Vestibular Screening Research Articles

Correlation between Pupilometer and the Vestibular/Ocular Motor Screening in Division I Female Collegiate Soccer Athletes

The objective of this study was to explore the correlation between pupilometer and Vestibular Ocular Motor Screening on Division 1 female collegiate soccer players. Concussions are one of the most prevalent acquired neurologic conditions occurring in young adults with an estimated 1.6 to 3.8 million head injuries.1,2 Concussions are assessed with a variety of measures such as the Vestibular/Ocular Motor Screen (VOMS). Visual disruptions are frequently observed following concussion with an estimated 65%-90% of patients complaining of visual disruption.4,5 A pupilometer measures objective pupillary activity such as pupil constriction latency, diameter, speed of constriction and dilation, and reflex recovery time.5 DESIGN/METHODS: This prospective study recruited Division I female soccer athletes aged 18 to 28. Athletes were excluded if they had a lower extremity injury in the past 3 months that caused the athlete to miss more than 1 day of practice, had a history of a head injury in the past 6 months, or were diagnosed with a visual, vestibular, or balance disorder. Twenty-six female Division I collegiate soccer athletes (mean age of 20.46 ± 2.36 years) completed baseline pupilometer and VOMS testing. Three of the twenty-six had borderline pupillary index scores and five had abnormal VOMS scores at baseline. One athlete had a concussion during the 2019 season and at retest, pupilometer results were normal but two VOMS components were abnormal. The pupilometer and VOMS were poorly correlated. While the neurocognitive consequences of participation in soccer is becoming uncertain, the current study suggests that 11% of female soccer athletes without a diagnosis of a concussion had abnormal pupilometer results and 19% had abnormal VOMS scores. Evidence is mounting that repetitive hits to the head can lead to potential neurocognitive impairments. Future studies are warranted to examine baseline measures across age in female soccer athletes.

Vestibular function in adults with intellectual disabilities: feasibility and outcome of a vestibular screening protocol in Special Olympics athletes

Objective This study aimed to evaluate the feasibility of a well-adapted vestibular screening battery to objectively examine the (peripheral) vestibular function, and to explore the characteristics of potential vestibular deficits in the adult ID population. Design Cross-sectional study design. Study sample Compared to an age- and gender-weighted control group, a heterogeneous group of forty-five adults with ID participated in the vestibular screening at the National Games of Special Olympics Belgium (2019), which consisted of a bone conduction cervical Vestibular Evoked Myogenic Potential (cVEMP) measurement and video Head Impulse Test (vHIT). Results The screening battery appeared to be feasible in the majority of the participants (cVEMP: 92%; vHIT: 72%). Overall, the occurrence of abnormal cVEMP and vHIT responses was significantly higher in the ID group, with significantly lower corrected peak-to-peak cVEMP amplitudes (p < 0.001), lower vHIT gains (p < 0.001), and higher cVEMP and vHIT asymmetry ratios in the ID group (p = 0.008 and p < 0.001 resp.). Conclusions Vestibular assessment using the cVEMP and vHIT technique shows a promising feasibility in adults with ID. In addition, this study suggests that people with ID exhibit an increased prevalence of (peripheral) vestibular deficits relative to the general population.

Bedside examination elderly patient with vertigo and dizziness

Bedside examination is undoubtedly important part of general investigation of elderly patients with vertigo and dizziness. The main purposes of such examination is to confirm the vestibular origin of vertigo, to find out where vestibular system has been damaged and to establish the extent of central vestibular compensation. Bedside examination for vestibular screening consists of an interview, analysis of spontaneous, gaze-evoked and positional nystagmus, Halmagyi head impulse test, vestibule-ocular reflex suppression test and Fukuda stepping test. These tests do not take a lot of time and for this reason can be recommended for neurologists, gerontologists and general practitioners in their everyday practice.

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

IntroductionSkull-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 methodsThis 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. ResultsSVINT 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). ConclusionSVINT 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.

