687 results match your criteria Vestibuloocular Reflex Testing

Pearls & Oy-sters: Vertical Diplopia and Ocular Torsion: Peripheral vs Central Localization.

Neurology 2022 Jun 6. Epub 2022 Jun 6.

Department of Neurology, Division of Neuro-Visual & Vestibular Disorders, Johns Hopkins University School of Medicine, Baltimore, MD.

We describe a case with torsional deviation of the eyes from a brainstem lesion. Torsional eye movement refers to changes in the position of the eyes in the roll plane around the visual axis. When the head is tilted laterally (that is, rolled towards the shoulder), the eyes roll in the opposite direction as part of the torsional vestibulo-ocular reflex known as the ocular counter-roll (OCR). Read More

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Instantaneous Gain in Video Head Impulse Test: A Reliability Study.

Turk Arch Otorhinolaryngol 2022 Mar 12;60(1):16-22. Epub 2022 May 12.

Department of Audiology, Hacettepe University Faculty of Health Sciences, Ankara, Turkey.

Objective: Vestibulo-ocular reflex gain at 40, 60, and 80 ms following the head movement start is calculated as the instantaneous gain. The purpose of this study was to investigate the reliability of instantaneous gain values at 40, 60, and 80 ms with testing and retesting in healthy adults.

Methods: The study was conducted with Interacoustics EyeSeeCam vHIT (Interacoustics, Denmark), and 42 healthy adults were evaluated twice at half-hour intervals (test and retest) by the same practitioner. Read More

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Reduced Gain and Shortened Time Constant of Vestibular Velocity Storage as a Source of Balance and Movement Sensitivities in Gravitational Insecurity.

Occup Ther Int 2022 6;2022:5240907. Epub 2022 May 6.

University of Minnesota, USA.

Gravitational insecurity (GrI) involves lifetime movement and balance concerns whose pathophysiological origins are unclear. We tested whether balance symptoms in mild GrI might involve anomalies in vestibular velocity storage (VVS), a brainstem/cerebellar circuit that amplifies gain and prolongs the persistence of weak vestibular signals from small/slow head movements. A Provisional Gravitational Insecurity Index (PGrI) was developed, evaluated for psychometrics/demographics, and used to identify otherwise healthy adults with life-long balance challenges as well as sex, age, and ethnicity-matched comparison adults without such challenges. Read More

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[The "difficult" patient-Vestibular testing under difficult conditions : Part 1: History taking and clinical neurotological examination].

Julia Dlugaiczyk

HNO 2022 Jun 18;70(6):485-495. Epub 2022 May 18.

Klinik für Ohren‑, Nasen‑, Hals- und Gesichtschirurgie & Interdisziplinäres Zentrum für Schwindel und neurologische Sehstörungen, Universitätsspital Zürich (USZ), Universität Zürich (UZH), Frauenklinikstrasse 24, 8091, Zürich, Schweiz.

Patients presenting with vertigo or dizziness may pose a real challenge for the clinical otorhinolaryngologist. This series of articles covers different aspects of the "difficult" dizzy patient. The first part is dedicated to pearls and pitfalls in history taking and clinical neurotological examination. Read More

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Head impulse testing in bilateral vestibulopathy in patients with genetically defined CANVAS.

Brain Behav 2022 06 2;12(6):e32546. Epub 2022 May 2.

Institute of Neurogenetics, University of Lübeck, Lübeck, Germany.

Background: To investigate the association between disease duration and the severity of bilateral vestibulopathy in individuals with complete or incomplete CANVAS (Cerebellar Ataxia with Neuropathy and Vestibular Areflexia Syndrome) and biallelic RFC1 repeat expansions.

Methods: Retrospective analysis of clinical data and the vestibulo-ocular reflex quantified by the video head impulse test in 20 patients with confirmed biallelic RFC1 repeat expansions.

