Videonystagmography Research Articles

Role of videonystagmography and cervical vestibular evoked myogenic potentials in the diagnosis of vestibular migraine

Background and objective: Vestibular migraine is widely accepted as a unique disease, although its pathophysiology remains uncertain. When the patient is asymptomatic, vestibular migraine is often challenging to diagnose as its many symptoms overlap with other conditions. This study aimed to assess the role of videonystagmography and cervical vestibular evoked myogenic potentials tests in diagnosing vestibular migraine. Methods: This study is a descriptive cross-sectional study conducted on 30 patients clinically diagnosed with vestibular migraine in the Audiology Center in Sulaimani City. The study duration was from December 1st, 2018, to June 30th, 2019. The author interpreted magnetic resonance imaging, videonystagmography, and cervical vestibular evoked myogenic potential results. Results: The patients' mean age was 34.9 years with a high predominance of the female gender. Vertigo was the main complaint of the patients (73.4%) with the recurrent course. A family history of migraine was present in 83.3% of the patients. Only two (6.7%) patients had abnormal findings on the brain magnetic resonance imaging. Videonystagmography examination showed that 40% of the patients had abnormal findings; 20% were abnormal on the left, 16.7% were abnormal on the right, and 3.3% were bilaterally abnormal. The cervical vestibular evoked myogenic potentials test was abnormal for 63.3% of the patients; 43.3% abnormality was on the left side, and 20% was on the right side. Conclusion: The cervical vestibular evoked myogenic potentials and videonystagmography tests are helpful in the diagnosis of vestibular migraine. Keywords: Vestibular migraine; Video nystagmography; Cervical vestibular-evoked myogenic potentials.

Capturing nystagmus in the emergency room: posterior circulation stroke versus acute vestibular neuritis

ObjectivesTo compare acute nystagmus characteristics of posterior circulation stroke (PCS) and acute vestibular neuritis (AVN) in the emergency room (ER) within 24 h of presentation.MethodsER-based video-nystagmography (VNG) was conducted, recording ictal nystagmus in 101 patients with PCS (on imaging) and 104 patients with AVN, diagnosed on accepted clinical and vestibular test criteria.ResultsPatients with stroke in the brainstem (38/101, affecting midbrain (n = 7), pons (n = 19), and medulla (n = 12)), cerebellum (31/101), both (15/101) or other locations (17/101) were recruited. Common PCS territories included posterior-inferior-cerebellar-artery (41/101), pontine perforators (18/101), multiple-territories (17/101) and anterior-inferior-cerebellar-artery (7/101). In PCS, 44/101 patients had no spontaneous nystagmus. Remaining PCS patients had primary position horizontal (44/101), vertical (8/101) and torsional (5/101) nystagmus. Horizontal nystagmus was 50% ipsiversive and 50% contraversive in lateralised PCS. Most PCS patients with horizontal nystagmus (28/44) had unidirectional “peripheral-appearing” nystagmus. 32/101 of PCS patients had gaze-evoked nystagmus. AVN affected the superior, inferior or both divisions of the vestibular nerve in 55/104, 4/104 and 45/104. Most (102/104) had primary position horizontal nystagmus; none had gaze-evoked nystagmus. Two inferior VN patients had contraversive torsional-downbeat nystagmus. Horizontal nystagmus with SPV ≥ 5.8 °/s separated AVN from PCS with sensitivity and specificity of 91.2% and 83.0%. Absent nystagmus, gaze-evoked nystagmus, and vertical-torsional nystagmus were highly specific for PCS (100%, 100% and 98.1%).ConclusionNystagmus is often absent in PCS and always present in AVN. Unidirectional ‘peripheral-appearing’ horizontal nystagmus can be seen in PCS. ER-based VNG nystagmus assessment could provide useful diagnostic information when separating PCS from AVN.

The effect of different types of convergent strabismus on horizontal eye movements.

