identified in several groups of workers. Little is known, however, about the effects of organic solvents on the vestibular system. Purpose The aim of the study was to comprehensively assess the vestibular system and auditory functions in a worker exposed to organic solvents. Research Design Both behavioral and physiological auditory and vestibular evaluations were performed. Results No auditory-related findings associated with solvent exposure were found. The vestibulo-ocular reflex gain was abnormal for all semicircular canals with significant catch-up saccades, as measured by the video head impulse test. The cervical vestibular evoked myogenic potentials was absent in the right ear and small but replicable in the left ear. Ocular vestibular evoked myogenic potential were bilaterally absent. Conclusions The results suggest a case of vestibulotoxicity induced by a long history of organic solvent exposure. We suggest that solvent-exposed individuals should be evaluated with a comprehensive battery of auditory and vestibular tests.

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Vestibular Function in Children and Adults Before and After Unilateral or Sequential Bilateral Cochlear Implantation

Frontiers in Neurology ◽

10.3389/fneur.2021.675502 ◽

2021 ◽

Vol 12 ◽

Author(s):

Ruirui Guan ◽

Yanqi Wang ◽

Sasa Wu ◽

Bo Zhang ◽

Jingwu Sun ◽

...

Keyword(s):

Cochlear Implantation ◽

Round Window ◽

Low Frequency ◽

Vestibular Function ◽

Head Impulse Test ◽

Caloric Test ◽

Vestibular Evoked Myogenic Potential ◽

Before And After ◽

Adults And Children ◽

Window Approach

Background: Cochlear implantation (CI) helps patients with severe or profound sensorineural hearing loss (SNHL) restore hearing and speech abilities. However, some patients exhibit abnormal vestibular functions with symptoms such as dizziness or balance disorders, after CI. Whether age at CI and CI approach (unilateral or sequential bilateral) affect vestibular functions in users with cochlear implants remains unclear.Objectives: To investigate the vestibular functions in children and adults before and after unilateral or sequential bilateral CI.Materials and Methods: Thirty-seven patients with severe or profound SNHL who were candidates for a first- or second-side CI were divided into three groups: first-side CI-implanted adults (≥18 years), first-side CI-implanted children (6–17 years), and second-side CI-implanted children (6–17 years). All cases were implanted with the round window approach to minimize damage to the intra-cochlear structures. The caloric test, vestibular evoked myogenic potential (VEMP) test, video head impulse test (vHIT), Dizziness Handicap Inventory (DHI), Pediatric Vestibular Symptom Questionnaire (PVSQ), and audiometric tests were performed before and 1 month after CI.Results: The abnormal rates of caloric test and VEMP test after CI in the first-side CI-implanted adults and children significantly increased compared with those before CI. The pre-implantation VEMP test showed significantly higher abnormal rates between first- and second-side CI-implanted children. No other significant differences of abnormal rates between first- and second-side CI-implanted children or between first-side CI-implanted adults and children were found. In second-side CI-implanted children, PVSQ scores significantly increased at day 3 post-implantation but decreased at day 30.Conclusion: CI has a negative effect on the results of caloric and VEMP tests, but not on vHIT, indicating that the otolith and low-frequency semicircular canal (SCC) are more vulnerable to damage from CI. The alterations of vestibular functions resulting from CI surgery may be independent of age at CI and CI approach (unilateral or sequential bilateral). Long-term impacts on the vestibular function from CI surgery, as well as the chronic electrical stimulation to the cochlea, are still to be investigated.

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Feasibility of Preoperative Video Head Impulse Test to Predict the Nerve of Origin in Patients with Vestibular Schwannomas

Journal of Clinical Medicine ◽

10.3390/jcm10122677 ◽

2021 ◽

Vol 10 (12) ◽

pp. 2677

Author(s):

Gi-Sung Nam ◽

Seong-Hoon Bae ◽

Hye-Jeen Kim ◽

Ji-Woong Cho ◽

In-Seok Moon

Keyword(s):