Results: Vestibulo-ocular reflex gain at first admittance 6. Read More

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Differential Activation of Canal and Otolith Afferents by Acoustic Tone Bursts in Rats.

J Assoc Res Otolaryngol 2022 Jun 4;23(3):435-453. Epub 2022 Apr 4.

Department of Otolaryngology-Head and Neck Surgery, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA.

Vestibular evoked myogenic potentials (VEMPs) are routinely used to test otolith function, but which specific vestibular afferent neurons and central circuits are activated by auditory frequency VEMP stimuli remains unclear. To examine this question, we analyzed the sensitivity of individual vestibular afferents in adult Sprague-Dawley rats to tone bursts delivered at 9 frequencies (125-4000 Hz) and 3 intensity levels (60, 70, 80 dB SL re: acoustic brainstem response (ABR) threshold). Afferent neuron tone sensitivity was quantified by the cumulative probability of evoking a spike (CPE). Read More

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Vestibulo-ocular dysfunction in mTBI: Utility of the VOMS for evaluation and management - A review.

NeuroRehabilitation 2022 ;50(3):279-296

Herbert Wertheim School of Optometry & Vision Science at the University of California, Berkeley, CA, USA.

Background: Individuals who have suffered a concussion/mild traumatic brain injury (mTBI) frequently report symptoms associated with vestibular and/or oculomotor dysfunction (VOD) like dizziness, nausea, fatigue, brain fog, headache, gait and neurocognitive impairments which are associated with the development of chronic symptoms. The Vestibular/Ocular Motor Screening (VOMS) tool has been established as a reliable and clinically relevant complement to use alongside a battery of post-concussion tests to improve screening and referral for further evaluation and treatment of VOD.

Objectives: This paper will review the pathoanatomy and symptomatology of common vestibular and oculomotor disorders after concussion, as well as the utility of the VOMS to assist in diagnosis, referral, and management. Read More

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Loss of α-9 Nicotinic Acetylcholine Receptor Subunit Predominantly Results in Impaired Postural Stability Rather Than Gaze Stability.

Front Cell Neurosci 2021 13;15:799752. Epub 2022 Jan 13.

Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States.

The functional role of the mammalian efferent vestibular system (EVS) is not fully understood. One proposal is that the mammalian EVS plays a role in the long-term calibration of central vestibular pathways, for example during development. Here to test this possibility, we studied vestibular function in mice lacking a functional α9 subunit of the nicotinic acetylcholine receptor (nAChR) gene family, which mediates efferent activation of the vestibular periphery. Read More

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January 2022

Imbalance and dizziness caused by unilateral vestibular schwannomas correlate with vestibulo-ocular reflex precision and bias.

J Neurophysiol 2022 02 26;127(2):596-606. Epub 2022 Jan 26.

Jenks Vestibular Physiology Laboratory, Massachusetts Eye and Ear, Boston, Massachusetts.

Imbalance and dizziness are disabling symptoms for many patients with vestibular schwannomas (VS) but symptom severity typically does not correlate with the vestibulo-ocular reflex (VOR) amplitude-based metrics used to assess peripheral vestibular damage. In this study, we tested the hypothesis that imbalance and dizziness in patients with VS relate to VOR metrics that are not based on response amplitude. Twenty-four patients with unilateral, sporadic VS tumors were studied, and objective (balance) and subjective (dizziness) vestibular dysfunction was quantified. Read More

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February 2022

The behavior of the optokinetic system.

David A Robinson

Prog Brain Res 2022 7;267(1):215-230. Epub 2022 Jan 7.

Late Professor of Ophthalmology, Biomedical Engineering and Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, United States.