To investigate the effect of different types of convergent strabismus on horizontal eye movements and compare data with healthy control subjects. This prospective, cross-sectional study included 38 patients with convergent strabismus (16 fully accommodative, 13 partially accommodative and 9 non-accommodative esotropia) and 19 age-matched control subjects. All of the participants had a detailed ophthalmological examination including visual acuity assessment, cover-uncover prism test, slit lamp, and indirect ophthalmoscopy examination. Videonystagmography (VNG) was used for the evaluation of horizontal eye movements such as saccadic accuracy, velocity, latency, and smooth pursuit velocity gain. The saccadic accuracy in the rightward direction was lower in the fully accommodative esotropia group compared to the partially accommodative esotropia group in the right eye (p = 0.002). The saccadic latency in the rightward direction was longer in the fully accommodative esotropia group compared to the control group (p = 0.008) and smooth pursuit velocity gain in the leftward direction was lower in the partially and non-accommodative esotropia group compared to the control group in binocular recording (p = 0.004, p = 0.001, respectively). There was no difference in the saccadic velocity among the study groups (p > 0.05). Finally, asymmetry of saccadic velocity and latency was observed between right- and leftward directions in the partially accommodative esotropia group in the right eye (p = 0.003, p = 0.008, respectively). This study demonstrated that horizontal eye movements may vary in different types of convergent strabismus. VNG may be an auxiliary tool to the clinical examination in differentiating fully or non-accommodative esotropia.

Analysis of Bone Mineral Density and Bithermal Caloric Test Results in Unilateral Idiopathic Benign Paroxysmal Positional Vertigo Patients

Benign paroxysmal positional vertigo (BPPV) is the most frequently diagnosed type of peripheral vestibular vertigo. Studies have reported a possible association between BPPV and osteoporosis; however, there is still a lack of evidence. This study aimed to investigate the characteristics of bone mineral density (BMD) and bithermal caloric test results in patients with unilateral posterior canal idiopathic benign paroxysmal positional vertigo (pc-iBPPV). BMD was measured in 65pc-iBPPV menopausal female patients and 65 healthy controls using dual-energy xray absorptiometry and then compared the T-score of BMD between the two groups. The bithermal caloric test was also performed with video nystagmography and the relationship between canal paresis, directional preponderance, T-score, and recurrence were analyzed. Lower T-scores were observed in pc-iBPPV patients compared with the normal subjects. Among 65 pc-iBPPV patients, free recurrence was observed in 38 (58.5%), single recurrence was noted in 14 (21.5%), and multiple recurrences were seen in 13 (20%) patients. The proportion of positive T-score and CP value increased with the pc-BPPV recurrence frequency. Statistically, a significant difference was found only in T-score, indicating that recurrence was raised with a decrement of T-score. The proportion of positive CP values tended to increase as BMD decreased. The decrement of BMD might be one of the pathogeneses in patients with unilateral pc-iBPPV and associated with multiple recurrences. Moreover, positive CP value cannot be regarded as a predictive factor for recurrence; however, there is a clear association between CP and BMD.

Quantitative assessment of oculomotor function by videonystagmography in multiple system atrophy

ObjectiveTo quantitatively assess oculomotor impairments in multiple system atrophy (MSA) and to explore their correlation with clinical characteristics. MethodsWe recruited 45 patients with MSA, including 21 with dominant ataxia (MSA-C), 24 with dominant parkinsonism (MSA-P), and 40 age-matched healthy controls. Detailed oculomotor performance in the horizontal direction was measured using videonystagmography (VNG). ResultsWe found that the proportion of abnormal eye movements in patients with MSA was 93.3% (37.7%, 51.1%, 73.3%, 71.1%, and 37.8% on fixation and gaze-holding, without fixation, saccade, smooth pursuit, and optokinetic nystagmus tests, respectively). Patients with MSA-C showed significantly lower gains in smooth pursuit test and optokinetic nystagmus test, and a higher incidence of hypermetria in the saccade test than patients with MSA-P (all P < 0.05). No oculomotor deficits were correlated with age, age of onset, sex, disease duration, or Unified Multiple System Atrophy Rating Scale (USMARS) (all r < 0.25, P > 0.1). ConclusionsAn extremely high incidence of oculomotor impairments could be observed using VNG in both the MSA-C and MSA-P subtypes, although there were some differences between them. SignificanceA comprehensive oculomotor examination could serve as a valuable tool in the diagnostic workup of patients with MSA.

