RESUMO
BACKGROUND: There may be confusion about which canal is involved in patients with benign paroxysmal positional vertigo (BPPV), especially with those that have subtle findings. The study aimed to determine if video head impulse testing may be used in such patients as a diagnostic tool. Symptom scoring and treatment efficiency in BPPV are essential parts of the process. Therefore, inventories like "Dizziness Handicap Inventory" may be useful in this regard. METHODS: Patients with posterior and lateral canal BPPV were included. Video head impulse testing was performed prior to treatment and 1 week after treatment. Vestibuloocular reflex (VOR) gains were noted and compared to the opposite side. The presence of correction saccades was noted as well. Also, pretreatment and posttreatment Dizziness Handicap Inventory scores were compared. RESULTS: Fifty-seven patients were diagnosed with posterior canal BPPV, and sixteen were with horizontal canal BPPV. In patients with posterior canal BPPV, there was no difference between the involved canal VOR gains and the other canals on the same side (P=.639). The involved horizontal canal did not differ from the opposite horizontal canal. Patients with lateral canal BPPV show more significant improvement after treatment compared to patients with posterior canal BPPV. CONCLUSION: Video head impulse testing may not be used to estimate the involved canal in BPPV; however, it may be used to evaluate the efficiency of the treatment, especially in the lateral canal.
Assuntos
Vertigem Posicional Paroxística Benigna , Teste do Impulso da Cabeça , Reflexo Vestíbulo-Ocular , Canais Semicirculares , Gravação em Vídeo , Humanos , Teste do Impulso da Cabeça/métodos , Vertigem Posicional Paroxística Benigna/diagnóstico , Vertigem Posicional Paroxística Benigna/fisiopatologia , Vertigem Posicional Paroxística Benigna/terapia , Masculino , Feminino , Pessoa de Meia-Idade , Reflexo Vestíbulo-Ocular/fisiologia , Idoso , Gravação em Vídeo/métodos , Adulto , Canais Semicirculares/fisiopatologia , Movimentos Sacádicos/fisiologiaRESUMO
Hyperventilation-induced nystagmus test (HINT) is capable of generating a response in 77.2% of cases of acute unilateral vestibulopathy (AUVP); both nystagmus toward the affected side (excitatory pattern) and toward the healthy side (inhibitory pattern) have been described. The aim of the study is to investigate the clinical and prognostic role of the test by evaluating its correlation with vestibulo-ocular reflex (VOR) gain. We evaluated 33 AUVP patients by performing the HINT and video head impulse test (V-HIT) during the acute phase and then at 15 and 90 days after the onset of the symptoms. The correlation between the VOR gain of the affected side and test responses was evaluated first, phase by phase, and then considering the pattern shown during the first assessments. Patients with a negative HINT had a higher mean VOR gain than patients with a positive test at both 15 and 90 days. Patients who showed an inhibitory pattern at the first assessment had a continuous improvement in V-HIT performance, while patients with an initial excitatory response had a transient decrease in gain at the subsequent evaluation (P=.001). No difference between these 2 groups emerged at 90 days (P=.09). The finding of a negative HINT during the follow-up correlates with good V-HIT performance and could be an indicator of good recovery. The inhibitory pattern is associated with a subsequent improvement; and it would be indicative of compensation. but, despite this, the prognostic value of the test is limited.
Assuntos
Teste do Impulso da Cabeça , Hiperventilação , Nistagmo Patológico , Reflexo Vestíbulo-Ocular , Humanos , Reflexo Vestíbulo-Ocular/fisiologia , Masculino , Hiperventilação/fisiopatologia , Hiperventilação/complicações , Feminino , Pessoa de Meia-Idade , Nistagmo Patológico/fisiopatologia , Nistagmo Patológico/diagnóstico , Teste do Impulso da Cabeça/métodos , Adulto , Idoso , Doença Aguda , Doenças Vestibulares/fisiopatologia , Doenças Vestibulares/diagnóstico , Testes de Função Vestibular/métodos , PrognósticoRESUMO
There is a lack of comparative studies examining changes in vestibulo-ocular reflex (VOR) gain with head velocity in the video head impulse test (vHIT) of patients with vestibular neuritis (VN). Thus, the purpose of present study was to identify the effect of head impulse velocity on the gain of the VOR during the vHIT in patients with VN. Head impulse velocities ranging from 100%-200°/s [158.08 ± 23.00°/s in the horizontal canal (HC), 124.88 ± 14.80°/s in the anterior canal (AC), and 122.92 ± 14.26°/s in the posterior canal (PC) were used during vHIT trials of 32 patients with VN. Differences in VOR gain on the ipsilesional and contralesional sides according to head velocity were analyzed. The mean VOR gains in ipsilesional side were decreased to 0.47 in the HC and 0.56 in the AC, leading to marked asymmetry compared to the contralesional side; PC gain was relatively preserved at 0.82 in the ipsilesional side. The mean head impulse velocity applied during vHIT trials in each semicircular canal plane did not differ bilaterally. On the contralesional side, VOR gain was negatively correlated with head impulse velocity (R2=0.25, P=.004 in HC; R2=0.17, P=.021 in AC; R2=0.24, P=.005 in PC), while VOR gain on the ipsilesional sides of the HC and AC was not. Head impulse velocity may have a differential impact on VOR gain, depending on the degree of deficit. Increasing head velocity in vHIT may be considered to identify subtle deficits on the contralesional side of patients with VN.
