Search Results (57)

Background/Objectives: To evaluate the clinical characteristics and diagnostic significance of dissociation between bithermal caloric test and video head impulse test (vHIT) in patients presenting with dizziness. Methods: We retrospectively reviewed 644 patients who underwent bithermal caloric testing and vHIT at a university-affiliated general hospital. Patients were classified into concordant and discordant groups based on test results. The discordant group was further subdivided into those with abnormal caloric test and normal vHIT, and those with normal caloric test and abnormal vHIT. Demographic data, vestibular function test outcomes, and clinical diagnoses were analyzed. Results: Discordant results were observed in 36.5% of patients. Among these, 31.8% had abnormal caloric responses with normal vHIT, and 4.7% had normal caloric responses with abnormal vHIT. Most patients in both discordant subgroups were diagnosed with peripheral vestibular disorders, such as Ménière’s disease and unilateral vestibulopathy. The abnormal caloric/normal vHIT pattern was more common and associated with low-frequency dysfunction. The normal caloric/abnormal vHIT pattern, though less frequent, also involved predominantly peripheral etiologies. Conclusions: Dissociation between caloric and vHIT results is not uncommon and provides important diagnostic insights. Employing both tests in a complementary manner enhances the identification of frequency-specific vestibular deficits and supports more accurate diagnosis and management of vestibular disorders. Full article

Objectives: Assessing balance in highly trained individuals, such as military pilots, poses challenges, as deficits may be underestimated when compared to general population norms. To address this, several studies have proposed tailored databases providing reference values for specific populations. This study retrospectively analyzed balance characteristics in active-duty military pilots of the Italian Air Force. Methods: We enrolled 106 subjects split into two groups: 53 military pilots from the Italian Air Force and 53 civilians without flight experience or exposure to specific vestibular stimuli. All participants underwent ENT examinations with audiometric testing to exclude related pathologies, followed by a personal history collection. Subsequently, they completed the EquiTest protocol across six standard conditions. Results: Significant differences were observed between Army Aviators and Non-Aviators. The PREF variable showed the most consistent distinction, with military pilots demonstrating a superior performance (p < 0.01). Additionally, borderline differences were noted in Condition 6 of the equilibrium scores (p = 0.056), and in the Centre of Gravity (COG) analysis along the X-axis for Conditions 1 and 5 (p = 0.090), and for Condition 2 (p = 0.050). These findings suggest enhanced postural control strategies among Army Aviators under conditions of sensory conflict. Conclusions: These findings suggest that normative balance values specific to military pilots should be used when evaluating aviators recovering from balance deficits. Such tailored benchmarks can help determine the need for rehabilitation before returning to duty, ensuring optimal performance under demanding conditions. Further research is necessary to explore the underlying mechanisms responsible for these adaptations and to identify the specific stimuli that contribute to the enhanced balance capabilities observed in this highly trained population. Full article

Background: Vestibular hypofunction occurs in 29.5% of older adults with benign paroxysmal positional vertigo (BPPV), but its impact on postural control, well-being and frailty was not studied before. This study compared the well-being, frailty and postural control between older adults with BPPV and vestibular hypofunction (oaBPPV+), and older adults with only BPPV (oaBPPV). Methods: Thirty-one older adults (≥65 years old) diagnosed with BPPV were recruited. Unilateral vestibular hypofunction was defined as a >25% caloric asymmetry, and bilateral vestibular hypofunction as a total response <6°/s per ear, using bithermal caloric irrigations. The oaBPPV+ group was compared to the oaBPPV group using the measures of well-being (Dizziness Handicap Inventory, Falls Efficacy Scale and 15-item Geriatric Depression Scale), frailty (Modified Fried Criteria), and postural control (timed chair stand test, mini-Balance Evaluation Systems test and Clinical Test of Sensory Interaction on Balance (CTSIB)). Falls and the number of repositioning maneuvers were documented. Significance level was set at α = 0.05. Results: Unilateral vestibular hypofunction was present in 32% of participants, mainly in females (p = 0.04). Bilateral vestibular hypofunction was not found. The oaBPPV+ group (n = 10, mean age 72.5 (4.5)) experienced more comorbidities (p = 0.02) than the oaBPPV group (n = 21, mean age 72.6 (4.9)). Groups did not differ regarding dizziness symptoms (p = 0.46), fear of falling (p = 0.44), depression (p = 0.48), falls (p = 0.08) or frailty (p = 0.36). However, the oaBPPV+ group showed significantly worse postural control under vestibular-dependent conditions (p < 0.001). Conclusions: Despite equally impaired well-being and frailty, the oaBPPV+ group showed greater sensory orientation deficits. Clinicians and researchers should be alert for co-existing vestibular hypofunction in older adults with BPPV, since this may exacerbate their already impaired postural control more than only BPPV. Full article

