Vestibular Impairments on Objective Diagnostic Tests in HIV+ Women and Control Men and Women.

OBJECTIVE: To describe the value of two vestibular test batteries across ages in healthy men and women for detecting vestibular disorders and to compare the occurrence of vestibular disorders in the healthy adult population and women with human immunodeficiency virus (HIV) disease. STUDY DESIGN: Two groups were tested on the battery of objective diagnostic tests of the vestibular system. SETTING: Two tertiary care centers. SUBJECTS: Healthy controls (284 women and 105 men) and women (63) with HIV/AIDS (HIV+) who are being followed up in a longitudinal study of HIV. They were tested on objective diagnostic tests of the vestibular system. RESULTS: In all age decades, healthy controls had evidence of vestibular impairment, significantly more in older adults. HIV+ subjects, all females, did not differ from healthy control females. CONCLUSION: These data suggest that at all ages, people do have decreased vestibular function, even young, asymptomatic, and apparently healthy adults. HIV disease, itself, does not cause an increased prevalence of peripheral vestibular disorders when HIV is controlled on antiretroviral medication. LEVEL OF EVIDENCE: 2 Laryngoscope, 131:E2318-E2322, 2021.

Usefulness of Exam Questions and Vital Signs for Predicting the Outcome of Objective Vestibular Tests.

OBJECTIVES/HYPOTHESIS: To determine the value of standard clinic screening questions and vital signs in predicting abnormal vestibular function, indicated by standard objective diagnostic tests. STUDY DESIGN: Retrospective records review. METHODS: We reviewed electronic medical records of 150 patients seen by the neurotologists or the physician assistant they supervised, in an out-patient tertiary care clinic, between June 2018 and March 2020, and subsequently referred for the complete objective vestibular test battery (VB). RESULTS: Of standard questions asked during the initial exam about vertigo, disequilibrium, lightheadedness and oscillopsia, only vertigo predicted an abnormal response on the VB. More males than females had abnormal VB responses, P < .05. Pulse was not related to VB score. Significantly more subjects with blood pressure in the range for stage 2 hypertension (blood pressure [BP] stage 2) had abnormal than normal results on the VB, P < .00001. Subjects with BP stage 2 had high rates of diabetes (34.2%) and hypertension (68.4%) as diagnosed by their primary care physicians or cardiologists. CONCLUSION: Complaints of subjective vertigo and BP in the range of hypertension stage 2 are most likely to predict abnormal findings on the VB. Therefore, during an examination of a patient who comes in complaining of dizziness, two measures may be the most useful for screening: BP in the range of hypertension type 2, when BP is taken by a nurse, and a question to determine whether or not the patient has true vertigo. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:1382-1385, 2021.

The skull vibration-induced nystagmus test: A useful vestibular screening test in children with hearing loss.

INTRODUCTION: Skull-Vibration-Induced-Nystagmus Test (SVINT), a non-invasive first line examination test, stimulates both otolith and canal structures and shows instantaneously a vestibular asymmetry. This study aimed to analyze the SVINT results observed in children with hearing loss (HL) amplified with hearing aids (HA) or unilateral cochlear implant (uCI) and healthy children. MATERIAL AND METHODS: This case-control study compared the results of SVINT, caloric test (CaT) and video head-impulse-test (VHIT) in 120 controls to 30 children with HA and 30 with uCI, aged 5-18 years old. SVINT was recorded with videonystagmography after very high frequency (VHF) stimulation of mastoids and vertex. RESULTS: SVINT results were non-pathological in 98% of the control group but modified in the HL group (P-value=0.04). In uCI participants, 13.3% had a bilateral weakness (BW) and 16.7% had a unilateral weakness (UW). In the HA group, 26.7% had BW, 10% had UW. SVINT was efficient to show a UW (6 out of 7 confirmed cases) but not efficient to show BW (1/12 confirmed cases). CONCLUSION: SVINT can detect unilateral vestibular deficit in the VHF with a sensitivity of 86% and specificity of 96%. The positive predictive value is 75% and negative predictive value is 98%. In the case of bilateral deficit, the SVINT is inoperant. In amplified participants, a UW was equally detected whether using SVINT, CaT or VHIT. SVINT is a well-tolerated and useful test to screen vestibular asymmetry in children with HL when combined with other vestibular tests and shows its complementary at very high frequencies.

