Research in Vestibular Science

Volume 18 (4); December 2019

Original Articles

Comparison of Suppression Head Impulse and Conventional Head Impulse Test Protocols: Kyung Jin Roh, Ju Young Kim, Eun Jin Son; Res Vestib Sci. 2019;18(4):91-97. Published online December 15, 2019; DOI: https://doi.org/10.21790/rvs.2019.18.4.91

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Objectives
The head impulse test paradigm (HIMP) assesses semicircular canal function by measuring compensatory saccades during head movements as an indication of an impaired vestibulo-ocular reflex (VOR). The recently introduced suppression head impulse test paradigm (SHIMP) examines anticompensatory saccades after head movements as a measure of intact VOR. Thus, HIMP measures a decrease in vestibular function, whereas SHIMP measures residual function. We evaluated the effectiveness of SHIMP, compared HIMP and SHIMP results in the same subjects, and examined the relationship between the 2 tests.
Methods
HIMP and SHIMP protocols were performed in 73 patients. The patients were instructed to maintain their gaze on a fixed target for the HIMP, or a moving target for the SHIMP during head impulses. The VOR gain and saccade parameters were compared.
Results
HIMP and SHIMP data were obtained for all ears except in 3 patients. The VOR gain with SHIMP was smaller than for HIMP, but showed significant correlation (r=0.8356, p＜0.001) and substantial agreement (k=0.79). However, neither the percentage of saccades (appearance of HIMP compensatory saccades and reduction of SHIMP anticompensatory saccades) nor their amplitudes were correlated between the 2 tests.
Conclusions
The HIMP and SHIMP protocols are valuable tools to evaluate VOR during high-velocity head movements. Our results confirm their agreement as measures of VOR gain during head impulses, but also show that the relationship between compensatory and anticompensatory saccades is not straightforward. Thus, care should be taken during clinical interpretation of either protocol.

Citations

Citations to this article as recorded by

Normalization of the Suppression Head Impulse Test (SHIMP) and its correlation with the Head Impulse Test (HIMP) in healthy adults
Suheda Baran, Gulce Kirazli, Pelin Pistav Akmese, Nese Celebisoy, Tayfun Kirazli
Journal of Vestibular Research.2024; 34(1): 15. CrossRef
Test-retest reliability of suppression head impulse paradigm (SHIMP) in healthy individuals
Aishwarya Nagarajan, Shashish Ghimire, Varsha Sam Elizabeth, Sujeet Kumar Sinha
Hearing, Balance and Communication.2023; 21(4): 312. CrossRef
A nystagmus extraction system using artificial intelligence for video-nystagmography
Yerin Lee, Sena Lee, Junghun Han, Young Joon Seo, Sejung Yang
Scientific Reports.2023;[Epub] CrossRef
Efeito da idade no equilíbrio corporal e nos resultados do vídeo teste do impulso cefálico em pacientes com insuficiência cardíaca
Gizele Francisco Ferreira do Nascimento, José Diniz Júnior, Rosiane Viana Zuza Diniz, Miguel Angelo Hyppolito, Erika Barioni Mantello
Audiology - Communication Research.2023;[Epub] CrossRef
Effect of age on body balance and on the results of the video head impulse test in patients with heart failure
Gizele Francisco Ferreira do Nascimento, José Diniz Júnior, Rosiane Viana Zuza Diniz, Miguel Angelo Hyppolito, Erika Barioni Mantello
Audiology - Communication Research.2023;[Epub] CrossRef
Development of An Algorithm for Slippage-Induced Motion Artifacts Reduction in Video-Nystagmography
Yerin Lee, Young Joon Seo, Sejung Yang
Research in Vestibular Science.2022; 21(4): 104. CrossRef
VOR gain of lateral semicircular canal using video head impulse test in acute unilateral vestibular hypofunction: A systematic review
Mohamad Alfarghal, Mohammed Abdullah Algarni, Sujeet Kumar Sinha, Aishwarya Nagarajan
Frontiers in Neurology.2022;[Epub] CrossRef
Evaluation of high frequency horizontal VOR parameters in patients with chronic bilateral and unilateral peripheral vestibulopathy: a preliminary study
Gulce Kirazli, Sevinc Hepkarsi, Tayfun Kirazli
Acta Oto-Laryngologica.2020; 140(12): 1007. CrossRef

