scholarly journals Skull Vibration-Induced Nystagmus Test in a Human Model of Horizontal Canal Plugging

2021 ◽  
Vol 11 (3) ◽  
pp. 301-312
Author(s):  
Georges Dumas ◽  
Christol Fabre ◽  
Anne Charpiot ◽  
Lea Fath ◽  
Hella Chaney-Vuong ◽  
...  
Keyword(s):  
Semicircular Canal ◽  
Vestibular Function ◽  
Human Model ◽  
Vestibular Evoked Myogenic Potentials ◽  
Head Impulse Test ◽  
Slow Phase ◽  
Caloric Test ◽  
Horizontal Semicircular Canal ◽  
Horizontal Canal ◽  
Tertiary Referral Center

Background/Aim: the aim of this study was to assess the skull vibration-induced nystagmus test (SVINT) results and vestibular residual function after horizontal semicircular canal (HSCC) plugging. Methods: In this retrospective chart review performed in a tertiary referral center, 11 patients who underwent unilateral horizontal semicircular canal plugging (uHSCCP) for disabling Menière’s disease (MD) were included. The skull vibration-induced nystagmus (SVIN) slow-phase velocity (SPV) was compared with the results of the caloric test (CaT), video head impulse test (VHIT), and cervical vestibular-evoked myogenic potentials (cVEMP) performed on the same day. Results: Overall, 10 patients had a strong SVIN beating toward the intact side (Horizontal SVIN-SPV: 8.8°/s ± 5.6°/s), 10 had a significant or severe ipsilateral CaT hypofunction, 10 had an ipsilateral horizontal VHIT gain impairment, and 3 had altered cVEMP on the operated side. Five had sensorineural hearing worsening. SVIN-positive results were correlated with CaT and horizontal VHIT (HVHIT) results (p < 0.05) but not with cVEMP. SVIN-SPV was correlated with CaT hypofunction in % (p < 0.05). Comparison of pre- and postoperative CaT % hypofunction showed a significant worsening (p = 0.028). Conclusion: SVINT results in a human model of horizontal canal plugging are well correlated with vestibular tests exploring horizontal canal function, but not with cVEMP. SVINT always showed a strong lesional nystagmus beating away from the lesion side. SVIN acts as a good marker of HSCC function. This surgical technique showed invasiveness regarding horizontal canal vestibular function.

Video Head Impulse Testing (vHIT) and the Assessment of Horizontal Semicircular Canal Function

2015 ◽  
Vol 26 (05) ◽  
pp. 518-523 ◽  
Author(s):  
Kristal M. Riska ◽  
Owen Murnane ◽  
Faith W. Akin ◽  
Courtney Hall
Keyword(s):  
Semicircular Canal ◽  
Objective Assessment ◽  
Vestibular Function ◽  
Vestibular Evoked Myogenic Potentials ◽  
Head Impulse Test ◽  
Clinical Test ◽  
Horizontal Semicircular Canal ◽  
Head Impulse ◽  
New Instrument ◽  
Qualitative Test

Background: Vestibular function (specifically, horizontal semicircular canal function) can be assessed across a broad frequency range using several different techniques. The head impulse test is a qualitative test of horizontal semicircular canal function that can be completed at bedside. Recently, a new instrument (video head impulse test [vHIT]) has been developed to provide an objective assessment to the clinical test. Questions persist regarding how this test may be used in the overall vestibular test battery. Purpose: The purpose of this case report is to describe vestibular test results (vHIT, rotational testing, vestibular evoked myogenic potentials, and balance and gait performance) in an individual with a 100% unilateral caloric weakness who was asymptomatic for dizziness, vertigo or imbalance. Data Collection and/or Analysis: Comprehensive assessment was completed to evaluate vestibular function. Caloric irrigations, rotary chair testing, vHIT, and vestibular evoked myogenic potentials were completed. Results: A 100% left-sided unilateral caloric weakness was observed in an asymptomatic individual. vHIT produced normal gain with covert saccades. Conclusions: This case demonstrates the clinical usefulness of vHIT as a diagnostic tool and indicator of vestibular compensation and functional status.

