Vestibular Disease Research Articles

Differentiating the Structural and Functional Instability of the Craniocervical Junction.

This paper presents the anatomical and biomechanical aspects of chronic instability of the craniocervical junction (CCJ) with a discussion on clinical diagnostics based on mobility tests and provocative tests related to ligamentous system injuries, as well as radiological criteria for CCJ instability. In addition to the structural instability of the CCJ, the hypothesis of its functional form resulting from cervical proprioceptive system (CPS) damage is discussed. Clinical and neurophysiological studies have shown that functional disorders or organic changes in the CPS cause symptoms similar to those of vestibular system diseases: dizziness, nystagmus, and balance disorders. The underlying cause of the functional form of CCJ instability may be the increased activity of mechanoreceptors, leading to "informational noise" which causes vestibular system disorientation. Due to the disharmony of mutual stimulation and the inhibition of impulses between the centers controlling eye movements, the cerebellum, spinal motoneurons, and the vestibular system, inadequate vestibulospinal and vestibulo-ocular reactions occur, manifesting as postural instability, dizziness, and nystagmus. The hyperactivity of craniocervical mechanoreceptors also leads to disturbances in the reflex regulation of postural muscle tone, manifesting as "general instability". Understanding this form of CCJ instability as a distinct clinical entity is important both diagnostically and therapeutically as it requires different management strategies compared to true instability. Chronic CCJ instability significantly impacts the quality of life (QOL) of affected patients, contributing to chronic pain, psychological distress, and functional impairments. Addressing both structural and functional instability is essential for improving patient outcomes and enhancing their overall QOL.

Sensitization of Visually Induced Motion Sickness by Prior Provocative Physical Motion

INTRODUCTION: Habituation to motion has therapeutic applications for motion sickness desensitization and rehabilitation of patients with vestibular disease. Less attention has been devoted to the opposite process: sensitization. METHODS: Subjects (N = 50) were randomly allocated to four sequences: Baseline visual stimulus; then 15 min of time gap; cross-coupled motion (C-C) or a Control condition; then a time gap of 15 min or 2 h; then a retest visual stimulus. Motion exposures were for 10 min or until moderate nausea, whichever was sooner. The visual stimulus was a scene rotating in yaw at 0.2 Hz with superimposed "wobble". C-C was whole-body rotation on a turntable with eight 45° head tilts during each 30-s period. Control was head tilt without rotation. Rotational velocity was incremented in staircase steps of 3° · s−1 every 30 s. RESULTS: Groups were equivalent for Total Motion Sickness Symptom scores elicited by the first visual stimulus (combined: mean ± SD 10.8 ± 8.4). C-C produced greater Total Symptoms (20.3 ± 6.8) than Control (3.1 ± 3.7). Subjects recovered subjectively from C-C before retest of visual stimulus. For the retest visual stimulus, Total Symptoms were higher following C-C (15.1 ± 9.0) than following Control (8.3 ± 7.1) for both the 15 min and 2 h retests. Sickness ratings (SR) mirrored these effects of C-C. DISCUSSION: C-C motion sensitized subsequent responses to visual stimulation up to 2 h later. Sensitization of visual stimulation crossed modalities and appeared subconscious since it occurred despite subjective recovery from C-C. For some individuals, a previously relatively innocuous visual stimulus became nauseogenic on retest. The results have implications for the use of visual technologies within hours of exposure to provocative motion. Golding JF, Alund D, Gresty MA, Flynn MB. Sensitization of visually induced motion sickness by prior provocative physical motion. Aerosp Med Hum Perform. 2024; 95(10):741–748.

Circulating levels of micronutrients and the risk of benign paroxysmal positional vertigo: A Mendelian randomization study

