Publications by authors named "Andrea Viziano"

36 Publications

Changes in body composition in unilateral vestibular hypofunction: relationships between bioelectrical impedance analysis and neuro-otological parameters.

Eur Arch Otorhinolaryngol 2021 Jan 3. Epub 2021 Jan 3.

Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy.

Purpose: Experimental works have indicated the potential of the vestibular system to affect body composition to be mediated by its extensive connections to brainstem nuclei involved in regulating metabolism and feeding behavior. The aim of this study was to evaluate-by means of bioelectrical impedance analysis (BIA)-the body composition in a group of chronic UVH normal-weighted patients when compared with an equally balanced group of healthy participants, serving as a control group (CG).

Methods: Forty-six chronic UVH and 60 CG participants underwent otoneurological (including video Head Impulse Test [vHIT] and static posturography testing [SPT]), BIA measurements and self-report (SRM) and performance measures (PM).

Results: Beyond significant (p < 0.001) changes in SPT variables (surface and length) and SRM/PM (including Dizziness Handicap Inventory, Dynamic Gait Index and Activity Balance Confidence scales), UVH participants demonstrated significant (p < 0.001) higher values of fat mass and visceral fat and lower values of muscle mass (p = 0.004), when compared to CG. Significant correlations were found in UVH participants between otoneurological and BIA measurements.

Conclusion: These study findings represent the first clinical in-field attempt at depicting, with the use of BIA parameters, changes in body composition related to chronic UVH. Since such alterations in metabolic parameters could be considered both the consequences and/or the cause of vestibular-related quality of life deficit, BIA parameters could be considered as cheap, easy to use, noninvasive assessments in case of chronic UVH.
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http://dx.doi.org/10.1007/s00405-020-06561-zDOI Listing
January 2021

Lateralization of cochlear dysfunction as a specific biomarker of Parkinson's disease.

Brain Commun 2020 18;2(2):fcaa144. Epub 2020 Sep 18.

Department of Systems Medicine, Parkinson's Disease Center, University of Rome 'Tor Vergata', 00133 Rome, Italy.

In the last decade, animal studies highlighted the sensitivity of hearing function to lack of specific cochlear dopamine receptors, while several studies on humans reported association between hearing loss and Parkinson's disease, partially recovered after levodopa administration in patients. Taken together, these observations suggest investigating the possible use of cochlear function outcome variables, particularly, otoacoustic emissions, as sensitive biomarkers of Parkinson's disease. Any lateralization of hearing dysfunction correlated with Parkinson's disease lateralization would (i) further confirm their association and (ii) provide a disease-specific differential outcome variable. Differential indicators are particularly useful for diagnostic purposes, because their effectiveness is not limited by physiological inter-subject fluctuations of the outcome variable. Recent advances in the acquisition and analysis techniques of otoacoustic emissions suggest using them for evaluating differential cochlear damage in the two ears. In this study, we quantitatively evaluated hearing function in a population of subjects with Parkinson's disease, to investigate the occurrence of hearing loss, and, particularly, whether hearing dysfunction shows lateralization correlated with motor symptoms. Pure tone audiometry and distortion product otoacoustic emissions were used as outcome variables in 80 patients (mean age 65 ± 9 years) and 41 controls (mean age 64 ± 10 years). An advanced customized acquisition and analysis system was developed and used for otoacoustic testing, which guarantees response stability independent of probe insertion depth, and has the sensitivity necessary to accurately assess the low levels of otoacoustic response typical of elderly subjects. To our knowledge, this is the first study introducing the distinction between ipsilateral and contralateral ear, with respect to the body side more affected by Parkinson's disease motor symptoms. Significant asymmetry was found in the auditory function, as both otoacoustic responses and audiometric hearing levels were worse in the ipsilateral ear. Significantly worse hearing function was also observed in patients with Parkinson's disease compared to controls, confirming previous studies. Several pathophysiological mechanisms may be hypothesized to explain asymmetric cochlear damage in Parkinson's disease, including the impairment of dopamine release and the involvement of extra-dopaminergic circuits, with the cholinergic pathway as a likely candidate. The observed asymmetry in the audiological response of patients with Parkinson's disease suggests that lateralization of hearing dysfunction could represent a specific non-motor signature of the disease. The possible diagnostic use of cochlear dysfunction asymmetry as a specific biomarker of Parkinson's disease deserves further investigation, needing a more precise quantitative assessment, which would require a larger sample size.
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http://dx.doi.org/10.1093/braincomms/fcaa144DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7751021PMC
September 2020

Reciprocal influences between cognitive decline and vestibular processing: commentary to "Dizziness in patients with cognitive impairment".

J Vestib Res 2020 Nov 27. Epub 2020 Nov 27.

Department of Clinical Sciences and Translational Medicine, University of Rome 'Tor Vergata', Italy.

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http://dx.doi.org/10.3233/VES-200724DOI Listing
November 2020

Bridging the gap between temporomandibular disorders, static balance impairment and cervicogenic dizziness: Posturographic and clinical outcomes.

J Electromyogr Kinesiol 2020 Oct 6;54:102455. Epub 2020 Aug 6.

University of Rome Tor Vergata, Department of Clinical Sciences and Translational Medicine, Italy.

Several studies have investigated the possible influence of temporomandibular disorders (TMD) on body posture and whether cervical spine disorders, such as cervicogenic dizziness (CGD) could play an additional role in affecting static balance. The purpose of this study was to analyze static postural behavior by means of static posturography, in patients affected by either TMD or CGD alone or by both conditions, and to compare findings with a group of healthy subjects. Significant changes in posturographic parameters were found among the three groups of patients and when compared with controls. When the three study groups were compared to each other, subjects affected by a combination of TMD and CGD showed worse postural performances with respect to subjects affected by CGD or TMD alone. Correlations with self-perceived dizziness, anxiety, depression and jaw functionality, investigated by means of validated questionnaires, were found among all patient groups. These results provide new evidences for the presence of static balance alterations in patients suffering from TMD with and without associated cervical spine impairment, by using a reliable diagnostic technique. Further studies are needed in order to identify any causal relation between these two disorders.
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http://dx.doi.org/10.1016/j.jelekin.2020.102455DOI Listing
October 2020

Reciprocal roles of joint position error, visual dependency and subjective perception in cervicogenic dizziness.