Assuntos
Teste do Impulso da Cabeça , Reflexo Vestíbulo-Ocular , Neuronite Vestibular , Humanos , Reflexo Vestíbulo-Ocular/fisiologia , Teste do Impulso da Cabeça/métodos , Neuronite Vestibular/fisiopatologia , Neuronite Vestibular/diagnóstico , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Idoso , Canais Semicirculares/fisiopatologia , Gravação em Vídeo/métodos , Movimentos da Cabeça/fisiologiaRESUMO
Different studies have tried to establish a relationship between dyslexia and the vestibular system function. Subjective Visual Vertical/Horizontal (SVV and SVH) and Video Head Impulse Test (VHIT) are useful for studying the vestibular system and can be easily performed in children. Our aim was to evaluate the vestibular function in dyslexic children by SVV/SVH and VHIT. We enrolled 18 dyslexic children (10M/8F; mean age 10.7 ± 2.3 years; range 7-14 years) and 18 age-matched children with typical development of learning abilities. All children performed VHIT, SVV and SVH. We found normal gain and symmetry of vestibulo-ocular-reflex both in dyslexic and typically developing children. Fifteen out of 18 dyslexic children (83.3%) showed a difference of at least one amongst SVV or SVH. The mean value of SVV was 2.3° and the mean value of SVH was 2.6°. Statistical analysis showed a significant difference between typically developing and dyslexic children for both SVV and SVH. We confirm a relationship between dyslexia and the alteration of SVV and SVH. Our results could be related to the pathogenetic hypothesis of a visual processing impairment related to a dysfunction of the magnocellular pathway or to a general deficit related to a multimodal cortical network.
Assuntos
Dislexia , Teste do Impulso da Cabeça , Humanos , Dislexia/fisiopatologia , Criança , Feminino , Masculino , Adolescente , Reflexo Vestíbulo-Ocular/fisiologiaRESUMO
OBJECTIVE: To evaluate semicircular canal function using video head impulse test (vHIT) in relapsing polychondritis (RP) patients presenting with dizziness and sensorineural hearing loss. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: Three patients with RP underwent vHIT and hearing tests. INTERVENTION: Diagnostic. MAIN OUTCOME MEASURES: The gain in vestibulo-ocular reflex (VOR) and the presence of catch-up saccade were examined, and the correlation between semicircular canal dysfunction and hearing loss was investigated. RESULTS: Of the six ears, five exhibited semicircular canal dysfunction. Among these, one ear showed dysfunction in two semicircular canals, while the remaining four ears demonstrated dysfunction in all three semicircular canals. Sensorineural hearing loss, ranging from moderate to profound, was detected by pure-tone audiometry in all six ears. Furthermore, a significant correlation was observed between VOR gain in the horizontal semicircular canal (HSC) and hearing level. CONCLUSIONS: This study demonstrated semicircular canal dysfunction in RP patients presenting with dizziness and hearing loss using vHIT. Moreover, a significant correlation was found between HSC dysfunction and the severity of hearing loss. While inner ear involvement is a key clinical symptom included in the diagnostic criteria for RP, there have been few reports evaluating vestibular dysfunction, and this is the first report on the evaluation of several cases using vHIT. Accurate assessment of vestibular function by vHIT may facilitate early diagnosis and intervention in RP, potentially improving patient outcomes.