scholarly journals Worldwide survey on laboratory testing of vestibular function

2019 ◽  
Vol 10 (5) ◽  
pp. 379-387 ◽  
Author(s):  
Michael Strupp ◽  
Joy Grimberg ◽  
Julian Teufel ◽  
Göran Laurell ◽  
Herman Kingma ◽  
...  
Keyword(s):  
Reference Values ◽  
Vestibular Function ◽  
Vestibular Evoked Myogenic Potentials ◽  
Head Impulse Test ◽  
Slow Phase ◽  
Bilateral Vestibulopathy ◽  
Large Variability ◽  
Horizontal Canal ◽  
Caloric Irrigation ◽  
Cutoff Values

BackgroundThe function of the peripheral vestibular system can nowadays be quantified. The video head impulse test (vHIT) and caloric irrigation are used for the semicircular canals, cervical vestibular evoked myogenic potentials (cVEMP) for the sacculus, and ocular vestibular evoked myogenic potentials (oVEMP) for the utriculus. Because there is no agreement on normal and pathologic values, we performed a worldwide survey.MethodsA web-based standardized survey questionnaire was used to collect data on “reference values” and “cutoff” values. Thirty-eight centers from all continents (except Africa) replied.Results“Reference values”: vHIT: mean for the vestibulo-ocular reflex gain of the left horizontal canal 0.91 (range: 0.7–1.01) and of the left horizontal canal 0.92 (0.7–1.05); side difference 0.15 (0.25–0.3). Caloric irrigation: mean peak slow phase velocity of caloric-induced nystagmus for warm (44°C) water 18.65°/s (12–30°/s); cold (30°C) water 18.21°/s (10–25°/s). cVEMP: P13-N23 amplitude mean for the lower limit 28.67 μV (16–50 μV); upper limit 200 μV (50–350 μV). “Cutoff values”: vHIT: side difference 0.26 (0.1–0.4), bilateral vestibulopathy <0.61 (0.3–0.8); unilateral vestibulopathy (UVP) <0.68 (0.4–0.8). Caloric irrigation pathologic side difference mean 25.93% (17.7%–40%) or 12°/sec (5–30°/s); side difference UVP 26.73% (20%–40%) or 29.8°/s (5–100°/s). cVEMP: P13/N23 amplitude mean lower cutoff 32.5 μV (15–50 μV), mean upper cutoff 125 μV (50–200 μV), asymmetry 36.08 μV (20–50 μV).ConclusionThis worldwide survey showed a large variability in terms of reference and pathologic cutoff values in the 38 centers included. Therefore, standardization of how to achieve these values and agreement on which values should be used is highly warranted to guarantee a high quality of vestibular testing and interpretation of clinical and scientific results.

Objective vestibular function changes in children following cochlear implantation

2021 ◽  
pp. 1-9
Author(s):  
Ruijie Wang ◽  
Xiuhua Chao ◽  
Jianfen Luo ◽  
Daogong Zhang ◽  
Jiliang Xu ◽  
...  
Keyword(s):  
Semicircular Canal ◽  
Cochlear Implantation ◽  
Vestibular Function ◽  
Semicircular Canals ◽  
Vestibular Evoked Myogenic Potentials ◽  
Head Impulse Test ◽  
Caloric Test ◽  
Otolith Organs ◽  
Deterioration Rate ◽  
Vestibular Aqueduct