Somatosens Mot Res 2020 12 10;37(4):262-270. Epub 2020 Aug 10.

Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy.

Aim: Since cervical joint position error (JPE) and visual dependency (VD) may reflect altered ascending inputs from the neck receptors, the aim of the present study was to test how these parameters may be impacted by those clinical parameters in cervicogenic dizziness (CGD) patients when compared with healthy subjects participants.

Materials And Methods: 93 subjects participants fulfilling inclusion criteria for CGD and 98 age- and gender-matched healthy subjects volunteers - undergoing cervical relocation and rod and disc test to evaluate JPE and VD, respectively - were compared to each other. Cervical range of motion (CROM), Dizziness Handicap Inventory (DHI), Neck Disability Index (NDI), Neck pain intensity (NPI), Tampa Scale for Kinesiophobia (TSK-17) and Hospital Anxiety and Depression Scale (HADS) were also collected in both groups.

Results: When compared to healthy participants, CGD patients were found to have a higher degree of JPE in right ( = 0.008, mean difference, MD: 2.88) and left ( = 0.006, MD: 2.55) rotation as well as in extension ( = 0.011, MD: 2.31), flexion ( = 0.009, MD: 2.35) and mean value ( = 0.001, MD: 2.53) and higher degrees of error in CCW at +40° and -40° ( = 0.012, MD: 0.85 and  = 0.016, MD: 0.82, respectively) and CW at +40° and -40° ( = 0.018, MD: 0.83 and  = 0.015 MD: 0.81, respectively). CGD patients also demonstrated a significant reduction in degrees of CROM in active flexion ( = 0.011, MD: -34.63), extension ( = 0.018, MD: -21.67), left ( = 0.012, MD: -28.29) and right ( = 0.009, MD: -28.52) rotation, and left ( = 0.02, MD: -7.29) and right ( = 0.021, MD: -5.05) lateral flexion. Furthermore, these patients demonstrated higher scores in total DHI ( = 0.007, MD: 25.17) (and relative DHI-P, DHI-F, DHI-E;  = 0.009, MD: 11.4;  = 0.014, MD: 8.73 and  = 0.018, MD: 5.03, respectively), in TSK-17 ( = 0.017, MD: 17.56), and HADS, both in anxiety ( = 0.022, MD: 4.62) and depression ( = 0.02, MD: 7.31) subscale.

Conclusions: A possible common physiopathological background may impact on processes involved in both the JPE and VD behaviour, entangled in a vicious circle with the impaired subjective clinical and quality of life perception.
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http://dx.doi.org/10.1080/08990220.2020.1803257DOI Listing
December 2020

Laterality of Auditory Dysfunction in Parkinson's Disease.

Mov Disord 2020 07;35(7):1283-1284

Department of Physics, University of Rome 'Tor Vergata', Rome, Italy.

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http://dx.doi.org/10.1002/mds.28131DOI Listing
July 2020

Combination of in-situ collagen injection and rehabilitative treatment in longlasting facial nerve palsy: a pilot randomized controlled trial.

Eur J Phys Rehabil Med 2020 Jul 15. Epub 2020 Jul 15.

Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy.

Background: Many rehabilitative attempts have been made to prevent or reduce residual deficits in patients with established and long-term facial palsy (FP). In many clinical settings in-situ injection of collagen-based medical devices (MDs) have been demonstrated to provide nutritional support for tissues.

Aim: To test the effectiveness of a collagen-based treatment for patients complaining of long standing FP, who are following a proprioceptive neuromuscular facilitation protocol (Kabat method) (Group A), compared to a FP group only undergoing the Kabat method (Group B).

Design: Randomised controlled trial.

Setting: Tertiary referral outpatient center and University Hospital.

Population: 41 patients with a medical diagnosis of long-term unilateral peripheral FP.

Methods: Twenty-one Group A patients were compared, after randomization, to nineteen matched Group B patients after 8 weeks of treatment. The outcomes were electromyographic findings, validated questionnaires (Facial Disability Index, FDI and General health-related quality of life assessment, QOL) and clinical grading (House-Brackmann, HB, and synkinesis grading scale). A correlation analysis was performed between pre-/post-treatment differences (Δ) in outcome and clinical-demographic measures.

Results: A significant within-subjects improvement, both in electrophysiological and questionnaire scores, was found in both groups. When compared with Group B, Group A patients exhibited a significant reduction of post-treatment polyphasic potentials of voluntary activity of orbicularis oculi (p = 0.017) and oris (p = 0.015) and a significant increase in post-treatment duration of voluntary activity of orbicularis oris (p = 0.018). Group A subjects demonstrated a significant improvement in questionnaire subscales regarding overall disease perception. Although positive correlations between the ΔFDI and Δpercentage of polyphasic potentials of voluntary activity were found in both groups, negative correlations in Group A were found between disease duration and Δduration of voluntary activity of orbicularis oculi and oris.

Conclusions: The combination of physical rehabilitative procedures with in-situ collagen injections, possibly acting in redirecting the phenomena of reinnervation/reorganization, demonstrated encouraging results in patients affected by long term FP.

Clinical Rehabilitation Impact: In-situ collagen injection could be a safe option enlarging the 'window of opportunity' to improve the voluntary muscle contraction pattern and general and specific disability referred by patients affected by long standing FP.
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http://dx.doi.org/10.23736/S1973-9087.20.06393-5DOI Listing
July 2020

Temporomandibular disorders and cervicogenic dizziness: Relations between cervical range of motion and clinical parameters.