Assessment of Vestibular Function in Adults with Prelingual Hearing Loss Using c/oVEMP Tests.

OBJECTIVES: The aim of the present study was to compare the vestibular system integrity of individuals with normal hearing with that of prelingual hearing impaired individuals. It is well known that ocular vestibular evoked myogenic potentials (oVEMPs) reflect utricular function, whereas cervical vestibular evoked myogenic potentials (cVEMPs) reflect saccular function. Therefore, oVEMP and cVEMP tests were applied to evaluate the vestibular system integrity of hearing impaired individuals participating in the research. MATERIALS AND METHODS: The study group consisted of sensorineural prelingual hearing-loss volunteers aged from 18 to 60 years, whereas the control group consisted of age- and gender-matched healthy volunteers. cVEMP and oVEMP tests were performed to evaluate the integrity of the vestibular system, and the results were compared with those of the control group. RESULTS: The study included 20 (76.9%) women and 6 (23.1%) men in the study group; on the other hand, the control group consisted of 19 (73.1%) women and 7 (26.9%) men. There was a difference between the study group and the control group when oVEMP and cVEMP responses were compared, and the response percentage was higher in the control group. The response rates of oVEMP and cVEMP in patients with prelingual hearing loss were 44.2% and 59.6%, respectively. There was also a statistically significant difference between the groups for oVEMP amplitude and cVEMP P1 latency (p≤0.05). CONCLUSION: These findings suggest that prelingual hearing loss is related to both utricular and saccular dysfunctions. However, oVEMPs were more often abnormal in prelingual deaf patients than cVEMPs, suggesting that utricular dysfunction may be more common than saccular dysfunction.

Clinician Use and Payments by Medical Specialty for Audiometric and Vestibular Testing Among US Medicare Beneficiaries.

Importance: Variations in diagnostic test use may indicate that there are opportunities for quality improvement in vestibular health care. To date, the extent to which clinician acquisition of tests varies nationwide by region and specialty of the clinician is unknown. Objective: To quantify variation in clinician use and payments for audiograms and vestibular tests across all geographic regions of the United States and by specialty of practice. Design, Setting, and Participants: This cross-sectional study used a population-based sample of 1 307 887 audiovestibular test claims from fee-for-service Medicare beneficiaries aged 65 years or older in the Medicare Provider Utilization and Payment Public Use File from January 1 through December 31, 2014. The analysis was completed from January 2 through June 1, 2019. Exposures: Diagnostic audiograms, caloric testing, and rotary chair testing. Main Outcomes and Measures: Test utilization was analyzed by hospital referral region, medical specialty, and total payments. Results: In 2014, clinicians performed 1 213 328 audiograms, 317 880 caloric tests (ie, single caloric irrigations), and 62 779 rotary chair tests, for a total of $38 647 350.21 in Medicare payments from the Centers for Medicare & Medicaid Services. No patient or clinician demographic characteristics were available. Across health care referral regions, rates of testing per 100 000 beneficiaries varied from 166 to 12 021 for audiograms, 15 to 4271 for caloric tests, and 13 to 3556 for rotary chair tests between the lowest-use and highest-use regions. Most audiograms and caloric tests were billed by audiologists (797 957 audiograms [65.8%]; 112 485 caloric tests [35.4%]) and otolaryngologists (376 728 audiograms [31.0%]; 70 567 caloric tests [22.2%]). In contrast, primary care physicians (18 933 [30.2%]) and neurologists (15 254 [24.3%]) billed the largest proportion of rotary chair tests compared with other specialists, including audiologists (7253 [11.6%]) and otolaryngologists (6464 [10.3%]). Conclusions and Relevance: Substantial geographic and clinician-level variation may have been observed in use of audiovestibular tests. Quality improvement efforts in vestibular health care may need to target a range of clinicians, including primary care physicians to be successful.

