scholarly journals Enhanced Eye Velocity With Backup Saccades in vHIT Tests of a Menière Disease Patient: A Case Report

2021 ◽  
Vol 8 ◽  
Author(s):  
Maria Montserrat Soriano-Reixach ◽  
Jorge Rey-Martinez ◽  
Xabier Altuna ◽  
Ian Curthoys
Keyword(s):  
Disease Patient ◽  
Vestibular Function ◽  
Position Error ◽  
Head Movements ◽  
Slow Phase ◽  
Head Impulse ◽  
Head Impulses ◽  
Eye Velocity ◽  
Gaze Position ◽  
Horizontal Head

Reduced eye velocity and overt or covert compensatory saccades during horizontal head impulse testing are the signs of reduced vestibular function. However, here we report the unusual case of a patient who had enhanced eye velocity during horizontal head impulses followed by a corrective saccade. We term this saccade a “backup saccade” because it acts to compensate for the gaze position error caused by the enhanced velocity (and enhanced VOR gain) and acts to return gaze directly to the fixation target as shown by eye position records. We distinguish backup saccades from overt or covert compensatory saccades or the anticompensatory quick eye movement (ACQEM) of Heuberger et al. (1) ACQEMs are anticompensatory in that they are in the same direction as head velocity and so, act to take gaze off the target and thus require later compensatory (overt) saccades to return gaze to the target. Neither of these responses were found in this patient. The patient here was diagnosed with unilateral definite Meniere's disease (MD) on the right and had enhanced VOR (gain of 1.17) for rightward head impulses followed by backup saccades. For leftwards head impulses eye velocity and VOR gain were in the normal range (VOR gain of 0.89). As further confirmation, testing with 1.84 Hz horizontal sinusoidal head movements in the visual-vestibular (VVOR) paradigm also showed these backup saccades for rightwards head turns but normal slow phase eye velocity responses without backup saccades for leftwards had turns. This evidence shows that backup saccades can be observed in some MD patients who show enhanced eye velocity responses during vHIT and that these backup saccades act to correct for gaze position error caused by the enhanced eye velocity during the head impulse and so have a compensatory effect on gaze stabilization.

scholarly journals Short-Latency Covert Saccades - The Explanation for Good Dynamic Visual Performance After Unilateral Vestibular Loss?

2021 ◽  
Vol 12 ◽  
Author(s):  
Julia Sjögren ◽  
Mikael Karlberg ◽  
Craig Hickson ◽  
Måns Magnusson ◽  
Per-Anders Fransson ◽  
...  
Keyword(s):  
Visual Perception ◽  
Head Movement ◽  
Position Error ◽  
Head Movements ◽  
Visual Performance ◽  
Head Impulse Test ◽  
Vestibular Loss ◽  
Intact Side ◽  
Head Impulse ◽  
Head Impulses

Background: Functional head impulse test (fHIT) tests the ability of the vestibulo-ocular reflex (VOR) to allow visual perception during head movements. Our previous study showed that active head movements to the side with a vestibular lesion generated a dynamic visual performance that were as good as during movements to the intact side.Objective: To examine the differences in eye position during the head impulse test when performed with active and passive head movements, in order to better understand the role of the different saccade properties in improving visual performance.Method: We recruited 8 subjects with complete unilateral vestibular loss (4 men and 4 women, mean age 47 years) and tested them with video Head Impulse Test (vHIT) and Functional Head Impulse Test (fHIT) during passive and active movements while looking at a target. We assessed the mean absolute position error of the eye during different time frames of the head movement, the peak latency and the peak velocity of the first saccade, as well as the visual performance during the head movement.Results: Active head impulses to the lesioned side generated dynamic visual performances that were as good as when testing the intact side. Active head impulses resulted in smaller position errors during the visual perception task (p = 0.006) compared to passive head-impulses and the position error during the visual perception time frame correlated with shorter latencies of the first saccade (p < 0.001).Conclusion: Actively generated head impulses toward the side with a complete vestibular loss resulted in a position error within or close to the margin necessary to obtain visual perception for a brief period of time in patients with chronic unilateral vestibular loss. This seems to be attributed to the appearance of short-latency covert saccades, which position the eyes in a more favorable position during head movements.

scholarly journals Vestibular implantation and longitudinal electrical stimulation of the semicircular canal afferents in human subjects

2015 ◽  
Vol 113 (10) ◽  
pp. 3866-3892 ◽  
Author(s):  
James O. Phillips ◽  
Leo Ling ◽  
Kaibao Nie ◽  
Elyse Jameyson ◽  
Christopher M. Phillips ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Eye Movements ◽  
Human Subjects ◽  
Vestibular Function ◽  
Slow Phase ◽  
Vestibular Loss ◽  
Stimulation Current ◽  
Eye Velocity ◽  
Over Time ◽  
Stimulation Of