BackgroundBenign paroxysmal positional vertigo (BPPV) is a typical vestibular disease characterized by recurrent episodes of vertigo. The role of micronutrients in BPPV pathogenesis has not been extensively studied, prompting this investigation into the relationship between circulating micronutrients and BPPV risk. This research aimed to explore the relationship between blood micronutrient levels and BPPV risk via Mendelian randomization (MR) analysis, a robust method for inferring causality from observational data. MethodsA total of 15 circulating micronutrients were assessed for their association with BPPV risk. MR analysis was conducted via the following methods: MR‒Egger, weighted median, simple model, inverse variance weighting (IVW), and weighted mode. Sensitivity analyses were performed to assess heterogeneity and pleiotropy. A multivariate MR analysis was also conducted, incorporating potential confounders such as trauma, chronic otitis media, hearing loss, peripheral atherosclerosis, ageing, and osteoporosis. ResultsMR analysis revealed an obvious association between selenium and BPPV risk (OR 1.074, 95 % CI 1.005 to 1.148; P = 0.035). Folate was negatively related (OR 0.694, 95 % CI 0.501 to 0.962, P = 0.028) but was excluded because of inconsistent OR values across methods. Sensitivity analysis supported the IVW results, and there was no evidence of significant heterogeneity among the selenium-related instrumental variables included in the study, nor was horizontal pleiotropy detected among the instrumental variables. Multivariate MR analysis confirmed that selenium was an independent risk factor for BPPV (OR 1.22, 95 % CI 1.059 to 1.406, P = 0.006), with no significant associations observed for other micronutrients or exposure factors. ConclusionThis study provides evidence that blood selenium levels are positively associated with the risk of BPPV, suggesting a potential role for selenium in the pathogenesis of this disorder. These findings are robust to various sensitivity analyses and support the use of MR analysis to identify novel risk factors for BPPV. The identification of selenium as an independent risk factor for BPPV has implications for the development of preventive strategies and targeted interventions. It is necessary to analyse the biological mechanisms of this association and determine the therapeutic value of limiting selenium intake for BPPV to provide support for the treatment of such patients.

Intelligent analysis and measurement of semicircular canal spatial attitude.

The primary aim of this investigation was to devise an intelligent approach for interpreting and measuring the spatial orientation of semicircular canals based on cranial MRI. The ultimate objective is to employ this intelligent method to construct a precise mathematical model that accurately represents the spatial orientation of the semicircular canals. Using a dataset of 115 cranial MRI scans, this study employed the nnDetection deep learning algorithm to perform automated segmentation of the semicircular canals and the eyeballs (left and right). The center points of each semicircular canal were organized into an ordered structure using point characteristic analysis. Subsequently, a point-by-point plane fit was performed along these centerlines, and the normal vector of the semicircular canals was computed using the singular value decomposition method and calibrated to a standard spatial coordinate system whose transverse planes were the top of the common crus and the bottom of the eyeballs. The nnDetection target recognition segmentation algorithm achieved Dice values of 0.9585 and 0.9663. The direction angles of the unit normal vectors for the left anterior, lateral, and posterior semicircular canal planes were [80.19°, 124.32°, 36.08°], [169.88°, 100.04°, 91.32°], and [79.33°, 130.63°, 137.4°], respectively. For the right side, the angles were [79.03°, 125.41°, 142.42°], [171.45°, 98.53°, 89.43°], and [80.12°, 132.42°, 44.11°], respectively. This study successfully achieved real-time automated understanding and measurement of the spatial orientation of semicircular canals, providing a solid foundation for personalized diagnosis and treatment optimization of vestibular diseases. It also establishes essential tools and a theoretical basis for future research into vestibular function and related diseases.

Pseudodominance in RFC1-Spectrum Disorder.

Cerebellar ataxia, neuropathy, vestibular areflexia syndrome (CANVAS) and disease spectrum is an autosomal recessive disorder associated with biallelic repeat expansion (RE) in the RFC1 gene. A high carrier frequency in the healthy population determines the possibility of having affected members in two consecutive generations. We describe pseudodominance in two families affected with RFC1 disorder (10 affected, 5 oligo/asymptomatic individuals). In Family A, after the 75-year-old index case was diagnosed with CANVAS, the 73-year-old wife decided to undergo screening for carrier testing. Although she did not report any symptoms, she resulted positive for the biallelic AAGGG RE thus leading to a diagnosis in the asymptomatic offspring as well and revealing a pseudodominant pattern of inheritance. In Family B pseudodominance was suspected after the identification of the RFC1 RE in the proband affected by sensitive neuropathy because of a positive family history for undetermined polyneuropathy in the mother. The post-mortem identification of the RFC1 RE in a sample specimen from the deceased mother, who had been under our care, allowed the solution of a "cold case". Our report suggests that pseudodominance is a confounding phenomenon to consider in RFC1-spectrum disorder and genetic counselling is instrumental in families with affected individuals.

