Objectives The slippage of the video-nystagmography devices causes motion artifacts in the trajectory of the pupil and thus results in distortion in the nystagmus waveform. In this study, the moving average was proposed to reduce slippage-induced motion artifacts from the real-world data obtained in the field.
Methods The dataset consists of an infrared video of positional tests performed on eight patients with a lateral semicircular canal benign paroxysmal positional vertigo. The trajectories of the pupil were obtained from the video with binarization, morphological operation, and elliptical fitting algorithm. The acquired data was observed and the section where the slippage occurred was labeled by an otolaryngologist. The moving average with windows of various lengths was calculated and subtracted from the original signal and evaluated to find the most adequate parameter to reduce the motion artifact.
Results The period of nystagmus in the given data was found to be ranged from 0.01 to 4 seconds. The slippages that appeared in the data can be categorized into fast and slow slippages. The length, distance, and speed of trajectories in the slippage ranges were also measured to find the characteristics of the motion artifact in video-nystagmography data. The shape of the nystagmus waveform was preserved, and the motion artifacts were reduced in both types of slippages when the length of the window in moving average was set to 1 second.
Conclusions The algorithm developed in this study is expected to minimize errors caused by slippage when developing a diagnostic algorithm that can assist clinicians.
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.
Objectives The aim of this study was to develop a filtering algorithm for raw nystagmus images and a diagnostic assistive algorithm using a principal component analysis (PCA) to distinguish the different types of benign paroxysmal positional vertigo (BPPV).
Methods Fifteen video clips of clinical data with typical nystagmus patterns of BPPV (13 cases) and with normal nystamgmus (two cases) were preprocessed when applied the thresholding, morphology operation, residual noise filtering, and center point extraction stages. We analyzed multiple data clusters in a single frame via a PCA; in addition, we statistically analyzed the horizontal and vertical components of the main vector among the multiple data clusters in the canalolithiasis of the lateral semicircular canal (LSCC) and the posterior semicircular canal (PSCC).
Results We obtained a clear imaginary pupil and data on the fast phases and slow phases after preprocessing the images. For a normal patient, a round shape of clustered dots was observed. Patients with LSCC showed an elongated horizontal shape, whereas patients with PSCC showed an oval shape at the (x, y) coordinates. The scalar values (mm) of the horizontal component of the main vector when performing a PCA between the LSCC- and PSCC-BPPV were substantially different (102.08±20.11 vs. 32.36±12.52 mm, respectively; p=0.0012). Additionally, the salar ratio of horizontal to vertical components in LSCC and PSCC exhibited a significant difference (16.11±10.74 mm vs. 2.61±1.07 mm, respectively; p=0.0023).
Conclusions The data of a white simulated imaginary pupil without any background noise can be a separate monitoring option, which can aid clinicians in determining the types of BPPV exhibited. Therefore, this analysis algorithm will provide assistive information for diagnosis of BPPV to clinicians.
Citations
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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
Dissociated vertical-torsional nystagmus is a unique form of nystagmus characterized by conjugate torsional but disparate vertical components. It has been mainly reported in internuclear ophthalmoplegia or medial medullary lesion involving the medial longitudinal fasciculus (MLF). The patterns of the nystagmus may be explained by a disruption of vestibulo-ocular reflex pathways from vertical semicircular canal or utriculo-ocular reflex within the MLF, but it is debatable. We described a dissociated upbeat-torsional nystagmus in a patient with vestibular nucleus infarction without involvement of MLF.
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.
Objectives During caloric irritation, the spinning/rotating sensation is predominant. However, there is no report on the temporal relationship between caloric nystagmus and perception.
Methods Consecutive 57 participants underwent bithermal caloric test in the dizziness clinic of Chungnam National University Hospital from February 2018 to September 2018. For vestibular perception, we asked the subject to report feelings of rotation and/or linear sensation during each warm and cold water irrigation period. Besides routine caloric parameters, the duration of nystagmus and vestibular sensation were analyzed.