Dysfunctions of the vestibular organ in patients with migrainous vertigo in the results of objective tests of the equilibrium system.

&lt;b&gt;Introduction:&lt;/b&gt; Migrainous vertigo (MV) is one of the most common causes of episodic vertigo. Diagnostic criteria for MV are described in the appendix to the third edition of the International Classification of Headache Disorders (Beta Version). The dysfunction exerts its impact on certain peripheral and central structures within the vestibular system. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Aim:&lt;/b&gt; The aim of the study was to assess the function of the central and peripheral vestibular system in patients with MV based on the results of objective clinical tests including videonystagmography (VNG) and cervical vestibular evoked myogenic potentials (cVEMP) depending on the duration of the disease. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Material and methods:&lt;/b&gt; A query of the medical records of patients receiving vertigo treatment at the Department of Otolaryngo-logy of the Centre of Postgraduate Medical Education over the last four years returned a total of 84 cases of patients diagnosed with MV; the patients were assigned to either of the following two groups: study group I (SG1) - 42 patients with MV in whom the symp-tom onset had occurred within one year prior to hospital admission, and study group II (SG2) - 42 patients who had been suffering from vertigo for about 10 years. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Results:&lt;/b&gt; Patients in both groups (SG1 and SG2) were diagnosed with all three types of vestibular dysfunction (central, peri-pheral and mixed), with peripheral vestibular dysfunction being the predominant finding. A thorough analysis of the dura-tion of vestibular attacks revealed that the patients suffering from MV for a longer period of time (SG2) suffered from vertigo attacks which were longer than those in the patients with the shorter lasting-disorder (SG1). The duration of vertigo episodes was also estimated to be prolonged in peripheral and mixed types of vestibular disorders. The percentage of individuals with peripheral and mixed vestibular disorders increased significantly with increasing MV episode durations.

P 56 Deep learning derived quantitative Video-NystagmoGraphy using smartphone cameras: DeepVNG

Background: The assessment of eye movements is commonly considered a “ window into the brain ”. However, sole clinical observation is limited to semiquantitative findings. Recent advances in quantitative oculomotor phenotyping using video-oculography (VOG) promise additional diagnostic and prognostic value. However, methodological complexity and limited availability have hampered broad use of VOG in clinical and outpatient settings. Here, a novel approach for binocular video-nystagmography (VNG), capitalizing on recently deployed artificial intelligence frameworks for markerless pose estimation, is validated. Methods: Standardized 2D-optokinetic stimuli were presented on a smartphone screen and elicited nystagmus was recorded with two methods: first, using a conventional smartphone camera (1920x1080 px, 30 frames per second) mounted frontoparallely on a tripod and second, using gold standard infrared VOG goggles (EyeSeeCam, 188x120 px, 220 frames per second). Using the open-source software DeepLabCut , a recurrent neural network (RCNN) architecture was fine-tuned for tracking of pupils and facial anatomical landmarks. For subsequent comparisons, kinematic parameters (e. g. slow phase velocity (SPV)) of nystagmus were calculated from RCNN- and VOG-derived time series datasets using an instantaneous gradient algorithm. Precision of methods was compared using ANOVA and modified T-statistics, namely two one-sided T-testing (TOST) and one-sample T-tests. Results: In monocular analyses of RCNN-derived data, neither eye nor stimulus direction exerted significant influence on SPV (F (1, 5) = 1.33, p= [DZ1] .30 and F (3, 15) = 0.66, p = .59). Furthermore, method did not significantly influence omnidirectional SPV measurements (F (1, 5) = 0.009, p = .78). Finally, TOST results demonstrated equivalence in both horizontal (upper bound T(5) = -3.45, p = .009; lower bound (T(5) = 5.0, p= .002) and vertical (T(5) = -3.06, p = .01; T(5) = 3.35, p = .01) stimulus planes. Conclusions: This proof-of-concept study shows that a deep learning based tool (DeepVNG) can extract characteristics of nystagmus from smartphone video recordings of eye movements elicited by standardized optokinetic stimuli with comparable precision to gold standard VOG. These results may lay the groundwork for broadly available “ vestibular event monitors ” assisting both caregivers and patients in detection and quantification of nystagmus and may open an avenue for more granular analyses of nystagmus expected to improve its diagnostic value.