Head-Shaking Nystagmus in the Early Stage of Unilateral Meniere's Disease.

OBJECTIVES: The aim of the present study was to evaluate the ability of head-shaking nystagmus (HSNy), evoked after the resolution of a vertigo spell, to predict an imminent crisis in the early stage of Meniere's disease (MD). MATERIALS AND METHODS: A total of 20 patients in the early stage of MD were included in the study. The head-shaking test (HST) was performed twice, during the first visit within 24 h of vertigo spell (T0) and 48 h later (T1). The onset of a new vertigo episode during the 2 weeks following the first visit was recorded in each patient's medical record. The sensitivity and specificity of HSNy toward predicting a new vertigo episode were calculated. RESULTS: At T0, an evoked ipsilesional HSNy in 15 (75%) patients was observed; in four of them, the HSNy had a biphasic component. The HSNy was present and persistent at T1 in 8 (42.1%) patients; among these cases, 6 patients had ipsilesional HSNy, and 2 patients a contralesional HSNy. None of the patients presented with a biphasic HSNy at T1. Seven (36.8%) patients experienced the recurrence of a vertigo crisis. Among these, 6 patients had ipsilesional HSNy at T1. Only 8 patients with ipsilesional HSNy at T0 did not have recurrence. The sensitivity of the ipsilesional HSNy in predicting the recurrence of vertigo in patients with MD was 100% at T0 and 85.7% at T1. The specificity was 46.6% and 100% at T0 and T1, respectively. CONCLUSION: The HST can be a useful test in the early stages of MD to predict a new vertigo attack.

Menière's Disease and Caloric Stimulation: Some News from an Old Test.

OBJECTIVES: The aim of the present study was to improve the instrumental diagnosis of assessing Menière's disease (MD) if the frequency and slow-phase velocity (SPV) of the thermally induced nystagmus analyzed through the caloric vestibular test (CVT) showed different alterations in relationship with an increasing severity of the cochlear involvement. MATERIALS AND METHODS: The study retrospectively analyzed the CVT results of 72 patients affected by unilateral "definite MD" according to the 2015 Barany Society Diagnostic Criteria and treated only conservatively. RESULTS: There were 7 (9.72%) patients in stage 1, 27 (37.50%) in stage 2, 35 (48.61%) in stage 3, and 3 (4.16%) in stage 4. The canal paresis (CP) calculated through the frequency of the thermally induced nystagmus on the affected side increased in more severe stages (p=0.033). Conversely, the CP calculated through the SPV was not significantly different among the stages showing abnormal values even in the early phases of the disease (71% in stage 1, 81% in stage 2, 91% in stage 3, and 100% in stage 4), exclusively on the affected side. CONCLUSION: Abnormalities of the thermally induced nystagmus on the affected side characterize most patients with MD, but only "SPV" alterations are common in the early stages. An increasing severity of the cochlear involvement progressively reflects also on the "frequency" parameter. Detecting a dissociation between these two parameters could represent an instrumental marker of the early forms of MD. Cite this article as: Cerchiai N, Navari E, Miccoli M, Casani AP. Menière's Disease and Caloric Stimulation: Some News from an Old Test. J Int Adv Otol 2019; 15(3): 442-6.

Vestibular Test Patterns in the NICoE Intensive Outpatient Program Patient Population.

The National Intrepid Center of Excellence (NICoE), on the campus of Walter Reed National Military Medical Center, was developed to help improve the lives of active duty service members (SMs) with traumatic brain injury (TBI) and comorbid behavioral health (BH) conditions. During the NICoE intensive outpatient program, SM who have all been identified as having some degree of TBI, undergo extensive interdisciplinary evaluations, including comprehensive vestibular assessment. These SMs sometimes present with vestibular symptoms ranging from lightheadedness to vertigo associated with the dual TBI/BH diagnoses, and vestibular testing results reported elsewhere have varied among this population. The study's purpose was to collate the vestibular test results obtained from a sample of the NICoE patients to determine if specific tests have a tendency to be abnormal in these SMs. Results indicate that oculomotor tests, particularly pursuit and saccade, were most often abnormal. The vertical subtests of the pursuit and saccade tests were abnormal more frequently than the horizontal subtests, suggesting that the vertical subtests should be utilized when evaluating the TBI population. Overall, oculomotor tests of vertical pursuit and saccades, as well as tests of central vestibular function, appear useful for detecting neurologic changes in active duty SMs with chronic symptoms after TBI.