Cranio 2020 Jun 16:1-10. Epub 2020 Jun 16.

Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata , Rome, Italy.

Objective: To analyze the cervical range of motion (CROM) and clinical parameters in patients affected by myogenous temporomandibular disorders (TMD), cervicogenic dizziness (CGD), both TMD and CGD (TMD/CGD), and a group of healthy subjects (HS).

Methods: CROM degrees, Dizziness Handicap Inventory (DHI), Tampa Scale for Kinesiophobia (TSK-17), Hospital Anxiety and Depression Scale (HADS), and Jaw Functional Limitation Scale 20 (JFLS-20) scores were compared between 46 TMD patients, 49 CGD subjects, 43 TMD/CGD patients, and 98 HS.

Results: TMD/CGD and CGD patients demonstrated significantly lower CROM degrees and higher DHI, TSK-17, and HADS values when compared to TMD patients. TMD/CGD and TMD patients demonstrated higher JFLS-20 values when compared to CGD and HS. Significant negative correlations were found in TMD/CGD and TMD patients between JFLS-20 and CROM in flexion and extension.

Discussion: Present findings demonstrated a relation between spine movement impairment and TMD.
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http://dx.doi.org/10.1080/08869634.2020.1780772DOI Listing
June 2020

Surgical treatment of otosclerosis leading to changes in postural control and quality of life.

Laryngoscope 2020 10 5;130(10):2448-2454. Epub 2019 Dec 5.

Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Italy.

Objective: Evaluating postural function in patients with otosclerosis by assessing otoneurological function and balance-related quality of life before and 6 weeks after surgical treatment. Correlations between and clinical features were investigated.

Methods: Thirty-three patients affected by otosclerosis underwent otoneurological examination, video Head Impulse Test (vHIT), and static posturography before and after stapedotomy. Quality of life and dizziness-related handicap were screened by means of validated questionnaires. Correlation analysis was performed in order to discover possible relations with audiological pre- and postoperative parameters.

Results: A significant improvement in posturographic parameters was found. Correlation analysis yielded a negative correlation between preoperative bone conduction auditory threshold and both vHIT scores and postural performance improvement, evaluated by spectral analysis. Moreover, a positive correlation was also found between improvements in posturographic scores and quality-of-life questionnaires.

Conclusion: The study results demonstrated an improvement in postural function and self-reported measures in a cohort of patients with otosclerosis 6 weeks after stapedotomy. The inverse correlation with preoperative auditory levels may reflect lesser chance for balance restoration in cases with worse sensorineural function. Possible implications for daily activities and overall quality of life were suggested by improved self-report questionnaire results.

Level Of Evidence: 4 Laryngoscope, 130:2448-2454, 2020.
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http://dx.doi.org/10.1002/lary.28438DOI Listing
October 2020

Postural control abnormalities related to sleep deprivation in patients with Marfan Syndrome.

J Vestib Res 2019;29(5):261-269

Department of Clinical Sciences and Translational Medicine, Otolaryngology Unit, 'Tor Vergata' University, Rome, Italy.

Background: Marfan syndrome (MFS) is a rare autosomal dominant connective tissue disorder affecting virtually every organ. Sleep disturbances, associated to high collapsibility in upper airways, are common in MFS; daytime sleepiness could lead to reduction in attention and motor coordination, with detrimental effects on balance.

Objective: To evaluate otoneurological function in MFS patients, compared to healthy subjects, and to investigate possible correlations with sleep deprivation extent.

Methods: Forty-one MFS patients underwent a thorough otoneurological examination, video Head Impulse Test (vHIT), and static posturography. Sleep parameters were recorded by home monitoring. Daytime sleepiness and dizziness-related handicap were screened by means of Dizziness Handicap Inventory (DHI) and Epworth Sleepiness Scale (ESS). Results were compared with 49 healthy controls (HC).

Results: DHI and ESS scores were increased in MFS patients (p < 0,01). vHIT scores showed no between-group effect. Classical (surface and length) and frequency-domain posturographic parameters were significantly increased in MFS with respect to HC (p < 0,01). A positive correlation was found between ESS scores and posturographic parameters in MFS patients.

Conclusions: An impaired postural control, related to the extent of sleep deprivation, was found in MFS patients. Such results could advocate for screening and treating sleep deprivation and balance dysfunctions in MFS patients.
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http://dx.doi.org/10.3233/VES-190684DOI Listing
June 2020

Diagnostic route of cervicogenic dizziness: usefullness of posturography, objective and subjective testing implementation and their correlation.

Disabil Rehabil 2019 Oct 26:1-8. Epub 2019 Oct 26.

Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata , Rome , Italy.

To evaluate posturography measurements, and their association with other clinical tests used for cervicogenic dizziness diagnosis, in a cohort of subjects suffering from cervicogenic dizziness, compared with healthy subjects. Ninety-three cervicogenic dizziness patients and 98 age- and gender-matched healthy subjects underwent video-Head impulse test, posturography testing, evaluation of cervical spine movements by means of cervical range of motion goniometer and self-report and performance measures, including Dizziness Handicap Inventory, Neck Disability Index, Neck Pain Intensity, Tampa Scale for Kinesiophobia and Hospital Anxiety and Depression Scale. Cervicogenic dizziness patients demonstrated significant increases in classical posturography parameters (i.e., surface and length) and in power spectra values within middle and high-frequency interval depicting balance control alterations especially due to proprioceptive integration changes. Furthermore, decreases in degrees of cervical range of motion and increases of self-report and performance measures - highlighting significant complaints of subjective feeling of dizziness - were found in these patients when compared with healthy subjects. Multiple correlations were found between posturography testing and cervical range of motion and Dizziness Handicap Inventory as well as between different self-report and performance measures in cervicogenic dizziness patients. The implementation of posturography - including power spectra analysis - coupled with appropriate exclusion of other disorders, may represent a useful tool in improving cervicogenic dizziness assessment in terms of cost, time consumption and correlation with other measurements. Implications for rehabilitation Uncertainties in diagnostic assessment of cervicogenic dizziness reflect doubts regarding the causes underpinning the symptoms of imbalance, unsteadiness, and disorientation. Posturography measurement is a low-cost, time-sparing technique and its implementations have proven to be useful in detecting significant alterations in body sway during perturbating situations. Implementation of power spectra analysis on posturography testing may represent a useful tool in improving cervicogenic dizziness assessment also in terms of rehabilitative treatment follow-up.
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http://dx.doi.org/10.1080/09638288.2019.1680747DOI Listing
October 2019