BACKGROUND: To date, systematically objective evaluations of vestibular function in children with cochlear implantation (CI) have been conducted sparsely, especiallyin children with large vestibular aqueduct syndrome (LVAS). OBJECTIVE: Our goal was to investigate the function of all five vestibular end-organs pre- and post-cochlear implantation in children with LVAS and normal CT. METHODS: In this retrospective cohort study, 34 children (age 4–17 years) with bilateral profound sensorineural hearing loss (SNHL) undergoing unilateral CI were included. Participants included 18 (52.9%) children with LVAS. Objective modalities to evaluate vestibular function included the caloric test, cervical vestibular-evoked myogenic potentials (cVEMP), ocular vestibular-evoked myogenic potentials (oVEMP), and video head impulse test (vHIT). All measurements were performed before surgery and 9 months after surgery. RESULTS: Mean age at CI was 8.1±3.7 years. Caloric testing showed hypofunction in 38.2%of cases before implantation and in 50%after (p >  0.05). We found a significant increase of overall abnormality rate in cVEMP and oVEMP from pre- to post-CI (p <  0.05). In all three semicircular canals tested by vHIT, there were no statistically significant mean gain changes (p >  0.05). Higher deterioration rates in cVEMP (53.3%) and oVEMP (52.0%) after surgery were observed (p <  0.05). In children with LVAS, cVEMP revealed a higher deterioration rate than superior semicircular canal (SSC) and posterior semicircular canal (PSC) (p <  0.05). In children with normal CT, the deterioration rates in VEMPs were both higher than those in vHIT (p <  0.05). CONCLUSIONS: In general, the otolith organs were the most affected peripheral vestibular sensors in children after cochlear implantation. The variations in otolith function influenced by CI were different between children with LVAS and normal CT. We recommend the use of this vestibular function test battery for children with cochlear implantation.

scholarly journals A case series shows independent vestibular labyrinthine function after major surgical trauma to the human cochlea

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Stefan K. Plontke ◽  
Torsten Rahne ◽  
Ian S. Curthoys ◽  
Bo Håkansson ◽  
Laura Fröhlich
Keyword(s):  
Case Series ◽  
Vestibular Function ◽  
Semicircular Canals ◽  
Vestibular Evoked Myogenic Potentials ◽  
Head Impulse Test ◽  
Surgical Trauma ◽  
Cochlear Function ◽  
Receptor System ◽  
Tertiary Referral Center ◽  
Significant Difference

Abstract Background The receptors for hearing and balance are housed together in the labyrinth of the inner ear and share the same fluids. Surgical damage to either receptor system was widely believed to cause certain permanent loss of the receptor function of the other. That principle, however, has been called into question because there have been anecdotal reports in individual patients of at least partial preservation of cochlear function after major surgical damage to the vestibular division and vice versa. Methods We performed specific objective vestibular function tests before and after surgical trauma (partial or subtotal cochlear removal) for treatment of intracochlear tumors in 27 consecutive patients in a tertiary referral center. Vestibular function was assessed by calorics (low-frequency response of the lateral semicircular canal), vestibulo-ocular reflex by video head impulse test (vHIT) of the three semicircular canals, cervical and ocular vestibular evoked myogenic potentials (cVEMP, saccule and oVEMP, utricle). Preoperative and postoperative distributions were compared with paired t-tests. Results Here we show that there was no significant difference between pre- and post-operative measures for all tests of the five vestibular organs, and that after major surgical cochlear trauma, the vestibular receptors continue to function independently. Conclusions These surprising observations have important implications for our understanding of the function and the surgery of the peripheral auditory and vestibular system in general and open up new possibilities for the development, construction and evaluation of neural interfaces for electrical or optical stimulation of the peripheral auditory and vestibular nervous system.

scholarly journals Clinical Characteristics of Patients With Dizziness/Vertigo Accompanied by Posterior Semicircular Canal Hypofunction

2021 ◽  
Vol 8 ◽  
Author(s):  
Zheyuan Li ◽  
Bo Liu ◽  
Hongli Si ◽  
Kangzhi Li ◽  
Bo Shen ◽  
...  
Keyword(s):  
Inner Ear ◽  
Semicircular Canal ◽  
Clinical Characteristics ◽  
Disease Onset ◽  
Vestibular Migraine ◽  
Vestibular Evoked Myogenic Potentials ◽  
Caloric Test ◽  
Horizontal Semicircular Canal ◽  
Inner Ear Disease ◽  
Autoimmune Inner Ear Disease