Can Cupulolithiasis Affect the Time Constant or Gain of the Velocity Step Test?: Min Tae Kim, Ji Eun Choi, Min Young Lee, Jae Yun Jung; Res Vestib Sci. 2019;18(4):98-102. Published online December 15, 2019; DOI: https://doi.org/10.21790/rvs.2019.18.4.98

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Abstract PDF

Objectives
The nystagmus evoked by an angular velocity step is influenced by the cupula dynamics and the status of velocity storage mechanisms. This study questioned whether the cupulolithiasis of horizontal canal benign paroxysmal positional vertigo (HC-BPPV) affects the time constant or gain of the velocity step test.
Methods
We performed a retrospective study of 30 patients who diagnosed with HC-BPPV and performed rotary chair test at Dankook University Hospital from June 2010 to May 2017. All patients had normal vestibular function on the sinusoidal harmonic acceleration test. According to the direction of nystagmus on the head roll test, we further divided the patients into “geotrophic” (canalolithiasis) and “apogeotrophic” (cupulolithiasis) groups. We compared the time constant (Tc), gain, and directional preponderance (DP) between the 2 groups. We also compared the time constant and gain between lesion side of BPPV and normal side in each group.
Results
In the supine head roll, geotrophic nystagmus observed in 14 patients and apogeotrophic nystagmus observed in 16 patients. When parameters of the velocity step test compared according to lesion side of BPPV (per-rotary of lesion side, postrotary of lesion side, per-rotary of normal side, and postrotary of normal side), there were no significant differences in Tc, gain, and DP between the 2 groups. There were also no significant differences in Tc and gain between lesion side and normal side in each group.
Conclusions
We assumed that cupulolithiasis of HC-BPPV could affect the cupular deflection evoked by an angular velocity step, but there were no significant differences in Tc and gain between patients with cupulolithiasis and canalolithiasis.

Citations

Citations to this article as recorded by

Influence of Otoliths on the Vestibulo-Ocular Reflex in Horizontal Canal Benign Paroxysmal Positional Vertigo
Hee Soo Yoon, Jae Yeong Jeong, Jae Ho Chung, Ha Young Byun, Chul Won Park, Seung Hwan Lee
Research in Vestibular Science.2020; 19(2): 49. CrossRef

The Value of Posterior Semicircular Canal Function in Predicting Hearing Recovery of Sudden Sensorineural Hearing Loss: Jung-Woo Shin, Sang Woo Kim, Youn Woo Kim, Wook Jang, Bo He Kim, Yun-Sung Lim, Seok-Won Park, Chang Gun Cho, Joo Hyun Park; Res Vestib Sci. 2019;18(4):103-110. Published online December 15, 2019; DOI: https://doi.org/10.21790/rvs.2019.18.4.103

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Abstract PDF

Objectives
Postulated etiologies for idiopathic sudden sensorineural hearing loss (SSNHL) include viral cochleitis, microvascular events. If SSNHL is caused by vascular compromise of common cochlear artery that supplies cochlea and posterior semicircular canal (PC), PC also can be damaged with cochlea. We aim to evaluate the prognostic value of PC function in relation to hearing recovery of SSNHL.
Methods
Seventy-six patients who were diagnosed and treated for SSNHL and who underwent video head impulse test (vHIT) and follow-ups for more than 3 months were reviewed retrospectively. We defined impairment of PC function as lower PC gain (＜0.7) or definite overt/covert saccade in vHIT. Patients were divided into 3 groups: group 1, SSNHL without dizziness; group 2, SSNHL with dizziness and impaired PC function; group 3, SSNHL with dizziness, but intact PC function. Hearing thresholds were repeatedly measured on the initial visit, 1 week, 1 month, and 3 months after treatment. Treatment outcome was analyzed by comparing hearing recovery rate using Siegel’s criteria and posttreatment audiometric changes among 3 groups.
Results
Thirty-two (29.6%), 33 (30.6%), and 43 patients (39.8%) were included into the groups 1, 2, and 3, respectively. The hearing recovery rate of the group 2 (39.4%) was significantly lower than that of groups 1 (65.6%) and 3 (65.1%) (p=0.043). Pre- and posttreatment changes of the PTA threshold was significantly lower in group 2 than group 1 (p=0.009). The change of speech discrimination in each group were not different.
Conclusions
Our findings suggest that the presence of PC impairment may be a poor prognostic sign for hearing recovery in patients with SSNHL.

