Unilateral Peripheral Vestibular Dysfunction Research Articles

Executive functions in patients with bilateral and unilateral peripheral vestibular dysfunction.

Previous research suggests that patients with peripheral vestibular dysfunction (PVD) suffer from nonspatial cognitive problems, including executive impairments. However, previous studies that assessed executive functions are conflicting, limited to single executive components, and assessments are confounded by other cognitive functions. We compared performance in a comprehensive executive test battery in a large sample of 83 patients with several conditions of PVD (34 bilateral, 29 chronic unilateral, 20 acute unilateral) to healthy controls who were pairwise matched to patients regarding age, sex, and education. We assessed basic and complex executive functions with validated neuropsychological tests. Patients with bilateral PVD performed worse than controls in verbal initiation and working memory span, while other executive functions were preserved. Patients with chronic unilateral PVD had equal executive performance as controls. Patients with acute unilateral PVD performed worse than controls in the exact same tests as patients with bilateral PVD (verbal initiation, working memory span); however, this effect in patients with acute PVD diminished after correcting for multiple comparisons. Hearing loss and affective disorders did not influence our results. Vestibular related variables (disease duration, symptoms, dizziness handicap, deafferentation degree, and compensation) did not predict verbal initiation or working memory span in patients with bilateral PVD. The results suggest that bilateral PVD not only manifests in difficulties when solving spatial tasks but leads to more general neurocognitive deficits. This understanding is important for multidisciplinary workgroups (e.g., neurotologists, neurologists, audiologists) that are involved in diagnosing and treating patients with PVD. We recommend screening patients with PVD for executive impairments and if indicated providing them with cognitive training or psychoeducational support.

Research advances in the mechanism of vestibular compensation and treatment

Unlike other sensory systems, since the vestibular system maintains the tension balance of the entire system in a"push-pull" mode, local dysfunction in the system will cause the balance of the entire system to collapse. Unilateral peripheral vestibular dysfunction will cause severe vestibular symptoms, but it can recover spontaneously within a few days to several weeks. This phenomenon is called "vestibular compensation"（VC）. Since the peripheral vestibular impact in most cases is irreversible, it is widely believed that the central mechanism plays a key role in the vestibular compensation process. Static symptom is fully compensated within a few weeks, which is in parallel with the restored balance in the resting discharge of the vestibular nucleus on both sides; the incomplete compensation of dynamic deficits takes longer and is achieved mainly through the mechanism of sensory substitution and behavioral substitution. Here we briefly reviewed the mechanism of vestibular compensation and treatment in order to provide an insight into further study and clinical treatment strategies.

Etiologic distribution of dizziness/vertigo in a neurological outpatient clinic according to the criteria of the international classification of vestibular disorders: a single-center study