Age-related Assessment of Postural Control Development: A Cross-sectional Study in Children and Adolescents.

J Mot Behav 2020 22;52(4):418-426. Epub 2019 Jul 22.

Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy.

The aim of this study was to outline an age-dependent range of posturography measures obtained from healthy children. One hundred and fifty healthy 4-18-year-old children underwent video Head Impulse Test and static posturography testing. Surface, length and power spectra values were compared between each group of pupils and 32 healthy adults. As well as a significant ( < 0.025) increase in surface and length, when compared to healthy adults, increased values within the low/middle frequency domain and within the high frequency domain were also observed in 4-13 and 4-7-year-old children, respectively. In conclusion, although the nature of postural control development remains largely undetermined, this study represents a first attempt to outline an age-dependent normal range of the relative contribution of inputs in typically developing children.
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http://dx.doi.org/10.1080/00222895.2019.1643284DOI Listing
July 2019

Anatomical Correlates and Surgical Considerations for Localized Therapeutic Hypothermia Application in Cochlear Implantation Surgery.

Otol Neurotol 2019 10;40(9):1167-1177

Department of Otolaryngology.

Hypothesis: Application of localized, mild therapeutic hypothermia during cochlear implantation (CI) surgery is feasible for residual hearing preservation.

Background: CI surgery often results in a loss of residual hearing. In preclinical studies, local application of controlled, mild therapeutic hypothermia has shown promising results as a hearing preservation strategy. This study investigated a suitable surgical approach to deliver local hypothermia in patients utilizing anatomical and radiologic measurements and experimental measurements from cadaveric human temporal bones.

Methods: Ten human cadaveric temporal bones were scanned with micro-computed tomography and anatomical features and measurements predicting round window (RW) visibility were characterized. For each bone, the standard facial recess and myringotomy approaches for delivery of hypothermia were developed. The St. Thomas Hospital (STH) classification was used to record degree of RW visibility with and without placement of custom hypothermia probe. Therapeutic hypothermia was delivered through both approaches and temperatures recorded at the RW, RW niche, over the lateral semicircular canal and the supero-lateral mastoid edge.

Results: The average facial recess area was 13.87 ± 5.52 mm. The introduction of the cooling probe through either approach did not impede visualization of the RW or cochleostomy as determined by STH grading. The average temperatures at RW using the FR approach reduced by 4.57 ± 1.68 °C for RW, while using the myringotomy approach reduced by 4.11 ± 0.98 °C for RW.

Conclusion: Local application of therapeutic hypothermia is clinically feasible both through the facial recess and myringotomy approaches without limiting optimal surgical visualization.
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http://dx.doi.org/10.1097/MAO.0000000000002373DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6750193PMC
October 2019

Vestibular rehabilitation in older adults with and without mild cognitive impairment: Effects of virtual reality using a head-mounted display.

Arch Gerontol Geriatr 2019 Jul - Aug;83:246-256. Epub 2019 May 10.

University of Rome Tor Vergata, Department of Clinical Sciences and Translational Medicine, Italy.

Purpose: Due to the gap in the knowledge in the field of vestibular rehabilitation the purpose of this randomized study is to highlight the outcomes of head-mounted display (HMD) implementation in older adults and patients with mild cognitive impairment (MCI), suffering from unilateral vestibular hypofunction (UVH).

Materials And Methods: Vestibulo-ocular reflex (VOR) gain, postural sway examination and dizziness-related and quality of life scores were collected in 12 UVH elderly and 12 UVH subjects suffering from MCI only undergoing vestibular rehabilitation and in 11 UVH elderly and 12 UVH subjects suffering from MCI undergoing a home-based HMD + vestibular rehabilitation protocol.

Results: Although the within-subjects analysis found in all groups a significant (p < 0.05) improvement in posturography parameters and dizziness-related and quality of life scores and no changes in VOR gain, implementation of HMD demonstrated a significant (p < 0.05) increase in post-treatment between-group comparisons in the same tests and VOR gain with respect to those older adults and participants with MCI only undergoing vestibular rehabilitation. Positive correlations were discovered between Mini-Mental Score Exam values and pre-/post-treatment differences in (i) power spectra values in the low-frequency interval (r = 0.72) and in (ii) Dynamic Gait Index scores (r = 0.76).

Conclusions: This study demonstrates that the implementation of a home-based virtual reality protocol may be a safe option in order to ameliorate VOR, postural control and the quality of life also in the vestibular impaired patients in whom the presence of cognitive decline could hinder the achievement of the goal of rehabilitation.
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http://dx.doi.org/10.1016/j.archger.2019.05.008DOI Listing
March 2020

Power spectra prognostic aspects of impulsive eye movement traces in superior vestibular neuritis.

Med Biol Eng Comput 2019 Aug 4;57(8):1617-1627. Epub 2019 May 4.

Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Via Montpellier, 1; E sud Tower, 00133, Rome, Italy.