Assuntos
Tontura , Teste do Impulso da Cabeça , Perda Auditiva Neurossensorial , Policondrite Recidivante , Reflexo Vestíbulo-Ocular , Canais Semicirculares , Humanos , Teste do Impulso da Cabeça/métodos , Canais Semicirculares/fisiopatologia , Tontura/fisiopatologia , Tontura/etiologia , Tontura/diagnóstico , Perda Auditiva Neurossensorial/fisiopatologia , Perda Auditiva Neurossensorial/diagnóstico , Pessoa de Meia-Idade , Feminino , Masculino , Reflexo Vestíbulo-Ocular/fisiologia , Estudos Retrospectivos , Policondrite Recidivante/fisiopatologia , Policondrite Recidivante/complicações , Policondrite Recidivante/diagnóstico , Adulto , Idoso , Audiometria de Tons Puros , Gravação em VídeoRESUMO
OBJECTIVES: Acoustic neuroma (AN) is a benign tumor that usually affects a patient's hearing and balance function. For the screening and diagnosis of AN, the traditional approach mainly relies on audiological examination and magnetic resonance imaging (MRI), often ignoring the importance of vestibular function assessment in the affected area. As an emerging method of vestibular function detection, video head impulse test (vHIT) has been widely used in clinic, but research on its use in AN diagnosis is relatively limited. This study aims to explore the value of vHIT in the diagnosis of AN, vestibular dysfunction assessment, and postoperative compensation establishment in unilateral AN patients undergoing unilateral AN resection through labyrinthine approach. METHODS: This retrospective study was conducted on 27 AN patients who underwent unilateral AN resection via labyrinthine approach from October 2020 to March 2022 in the Department of Otolaryngology-Head and Neck Surgery, the Second Xiangya Hospital, Central South University. vHIT was performed 1 week before surgery to assess vestibular function, pure tone audiometry (PTA) was used to assess hearing level, and ear MRI was used to assess tumor size. Follow-up vHIT was conducted at 1 week, 1 month, 6 months, and 1 year post-surgery. The correlation of vHIT with hearing and tumor size was analyzed. RESULTS: Preoperative vHIT showed that the posterior semicircular canal on the affected side was the most common semicircular canal with reduced vestibulo-ocular reflex (VOR) gain. There was a correlation between the VOR gain of vHIT on the affected side and the hearing level (r=-0.47, P<0.05) or tumor size (r=-0.54, P<0.01). The results of vHIT on the affected side showed that the hearing level and mean VOR gain of the anterior semicircular canal increased slightly with time, and the amplitude and saccade percentage of the dominant saccades of the 3 semicircular canals increased, while the latency time decreased, with the most obvious changes occurring 1 week post-surgery. CONCLUSIONS: vHIT can effectively monitor the changes of vestibular function in AN patients before and after surgery and has application value in assisting the diagnosis of vestibular dysfunction in AN patients.
Assuntos
Teste do Impulso da Cabeça , Neuroma Acústico , Humanos , Neuroma Acústico/cirurgia , Neuroma Acústico/fisiopatologia , Neuroma Acústico/diagnóstico por imagem , Teste do Impulso da Cabeça/métodos , Estudos Retrospectivos , Audiometria de Tons Puros , Feminino , Masculino , Imageamento por Ressonância Magnética , Orelha Interna/diagnóstico por imagem , Orelha Interna/cirurgia , Vestíbulo do Labirinto/fisiopatologia , Vestíbulo do Labirinto/cirurgia , Pessoa de Meia-IdadeAssuntos
Doenças Autoimunes , Doença de Meniere , Humanos , Doença de Meniere/diagnóstico , Doença de Meniere/imunologia , Masculino , Diagnóstico Diferencial , Doenças Autoimunes/diagnóstico , Doenças Autoimunes/imunologia , Feminino , Pessoa de Meia-Idade , Adulto , Orelha Interna/imunologia , Audiometria de Tons Puros , Idoso , Doenças do Labirinto/imunologia , Doenças do Labirinto/diagnóstico , Teste do Impulso da CabeçaRESUMO
BACKGROUND: To improve diagnostic precision in pediatric vertigo, particularly in Vestibular Migraine of Childhood (VMC), probable VMC (pVMC), Recurrent Vertigo of Childhood (RVC), and unspecified categories, by delineating clinical characteristics and prevalence to refine diagnostics and treatments. METHODS: Retrospective analysis of 102 pediatric patients (five to 18 years; 46 females, 56 males) at the Dizziness Center of the Otolaryngology Department in a tertiary-level hospital from January 2019 to December 2023. Patients were classified into VMC, pVMC, RVC, and indeterminate groups. Evaluations included audiometry and vestibular tests (video head impulse test [vHIT] or caloric testing), conducted in the audiology unit and vestibular testing laboratory. Data were analyzed using IBM SPSS 20.0. RESULTS: Diagnoses were 8.8% VMC, 31.4% pVMC, 51.0% RVC, and 8.8% indeterminate. Nausea and vomiting were common in VMC and pVMC; cochlear symptoms like tinnitus and hearing loss predominated in VMC. Although vestibular testing showed no significant group differences, VMC had more vHIT abnormalities and RVC had more caloric test anomalies. CONCLUSIONS: This study highlights the need for comprehensive diagnostics in pediatric vestibular disorders, revealing unique and overlapping traits across VMC, pVMC, and RVC. Insights call for further research to refine diagnostic criteria and improve treatment methods.