BILIARY DUCTAL PLATE MALFORMATION WITH SECONDARY PORTAL HYPERTENSION AND MULTIPLE ACQUIRED SHUNTS IN A LITTER OF AMUR TIGERS (PANTHERA TIGRIS ALTAICA).

Congenital abnormalities in tigers (Panthera tigris) are infrequently reported but have included ectrodactyly, cataracts, and vestibular disease. Primary hepatic disease has been documented in multiple nondomestic felid species but is considered uncommon in tigers. To the authors' knowledge, there are no previous reports of congenital abnormalities of the liver in tigers. In May 2022, two male Amur tiger cubs (Panthera tigris altaica) were born at a zoological institution via cesarean section to address dystocia, following the natural birth of a female cub. Between two and six months of age, all three cubs developed progressive lethargy, inappetence, and neurological signs consistent with hepatic encephalopathy, including obtundation and ataxia. In all three cases, serum biochemical values revealed progressive, marked elevations in hepatic enzyme levels with reduction in hepatic synthetic products (albumin, urea, cholesterol). Computed tomographic imaging showed a large cluster of aberrant tortuous vessels craniomedial to the left kidney in all three tigers, consistent with acquired extrahepatic portosystemic shunts. Histologic examination of the livers identified biliary ductal plate malformations. This report details the presentation, clinical findings, diagnoses, and therapeutic interventions attempted in three Amur tiger cubs with biliary ductal plate malformation and subsequent portal hypertension with multiple acquired portosystemic shunts, an unusual abnormality not previously reported in non-domestic felids.

Association between sleep disorders and vestibular vertigo

Sleep disorders have a high comorbidity rate with vestibular diseases. The results of some small sample clinical studies have confirmed the effect of sleep deprivation on vestibular function. However, the mechanism of the effect of sleep disorder on vestibular system is still unclear. This article analyzes the possible mechanism of the effect of sleep disorders on vestibular function from the aspects of neuroanatomy and neurotransmitters, and summarizes the relationship between sleep disorder and benign paroxysmal positional vertigo, Meniere's disease, vestibular migraine and other diseases.

Understanding Factors That Cause Benign Paroxysmal Positional Vertigo, Ménière Disease, and Vestibular Neuritis: A Two-Sample Mendelian Randomization Study.

Vertigo is a prevalent clinical symptom, frequently associated with benign paroxysmal positional vertigo (BPPV), Ménière disease (MD), and vestibular neuritis (VN), which are three common peripheral vestibular disorders. However, there is a relative lack of research in epidemiology and etiology, with some existing studies presenting discrepancies in their conclusions. We conducted a two-sample Mendelian randomization (MR) analysis to explore potential risk and protective factors for these three peripheral vestibular disorders. Based on genome-wide association studies, we executed a univariable MR to investigate the potential associations between 38 phenotypes and MD, BPPV, and VN. We used the inverse variance weighted method as the primary MR result and conducted multiple sensitivity analyses. We used false discovery rate (FDR) correction to control for type I errors. For findings that were significant in the univariable MR, a multivariable MR analysis was implemented to ascertain direct effects. In addition, we replicated analyses of significant results from the univariable MR to enhance the robustness of our analyses. For BPPV, both alcohol consumption (odds ratio [OR] = 0.57, 95% confidence interval [CI] = 0.43 to 0.76, FDR Q = 0.004) and educational attainment (OR = 0.77, 95% CI = 0.68 to 0.88, FDR Q = 0.003) were found to decrease the risk. The genetic prediction analysis identified major depression (OR = 1.75, 95% CI = 1.28 to 2.39, FDR Q = 0.008) and anxiety (OR = 5.25, 95% CI = 1.79 to 15.42, FDR Q = 0.036) increased the risk of MD. However, the impact of major depression on MD could be influenced by potential horizontal pleiotropy. Systolic blood pressures (OR = 1.03, 95% CI = 1.02 to 1.04, FDR Q = 4.00 × 10 -7 ) and diastolic blood pressures (OR = 1.05, 95% CI = 1.03 to 1.07, FDR Q = 2.83 × 10 -6 ) were associated with an increased risk of VN, whereas high-density lipoprotein (OR = 0.77, 95% CI = 0.67 to 0.89, FDR Q = 0.009) and urate (OR = 0.75, 95% CI = 0.63 to 0.91, FDR Q = 0.041) reduces the risk of VN. Only the relationship between urate and VN was not replicated in the replication analysis. Multivariable MR showed that the protective effect of education on BPPV was independent of Townsend deprivation index. The protective effect of high-density lipoprotein against VN was independent of triglycerides and apolipoprotein A1. The risk impacts of systolic and diastolic blood pressures on VN exhibited collinearity, but both are independent of chronic kidney disease and estimated glomerular filtration rate. The impacts of anxiety and severe depression on MD demonstrated collinearity. Our study identified the risk association between systolic and diastolic blood pressure with VN and the protective influence of high-density lipoprotein on VN, which may support the vascular hypothesis underlying VN. Furthermore, we observed an elevated risk of MD associated with anxiety. The potential protective effects of education and alcohol consumption on BPPV need further exploration in subsequent studies to elucidate specific mechanistic pathways. In summary, our MR study offers novel insights into the etiology of three peripheral vestibular diseases from a genetic epidemiological standpoint.

