Efficacy of Vestibular Rehabilitation Following Acute Vestibular Neuritis: A Randomized Controlled Trial.

OBJECTIVE: To investigate whether a vestibular rehabilitation program started early after diagnosis of vestibular neuritis combined with standard care reduces dizziness and improves functions of daily life more effectively than standard care alone in patients with acute vestibular neuritis. STUDY DESIGN: Non-blinded, randomized controlled trial with 2 parallel groups. SETTING: Specialist centers in 2 university hospitals. PATIENTS: Patients, 18-70 years, with acute vestibular neuritis confirmed by videonystagmography. INTERVENTION: Standard care was 10 days of prednisolone, general information, and counseling given to all patients. In addition to standard care, the intervention group received supervised exercise therapy (vestibular rehabilitation). Vestibular rehabilitation was given in a group format, individually tailored, and supported by home exercises. MAIN OUTCOME MEASURE: Perceived dizziness during head motion. Secondary outcomes were walking speed, standing balance, Hospital Anxiety and Depression Scale (HADS), Vertigo Symptom Scale, Visual Analog Scales (VASs), Dizziness Handicap Inventory (DHI), The University of California Los Angeles Dizziness Questionnaire. RESULTS: Sixty-five patients were included, 27 participated in the vestibular rehabilitation group. There was a statistically significant difference in favor of the vestibular rehabilitation group in overall perceived dizziness at 3 (p = 0.007) and 12 months (p = 0.001). No statistically significant differences were found in standing balance and walking speed. Results from self-report measures showed a statistically significant difference at 12 months in HADS (p = 0.039), DHI (p = 0.049) and VAS-C (p = 0.012). CONCLUSION: A vestibular rehabilitation program started early after confirmed vestibular neuritis diagnosis in addition to standard care reduces the perception of dizziness and improves functions of daily life more effectively than standard care alone.

Ocular vestibular-evoked myogenic potentials (oVEMP) to skull taps in normal and dehiscent ears: mechanisms and markers of superior canal dehiscence.

The site of stimulus delivery modulates the waveforms of cervical- and ocular vestibular-evoked myogenic potentials (cVEMP and oVEMP) to skull taps in healthy controls. We examine the influence of stimulus location on the oVEMP waveforms of 18 patients (24 ears) with superior canal dehiscence (SCD) and compare these with the results of 16 healthy control subjects (32 ears). oVEMPs were recorded in response to taps delivered with a triggered tendon-hammer and a hand-held minishaker at three midline locations; the hairline (Fz), vertex (Cz) and occiput (Oz). In controls, Fz stimulation evoked a consistent oVEMP waveform with a negative peak (n1) at 9.5 ± 0.5 ms. In SCD, stimulation at Fz produced large oVEMP waveforms with delayed n1 peaks (tendon-hammer = 13.2 ± 1.0 ms and minitap = 11.5 ± 1.1 ms). Vertex taps produced diverse low-amplitude waveforms in controls with n1 peaks at 15.5 ± 1.2 and 13.2 ± 1.3 ms for tendon-hammer taps and minitaps, respectively; in SCD, they produced large amplitude oVEMP waveforms with n1 peaks at 12.9 ± 0.8 ms (tendon-hammer) and 12.1 ± 0.5 ms (minitap). Occiput stimulation evoked oVEMPs with similar n1 latencies in both groups (tendon-hammer = 11.3 ± 1.3 and 10.7 ± 0.8; minitap = 10.3 ± 0.9 and 11.1 ± 0.4 for control and SCD ears, respectively). Compared to reflex amplitudes, n1 peak latencies to Fz taps provided clearer separation between SCD and control ears. The distinctly different effects of Fz and vertex taps on the oVEMP waveforms may represent an additional non-osseous mechanism of stimulus transmission in SCD. For skull taps at Fz, a prolonged n1 latency is an indicator of SCD.

Ocular vestibular evoked myogenic potentials: skull taps can cause a stimulus direction dependent double-peak.

OBJECTIVE: To explore the mechanisms for skull tap induced ocular vestibular evoked myogenic potentials (oVEMP). METHODS: An electro-mechanical "skull tapper" was used to test oVEMP in response to four different stimulus sites (forehead, occiput and above each ear) in healthy subjects (n=20) and in patients with unilateral loss of vestibular function (n=10). RESULTS: In normals, the oVEMP in response to forehead taps and the contra-lateral oVEMP to taps above the ears were similar. These responses had typical oVEMP features, i.e. a short-latency negative peak (n10) followed by a positive peak (p15). In contrast, the ipsi-lateral oVEMP to the laterally directed skull taps, as well as the oVEMP to occiput taps, had an initial double negative peak (n10+n10b). In patients with unilateral loss of vestibular function, the crossed responses from the functioning labyrinth were very similar to the corresponding oVEMP in normals. CONCLUSIONS: The present data support a theory that skull tapping may cause both a response that is more stimulus direction dependent and one that is less so. SIGNIFICANCE: Whereas the stimulus direction dependent occurrence of the negative double-peak might reveal the functional status of one part of the labyrinth, the rather stimulus direction-independent response might reveal the functional status of other parts.