Optokinetic responses in several species are compared, describing differences in afoveate and foveate animals, and the effects of visual testing conditions, including directions of stimulus motion. Smooth pursuit contributes to responses to full-field visual motion in foveate species; in the latter, measurement of optokinetic after-nystagmus in darkness allows investigation of the optokinetic system. The concept of optokinetic-vestibular symbiosis and velocity storage are discussed, pertinent electrophysiological studies (such as vestibular nucleus neurons that respond to both optokinetic and vestibular stimuli) are reviewed and a model is developed. Read More

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Enhanced Eye Velocity With Backup Saccades in vHIT Tests of a Menière Disease Patient: A Case Report.

Front Surg 2021 8;8:727672. Epub 2021 Dec 8.

Vestibular Research Laboratory, School of Psychology, The University of Sydney, Sydney, NSW, Australia.

Reduced eye velocity and overt or covert compensatory saccades during horizontal head impulse testing are the signs of reduced vestibular function. However, here we report the unusual case of a patient who had enhanced eye velocity during horizontal head impulses followed by a corrective saccade. We term this saccade a "backup saccade" because it acts to compensate for the gaze position error caused by the enhanced velocity (and enhanced VOR gain) and acts to return gaze directly to the fixation target as shown by eye position records. Read More

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December 2021

Investigation of Sensorimotor Impairments in Individuals 4 Weeks to 6 Months After Mild Traumatic Brain Injury.

Arch Phys Med Rehabil 2022 05 30;103(5):921-928. Epub 2021 Nov 30.

University of Queensland, Neck and Head Research Unit, School of Health and Rehabilitation Sciences, Brisbane, Australia.

Objective: To identify whether adults 4 weeks to 6 months post mild traumatic brain injury (mTBI) have sensorimotor impairments compared with controls without mTBI. A secondary aim was to determine if impairments were evident irrespective of participant perceived absence of symptoms.

Design: Observational cohort study. Read More

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Post headshake nystagmus: further correlation with other vestibular test results.

Eur Arch Otorhinolaryngol 2022 Aug 28;279(8):3911-3916. Epub 2021 Nov 28.

Department of Otolaryngology-Head and Neck Surgery, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, 8N-873, Toronto, ON, M5G 2C4, Canada.

Background: It is generally accepted that headshake nystagmus (HSN) is generated from an asymmetrical peripheral vestibular input and a correlation exists between HSN and canal paresis. There have been limited reports, however, how HSN correlates with the more recently introduced tests of vestibular function.

Aims/objectives: To evaluate the correlation between HSN and unilateral weakness on caloric testing, high-frequency vestibulo-ocular reflex (VOR) function on video head impulse testing (VHIT) and otolith function determined by vestibular evoked myogenic potentials (VEMPs). Read More

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Quantitative vestibular function tests in posterior circulation stroke patients: A review.

Med J Malaysia 2021 11;76(6):898-905

Universiti Kebangsaan Malaysia, Faculty of Health Sciences, Audiology Programme, Kuala Lumpur, Malaysia.

While specific bedside examinations are known to be sensitive in identifying stroke among acute vestibular syndrome patients, complementary quantitative vestibular function testing can be helpful to quantify vestibular loss due to stroke. In contrast to peripheral vestibular dysfunction, diagnosis of central vestibular dysfunction can be challenging for unskilful clinicians. This article presents a comprehensive overview of quantitative vestibular function test findings such as the video head impulse test (vHIT), cervical vestibular evoked myogenic potentials (cVEMPs), ocular vestibular evoked myogenic potentials (oVEMPs), videonystagmography (VNG) and caloric test among stroke patients. Read More

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November 2021

Central Ocular Motor Disorders: Clinical and Topographic Anatomical Diagnosis, Syndromes and Underlying Diseases.

Klin Monbl Augenheilkd 2021 Nov 16;238(11):1197-1211. Epub 2021 Nov 16.

Neurologische Klinik der Universität zu Lübeck, Deutschland.