ObjectiveThe study aimed to determine the etiological characteristics of patients with dizziness/vertigo attending a neurological clinic according to the criteria of the International Classification of Vestibular Disorders (ICVD), hoping to provide a valuable reference for clinicians to diagnose and treat dizziness/vertigo.MethodA total of 638 consecutive patients with a chief complaint of dizziness/vertigo who attended the vertigo clinic of our neurology department from January 2019 to January 2020 were included. Clinical data of patients, including baseline data, medical history, neurological, neuro-otological, and auxiliary examination results were collected. The etiologic distribution of dizziness/vertigo was determined by analyzing the diagnoses of patients.ResultsOf the 638 patients with dizziness/vertigo, 38.8% were males, 61.2% were females, with a male: female ratio of 1:1.58 and a mean age of 52.9 ± 16.9 years. Benign paroxysmal positional vertigo (BPPV) was the most common cause of dizziness/vertigo in both female (38.9%) and male patients (25.5%). Subgroup analysis based on sex showed that vestibular migraine (VM) and probable autoimmune inner ear disease (p-AIED) were more prevalent in female patients (10.7% and 3.8%, respectively), while vascular vertigo/dizziness was more common in male patients (10.1%). Subgroup analysis based on age showed that the most common diseases were VM in patients aged 0–30 years (27.4%), BPPV in patients aged 31–60 years (27.1%) and 61–100 years (46.0%). Episodic vestibular syndrome (EVS) was the most commonly observed, accounting for up to 60.6% (389/638) of all patients, and the most common diagnoses were BPPV (55.3%, 215/389), VM (15.2%, 59/389), primary unilateral peripheral vestibular dysfunction (p-UPVD) of unknown etiology (11.8%, 46/389), p-AIED (4.4%, 17/389), and vascular vertigo/dizziness (2.8%, 11/389) in these patients. Chronic vestibular syndrome (CVS) was found in 14.0% (90/638) of the patients, and the most common diagnoses were persistent postural-perceptual dizziness (PPPD, 35.6%, 32/90), psychogenic dizziness (18.9%, 17/90), p-UPVD of unknown etiology (15.6%, 14/90), vascular vertigo/dizziness (15.6%, 14/90), and bilateral vestibulopathy (7.8%, 7/90). Acute vestibular syndrome (AVS) was observed in 8.4% (54/638) of the patients, and the most common diagnoses were p-UPVD of unknown etiology (31.5%, 17/54), vestibular neuritis (24.1%, 13/54), probable labyrinthine apoplexy (16.7%, 9/54), stroke (13.0%, 7/54), and psychogenic dizziness (11.1%, 6/54). 16.4% (105/638) of the patients were found to have other disorders, including 15.2% (16/105) of patients with internal diseases, and 84.8% (89/105) of patients with unknown causes. In terms of localization diagnosis, 56.1%, 17.0%, 10.0%, and 16.4% of the patients were diagnosed with peripheral vestibular disorder, central vestibular disorder, psychiatric and functional vestibular disorders, and other disorders, respectively.Conclusion(1) Dizziness/vertigo was more common in females, which was frequently caused by damage to the vestibular system. Non-vestibular or unknown etiologies were also seen in some patients; (2) VM was more prevalent in women than in men, vascular vertigo/dizziness was more commonly observed in men; (3) EVS was more common in patients with dizziness/vertigo. The most common causes of dizziness/vertigo were peripheral vestibular disorders in patients with AVS and EVS, PPPD and psychogenic dizziness in patients with CVS. The most common causes were BPPV and p-UPVD of unknown etiology in patients with a peripheral vestibular disorder, VM and vascular vertigo/dizziness in patients with central vestibular disorder, PPPD and psychogenic dizziness in patients with psychiatric and functional vestibular disorders.

Effectiveness of Balance Rehabilitation Unit (BRU) Posturography Versus Conventional Rehabilitation in Patients With Unilateral Peripheral Vestibular Dysfunction.

Patients with unilateral peripheral vestibular deficit (UPVD) experience vertigo, dizziness, disability, negative influences on their quality of life, anxiety, and depression. In vestibular rehabilitation, virtual reality (VR) has proven to be effective. This investigation sought to evaluate the efficacy of the Balance Rehabilitation Unit (BRUTM) (MedicaaTM Montevideo, Uruguay, Balance Suite, version BRU 415) in patients with UPVD. A prospective, randomized, controlled study involved 38 patients from the Otoneurologic Service at the National Institute of Rehabilitation "Luis Guillermo Ibarra Ibarra" in Mexico. A physician specialist diagnosed the patients with UPVD and assigned them randomly to one of two groups. Group 1 (n = 19) received traditional vestibular rehabilitation, whereas Group 2 (n = 19) received BRUTM-supported vestibular rehabilitation. Both groups were monitored by medical professionals. Patients were evaluated with the Dizziness Handicap Inventory, static and dynamic balance assessments, the dynamic gait index, and the sensory organization test. The statistical analysis was conducted using the Student's t-test, with p 0.05 considered statistically significant. The difference in mean age between the conventional therapy and BRUTM groups was not statistically significant. Both conventional vestibular rehabilitation and the BRUTM led to statistically significant improvements in all assessed parameters, with no statistically significant differences between the two groups. Balance, mobility, and quality of life were enhanced similarly in UPVD patients by BRUTM-supported vestibular rehabilitation and conventional vestibular rehabilitation. In addition, BRUTM facilitated patient motivation, exercise feedback, and confidence enhancement.