Animal experiments and limited data in humans suggest that electrical stimulation of the vestibular end organs could be used to treat loss of vestibular function. In this paper we demonstrate that canal-specific two-dimensionally (2D) measured eye velocities are elicited from intermittent brief 2 s biphasic pulse electrical stimulation in four human subjects implanted with a vestibular prosthesis. The 2D measured direction of the slow phase eye movements changed with the canal stimulated. Increasing pulse current over a 0–400 μA range typically produced a monotonic increase in slow phase eye velocity. The responses decremented or in some cases fluctuated over time in most implanted canals but could be partially restored by changing the return path of the stimulation current. Implantation of the device in Meniere's patients produced hearing and vestibular loss in the implanted ear. Electrical stimulation was well tolerated, producing no sensation of pain, nausea, or auditory percept with stimulation that elicited robust eye movements. There were changes in slow phase eye velocity with current and over time, and changes in electrically evoked compound action potentials produced by stimulation and recorded with the implanted device. Perceived rotation in subjects was consistent with the slow phase eye movements in direction and scaled with stimulation current in magnitude. These results suggest that electrical stimulation of the vestibular end organ in human subjects provided controlled vestibular inputs over time, but in Meniere's patients this apparently came at the cost of hearing and vestibular function in the implanted ear.

scholarly journals The Effect of Different Head Movement Paradigms on Vestibulo-Ocular Reflex Gain and Saccadic Eye Responses in the Suppression Head Impulse Test in Healthy Adult Volunteers

2021 ◽  
Vol 12 ◽  
Author(s):  
Dmitrii Starkov ◽  
Bernd Vermorken ◽  
T. S. Van Dooren ◽  
Lisa Van Stiphout ◽  
Miranda Janssen ◽  
...  
Keyword(s):  
Healthy Subjects ◽  
Healthy Adult ◽  
Head Movements ◽  
Head Impulse Test ◽  
Head Impulse ◽  
Ocular Reflex ◽  
Vestibulo Ocular Reflex ◽  
Reflex Gain ◽  
Head Impulses ◽  
Adult Volunteers

Objective: This study aimed to identify differences in vestibulo-ocular reflex gain (VOR gain) and saccadic response in the suppression head impulse paradigm (SHIMP) between predictable and less predictable head movements, in a group of healthy subjects. It was hypothesized that higher prediction could lead to a lower VOR gain, a shorter saccadic latency, and higher grouping of saccades.Methods: Sixty-two healthy subjects were tested using the video head impulse test and SHIMPs in four conditions: active and passive head movements for both inward and outward directions. VOR gain, latency of the first saccade, and the level of saccade grouping (PR-score) were compared among conditions. Inward and active head movements were considered to be more predictable than outward and passive head movements.Results: After validation, results of 57 tested subjects were analyzed. Mean VOR gain was significantly lower for inward passive compared with outward passive head impulses (p < 0.001), and it was higher for active compared with passive head impulses (both inward and outward) (p ≤ 0.024). Mean latency of the first saccade was significantly shorter for inward active compared with inward passive (p ≤ 0.001) and for inward passive compared with outward passive head impulses (p = 0.012). Mean PR-score was only significantly higher in active outward than in active inward head impulses (p = 0.004).Conclusion: For SHIMP, a higher predictability in head movements lowered gain only in passive impulses and shortened latencies of compensatory saccades overall. For active impulses, gain calculation was affected by short-latency compensatory saccades, hindering reliable comparison with gains of passive impulses. Predictability did not substantially influence grouping of compensatory saccades.

scholarly journals Enhanced Eye Velocity in Head Impulse Testing—A Possible Indicator of Endolymphatic Hydrops

2021 ◽  
Vol 8 ◽  
Author(s):  
Ian S. Curthoys ◽  
Leonardo Manzari ◽  
Jorge Rey-Martinez ◽  
Julia Dlugaiczyk ◽  
Ann M. Burgess
Keyword(s):  
Endolymphatic Hydrops ◽  
Physiological Saline ◽  
Prospective Clinical Study ◽  
Systematic Change ◽  
Membranous Labyrinth ◽  
Head Impulse ◽  
Head Velocity ◽  
Head Impulses ◽  
Eye Velocity ◽  
Intake Control