Background/Objectives: Dizziness and vertigo are common symptoms. Vertigo, caused by vestibular deficit, is usually diagnosed with videonystagmography (VNG) and cervical vestibular evoked myogenic potential (cVEMP). Normative values of these examinations have been established for adults; however, the impact of age is still uncertain. This study aimed to compare the results of VNG and cVEMP between adults and children. Methods: We analyzed and compared the results of VNG and cVEMP in 119 patients (35 adults and 84 children.) Results: Statistically significant differences were observed between adults and children in the amplitude of the cVEMP examination. In the subgroup analysis by age, we also noticed differences in VNG examination in nystagmus induced by rotation in patients with peripheral vertigo and in IFO (index fixation test) and VOR (vestibulo-ocular reflex) in patients with non-peripheral vertigo. Conclusions: This study confirms that there are differences in vestibular examination results between children and adults. However, the exact impact of age on each part of the vestibular examination requires further investigation. Full article

Background/Objectives: Vestibular Physical Therapy (VPT) plays a crucial role in the rehabilitation of patients with vestibular disorders by promoting vestibular compensation through adaptation, habituation, and substitution mechanisms. While traditional VPT approaches have demonstrated effectiveness in restoring balance and gaze stability, some patients with chronic vestibular dysfunction continue to experience persistent deficits. Methods: review of recent advancements in neuroplasticity research suggest the need for updated rehabilitation strategies that integrate sensorimotor substitution, saccadic training, optokinetic stimulation, and cognitive–motor dual-task training to optimize vestibular compensation. Results: This perspective article explores innovative VPT approaches aimed at improving dynamic gaze and postural stability in a more challenging way. We emphasize the importance of personalized rehabilitation strategies that leverage multisensory integration to enhance neuroplastic recovery. Conclusions: By refining VPT interventions, we can maximize functional outcomes and improve the quality of life for individuals with vestibular disorders. Full article

Background: The clinical profiles of MNDs are dominated by inexorable motor decline, but subclinical proprioceptive, nociceptive and somatosensory deficits may also exacerbate mobility, dexterity, and bulbar function. While extra-motor pathology and frontotemporal involvement are widely recognised in motor neuron diseases (MNDs), reports of sensory involvement are conflicting. The potential contribution of sensory deficits to clinical disability is not firmly established and the spectrum of sensory manifestations is poorly characterised. Methods: A systematic review was conducted to examine the clinical, neuroimaging, electrophysiology and neuropathology evidence for sensory dysfunction in MND phenotypes. Results: In ALS, paraesthesia, pain, proprioceptive deficits and taste alterations are sporadically reported and there is also compelling electrophysiological, histological and imaging evidence of sensory network alterations. Gait impairment, impaired dexterity, and poor balance in ALS are likely to be multifactorial, with extrapyramidal, cerebellar, proprioceptive and vestibular deficits at play. Human imaging studies and animal models also confirm dorsal column-medial lemniscus pathway involvement as part of the disease process. Sensory symptoms are relatively common in spinal and bulbar muscular atrophy (SBMA) and Hereditary Spastic Paraplegia (HSP), but are inconsistently reported in primary lateral sclerosis (PLS) and in post-poliomyelitis syndrome (PPS). Conclusions: Establishing the prevalence and nature of sensory dysfunction across the spectrum of MNDs has a dual clinical and academic relevance. From a clinical perspective, subtle sensory deficits are likely to impact the disability profile and care needs of patients with MND. From an academic standpoint, sensory networks may be ideally suited to evaluate propagation patterns and the involvement of subcortical grey matter structures. Our review suggests that sensory dysfunction is an important albeit under-recognised facet of MND. Full article