Probable Benign Paroxysmal Positional Vertigo Converts into Definite BPPV in One in Six Patients.

OBJECTIVE: Patients with positional vertigo who have a positive Dix-Hallpike (DH) test are diagnosed as having definite benign paroxysmal positional vertigo (BPPV), and those who have a negative DH test as having probable BPPV. Little is known about the course of the disease in the latter group. The aim of the present study was to assess how many patients with probable BPPV convert into having a positive DH test during follow-up. MATERIALS AND METHODS: We included new patients who had experienced typical positional vertigo within the past 4 weeks and had a negative DH test. Patients were followed up over a period of 8 weeks. If the symptoms re-occurred, they were invited to return to the clinic for diagnostic DH test and, if positive, treated with a canalith repositioning maneuver. RESULTS: During the inclusion period of 18 months, 167 patients had probable BPPV, in which 43 fulfilled the inclusion criteria. The mean age of the patients was 57 (SD 14.5) years. Of the patients, 27 (63%) were females. During follow-up, 25 (58%) patients suffered from recurring positional vertigo, in which 13 underwent the DH test. Of the 13 patients, 8 were positive in 7 (16%) patients; 1 patient had a positive DH test twice. CONCLUSION: Among patients with a history of BPPV but a negative DH test at the first consultation, more than half (58%) experienced positional vertigo within 8 weeks. In 1 of 6 patients, the diagnosis was changed from probable to definite BPPV. Our advice to professionals who are confronted with a patient with symptoms of BPPV, but with a negative DH test, is to adopt a policy of low-threshold access for patients with recurring symptoms.

Stereotactic radiotherapy of vestibular schwannoma : Hearing preservation, vestibular function, and local control following primary and salvage radiotherapy.

OBJECTIVE: The aim of this publication is to present long-term data on functional outcomes and tumor control in a cohort of 107 patients treated with stereotactic radiotherapy (RT) for vestibular schwannoma. PATIENTS AND METHODS: Included were 107 patients with vestibular schwannoma (primary or recurrent following resection) treated with stereotactic RT (either fractioned or single-dose radiosurgery) between October 2002 and December 2013. Local control and functional outcomes were determined. Analysis of hearing preservation was limited to a subgroup of patients with complete audiometric data collected before treatment and during follow-up. Vestibular function test (FVT) results could be analyzed in a subset of patients and were compared to patient-reported dizziness. RESULTS: After a mean follow-up of 46.3 months, actuarial local control for the whole cohort was 100% after 2, 97.6% after 5, and 94.1% after 10 years. In patients with primary RT, serviceable hearing was preserved in 72%. Predictors for preservation of serviceable hearing in multivariate analysis were time of follow-up (odds ratio, OR = 0.93 per month; p = 0.021) and pre-RT tumor size (Koos stage I-IIa vs. IIb-IV; OR = 0.15; p = 0.031). Worsening of FVT results was recorded in 17.6% (N = 3). Profound discrepancy of patient-reported dizziness and FVT results was observed after RT. In patients with primary RT, worsening of facial nerve function occurred in 1.7% (N = 1). CONCLUSION: Stereotactic RT of vestibular schwannoma provides good functional outcomes and high control rates. Dependence of hearing preservation on time of follow-up and initial tumor stage has to be considered.

The impaired subjective perception of verticality independent of peripheral vestibular function in dizzy elderly with orthostatic hypotension.