Objective: To investigate the clinical characteristics of patients with dizziness/vertigo accompanied by loss of the posterior canal(s) (LPC).Methods: Clinical data of 23 patients with LPC were collected. We determined video-head-impulse test (vHIT) gains of all six semicircular canals and correlated vHIT findings with other vestibulo-cochlear tests, including caloric test, ocular and cervical vestibular-evoked myogenic potentials (oVEMP, cVEMP), pure tone audiometry (PTA), and analyzed the differences in clinical manifestations of patients with LPC with different etiologies.Results: LPC was identified in 23 patients. At the time of disease onset, most patients presented with dizziness (47.8%) and vertigo (30.4%) only, and some patients (21.7%) complained of unsteadiness. Among these 23 patients with LPC, there were 14 (60.9%) patients of isolated LPC (ILPC), 21 (91.3%) patients of unilateral LPC (ULPC), and 2 (8.7%) patients of bilateral LPC (BLPC). (1) Among 14 patients with ILPC, 13 (92.9%) patients had unilateral ILPC, the rate of ipsilesional impairment on caloric test, or oVEMP/cVEMP test or PTA ipsilesionally was 53.8% (7/13) in patients with unilateral ILPC. The causes of unilateral ILPC were vertigo/dizziness of unclear origin (38.5%), labyrinthine infarction (15.4%), vestibular migraine (15.4%), and other diseases (30.8%); (2) among 21 patients with ULPC, 7 patients (33.3%) were accompanied with horizontal semicircular canal hypofunction ipsilesionally, the abnormal rate of caloric test, or oVEMP/cVEMP tests or PTA ipsilesionally was 57.1%. The causes of ULPC were vertigo/dizziness of unclear origin (33.3%), autoimmune inner ear disease (14.3%), labyrinthine infarction (14.3%), vestibular neuritis (9.5%), vestibular migraine (9.5%), and other diseases (19.0%); (3) among two patients with BLPC, one patient presented with unsteadiness, the causes of BLPC were vestibular paroxysmia and autoimmune inner ear disease.Conclusion: vHIT is a fast and effective method for assessing LPC, which can be used to detect isolated PC dysfunction. The causes of ILPC were peripheral origin or central origin. Patients with ILPC and ULPC mostly presented with dizziness/vertigo, and ULPC was often accompanied by ipsilateral vestibulo-cochlear impairment.

Influence of vestibular rehabilitation on the recovery of all vestibular receptor organs in patients with unilateral vestibular hypofunction

2020 ◽  
Vol 47 (2) ◽  
pp. 227-235
Author(s):  
Anamarija Sestak ◽  
Sinisa Maslovara ◽  
Zeljko Zubcic ◽  
Andrijana Vceva
Keyword(s):  
Vestibular Function ◽  
Vestibular Rehabilitation ◽  
Vestibular Evoked Myogenic Potentials ◽  
Head Impulse Test ◽  
Caloric Test ◽  
Vestibular Hypofunction ◽  
Sf 36 ◽  
Significant Difference ◽  
Different Types ◽  
Vestibular Receptor

BACKGROUND: Only a few studies in the literature demonstrate the effect of vestibular rehabilitation (VR) on all vestibular receptor organs. Furthermore, very little evidence of the effect of VR on isolated otolith dysfunction (IOD) is available. OBJECTIVE: The study aimed to investigate the effect of VR on all vestibular receptor organs in patients with different types of unilateral vestibular hypofunction (UVH). METHODS: We enrolled 80 patients with three different types of UVH; combined and isolated loss of semicircular canal and otolith organ function. All patients performed a 12-week customized program of VR and received a full battery of vestibular function tests, before and after the VR. The DHI and SF-36 were performed before, after 6 weeks, and 12 weeks of the VR. RESULTS: Parameters of the caloric test, video head impulse test, ocular and cervical vestibular evoked myogenic potentials were significantly improved after VR. A total of 59 (74%) patients fully recovered, with no significant difference in recovery regarding the type (p = 0.13) and stage of UVH (p = 0.13). All patients reported significantly lower disability and a better quality of life after the VR based on the DHI and SF-36 score. CONCLUSIONS: Vestibular rehabilitation has a positive effect on the recovery of all vestibular receptor organs and it should be used in patients with IOD.