Vestibular Screening in Pediatric Patients with Otitis Media

Otitis media with effusion (OME) is a common cause of vestibular disturbances in children. However, young children often lack the language to express their symptoms, and it is uncommon to screen children for vestibular impairments. The purpose of this study was to develop a screening protocol for children presenting with OME to determine if diagnostic vestibular testing is necessary. Children with normal hearing (NH), sensorineural hearing loss (SNHL), and conductive hearing loss (CHL) due to OME participated in a vestibular screening. There were 30 participants, ages four to eight years, ranging from 48 to 101 months included in the study: 10 with NH, 11 with CHL due to OME, and 9 with SNHL. The vestibular screening consists of patient and parent questionnaires and a functional evaluation. The tests examined coordination, balance, oculomotor function, and nystagmus. Those with CHL were significantly more likely to display abnormal smoothness of pursuit, as measured with observations for rapid tracking, absence of or delayed saccades, and overshoot, than those with NH or SNHL (p = 0.012). Parents of children with CHL due to OME were more likely to report their child experiencing middle ear pressure than the parents of children with NH or SNHL (p = 0.010). In addition, children with CHL were less likely to report hearing loss than those with NH or SNHL. Parent and patient report were not found to be reliable indicators of vestibular disturbances. This pilot study suggests that children with CHL due to OME present with more oculomotor abnormalities than their peers with NH. Further research is necessary to determine validity and reliability of the findings for this present study.

Symptoms and Vestibular Screening in Pediatric Concussion

Abstract Purpose Purpose: Children under age 11 participate in sports with a risk of concussion. Tools are limited for assessment. Clinicians rely on exam for management and return to play. Researchers have started assessment adaptation: Sport Concussion Assessment Tool-5 Child (SCAT-5 Child) (Davis et al., 2017) and Vestibular/Ocular Motor Screening (VOMS) (Mucha et al., 2014). The purpose of this study was to compare scores on components of the SCAT-5 Child, Pediatric VOMS, and SCAT-5 Parent. Methods Method: Participants included 59 children (M-33/26-F) aged 5-10 (7.50±1.17) within 30 days from concussion. Participants completed the SCAT-5 Child, SCAT-5 parent, and Pediatric VOMS at all visits. Descriptive statistics were used to calculate population characteristics. Paired t-tests were used to compare measures. Results Results: 42.6% (n=25) reported symptoms on VOMS at first visit. Only 10.0% reported symptom on VOMS (p=.003) at second visit. VOMS scores were improved across visits (p=.003). Participants reported decreases in symptom severity (p&lt;.001) and number (p&lt;.001) on the SCAT-5 Child across visits. Parents reported decreases in symptom severity (p=.009) and number (p=.005). Both children (p=.001) and parents (p=.001) reported significant increases in BTN% across visits. Participants and parent reported similar scores in number of symptoms, severity, and BTN% on the SCAT-5 at both visits. Conclusion Conclusions: Results demonstrate the Pediatric VOMS assessment is useful to evaluate vestibular/ocular impairment. The SCAT-5 Child and Parent do not evaluate these areas. Symptom ratings decrease and are similar between parent and child, indicating this measure remains consistent across reporters. Findings highlight needed expansion of clinical assessments and research in pediatrics.

Incremental Validity of Components of the Vestibular/Ocular Motor Screening for Concussion

Abstract Purpose The Vestibular/Ocular Motor Screening (VOMS) tool for concussion evaluates symptom provocation (in a fixed order) across the following neuromotor tasks: smooth pursuits (SP), saccades-horizontal (Sac-H), saccades-vertical (Sac-V), near point of convergence (NPC), vestibular-ocular reflex-horizontal (VOR-H), vestibular-ocular reflex-vertical (VOR-V), and visual motion sensitivity (VMS). The current study evaluates the incremental validity of each VOMS component in consecutive order. Methods Retrospective record review of 193 subjects (49% male) aged 10–22 years old diagnosed with concussion (sport and non-sport injuries) and demonstrated an abnormal VOMS (defined by symptom provocation &gt;2 or NPC &gt;5cm) at initial evaluation in a specialty concussion clinic. Hierarchical regression was performed with VOMS total score (range: 0-320) as the dependent variable and each VOMS component as predictors in seven consecutive steps. Results The model was significant (p&lt;.001) at each step; the final model including all seven VOMS components in order (SP, Sac-H, Sac-V, NPC, VOR-H, VOR-V, and VMS) was significant, F(7,185)= 6.87, p&lt;.001 and accounted for 20.6% of the variance in total VOMS score. The only significant predictors in the final model included: SP (p=.01), NPC (p=.04), and VOR-H (p=.04). Conclusion Provocation of symptoms on SP, NPC, and VOR-H are the best predictors of total VOMS score. NPC and VOR-H symptom provocation provide unique value to vestibular screening beyond symptom provocation on SP and after completion of all other VOMS components. This information may be clinically useful when vestibular screening must be expedited (e.g., highly symptomatic patient, sideline assessment).