Purpose: Accurate and precise navigation in space and postural stability rely on the central integration of multisensory input (vestibular, proprioceptive, visual), weighted according to its reliability, to continuously update the internal estimate of the direction of gravity. In this study, we examined both peripheral and central vestibular functions in a world-renowned 53-year-old male tightrope walker and investigated the extent to which his exceptional performance was reflected in our findings. Methods: Comprehensive assessments were conducted, including semicircular canal function tests (caloric irrigation, rotatory-chair testing, video head impulse testing of all six canals, dynamic visual acuity) and otolith function evaluations (subjective visual vertical, fundus photography, ocular/cervical vestibular-evoked myogenic potentials [oVEMPs/cVEMPs]). Additionally, static and dynamic posturography, as well as video-oculography (smooth-pursuit eye movements, saccades, nystagmus testing), were performed. The participant’s results were compared to established normative values. High-resolution diffusion tensor magnetic resonance imaging (DT-MRI) was utilized to assess motor tract integrity. Results: Semicircular canal testing revealed normal results except for a slightly reduced response to right-sided caloric irrigation (26% asymmetry ratio; cut-off = 25%). Otolith testing, however, showed marked asymmetry in oVEMP amplitudes, confirmed with two devices (37% and 53% weaker on the left side; cut-off = 30%). Bone-conducted cVEMP amplitudes were mildly reduced bilaterally. Posturography, video-oculography, and subjective visual vertical testing were all within normal ranges. Diffusion tensor MRI revealed no structural abnormalities correlating with the observed functional asymmetry. Conclusions: This professional tightrope walker’s exceptional balance skills contrast starkly with significant peripheral vestibular (otolithic) deficits, while MR imaging, including diffusion tensor imaging, remained normal. These findings highlight the critical role of central computational mechanisms in optimizing multisensory input signals and fully compensating for vestibular asymmetries in this unique case. Full article

Background/Objectives: Vestibular agnosia is characterized by a reduced or absent self-motion perception while demonstrating the presence of normal peripheral vestibular function following stimulation. This condition has previously been reported by previous authors in different populations and more recently in traumatic brain injury patients. However, the underlying mechanisms responsible for vestibular agnosia remain a matter of debate. The objective of this manuscript is to review and compare the behavioral and neuroanatomical findings in populations where vestibular agnosia has been demonstrated to better understand the underlying mechanism. Methods: A review of the literature was conducted using four databases: Medline, Embase, Google Scholar, and PubMed. A normal vestibulo-ocular reflex function with an impaired self-motion perception following vestibular stimulation represented the inclusion criteria used. Results: Behavioral data reviewed in the studies revealed a clear association with postural instability. However, no consensus can be drawn from neuroanatomical data due to variability in brain impairments in those populations even though impairments in the parietal cortex are often reported. Conclusions: In general, behavioral data and neuroanatomical data regarding vestibular agnosia have been poorly documented throughout the literature. However, vestibular agnosia can be observed in different populations and is present in concomitant postural control deficits, an important predictor of falls. Finally, even though the parietal cortex has been associated with vestibular agnosia, future studies are required to adequately identify the underlying mechanism. Indeed, the parietal cortex could be part of a larger network mediating vestibular agnosia. This review proposes various methods that future studies should use to overcome the present limitations. Full article

The objective of this study was to describe an outbreak of equine herpesvirus-1 myeloencephalopathy (EHM) in a population of aged equids. The outbreak was linked to the introduction of five healthy non-resident horses 15 days prior to the first case of acute recumbency. This fulminant EHM outbreak was predisposed by the grouping of the 33 unvaccinated animals in two large pens with shared water and feed troughs. Fourteen horses (42.4%) developed neurological deficits within the first week of the outbreak. Four additional equids developed fever and respiratory signs (EHV-1 infection), while fifteen horses remained healthy. EHM was supported by the detection of EHV-1 N₇₅₂ in blood (n = 11) and/or nasal secretions (9). Three out of four equids with EHV-1 infection and two out of fifteen healthy horses tested qPCR-positive for EHV-1. All animals were managed in the field. EHM and EHV-1 equids were treated with a combination of antiherpetic, anti-inflammatory, and antithrombotic drugs. Six out of fourteen EHM horses (42.9%) were euthanized because of recumbence and the inability to stand with assistance or vestibular signs. Anti-EHV-1 total IgG and IgG 4/7 levels in acute serum samples showed no significant difference amongst the three disease groups (p > 0.05); however, antibody levels rose significantly between acute and convalescent serum samples for EHM (p = 0.0001) and EHV-1 equids (p = 0.02). This outbreak highlights a very high EHM attack and fatality rate in a population of aged equids and rapid spread of EHV-1, as the population shared common pens and feeding practices. The outbreak also showed that EHM cases can be managed in the field when referral to a hospital is not an option. Full article