Assuntos
Transtornos de Enxaqueca , Centros de Atenção Terciária , Vertigem , Humanos , Feminino , Masculino , Criança , Adolescente , Vertigem/diagnóstico , Vertigem/etiologia , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/complicações , Estudos Retrospectivos , Pré-Escolar , Doenças Vestibulares/diagnóstico , Recidiva , Testes de Função Vestibular , Teste do Impulso da Cabeça , Testes CalóricosRESUMO
INTRODUCTION: Recently, end-point nystagmus, traditionally observed in an upright position, has been identified in the Dix-Hallpike position among healthy subjects, suggesting a physiological origin.However, its characteristics in individuals with vestibular hypofunction remain unexplored. OBJECTIVE: To elucidate the impact of vestibular hypofunction on the characteristics of positional end-point nystagmus. METHODS: Thirty-one patients diagnosed with acute unilateral vestibulopathy according to Bárány Society criteria were selected. A video head impulse test was conducted in all participants, followed by McClure and Dix-Hallpike maneuvers with and without gaze fixation, and with the initial position of the eye in the straight-ahead position or in the horizontal end-point position. Nystagmus direction, sense, latency, slow-phase velocity, and duration were recorded. The relationship between these characteristics and video head impulse test values was analyzed. RESULTS: Positional end-point nystagmus was observed in 92.6% of subjects with vestibular hypofunction, significantly more than in healthy individuals. Nystagmus direction varied depending on the performed positional test and on the vestibulo-ocular reflex gains. Gaze occlusion and the initial horizontal end-point position increased its frequency. CONCLUSION: Vestibular hypofunction influences the manifestation of positional end-point nystagmus. Recognizing this nystagmus can aid in resolving diagnostic uncertainties and preventing the misdiagnosis of benign paroxysmal positional vertigo in subjects with acute unilateral vestibulopathy.
Assuntos
Teste do Impulso da Cabeça , Nistagmo Patológico , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Nistagmo Patológico/diagnóstico , Nistagmo Patológico/fisiopatologia , Adulto , Teste do Impulso da Cabeça/métodos , Nistagmo Fisiológico/fisiologia , Doenças Vestibulares/diagnóstico , Doenças Vestibulares/fisiopatologia , Idoso de 80 Anos ou mais , Testes de Função Vestibular/métodos , Neuronite Vestibular/diagnóstico , Neuronite Vestibular/fisiopatologia , Neuronite Vestibular/complicações , Reflexo Vestíbulo-Ocular/fisiologiaRESUMO
Objective:To explore the correlation between the parameters of suppression head impulse paradigmï¼SHIMPï¼ and changes in dizziness handicap inventoryï¼DHIï¼ scores. Additionally, to evaluate the degree of vertigo and prognosis of patients with acute vestibular neuritis through SHIMP parameters. Methods:Thirty-three patients with acute vestibular neuritis were enrolled for DHI evaluation, vHIT and SHIMP. A secondary DHI score were evaluated after after two weeks, once patients no longer exhibited spontaneous nystagmus. The decrease in the second DHI score was used as the efficacy indexï¼EIï¼. All patients were divided into significantly effective group, effective group and ineffective group based on EI. Differences of the VOR gain values of SHIMP and the anti-compensatory saccade were compared among the three groups. Results:There were 13 cases in the significant effective group, 11 cases in the effective group, and 9 cases in the ineffective group. â The mean gain of the horizontal semicircular canal in the significant effective group, the effective group, and the ineffective group wasï¼0.50±0.11ï¼, ï¼0.44±0.12ï¼, andï¼0.34±0.08ï¼, respectively. The difference between the significant effective group and the ineffective group was statistically significantï¼P<0.01ï¼. The gain of horizontal semicircular canal was positively correlated with EIï¼r=0.538 5, P<0.01ï¼ ãâ¡The occurrence rate of the anti-compensatory saccade in the significant effective group, the effective group, and the ineffective group wasï¼51.23±19.59ï¼, ï¼33.64±17.68ï¼, andï¼13.78±11.81ï¼, respectively. Pairwise comparisons between each group showed statistical significanceï¼P<0.05ï¼. The occurrence rate of anti-compensatory saccade was positively correlated with EIï¼r=0.658 2, P<0.01ï¼. Conclusion:The horizontal semicircular canal gain and the occurrence rate of the anti-compensatory saccade in SHIMP for patients with acute vestibular neuritis were closely correlated with decrease in DHI score.