Vestibular Infant Screening – Flanders: The implementation of a standard vestibular screening protocol for hearing-impaired children in Flanders

ObjectivesThe Vestibular Infant Screening – Flanders (VIS-Flanders) project aims to implement and refine a vestibular screening protocol for all children with neonatal hearing loss in Flanders (Belgium) to limit the impact of a vestibular dysfunction on the motor, cognitive and psychosocial development of hearing-impaired children. MethodsEach child with a confirmed neonatal hearing loss in Flanders will undergo a vestibular screening at the age of 6 months in the reference centers involved in the neonatal hearing screening program. The cervical Vestibular Evoked Myogenic Potential (cVEMP) test will be used as a screening tool. The test is short, child-friendly, feasible at a young age and highly correlated with motor and balance performance. The results of an extensive follow-up protocol at the Ghent University Hospital will enable further refinement of the screening protocol. ResultsData collection in all reference centers has started since June 2018. This paper outlines the rationale for the screening and the set-up of this four-year project. ConclusionsCurrent available literature strongly favors vestibular assessment in congenitally hearing-impaired children. A standard vestibular screening for these children should lead to early identification of vestibular deficits and subsequent prompt referral for further motor assessment and rehabilitation, in order to limit the impact of a vestibular dysfunction in developing children and improve their quality of life.

Vestibular Screening in Pediatric Patients with Otitis Media

Vestibular Screening in Pediatric Patients with Otitis Media

Concurrent validity and responsiveness to change of the vestibular screening tool

BACKGROUND: Vestibular disorders are common in the Emergency Department and valid tools are required to screen for vestibular disorders and monitor outcomes. The aim was to determine the new vestibular screening tool’s (VST) concurrent validity with the dizziness handicap inventory (DHI), responsiveness to change in symptoms after vestibular rehabilitation across the continuum of care and the minimal clinically important difference. METHODS: Longitudinal prospective study undertaken with adults (N.=195) presenting to hospital with non-emergent dizziness (mean age=64.4±15.4 years; female=59.5%). The VST and DHI were completed concurrently at three assessment points: initial, discharge and 3-month follow-up. Physiotherapy tests categorized people (vestibular/non-vestibular). People in the vestibular group were offered treatment. RESULTS: The VST demonstrated moderate to high associations with DHI total (r=0.673-0.768) with DHI physical sub-category scores (r=0.759-0.809) at each assessment-point. The mean change scores for both measures significantly decreased across the continuum of care (P≤0.05) with a clinically meaningful VST change score of 2-points determined. Across the care pathway, moderate to high associations presented between changes in VST and DHI total scores (r=0.697-0.709). CONCLUSIONS: The VST demonstrates concurrent validity with the DHI and is responsive to change following vestibular rehabilitation intervention. The VST could be clinically useful in a hospital setting.

Vestibulo-ocular function in patients with sporadic ataxia

Objective: To identify vestibular alterations in patients with sporadic ataxia (SA).Materials and methods: A retrospective, cross-sectional study was carried out. Eleven patients, four females and seven males, 35–58 years of age (mean age, 46.6 ± 8 years) were evaluated, and they underwent the following procedures: anamnesis, otorhinolaryngological assessment to exclude any kind of middle ear impairments that may hinder exam results, and vestibular evaluation to verify the existence of vestibular disorders, kind and site of the lesion. Significance criterion by comparing the result of the vestibular screening (analysing normal and altered results) was p < .05.Results: Clinically, patients evidenced greater occurrence of gait imbalance (81.8%), dysarthria (63.8%) and dysphagia (54.5%). Dizziness was reported in 45.4% of the cases. In the vestibular testing, prevalence of alterations occurred in the caloric test (54.5%), in the rotation test (45.5%), and in the search for gaze and optokinetic nystagmus (27.3%, each). The presence of testing alteration was observed in 73% of the patients, central vestibular disorder was the greatest occurrence in 64% of the exams.Conclusions: Vestibular function disorder occurred in 73% of the patients, detected in the caloric test, central vestibular system disorder, deficit kind, was prevalent. The high number of alterations, diagnosed in the test, point to the relevance of the labyrinth screening in this rare kind of ataxia, and evidence the importance of patients’ early diagnosis and follow-up.