BACKGROUND: The elderly often complain of faintness, lightheadedness, dizziness, and unsteadiness, which may be associated with the orthostatic hypotension (OH), but most of them are subclinical. The pathogenic mechanism of subjective symptoms in the elderly with OH is controversial. AIMS: The aim of this study was to assess the involvement of the irregularity of the vertical perception in the dizzy elderly with OH. METHODS: This study consisted of 403 patients seeking treatment for dizziness in our hospital. The neurotological examinations include the subjective visual vertical (SVV) test and the bithermal caloric test. The self-perceived handicapping effects imposed by dizziness were assessed by the dizziness handicap inventory (DHI). The variability (standard deviation) and the average deviation of eight trials (four trials in each direction) were calculated. In addition, they underwent the orthostatic Schellong test for the diagnosis of the OH. They were separated into three groups, including patients aged ≥65 years, patients aged 50-64 years, and patients aged <50 years. RESULTS: The variability of the SVV in the patients aged ≥65 years with OH was significantly larger than that in the patients aged ≥65 years without OH. There was no significant difference in the average deviation of the SVV, the canal paresis % by the bithermal caloric test, and the DHI score among groups. CONCLUSIONS: The result suggests that the elderly patients with OH have subclinical impairment in the perception of the verticality independent of the peripheral vestibular function.

Impacto del implante coclear en la función vestibular periférica / Impact of cochlear implantation in peripheral vestibular function / Impacto do implante coclear na função vestibular periferica

Introducción: el implante coclear (IC) se ha convertido en el tratamiento más efectivo para la hipoacusia neurosensorial severa-profunda. En los últimos años se han ampliado sus indicaciones, especialmente los casos bilaterales. Es por ello que en la comunidad otológica surge el interrogante de cómo puede afectar a la función vestibular la inserción de un array de electrodos intracocleares. Material y método: Estudio descriptivo, de tipo longitudinal, entre diciembre de 2013 y julio de 2016. Se realizó una revisión de 92 historias clínicas de pacientes que se sometieron a implante coclear en el mismo centro por el mismo equipo y cumplían criterios de inclusión. Resultados: De los 92 pacientes evaluados en el preoperatorio se observaron: Normofunción vestibular bilateral: 56 pacientes (60,8%), Hipofunción vestibular bilateral: 13 pacientes (14,1%), Hipofunción vestibular unilateral: 21 pacientes (22,8%). De los 46 oídos evaluados pre y post IC, un 14,8% (7 pacientes) presentaron hipofunción vestibular post IC, con normofunción previa. Solo 2 pacientes del total de la muestra presentaron sintomatología vestibular severa, con hipovalencias objetivadas en el post operatorio. Conclusiones: Se recomienda evaluar la función vestibular periférica en todos los pacientes candidatos a implante coclear, ya que de no existir otras consideraciones podría ser de utilidad a la hora de definir el lado a implantar.

Introduction: cochlear implant (IC) has become the most effective treatment for severe-deep neurosensory hearing loss. In recent years, indications have been extended, especially bilateral cases. This is why in the otological community the question arises as to how insertion of an array of intracochlear electrodes can affect the vestibular function. Material and method: A descriptive longitudinal study between december 2013 and july 2016. A review of 92 clinical records of patients who underwent cochlear implantation at the same center by the same team and met inclusion criteria were performed. Results: Of the 92 patients evaluated in the preoperative period, bilateral vestibular normobility: 56 patients (60.8%), bilateral vestibular hypofunction: 13 patients (14.1%), unilateral vestibular hypofunction: 21 patients (22.8%). Of the 46 ears assessed pre- and post-IC, 14.8% (7 patients) presented vestibular hypofunction post-IC, with previous normofunction. Only 2 patients from the total sample had severe vestibular symptoms, with postoperative hypovalences. Conclusions: It is recommended to evaluate the peripheral vestibular function in all patients candidates for cochlear implants since, if there were no other considerations, it might be useful to define the side to be implanted.