Evaluating Oculomotor Tests before and after Vestibular Rehabilitation in Patients with Parkinson's Disease: A Pilot Pre-Post Study.

Introduction The elderly population is commonly affected by balance and gait disorders that increase the risk of falls. Pivotal systems for efficient postural control are sensory, motor, visual, vestibular, and cognitive. Disruption in any of these systems could lead to postural instability. Vestibular rehabilitation is a set of exercises that positively affect the primary components of the central sensory-motor integration, including somatosensory, visual, and vestibular systems. Accordingly, we hypothesized that vestibular rehabilitation exercises might improve both oculomotor functions and upright postural control in patients with Parkinson's disease. Materials and Methods 11 idiopathic Parkinson's patients voluntarily participated in this study based on inclusion criteria: central vestibular dysfunction and the Hoehn and Yahr scale scores less than or equal to 3. Videonystagmography (VNG) and the Berg Balance Scale (BBS) scores were measured at the baseline. Then, the patients underwent vestibular rehabilitation training for 24 sessions (3 sessions per week). The VNG and BBS were measured again after 48 hours of the completion of the last session of the training. Result After completing vestibular rehabilitation sessions, there were significant improvements in balance (P ≤ 0.001). Eye-tracking and gaze function statistically improved in 7 patients and 6 patients, respectively. Conclusion Vestibular rehabilitation produced positive effects on oculomotor function and balance in a small cohort of people with PD. Consequently, it could be considered as a possible effective intervention for Parkinson's patients. This trial is registered with IRCT201709123551N6.

Comparison between video head impulse and videonystagmography in patients with vertiginous migraine

Background and aim In addition to the classic migraine symptoms of vertigo, dizziness, and imbalance, vestibular migraine causes vertigo, dizziness, and imbalance. The video head impulse test (VHIT) is a novel approach for determining the function of each semicircular canal. Although videonystagmography (VNG) is an effective tool for identifying peripheral vertigo, not all patients with central vertigo can be easily detected. The goal of this research is to confirm the findings of the functional outcome of VHIT versus VNG in patients with vertiginous migraine. Patients and methods We selected 40 patients (both sexes) with vestibular migraine and 25 normal individuals as control. Both groups were subjected to complete clinical examination after thorough history taking, laboratory investigations, VHIT, and VNG. Results VNG had excellent predictive value in the patients’ group (95% confidence interval=0.891–0.998, P=0.0001) with a 96.6% sensitivity and 86.2% specificity, while VHIT had poor predictive value with a sensitivity of 100% and specificity of 48.1% (95% confidence interval=0.523–0.779, P=0.099). Conclusion VNG has a specificity and sensitivity for the prognosis of vestibular migraine that is virtually identical to VHIT.

Effectiveness of virtual reality-based vestibular rehabilitation in patients with peripheral vestibular hypofunction.