Introduction: On video head impulse testing (vHIT) of semicircular canal function, some patients reliably show enhanced eye velocity and so VOR gains >1.0. Modeling and imaging indicate this could be due to endolymphatic hydrops. Oral glycerol reduces membranous labyrinth volume and reduces cochlear symptoms of hydrops, so we tested whether oral glycerol reduced the enhanced vHIT eye velocity.Study Design: Prospective clinical study and retrospective analysis of patient data.Methods: Patients with enhanced eye velocity during horizontal vHIT were enrolled (n = 9, 17 ears) and given orally 86% glycerol, 1.5 mL/kg of body weight, dissolved 1:1 in physiological saline. Horizontal vHIT testing was performed before glycerol intake (time 0), then at intervals of 1, 2, and 3 h after the oral glycerol intake. Control patients with enhanced eye velocity (n = 4, 6 ears) received water and were tested at the same intervals. To provide an objective index of enhanced eye velocity we used a measure of VOR gain which captures the enhanced eye velocity which is so clear on inspecting the eye velocity records. We call this measure the initial VOR gain and it is defined as: (the ratio of peak eye velocity to the value of head velocity at the time of peak eye velocity). The responses of other patients who showed enhanced eye velocity during routine clinical testing were analyzed to try to identify how the enhancement occurred.Results: We found that oral glycerol caused, on average, a significant reduction in the enhanced eye velocity response, whereas water caused no systematic change. The enhanced eye velocity during the head impulses is due in some patients to a compensatory saccade-like response during the increasing head velocity.Conclusion: The significant reduction in enhanced eye velocity during head impulse testing following oral glycerol is consistent with the hypothesis that the enhanced eye velocity in vHIT may be caused by endolymphatic hydrops.

A review of the effects of space flight on the asymmetry of vertical optokinetic and vestibulo-ocular reflexes

2003 ◽  
Vol 13 (4-6) ◽  
pp. 255-263
Author(s):  
Gilles Clément
Keyword(s):  
Phase Velocity ◽  
Optokinetic Nystagmus ◽  
Visual Stimulation ◽  
Head Movements ◽  
Slow Phase ◽  
Eye Position ◽  
Slow Phase Velocity ◽  
Ocular Reflex ◽  
Vestibulo Ocular Reflex ◽  
Eye Velocity

Prolonged microgravity during orbital flight is a unique way to modify the otolith inputs and to determine the extent of their contribution to the vertical vestibulo-ocular reflex (VOR) and optokinetic nystagmus (OKN). This paper reviews the data collected on 10 astronauts during several space missions and focuses on the changes in the up-down asymmetry. Both the OKN elicited by vertical visual stimulation and the active VOR elicited by voluntary pitch head movements showed an asymmetry before flight, with upward slow phase velocity higher than downward slow phase velocity. Early in-flight, this asymmetry was inverted, and a symmetry of both responses was later observed. An upward shift in the vertical mean eye position in both OKN and VOR suggests that these effects may be related to otolith-dependent changes in eye position which, in themselves, affect slow phase eye velocity.

The Effects of Cochlear Implantation on Vestibular Function

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P60-P60
Author(s):  
Thuy-Anh N. Melvin ◽  
Americo Migliaccio ◽  
John P Carey ◽  
Charles Coleman Della Santina
Keyword(s):  
Cochlear Implantation ◽  
Full Range ◽  
Vestibular Function ◽  
Head Movements ◽  
Vestibular Evoked Myogenic Potentials ◽  
Head Impulse Test ◽  
Head Impulse ◽  
Vestibular Hypofunction ◽  
Before And After ◽  
Vestibulo Ocular Reflex

Objective 1) Measure vestibular function before and after cochlear implantation (CI) using a battery of tests covering the full range of stimulus frequencies over which the normal angular vestibulo-ocular reflex (VOR) stabilizes gaze. Methods Semicircular canal (SCC) function was assayed using head impulse test during 3-dimensional scleral search coil eye movement recordings (HIT), dynamic visual acuity during rapid head movements (DVA), head-shake nystagmus (HSN), and caloric electronystagmography (ENG). Saccular function was determined using vestibular-evoked myogenic potentials (VEMP). Patient self-assessment via the dizziness handicap inventory (DHI) and clinical head impulse testing (cHIT) were also measured. Results One of 28 post-implanted ears (4%) suffered severe loss of vestibular function in all 3 SCCs. HSN revealed no change in 11 subjects. ENG revealed new hypofunction in 1 of 16 ears (6%). Passive DVA revealed no significant change for 16 implanted ears. VEMP revealed significant increase or disappearance in threshold in 5 of 16 ears (31%). DHI scores were variable and correlated poorly with objective tests. The cHIT performed by one otolaryngologist in 14 subjects exhibited 44% sensitivity and 94% specificity for detection of severe hypofunction confirmed via quantitative HIT. Conclusions CI carries a small but nontrivial risk of iatrogenic vestibular hypofunction in the implanted ear. For bilateral simultaneous-CI, the risk of bilateral vestibular hypofunction is ∼0.16%, comparable to the likelihood of meningitis. The cHIT was highly specific for vestibular hypofunction in this study, but likely depends heavily on the examiner's threshold for abnormal.