Since usefulness of power spectra (PS) analysis was demonstrated in many fields of electrophysiology, the aims of the present study were to evaluate differences in frequency domain values of eye velocity traces between a group of 60 healthy subjects (HC) and 35 matched superior vestibular neuritis (VN) patients and to determine prognostic aspects of such values in terms of superior VN recovery. PS calculated on video head impulse test traces was compared between HC and during the acute stage of vertigo (T1) and after 3 months (T2) in superior VN patients. A multiple regression and desirability model between Δ (T2gain - T1gain) vestibulo-ocular reflex (VOR) gain and five prognostic factors were employed. Significant PS differences within the 7.8-16.6 Hz domain were found between superior VN and HC. A significant negative correlation was found between the 7.8-16.6 Hz domain unitary PS value and Δ VOR gain (β = - 0.836). The desirability model depicted a cutoff value of the unitary PS equal to 1.82 in order to obtain a Δ VOR gain rate at least equal to 0.1. Present findings could be a further step for monitoring those superior VN patients with systemic risk factors and high risk of VOR incomplete recovery. Graphical abstract In the top left, healthy control (HC) and superior vestibular neuritis (VN) subjects were screened by means of video head impulse test. In the top right, significant differences in power spectra values were depicted within the 7.8-16.6 Hz domain when comparing the two groups of subjects. In the bottom center, the desirability model depicts a cutoff value of the power spectra equal to 1.82 in order to obtain a Δ vestibulo-ocular reflex gain rate at least equal to 0.1.
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http://dx.doi.org/10.1007/s11517-019-01982-3DOI Listing
August 2019

Visual dependency and postural control on swing performance in golf players.

Eur J Sport Sci 2019 Aug 17;19(7):922-930. Epub 2019 Feb 17.

a Department of Clinical Sciences and Translational Medicine , University of Rome "Tor Vergata" , Rome , Italy.

Individuals have to reweight the respective contribution of the different sources of sensorial information for regulating posture and balance, especially during fine task execution. Given the evidences indicating strategy during swing performance as associated with prioritization of task-relevant visuospatial information for skill execution, the aim of the present work is to assess differences in visual dependency (VD) and postural control in a population of expert (EXP) and non-expert (NEXP) golfers when compared with healthy subjects (HC) and to discover possible relationships between these outcomes and swing performance. Thus, 15 golfers (EXP = 7; NEXP = 8) and 32 matched HC underwent otoneurological testing including video Head Impulse Test, posturography and Rod and Disk Test (RDT). Golf players also underwent a swing session procedure, which performance was measured by means of the Flightscope X2 Doppler-radar launch monitor system. EXP subjects demonstrated significant ( < 0.05) lower values in i) counter-clockwise (CCW) and clockwise (CW) dynamic conditions when compared with both NEXP and HC subjects RDT outcome measures and ii) surface and length posturography values as compared with HC subjects. When treating golf players outcomes as 'a continuum', CCW and CW scores were found to positively correlate with both lateral distance and horizontal launch angle and to negatively correlate with spin rpm. In conclusion, the present study suggests that the high-level of visual-independency demonstrated by EXP subjects may be functionally related in expert golfers to an effective motor strategy preferentially not referring to an inappropriate reliance on visual input.
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http://dx.doi.org/10.1080/17461391.2019.1571635DOI Listing
August 2019

New trends in otoneurological dysfunctions in OSA patients concerning "The balance of sleep: Role of the vestibular sensory system".

Sleep Med Rev 2019 04 6;44:85-86. Epub 2018 Dec 6.

University of Rome Tor Vergata, Department of Clinical Sciences and Translational Medicine, Italy; ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy. Electronic address:

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http://dx.doi.org/10.1016/j.smrv.2018.12.002DOI Listing
April 2019

Postural and vestibular changes related to CPAP treatment in moderate-to-severe OSA patients: a 12-month longitudinal study.

Sleep Breath 2019 Jun 19;23(2):665-672. Epub 2018 Nov 19.

Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Via Montpellier, 1, E sud Tower, 00133, Rome, Italy.

Purpose: To assess whether vestibulo-ocular reflex (VOR) gain, posturography parameters and related clinical outcomes can improve in OSA patients after 12 months of CPAP treatment, taking into consideration that a certain degree of vestibular dysfunction has been identified in these subjects.

Methods: Vestibular, postural, clinical, and polygraphic parameters were assessed in 32 OSA patients before and after beneficial CPAP treatment by means of video head impulse test (vHIT), static posturography (SP), Dizziness Handicap Inventory (DHI), Epworth Sleepiness Scale (ESS), and Apnea-Hypopnea Index (AHI), respectively, and were compared by means of a "within-subject" ANOVA model and Spearman's rank correlation.

Results: After the 12-month period of treatment, OSA patients demonstrated a significant reduction in AHI values, in both opened and closed eyes conditions of surface and length as well as in power spectra recorded in low, middle, and high frequency interval. Although a significant improvement was also recorded among DHI and ESS scores, VOR gain increase did not survive to post-hoc corrections. Finally, positive correlations between the differences between pre- and post-treatment AHI, ESS, and PS values were found.

Conclusions: The present work highlighted that postural instability and dizziness-related conditions due to OSA may improve after 12 months of CPAP treatment. Although VOR gain did not demonstrate significant improvement, this study might open future perspectives directed to assessing VOR gain changes after longer periods of CPAP treatment.
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http://dx.doi.org/10.1007/s11325-018-1754-zDOI Listing
June 2019

Gradient impact of cognitive decline in unilateral vestibular hypofunction after rehabilitation: preliminary findings.

Eur Arch Otorhinolaryngol 2018 Oct 29;275(10):2457-2465. Epub 2018 Aug 29.

Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Via Montpellier, 1, E sud Tower, 00133, Rome, Italy.

