Vestibular Thresholds: A Review of Advances and Challenges in Clinical Applications.

Megan J Kobel,Jameson K Mattingly,Daniel M Merfeld,Andrew R Wagner

doi:10.3389/fneur.2021.643634

Megan J Kobel, Jameson K Mattingly + Show 2 more

Open Access

https://doi.org/10.3389/fneur.2021.643634

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Abstract

Vestibular disorders pose a substantial burden on the healthcare system due to a high prevalence and the severity of symptoms. Currently, a large portion of patients experiencing vestibular symptoms receive an ambiguous diagnosis or one that is based solely on history, unconfirmed by any objective measures. As patients primarily experience perceptual symptoms (e.g., dizziness), recent studies have investigated the use of vestibular perceptual thresholds, a quantitative measure of vestibular perception, in clinical populations. This review provides an overview of vestibular perceptual thresholds and the current literature assessing use in clinical populations as a potential diagnostic tool. Patients with peripheral and central vestibular pathologies, including bilateral vestibulopathy and vestibular migraine, show characteristic changes in vestibular thresholds. Vestibular perceptual thresholds have also been found to detect subtle, sub-clinical declines in vestibular function in asymptomatic older adults, suggesting a potential use of vestibular thresholds to augment or complement existing diagnostic methods in multiple populations. Vestibular thresholds are a reliable, sensitive, and specific assay of vestibular precision, however, continued research is needed to better understand the possible applications and limitations, especially with regard to the diagnosis of vestibular disorders.

Highlights

The vestibular system senses head motion, including rotation, translation and orientation relative to gravity, via input from the semicircular canals (SCC), otolith organs, and their subsequent central integration
The inherent limitations of current vestibular function tests have prompted this review to explore the state of the evidence as it pertains to the use of vestibular perceptual thresholds in clinical medicine
Vestibular perceptual thresholds have the capacity to quantify the integrity of each vestibular end organ, a substantial improvement upon current vestibular assessments

Summary

Introduction

The vestibular system senses head motion, including rotation, translation and orientation relative to gravity, via input from the semicircular canals (SCC), otolith organs, and their subsequent central integration. Signals from the vestibular periphery have a wide range of reflexive functions, including gaze stabilization via the vestibulo-ocular reflex (VOR), postural control, and autonomic regulation. The vestibular system contributes to percepts of head motion and spatial orientation, along with contributions from vision, somatosensation, and proprioception. When an injury occurs to the peripheral end organs or central vestibular structures, patients may report abnormal perception of self-motion, imbalance, blurring of vision, and oscillopsia. Diagnosis and management of patients with vestibular disorders can be challenging due to poor understanding of the underlying pathology, and the lack of reliable objective tests capable of fully evaluating peripheral and/or central vestibular function. Standard physiological assessment of the vestibular system focuses on reflexes including the VOR

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