Research in Vestibular Science

Original Articles

Re-fixation Saccade at Video-Head Impulse Test in Patients with Sudden Sensorineural Hearing Loss: Dong Hyuk Jang, Sun Seong Kang, Hyun Joon Shim, Yong-Hwi An; Res Vestib Sci. 2023;22(2):46-51. Published online June 15, 2023; DOI: https://doi.org/10.21790/rvs.2023.22.2.46

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Abstract PDF: Objectives
This study was performed to evaluate characteristics and their prognostic value of video-head impulse test (vHIT) in sudden sensorineural hearing loss (SSNHL) with vertigo.
Methods
Of the 612 patients with a diagnosis of SSNHL from 2010 to 2018, 110 patients (18.0%) with vertigo and 39 patients (6.4%) with vHIT results were recruited. The patients were evaluated for their pure-tone hearing average (at initial, 1-month, and 6-month visit), the presence of re-fixation saccade and gains at vHIT, the canal paresis (CP) at ccaloric test.
Results
Patients with saccade (+) showed higher pure-tone averages than those with saccade (‒) on initial and follow-up audiograms. The improvement in pure-tone averages was less in the saccade (+) group than in the saccade (‒) group. There was no significant difference of hearing recovery between SSNHL patients with normal gain and those with decreased gain. There was no difference of hearing improvement between CP (+) and CP (‒) groups according to the presence of re-fixation saccade.
Conclusions
Concurrent re-fixation saccade at vHIT is a negative prognostic factor of hearing function in SSNHL. Re-fixation saccade in SSNHL may suggest widespread damages to both the cochlea and the vestibule, leading to the poor prognosis.

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; Res Vestib Sci. 2023;22(2):34-45. Published online June 15, 2023; DOI: https://doi.org/10.21790/rvs.2023.22.2.34

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Abstract PDF: Objectives
The objective of this study was to analyze vestibulocochlear function results in patients identified with isolated semicircular canal (SCC) hypofunction using the video head impulse test (vHIT).
Methods
A retrospective review was conducted on the clinical records of 123 patients diagnosed with isolated SCC hypofunction based on vHIT results. Among these patients, 72 had isolated posterior SCC (PSCC) hypofunction, 25 had isolated lateral SCC (LSCC) hypofunction, and 26 had isolated anterior SCC (ASCC) hypofunction. Descriptive analyses were performed on various vestibulocochlear tests including pure tone audiometry, sinusoidal harmonic acceleration (SHA), spontaneous nystagmus (SN), head-shaking nystagmus (HSN), caloric testing, and cervical vestibular evoked myogenic potential, with results analyzed separately for each SCC hypofunction group.
Results
The study found that 66.0% of the evaluated patients exhibited abnormal results in at least one vestibulocochlear function test. PSCC hypofunction patients showed a significantly higher incidence of hearing loss compared to ASCC and LSCC hypofunction patients. LSCC hypofunction patients exhibited higher rates of corrective saccade, phase asymmetry of SHA, and SN abnormalities compared to other SCC hypofunction patients. Additionally, the rates of corrective saccade and phase asymmetry of SHA were also higher in LSCC hypofunction patients. ASCC hypofunction patients demonstrated significantly higher rates of normal corrective saccade, phase lead of SHA, and SN.
Conclusions
The analysis of this study suggests that even in cases where vHIT indicates isolated SCC hypofunction, additional vestibulocochlear function tests should be conducted to identify any associated vestibulocochlear dysfunctions. This highlights the importance of comprehensive evaluation to accurately diagnose and manage patients with SCC hypofunction.

