Search Results (40)

Background/Objectives: This study compared vestibular evoked myogenic potentials (VEMP) and video head impulse test (vHIT) findings between long-term hearing aid users and non-users with moderately severe to profound sensorineural hearing loss (SNHL) to investigate whether prolonged use of high-power hearing aids has any effect on the functioning of peripheral vestibular organs. Methods: A cross-sectional study was conducted in the audiology clinic of a tertiary care hospital. Using convenience sampling, 67 adults aged 20–64 years who visited for hearing evaluation or hearing aid services were recruited and allocated into hearing aid user and non-user groups. VEMP latency and amplitude and vHIT vestibulo-ocular reflex (VOR) gain values were compared between groups. Multiple linear regression was performed to examine the association between the duration of hearing aid use and vestibular function. Results: No significant group differences were observed for any VEMP or vHIT parameter, except for the latency of P1 of the cVEMP in the left ear. Regression analyses indicated that the duration of hearing aid use was not significantly associated with any vestibular test measure. Conclusions: Long-term use of high-power hearing aids does not appear to be associated with measurable alterations in vestibular function. Nonetheless, longitudinal studies with improved control of confounding variables are recommended to validate these preliminary findings. Full article

(1) Background: Subclinical neck pain is mild-to-moderate neck pain that has not yet been treated, and where individuals experience pain-free days. Alterations in sensorimotor integration, motor control, proprioception, and cerebellar inhibition have been observed in individuals with subclinical neck pain. Upregulation of the cervico-ocular reflex is documented in subclinical neck pain, with no difference in the gain of the vestibulo-ocular reflex. Vestibulo-ocular reflex gain adaptation and associated differences in visuo-motor control have not been successfully measured in this population. This study aims to investigate the vestibulo-ocular reflex gain adaptation and visuo-motor control in individuals with subclinical neck pain. (2) Methods: 30 right-hand-dominant participants (19 healthy controls: 10 male and 9 female; 16 subclinical neck pain: 6 male and 10 female) aged 18 to 35 performed an eye tracking task. Participants were seated 90cm away from a monitor and instructed to hold their gaze on a stationary or moving target projected onto a screen while performing active head rotations. Trials were divided into 12 blocks (pre-adaptation, 10 adaptation, and post-adaptation) for a total of 192 trials. During adaptation, the target would move at increasing speeds during each block, increasing by 10% of active head velocity up to a maximum of 100%. (3) Results: The subclinical neck pain group demonstrated significantly higher total saccades (p = 0.006, ƞ² = 0.240) and overt catch-up saccades (p = 0.041, ƞ² = 0.141) than the healthy control group. (4) Conclusion: Subclinical neck pain alters the visual–vestibular interaction. Full article

Background/Objective: The Suppression Head Impulse Paradigm (SHIMP) is a specialized variant of the Head Impulse Test (HIT), designed to evaluate the suppression of the angular Vestibulo-Ocular Reflex (aVOR) by central mechanisms. These mechanisms are primarily mediated by brainstem structures, including the vestibular nuclei, their projections to ocular motor nuclei, and modulatory inputs from the cerebellum. Damage to these areas can impair the generation of anti-compensatory saccades (ACs), even when the peripheral vestibular apparatus remains intact. The present study explores this phenomenon in a cohort of patients with neurological disorders known to potentially involve the brainstem, including multiple sclerosis, severe traumatic brain injury, stroke, and Parkinson’s disease. Methods: This cross-sectional study included 119 patients with multiple sclerosis (PwMS), severe traumatic brain injury (PwTBI), stroke (PwS), and Parkinson’s disease (PwPD). The video Head Impulse Test was performed to assess the aVOR gain across all semicircular canals using both the HIMP and SHIMP. The presence, absence, or delay of ACs was systematically recorded. Results: Among the 119 patients evaluated (238 semicircular canals), 24 (20%) demonstrated normal aVOR gain but failed to generate ACs during SHIMP. The absence of ACs was observed in seven PwMS, five with PwTBI, six with PwS, and six with PwPD. Conclusions: The absence of ACs despite normal aVOR gain suggests a potential impairment in the central pathways controlling saccadic responses, independently of peripheral vestibular function. These findings underscore the clinical relevance of integrating the SHIMP into vestibular assessments to improve the identification of central vestibular dysfunction in neurological disorders. Full article