Introdução: el implante coclear (IC) se ha transformado no tratamento mais efectivo para a hipoacusia neurosensorial severa-profunda. Os últimos juros se han ampliado sus indicaciones, especialmente os casos bilaterais. É por isso que na comunidade otológica surge o interrogante de como pode afetar a função vestibular a inserção de uma matriz de eletrodos intracocleares. Material e método: Estudo descritivo, de tipo longitudinal, entre dezembro de 2013 e julho de 2016. Se realizou uma revisão de 92 historias clínicas de pacientes que se tornaram mais importantes um implante coclear em si mesmo por meio do mesmo e consideramos critérios de inclusão. Resultados: De los 92 pacientes avaliados no pré- operatório observado: Normofunção vestibular bilateral: 56 pacientes (60,8%), Hipofunção vestibular bilateral: 13 pacientes (14,1%), Hipofunção vestibular unilateral: 21 pacientes (22,8%). De los 46 oídos avaliados e pós IC, un 14,8% (7 pacientes) apresentaram hipofunção vestibular post IC, con normofunción previa. Solo 2 pacientes do total da amostra apresentaram sintomatologia vestibular severa, com hipovalencias objetivadas no pós-operatório. Conclusões: verificar a função vestibular periférica em todos os pacientes candidatos a implante coclear ya que não existe de outras formas consideradas poder ser de utilidade à hora de definir o lado a implantar.

Development of a Statistical Model for the Prediction of Common Vestibular Diagnoses.

IMPORTANCE: Treatment of patients with vestibular disorders can be complex, requires lengthy clinic visit time, and uses greater clinical resources for diagnosis. A pre-encounter intake questionnaire may predict the most common disorders, allowing for more efficient allocation of resources and use of clinicians. OBJECTIVE: To develop a statistical model for predicting vestibular diagnoses, prior to clinical evaluation, from an intake questionnaire. DESIGN, SETTING, AND PARTICIPANTS: Retrospective review of 414 consecutive new vestibular patient intake questionnaires (September 2012 through January 2014) and associated medical records with performance of logistic regression analyses and development of predictive models (July 2013 through May 2015). INTERVENTIONS: Use of a vestibular intake questionnaire for triaging of new patients with complaints of dizziness. MAIN OUTCOMES AND MEASURES: Predictors for the diagnosis of benign paroxysmal positional vertigo (BPPV), Ménière's disease, and vestibular migraine. RESULTS: Of the 414 questionnaires analyzed, 381 (92%) had clinician information necessary to define a final diagnosis. Patients were 34% male and had a mean (range) age of 57 (19-91) years. Of the diagnoses, 183 (48%) were ear related (including 103 BPPV and 49 Meniere's disease), 141 (37%) neurological (including 109 vestibular migraine), 36 (9%) medical, 8 (2%) of psychological origin, 46 (12%) of unknown etiology, and 33 (9%) other causes. The diagnosis of BPPV could be predicted from 4 variables with a sensitivity of 79% and specificity of 65%. The diagnosis of Ménière's disease could be predicted from 5 variables with a sensitivity of 81% and specificity of 85%. The diagnosis of vestibular migraine could be predicted from 4 variables with a sensitivity of 76% and specificity of 59%. CONCLUSIONS AND RELEVANCE: A pre-encounter history questionnaire can provide useful diagnostic information for common vestibular disorders. This can help direct appointment scheduling to improve clinical efficiency, time to intervention, and use of resources. Further refinement may enable the use of shorter questionnaires or screening algorithms.

Caracterización de las alteraciones vestibulares en pacientes con síndrome de latigazo cervical / Vestibular disorders in patients with whiplash injury syndrome