Assuntos
Teste do Impulso da Cabeça , Neuronite Vestibular , Humanos , Neuronite Vestibular/fisiopatologia , Neuronite Vestibular/diagnóstico , Teste do Impulso da Cabeça/métodos , Feminino , Masculino , Tontura , Doença Aguda , Vertigem , Pessoa de Meia-Idade , Prognóstico , Adulto , Canais Semicirculares/fisiopatologiaRESUMO
People with multiple sclerosis (PwMS) who report dizziness often have gaze instability due to vestibulo-ocular reflex (VOR) deficiencies and compensatory saccade (CS) abnormalities. Herein, we aimed to describe and compare the gaze stabilization mechanisms for yaw and pitch head movements in PwMS. Thirty-seven PwMS (27 female, mean ± SD age = 53.4 ± 12.4 years old, median [IQR] Expanded Disability Status Scale Score = 3.5, [1.0]. We analyzed video head impulse test results for VOR gain, CS frequency, CS latency, gaze position error (GPE) at impulse end, and GPE at 400 ms after impulse start. Discrepancies were found for median [IQR] VOR gain in yaw (0.92 [0.14]) versus pitch-up (0.71 [0.44], p < 0.001) and pitch-down (0.81 [0.44], p = 0.014]), CS latency in yaw (258.13 [76.8]) ms versus pitch-up (208.78 [65.97]) ms, p = 0.001] and pitch-down (132.17 [97.56] ms, p = 0.006), GPE at impulse end in yaw (1.15 [1.85] degs versus pitch-up (2.71 [3.9] degs, p < 0.001), and GPE at 400 ms in yaw (-0.25 [0.98] degs) versus pitch-up (1.53 [1.07] degs, p < 0.001) and pitch-down (1.12 [1.82] degs, p = 0.001). Compared with yaw (0.91 [0.75]), CS frequency was similar for pitch-up (1.03 [0.93], p = 0.999) but lower for pitch-down (0.65 [0.64], p = 0.023). GPE at 400 ms was similar for yaw and pitch-down (1.88 [2.76] degs, p = 0.400). We postulate that MS may have preferentially damaged the vertical VOR and saccade pathways in this cohort.
Assuntos
Esclerose Múltipla , Reflexo Vestíbulo-Ocular , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/fisiopatologia , Esclerose Múltipla/complicações , Adulto , Reflexo Vestíbulo-Ocular/fisiologia , Idoso , Fixação Ocular/fisiologia , Movimentos da Cabeça/fisiologia , Movimentos Sacádicos/fisiologia , Teste do Impulso da Cabeça/métodosRESUMO
BACKGROUND: The cochlear implant (CI) is effective for rehabilitating patients with severe to profound sensorineural hearing loss. However, its placement and use have been associated with various complications, such as those affecting the vestibular system. The objective of this study was to compare vestibular function using the video head impulse test (vHIT) in pediatric patients before and after CI placement. METHODS: A descriptive and retrospective study was conducted. The outcomes of 11 pediatric patients of both sexes with a history of profound hearing loss were evaluated. The results of vestibular-ocular reflex (VOR) gain, saccades, asymmetry, Pérez Rey (PR) index, and VOR/saccade ratio for both ears obtained by the vHIT test before and after CI placement were compared. RESULTS: Of the 11 patients evaluated, the VOR gain showed that 81.8% had normal function, 18.2% had hypofunction, and no patients had hyperfunction before implantation. No statistically significant differences were found when compared with post-implant off and post-implant on conditions (p > 0.05). The extracted variables, asymmetry, PR index, and the VOR/saccades ratio also showed no statistically significant differences between the pre- and post-implant conditions, whether off or on. CONCLUSIONS: The vestibular function of pediatric patients did not show significant changes before and after CI placement. The vHIT test is a valuable tool for assessing vestibular function and could be considered a criterion for surgical and rehabilitation decisions in patients undergoing CI placement.
INTRODUCCIÓN: El implante coclear es un dispositivo eficaz para la rehabilitación de pacientes con hipoacusia neurosensorial severa a profunda. Sin embargo, su colocación y uso se ha asociado a diversas complicaciones, entre ellas a nivel del sistema vestibular. El objetivo del presente estudio fue comparar la función vestibular mediante la prueba de videoimpulso cefálico (vHIT) de pacientes pediátricos antes y después de la colocación del implante coclear. MÉTODOS: Se llevó a cabo un estudio descriptivo y retrospectivo. Se evaluaron los resultados de 11 pacientes pediátricos de ambos sexos con antecedente de hipoacusia profunda. Se compararon los resultados de ganancia del VOR, sacadas, asimetría, índice PR así como la relación VOR/sacadas para ambos oídos obtenidos mediante la prueba vHIT antes y después de la colocación del implante coclear. RESULTADOS: De los 11 pacientes evaluados, la ganancia del VOR mostró que el 81.8% tenía normofunción, 18.2% hipofunción y ningún paciente hiperfunción antes del implante. Al compararlo con la ganancia post implante apagado y post implante encendido no se encontraron diferencias estadísticamente significativas (p > 0.05). Las variables sacadas, asimetría, índice PR así como la relación VOR/sacadas tampoco mostraron diferencias estadísticamente significativas entre las condiciones pre y pos implante ya sea apagado o encendido. CONCLUSIONES: La función vestibular de pacientes pediátricos no mostró cambios significativos previo y posterior a la colocación del implante coclear. La prueba vHIT es una herramienta útil que permite evaluar la función vestibular y que podría considerarse como criterio para tomar decisiones quirúrgicas en pacientes que se encuentran en protocolo para implante coclear.