The value of postcontrast delayed 3D fluid-attenuated inversion recovery MRI in the diagnosis of unilateral peripheral vestibular dysfunction.

Clinically, unilateral peripheral vestibular dysfunction (UPVD) with dizziness or vertigo as the chief complaint is quite common. This study aimed to investigate the correlations between 3-dimensional fluid-attenuated inversion recovery magnetic resonance imaging (3D-FLAIR MRI) findings and cochleovestibular function test results in patients with UPVD and to explore the possible etiologies of UPVD. This retrospective study enrolled 76 patients with UPVD. Endolymphatic hydrops (EH) and perilymphatic enhancement (PE) in the vestibule and cochlea on 3D-FLAIR images, their correlations with the parameters of the cochleovestibular function test and vascular risk factors, and the immunological findings of patients with EH and PE were assessed. Of the included patients, 48.7% showed positive MRI findings (the presence of EH and PE on 1 side). The pure-tone average (PTA) was higher in patients with cochlear PE than in those with vestibular (P=0.014) and cochlear EH (P=0.02). The canal paresis (CP) value was also higher in patients with vestibular PE than in those with vestibular (P=0.002) and cochlear EH (P=0.003). Video head impulse test (vHIT) gains were lower in patients with vestibular and cochlear PE than in those with vestibular and cochlear EH (P<0.001). A positive correlation was observed between the degree of vestibular and cochlear EH and PTA (both P values <0.001). PTA and CP with a cutoff value of 32 dB and 46.5%, respectively, yielded high sensitivity and specificity in determining positive MRI findings (P<0.001 and P=0.029, respectively). The prevalence of vascular risk factors was significantly higher in patients with PE than in those with EH (P=0.033). (I) Nearly half of the patients UPVD exhibited abnormal MRI findings. Cutoff values for PTA and CP of 32 dB and 46.5%, respectively, indicated that patients were more likely to have abnormal imaging findings. (II) The severity of EH was positively correlated with hearing impairment. (III) Patients with PE showed severe hearing impairment and vestibular dysfunction, which was presumed to be associated with vascular damage.

The value of vestibular graviceptive pathway evaluation in the diagnosis of unilateral peripheral vestibular dysfunction.

Evaluation of vestibular graviceptive pathway (VGP) in patients with unilateral peripheral vestibular dysfunction (UPVD) has received increasing attention from researchers. The study aimed to investigate the value of VGP evaluation in the diagnosis of UPVD. Ninety-five UPVD patients were divided into attack and remission phase groups. VGP evaluation-related indicators, including subjective visual vertical (SVV), subjective visual horizontal (SVH), head tilt, ocular torsion (OT), and skew deviation (SD), were measured, and their correlations with cochleovestibular function test results were analyzed. The possible etiologies of contralesional VGP (c-VGP) were analyzed. Positive rates of SVV, SVH, OT, and SD were significantly higher, and the degrees of SVV, SVH, and OT were significantly greater in the attack phase group than the remission phase group. The sides with abnormal VGP evaluation results were correlated with the sides with hearing loss, abnormal caloric, and video head impulse test (vHIT) results. A total of 14 patients showed c-VGP, and possible etiologies included contralateral benign paroxysmal positional vertigo (n=4), bilateral hearing loss (n=8), bilateral vHIT gain reduction (n=1), autoimmune diseases (n=6), vascular risk factors (n=6), lacunar infarction (n=3), and endolymphatic hydrops (n=3). Alterations in SVV, SVH, OT, and SD were noted in UPVD patients in different phases, which are presumed to be related to dynamic vestibular compensation; correlations between VGP evaluation results and cochleovestibular function test results indicate that VGP evaluation may be helpful for the diagnosis of the side affected in UPVD; the presence of c-VGP may be related to bilateral labyrinth lesions or endolymphatic hydrops on the affected side; and the involvement of autoimmune mechanisms also deserves attention.