The key to the diagnosis of ocular motor disorders is a systematic clinical examination of the different types of eye movements, including eye position, spontaneous nystagmus, range of eye movements, smooth pursuit, saccades, gaze-holding function, vergence, optokinetic nystagmus, as well as testing of the function of the vestibulo-ocular reflex (VOR) and visual fixation suppression of the VOR. This is like a window which allows you to look into the brain stem and cerebellum even if imaging is normal. Relevant anatomical structures are the midbrain, pons, medulla, cerebellum and rarely the cortex. Read More

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November 2021

Clinical Testing of Head Impulse Paradigm and Suppression Head Impulse Paradigm Using a Diagnostic Headband: Combined Clinical Sign for Improved Performance.

Otol Neurotol 2022 02;43(2):e268-e273

Neurotology Department, Instituto de Neurociencias de Buenos Aires (INEBA), Buenos Aires, Argentina.

Objective: We developed a clinical sign that improves the sensitivity, specificity, and predictive values of the Head Impulse Paradigm (HIMP) Test by adding the Suppression Head Impulse Paradigm (SHIMP) Test using a diagnostic headband.

Methods: Prospective and descriptive study analyzing the function of 1,255 horizontal semicircular canals of subjects with differing vestibulo-ocular reflex (VOR) gains who showed-up with symptoms related to neurotology (Montevideo, Uruguay, March 2017 to March 2019). The clinical HIMP and SHIMP tests were assessed and the amplitudes of overt saccades were compared to each other. Read More

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February 2022

Vestibular testing in children - The suppression head impulse (SHIMP) test.

Int J Pediatr Otorhinolaryngol 2021 Dec 4;151:110921. Epub 2021 Sep 4.

Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Germany. Electronic address:

Introduction: The incidence of vestibular disorders and vertigo during childhood is increasing and pediatric clinicians have become more sensitive to children's balance disorders; thus, there is a need for appropriate detection test procedures for peripheral vestibular hypofunction. In order to ensure a reliable diagnosis and minimize misdiagnosis, a standardized clinical procedure via careful history and clinical examination is recommended. However, children, especially, are often unable to verbalize "vertigo" in a concrete manner, which often necessitates a consultation with a pediatrician holding nonspecific symptoms. Read More

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December 2021

Short-Latency Covert Saccades - The Explanation for Good Dynamic Visual Performance After Unilateral Vestibular Loss?

Front Neurol 2021 31;12:695064. Epub 2021 Aug 31.

Department of Clinical Sciences, Otorhinolaryngology Head and Neck Surgery, Skåne University Hospital, Lund University, Lund, Sweden.

Functional head impulse test (fHIT) tests the ability of the vestibulo-ocular reflex (VOR) to allow visual perception during head movements. Our previous study showed that active head movements to the side with a vestibular lesion generated a dynamic visual performance that were as good as during movements to the intact side. To examine the differences in eye position during the head impulse test when performed with active and passive head movements, in order to better understand the role of the different saccade properties in improving visual performance. Read More

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Derivation of the Buffalo Concussion Physical Examination risk of delayed recovery (RDR) score to identify children at risk for persistent postconcussive symptoms.

Br J Sports Med 2021 Dec 11;55(24):1427-1433. Epub 2021 Sep 11.

Orthopaedics and Sports Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.

Objective: The Buffalo Concussion Physical Examination (BCPE) is a brief, but pertinent physical examination designed for the subacute, outpatient assessment of concussion. The purpose of this study was to perform the BCPE on a larger sample and derive a scoring system to identify children at risk for Persistent Post-Concussive Symptoms (PPCS, recovery ≥30 days).

Methods: This prospective, observational cohort study from September 2016 to March 2019 was performed at three university-affiliated concussion clinics. Read More

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December 2021

Vestibular performance in high-level soccer and ice hockey players: Sport-specific norm values and implications.

J Sci Med Sport 2022 Jan 13;25(1):81-88. Epub 2021 Aug 13.

Schulthess Klinik, Swiss Concussion Center, Switzerland; University Hospital Zurich, Clinical Neuroscience Center, Switzerland; University Hospital Zurich, Department of Neurology, Switzerland.