The rehabilitation of classical peripheral vestibular disorders is long and costly. Recently, interactive systems based on virtual reality (VR) technology have reduced the cost of vestibular rehabilitation therapy (VRT) and made the process more enjoyable. This study aims to investigate the effects of VR-based VRT in patients diagnosed with peripheral vestibular hypofunction (PVH). In this study, a VR-based VRT program that utilized Sony Playstation®4 VR Head Mounted Display was applied to 25 patients (between 18-60) diagnosed with PVH. PVH was diagnosed by evaluating the patients' clinical histories, the findings in the "Micromedical Technologies VisualEyes Spectrum" videonystagmography (VNG) and the "Micromedical Aqua Stim" model bithermal water caloric tests. VR-based VRT program was applied to the patients for 4 weeks, 2 sessions per week, 8 sessions in total. Each session lasted around 30 to 40 min. All patients underwent the Dizziness Handicap Inventory (DHI), Sensory Organization Test (SOT), Adaptation Test (ADT), Limits of Stability (LOS), and Rhythmic Weight Shift (RWS) before, after, and 8-week follow-up of the VRT program. In addition, the Cybersickness Survey was applied to the patients at the end of the VR-based VRT session every week. The DHI mean scores of the patients were 54.60, 19.20, and 16.84, respectively, before, just after, and at the 8-week follow-up VRT (p < 0.001). The mean SOT composite score of the patients was obtained as 58.08 before VRT; 77.16 after VRT and 76.40 at 8-week after VRT (p < 0.000). On the other hand, the values in the 'movement velocity' and "direction control" parameters of the patients in LOS and RWS showed a significant improvement after VRT compared to before VRT (p < 0.000). From before VRT to 8 weeks after VRT, the patient's oscillation averages in the 'toes up' and 'toes down' positions in ADT reduced progressively (p < 0.000). This study demonstrates that implementing a VR-based VRT protocol may be an efficient option to improve posture stability and the quality of life in patients with PVH. In addition, VR-based vestibular rehabilitation therapy has shown to be effective for PVH patients in the mid-term.

Video head impulse test in multiple sclerosis patients

ObjectivesThe aim was to assess the vestibulo-ocular and oculomotor functions in multiple sclerosis (MS) patients using video head impulse test (vHIT) and videonystagmography (VNG).BackgroundVestibular symptoms are common symptoms of MS.Patients and methodsThis study is a case–control study. Participants included in this study were divided into two groups: 30 normal participants not complaining of any vestibular symptoms and 30 MS patients diagnosed according to the McDonald criteria 2017. Vestibular assessment using vHIT and VNG was done to both groups.ResultsVNG abnormalities were reported in 53.3% of MS patients, the abnormalities were reported in the saccade, pursuit, optokinetic, gaze, and positional tests. Half of MS patients (15) (50%) had abnormal low vHIT gain. There was a significant statistical difference between cases and controls as regards anterior and posterior canal gain. Abnormal low gain in vHIT was reported in 16.7% in lateral SCC, 20% in posterior SCC, and 26.7% in the anterior canal. There was a significant statistical relationship between abnormal gain in vHIT and vestibular symptoms (P = 0.001 and 0.020 for imbalance and vertigo, respectively). There was a statistically significant relationship between brainstem lesions and vHIT gain of lateral and posterior canals (P = 0.006 and 0.002 for lateral and posterior canals, respectively).ConclusionThe vestibular system may be affected in MS patients, 67% of patients had vestibular symptoms. Abnormal low gain of the vestibule–ocular reflex was reported in half of MS patients. There was a significant association between vHIT gain abnormalities and brainstem lesions.

Effect of Acupuncture on Waveform Characteristics and Visual Acuity in Idiopathic Infantile Nystagmus: A Prospective Interventional Study

Introduction: Idiopathic Infantile Nystagmus or Infantile Nystagmus Syndrome (INS) is one of the known causes for congenital nystagmus. Though the exact aetiology is unknown, there have been studies related to its treatment using prisms and contact lens. However, there have been not many clinical studies using the alternative therapy like acupuncture is done to analyse the effect on nystagmus. Therefore, the rationale of the study was to know the effect of acupuncture in INS and identify the same by Videonystagmography (VNG). Aim: To evaluate the effect of acupuncture on waveform characteristics and visual acuity in INS. Materials and Methods: This prospective interventional study was performed at Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India, during the period of March 2004 to March 2006. Institutional review board/ethical clearance was obtained and patients with INS of more than 18 years, who were co-operative, underwent acupuncture needle stimulation of sternocleidomastoid. The needles in sternocleidomastoid were stimulated every 5 minutes for 15 minutes for 10 sittings (5 days). Nystagmus parameters like slow phase velocity, amplitude, frequency were recorded by videonystagmograpy for 20 minutes. Changes in waveform and visual acuity (Snellen visual acuity charts) were examined on every visit on all five days and patients were followed-up for three months. Visual acuity, nystagmus intensity, amplitude, frequency and slow phase velocity were the parameters analysed. A repeated measure- Analysis of Variance (ANOVA) test and Freidman test was performed using Statistical Package for the Social Sciences (SPSS) (version 16.1) to analyse the data. A p-value &lt;0.05 was considered significant. Results: Ten patients with INS underwent the procedure. Significant improvement in distant visual acuity was noted at three months (right eye p=0.039, left eye p=0.050). Significant decrease in frequency during treatment (p=0.046, p=0.014 at 10 minutes and 15 minutes respectively) was noted. Dampening of nystagmus amplitude was seen during acupuncture therapy, which got enhanced by twirling of the needles. No permanent changes in waveform characteristics were seen after therapy in the follow-up for over three months. Conclusion: The afferent stimulation from neck muscles by acupuncture in infantile nystagmus does affect waveforms during therapy and visual acuity after the therapy on short-term.