Pure Tone Audiometry ◽

Vestibular Nerve ◽

Head Impulse Test ◽

Caloric Test ◽

Surgical Removal ◽

Video Head Impulse Test ◽

Vestibular Evoked Myogenic Potential ◽

Head Impulse ◽

Function Test ◽

Inferior Vestibular Nerve

Vestibular schwannoma (VS) originates from Schwann cells in the superior or inferior vestibular nerve. Identifying the precise origin will help in determining the optimal surgical approach. We retrospectively analyzed the preoperative vestibular function test according to VS origin to determine whether the test is a valuable indicator of tumor origin. Forty-seven patients with VS (male:female = 18:29, mean age: 54.06 ± 13.50 years) underwent the cochleovestibular function test (pure-tone audiometry, caloric test, video head impulse test (vHIT), cervical and ocular vestibular-evoked myogenic potential, and posturography). All patients then underwent surgical removal of VS, and the schwannoma origin was confirmed. The tumor originated from the superior vestibular nerve (SVN group) in 21 patients, the inferior vestibular nerve (IVN group) in 26 patients, and an undetermined site in eight patients. The only value that differed significantly among the groups was the gain of the vestibular-ocular reflex (VOR) in the ipsilesional posterior canal (iPC) during the vHIT. Our results indicate that VOR gain in the iPC may be used to predict the nerve origin in patients with VS. Other cochleovestibular function tests have limited value to discriminate nerve origins, especially in cases of medium to large VS.

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Significance of continuing audiovestibular practice during Covid-19 pandemic

The Egyptian Journal of Otolaryngology ◽

10.1186/s43163-021-00073-1 ◽

2021 ◽

Vol 37 (1) ◽

Author(s):

Oğuz Yilmaz ◽

Dilara Bayazit ◽

Handan Yaman ◽

Berna Özge Mutlu

Keyword(s):

Risk Factors ◽

Cochlear Implant ◽

Auditory Brainstem ◽

University Hospital ◽

Head Impulse Test ◽

Caloric Test ◽

Vestibular Evoked Myogenic Potential ◽

Test Procedures ◽

Lip Reading ◽

Brainstem Response

Abstract Background We aimed to evaluate the significance of continuing audiovestibular practice during the Covid-19 pandemic in the audiology clinic of the university hospital. Methods The precautions, test procedures, and risk factors associated with the practice of audiology were evaluated. The number and diagnoses of the cases between 23 March and 23 May 2020 were also compared with the results of the same 2 months in 2019 in an attempt to evaluate the alterations in the audiology practice. Results The audiology practice has continued during the pandemic, and numerous audiovestibular tests like newborn hearing screening, pure tone and speech audiometry, auditory brainstem response (ABR) test, bedside vestibular assessment, videomystagmography (VNG), caloric test, vestibular evoked myogenic potential (VEMP), computerized dynamic posturography (CDP), video head impulse test (vHIT), intraoperative cochlear implant measurement, and postop cochlear implant fittings were performed. The number of tests has decreased significantly in the course of the pandemic (p < 0.01). No evidence of Covid-19 disease was detected in the audiology staff and patients. In general, no major risk was seen during testing under protective measures except for vestibular testing which induced vomiting and taking out the mask for lip reading during cochlear implant fitting in the elderly. Conclusion It is possible to perform audiovestibular tests during the Covid-19 pandemic by wearing necessary protective equipment and disinfecting the potential surfaces. Vomiting during vestibular tests, uncovering the nose and mouth for lip reading, and small-sized test cabins are the main risk factors of contamination in the audiology clinics.

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Acute Vertigo in a Patient with Long-Term Organic Solvent Exposure: Importance of a Comprehensive Audio-Vestibular Test Battery

Journal of the American Academy of Audiology ◽

10.3766/jaaa19034 ◽

2019 ◽

Author(s):

Maxime Maheu ◽

Franc¸ois Champoux ◽

Adrian Fuente

Keyword(s):

Organic Solvents ◽

Vestibular System ◽

Semicircular Canals ◽

Vestibular Evoked Myogenic Potentials ◽

Head Impulse Test ◽

Solvent Exposure ◽

Vestibular Evoked Myogenic Potential ◽

Vestibular Tests ◽

History Of

Background: Ototoxicity induced by organic solvents has been identified in several groups of workers.Little is known, however, about the effects of organic solvents on the vestibular system. Purpose: The aim of the study was to comprehensively assess the vestibular system and auditory functionsin a worker exposed to organic solvents. Research Design: Both behavioral and physiological auditory and vestibular evaluations wereperformed. Results: No auditory-related findings associated with solvent exposure were found. The vestibulo-ocularreflex gain was abnormal for all semicircular canals with significant catch-up saccades, as measured bythe video head impulse test. The cervical vestibular evoked myogenic potentials was absent in the rightear and small but replicable in the left ear. Ocular vestibular evoked myogenic potential were bilaterallyabsent. Conclusions: The results suggest a case of vestibulotoxicity induced by a long history of organic solventexposure. We suggest that solvent-exposed individuals should be evaluated with a comprehensive batteryof auditory and vestibular tests.