Assessment of the Vestibuloocular Reflex in Patients with Unilateral Chronic Middle Ear Disease Using the Video Head Impulse Test: A Preliminary Study: Gi-Sung Nam, Wonyong Baek, Sung-Il Cho; Res Vestib Sci. 2022;21(3):80-85. Published online September 15, 2022; DOI: https://doi.org/10.21790/rvs.2022.21.3.80

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Abstract PDF: Objectives
This study aims to investigate the usefulness of the video head impulse test (vHIT) as a method for evaluating vestibular function in patients with unilateral chronic middle ear disease.
Methods
Nineteen patients with various unilateral middle ear diseases including chronic otitis media (COM), COM with cholesteatoma, and adhesive otitis media successfully underwent preoperative vHIT. The gain of vestibuloocular reflex (VOR) and the presence of corrective saccades were compared between the affected ear and the healthy ear.
Results
A total of eight male and 11 female patients with a mean age of 43.1 years were included in this retrospective study. Twelve ears had COM, four had COM with cholesteatoma, and three had adhesive otitis media. A positive history of vertigo or dizziness was reported in 36.8% of the cases. The VOR gain of the affected ears and the healthy ears were 0.97±0.16 vs. 1.00±0.08 in the horizontal canal, 0.91±0.11 vs. 0.87±0.11 in the anterior canal, and 0.87±0.17 vs. 0.99±0.12 in the posterior canal, respectively. Only VOR gain of the posterior canal was significantly decreased compared with healthy ears.
Conclusions
The average VOR gains in the patients with chronic middle ear disease were within the pre-defined values of normality; however, when compared quantitatively, posterior canal gain of affected ears was significantly decreased compared to healthy ears. Our results can be explained by the anatomical proximity of the ampulla of the posterior canal and middle ear space.

Canal Dysfunction Detected by Video Head Impulse Test in Patients with Vestibular Migraine and Its Relationship with Symptomatic Improvement: Ji Won Choi, Won Sub Lim, Sung Seok Ryu, Yeonjoo Choi, Sang Hun Lee, Seung Cheol Ha, Hong Ju Park; Res Vestib Sci. 2022;21(2):46-52. Published online June 15, 2022; DOI: https://doi.org/10.21790/rvs.2022.21.2.46

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Abstract PDF: Objectives
Video head impulse test (vHIT) can evaluate function of the vestibuloocular reflex for high frequency range of head rotation. We aimed to characterize the abnormal patterns of canal dysfunction by vHIT in vestibular migraine (VM) and evaluate the relationship between the presence of canal dysfunction and symptomatic improvement.
Methods
Eighty-seven patients with VM were included. Abnormality of vHIT at the initial examination was determined by the vHIT gain and the degrees of the corrective saccades at each canal and each side. The relationship between the abnormal patterns and the symptomatic improvement (no need for preventive medication) after modification of life styles and preventive medications for 1, 3, and 6 months was evaluated.
Results
Abnormal vHIT of the lateral canal was 13.8% when determined by the gain criteria and 31.0% when based on both gain and corrective saccade, regardless of the side. Abnormal vHIT of the superior and posterior canals were 18.4% and 27.6%, regardless of the side. Abnormal vHIT at any canal and side was observed in 47%. Patients showed symptomatic improvement in 29.9%, 71.3%, and 88.5% after modification of life styles and preventive medications for 1, 3, and 6 months. Abnormal vHIT results of canals were significantly related to the poor response to preventive mediations.
Conclusions
Prolonged preventive medication was required for symptomatic improvement in VM patients when vHIT results of any canals were abnormal, suggesting that peripheral vestibular abnormality is closely related to the pathophysiology of vestibular migraine.

Case Report

Isolated Floccular Infarction with Impairment of High-Frequency Vestibulo-Ocular Reflex: A Case Report: Eun Hye Oh, Hyun-Sung Kim, Jae-Hwan Choi; Res Vestib Sci. 2021;20(4):147-150. Published online December 15, 2021; DOI: https://doi.org/10.21790/rvs.2021.20.4.147

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Abstract PDF: The flocculus plays a crucial role in control of eye movements. Based on animal experiment, it is suggested that the flocculus is important for governing vestibuleocular reflexes. In humans, an isolated floccular lesion is extremely rare. We report oculomotor abnormalities in a patient with unilateral infarction of the flocculus, and compare our results with those of previously reported patients with floccular lesion.