Vestibular function testing in the 21st century: video head impulse test, vestibular evoked myogenic potential, video nystagmography; which tests will provide answers?

To most neurologists, assessing the patient with vertigo is an unpleasant and worrisome task. A structured history and focused examination can be complemented by carefully selected laboratory tests, to reach an early and accurate diagnosis. We provide evidence-based recommendations for vestibular test selection. The video head impulse test (vHIT), cervical and ocular vestibular evoked myogenic potential (VEMP) and home-video nystagmography are four modern, noninvasive methods of assessing vestibular function, which are equally applicable in the hospital and office-practice. Collectively, they enable assessment of all five vestibular end-organs. The prevalence and patterns of test abnormalities are distinct for each vestibular disorder. We summarize typical abnormalities encountered in four common vestibular syndromes. In the context of acute vestibular syndrome, an abnormal vHIT with low gain and large amplitude refixation saccades and an asymmetric oVEMP separates innocuous vestibular neuritis from stroke. In episodic spontaneous vertigo, high-velocity ictal nystagmus and asymmetric cVEMP help separate Ménière's disease from vestibular migraine. In chronic imbalance, all three tests help detect unilateral or bilateral vestibular loss as the root cause. Recurrent positional vertigo requires no laboratory test and can be diagnosed and treated at the bedside, guided by video nystagmography.

Nystagmus Parameters of Supine Roll Test Correlates With Prognosis After Repositioning Maneuver in Horizontal Semicircular Canal Benign Paroxysmal Positional Vertigo.

Background: Positional nystagmus induced by supine roll test is characteristic for diagnosing horizontal semicircular canal benign paroxysmal positional vertigo (HC-BPPV). In this study, we aimed to explore the value of nystagmus parameters in by supine roll test (SRT) as prognostic factors in HC-BPPV.Methods: We retrospectively analyzed the nystagmus parameters of 813 patients diagnosed with HC-BPPV by the SRT model in the SRM-IV system through video nystagmography. Then we used the computer-controlled canalith repositioning procedure (CCRP) mode for treatment. Based on the outcomes, patients were divided into either the cured group or the resistant group. The 1:1 propensity score matching (PSM) was applied to minimize potential selection bias. Then univariable and multivariable analyses were performed to identify the association of nystagmus parameters and the efficacy of CCRP.Results: Among the 813 patients, 99 (12.2%) were classified in the resistant group. The right side of HC-BPPV patients was twice the number of the left side patients (537 vs. 276). PSM is used to pair resistant patients to the cured patients, in which 99 pairs were successfully matched. Results of univariate and multivariate analyses showed that patients in the resistant group have longer latency in the affected side [odds ratio (OR) = 1.231 (1.110–1.366); P < 0.001] and slower slow phase velocity (SPV) in the healthy side [OR = 0.957 (0.917–0.999); P = 0.045].Conclusion: Nystagmus parameters may represent the characteristics of canalith. HC-BPPV patients with a longer latency in the affected side and slower SPV on the healthy side during SRT have a higher risk of HC-BPPV persisting after a single CCRP.