Hippocampal volume in patients with bilateral and unilateral peripheral vestibular dysfunction

Previous studies have found that peripheral vestibular dysfunction is associated with altered volumes in different brain structures, especially in the hippocampus. However, published evidence is conflicting. Based on previous findings, we compared hippocampal volume, as well as supramarginal, superior temporal, and postcentral gyrus in a sample of 55 patients with different conditions of peripheral vestibular dysfunction (bilateral, chronic unilateral, acute unilateral) to 39 age- and sex-matched healthy controls. In addition, we explored deviations in gray-matter volumes in hippocampal subfields. We also analysed correlations between morphometric data and visuo-spatial performance. Patients with vestibular dysfunction did not differ in total hippocampal volume from healthy controls. However, a reduced volume in the right presubiculum of the hippocampus and the left supramarginal gyrus was observed in patients with chronic and acute unilateral vestibular dysfunction, but not in patients with bilateral vestibular dysfunction. No association of altered volumes with visuo-spatial performance was found. An asymmetric vestibular input due to unilateral vestibular dysfunction might lead to reduced central brain volumes that are involved in vestibular processing.

MRI utricle diameter asymmetry is significantly greater in dogs with idiopathic vestibular syndrome compared with unaffected dogs.

Idiopathic vestibular syndrome (IVS) is the most common cause of acute unilateral peripheral vestibular dysfunction in older dogs. The purpose of this retrospective, cross-sectional study was to characterize morphological changes in the utricle of dogs affected by IVS, using MRI. To evaluate differences between affected and unaffected utricles, the ratio of the largest to the smallest utricle diameter was obtained, as measured on transverse T2-weighted images, and defined as the utricle asymmetricity ratio (UAR). Out of 137 patients diagnosed with IVS after excluding other vestibular diseases by MRI, 101 were eligible for inclusion. Additionally, 31 older dogs with no signs of vestibular disorders or other intracranial diseases were included as a control group. The disease group was divided into two subgroups in which the direction of head tilt and nystagmus symptoms versus the decreased utricle diameters were consistent or inconsistent. The medians of UARs of the IVS and control groups were 0.83 (range 0.37-1.00) and 0.98 (0.70-1.00), respectively. The medians of the UARs of the consistent and inconsistent IVS subgroups were 0.82 (0.37-0.99) and 0.90 (0.74-1.00), respectively. The UAR of the IVS group was significantly decreased than that of the control group and UAR of the consistent sub-group was significantly decreased than that of the inconsistent sub-group (P<.01). In conclusion, significant asymmetry of utricle diameter was identified in dogs with IVS versus unaffected dogs. We propose that canine IVS may possibly be correlated with structural atrophy of the vestibular system.

Visual dependence after vestibular rehabilitation by virtual reality in individuals with unilateral peripheral vestibular dysfunction – one year of results

Abstract Introduction One of the most common approaches in individuals with unilateral peripheral vestibular dysfunction (UPVD) is vestibular rehabilitation (RV). Many factors can negatively affect the result of RV. Virtual reality based treatment may represent an important tool in the solution of these problems. In individuals with UPVD there is a decrease in the reception of vestibular stimuli and there is an adjustment in the reception of visual and proprioceptive stimuli. They use more visual cues to minimise the decrease in vestibular stimuli – visual dependence (VD). Although the importance and results of virtual reality as a tool in improving balance in individuals with UPVD have already been demonstrated, we intend to demonstrate that virtual reality allows significant improvements in the decrease in VD. Objectives The aim of the study is to compare VD levels in individuals with UPVD after RV program by virtual reality. Methodology For the evaluation of VD, dynamic posturography was performed with the Balance Rehabilition Unit equipment for 39 people with UPVD, before and after the RV program by virtual reality. Ten conditions were tested, with different visual and propriocetive stimuli. The parameters considered were the oscillation area of the pressure centre and the sway velocity. Results In the parameter of the oscillation area of the pressure centre, statistically significant results were found in the 10 conditions tested. In the sway velocity parameter, statistically significant results were found in the condition 1, 2, 3, 4, 5 e 10. Conclusion Virtual reality incorporated in the RV programs presents itself as an important tool in improving VD in individuals with UPVD.