Agreement between the Skull Vibration-Induced Nystagmus Test and Semicircular Canal and Otolith Asymmetry

2021 ◽  
Author(s):  
Yue Zhang ◽  
Jamie Soper ◽  
Christine M. Lohse ◽  
Scott D.Z. Eggers ◽  
Kenton R. Kaufman ◽  
...  
Keyword(s):  
Semicircular Canal ◽  
Vestibular Function ◽  
Chief Complaint ◽  
Vestibular Evoked Myogenic Potentials ◽  
Caloric Test ◽  
Otolith Organ ◽  
Organ Function ◽  
Test Sensitivity ◽  
Data Collection And Analysis ◽  
Higher Sensitivity

Abstract Background How significant asymmetries in otolith organ function in the presence of symmetrical and asymmetrical semicircular canal function influence skull vibration-induced nystagmus testing (SVINT) has not been well described. Purpose The aim of the study is to examine the agreement between SVINT and caloric testing, ocular vestibular-evoked myogenic potentials (oVEMP), and cervical vestibular-evoked myogenic potentials (cVEMP) for detecting asymmetric vestibular function. Research Design This is a retrospective study of patients presenting with the chief complaint of vertigo, dizziness, or imbalance. Study Sample A total of 812 patients were studied with a median age at testing of 59 years (interquartile range 46–70; range 18–93) and included 475 (59%) women. Intervention Either the monothermal warm caloric test or alternate binaural bithermal caloric test, oVEMP, and cVEMP tests were administered to all patients. All patients underwent the SVINT prior to vestibular laboratory testing. Data Collection and Analysis Agreement between tests categorized as normal versus abnormal was summarized using percent concordance (PC). Sensitivity and specificity values were calculated for SVINT compared with other tests of vestibular function. Results There was higher agreement between ipsilateral and contralateral SVINT with the caloric test (PC = 80% and 81%, respectively) compared with oVEMP (PC = 63% and 64%, respectively) and cVEMP (PC = 76% and 78%, respectively). Ipsilateral and contralateral SVINT showed higher sensitivity for the caloric test (sensitivity = 47% and 36%, respectively) compared with oVEMP (sensitivity = 26% and 21%, respectively), or cVEMP (sensitivity = 33% vs. 27%, respectively). Specificity of SVINT was high (>80%) for all assessments of vestibular function. Conclusion The presence of SVIN is a useful indicator of the asymmetry of vestibular function between the two ears when making judgments about semicircular canal asymmetry but is less sensitive to asymmetries in otolith organ function.

scholarly journals Nightly Hypoxia Does Not Seem to Lead to Otolith Dysfunction in Patients With Obstructive Sleep Apnea

2020 ◽  
pp. 014556132092212
Author(s):  
Richard Birk ◽  
Miriam Dietz ◽  
Jörg Ulrich Sommer ◽  
Boris A. Stuck ◽  
Karl Hörmann ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Vestibular Function ◽  
Oxygen Desaturation ◽  
Vestibular Evoked Myogenic Potentials ◽  
Head Impulse Test ◽  
Apnea Hypopnea Index ◽  
Horizontal Semicircular Canal ◽  
Respiratory Parameters ◽  
Obstructive Sleep

Objectives: Obstructive sleep apnea (OSA) is a common sleep disorder, which is associated with recurrent oxygen desaturation during sleep. It has already been shown that nocturnal hypoxia may lead to cochlear dysfunction in patients with OSA. Less is known whether hypoxia during sleep also impacts vestibular function in those patients. Thus, the aim of the presented study was to assess a potential vestibulotoxic effect of nightly desaturations with hypoxia in patients with OSA by investigating a possible correlation between respiratory parameters and vestibular function tests. Methods: A total of 56 patients were included in the study and underwent a fully attended cardiorespiratory polysomnography (PSG). Vestibular function was assessed using video head impulse test to evaluate horizontal semicircular canal function and cervical vestibular evoked myogenic potentials (cVEMPs) and ocular vestibular evoked myogenic potentials (oVEMPs) to measure otolith function. Descriptive data analysis was conducted and correlation analysis between selected PSG parameters and the results of vestibular testing was performed using Kendall τ coefficient. Results: A significant correlation between vestibular function and respiratory polysomnographic parameters could not be demonstrated in the study ( P > .05) but cVEMP and oVEMP results showed a trend toward a correlation with oxygen desaturation indices and apnea–hypopnea index. Additionally, otolith hypofunction was more prevalent in patients with hypertension as well as OSA. Conclusion: The results of our study show that there is no significant correlation between vestibular function and sleep apnea parameters, although otolith dysfunction might be more prevalent in patients with OSA and hypertension.