Post-traumatic peripheral vestibular disorders (excluding positional vertigo) in workers following head injury

Benign paroxysmal positional vertigo has typically been reported to be the most common cause of post-traumatic dizziness. There is however paucity in the literature about other peripheral vestibular disorders post-head injury. This article provides an overview of other causes of non-positional dizziness post-head trauma from our large institutional experience. The UHN WSIB Neurotology database (n = 4291) between 1998 and 2018 was retrospectively studied for those head-injured workers presenting with non-positional peripheral vestibular disorders. All subjects had a detailed neurotological history and examination and vestibular testing including video nystagmography, video head impulse testing (or a magnetic scleral search coil study), vestibular-evoked myogenic potentials, and audiometry. Imaging studies included routine brain and high-resolution temporal bone CT scans and/or brain MRI. Based on a database of 4291 head-injured workers with dizziness, 244 were diagnosed with non-positional peripheral vertigo. Recurrent vestibulopathy (RV) was the most common cause of non-positional post-traumatic vertigo. The incidence of Meniere’s disease in the post-traumatic setting did not appear greater than found in the general population. The clinical spectrum pertaining to recurrent vestibulopathy, Meniere’s disease, delayed endolymphatic hydrops, drop attacks, superior semicircular canal dehiscence syndrome, and uncompensated peripheral vestibular loss are discussed.

The Effects of Vestibular Rehabilitation on Kinesiophobia and Balance with Individuals Who has Vestibular Hypofunction.

The study aimed to examine the effects of vestibular rehabilitation on kinesiophobia, quality of life, dynamic visual acuity, and balance. Thirty vestibular hypofunction patients aged 18–65 years who were diagnosed by videonystagmography (VNG) voluntarily participated in the study. Before and after treatment Tampa Kinesiophobia Scale, World Health Organization Quality of Life Scale-Turkish Short Form, Tandem Stance Test, Dynamic Visual Acuity, Visual Analog Scale to measure dizziness, Subjective Visual Vertical and Subjective for verticality and horizontality perception Visual Horizontal tests were applied. The exercise program was applied for 8 weeks. Patients were observed in the hospital every two weeks. The exercises given in the session were given as home exercises, 3 times a day, for 10 repetitions. As a result of the study, statistical correlations were found tandem stance test, subjective visual vertical and subjective visual horizontal tests for the perception of verticality and horizontality, visual analog scale to measure the severity of dizziness, dynamic visual acuity, quality of life and tampa kinesiophobia scales (p < 0.05). It can be said that vestibular rehabilitation improves the quality of life, balance, dynamic visual acuity, and overcomes kinesiophobia in patients. Trial registration number: NCT05070936, Date of registration:10/06/2021 (Retrospectively registered).

The Efficacy of Combined VHIT and VNG in the Diagnosis of Vertigo Caused by Meniere's Disease.

This study aimed to evaluate the efficacy of video head impulse test (VHIT) and Videonystagmography (VNG) diagnostic tests in the diagnosis of vertigo caused by Meniere's disease. In this cross-sectional study 20 patients (10 in Meniere's group and 10 in control group) with vertigo attacks were involved. Patients were diagnosed with Meniere's disease (according to clinical criteria) or acute vertigo due to other causes after taking a history, complete examination, audiometry screening, and recording patient information in a pre-prepared checklist. Patients were referred to an audiology clinic for performing ECOG, VHIT, and VNG. All variables and sensitivity, specificity, positive predictive value, and negative predictive value were recorded and analyzed. There was no statistical difference between two groups regarding the mean age and gender of the patients (p > 0.05). The results showed no statistically significant difference between the study groups regarding the frequency distribution of ECOG, VNG, VHIT results. Also the results showed no statistically significant difference between the study groups regarding the frequency distribution of combined VNG and VHIT results. Combined VNG and VHIT had a relatively low sensitivity but high specificity in diagnosing Meniere's disease compared with the ECOG test, which had a sensitivity of 70% and a specificity of 90%. At the time of attack in this study, combined VNG and VHIT had a sensitivity of 50% and a specificity of 90%. According to the results of the current study, it can be concluded that patients in whom the result of combined VNG and VHIT was positive for Meniere's were more likely to have Meniere's disease based on clinical criteria.

Videonystagmography (VNG) Findings in Patients with Vestibular Migraine: A Hospital-Based Study.