Correlations between Hearing Thresholds and Caloric Responses Among a Heterogeneous Sample of Dizzy Patients

1988 ◽  
Vol 53 (1) ◽  
pp. 65-70 ◽  
Author(s):  
C. Formby ◽  
C. Hixson-Robles ◽  
G. T. Singleton
Keyword(s):  
High Frequency ◽  
Hearing Threshold ◽  
Vestibular Function ◽  
Slow Phase ◽  
High Frequency Range ◽  
Frequency Range ◽  
Heterogeneous Sample ◽  
Hearing Thresholds ◽  
Eye Velocity ◽  
Unilateral Weakness

Auditory and vestibular function were compared in a heterogeneous sample of dizzy patients ( N = 52). Hearing thresholds for the conventional audiometric frequencies were measured for each patient and parceled into two frequency ranges, 0.25–1 kHz and 2–8 kHz. Hearing thresholds also were measured for each patient over an extended high-frequency range that included the frequencies 10, 12, and 14 kHz. Bithermal caloric responses for these patients were available and were grouped for unilateral weakness (UW) or no unilateral weakness (NOUW). Hearing thresholds ipsilateral to the side of unilateral weakness (UW) yielded significant ( p < .05) modest correlations ( r = .39–.52) with UW for all three audiometric frequency ranges ( N = 35). These findings do not suggest a strong tonotopic relation between the audiometric and UW data. Hearing thresholds for the frequency range 10–14 kHz, but not for the conventional audiometric frequencies, correlated with slow-phase eye velocity (SPV) when SPV was averaged across the four caloric conditions for each of 17 NOUW patients. The latter finding indicates a subtle trend for eye velocity to increase as a function of increasing hearing threshold.

In Multiple-Step Gaze Shifts: Omnipause (OPNs) and Collicular Fixation Neurons Encode Gaze Position Error; OPNs Gate Saccades

2002 ◽  
Vol 88 (4) ◽  
pp. 1726-1742 ◽  
Author(s):  
André Bergeron ◽  
Daniel Guitton
Keyword(s):  
Superior Colliculus ◽  
Firing Frequency ◽  
Position Error ◽  
Head Movements ◽  
Gaze Shifts ◽  
Gaze Saccade ◽  
Saccade Onset ◽  
Gaze Position ◽  
Gaze Saccades ◽  
Multiple Step

The superior colliculus (SC), via its projections to the pons, is a critical structure for driving rapid orienting movements of the visual axis, called gaze saccades, composed of coordinated eye-head movements. The SC contains a motor map that encodes small saccade vectors rostrally and large ones caudally. A zone in the rostral pole may have a different function. It contains superior colliculus fixation neurons (SCFNs) with probable projections to omnipause neurons (OPNs) of the pons. SCFNs and OPNs discharge tonically during visual fixation and pause during single-step gaze saccades. The OPN tonic discharge inhibits saccades and its cessation (pause) permits saccade generation. We have proposed that SCFNs control the OPN discharge. We compared the discharges of SCFNs and OPNs recorded while cats oriented horizontally, to the left and right, in the dark to a remembered target. Cats used multiple-step gaze shifts composed of a series of small gaze saccades, of variable amplitude and number, separated by periods of variable duration (plateaus) in which gaze was immobile or moving at low velocity (<25°/s). Just after contralaterally (ipsilaterally) presented targets, the firing frequency of SCFNs decreased to almost zero (remained constant at background). As multiple-step gaze shifts progressed in either direction in the dark, these activity levels prevailed until the distance between gaze and target [gaze position error (GPE)] reached ∼16°. At this point, firing frequency gradually increased, without saccade-related pauses, until a maximum was reached when gaze arrived on target location (GPE = 0°). SCFN firing frequency encoded GPE; activity was not correlated to characteristics or occurrence of gaze saccades. By comparison, after target presentation to left or right, OPN activity remained steady at pretarget background until first gaze saccade onset, during which activity paused. During the first plateau, activity resumed at a level lower than background and continued at this level during subsequent plateaus until GPE ∼8° was reached. As GPE decreased further, tonic activity during plateaus gradually increased until a maximum (greater than background) was reached when gaze was on goal (GPE = 0°). OPNs, like SCFNs, encoded GPE, but they paused during every gaze saccade, thereby revealing, unlike for SCFNs, strong coupling to motor events. The firing frequency increase in SCFNs as GPE decreased, irrespective of trajectory characteristics, implies these cells get feedback on GPE, which they may communicate to OPNs. We hypothesize that at the end of a gaze-step sequence, impulses from SCFNs onto OPNs may suppress further movements away from the target.