Results In most participants, the caloric nystagmus preceded the vestibular sensation (79.6% in right warm, 83.3% in left warm, 88.5% in right cool, and 84.6% in left cool stimuli). The precedence of perception was observed in 5 normal persons and 15 patients with vestibular migraine (n=4), unilateral vestibulopathy (n=3), and Menière’s disease (n=2), multiple systemic atrophy (n=2), cerebellar ataxia (n=2), vertebrobasilar insufficiency (n=1), and post-earthquake dizziness (n=1). The mean latency between nystagmus and perception was 11.7 seconds. And the duration of nystagmus was longer than that of perception in all conditions. Non-spinning sensations during the caloric test were also observed in some participants (26.8% in right warm, 30.3% in left warm, 29.1% in right cool, and 24.1% in left cool stimuli).
Conclusions During the bithemal alternate caloric test, various vestibular perception and temporal relationship between perception and nystagmus suggest the bithermal caloric stimulation does not reflect only the signal originating from the horizontal canal pathway. A further validation study is needed.
Objectives The aim of the study was to evaluate the possible alteration of the vestibulo-ocular reflex (VOR) in patients with horizontal canal benign paroxysmal positional vertigo (h-BPPV) using the video head impulse test (vHIT).
Methods This was a prospective case-control study of BPPV patients. We includeed 133 patients with h-BPPV who underwent the vHIT prior to the positioning test. The control group consisted of 76 normal subjects who also underwent the vHIT. The vHIT parameters of gain and asymmetry were assessed, and clinical parameters such as treatment duration, number of canalith reposition maneuvers executed and recurrence rates were evaluated. The VOR and clinical parameters were compared between the h-BPPV and control group. The VOR parameters of h-BPPV canalolithiasis were also compared with those of cupulolithiasis.
Results The mean age of the patients was 56.5 years and the male to female ratio was 1:2.02. Of the patients, 75 were diagnosed as having the canalolithiasis type of h-BPPV, while the other 58 had the cupulolithiasis type. The mean vHIT gains of the ipsi-lesional horizontal canal plane were 1.13 and 1.15 in the h-BPPV and control group, respectively (p=0.564). However, the asymmetry of the VOR was significantly higher in the h-BPPV than the control group (p=0.013), while the gains and asymmetries of the vHIT in the canalolith and cupulolith types were not significantly different (p=0.454, p=0.826).
Conclusions The asymmetry of VOR is significantly elevated in the cupulolith type of hBPPV.
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
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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
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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
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
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.
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Objectives We investigated clinical significance of head shaking nystagmus (HSN) and perverted HSN (pHSN) in patients with peripheral and central vestibular disorders. Methods: We reviewed medical records of 822 consecutive subjects who were referred to a dizziness clinic. We performed neurologic examination including video-oculography in darkness for 60 seconds before, during and for 100 seconds after head-shaking. HSN was considered to develop when post-head-shaking nystagmus last at least 5 beats with latency from end of head-shaking of no more than 5 seconds, and a velocity at least 3°/sec. Results: In control group (n=45), there were observed spontaneous nystagmus (SN) in 2.2%, HSN in 17.8%, pHSN in 6.7%. In patients with peripheral vestibular disorder group (n=397), there were observed SN in 14.1%, HSN in 40.6%, pHSN in 9.8%. In patients with central vestibular disorder group (n=217), there were observed SN in 17.5%, HSN in 24.0%, pHSN in 13.4%. In unspecified dizziness group (n=208), there were observed SN in 1.9%, HSN in 13.0%, pHSN in 1.9%. pHSN was frequently observed in central vestibular disorders such as stroke, vestibular migraine, cerebellar ataxia, and vertebro-basilar insufficiency. However, pHSN was also observed at higher rate than expected in peripheral vestibular disorders including benign paroxysmal positional vertigo especially involving vertical canals, Meniere disease and even in unilateral vestibulopathy. Conclusions: Our results show that perverted HSN in dizzy populations was frequently observed not only in cases of central vestibular disorders but also in peripheral disorders. Perverted HSN can develop by any conditions that cause difference in vestibular velocity storage in vertical component of vestibular-ocular reflex.