Vestibular migraine (VM) is a disorder where vestibular symptoms are causally related to migraine. It is one of the common causes of recurrent vertigo in the general population. It has often remained as an under-recognized condition with largely unknown pathophysiology. Accurate diagnosis is essential in vestibular pathologies as it determines the management in each case. The aim of this reasearch was to compare vestibular functions of patients with VM and healthy controls using VNG and to study the VNG patterns of patients diagnosed with VM. This study is a retrospective analysis of subjects who have undergone videonystagmography (VNG) testing from October 2018 to October 2020 done in a tertiary referral hospital. Those patients satisfying diagnostic criteria for vestibular migraine were subjected to VNG testing. Group 1 consisted of 35 vestibular migraine patients, and group 2 consisted of 35 age and sex-matched healthy controls. Statistical comparison of parameters of these groups were made.We found that the mean age of VM patients in the study was 40 ± 9.9, and the females were predominantly affected (Female: Male = 2.8:1). Statistically significant difference was obtained between VM patients and healthy controls in vertical smooth pursuit and in the positional tests using the Dix Hallpike test on the right side (p value < 0.05). We conclude that a careful study of VNG patterns can serve as a valuable tool in hard to diagnose cases of vestibular migraine.

Effect of using smart phones on balance functions

Abstract Objective To investigate the effect of visual fatigue caused by smart phone on the balance function. Subjects and Methods Forty subjects divided into 2 groups were included in the present study . Group I, twenty normal healthy subjects with mean age of 28.8 years. Group II, twenty subjects with a clinical diagnosis of peripheral vestibular disorder with mean age of 38.85years. They were subjected to a computer vision syndrome questionnaire (CVS-Q) , occulomotor tests of videonystagmography (VNG) and sensory organization test (SOT) of computerized dynamic posturography (CDP) before and after visual fatigue induction. Results Significant differences existed between C5, 6 and composite scores in group I and in C4 and composite scores in group II after visual fatigue induction. However, there was no significant difference between occulomotor tests in both groups after visual fatigue induction. Conclusions The smart phone use can affect the balance function in healthy subjects and augment the deficit in those with balance problem. Reducing visual fatigue should be considered through various procedures as taking proper rest, adjusting the brightness of screen, avoid any wrong posture and using filters if possible.

Vestibular Function in Children with Type 1 Diabetes: Videonystagmography Testing

Background: Vestibular system is critical for maintaining balance and learning complex tasks. This study aimed to determine the frequencies, types, and predictors of vestibular dysfunctions (VDs) in children with type 1 diabetes (T1D) using videonystagmography (VNG). Patients and Methods: This study included 65 patients (children with T1D = 40; controls = 25). The patients underwent VNG. Results: Patients (boys = 15; girls = 25) had a mean age of 14.05 ± 1.82 years and duration of illness of 6.30 ± 2.84 years. The majority had frequent attacks of diabetic ketoacidosis (DKA) (65%) and hypoglycemia (40%). Dizziness was reported in 20%. VNG abnormalities were reported in 70% (n = 28), of them 71.43 and 28.57% had central and peripheral VDs, respectively. Dizziness was associated with peripheral VD. Compared to patients without VDs, those with VDs were older and had earlier age at onset and longer duration of diabetes (>5 years), higher levels of HbA1c (>7%), higher frequencies of DKA and hypoglycemic attacks, comorbid medical conditions, and diabetic complications. Multiple logistic regression analysis showed that presence of VNG abnormalities (VDs) was independently correlated with diabetes duration >5 years (odds ratio [OR] = 4.52 [95% confidence interval [CI] = 3.55–7.04], p = 0.001), HbA1c% levels >7% (OR = 3.42 [95% CI = 2.84–5.75], p = 0.001), and presence of hypoglycemic attacks (OR = 4.65 [95% CI = 2.85–7.55]). Conclusions: -VDs are prevalent in children with T1D and correlated with the duration and severity of diabetes and the occurrence of hypoglycemic attacks. Therefore, optimizing glycemic control and prevention and treatment of diabetic complications and comorbidities are important. Multidisciplinary follow-ups are required for early detection and management of diabetic VDs.