scholarly journals The resilience of the inner ear—vestibular and audiometric impact of transmastoid semicircular canal plugging

2021 ◽  
Author(s):  
Joost J. A. Stultiens ◽  
Nils Guinand ◽  
Vincent Van Rompaey ◽  
Angélica Pérez Fornos ◽  
Henricus P. M. Kunst ◽  
...  
Keyword(s):  
Semicircular Canal ◽  
Bone Conduction ◽  
Vestibular Function ◽  
Semicircular Canals ◽  
Vestibular Evoked Myogenic Potentials ◽  
Head Impulse Test ◽  
Superior Semicircular Canal Dehiscence ◽  
Caloric Response ◽  
The Impact

Abstract Background Certain cases of superior semicircular canal dehiscence or benign paroxysmal positional vertigo can be treated by plugging of the affected semicircular canal. However, the extent of the impact on vestibular function and hearing during postoperative follow-up is not known. Objective To evaluate the evolution of vestibular function and hearing after plugging of a semicircular canal. Methods Six patients underwent testing before and 1 week, 2 months, and 6 months after plugging of the superior or posterior semicircular canal. Testing included caloric irrigation test, video Head Impulse Test (vHIT), cervical and ocular Vestibular Evoked Myogenic Potentials (VEMPs) and audiometry. Results Initially, ipsilateral caloric response decreased in all patients and vHIT vestibulo-ocular reflex (VOR) gain of each ipsilateral semicircular canal decreased in 4/6 patients. In 4/6 patients, postoperative caloric response recovered to > 60% of the preoperative value. In 5/6 patients, vHIT VOR gain was restored to > 85% of the preoperative value for both ipsilateral non-plugged semicircular canals. In the plugged semicircular canal, this gain decreased in 4/5 patients and recovered to > 50% of the preoperative value. Four patients preserved cervical and ocular VEMP responses. Bone conduction hearing deteriorated in 3/6 patients, but recovered within 6 months postoperatively, although one patient had a persistent loss of 15 dB at 8 kHz. Conclusion Plugging of a semicircular canal can affect both vestibular function and hearing. After initial deterioration, most patients show recovery during follow-up. However, a vestibular function loss or high-frequency hearing loss can persist. This stresses the importance of adequate counseling of patients considering plugging of a semicircular canal.

scholarly journals Head Impulse Test

2012 ◽  
Vol 4 (2) ◽  
pp. 106-111 ◽  
Keyword(s):  
Semicircular Canal ◽  
Prognostic Significance ◽  
The Other ◽  
Reliable Indicator ◽  
Head Impulse Test ◽  
Caloric Test ◽  
Horizontal Semicircular Canal ◽  
Head Impulse ◽  
Vestibular Deficit ◽  
Simple Bedside

ABSTRACT In 1988, Michael Halmagyi and Ian Curthuoys described a simple yet reliable indicator of unilateral peripheral vestibular deficits at the bedside. This ‘head impulse test’ (HIT) as is has been known since, has stood the test of being a reliable indicator of vestibular deficit, especially for the horizontal semicircular canal. The test has been described using various techniques, such as the scleral search coil, the video HIT, etc. but even a simple bedside clinical evaluation with a little amount of experience usually sufficed to detect overt vestibular deficits. Numerous studies have compared the efficacy of the HIT as compared with other tests of vestibular deficit, the caloric test (CT) being the most commonly compared one. A look at the physiology behind the two tests reveals the differing pathways tested by the two tests in mention, and hence it would be wise to say that the two are complimentary, rather than exclusive of the other. The HIT today forms a vital part of the armamentarium of the otologist to arrive at rapid understanding of the nature of the vestibular deficit, the laterality of the lesion, and the probable prognostic significance. How to cite this article Khattar VS, Hathiram BT. Head Impulse Test. Otorhinolaryngol Clin Int J 2012;4(2):106-111.

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