Wernicke’s encephalopathy (WE) is a neurological disorder induced by a dietary vitamin B1 (thiamine) deficiency which is characterized by encephalopathy, gait ataxia, and variant ocular motor dysfunction. In addition to these classical signs of WE, a loss of the horizontal vestibulo-ocular reflex (VOR) is being reported as the major underdiagnosed symptoms in WE. In this retrospective single center study, we report four cases of WE initially presented with impaired horizontal VOR in addition to the classical clinical presentations, and imaging and neurotological laboratory findings were described.
Objective: Recording the nystagmus of small experimental rodents is an integral
technique in vestibular research. Theoretically, the size and the shape of markers
strongly affect the analysis of 3 dimensional nystagmus.
Methods The nystagmus of 6 healthy ICR mice were recorded and their gain
values were compared using 200 μm, 300 μm, 400 μm, and 600 μm isosceles
triangle markers at the peak velocity of 60o/sec and 100o/sec with the rotational
stimulations of 0.1 Hz, 0.2 Hz, and 0.5 Hz.
Results The gain values of 3 different sizes of the markers showed no significant
differences in horizontal- vertical-torsional component. However, it was unable
to record the nystagmus with 200 μm markers since the markers were too small
to be placed and stayed on the center of the pupils.
Conclusion Technicians can decide the size of the markers from 200 to 600 ?m
to record the nystagmus of mice, depending on the technicians’ skills.
Objective: The video head impulse test (vHIT) is useful for evaluation of high
frequency vestibulo-ocular reflex. There are a few reports regarding the recovery of
head impulse test in vestibular neuritis (VN) but the factors for the recovery were not
studied. The study aimed to identify the recovery patterns of vHIT in VN and the
factors influencing the recovery.
Methods Among 31 patients with acute VN, 18 patients with identified recovery
pattern were selected. We conducted serial checks of subjective vertigo and spontaneous
nystagmus until discharged (1?8 days), and scheduled vHITs. We found three patterns
in serial vHITs during follow-ups and analyzed the relationship of initial vestibular
function tests, serial check-ups of subjective vertigo, bedside neuro-otologic tests, and
vHITs.
Results Five patients showed normal vHIT gain in acute stage (non-damaged pattern)
and 8 patients’ gains were recovered after 30 days after symptom onset (early recovered
pattern). Poor recovery pattern was found in 5 patients (poorly recovered pattern). There
were relationship between vHIT recovery patterns and the severity of vestibular dysfunctions.
Duration of spontaneous nystagmus (until grade 1), degree of subjective
visual vertical tilt, ocular vestibular myogenic potential abnormalities, and abnormality
of rotatory chair test were all related to poorly recovered vHIT patterns. All poor
recovery patients had residual symptom at 30 days after symptom onset.
Conclusion The vHIT may give clinicians useful hints in predicting prognosis in VN,
and the recovery of vHIT would be delayed if the damage were more extensive.
Objective: There have been several efforts to elucidate the pathophysiology of the
vestibular migraine (VM). But, there is no consistent result. This study was to identify
the possible pathophysiology of VM by comparing vestibulo-ocular reflex (VOR) parameters
between VM, and the tension type headache (TTH) patients. In addition, we
compared VOR parameters between ictal and interictal period in the VM group.
Methods Seventy eight patients were included: 44 having VM and 34 TTH. Three
parameters (gain, asymmetry, and phase) of the horizontal VOR rotating at 60 degrees
were measured. In 10 VM patients VOR parameters were obtained twice sequentially
first in the ictal and second in the interictal period.
Results Although the average of the VOR gain in VM group was lower than that
of TTH group but there was no statistical significance. An asymmetry of the VOR
was significantly higher in VM group. There were various changes in other VOR
parameters between ictal and interictal periods with no consistent trends.
Conclusion We could deduce that VM patients might have subclinical vestibular
dysfunction from the reduced gain and increased asymmetry of the VOR in the interictal
period. Dynamic changes of the VOR in the ictal period could be responsible for
dizziness in VM patients, which are caused by the pathological alteration of the
physiologic plasticity of the VOR.