The brainstem plays a pivotal role in the generation and control of eye movements—including saccades, smooth pursuit, the vestibulo-ocular reflex (VOR), vergence, and gaze holding. Beyond its vital physiological functions, it is also essential for the coordination of balance and movement. Consequently, eye movement disorders of brainstem origin are often accompanied by vertigo, imbalance, unsteady gait, and diplopia, particularly during changes in head or body position. A sound understanding of the neural structures involved in oculomotor and vestibular control is therefore crucial for accurately identifying and localizing a wide variety of brainstem syndromes. However, oculomotor abnormalities resulting from brainstem disease represent a major diagnostic challenge for the neurotologist, owing to the wide spectrum of possible etiologies (vascular, traumatic, degenerative, neoplastic), their variable severity and clinical course (acute, fluctuating, or progressive), and the frequent concomitant involvement of other central structures, particularly the cerebellum. This mini review summarizes the pathophysiological mechanisms and clinical features of oculomotor disorders and nystagmus associated with brainstem disease. Full article

Background and Clinical Significance: Intralabyrinthine schwannoma (ILS) is a rare benign tumor of the inner ear, often presenting with nonspecific symptoms such as hearing loss, tinnitus and vertigo. Vestibular function in ILS patients remains underexplored. This study aims to evaluate vestibulo-ocular reflex (VOR) function and inner ear magnetic resonance imaging (MRI) signal changes in ILS, and to provide insights into potential mechanisms underlying vestibular dysfunction. Case Presentation: We report four cases of MRI confirmed ILS, including two intravestibular and two intravestibulocochlear schwannomas. All patients exhibited unilateral canal paresis on caloric testing, and two of three showed abnormal video head impulse test (vHIT) with decreased VOR gain and corrective saccades. Decreased signal intensity was observed in the semicircular canals in three cases, in the vestibule in one case, and in the cochlea in one case. A systematic literature review including 10 studies (n = 171) showed a 73.3% rate of abnormal caloric responses. Five studies conducted vHIT, reporting reduced mean VOR gain and corrective saccades, though quantitative analysis was limited. Cervical and ocular vestibular evoked myogenic potential abnormalities were found in 68.4% and 65.7% of reported cases, respectively. Conclusions: Impaired VOR function in patients with ILS may result not only from anatomical disruption but also from underlying biochemical or metabolic alterations within the inner ear. Full article

Background/Objectives: Considering the extensive use of digital tools among adolescents and the effects of game addiction on physical, social, emotional, and cognitive domains, this study aimed to investigate the relationship between digital game addiction and the vestibulo-ocular reflex in high school students. Methods: In this descriptive relational study, the relationship between digital game addiction and the functional head impulse test was investigated in adolescents. Two groups of adolescents, with and without digital game addiction, were compared based on the functional head impulse test. The Digital Game Addiction Scale was administered to assess digital game addiction in adolescents aged 14 to 18 years. Results: The findings were analyzed statistically, and the results indicated a statistically significant relationship between digital game addiction and the vestibulo-ocular reflex, with digital game addiction negatively affecting the vestibulo-ocular reflex in adolescents. Conclusions: The findings indicate that digital game addiction in adolescents may impair VOR function, suggesting a potential negative impact on balance and perceptual processing. These results highlight the importance of early interventions and digital literacy programs to mitigate the adverse effects of excessive gaming during adolescence. Full article