Objetivo: Determinar la prevalencia de alteraciones vestibulares en pacientes con síndrome de latigazo cervical (SLC). Material y método: Estudio transversal en 24 pacientes consecutivos atendidos por presentar SLC con grado II o III de la Quebec Task Force y tiempo de evolución menor de seis meses. Se realizó exploración clínica vestibular completa y exploración instrumental con videonistagmografía (VNG), incluyendo prueba calórica bitérmica, registro de potenciales evocados miogénicos vestibulares (VEMPs), prueba de la vertical visual subjetiva (VVS) y posturografía dinámica. También fueron evaluados mediante los cuestionarios SF-36 (salud general), DHI-S (discapacidad vestibular) y SIMS (simulación). Resultados: La prevalencia de alteraciones vestibulares se situó en el 25%. El reflejo vestíbulo-cólico evaluado mediante VEMPs estaba alterado en el 25% de los pacientes con SLC. La VSV se encontraba alterada en el 17% de los casos. La posturografía dinámica identificó un patrón vestibular en el 25% de los casos. La estimación de simulación entre los pacientes con SLC se produjo, al menos, en el 25% de los casos. Conclusión: La alteración de varias pruebas vestibulares en pacientes con SLC sugiere una disfunción vestibular asociada a ILT prolongada. Las puntuaciones elevadas en los cuestionarios de discapacidad vestibular (DHI) y de simulación de síntomas (SIMS) podrían ser utilizadas como indicadores de percepción de trastorno vestibular grave e ILT prolongada (AU)

Objective: To determine the prevalence of vestibular dysfunction in patients with whiplash. Material and method: A cross-sectional study including 24 consecutive patients with grade II or III whiplash according to the Quebec Task Force scale and time course < 6 months. A complete vestibular examination with video-oculographic recording was performed including a bithermal caloric test, vestibular evoked myogenic potentials (VEMPs), subjective visual vertical (SVV) and dynamic posturography. We also used the questionnaires SF-36 (general health), DHI-S (vestibular handicap) and SIMS (malingering). Results: The prevalence of vestibular dysfunction is around 25%. The vestibulo-collic reflex evaluated by VEMPs was absent in 25% of patients with whiplash. SVV was abnormal in 17% of cases. Dynamic posturography showed a vestibular pattern in 25% of cases. Scores suggesting malingering in whiplash was observed in 25% of cases. Conclusion: The finding of several abnormal tests in patients with whiplash suggests a vestibular dysfunction associated with a long incapacity. High scores in the DHI and SIMS scales could be useful as predictors of severe vestibular disorder with long incapacity (AU)

Ocular and cervical vestibular evoked myogenic potentials in response to bone-conducted vibration in patients with probable inferior vestibular neuritis.

BACKGROUND AND AIMS: Previous evidence shows that the n10 component of the ocular vestibular evoked myogenic potential indicates utricular function, while the p13 component of the cervical vestibular evoked myogenic potential indicates saccular function. This study aimed to assess the possibility of differential utricular and saccular function testing in the clinic, and whether loss of saccular function affects utricular response. METHODS: Following vibration conduction from the mid-forehead at the hairline, the ocular n10 component was recorded by surface electromyograph electrodes beneath both eyes, while the cervical p13-n23 component was recorded by surface electrodes over the tensed sternocleidomastoid muscles. RESULTS: Fifty-nine patients were diagnosed with probable inferior vestibular neuritis, as their cervical p13-n23 component was asymmetrical (i.e. reduced or absent on the ipsilesional side), while their ocular n10 component was symmetrical (i.e. normal beneath the contralesional eye). CONCLUSION: The sense organ responsible for the cervical and the ocular vestibular evoked myogenic potentials cannot be the same, as one response was normal while the other was not. Reduced or absent saccular function has no detectable effect on the ocular n10 component. On vibration stimulation, the ocular n10 component indicates utricular function and the cervical p13-n23 component indicates saccular function.

[Normative data and clinical practice of sinusoidal harmonic acceleration test].

OBJECTIVE: To establish the normative data of sinusoidal harmonic acceleration test (SHAT) and evaluate the value of clinical application. METHODS: One hundred and twenty normal persons, 21 Meniere's disease patients, 2 bilateral vestibular peripheral lesion patients, 15 unilateral vestibular peripheral lesion patients and 10 central lesion patients were tested with SHAT. RESULTS: The calibration time was longer in the older persons. The phase decreased with the frequency, and the gain increased with the frequency, but the reliability of the re-test of the phase was better in the lower frequency. The results of the 7 Meniere's disease patients without symptoms were normal, 14 patients post-attack revealed abnormal, 11 had phase abnormal, 3 had gain decrease, 10 revealed asymmetry and spontaneous nystagmus simultaneously, 8 patients had two parameters abnormal. The unilateral vestibular peripheral lesion patients showed 73% (11/15) phase abnormal, 67% (10/15) gain decrease and 40% (6/15) asymmetry, while 5/6 asymmetry patients had spontaneous nystagmus. The gain of the bilateral vestibular peripheral lesion patients showed severe decrease. The abnormal rate in central lesion patients were 70% (7/10) in phase, 20% (2/10) in gain and 40% (4/10) in asymmetry, but the patients with asymmetry had no spontaneous nystagmus. CONCLUSIONS: The normal range of the phase, gain and asymmetry of SHAT is in narrow bandwidth. The phase is the most important abnormal sign.