Objectives: Quantitative vestibular testing in athletes after sports-related concussion (SRC) has become more popular due to accompanying injuries of the peripheral-vestibular organs that require targeted treatment. Sports-specific normative values are currently not available. Taking into account potential adaptational mechanisms, we obtained sports-specific, age- and peak-head-velocity-corrected normative values of peripheral-vestibular function and postural-stability in football (soccer, FB) and ice-hockey (IH) players. Read More

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January 2022

Evaluating the Vestibulo-Ocular Reflex Following Traumatic Brain Injury: A Scoping Review.

Brain Inj 2021 11 8;35(12-13):1496-1509. Epub 2021 Sep 8.

School of Physical and Occupational Therapy, McGill University, Montreal, Canada.

To identify the tests and tools used to evaluate vestibulo-ocular reflex (VOR) function after traumatic brain injury (TBI) in all age groups and across TBI severity. An electronic search was conducted to include relevant peer-reviewed literature published up to November 2019. Studies included those done with humans, of all ages, and had assessments of oculomotor and/or vestibulo-ocular function in TBI. Read More

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November 2021

Influence of Tasking During Vestibular Testing.

Am J Audiol 2021 Sep 20;30(3):755-760. Epub 2021 Aug 20.

Ear, Nose, Throat, and Audiology, CHI Health, Omaha, NE.

Purpose The purpose of this study was to investigate the effectiveness of different types of tasking on the measurement of peak slow phase velocity (SPV) for caloric testing and rotary chair testing. Method This study evaluated the peak SPV response for caloric testing and rotary chair across five conditions. Three verbal, one tactile, and one condition without tasking were used for both caloric testing and rotary chair. Read More

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September 2021

Cerebellar ataxia, neuropathy and vestibular areflexia syndrome (CANVAS): genetic and clinical aspects.

Pract Neurol 2022 Feb 13;22(1):14-18. Epub 2021 Aug 13.

Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK

Cerebellar ataxia, neuropathy and vestibular areflexia syndrome (CANVAS) typically presents in middle life with a combination of neuropathy, ataxia and vestibular disease, with patients reporting progressive imbalance, oscillopsia, sensory disturbance and a dry cough. Examination identifies a sensory neuropathy or neuronopathy and bilaterally impaired vestibulo-ocular reflex. The underlying genetic basis is of biallelic AAGGG expansions in the second intron of replication factor complex subunit 1 (RFC1). Read More

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February 2022

The resilience of the inner ear-vestibular and audiometric impact of transmastoid semicircular canal plugging.

J Neurol 2021 Aug 10. Epub 2021 Aug 10.

Department of Otorhinolaryngology & Head and Neck Surgery, Faculty of Health Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands.

Background: Certain cases of superior semicircular canal dehiscence or benign paroxysmal positional vertigo can be treated by plugging of the affected semicircular canal. However, the extent of the impact on vestibular function and hearing during postoperative follow-up is not known.

Objective: To evaluate the evolution of vestibular function and hearing after plugging of a semicircular canal. Read More

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Changes in daily energy expenditure and movement behavior in unilateral vestibular hypofunction: Relationships with neuro-otological parameters.

J Clin Neurosci 2021 Sep 17;91:200-208. Epub 2021 Jul 17.

ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy; Eurac Research, Institute of Mountain Emergency Medicine, Bolzano, Italy. Electronic address:

The vestibular system has been found to affect energy homeostasis and body composition, due to its extensive connections to the brainstem and melanocortin nuclei involved in regulating the metabolism and feeding behavior. The aim of this study was to evaluate - by means of a wrist-worn physical activity tracker and bioelectrical impedance analysis (BIA) - the energy expenditure (EE) in resting (REE) and free-living conditions and movement behavior in a group of chronic unilateral vestibular hypofunction (UVH) patients when compared with a control group (CG) of healthy participants. Forty-six chronic UVH and 60 CG participants underwent otoneurological (including video-Head Impulse Test [vHIT] for studying vestibulo-ocular reflex [VOR] and static posturography testing [SPT]), and EE and movement measurements and self-report (SRM) andperformance measures (PM). Read More

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September 2021

Repeated video head impulse testing in patients is a stable measure of the passive vestibulo-ocular reflex.