Determining the prevalence of vestibular screening failures in pediatric cancer patients whose therapies include radiation to the head/neck and platin-based therapies: A pilot study.

Sensorineural hearing loss due to ototoxic cancer therapy is well established; effects on the vestibular system are unknown. We examined the feasibility of implementing vestibular screens for pediatric cancer survivors exposed to ototoxic agents. The prevalence of screening failures is reported. Cancer survivors who were 6-17 years, at least 1-month posttreatment, and received ototoxic therapy (radiation to the head/neck, cisplatin, carboplatin) were eligible. Screening measures included (1) Pediatric Vestibular Symptom Questionnaire, (2) Modified Clinical Test of Sensory Interaction on Balance, and (3) Dynamic Visual Acuity. Vestibular screening failures were observed in 30 participants (60%). Patients with a brain tumor diagnosis were at increased risk for failures compared to nonbrain tumor patients (74.2%vs. 36.8%, P=0.009). Patients who underwent brain surgery were at increased risk for failures compared to patients without brain surgery (71%vs. 42%, P=0.043). Patients with a longer duration between end of treatment and vestibular screening had a reduced risk of failures, with an almost 20% decrease for each year between the time points (odds ratio=0.812; 95% confidence interval: 0.683-0.964, P=0.018). Receiving carboplatin correlated with a decreased risk of failure (P=0.016), due to a negative correlation with other clinical risk factors (diagnosis of a brain tumor, major brain surgery) that are associated with vestibular screening failure. Vestibular screening failures are highly prevalent in childhood cancer survivors who received ototoxic therapy. Broad screening of this population and further characterization of these patients are warranted.

Reliability and Normative Data for the Dynamic Visual Acuity Test for Vestibular Screening.

The purpose of this study was to determine reliability of computerized dynamic visual acuity (DVA) testing and to determine reference values for younger and older adults. A primary function of the vestibular system is to maintain gaze stability during head motion. The DVA test quantifies gaze stabilization with the head moving versus stationary. Commercially available computerized systems allow clinicians to incorporate DVA into their assessment; however, information regarding reliability and normative values of these systems is sparse. Forty-six healthy adults, grouped by age, with normal vestibular function were recruited. Each participant completed computerized DVA testing including static visual acuity, minimum perception time, and DVA using the NeuroCom inVision System. Testing was performed by two examiners in the same session and then repeated at a follow-up session 3 to 14 days later. Intraclass correlation coefficients (ICCs) were used to determine inter-rater and test-retest reliability. ICCs for inter-rater reliability ranged from 0.323 to 0.937 and from 0.434 to 0.909 for horizontal and vertical head movements, respectively. ICCs for test-retest reliability ranged from 0.154 to 0.856 and from 0.377 to 0.9062 for horizontal and vertical head movements, respectively. Overall, raw scores (left/right DVA and up/down DVA) were more reliable than DVA loss scores. Reliability of a commercially available DVA system has poor-to-fair reliability for DVA loss scores. The use of a convergence paradigm and not incorporating the forced choice paradigm may contribute to poor reliability.

Audiology involvement in vestibular schwannoma screening

How one radiology department developed a time- and cost-saving system.

Construction and Validation of the Vestibular Screening Tool for Use in the Emergency Department and Acute Hospital Setting

ObjectivesTo construct a new vestibular screening tool to identify likely vestibular disorders and guide referral of dizzy patients presenting to hospital and to test the vestibular screening tool for construct and discriminative validity and reliability of physiotherapy assessors. DesignMethodologic study. SettingEmergency and acute hospital wards of a metropolitan hospital. ParticipantsAdults (N=114) presenting to hospital with dizziness (mean age, 67.36±14.88y; 57% women). InterventionNot applicable. Main Outcome MeasuresThree vestibular screening tools (3, 4, and 5 items) were investigated. Physiotherapy vestibular diagnostic tests categorized patients as vestibular or nonvestibular patients. Subsets of patients were assessed twice by 2 physiotherapists (n=20) and twice by the same physiotherapist (n=30). ResultsEach of the vestibular screening tools had a good fit to the Rasch measurement model. Factor analysis demonstrated individual items loaded across 1 factor, confirming unidimensionality of the 3 vestibular screening tools, and Cronbach α determined internal consistency. The 4-item vestibular screening tool had the greatest area under the curve using receiver operator curve analysis (.894), with highest sensitivity (83%) and specificity (84%) for identifying vestibular disorders (cutoff value ≥4/8). Sensitivity of the 3- and 5-item versions was lower than the 4-item vestibular screening tool (80%). The 4-item vestibular screening tool scores showed high intrarater (κ item scores, .831–1; intraclass correlation coefficient [ICC] total, .988) and interrater (κ item scores, .578–.921; ICC total, .878) reliability. ConclusionsThe 4-item vestibular screening tool is a reliable, valid tool for screening dizzy patients presenting to hospital, with unidimensional construct validity, high sensitivity, and specificity for identifying likely vestibular disorders. The vestibular screening tool could be used clinically to streamline referrals of dizzy patients to vestibular clinics.