Background/Objectives: Recurrent acute otitis media (rAOM) is a common disease in childhood, but its impact on the vestibular system remains poorly understood. The present study aimed to evaluate the long-term effects of rAOM on balance and vestibular function in pediatric patients. Methods: A total of 55 children, aged 8 years (25 males and 30 females), with a documented history of rAOM, no AOM episodes in the past year, and no previous ear surgery were assessed. Static posturography was used to assess postural instability, measuring sway area (SX, mm²) under four conditions: eyes open and eyes closed, with and without foam pads. Vestibular function was evaluated using the video head impulse test (v-HIT) to quantify vestibulo–ocular reflex (VOR) gain and corrective saccades across all six semicircular canals. Results: Children with a history of rAOM demonstrated significantly greater postural instability than healthy controls (p < 0.001 for all test conditions). The number of AOM episodes was the primary factor influencing balance dysfunction, with children who had more than eight episodes showing the most pronounced deficits in postural stability (p < 0.05). In some cases, the v-HIT revealed hypofunction in the right anterior (14.5%), left posterior (7.3%), left lateral (5.5%), left anterior (3.6%), and right posterior (3.6%) semicircular canals. Conclusions: The results of this study suggest that rAOM can lead to lasting balance and vestibular dysfunction, highlighting the importance of early monitoring and potential rehabilitation. Full article

Congenital cytomegalovirus infection (cCMV) is a frequent cause of non-hereditary sensorineural hearing loss (SNHL) and developmental disabilities. The contribution of cCMV to childhood hearing loss has been estimated to be about 25% of all hearing loss in children at 4 years of age. Although the vestibular insufficiency (VI) in cCMV has not been well-characterized and therefore, underestimated, recent studies suggest that VI is also frequent in children with cCMV and can lead to adverse neurodevelopmental outcomes. The pathogenesis of SNHL and VI in children with cCMV has been thought to be from direct viral cytopathic effects as well as local inflammatory responses playing a role. Hearing loss in cCMV can be of varying degrees of severity, unilateral or bilateral, present at birth or develop later (late-onset), and can progress or fluctuate in early childhood. Therefore, newborn hearing screening fails to identify a significant number of children with CMV-related SNHL. Although the natural history of cCMV-associated VI has not been well characterized, recent data suggests that it is likely that VI also varies considerably with respect to the laterality, timing of onset, degree of the deficit, and continued deterioration during early childhood. This article summarizes the current understanding of the natural history and pathogenesis of auditory and vestibular disorders in children with cCMV. Full article

Background: Bilateral vestibulopathy (BVP) is a disabling condition characterized by a deficit in vestibular function on both sides. Current diagnostic criteria consider instrumental data only from horizontal canals, excluding vertical canals and otolithic function, with the possibility of not including some variants of BVP. This study aims to evaluate vestibular functions in people with chronic vestibular syndrome through a comprehensive battery of tests. Methods: This diagnostic accuracy study included patients who met criteria for probable BVP. The index test included a thorough evaluation of the vestibular system, using the video Head Impulse Test (vHIT) to measure the gain of the angular vestibulo-ocular reflex (aVOR) in all six semicircular canals and the cervical and ocular vestibular-evoked myogenic potentials (VEMPs) to assess otolith function. The diagnostic criteria established by the Barany Society were considered the standard reference, including only the horizontal vHIT as an instrumental assessment. Results: 78 patients (41 male, age 61.40 ± 12.99) were enrolled. The Barany criteria showed a low ability to rule out BPV (sensitivity = 46%). The median Dizziness Handicap Inventory (DHI) varied from 66 to 69 among the models studied, and a significant difference in DHI scores between positive and negative tests was observed for the Barany criteria and the six-canals vHIT model. Conclusions: Our findings highlight the potential to transform BPV diagnostic criteria. The identification of new bilateral vestibular dysfunction variants through improved diagnostic tools calls for revising current criteria, with promising implications for patient care and understanding of etiological and prognostic aspects. Full article