The dissociation between pathological caloric testing and a normal video head impulse test helps differentiate between Menière's disease, vestibular migraine, and other vestibular disorders: a confirmatory study in a large cohort of 2,101 patients.

Vestibular migraine (VM) and Menière's disease (MD) are characterized by episodes of vertigo of similar duration. It is well known that differentiation between both diseases is not always possible based only on the patient history, physical examination, and audiological testing. In addition, the quantification of the vestibular function can also be helpful since, among patients with MD, there is often a dissociation between a normal/pseudo-normal video head impulse test (vHIT) and reduced caloric testing. The goal of this confirmatory study was to determine the sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of this dissociation to differentiate between MD and VM as well as between MD and other vestibular diseases. We performed a retrospective analysis of 2,101 patients. The examination group consisted of 1,100 patients; of these, 627 (57%) had MD according to the diagnostic criteria of the Bárány Society and 473 (43%) had VM. The comparison group consisted of 1,001 patients with other peripheral, central, or functional vestibular disorders. Statistical analysis revealed the following findings for the dissociation: MD vs. VM: specificity: 83.5%, sensitivity: 58.9%, PPV: 82.6%, and NPV: 60.5%, and MD vs. all other vestibular disorders (VM plus others): specificity: 83.5%, sensitivity: 58.9%, PPV: 60.3%, and NPV: 82.7%. The dissociation between a normal vHIT and a reduced caloric response is due to the high specificity and PPV suited for the differentiation between MD and VM. This part of the study confirms previous findings in a large cohort of patients. When it comes to differentiating between MD and all observed vestibular disorders, if there is no dissociation, the diagnosis of MD is unlikely.

Spatial position changes in the semicircular canals may be the anatomical basis of Meniere's disease: a preliminary study based on ultra-high-resolution computed tomography (CT) and intelligent segmentation.

Meniere's disease (MD) is an ear-related vestibular disorder accompanied by vertigo, hearing loss, and tinnitus. The anatomical structure and spatial position of the semicircular canals are important for understanding vestibular function and disease; however, research on MD and the effect of anatomical changes in the semicircular canals is limited. This study explored the relationship between the spatial location of the semicircular canals and MD using ultra-high-resolution computed tomography (U-HRCT) and intelligent segmentation. Isotropic U-HRCT images obtained from patients with MD and healthy controls (HCs) were retrospectively analyzed. We extracted the semicircular canal structures and extracted their skeleton. The plane of the skeleton of each semicircular canal was fitted separately. The mutual angles between the semicircular canals, and the angles between each semicircular canal and each plane of the coordinate system were measured. Among 45 MD-affected ears (MDAEs), 33 MD-healthy ears (MDHEs), and 45 HC ears, the angle between the superior and lateral semicircular canals (LSCs) and the angle between the superior and posterior semicircular canals (PSCs) were larger in the MDAE and MDHE groups than the HC group (P<0.01), while the angle between the posterior and LSCs was smaller in the MDAE group than the HC group (P<0.001). The angles between the superior and PSCs and coronal plane (CP) of the coordinate system were significantly smaller in the MDAE and MDHE groups than the HC group (P<0.01); however, the angles between the LSC and axial plane and CP were significantly larger in the MDAE and MDHE groups than the HC group (P<0.001). Spatial position changes in the semicircular canals may be the anatomical basis of MD.

Association of Vestibular Disorders and Cognitive Function: A Systematic Review.