Purpose: Considering recent advances in central cognitive- and age-related processing interfering with balance and sensory reweighting in uncompensated vestibular disorders, purpose of this study is to highlight the vestibular rehabilitation (VR) outcomes in a population of older adults and age-matched mild cognitive impairment (MCI) patients, both affected by unilateral vestibular hypofunction (UVH) and undergoing VR.

Methods: Vestibulo-ocular reflex (VOR), postural sway examination (respectively, performed by video head impulse test and static posturography) and dizziness-related and quality-of-life scores were collected in 12 UVH MCI individuals ≥ 55 years and 12 matched UVH older adults with age-appropriate cognitive function-cognitively evaluated by means of Mini-Mental State Examination (MMSE) and Alzheimer's Disease Assessment Scale-before and after a VR protocol.

Results: A significant post-treatment reduction in surface, length and power spectra (PS) values within low-frequency domain and an improvement in performance measures were recorded in both groups. Moreover, the VR protocol highlighted-when comparing pre-/post-treatment differences (Δ)-a significant (i) increase in Δ VOR gain; (ii) decrease in Δ surface and length and (iii) increase in Δ PS within low-frequency domain in older adults when compared to MCI patients. Positive correlations were found between MMSE and Δ Dynamic Gait Index, Δ surface and Δ PS within low-frequency domain when treating patients as 'a continuum' along the cognitive decline.

Conclusions: Present pilot findings suggest that the cognitive domain insight in older adults scheduled for VR protocols may positively impact on disability consequences.
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http://dx.doi.org/10.1007/s00405-018-5109-yDOI Listing
October 2018

Perspectives on multisensory perception disruption in idiopathic environmental intolerance: a systematic review.

Int Arch Occup Environ Health 2018 Nov 7;91(8):923-935. Epub 2018 Aug 7.

Department of Clinical Sciences and Translational Medicine, University of Rome'Tor Vergata', Via Montpellier, 1; E sud Tower, 00133, Rome, Italy.

Purpose: Multiple chemical sensitivity (MCS) also known as idiopathic environmental intolerance/illness (IEI) encompasses a cohort of subjective symptoms characterized by susceptibility to a wide spectrum of environmental compounds, causing symptoms involving various organs and a decrease in quality of life. The aim of this systematic review is to summarize evidence about MCS, with focus on indexed studies analyzing sensory pathway-related disorders.

Methods: Medical databases were searched for English language articles related to the topic, published between 1965 and 2017 in academic, peer-reviewed journals. Particular focus was concentrated on articles depicting disturbances involving sensory organs. References of the relevant articles were examined to identify additional significant documents.

Results: Fifty-eight studies were eligible for full text review. Of these, 34 studies met the selection criteria and were included in this analysis. Many variables, such as different diagnostic criteria, lack of homogeneous symptom questionnaires and the general incidence of personality traits in control subjects, biased studies as confounding factors. However, moderate evidences show that sensory pathways are somewhat altered, especially with respect to information processing in the limbic system and related cortical areas. Recent studies suggested the presence, in MCS cohorts, of attention bias, sensitization and limbic kindling, as well as recently revealed subclinical organic alterations along sensory pathways.

Conclusions: Evidences are consistent with MCS/IEI to be the result of a neural altered processing of sensorial ascending pathways, which combined with peculiar personality traits constitutes the underpinning of a multisensory condition needing multidisciplinary clinical approach.
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http://dx.doi.org/10.1007/s00420-018-1346-zDOI Listing
November 2018

Long-term effects of vestibular rehabilitation and head-mounted gaming task procedure in unilateral vestibular hypofunction: a 12-month follow-up of a randomized controlled trial.

Clin Rehabil 2019 Jan 16;33(1):24-33. Epub 2018 Jul 16.

1 Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata," Rome, Italy.

Objective:: To investigate the long-term effects of adding virtual reality-based home exercises to vestibular rehabilitation in people with unilateral vestibular hypofunction.

Design:: Follow-up otoneurological examination in two randomized groups following a previous one-month trial.

Setting:: Tertiary rehabilitation center.

Subjects:: A total of 47 patients with unilateral vestibular hypofunction, one group ( n = 24) undergoing conventional vestibular rehabilitation and the other one ( n = 23) implementing, in addition, head-mounted gaming home exercises, 20 minutes per day for one month.

Interventions:: One year after completing rehabilitation, patients underwent testing with static posturography, video head impulse test, self-report questionnaires, and a performance measure.

Main Measures:: Vestibulo-ocular reflex gain, posturographic parameters such as length, surface, and fast Fourier transform power spectra, self-report, and gait performance measure scores.

Results:: Vestibulo-ocular reflex gain was significantly better with respect to pretreatment in both groups. The mixed-method group showed significantly higher gain scores: mean (standard deviation (SD)) at 12 months was 0.71 (0.04), versus 0.64 (0.03) for the vestibular rehabilitation-only group ( P < 0.001). Accordingly, some classical posturography scores such as surface with eyes open and length with eyes closed and low-frequency power spectra were significantly different between groups, with the virtual reality group showing improvement ( P < 0.001). Self-report measures were significantly better in both groups compared to pretreatment, with significant improvement in the mixed-method group as compared to conventional rehabilitation alone: Dizziness Handicap Inventory mean total score was 24.34 (2.8) versus 35.73 (5.88) with a P-value <0.001.

Conclusion:: Results suggest that head-mounted gaming home exercises are a viable, effective, additional measure to improve long-term vestibular rehabilitation outcomes.
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http://dx.doi.org/10.1177/0269215518788598DOI Listing
January 2019

Degree of Functional Impairment Associated With Vestibular Hypofunction Among Older Adults With Cognitive Decline.

Otol Neurotol 2018 06;39(5):e392-e400

Department of Clinical Sciences and Translational Medicine.

Objective: Considering the altered multisensory signal compensation during senescence, the aim of the present study was to evaluate the integration rearrangements in unilateral vestibular hypofunction (UVH) during age-related cognitive decline.