Assuntos
Implante Coclear , Implantes Cocleares , Teste do Impulso da Cabeça , Perda Auditiva Neurossensorial , Reflexo Vestíbulo-Ocular , Humanos , Feminino , Masculino , Teste do Impulso da Cabeça/métodos , Estudos Retrospectivos , Criança , Pré-Escolar , Reflexo Vestíbulo-Ocular/fisiologia , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/fisiopatologia , Perda Auditiva Neurossensorial/reabilitação , Gravação em Vídeo , Movimentos Sacádicos/fisiologia , Adolescente , Vestíbulo do Labirinto/fisiopatologiaRESUMO
OBJECTIVE: The purpose of this study was to evaluate the value of asymmetry values, gain, and pathological saccades of the video head impulse test (vHIT) in sudden sensorineural hearing loss (SSNHL). STUDY DESIGN: Retrospective study. SETTING: Tertiary referral center. PATIENTS: A total of 226 individuals diagnosed with unilateral definite SSNHL were hospitalized. The assessment included a comprehensive evaluation of medical history, pure-tone test, acoustic impedance, positional test, video nystagmography (VNG), vHIT, vestibular evoked myogenic potentials (VEMPs) and magnetic resonance. INTERVENTIONS: vHIT, VNG, cVEMP, oVEMP. Statistical analysis was performed with SPSS version 22.0 for Windows. MAIN OUTCOME MEASURES: The asymmetry values, gain, and pathological saccades of the vHIT. RESULTS: The abnormal gain of vHIT in anterior, horizontal, and posterior canal in SSNHL patients with vertigo were revealed in 20 of 112 (17.9%), 24 of 112 (21.4%), and 60 of 112 (53.6%), respectively. The vHIT pathological saccades (overt + covert) of anterior, horizontal, and posterior canal in SSNHL patients with vertigo were observed in 5 of 112 (4.6%), 52 of 112 (46.4%), and 58 of 112 (51.8%), respectively. Multivariate analysis indicated that the prognosis of patients with vertigo was correlated with vHIT gain of posterior canal, pathological saccade in horizontal canal, asymmetric ratio of horizontal canal gain, asymmetric ratio of posterior canal gain, Canal paresis (%) on caloric test and spontaneous nystagmus. CONCLUSION: In the vHIT of patients with SSNHL with vertigo, the posterior canal is most easily affected. Reduced gain of posterior canal, pathological saccade of horizontal canal, and larger asymmetric gain of posterior canal and horizontal canal may be negative prognostic factors.
Assuntos
Teste do Impulso da Cabeça , Perda Auditiva Neurossensorial , Perda Auditiva Súbita , Movimentos Sacádicos , Potenciais Evocados Miogênicos Vestibulares , Humanos , Teste do Impulso da Cabeça/métodos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Movimentos Sacádicos/fisiologia , Estudos Retrospectivos , Perda Auditiva Neurossensorial/fisiopatologia , Perda Auditiva Neurossensorial/diagnóstico , Idoso , Perda Auditiva Súbita/fisiopatologia , Perda Auditiva Súbita/diagnóstico , Potenciais Evocados Miogênicos Vestibulares/fisiologia , Adolescente , Vertigem/fisiopatologia , Vertigem/diagnóstico , Adulto Jovem , Imageamento por Ressonância Magnética , Idoso de 80 Anos ou maisRESUMO
Video head impulse tests (video-HITs) are commonly used for vestibular evaluation; however, the results can be contaminated by various artifacts, including technical errors, recording problems, and participant factors. Although video-HITs can be used in patients with Parkinson's disease (PD), the effect of neck rigidity has not been systematically investigated. This study aimed to investigate the effect of neck rigidity on video-HIT results in patients with PD. We prospectively recruited 140 consecutive patients with PD (mean age ± standard deviation = 68 ± 10 years, 69 men) between September 2021 and April 2024 at Korea University Medical Center. The video-HIT results were compared with those of 19 age- and sex-matched healthy participants. Neck rigidity was stratified as a subdomain of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale motor part (MDS-UPDRS-III). In 59 patients, the vestibulo-ocular reflex (VOR) gain was overestimated in at least one canal plane (58/140, 41%), mostly in the anterior canal (AC, n = 44), followed by the horizontal (HC, n = 15) and posterior canals (PC, n = 7). VOR gain overestimation was also observed in patients with no (18/58, 35%), subtle (20/58, 34%), or mild (17/58, 29%) neck rigidity. Multivariable logistic regression analysis showed that VOR overestimation was positively associated with neck rigidity (odds ratio [OR] [95% confidence interval] = 1.51 [1.01-2.25], p = 0.043). The head velocities of patients decreased during head impulses for the AC (p = 0.033 for the right AC; p = 0.014 for the left AC), whereas eye velocities were similar to those of healthy participants. Our findings suggest that neck rigidity may be a confounder that can contaminate video-HIT results. Thus, the results of video-HITs, especially for the AC, should be interpreted with the context of head velocity during head impulses in patients with neck rigidity.