J Otol 2021 Jul 18;16(3):128-137. Epub 2020 Dec 18.

Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, 21205, USA.

Objectives: The video head impulse test (vHIT) is used as a measure of compensation yet it's stability in patients with vestibular pathology is unknown.

Methods: 144 patients (n = 72 female, mean 54.46 ± 15. Read More

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Contralesional High-Acceleration Vestibulo-Ocular Reflex Function in Vestibular Schwannoma.

Otol Neurotol 2021 09;42(8):e1106-e1110

Department of Otolaryngology-Head and Neck Surgery, University Health Network, Toronto, ON, Canada.

Impairment of ipsilesional vestibulo-ocular reflex (VOR) function is well described in vestibular schwannoma (VS) and a correlation between gain of the VOR and tumor size has been suggested. Bilateral VOR impairment may also occur in VS patients, but its mechanisms are poorly understood. We sought to explore the effect of unilateral VS on ipsilesional and contralesional high-acceleration VOR function using video head impulse testing, and evaluate potential factors responsible for contralesional VOR impairment. Read More

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September 2021

Paradigm shift in acute dizziness: is caloric testing obsolete?

J Neurol 2022 Feb 30;269(2):853-860. Epub 2021 Jun 30.

Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, 3010, Bern, Switzerland.

Objective: Cold and warm water ear irrigation, also known as bithermal caloric testing, has been considered for over 100 years the 'Gold Standard' for the detection of peripheral vestibular hypofunction. Its discovery was awarded a Nobel Prize. We aimed to investigate the diagnostic accuracy of Caloric Testing when compared to the video head impulse test (vHIT) in differentiating between vestibular neuritis and vestibular strokes in acute dizziness. Read More

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February 2022

Vestibular Function Measured Using the Video Head Impulse Test in Congenital Nystagmus and Vertigo: A Case Report.

Front Neurol 2021 8;12:690402. Epub 2021 Jun 8.

Unidad de Oído y Vértigo, Hospital Nuestra Señora del Rosario, Madrid, Spain.

In patients with congenital nystagmus (CN), the study of vestibular function is complicated by many factors related to the measurement of the vestibulo-ocular reflex (VOR) by means of caloric testing and the video head impulse test (vHIT), and to date no such studies have successfully employed the vHIT to evaluate vestibular function in these patients. We present a case with CN and vertigo in which peripheral vestibular function was evaluated using the vHIT system, including head impulse testing and the suppression head impulse protocol. We show that it is possible (a) to identify lateral VOR changes such as abnormalities resembling those produced by bilateral vestibular lesions, though not necessarily related to the same mechanism; (b) to identify peripheral VOR lesions of the vertical semicircular canals (SCC); and (c) to document compensation and recovery subsequent to these peripheral lesions during follow-up of patients with CN. Read More

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Head Impulse Test Paradigm and Suppression Head Impulse Test Paradigm in Individuals With and Without Motion Sickness.

Am J Audiol 2021 Sep 12;30(3):518-523. Epub 2021 Jun 12.

Department of Audiology, All India Institute of Speech and Hearing, Mysuru.

Purpose This study aimed to assess the vestibuloocular reflex (VOR) gain using both the Head Impulse Test Paradigm (HIMP) and Suppressive Head Impulse Test Paradigm (SHIMP) in individuals with motion sickness. Method Fifty eight participants (58 females) in the age range of 18-25 years were recruited for the study. The participants were divided into two groups, Group A had 29 participants with no motion sickness, and Group B consisted of 29 individuals who had motion sickness. Read More

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September 2021