Study Design: Cross-sectional study.

Setting: Longitudinal cohort study unit and of University tertiary referral center.

Patients: Older UVH individuals ≥ 55 years with Mild Cognitive Impairment (MCI) or Alzheimer Disease (AD) and matched UVH control group with age-appropriate cognitive function.

Intervention: Vestibulo-ocular reflex, postural sway examination (respectively performed by means of video head impulse test and static posturography), and dizziness-related and quality of life scores were collected in all three groups of UVH patients cognitively evaluated by means of Mini Mental State Examination and Alzheimer's Disease Assessment Scale (ADAS-cog).

Main Outcome Measures: Vestibulo-ocular reflex gain, length, surface, and spectral values of body oscillation were measured. Dizziness Handicap Inventory, Activities-specific Balance Confidence scale, and Dynamic Gait Index scores were collected.

Results: A significant (p < 0.05) increase in surface and length values during both eyes closed and eyes open conditions was found when comparing scores for AD to both MCI and control group patients, respectively. These patients demonstrated significantly (p < 0.05) lower spectral values of body oscillation on posturography platform in both eyes closed and eyes open condition within the low-frequency interval than MCI and AD patients.

Conclusion: This is the first study reporting an association between cognitive decline and posturography parameters with possible preventive clinical implications in evaluating the risk for falls in high-risk patients, such as older adults with common neuro-otological disorders.
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http://dx.doi.org/10.1097/MAO.0000000000001746DOI Listing
June 2018

Towards the enhancement of body standing balance recovery by means of a wireless audio-biofeedback system.

Med Eng Phys 2018 04 10;54:74-81. Epub 2018 Feb 10.

Department of Electronic Engineering, University of Rome "Tor Vergata", Via del Politecnico 1, 00133 Rome, Italy. Electronic address:

Human maintain their body balance by sensorimotor controls mainly based on information gathered from vision, proprioception and vestibular systems. When there is a lack of information, caused by pathologies, diseases or aging, the subject may fall. In this context, we developed a system to augment information gathering, providing the subject with warning audio-feedback signals related to his/her equilibrium. The system comprises an inertial measurement unit (IMU), a data processing unit, a headphone audio device and a software application. The IMU is a low-weight, small-size wireless instrument that, body-back located between the L2 and L5 lumbar vertebrae, measures the subject's trunk kinematics. The application drives the data processing unit to feeding the headphone with electric signals related to the kinematic measures. Consequently, the user is audio-alerted, via headphone, of his/her own equilibrium, hearing a pleasant sound when in a stable equilibrium, or an increasing bothering sound when in an increasing unstable condition. Tests were conducted on a group of six older subjects (59y-61y, SD = 2.09y) and a group of four young subjects (21y-26y, SD = 2.88y) to underline difference in effectiveness of the system, if any, related to the age of the users. For each subject, standing balance tests were performed in normal or altered conditions, such as, open or closed eyes, and on a solid or foam surface. The system was evaluated in terms of usability, reliability, and effectiveness in improving the subject's balance in all conditions. As a result, the system successfully helped the subjects in reducing the body swaying within 10.65%-65.90%, differences depending on subjects' age and test conditions.
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http://dx.doi.org/10.1016/j.medengphy.2018.01.008DOI Listing
April 2018

Three-dimensional head-mounted gaming task procedure maximizes effects of vestibular rehabilitation in unilateral vestibular hypofunction: a randomized controlled pilot trial.

Int J Rehabil Res 2017 Dec;40(4):325-332

aDepartment of Clinical Sciences and Translational Medicine bDepartment of Systems Medicine, Neuroscience Unit, University of Rome Tor Vergata cITER Center for Rehabilitation, Rome, Italy.

Considering the emerging advantages related to virtual reality implementation in clinical rehabilitation, the aim of the present study was to discover possible (i) improvements achievable in unilateral vestibular hypofunction patients using a self-assessed head-mounted device (HMD)-based gaming procedure when combined with a classical vestibular rehabilitation protocol (HMD group) as compared with a group undergoing only vestibular rehabilitation and (ii) HMD procedure-related side effects. Therefore, 24 vestibular rehabilitation and 23-matched HMD unilateral vestibular hypofunction individuals simultaneously underwent a 4-week rehabilitation protocol. Both otoneurological measures (vestibulo-ocular reflex gain and postural arrangement by studying both posturography parameters and spectral values of body oscillation) and performance and self-report measures (Italian Dizziness Handicap Inventory; Activities-specific Balance Confidence scale; Zung Instrument for Anxiety Disorders, Dynamic Gait Index; and Simulator Sickness Questionnaire) were analyzed by means of a between-group/within-subject analysis of variance model. A significant post-treatment between-effect was found, and the HMD group demonstrated an overall improvement in vestibulo-ocular reflex gain on the lesional side, in posturography parameters, in low-frequency spectral domain, as well as in Italian Dizziness Handicap Inventory and Activities-specific Balance Confidence scale scores. Meanwhile, Simulator Sickness Questionnaire scores demonstrated a significant reduction in symptoms related to experimental home-based gaming tasks during the HMD procedure. Our findings revealed the possible advantages of HMD implementation in vestibular rehabilitation, suggesting it as an innovative, self-assessed, low-cost, and compliant tool useful in maximizing vestibular rehabilitation outcomes.
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http://dx.doi.org/10.1097/MRR.0000000000000244DOI Listing
December 2017

A Comprehensive Insight into the Rehabilitative Treatment of Persistent Benign Paroxysmal Positional Vertigo.

J Int Adv Otol 2017 Apr;13(1):147-148

Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Italy.

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http://dx.doi.org/10.5152/iao.2017.3564DOI Listing
April 2017

Early cortical metabolic rearrangement related to clinical data in idiopathic sudden sensorineural hearing loss.