Reactive postural control (RPC), essential for maintaining balance during daily activities, relies on a complex sensory system integrating visual, vestibular, and proprioceptive inputs. Deficits in RPC can lead to falls, especially in unpredictable environments where sensory inputs are challenged. Traditional rehabilitation often fails to prepare patients adequately for real-world conditions. This study aims to explore the effects of varying instability levels (ILs) and sensory integration strategies (SIS) on RPC by evaluating balance disturbances without applying additional external force. Twenty-five healthy participants (12 men, 13 women, 24.5 ± 6.1 years) performed balance tasks on Abili^® platforms with adjustable ILs (0, 1, 2, 3) while altering sensory strategies (Basic, Visual, Proprioception, Vestibular) using the Modified Clinical Test of Sensory Integration and Balance (mCTSIB). RPC efficiency was measured using the 95th percentile confidence interval for chest movement’s ellipsoid volume and average velocity, analyzed with Wilcoxon signed-rank tests and Cliff’s delta effect size. Results showed significant increases in chest movement velocity and volume, particularly with the Vestibular strategy at higher ILs, with a 7176% increase in chest volume from Basic strategy at 0IL to Vestibular strategy at 3IL. Additionally, removing visual input (Visual and Vestibular strategies) had a greater impact on chest movement than increasing instability levels. These findings underscore the significant role of combined platform instability and reduced sensory input on postural control. This study presents a novel method for challenging balance and suggests that sensory integration with variable instability could be valuable in training and rehabilitation, even for healthy individuals. Full article

Extremely preterm birth entails an increased risk for multimorbidity and the prevalence of developmental deficits because this risk is negatively correlated to the number of gestation weeks. This work evaluated subcortical volume changes in children born extremely preterm who received Katona neurohabilitation, as well as the effects of subcortical volume and treatment adherence on their three-year-old neurodevelopment outcomes. Fifteen extremely preterm-born participants were treated from two months to two years old and followed up until past three years of age. The participants received Katona neurohabilitation, which provides vestibular and proprioceptive stimulation and promotes movement integration through the early, intensive practice of human-specific elementary movements. Subcortical brain volumes from magnetic resonance images were obtained at the beginning and after treatment. Also, treatment adherence to Katona neurohabilitation and neurodevelopment outcomes were measured. The results showed that absolute subcortical volumes increased after treatment; however, when adjusted by intracranial volume, these volumes decreased. Subcortical function inhibition allows cortical control and increased connectivity, which may explain decreased adjusted volume. Regression analyses showed that after-treatment hippocampal volumes had a discrete predictive value. However, treatment adherence showed a clear effect on mental and psychomotor neurodevelopment. Thus, the effectiveness of Katona neurohabilitation is constrained by treatment adherence. Full article

Background: Postural control deficits have been documented in children with autism spectrum disorder (ASD), yet vestibular system contributions to postural control have not been widely considered. The purpose of this study is to explore the relationship between functional balance, postural sway, and vestibular function in children with ASD. Methods: Ten children with a confirmed diagnosis of ASD according to DSM-V guidelines along with ten children with no known neurodevelopmental or motor delays participated in the study. Bruininks–Oseretsky Test of Motor Proficiency and the Paediatric Balance Scale measured functional balance ability, and postural sway was measured using static posturography with modified sensory inputs. Peripheral vestibular function was measured using cervical vestibular evoked myogenic potentials and video head impulse testing. Correlations between measures were performed. Results: When visual cues were removed, children with ASD demonstrated larger path velocities indicative of reduced postural control, and different patterns of postural sway. Functional balance was correlated with path velocities for conditions where sensory information was modified. No differences in peripheral vestibular function were noted between groups, and functional balance was not correlated with vestibular function. Conclusions: Findings suggest that while peripheral vestibular function is similar between groups, postural control differences in children with ASD remain, particularly for conditions where sensory information is modified. Furthermore, demonstrated patterns of postural sway suggest sensory system integration is less developed in children with ASD. These findings highlight the importance of utilising a range of clinical tools to quantify balance ability and consideration of postural control measures to inform intervention. Full article