Objectives: The present study aimed to analyze the psychophysiological and neuromuscular reflex modifications following a single functional neurology intervention in individuals presenting vestibulo-ocular reflex (VOR) cancellation dysfunction. Methods: A total of 66 healthy participants, comprising an experimental group (n = 48; 22 females, 26 males; mean age 28.1 ± 7.8 years) and a control group (n = 18; 9 females, 9 males; mean age 28.6 ± 7.0 years), underwent comprehensive assessments at four distinct measurement moments: baseline, post-indicator muscle failure pre-intervention, immediately post-functional neurology intervention, and post-intervention indicator muscle failure, assessing neuromuscular (handgrip strength) and psychophysiological parameters, including blood oxygen saturation, heart rate, cortical arousal (critical flicker fusion threshold, CFFT), and pain perception (pressure pain threshold, PPT). The functional neurology treatment was tailored based on the ^®NeuroReEvolution protocol, emphasizing individualized proprioceptive recalibration, trigger point desensitization, and holistic neuroreflex modulation. Results: Statistical analyses indicated significant improvements within the experimental group following intervention. Specifically, tolerance to VOR cancellation stimuli significantly increased from a baseline of 1.0 ± 0.0 to 129.0 ± 36.7 post-intervention (p < 0.001, η² = 0.926), whereas the control group demonstrated no meaningful change. Furthermore, significant enhancements were noted in pressure pain threshold (27.49 ± 0.67 to 35.69 ± 0.60 kgf; p = 0.029), handgrip strength (20.41 ± 0.72 N to 26.56 ± 0.52 N; p = 0.012), and critical flicker fusion threshold (32.24 ± 0.45 Hz to 38.32 ± 0.60 Hz; p = 0.003). Conclusions: The results of this study demonstrate that a single functional neurology intervention significantly improved psychophysiological responses and neuromuscular reflex performance in participants with vestibulo-ocular reflex (VOR) cancellation dysfunction. Specifically, the intervention led to marked enhancements in pain tolerance, cortical arousal, and handgrip strength, and notably, an increased tolerance to VOR cancellation stimuli, indicating improved vestibular control. Cardiovascular parameters remained stable, highlighting the safety of the intervention. These findings support functional neurology as an effective therapeutic approach to address VOR-related dysfunctions by promoting neurophysiological resilience and motor function optimization. Full article

Background/Objectives: The most frequent neurologic cause of recurrent vertigo is vestibular migraine (VM). However, its diagnosis relies primarily on patients’ histories, as specific diagnostic tests for VM are currently lacking. We aimed to examine and compare clinical features, vestibulo-ocular reflexes (VORs), and subjective visual vertical (SVV) between the ictal (IC) and inter-ictal (II) phases in VM patients. Methods: A repeated-measures study involved 31 patients with definite VM. Vestibular function was assessed using a video head impulse test (vHIT) to evaluate VOR results, and SVV testing to determine verticality perception. Otoneurological examination, including migraine-related disability, was noted. Analyses of repeated measures for numerical traits (SVV deviations, VOR, and clinical outcomes) were conducted using a linear mixed model (LMM), with phase, age, and sex as fixed effects and individual-specific random intercepts. Differences between the IC and II phases for dichotomous variables were analyzed using the χ2 or Fisher’s exact test. Results: The LMM analysis revealed that SVV deviations were significantly higher ictally (IC-ly) (β = 0.678, p = 1.51 × 10⁻⁶) than interictally (II-ly). VOR results remained normal across phases (p > 0.05), and refixation saccades did not differ significantly based on vHIT results (p > 0.05). Nausea (100% vs. 38.71%, p = 6.591 × 10⁻⁸), photophobia (100% vs. 35.48%, p = 1.839 × 10⁻⁸), and phonophobia (90.32% vs. 6.45%, p = 9.336 × 10⁻¹²) were significantly more frequent IC-ly than II-ly. Conclusions: Our findings highlight phase-dependent alterations in spatial orientation, with increased SVV deviations IC-ly despite stable VOR. The significant differences in migraine-associated symptoms reinforce the dynamic nature of VM. These results emphasize the importance of timing in vestibular assessments and suggest that SVV testing during IC VM episodes may enhance diagnostic accuracy. Full article