Assuntos
Teste do Impulso da Cabeça , Rigidez Muscular , Doença de Parkinson , Reflexo Vestíbulo-Ocular , Gravação em Vídeo , Humanos , Doença de Parkinson/fisiopatologia , Doença de Parkinson/diagnóstico , Masculino , Feminino , Idoso , Teste do Impulso da Cabeça/métodos , Pessoa de Meia-Idade , Reflexo Vestíbulo-Ocular/fisiologia , Rigidez Muscular/etiologia , Rigidez Muscular/fisiopatologia , Rigidez Muscular/diagnóstico , Estudos Prospectivos , Músculos do Pescoço/fisiopatologiaRESUMO
PURPOSE: The objective of this study was to determine the normative vestibulo-ocular reflex gain output values of the computerized rotational head impulse test (crHIT) with stationary visual targets (earth bound) in healthy participants in each decade age band of life: 10-19, 20-29, 30-39, 40-49, 50-59, 60-69, and 70+ years. METHOD: Seventy-seven community-dwelling participants (10-85 years of age) with normal lateral semicircular canal (SCC) functioning and no symptoms or history of vestibular dysfunction were recruited through convenience sampling and assessed with the crHIT using stationary targets. These participants were assessed using two standard protocols in a randomized order. RESULTS: Results from 77 participants (M age = 46 years; 43 women, 34 men) were analyzed. Pearson's correlation coefficient and simple linear regression indicated a statistically significant relationship between crHIT gain output and age (p > .05) for right gain, 1030°/s2, and left gain, 1005°/s2. Although a statistically significant relationship was found, the slope was minor, demonstrating that the clinical effect of age on crHIT gain output was insignificant. Furthermore, no statistically significant relationship exists between crHIT gain output and gender (p > .05). Age-dependent normative data were calculated using the 2.5th and 97.5th confidence interval (CI) percentile method. The responses of angular vestibulo-ocular reflex (aVOR) gain values for crHIT are expected to occur within the range for lower limit reference interval (RI) of 0.85-0.9 and upper limit RI of 1.11-1.18 for 1030°/s2 and lower limit RI of 0.86-0.92 and upper limit RI of 1.13-1.16 for 1005°/s2. It can be expected that 90% CI of the population with normal lateral SCC functioning will have aVOR gain values that fall within this range. CONCLUSION: Despite a statistically significant relationship that exists with aVOR gain output and age, the changes are minor, declining by 0.0088 units per 10 years, justifying the same normative data for all decade age bands.
Assuntos
Teste do Impulso da Cabeça , Reflexo Vestíbulo-Ocular , Humanos , Masculino , Pessoa de Meia-Idade , Feminino , Adulto , Idoso , Teste do Impulso da Cabeça/métodos , Reflexo Vestíbulo-Ocular/fisiologia , Adolescente , Adulto Jovem , Idoso de 80 Anos ou mais , Valores de Referência , Criança , Fatores Etários , Canais Semicirculares/fisiologia , Rotação , Diagnóstico por Computador/métodosRESUMO
BACKGROUND: Patients presenting to the emergency department with acute vertigo pose a diagnostic challenge. While 'benign' peripheral vestibulopathy is the most common cause, the possibility of a posterior circulation stroke is paradoxically the most feared and missed diagnosis in the emergency department. OBJECTIVES: This review will attempt to cover the significant advances in the ability to diagnose acute vertigo that have occurred in the last two decades. The review discusses the role of neurological examinations, imaging and specific oculomotor examinations. The review then discusses the relative attributes of the Head Impulse-Nystagmus-Test of Skew plus hearing ('HINTS+') examination, the timing, triggers and targeted bedside eye examinations ('TiTrATE'), the associated symptoms, timing and triggers, examination signs and testing ('ATTEST') algorithm, and the spontaneous nystagmus, direction, head impulse testing and standing ('STANDING') algorithm. The most recent technological advancements in video-oculography guided care are discussed, as well as other potential advances for clinicians to look out for.