Citations

Citations to this article as recorded by

Artificial Neural Network-Assisted Classification of Hearing Prognosis of Sudden Sensorineural Hearing Loss With Vertigo
Sheng-Chiao Lin, Ming-Yee Lin, Bor-Hwang Kang, Yaoh-Shiang Lin, Yu-Hsi Liu, Chi-Yuan Yin, Po-Shing Lin, Che-Wei Lin
IEEE Journal of Translational Engineering in Healt.2023; 11: 170. CrossRef
Vestibular mapping in Ramsay-Hunt syndrome and idiopathic sudden sensorineural hearing loss
Joon-Pyo Hong, Jung-Yup Lee, Min-Beom Kim
European Archives of Oto-Rhino-Laryngology.2023; 280(12): 5251. CrossRef
A Comparative Analysis of the Vestibulocochlear Function in Patients with Isolated Semicircular Canal Hypofunction Using a Video Head Impulse Test
Yu Jung Park, Min Young Lee, Ji Eun Choi, Jae Yun Jung, Jung Hwa Bahng
Research in Vestibular Science.2023; 22(2): 34. CrossRef
Video head impulse test for the assessment of vestibular function in patients with idiopathic sudden sensorineural hearing loss without vertigo
N Battat, O J Ungar, O Handzel, R Abu Eta, Y Oron
The Journal of Laryngology & Otology.2023; 137(12): 1374. CrossRef
Vestibular mapping assessment in idiopathic sudden sensorineural hearing loss
Hee Won Seo, Jae Ho Chung, Hayoung Byun, Seung Hwan Lee
Ear & Hearing.2022; 43(1): 242. CrossRef
Association of Metabolic Syndrome with Sensorineural Hearing Loss
Hwa-Sung Rim, Myung-Gu Kim, Dong-Choon Park, Sung-Soo Kim, Dae-Woong Kang, Sang-Hoon Kim, Seung-Geun Yeo
Journal of Clinical Medicine.2021; 10(21): 4866. CrossRef

Comparison of Treatment Outcomes between Intratympanic Steroid Injection and Oral Diuretics in Patients with Acute Low Frequency Sensorineural Hearing Loss with Vertigo: Yong-Hwi An, Hyun Joon Shim; Res Vestib Sci. 2019;18(4):111-117. Published online December 15, 2019; DOI: https://doi.org/10.21790/rvs.2019.18.4.111

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Abstract PDF: Objectives
Sudden sensorineural hearing loss and Meniere disease can be managed with intratympanic steroid injection (ITSI) as a primary treatment. The aim of this study was to compare the effectiveness of ITSI versus oral diuretics for acute low frequency sensorineural hearing loss (LFHL) with vertigo.
Methods
A total 76 patients with LFHL that had developed within previous 2 weeks were enrolled and categorized into 2 groups: treated with ITSI four times on 4 consecutive days (ITSI group; 42 patients) and treated with diuretics orally for 2 weeks (diuretics group; 34 patients). After 6 months, we analyzed treatment outcomes using subjective improvement and audiometric change.
Results
Hearing thresholds at low frequencies ≤500 Hz were significantly improved in both ITSI and diuretics group (p＜0.05). The cure rate of ITSI group was not significantly higher than that of diuretics group (54.8% vs. 52.9%, p＞0.05). For subjective symptoms, there were no significant differences of improvement rate in both groups (ITSI 64.3% vs. diuretics 61.8%, p＞0.05). In pure tone audiometry, the improvement rate of ITSI group was not significantly different from that of diuretics group (78.6% vs. 70.6%, p＞0.05). There was a significant correlation between the cure rate and duration of symptoms.
Conclusions
Both ITSI and diuretics are effective treatment modalities for acute LFHL with vertigo within 2 weeks of development. There is no difference of treatment outcomes between ITSI and diuretics in patients with acute LFHL and vertigo.