Weighting and reweighting of visual input via head mounted display given unilateral peripheral vestibular dysfunction

We translated a well-established laboratory paradigm to study sensory integration into a Head-Mounted-Display (HMD). In the current study, a group of 23 individuals with unilateral vestibular dysfunction and 16 age-matched controls observed moving spheres projected from the Oculus Rift. We confirmed increased visual weighting with an unstable surface and decreased visual weighting (i.e., reweighting) with increased visual amplitude. We did not observe significant differences in gains and phases between individuals with vestibular dysfunction and age-matched controls. The vestibular group increased sway in mid and high frequencies significantly more than controls with the change in surface or visual amplitude. Mild visual perturbations within HMDs carry the potential to become a useful portable assessment of postural control in individuals with vestibular disorders.

Labyrinthectomy: Our Experience in a Tertiary Care Centre.

Labyrinthectomy is an effective surgical procedure for the management of poorly compensated unilateral peripheral vestibular dysfunction in the presence of a nonserviceable hearing. It involves removal of labyrinthine portion of the inner ear and exenteration of the neuroepithelium. In our institution, 8 cases underwent surgical labyrinthectomy from a period of 2013-2018 for various extensive disease manifestations, age ranges from 2 to 48years. Includes, a child of 2years age presented with bilateral foul smelling otorrhoea with external auditory canal cartilaginous stenosis, 5 cases of extensive cholesteatoma with labrynthitis and 2 cases of purulent labrynthitis among them 1 were suffering from Tuberculosis and was on Category 1 ATT and other one suffering from extensive granulation at the tympanomastoid area which was inconclusive of the diagnosis even after histopathological examination, so treated as tuberculosis and started on prophylactic antitubercular treatment in addition to surgery. All patients except the child gave past history of giddiness, but at the time of presentation they were not having giddiness or noticeable nystagmus and all had profound unilateral sensorineural hearing loss. Thus all the patients underwent a radical mastoidectomy with total labyrinthectomy and blind sac closure in 2 patients.

Efficacy of vestibular rehabilitation on quality of life of patients with unilateral vestibular dysfunction

Objective: The aim of this study is to determine the efficacy of vestibular rehabilitation (VR) exercise of patients with uncompensated unilateral peripheral vestibular dysfunction. Materials and Methods: An intervention study was conducted on 20 patients their age ranging from 20 to 60 years. The main complaint of the participants was chronic dizziness (dizziness for >3 months). Dizzy patients were recruited from the Ear, Nose, and Throat department. The study was conducted in the audiovestibular unit. All participants in the study were subjected to basic audiological evaluation and vestibular evaluation (videonystagmography). The Dizziness handicap inventory questionnaire (DHI) was carried out twice (pre and post) rehabilitation program. The VR therapy was performed according to the protocol established by Cawthorne and Cooksey and Norre exercises. Results: All the DHI scores reduced significantly after VR. There were no differences among genders; adults and elderly patients. Conclusion: The result of this study proved the importance and the efficacy of VR. It considered a useful therapeutic approach for improvement in the quality of life of individuals with unilateral peripheral vestibular weakness. The improvement was not influenced by sex, age, or duration of disease. It considered a low-cost, short, and safe treatment technique which can be widely used in outpatients without the need for sophisticated tools.