scholarly journals Quantifying a Learning Curve for Video Head Impulse Test: Pitfalls and Pearls

2021 ◽  
Vol 11 ◽  
Author(s):  
Athanasia Korda ◽  
Thomas C. Sauter ◽  
Marco Domenico Caversaccio ◽  
Georgios Mantokoudis
Keyword(s):  
Learning Curve ◽  
Vestibular Function ◽  
Head Impulse Test ◽  
Video Head Impulse Test ◽  
Head Acceleration ◽  
Video Instruction ◽  
Head Impulse ◽  
Head Velocity ◽  
Low Head ◽  
Head Impulses

Objective: The video head impulse test (vHIT) is nowadays a fast and objective method to measure vestibular function. However, its usability is controversial and often considered as a test performed by experts only. We sought to study the learning curve of novices and to document all possible mistakes and pitfalls in the process of learning.Methods: In a prospective cohort observational study, we included 10 novices. We tested their ability to perform correctly horizontal head impulses recorded with vHIT. We assessed vHITs in 10 sessions with 20 impulses per session giving a video instruction after the first session (S1) and individual feedback from an expert for session 2 (S2) up to session 10 (S10). We compared VOR gain, the HIT acceptance rate by the device algorithm, mean head velocity, acceleration, excursion, and overshoot between sessions.Results: A satisfying number of accepted HITs (80%) was reached after an experience of 160 vHITs. Mean head velocity between sessions was always in accepted limits. Head acceleration was too low at the beginning (S1) but improved significantly after the video instruction (p = 0.001). Mean head excursion and overshoot showed a significant improvement after 200 head impulses (p &lt; 0.001 each).Conclusions: We showed that novices can learn to perform head impulses invHIT very fast provided that they receive instructions and feedback from an experienced examiner. Video instructions alone were not sufficient. The most common pitfall was a low head acceleration.

Vestibular Function and Motion Sickness Susceptibility: Videonystagmographic Evidence From Oculomotor and Caloric Tests

2020 ◽  
Vol 29 (2) ◽  
pp. 188-198
Author(s):  
Cynthia G. Fowler ◽  
Margaret Dallapiazza ◽  
Kathleen Talbot Hadsell
Keyword(s):  
Phase Velocity ◽  
Motion Sickness ◽  
Repeated Measures ◽  
Short Form ◽  
Vestibular Function ◽  
Slow Phase ◽  
Test Results ◽  
Normal Range ◽  
Slow Phase Velocity ◽  
Caloric Tests

Purpose Motion sickness (MS) is a common condition that affects millions of individuals. Although the condition is common and can be debilitating, little research has focused on the vestibular function associated with susceptibility to MS. One causal theory of MS is an asymmetry of vestibular function within or between ears. The purposes of this study, therefore, were (a) to determine if the vestibular system (oculomotor and caloric tests) in videonystagmography (VNG) is associated with susceptibility to MS and (b) to determine if these tests support the theory of an asymmetry between ears associated with MS susceptibility. Method VNG was used to measure oculomotor and caloric responses. Fifty young adults were recruited; 50 completed the oculomotor tests, and 31 completed the four caloric irrigations. MS susceptibility was evaluated with the Motion Sickness Susceptibility Questionnaire–Short Form; in this study, percent susceptibility ranged from 0% to 100% in the participants. Participants were divided into three susceptibility groups (Low, Mid, and High). Repeated-measures analyses of variance and pairwise comparisons determined significance among the groups on the VNG test results. Results Oculomotor test results revealed no significant differences among the MS susceptibility groups. Caloric stimuli elicited responses that were correlated positively with susceptibility to MS. Slow-phase velocity was slowest in the Low MS group compared to the Mid and High groups. There was no significant asymmetry between ears in any of the groups. Conclusions MS susceptibility was significantly and positively correlated with caloric slow-phase velocity. Although asymmetries between ears are purported to be associated with MS, asymmetries were not evident. Susceptibility to MS may contribute to interindividual variability of caloric responses within the normal range.

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