Background: The impact of dance training on brainstem-mediated vestibular reflexes remains unclear. This study examined the vestibulo-ocular reflex (VOR) and its suppression during high-speed head movements, which may closely resemble the head-turning speeds used in dancers’ spotting techniques, using the video head impulse test. Methods: Eighteen female college students (mean age: 21 years) were divided into two groups—nine trained dancers (≥six years of dance training) and nine age-matched non-dancers—all without a history of hearing, vestibular, or neurological disorders. VOR function was assessed using the head impulse paradigm (HIMP) and the suppression head impulse paradigm (SHIMP) for right and left lateral stimulation, with minimum head velocities of 150°/s. Results: All participants exhibited VOR measures within normal limits and the VOR gain of dancers did not significantly differ from that of non-dancers. However, most dancers reported a preference for right-sided pirouettes and the right-side SHIMP gain negatively correlated with years of training, suggesting a link between preferred turning direction and VOR suppression ability. Furthermore, dancers with over 15 years of training exhibited earlier anti-compensatory saccade latencies (~75 ms) during SHIMP. Conclusions: Trained dancers maintain a healthy VOR and may develop enhanced voluntary control, enabling more effective VOR suppression. The earlier onset of anti-compensatory saccades suggests neural adaptations in eye–head coordination for high-velocity movements. Given the study’s small sample size and the inclusion of non-fulltime dancers, future research with larger samples of professional dancers is needed for enhanced generalizability. These findings provide preliminary evidence of dance-related neuroplasticity in brainstem-mediated vestibular reflexes and open new research avenues. 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: Vestibulo-ocular reflex (VOR) function, measured by the video head impulse test (vHIT) gains, plays a crucial role in postural stability and quality of life. Cochlear implant recipients often experience vestibular dysfunction, but its relationship with balance and patient-reported outcomes remains underexplored. This study aimed to (1) evaluate the relationship between vHIT gains and postural stability in cochlear implant recipients; (2) assess the impact of vHIT gains on quality-of-life metrics; and (3) identify key predictors of postural stability, including vHIT gains and demographic/clinical characteristics. Methods: This cross-sectional study was conducted between August 2023 and February 2024 and included 46 participants that comprised cochlear implant recipients and age-matched normal hearers who underwent the vHIT for lateral, anterior, and posterior semicircular canal function. Postural stability was assessed using dynamic posturography, and quality of life was measured using the Short Form-36 (SF-36). Multiple linear regression and correlation analyses were performed. Results: The vHIT gains demonstrated significant positive correlations with postural stability, with the lateral canal showing the strongest association (r = 0.742, p = 0.001), followed by the posterior (r = 0.701, p = 0.003) and anterior canals (r = 0.684, p = 0.005). A multiple regression analysis identified the lateral canal as the most significant predictor of postural stability (β = 0.512, p = 0.001, adjusted R² = 0.47). Quality-of-life metrics were inversely correlated with the vHIT gains, particularly in the posterior canal (r = −0.712, p = 0.002), which explained 43–51% of the variance. Conclusions: This study highlighted the lateral semicircular canal as the primary determinant of postural stability in cochlear implant recipients, underscoring the importance of vestibular assessments in optimizing balance and functional outcomes. Full article

Background/Objectives: This study aims to evaluate the feasibility of the angular vestibulo-ocular reflex (aVOR) function assessment in children with cerebral palsy (CP) using the video Head Impulse Test (vHIT) and to investigate how vestibular impairments correlate with functional motor ability. Methods: This cross-sectional study included children diagnosed with CP who attempted a vestibular function assessment with the vHIT. Descriptive statistics and a subgroup analysis based on clinical expression were performed. Finally, the correlation between aVOR gain and functional motor ability was investigated. Results: Thirteen children underwent assessments of the horizontal semicircular canals. Six out of thirteen children presented at least one dysfunctional canal; overall, eight out of twenty-six horizontal semicircular canals were dysfunctional in the HIMP paradigm. A subgroup analysis revealed a dysfunctional aVOR gain in all the children presenting ataxia. The correlation analysis demonstrated a strong negative association between aVOR gain and the Gross Motor Function Classification System (−0.73 and −0.68 for the left and right horizontal canal, respectively; p < 0.05). Conclusions: Vestibular dysfunctions are prevalent in children with CP and strongly correlate with motor function. An instrumental vestibular assessment in children with cognitive-motor disability seems feasible, in particular for horizontal canals and the HIMP paradigm. This could be important for better framing a child’s function and enhancing the management of balance and motor impairments with more specific strategies for children with CP. Full article