Sensory organization test principally reflects utricular function

Conclusion: Our study showed that sensory organization test (SOT) could principally reflect utricular function, and our cut-score of VEST ratio (the indicator of inputs from the vestibular system in balance performance) in SOT could help to screen patients with unilateral peripheral vestibular dysfunction in non-fallers.Objectives: We aimed to know SOT reflects the function of which vestibular end organs and to assess the possibility of screening patients with peripheral vestibular dysfunction in non-fall population by means of SOT.Methods: A total of 75 patients with unilateral peripheral vestibular dysfunction underwent SOT, ocular vestibular-evoked myogenic potential (oVEMP), cervical vestibular-evoked myogenic potential (cVEMP) and caloric tests.Results: Regression model indicated that oVEMP, as an independent variable, exerted the greatest influence on VEST ratio, followed by age and cVEMP. There were no significant differences in VEST ratio among groups with different extents of peripheral vestibular involvement (p > .05). VEST ratio in the vestibular impairment groups was significantly lower than in the control group and significantly higher than in fall group (p < .01). VEST ratio in group with normal oVEMP was significantly higher than in group with abnormal oVEMP (p = .013). The cut-score between populations with functional and dysfunctional vestibule was 0.649.

The analysis of the value of spontaneous nystagmus in peripheral vestibular hypofunction

Objective:To study the characteristics and clinical value of spontaneous nystagmus in patients with peripheral vestibular dysfunction.Method:Sixty cases with acute unilateral peripheral vestibular dysfunction were studied.All were diagnozed as vestibular neuritis(VN) . The relationship between SN and disease duration,DP and UW were analyzed.Result:SN was present in49 patients(81.7%)and absent in the remaining 11(18.3%).The intensity of SN ranged from 0.5°/s-20.4°/s and had negative correlation with the disease duration(r=-0.478，P<0.01). The patients were divided into 3 groups (mild,medium and severe) according to SN intensity,with median duration of disease being 6.5 d，5 d and 3 d respectively. The difference between groups was statistically significant(χ²=9.071，P<0.01).The result of the caloric test were as following：caloric test revealed DP in 44 cases（89.8%） of SN ;DP values were normal in 8 cases（10.2%）;SN intensity was positively correlated with DP value（r=0.513,P<0.01） ;unilateral weakness was found in 35 cases（71.4%）,with the direction of SN towards the weakness side in 4 cases and towards the opposite direction in the remaining 31 cases; 7 cases（14.3%）had bilateral weakness and 7 cases（14.3%）normal. There were no relationship between the intensity of SN and UW value（r=-0.321,P>0.05）.The UW value of patients with SN (40.9±26.3）% was compared to the group without SN（29.9±18.2）% . The difference was statistically significant (F=4.497,P<0.05).Conclusion:The intensity of SN in patients with acute unilateral peripheral vestibular dysfunction was often moderate and severe. The intensity of SN waned as the disease progressed or the direction reversed,The vestibular injury in patient with SN was more severe than those without. SN is useful in clinical assessment of vestibular injury and compensatory status.

The application of subjective visual gravity in assessment of vestibular compensation: a pilot study