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Screening tools for common mental disorders in older adults in South Asia: a systematic scoping review

International Psychogeriatrics ◽

10.1017/s1041610220003804 ◽

2021 ◽

pp. 1-12

Author(s):

Lachlan Fotheringham ◽

Stella-Maria Paddick ◽

Evelyn Barron Millar ◽

Claire Norman ◽

Ammu Lukose ◽

...

Keyword(s):

Mental Disorders ◽

Older People ◽

Diagnostic Accuracy ◽

South Asia ◽

Scoping Review ◽

Validation Studies ◽

Common Mental Disorders ◽

Global Mental Health ◽

Depression Scale ◽

Screening Tools

ABSTRACT Objectives: Common mental disorders (CMDs), particularly depression, are major contributors to the global mental health burden. South Asia, while diverse, has cultural, social, and economic challenges, which are common across the region, not least an aging population. This creates an imperative to better understand how CMD affects older people in this context, which relies on valid and culturally appropriate screening and research tools. This review aims to scope the availability of CMD screening tools for older people in South Asia. As a secondary aim, this review will summarize the use of these tools in epidemiology, and the extent to which they have been validated or adapted for this population. Design: A scoping review was performed, following PRISMA guidelines. The search strategy was developed iteratively in Medline and translated to Embase, PsychInfo, Scopus, and Web of Science. Data were extracted from papers in which a tool was used to identify CMD in a South Asian older population (50+), including validation, adaptation, and use in epidemiology. Validation studies meeting the criteria were critically appraised using the Quality Assessment of Diagnostic Accuracy Studies – version 2 (QUADAS-2) tool. Results: Of the 4694 papers identified, 176 met the selection criteria at full-text screening as relevant examples of diagnostic or screening tool use. There were 15 tool validation studies, which were critically appraised. Of these, 10 were appropriate to evaluate as diagnostic tests. All of these tools assessed for depression. Geriatric Depression Scale (GDS)-based tools were predominant with variable diagnostic accuracy across different settings. Methodological issues were substantial based on the QUADAS-2 criteria. In the epidemiological studies identified (n = 160), depression alone was assessed for 82% of the studies. Tools lacking cultural validation were commonly used (43%). Conclusions: This review identifies a number of current research gaps including a need for culturally relevant validation studies, and attention to other CMDs such as anxiety.

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The Added Value of Inflow-Based Vascular-Space-Occupancy and Diffusion-Weighted Imaging in Preoperative Grading of Gliomas

Neurodegenerative Diseases ◽

10.1159/000512545 ◽

2021 ◽

pp. 1-8

Author(s):

Haimei Cao ◽

Xiang Xiao ◽

Jun Hua ◽

Guanglong Huang ◽

Wenle He ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Roc Curve ◽

Diffusion Weighted Imaging ◽

Low Grade ◽

High Grade ◽

Mr Images ◽

Vascular Space ◽

Diffusion Weighted ◽

High Grade Gliomas ◽

And Diffusion

Objectives: The present study aimed to study whether combined inflow-based vascular-space-occupancy (iVASO) MR imaging (MRI) and diffusion-weighted imaging (DWI) improve the diagnostic accuracy in the preoperative grading of gliomas. Methods: Fifty-one patients with histopathologically confirmed diffuse gliomas underwent preoperative structural MRI, iVASO, and DWI. We performed 2 qualitative consensus reviews: (1) structural MR images alone and (2) structural MR images with iVASO and DWI. Relative arteriolar cerebral blood volume (rCBVa) and minimum apparent diffusion coefficient (mADC) were compared between low-grade and high-grade gliomas. Receiver operating characteristic (ROC) curve analysis was performed to compare the tumor grading efficiency of rCBVa, mADC, and the combination of the two parameters. Results: Two observers diagnosed accurate tumor grade in 40 of 51 (78.4%) patients in the first review and in 46 of 51 (90.2%) in the second review. Both rCBVa and mADC showed significant differences between low-grade and high-grade gliomas. ROC analysis gave a threshold value of 1.52 for rCBVa and 0.85 × 10−3 mm2/s for mADC to provide a sensitivity and specificity of 88.0 and 81.2% and 100.0 and 68.7%, respectively. The area under the ROC curve (AUC) was 0.87 and 0.85 for rCBVa and mADC, respectively. The combination of rCBVa and mADC values increased the AUC to 0.92. Conclusion: The combined application of iVASO and DWI may improve the diagnostic accuracy of glioma grading.