Test-retest Reliability Of The Vestibular Ocular-motor Screening (voms) Tool Among High School Athletes

Test-retest Reliability Of The Vestibular Ocular-motor Screening (voms) Tool Among High School Athletes

Bedside examination for vestibular screening in occupational medicine.

The aim of the study was to assess the usefulness of bedside examination for screening of vestibular and balance system for occupational medicine purposes. Study group comprised 165 patients referred to Audiology and Phoniatric Clinic due to vestibular and/or balance problems. Caloric canal paresis of 19% was the cut off value to divide patients into 43 caloric-positive vestibular subjects and 122 caloric-negative patients. The latter group comprised 79 subjects revealing abnormalities of videonystagmographic (VNG) oculomotor tests (central group) and 43 subjects with normal VNG. Vestibular and balance symptoms were collected. Five tests were included to bedside examination: Romberg and Unterberger tests, Head Impulse Test (HIT), Dynamic Visual Acuity (DVA) and gaze nystagmus assessment. Vestibular and balance symptoms were reported by 82% of vestibular, 73% of central and 40% of VNG-normal patients. Thirteen out of 18 VNG-normal but symptomatic subjects (73%) had abnormal tests in clinical assessment. The sensitivity of bedside test set for vestibular pathology was 88% as compared to caloric test and 68% for central pathology as compared to VNG oculomotor tests. The combination of 5 bedside tests reveal satisfactory sensitivity to detect vestibular abnormalities. Bedside examination abnormalities are highly correlated with vestibular/balance symptoms, regardless the normal results of VNG. Thus, this method should be recommended for occupational medicine purposes.

Brief Vestibular and Ocular Motor Screening (VOMS) Assessment

Brief Vestibular and Ocular Motor Screening (VOMS) Assessment

Characterizing Self-Reported Dizziness and Otovestibular Impairment among Blast-Injured Traumatic Amputees: A Pilot Study

The incidence of vestibular and audiologic injury related to blast injury remains underreported. The primary objective of this study was to document self-reported otovestibular impairment in blast-injured amputees. Secondary objectives include a description of the Walter Reed Army Medical Center Blast Injury Questionnaire and other aspects of the audiology service and amputee physical therapy section standards of care for blast injury management. A case study illustrates the application of these standards of care. Thirty-three patients were evaluated by audiologists and physical therapists using the Walter Reed Army Medical Center Blast Injury Questionnaire, followed by audiologic and vestibular screening; 24% of patients reported symptoms of vertigo or oscillopsia following blast trauma, and 51% reported subjective hearing loss. The case study subject reported an increase in function after vestibular rehabilitation therapy. Thorough screening by audiologists and physical therapists can facilitate appropriate diagnosis and management for blast-injured patients.

Rotational chair instead of ENG as the primary vestibular test

Objectives: To present a rotational chair based testing algorithm for initial evaluation of dizzy patients. Methods: Retrospective chart review. Results: One thousand consecutive patients undergoing evaluation for dizziness and imbalance at a tertiary care, referral balance center were included. Rotatational chair testing was used as the primary vestibular study with ENG used as a confirmatory test instead of a vestibular screening test. The rotational chair protocol included an ocular screening battery, VOR (vestibulo-ocular reflex testing with sinusoidal and step velocity testing and visual-vestibular interaction testing including VVOR and visual fixation studies. Rotational chair data without ENG was adequate for confirming the vestibular pathology diagnosis in 70% of patients. Only 10% of patients with normal rotation chair results had abnormal ENG results. In nearly 40% of patients with rotational chair abnormalities, the ENG results were normal. Conclusions: Given the broader array of vestibular and visual-vestibular-interaction information available, rotational chair testing may be a better vestibular screening study than ENG in diagnosing dizzy patients. Prospective investigation of this topic is warranted.