The purpose of this study is to consolidate and condense the available evidence about the potential association between vestibular diseases and cognitive impairment. A systematic search was conducted on four English databases (PubMed, Embase, Web of Science, Cochrane Library) from the time of library construction to March 2024. The study incorporated various keywords such as "vestibular disorders," "vertigo," "dizziness," "Meniere's disease," "benign paroxysmal positional vertigo," "vestibular migraine," "vestibular neuritis," "labyrinthitis," "bilateral vestibular disease," as well as "cognitive function" and "cognitive dysfunction." A qualitative review was conducted to look for and assess pertinent studies. A total of 45 publications were incorporated, encompassing prevalent vestibular disorders, mostly targeting individuals in the middle-aged and older demographic. The findings indicate that individuals with vestibular disorders experience varying levels of cognitive impairment, which is evident in different aspects, with visuospatial cognitive deficits being more prominent. Furthermore, patients with chronic vestibular syndromes are more prone to cognitive dysfunction. Lastly, the hippocampus plays a crucial role in the intricate vestibular neural network. The findings of this comprehensive review indicate that vestibular disorders can result in impairments across various aspects of cognitive functioning, particularly in visuospatial cognition. The underlying mechanism may be associated with a decrease in the size of the hippocampus. Individuals suffering from chronic vestibular dysfunction exhibit a higher likelihood of experiencing cognitive deficits. NA Laryngoscope, 2024.

Hearing, Balance, and Mortality: Sex-Specific Patterns in a Longitudinal Study.

Assess the association of hearing on sex-specific overall mortality and death from acute cardiovascular disease and evaluate if these effects are modulated by postural balance. Cohort study. Otolaryngology department at an academic hospital. Patients underwent standard clinical examination, laboratory examination including stabilometry and audiometry. Pure tone average on the best hearing ear was calculated from 0.5, 1, 2, and 3 kHz. Cause of death was retrieved from the Norwegian Cause of Death Registry. A total of 1036 patients (58.8% women) were followed for 26 ± 3 years. In Cox regression analyses for overall mortality adjusted for age, past medical history, and vestibular disease, 10 dB increase in hearing threshold was associated with a 14% increase in mortality among men (hazard ratio 95% confidence interval: 1.02-1.28, P = .02), but no significant association was seen between hearing and mortality in women (0.92-1.15, P = .60). The same analyses for acute cardiovascular death found that a 10 dB increase in hearing threshold was associated with a 57% increase in hazard ratio in men (1.21-2.05, P < .001), but no significant effect of hearing on survival was seen in women (P = .71). Adjusting for postural balance did not change the association between hearing and mortality. This study finds hearing threshold is associated with overall mortality and acute cardiovascular death among men, with no such association observed among women. Our findings indicate important differences between men and women and suggest that such differences should be taken into consideration in audiological research.

Test-Retest Reliability of Tone Burst-Induced 500 Hz Air-Conduction Masseter Vestibular Evoked Myogenic Potential in Healthy Individuals.

: Masseter vestibular evoked myogenic potential (mVEMP) is a newly developed tool which is used to assess the vestibulo-trigeminal neural and saccular functioning pathways. Recently, this test was added to a full test battery for evaluating the brainstem of people with neurological disorders and other vestibular diseases. For any test to qualify as a standard test, the test must have high reliability across all testing windows. Hence, the present study focused on validating the reliability of mVEMP in a large population. : The study included 50 healthy participants with normal hearing. All the participants were tested using mVEMP and underwent retest within a month after the initial test. All parameters (latencies, peak-to-peak amplitude, asymmetric ratio) were observed for both sessions. To determine the statistically significant differences between and across the sessions, non-parametric tests such as Mann-Whitney U and Wilcoxon signed-rank tests were used. : The test-retest reliability of all parameters were observed. The reliability was fair-to-good for P11 and N21 latencies. The other parameters showed less significance. There were no significant differences in sex and ear comparisons between and across the sessions. : Our study demonstrated that the mVEMP is a reliable test which can be used to assess peripheral vestibular system dysfunction and neurological conditions.