To discuss the characteristics of subjective visual gravity (subjective visual vertical/horizontal, SVV/SVH) and assess its clinical application for peripheral unilateral vestibular compensation. 69 cases of acute peripheral unilateral vestibular dysfunction patients (case group) accepted SVV/SVH, spontaneous nystagmus (SN), caloric test (CT) and other vestibular function tests. 49 healthy people (control group) accepted SVV/SVH only. SVV/SVH, SN and unilateral weakness (UW) were selected as for the observation indicators. The correlations between SVV/SVH, SN, UW and courses were investigated respectively, as well as the characteristic of SVV/SVH, SN in period of vestibular compensation. Among case group SVV, SVH positive in 42 patients(60.9%) and 44 patients(63.8%), the absolute values of the skew angle were in the range between 2.1°-20.0°, 2.1°-22.2°. Skew angles of SVV/SVH in control were in the range between -1.5°-2.0° and -2.0°-1.6°, and had no statistical significance with case group(t=5.336 and 5.864, P<0.05). SN-positive 28 cases (40.6%), the range of intensities at 2.4°-17.1°; UW-positive 50 cases (72.5%). In case group, positive correlation between SVV and SVH(r=0.948, P=0.00), negatively correlated between SVV/SVH and SN respectively(r values were -0.720, -0.733, P values were 0.00), no correlation between the skew angle of SVV/SVH, strength of SN and UW value(r values were 0.191, 0.189, and 0.179, P>0.05), there was no correlation between the absolute value of SVV, SVH, SN, UW with the duration (rs values were -0.075, -0.065, -0.212, and 0.126, P>0.05). Subjective visual gravity can be used not only to assess the range of unilateral peripheral vestibular dysfunction, but also help assess the static compensatory of otolithic, guidance and assessment of vestibular rehabilitation.

In people with unilateral peripheral vestibular dysfunction, what are the effects of vestibular rehabilitation?

In people with unilateral peripheral vestibular dysfunction, what are the effects of vestibular rehabilitation?

What nonpharmacologic therapies for patients with chronic vertigo, not from Meniere's disease, are effective for the relief of symptoms?

Evidence-based answer For benign paroxysmal positional vertigo (BPPV), the Epley maneuver is effective; adding post-Epley activity restrictions does not result in further improvement (SOR: A, meta-analyses). For unilateral peripheral vestibular dysfunction from multiple etiologies, vestibular rehabilitation exercises are helpful (SOR: A, meta-analysis and RCT).

Vestibular rehabilitation for unilateral peripheral vestibular dysfunction.

This is an update of a Cochrane review first published in The Cochrane Library in Issue 4, 2007 and previously updated in 2011.Unilateral peripheral vestibular dysfunction (UPVD) can occur as a result of disease, trauma or postoperatively. The dysfunction is characterised by complaints of dizziness, visual or gaze disturbances and balance impairment. Current management includes medication, physical manoeuvres and exercise regimes, the latter known collectively as vestibular rehabilitation. To assess the effectiveness of vestibular rehabilitation in the adult, community-dwelling population of people with symptomatic unilateral peripheral vestibular dysfunction. We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ISRCTN and additional sources for published and unpublished trials. The most recent search was 18 January 2014. Randomised controlled trials of adults living in the community, diagnosed with symptomatic unilateral peripheral vestibular dysfunction. We sought comparisons of vestibular rehabilitation versus control (e.g. placebo), other treatment (non-vestibular rehabilitation, e.g. pharmacological) or another form of vestibular rehabilitation. Our primary outcome measure was change in the specified symptomatology (for example, proportion with dizziness resolved, frequency or severity of dizziness). Secondary outcomes were measures of function, quality of life and/or measure(s) of physiological status, where reproducibility has been confirmed and shown to be relevant or related to health status (for example, posturography), and adverse effects We used the standard methodological procedures expected by The Cochrane Collaboration. We included 39 studies involving 2441 participants with unilateral peripheral vestibular disorders in the review. Trials addressed the effectiveness of vestibular rehabilitation against control/sham interventions, medical interventions or other forms of vestibular rehabilitation. Non-blinding of outcome assessors and selective reporting were threats that may have biased the results in 25% of studies, but otherwise there was a low risk of selection or attrition bias.Individual and pooled analyses of the primary outcome, frequency of dizziness, showed a statistically significant effect in favour of vestibular rehabilitation over control or no intervention (odds ratio (OR) 2.67, 95% confidence interval (CI) 1.85 to 3.86; four studies, 565 participants). Secondary outcomes measures related to levels of activity or participation measured, for example, with the Dizziness Handicap Inventory, which also showed a strong trend towards significant differences between the groups (standardised mean difference (SMD) -0.83, 95% CI -1.02 to -0.64). The exception to this was when movement-based vestibular rehabilitation was compared to physical manoeuvres for benign paroxysmal positional vertigo (BPPV), where the latter was shown to be superior in cure rate in the short term (OR 0.19, 95% CI 0.07 to 0.49). There were no reported adverse effects. There is moderate to strong evidence that vestibular rehabilitation is a safe, effective management for unilateral peripheral vestibular dysfunction, based on a number of high-quality randomised controlled trials. There is moderate evidence that vestibular rehabilitation resolves symptoms and improves functioning in the medium term. However, there is evidence that for the specific diagnostic group of BPPV, physical (repositioning) manoeuvres are more effective in the short term than exercise-based vestibular rehabilitation; although a combination of the two is effective for longer-term functional recovery. There is insufficient evidence to discriminate between differing forms of vestibular rehabilitation.