The challenges of managing vestibular disorders: a qualitative study of clinicians' experiences associated with low referral rates for vestibular rehabilitation.

AIMS: To explore clinicians' perspectives influencing the under-diagnosis and management of patients with vestibular impairment (VI). METHODS: Data were collected using open-ended, semi-structured interviews with 18 clinical providers from primary care, neurology, otolaryngology and audiology affiliated with the Veterans Administration Medical Center in Atlanta, Georgia, from January to September 2007. Topics discussed included healthcare experiences for dizzy patients with possible VI, and perceived barriers and facilitators for clinical practice according to published guidelines. The constant comparison method was used for qualitative content analysis. RESULTS: Clinicians rarely, if ever, diagnosed VI themselves or were aware of vestibular rehabilitation as the appropriate treatment for vestibular disorders. They infrequently performed bedside tests for positional nystagmus or vestibular hypofunction to identify VI and almost never performed canalith repositioning. Not uncommonly, they ordered a wide variety of diagnostic tests, such as neuroimaging, cardiac studies and audiograms, prior to make referral to a specialist, if they made referral at all. Perceived barriers to identifying VI in patients and giving treatment consistent with published recommendations commonly included lack of knowledge and training, perceived time constraints in clinic and difficulties with dizzy patients giving vague descriptions of their symptoms. CONCLUSIONS: Perceptions of lacking knowledge in caring for patients with possible VI were experienced by clinicians both in primary and specialty care. Clinicians were frequently unaware of the concept of vestibular rehabilitation. Many wanted to learn more to improve healthcare delivery for their patients. Education appears necessary not only for enhancing patient therapeutic benefit, but also for minimising costs for unnecessary physician hours and diagnostic tests.

Age-stage differences in body sway during a static upright posture based on sway factors and relative accumulation of power frequency.

This study was done to examine age-stage (preschool children, young adults, and elderly people) differences in the center-of-pressure sway using body-sway factors (unit-time sway, front-back sway, left-right sway, and high frequency-band power), power-spectrum distribution, and relative accumulation of power frequency (25%, 50%, and 75% RAPF) of the center-of-pressure spectrum. The center-of-pressure movement for 1 min. was measured twice using Anima's stabilometer. Data-sampling frequency was set at 20 Hz. Significant age-stage differences were found for 3 factors except for left-right sway, which was larger for preschool children and elderly than for young adults. The power spectrum of body sway in any age-stage was noted mainly in low frequency bands. A marked age-stage difference was found at 75% RAPF. Body-sway characteristics in each age-stage differ, and differences of postural-sway frequency are marked in the low frequency bands.

Power spectrum characteristics of sway position and velocity of the center of pressure during static upright posture for healthy people.

This study assessed sex and individual differences in sway-position and velocity power spectra and reliability of power frequency with 30 health young people. The body sway for 1 min. was measured twice over a 1-min. rest. There were no significant sex differences in the spectra. Frequency bands with a large coefficient of variance over 10.0 appeared up to 0.6 Hz. 75% relative accumulated power frequency appeared at 1.10-1.23 Hz in the position and at 2.00-3.05 Hz in the velocity spectra. Most power was in the low frequency band (A and B frequency intervals) of the international standard. Relative accumulated power frequency of position and velocity power spectra was reasonably reliable. It may be necessary to establish a new evaluation frequency interval by direction of sway-position and velocity using relative accumulated power frequency for healthy people.