Hear Res 2017 07 25;350:91-99. Epub 2017 Apr 25.

University of Rome Tor Vergata, Department of Clinical Sciences and Translational Medicine, Otolaryngology Unit, Italy.

Results in studies concerning cortical changes in idiopathic sudden sensorineural hearing loss (ISSNHL) are not homogeneous, in particular due to the different neuroimaging techniques implemented and the diverse stages of ISSNHL studied. Considering the recent advances in state-of-the-art positron emission tomography (PET) cameras, the aim of this study was to gain more insight into the neuroanatomical differences associated with the earliest stages of unilateral ISSNHL and clinical-perceptual performance changes. After an audiological examination including the mean auditory threshold (mean AT), mean speech discrimination score (mean SDS) and Tinnitus Handicap Inventory (THI), 14 right-handed ISSNHL patients underwent brain [F]fluorodeoxyglucose (FDG)-PET within 72 h of the onset of symptoms. When compared to an homogeneous group of 35 healthy subjects by means of statistical parametric mapping, a relative increase in FDG uptake was found in the right superior and medial frontal gyrus as well as in the right anterior cingulate cortex in ISSNHL patients. Conversely, the same group showed a significant relative decrease in FDG uptake in the right middle temporal, precentral and postcentral gyrus as well as in the left posterior cingulate cortex, left lingual, superior, middle temporal and middle frontal gyrus and in the left insula. Regression analysis showed a positive correlation between mean THI and glucose consumption in the right anterior cingulate cortex and a positive correlation between mean SDS and glucose consumption in the left precentral gyrus. The relative changes in FDG uptake found in these brain regions and the positive correlation with mean SDS and THI scores in ISSNHL could possibly highlight new aspects of cerebral rearrangement, contributing to further explain changes in those functions that support speech recognition during the sudden impairment of unilateral auditory input.
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http://dx.doi.org/10.1016/j.heares.2017.04.011DOI Listing
July 2017

Integrating postural and vestibular dimensions to depict impairment in moderate-to-severe obstructive sleep apnea syndrome patients.

J Sleep Res 2017 08 20;26(4):487-494. Epub 2017 Mar 20.

Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy.

Vestibular dysfunction was linked to moderate-to-severe obstructive sleep apnea syndrome (OSAS) patients in literature. However, due to a lack of knowledge among valid and recent implementations conceived to study postural control on static posturography (SP) and vestibulo-ocular reflex (VOR) gain under physiological conditions (video Head Impulse Test; vHIT), the aim of this work was to integrate (i) VOR changes via vHIT implementation, (ii) postural arrangement by studying both classical parameters and frequency spectra (PS) and (iii) correlation between these findings, polygraphic (PG) and subjective scores along Dizziness Handicap Inventory (DHI) and Epworth Sleepiness Scale (ESS). Thus, 32 moderate-to-severe OSAS patients and 32 healthy subjects - studied by using PG, DHI and ESS - underwent vHIT and SP posturographic assessment. Analysis of variance was performed to disclose between-group effects and correlation analysis was implemented between otoneurological, PG, DHI and ESS values. OSAS group demonstrated a significant decay of VOR gain and an increase in both frequency spectra PS values, especially within the low-frequency interval, and in classical posturographic SP parameters. Further, positive and negative correlations between mean SaO and gain and low frequency interval spectra PS were found, respectively. Strengthening previous hypothesis related to brainstem chronic hypoxemia phenomena affecting vestibular network, implementation of these data could generate future attentions (i) for screening under physiological conditions postural and vestibular detriments in OSAS subjects, especially exposed at risk settings, and (ii) among PG parameters, such as mean SaO , to propose further reliable tools in monitoring postural and vestibular decay in these patients demonstrating PG parameters detriments.
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http://dx.doi.org/10.1111/jsr.12516DOI Listing
August 2017

Noise sensitivity and hyperacusis in patients affected by multiple chemical sensitivity.

Int Arch Occup Environ Health 2017 Feb 12;90(2):189-196. Epub 2016 Nov 12.

Department of Clinical Sciences and Translational Medicine, 'Tor Vergata' University, Via Montpellier, 1, E sud Tower, 00133, Rome, Italy.

Purpose: The aim of this study was to investigate the presence of noise sensitivity and hyperacusis in patients suffering from multiple chemical sensitivity (MCS), a chronic condition characterized by several symptoms following low-level chemical exposure. Moreover, distortion product otoacoustic emissions (DPOAE) were performed to further study cochlear function.

Methods: A questionnaire-based survey was performed. Eighteen MCS patients, selected with strict diagnostic criteria, and 20 healthy age- and gender-matched subjects filled Weinstein's Noise Sensitivity Questionnaire (WNS) and Khalfa's Hyperacusis Questionnaire (HQ). Results were compared with scores from the quick Environmental Exposure Sensitivity Index (qEESI), a routinarily used questionnaire to screen MCS symptoms, and with DPOAE values. An analysis of variance (ANOVA) was performed between MCS and control subjects scores; moreover, Spearman's rank correlation test was performed between questionnaire results.

Results: ANOVA testing on DPOAE values showed any significant difference between groups, while WNS, HQ and qEESI scores were significantly higher in MCS group compared to controls. Correlation analysis showed strong positive correlation between WNS, HQ and qEESI in MCS subjects.

Conclusions: For the first time, auditory-related perceptual disorders were studied in MCS. A strong association between WNS, HQ results and MCS symptoms severity has been highlighted. These findings suggest that decreased sound tolerance and noise sensitivity could be considered as possible new aspects of this syndrome, contributing to its peculiar phenotype. Furthermore, as DPOAE values did not differ from healthy subjects, present findings might suggest a 'central' source for such disorders in this group of patients.
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http://dx.doi.org/10.1007/s00420-016-1185-8DOI Listing
February 2017