Differentiation between Peripheral and Non-Peripheral Vestibular Diseases by Machine Learning of Stabilometry

Differentiation between Peripheral and Non-Peripheral Vestibular Diseases by Machine Learning of Stabilometry

Aberrant cerebral blood flow and functional connectivity in patients with vestibular migraine: a resting-state ASL and fMRI study

BackgroundPrior neuroimaging studies on vestibular migraine (VM) have extensively certified the functional and structural alterations in multiple brain regions and networks. However, few studies have assessed the cerebral blood flow (CBF) in VM patients using arterial spin labeling (ASL). The present study aimed to investigate CBF and functional connectivity (FC) alterations in VM patients during interictal periods.MethodsWe evaluated 52 VM patients and 46 healthy controls (HC) who received resting-state pseudo-continuous ASL and functional magnetic resonance imaging (fMRI) scanning. Comparisons of voxel-based CBF and seed-based FC were performed between the two groups. Brain regions showed significant group differences in CBF analyses were chosen as seeds in FC analyses. Additionally, the associations between abnormal imaging results and clinical features were explored.ResultsCompared with HC, VM patients showed higher normalized CBF in the right precentral gyrus (PreCG), left postcentral gyrus (PostCG), left superior frontal gyrus and bilateral insular (p < 0.05, FDR corrected). Furthermore, VM patients exhibited increased FC between the right PreCG and areas of the left PostCG, left cuneus and right lingual gyrus (p < 0.05, FDR corrected). In addition, we observed decreased FC between the left insular and regions of the left thalamus and right anterior cingulate cortex, as well as increased FC between the left insular and right fusiform gyrus in VM patients (p < 0.05, FDR corrected). Moreover, these variations in brain perfusion and FC were significantly correlated with multiple clinical features including frequency of migraine symptoms, frequency of vestibular symptoms and disease duration of VM (all p < 0.05).ConclusionsPatients with VM during interictal period showed hyperperfusion and abnormal resting-state FC in brain regions potentially contributed to disrupted multi-sensory and autonomic processing, as well as impaired ocular motor control, pain modulation and emotional regulation. Our study provided novel insights into the complex neuropathology of VM from a CBF perspective.

Prevalence of vestibular disease in France: analysis of prescription data from a national health insurance database

Vestibular problems are frequent reasons for primary care consultations. However, there is considerable uncertainty about the prevalence and cost of vestibular disorders. Despite ambiguous effectiveness data, the histamine analogue betahistine is widely and almost exclusively used for treatment of vertigo. Prescription of betahistine can, therefore, be used as a proxy estimate for prevalence. We used openly available claims data from the French health insurance data warehouse, defining annual prevalence of vestibular disease as the number of people who received at least one betahistine prescription that year. Dosage and pack size of each prescribed formulation were extracted to calculate the sum of betahistine in mg and the Defined Daily Dose (DDD) for age and sex strata and in total. To estimate the relative impact of one landmark trial, the BEMED study, we compared prescriptions from the years 2014/2015 to prescriptions in 2019/2022. A total of 735,121 (2014), 694,705 (2015), 614,431 (2019), and 562,476 (2022) persons filled in a prescription of betahistine. Patients were predominantly older and female. Average amount dispensed per year and per person increased from 4422.54 mg during the pre-BEMED period to 4736.90 mg during the post-BEMED period. DDD decreased from 130 Mio per year in 2014/2015 to 116 Mio per year in 2019/2022. Total costs for betahistine decreased by 42% from 21,615,037 Euro in 2014 to 12,894,249 Euro in 2022. Vestibular disease is frequent in France and has a relevant impact on population health. Despite conflicting clinical evidence, betahistine continues to be prescribed widely in medical practice.

Psychometrics of inertial heading perception.

Inertial self-motion perception is thought to depend primarily on otolith cues. Recent evidence demonstrated that vestibular perceptual thresholds (including inertial heading) are adaptable, suggesting novel clinical approaches for treating perceptual impairments resulting from vestibular disease. Little is known about the psychometric properties of perceptual estimates of inertial heading like test-retest reliability. Here we investigate the psychometric properties of a passive inertial heading perceptual test. Forty-seven healthy subjects participated across two visits, performing in an inertial heading discrimination task. The point of subjective equality (PSE) and thresholds for heading discrimination were identified for the same day and across day tests. Paired t-tests determined if the PSE or thresholds significantly changed and a mixed interclass correlation coefficient (ICC) model examined test-retest reliability. Minimum detectable change (MDC) was calculated for PSE and threshold for heading discrimination. Within a testing session, the heading discrimination PSE score test-retest reliability was good (ICC = 0. 80) and did not change (t(1,36) = -1.23, p = 0.23). Heading discrimination thresholds were moderately reliable (ICC = 0.67) and also stable (t(1,36) = 0.10, p = 0.92). Across testing sessions, heading direction PSE scores were moderately correlated (ICC = 0.59) and stable (t(1,46) = -0.44, p = 0.66). Heading direction thresholds had poor reliability (ICC = 0.03) and were significantly smaller at the second visit (t(1,46) = 2.8, p = 0.008). MDC for heading direction PSE ranged from 6-9 degrees across tests. The current results indicate moderate reliability for heading perception PSE and provide clinical context for interpreting change in inertial vestibular self-motion perception over time or after an intervention.