Assuntos
Vertigem , Humanos , Vertigem/diagnóstico , Vertigem/terapia , Doença Aguda , Teste do Impulso da Cabeça/métodos , Algoritmos , Exame Neurológico/métodos , Testes de Função Vestibular/métodos , Diagnóstico Diferencial , Serviço Hospitalar de Emergência , Nistagmo Patológico/diagnósticoRESUMO
Objective: We describe an uncharacteristic vestibular-ocular reflex (VOR) pattern, studied by video head impulse tests (VHIT) in patients suffering from unilateral isolated posterior semicircular canal (PSC) hypofunction. In these patients, we found an upward sliding of the eyes, followed by an oblique downward catch-up saccade during horizontal head impulse to the healthy side. Methods: We present a retrospective study of all VHIT exams presenting isolated PSC hypofunction between May 2020 and November 2022. Results: We found 37 patients, which led to the discovery of such incongruent eye movement in 19 cases; their gain data are shown and compared to the remaining 18 cases in which such an anomaly was absent. A control group of 31 healthy subjects was recruited to define the reference criteria for VHIT gain values. The correlation between the amplitude of the vertical saccade and the relative functional imbalance of the vertical semicircular canals was studied. Conclusions: We have observed that in approximately half of the subjects with isolated CSP deficiency, there is a VOR anomaly. A possible pathophysiological explanation of the unbalanced effect of vertical semicircular canal stimulation of a labyrinth during horizontal head thrust toward the opposite side is proposed. The planar incongruity of the response of the VOR described here appears more evident at the onset of the CSP deficit. Current VHIT systems do not detect this incongruent eye reflex. They can lead to an error in gain evaluation (pseudo-deficit) of the lateral semicircular canal of the healthy side and problems in performing the test (trace rejected). In the future, software for VHIT should take into account the possibility of non-coplanar ocular responses to cephalic stimuli.
Assuntos
Teste do Impulso da Cabeça , Reflexo Vestíbulo-Ocular , Movimentos Sacádicos , Canais Semicirculares , Humanos , Estudos Retrospectivos , Movimentos Sacádicos/fisiologia , Canais Semicirculares/fisiopatologia , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Reflexo Vestíbulo-Ocular/fisiologia , Idoso , Adulto JovemRESUMO
BACKGROUND: Differential diagnosis of acute vertigo syndrome is challenging given the similarities between clinical presentations of posterior circulation stroke and peripheral vestibular dysfunction. The Head Impulse, Nystagmus, Test of Skew ('HINTS') assessment is a clinical bedside test used to aid diagnosis. METHODS: Comprehensive training on use of the Head Impulse, Nystagmus, Test of Skew assessment was provided to one stroke consultant, and the effectiveness of the test in that setting was assessed. Further education was completed with more members of the stroke and emergency department multi-disciplinary team. Quality improvement measures including magnetic resonance imaging use and bed utilisation were explored. RESULTS: Following training of one stroke consultant, the Head Impulse, Nystagmus, Test of Skew assessment was found to be a feasible, accurate bedside test within this acute stroke service. Further training for the multi-disciplinary team was completed, but outcome measures were not explored because of the coronavirus disease 2019 pandemic and maternity leave. CONCLUSION: There is a role for trained members of the multi-disciplinary team to successfully use the Head Impulse, Nystagmus, Test of Skew assessment in hyperacute stroke settings, to aid diagnosis in acute vertigo syndrome.
Assuntos
Teste do Impulso da Cabeça , Acidente Vascular Cerebral , Vertigem , Humanos , Diagnóstico Diferencial , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Teste do Impulso da Cabeça/métodos , Vertigem/diagnóstico , Nistagmo Patológico/diagnóstico , COVID-19/complicações , COVID-19/diagnóstico , Testes de Função Vestibular/métodos , Síndrome , Doenças Vestibulares/diagnósticoRESUMO
OBJECTIVE: Acute unilateral peripheral vestibulopathy (AUPVP) is a frequent form of peripheral vestibular vertigo characterized by unilateral vestibular organ dysfunction. Diagnostic challenges in anamnesis and bedside examination can lead to potential misdiagnoses. This study investigated the sensitivity of bedside examinations in diagnosing AUPVP. METHODS: This retrospective analysis examined 136 AUPVP inpatients at a level 3 university hospital between 2017 and 2019. Demographic data and bedside test results were collected. Instrumental otoneurological tests included caloric testing and video head impulse test (HIT). The sensitivity of each bedside parameter was computed based on the instrumental diagnostics, and statistical analyses were performed. RESULTS: The study included 76 men and 60 women, with a mean age of 59.2 years. Spontaneous nystagmus exhibited a sensitivity of 92%, whereas the absence of skew deviation was identified with a sensitivity of 98%. Abnormal bedside HIT showed a sensitivity of 87%. The combined HINTS (HIT, nystagmus, and test of skew) had a sensitivity of 83%. The Romberg test and Fukuda test demonstrated sensitivities of 26% and 48%, respectively. CONCLUSION: The sensitivity of bedside tests varied from 26% to 98%. This aligns with previous literature, highlighting the challenge of differentiating AUPVP from vestibular pseudoneuritis solely through bedside examination. Although the tests excel in excluding central causes, they are insufficient for diagnosing AUPVP with certainty. In addition, the bedside examination sensitivities vary widely, and early radiological imaging can be misleading. Therefore, this study underlines the necessity of prompt otoneurological testing for accurate exclusion of vestibular pseudoneuritis and thus improve patient outcomes.