Case Reports

Ponto-medullary Junction Infarction Presenting as Ipsilateral Abducens Nerve Palsy and Contralateral Hemiparesis without Facial Involvement: Ji Hun Lim, Young Seo Kim, Hak Seung Lee; Res Vestib Sci. 2019;18(4):118-121. Published online December 15, 2019; DOI: https://doi.org/10.21790/rvs.2019.18.4.118

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2 Crossref

Abstract PDF

Raymond syndrome is a pontine syndrome consisting of ipsilateral abducens nerve palsy, contralateral facial paralysis, and contralateral hemiparesis. However, subsequent clinical observations argued on the presentation of facial involvement. The only differentiating point between the facial including called classic type and the facial sparing Raymond syndrome is the location of the lesion. The classic type involves abducens nerve, corticofacial, and corticospinal tracts; while in the facial sparing type, corticofacial tracts, and peripheral facial nerves are spared. We experienced a 78-year-old man presented with sudden onset dizziness, binocular horizontal diplopia, and right-sided motor weakness. Neurological examination showed he had left abducens nerve palsy and right hemiparesis without facial involvement. Brain magnetic resonance imaging showed acute ischemic infarction in the left ponto-medullary junction. Regardless of the presence or absence of facial palsy, the combination of abducence nerve palsy and contralateral hemiparesis should direct the clinician’s attention towards the medial ventral caudal ponto-medullary junction.

Citations

Citations to this article as recorded by

Pontine ischaemic stroke syndromes
Marcus Ground, Martin N M Punter, Ian Rosemergy
Practical Neurology.2023; 23(6): 501. CrossRef
An Atypical Radiologic Presentation of Right Sixth Lateral Rectus Palsy: A Case Report
Anicia Mirchandani, Sheena Saleem, Lalitha Sivaswamy
Cureus.2022;[Epub] CrossRef

A Case of Bilateral Semicircular Canal Dysplasia with Normal Cochlear Found in Bilateral Vestibulopathy: Seokhwan Lee, Sung-Won Choi; Res Vestib Sci. 2019;18(4):122-127. Published online December 15, 2019; DOI: https://doi.org/10.21790/rvs.2019.18.4.122

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Abstract PDF: A 25-year-old woman presented with atypical dizziness with oscillopsia. The neuro-otological evaluations showed bilateral vestibulopathy with mild sensorineural hearing loss. Computed tomography and magnetic resonance imaging demonstrated bilateral isolated lateral canal dysplasia (LSCD) with normal cochlea. LSCD is relatively common inner ear malformation, but it is rarely found in bilateral vestibulopathy. In case of patients with bilateral vestibulopathy who cannot find the cause, should be considered conducting radiological examinations in mind of the inner ear anomalies.

A Case of Patient with Acute Peripheral Vestibulopathy Involving Isolated Posterior Semicircular Canal: Sang Kwon Im, Mee Hyun Song, Ja Won Gu, Dae Bo Shim; Res Vestib Sci. 2019;18(4):128-132. Published online December 15, 2019; DOI: https://doi.org/10.21790/rvs.2019.18.4.128

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Abstract PDF Supplementary Material: Down-beat nystagmus in peripheral vestibulopathy may rarely occur in selective involvement of inferior division. Diagnosis of isolated inferior vestibular neuritis is based on torsional down-beating spontaneous nystagmus, abnormal head-impulse test for the posterior semicircular canal, and abnormal cervical vestibular evoked myogenic potentials (cVEMPs) with normal bithermal caloric tests and ocular vestibular evoked myogenic potentials (oVEMPs). Herein we report a 50-year-old male patient with spontaneous down-beat nystagmus who demonstrated vestibular dysfunction involving only the posterior semicircular canal. The patient showed normal results in the bithermal caloric test, the oVEMPs and cVEMPs test. Video head impulse test showed decreased gain and corrective saccades only in the posterior semicircular canal. This case is significant in showing that peripheral dizziness with spontaneous down-beating nystagmus can occur as a result of an abnormality involving only a single semicircular canal.

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