Background and Objectives: The video head impulse test is a landmark in vestibular diagnostic methods to assess the high-frequency semicircular canal system. This test is well established in the adult population with immense research since its discovery. The usefulness and feasibility of the test in children is not very well defined, as research has been limited. This systematic review investigated and analysed the existing evidence regarding the test. The objectives were to derive meaningful inferences in terms of the feasibility, implementation, and normative vestibulo-ocular reflex (VOR gain) in normal children and in children with vestibular hypofunction. Methods: Research repositories were searched with keywords, along with inclusion and exclusion criteria, to select publications that investigated the vHIT in both a normative population of children as well as in pathological cohorts. The average normal VOR gain was then calculated in all semicircular canals for both the normal and the vestibular hypofunction groups. For the case–control studies, a meta-analysis was performed to assess the heterogeneity and pooled effect sizes. Results and Discussion: The review analysed 26 articles that included six case–control studies fulfilling the study selection criteria, out of more than 6000 articles that have been published on the vHIT. The described technique suggested 10–15 head impulses at 100–200°/s head velocity and 10–20° displacement fixating on a wall target 1 to 1.5 m away. The average VOR gain in the lateral semicircular canals combining all studies was 0.96 +/− 0.07; in anterior semicircular canals, it was 0.89 +/− 0.13, and for posterior semicircular canals, it was 0.9 +/− 0.12. The normal VOR gains measured with individual equipment (ICS Impulse, EyeSeeCam and Synapsys) in the lateral semicircular canals were largely similar (p > 0.05 when ICS Impulse and EyeSeeCam were compared). The pooled effect size in the control group was 1, and the heterogeneity was high. It was also observed that implementing the test is different from that in adults and requires considerable practice with children, factoring in the issue of peripheral and central vestibular maturation. Special considerations were suggested in terms of the pupillary calibration, goggle fitting, and slippage and play techniques. Conclusions: The vHIT as a diagnostic test is possible in children with important caveats, practice, and knowledge regarding a developing vestibular system. It yields significantly meaningful inferences about high-frequency semicircular canal function in children. Adult norms should not be extrapolated in children, as the VOR gain is different in children. Full article

Background: Vestibular Hypofunction (VH) and hearing loss can affect quality of life and lead to disability, especially in the elderly. Studies investigating presbycusis and vestibular function in the aging population have been conducted separately, but few have examined the combination of both conditions in older patients, with inconsistent results that may be due to small sample sizes or heterogeneity in the methods used to assess vestibular function. We aimed to characterize the occurrence of VH in patients with presbycusis using the video head impulse test (vHIT), which is a specific and reliable assessment tool for VH. Methods: A prospective, cross-sectional study of 200 individuals was conducted at Hamad Medical Corporation-Qatar in Doha, Qatar. Adults aged 50 years and older with bilateral age-related hearing loss were screened for eligibility and those who were eligible completed the vHIT. Patient history, demographics, audiological and clinical data were collected. VH was defined as vestibulo-ocular reflex (VOR) gain of <0.79 and presence of corrective saccades. Results: In our study population, (n = 200 mean age 64.1 ± 8.4 [Range = 37], 31.5% females), VH was identified in 12 out of 200 patients (6.0%, 95% CI: 3.3–10.1) with bilateral age-related hearing loss (ARHL), equivalent to approximately 1 in 17 patients. VH was detected in the left ear in 11 patients (5.5%, 95% CI: 2.9–9.9), the right ear in five patients (2.5%, 95% CI: 0.8–5.8), and bilaterally in four patients (2.0%, 95% CI: 0.6–5.4). Conclusions: In our study population, vestibular hypofunction was observed in 6% of patients with bilateral symmetrical age-related sensorineural hearing loss, suggesting that vestibular screening may be useful in this population at risk. 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