Original Articles

Relationship between Chronological Orders of Symptoms and Vestibular Abnormality in Patients with Vestibular Migraine: Sae Eun YI, Jun Woo Park, Jang Wook Kwak, Yeonjoo Choi, Sang Hun Lee, Seung Cheol Ha, Hong Ju Park; Res Vestib Sci. 2021;20(2):51-57. Published online June 14, 2021; DOI: https://doi.org/10.21790/rvs.2021.20.2.51

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Abstract PDF: Objectives
Pathophysiology of vestibular migraine (VM) is still controversial. Vertigo may act as a trigger for migraine or there might other mechanisms which cause migraine and dizziness. VM patients have headaches and dizziness simultaneously or sequentially. Therefore, we hypothesized that the sequence of symptoms might suggest different mechanisms and compared the results of vestibular function tests (VFTs) according to chronological order of headache and vertigo.
Methods
Forty-two patients with VM were included. They were divided into three subgroups according to the chronological orders of headache and vertigo, and the results of VFTs and the symptomatic improvement were compared between each group.
Results
Dizziness appeared first in 15 patients (35.7%), both symptoms appeared simultaneously in 20 patients (47.6%), and headaches appeared first in 7 (16.7%). There were no significant differences in symptom duration among the groups. Fourteen (33.3%) showed abnormal caloric results, 7 (16.7%) in head impulse test, 16 (38.1%, vestibular score) and 19 (45.2%, composite score) in sensory organizing test, and 13 (31.0%) in vestibular evoked myogenic potential test. Abnormal rate of the caloric test in the simultaneous group was significantly lower than those of the other two groups. Nineteen (45.2%) showed complete remission in 3 months after preventive medication with no significant difference between each group.
Conclusions
VM patients whose vertigo occurred with headache simultaneously showed lower incidence of caloric abnormality, suggesting that they have abnormality in central vestibular system rather than peripheral vestibular organs.

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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Abstract PDF

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

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

Analysis of Age-Dependent Normative Values of Suppression Video-Head-Impulse Test in Healthy Korean Subjects: Do Yoon Jeong, Yoon Sik Park, Sung Il Cho; Res Vestib Sci. 2019;18(1):8-13. Published online March 15, 2019; DOI: https://doi.org/10.21790/rvs.2019.18.1.8

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Abstract PDF

Objectives
Suppression head impulse paradigm (SHIMP) in video head impulse test is now newly used to test vestibular function. The aim of this study was to analyze normative values of SHIMP for healthy Korean subjects in each decade of life.
Methods
SHIMP and HIMP responses were measured with the video head impulse test in 70 healthy subjects. Vestibulo-ocular reflex gain and anticompensatory saccade were analyzed and compared at each decade of life.
Results
All subjects produced anticompensatory saccades in SHIMP. Gain values did not vary significantly with age. Gain values in SHIMP were lower than gain values in HIMP. The gain values of rightward impulse were higher than the gain values of leftward impulse.
Conclusions
Gain values and anticompensatory saccades in SHIMP were consistently equal in each decade of life. Normative values of SHIMP seems largely unaffected by aging.

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; : 1. CrossRef

Review

Clinical Application and Update of Video Head Impulse Test: Jung Yup Lee, Jin Su Park, Min-Beom Kim; Res Vestib Sci. 2018;17(3):79-89. Published online September 18, 2018; DOI: https://doi.org/10.21790/rvs.2018.17.3.79

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1,315 Download
8 Crossref

Abstract PDF

Recently with the introduction of video head impulse test (vHIT), it can be easily performed quantitative and objective measurement of vestibulo-ocular reflex (VOR). vHIT has been used as a clinical vestibular function test that can individually evaluate the function of each semicircular canal. Loss of VOR gain and corrective catch-up saccades that occur during the vHIT usually indicate peripheral vestibular hypofunction, whereas in acute vestibular syndrome, normal vHIT should prompt a search for a central lesion. In this study, we will examine the principle of vHIT and its interpretation, and explain its clinical application in peripheral and central vestibulopathy. In addition, we will compare the caloric test and the differences, and review the most recently introduced suppression head impulse paradigm test.