Ocular vestibular evoked myogenic potential elicited from binaural air-conducted stimulations: clinical feasibility in patients with peripheral vestibular dysfunction

Conclusion: Ocular vestibular evoked myogenic potentials (oVEMPs) to binaural air-conducted stimulation (ACS) may provide a convenient way of assessing the crossed vestibulo-ocular reflex in patients with vestibular dysfunction as well as in healthy subjects. Objective: To investigate the clinical feasibility of using oVEMPs in response to binaural ACS to assess normal subjects and patients with vestibular dysfunction. Methods: The study investigated 24 normal subjects (14 men and 10 women, aged from 23 to 60 years) and 14 patients with unilateral peripheral vestibular dysfunction. Each subject underwent oVEMP testing in response to monaural ACS and binaural ACS (500 Hz tone burst, 135 dBSPL). Results: In normal subjects, bilateral oVEMPs were elicited in 75% of subjects in response to monaural ACS and in 91% in response to binaural ACS. Asymmetry ratios (ARs) of the responses to binaural ACS were significantly smaller than those of the responses to monaural ACS (p < 0.01). In patients with unilateral vestibular dysfunction, there were no significant differences in the amplitude, latency, or AR of the responses between monaural and binaural ACS. Approximately 30% of patients showed reduced ARs to binaural ACS relative to monaural ACS, primarily due to contamination by uncrossed responses elicited in healthy ears.

Kinezyterapia u pacjentów z obwodowym uszkodzeniem narządu przedsionkowego

IntroductionKinesitherapy is widely accepted management in patients with vertigo and imbalance, but there has been inadequate evidence that one form of therapy is superior to another. The aimof the study was to compare effectiveness of two kinesitherapy protocols in patients with the peripheral vestibular system disorders. Material and methodsFifty patients (mean age 46.0±13.1 year) with vertigo and balance instability lasting over 3 months with unilateral vestibular disorder, confirmed in Videnystagmography, were included in the study. Thirty patients underwent supervised and 20 patients home-based exercise programs. All of them were assessed three times at the baseline, after 4 weeks and 3 months, on vertigo intensity and frequency with the Vertigo Syndrome Scale (VSS), Vertigo Visual Analog Scale (VAS) and clinical unsteadiness with tests (Romberg, Amended Motor Club Assesment (AMCA), Eurofit test – standing on one leg. ResultsIn both groups the clinical tasks and the intensity of vertigo in VAS significantly decreased. The mean value of VSS (part physical and emotional)score significantly decreased only in supervised group at the end of 4 weeks and 3 months (p=ns). Recovery was more dynamic in supervised group than home-based exercises group, in AMCA test (3.9 vs. 1.3 s, p<0.05) in Eurofit tests eye open (14.1 vs. 0.9 s, p<0.05) and eye closed (3.5 vs. 1 s, p<0.05). ConclusionsIn patients with unilateral peripheral vestibular dysfunction supervised and home-based group kinesitherapy is an effective treatment method. In supervised group patients recovery has been faster.