Psychometric Properties and Concurrent Validity of a 10-Item Questionnaire for Patients With Vestibular Disorders.

This study aimed to investigate the psychometric properties and concurrent validity of the Haukeland Dizziness Questionnaire (HDQ-10), a 10-item questionnaire designed for simplified assessment of symptom severity and emotional effects in patients with vestibular disorders. Cross-sectional study. Secondary referral hospital. Out of 238 consecutive patients examined for suspected vestibular disease at an otolaryngology clinic, 201 completed the questionnaire. The psychometric properties of the HDQ-10 were examined by exploratory factor analysis and analysis of internal consistency. Concurrent validity was determined in comparison with the Dizziness Handicap Inventory (DHI), Vertigo Symptom Scale-Short Form (VSS-SF), and the Hospital Anxiety and Depression Scale. The factor analysis revealed 3 subscales of the questionnaire covering "function,""unsteadiness," and "emotion."The examination of the total scale (α = .866) and its subscales indicated satisfactory psychometric properties. The HDQ-10 correlated highly with both DHI (r = .732. P < .001) and VSS-SF (r = .720. P < .001) indicating good concurrent validity. The HDQ-10 is a 10-item questionnaire designed for simplified assessment of symptom severity and emotional effects in patients with vestibular disorders. It has satisfactory psychometric properties and good concurrent validity compared to existing dizziness questionnaires.

Spatial anxiety contributes to the dizziness-related handicap of adults with peripheral vestibular disease.

In subjects with peripheral vestibular disease and controls, we assessed: 1. The relationship between spatial anxiety and perceived stress, and 2. The combined contribution of spatial anxiety, spatial perspective-taking, and individual cofactors to dizziness-related handicap. 309 adults participated in the study (153 with and 156 without peripheral vestibular disease), including patients with bilateral vestibular deficiency, unilateral deficiency (evolution <3 or ≥3 months), Meniere's disease, and Benign Paroxysmal Positional Vertigo. Assessments included: general health, personal habits, spatial anxiety (3-domains), perceived stress, spatial perspective-taking, dizziness-related handicap (3-domains), unsteadiness, sleep quality, motion sickness susceptibility, trait anxiety/depression, state anxiety, depersonalization/derealization. After bivariate analyses, analysis of covariance was performed (p ≤ 0.05). Spatial anxiety was related to unsteadiness and perceived stress, with an inverse relationship with trait anxiety (ANCoVA, adjusted R2 = 0.27-0.30, F = 17.945-20.086, p < 0.00001). Variability on perspective-taking was related to vestibular disease, trait and state anxiety, motion sickness susceptibility, and age (ANCoVA, adjusted R2 = 0.18, F = 5.834, p < 0.00001). All domains of spatial anxiety contributed to the Physical domain of dizziness-related handicap, while the Navigation domain contributed to the Functional domain of handicap. Handicap variability was also related to unsteadiness, spatial perspective-taking, quality of sleep, and trait anxiety/depression (ANCoVA, adjusted R2 = 0.66, F = 39.07, p < 0.00001). Spatial anxiety is related to perceived stress in adults both with and without vestibular disease, subjects with trait anxiety rated lower on spatial anxiety. State anxiety and acute stress could be helpful for recovery after peripheral vestibular lesion. Spatial anxiety and perspective-taking contribute to the Physical and Functional domains of dizziness-related handicap, possibly because it discourages behavior beneficial to adaptation.

Application of bedside HINTS, ABCD2 score and truncal ataxia to differentiate cerebellar–brainstem stroke from vestibular neuritis in the emergency room

Background and purposeAcute vestibular syndrome (AVS) typically manifests as isolated dizziness or vertigo with no apparent neurological impairments. However, distinguishing life-threatening stroke from innocuous peripheral vestibular lesions in the emergency...