Citations

Citations to this article as recorded by

Application of the Barany Society's Presbyvestibulopathy Criteria in Older Adults With Chronic Dizziness
Joon‐Pyo Hong, Min‐Beom Kim
Otolaryngology–Head and Neck Surgery.2024; 170(2): 515. 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
Re-fixation Saccade at Video-Head Impulse Test in Patients with Sudden Sensorineural Hearing Loss
Dong Hyuk Jang, Sun Seong Kang, Hyun Joon Shim, Yong-Hwi An
Research in Vestibular Science.2023; 22(2): 46. 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
A Comparative Study Using Vestibular Mapping in Sudden Sensorineural Hearing Loss With and Without Vertigo
Joon‐Pyo Hong, Jung‐Yup Lee, Min‐Beom Kim
Otolaryngology–Head and Neck Surgery.2023; 169(6): 1573. CrossRef
A Study on the Evaluation of Brainstem Dysfunction in Rapid Eye Movement Sleep Behavior Disorder Using Video Nystagmography
Young Hun Kim, Jeongho Park, Seung Ho Choo, Hyunjin Jo, Dae-Won Seo, Byung-Euk Joo, Eun Yeon Joo
Journal of the Korean Neurological Association.2023; 41(4): 293. 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
Group Vestibular Rehabilitation Program: A Cost-Effective Outpatient Management Option for Dizzy Patients
Jae Sang Han, Jung Mee Park, Yeonji Kim, Jae-Hyun Seo, So Young Park, Shi Nae Park
Otology & Neurotology.2022; 43(9): 1065. CrossRef

Original Article

Comparison of Video Head Impulse Test with Posterior Semicircular Canal Plane and Cervical Vestibular Evoked Myogenic Potential: Jin Su Park, Yong Woo Lee, Jung Yup Lee, Jae Ho Ban, Sun O Chang, Min-Beom Kim; Res Vestib Sci. 2016;15(3):74-79. Published online September 15, 2016; DOI: https://doi.org/10.21790/rvs.2016.15.3.74

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Abstract PDF

Objective: Cervical vestibular evoked myogenic potential (cVEMP) is thought to be assessing the function of the saccule and inferior vestibular nerve. Therefore, cVEMP indirectly reflects the function of the posterior semicircular canal. Recently, the video head impulse test (vHIT) is considered as useful clinical tool to detect each semicircular canal dysfunction. Goal of this study was to evaluate and compare the results of cVEMP with posterior canal plane of vHIT (p-vHIT).
Methods
Retrospectively, we compared the results of cVEMP with p-vHIT in 43 patients who visited with dizziness. We analyzed the inter-test agreement of cVEMP with p-vHIT.
Results
Positive asymmetry of cVEMP was present in 37.2% (16/43), and no responses of both ears were identified in 16.3% (7/43). In p-vHIT analysis, unilateral positive was 27.9% (12/43), bilateral positive was 11.6% (5/43) and negative in both sides was 60.5% (26/43). The inter-test agreement between cVEMP and p-vHIT was 75.8% (25/33) as we considered even in lesion side. And, Fleiss’s kappa value showed a fair to good agreement (kappa value=0.559). In bilateral no response group (7 patients) in cVEMP, variable additional information could be obtained using p-vHIT.
Conclusion
cVEMP and p-vHIT showed relatively lower inter-test agreement than expected. But, p-vHIT could be easily performed, and give additional information for differential diagnosis.

Citations

Citations to this article as recorded by

Clinical Characteristics of the Patients with Dizziness after Car Accidents
Young Min Hah, Chul Won Yang, Sang Hoon Kim, Seung Geun Yeo, Moon Suh Park, Jae Yong Byun
Korean Journal of Otorhinolaryngology-Head and Nec.2017; 60(8): 390. CrossRef

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