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Treadmill in Parkinson’s: influence on gait, balance, BDNF and Reduced Glutathione

Fisioterapia em Movimento ◽

10.1590/1980-5918.030.s01.ao09 ◽

2017 ◽

Vol 30 (suppl 1) ◽

pp. 93-100

Author(s):

Luciana Dias Belchior ◽

Betina Santos Tomaz ◽

Ana Paula Vasconcellos Abdon ◽

Norberto Anizio Ferreira Frota ◽

Daniela Gardano Bucharles Mont’Alverne ◽

...

Keyword(s):

Quality Of Life ◽

Reduced Glutathione ◽

Demographic Data ◽

Strong Association ◽

Disease Onset ◽

Depression Scale ◽

Blood Parameters ◽

Treadmill Training ◽

Static And Dynamic Analysis

Abstract Introduction: Parkinson’s disease (PD) is characterized by nigrostriatal degeneration, with dopaminergic depletion, and inflammatory and oxidative changes in the brain, leading to movement and coordination disorders. Recent studies have shown that treadmill training can be beneficial for these patients, but there is little evidence assessing the related blood parameters, such as oxidative stress and neurotrophin levels. Objective: Assess the influence of treadmill training for patients with Parkinson’s on gait, balance, Brain-Derived Neurotrophic Factor (BDNF) and reduced glutathione. Methods: Twenty-two patients with PD (Hoehn and Yahr II and III), older than 40 years, were randomly allocated to two groups: CG (n = 12) - drug treatment and IG (n = 10) - treadmill. Assessments related to functional capacity (quality of life, static and dynamic analysis of gait) and blood parameters such as GSH and BDNF were conducted before and after the eight-week intervention. Results: The demographic data of the groups were homogeneous in terms of age, sex, height, weight, time since disease onset, mini mental examination and the geriatric depression scale. Significant intergroup differences were found for the mental component summary, surface variation, latero-lateral oscillation, antero-posterior oscillation and mean velocity in the post-intervention period. The IG exhibited a strong association between BDNF and GSH, with statistically significant values. Conclusion: It was concluded that controlled treadmill walking improves static balance, quality of life and plasma BDNF and GSH levels in patients with PD.

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Diagnostic accuracy of the Geriatric Depression Scale-30, Geriatric Depression Scale-15, Geriatric Depression Scale-5 and Geriatric Depression Scale-4 for detecting major depression: protocol for a systematic review and individual participant data meta-analysis

BMJ Open ◽

10.1136/bmjopen-2018-026598 ◽

2018 ◽

Vol 8 (12) ◽

pp. e026598 ◽

Cited By ~ 3

Author(s):

Andrea Benedetti ◽

Yin Wu ◽

Brooke Levis ◽

Machelle Wilchesky ◽

Jill Boruff ◽

...

Keyword(s):

Systematic Review ◽

Major Depression ◽

Diagnostic Accuracy ◽

Meta Analysis ◽

Geriatric Depression Scale ◽

Depression Scale ◽

Individual Participant Data ◽

Geriatric Depression ◽

Subgroup Analyses ◽

Individual Participant

IntroductionThe 30-item Geriatric Depression Scale (GDS-30) and the shorter GDS-15, GDS-5 and GDS-4 are recommended as depression screening tools for elderly individuals. Existing meta-analyses on the diagnostic accuracy of the GDS have not been able to conduct subgroup analyses, have included patients already identified as depressed who would not be screened in practice and have not accounted for possible bias due to selective reporting of results from only better-performing cut-offs in primary studies. Individual participant data meta-analysis (IPDMA), which involves a standard systematic review, then a synthesis of individual participant data, rather than summary results, could address these limitations. The objective of our IPDMA is to generate accuracy estimates to detect major depression for all possible cut-offs of each version of the GDS among studies using different reference standards, separately and among participant subgroups based on age, sex, dementia diagnosis and care settings. In addition, we will use a modelling approach to generate individual participant probabilities for major depression based on GDS scores (rather than a dichotomous cut-off) and participant characteristics (eg, sex, age, dementia status, care setting).Methods and analysisIndividual participant data comparing GDS scores to a major depression diagnosis based on a validated structured or semistructured diagnostic interview will be sought via a systematic review. Data sources will include Medline, Medline In-Process & Other Non-Indexed Citations, PsycINFO and Web of Science. Bivariate random-effects models will be used to estimate diagnostic accuracy parameters for each cut-off of the different versions of the GDS. Prespecified subgroup analyses will be conducted. Risk of bias will be assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool.Ethics and disseminationThe findings of this study will be of interest to stakeholders involved in research, clinical practice and policy.PROSPERO registration numberCRD42018104329.

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