OBJECTIVE: Compare the vestibulo-ocular reflex (VOR) gain, compensatory saccades and head and eye coordination during head impulses between patients with dizziness but normal VOR gain and healthy controls.
METHODS: Video head impulses test (vHIT; ICS impulse, Otometrics, Denmark) was reviewed in 40 participants (20 patients with dizziness; 20 controls). VOR gain, saccades characteristics (frequency of occurrence, amplitude, latency) and time difference between head and eye velocity was compared.
RESULTS: No significant difference between groups was observed for VOR gain. However, saccade frequency was greater and time difference between head and eye was prolonged in patients with dizziness. No significant difference was observed for saccade amplitude, nor for saccade latency between groups.
CONCLUSIONS: The present study highlights that saccades observed in patients with normal VOR gain could reflect a clinical marker for dizziness in patients with normal VOR gain. We propose that theses saccades are caused by a prolonged time delay between head and eye velocity leading to a gaze position error.
CONCLUSIONS: The results support previous findings suggesting additional value of saccades and time delay when interpreting vHIT results. This study goes further by proposing time delay as a possible mechanism to explain increased saccade frequency in dizzy patients with normal VOR gain.

UNASSIGNED: Unlike air-conducted sounds (ACS) and bone-conducted vibration (BCV), galvanic vestibular stimulation (GVS) evokes vestibular evoked myogenic potentials (VEMPs) from the vestibular nerve.
UNASSIGNED: Case-control study was conducted in unilateral VS patients pre-operatively. Healthy ears were controls. Patients examined ACS, BCV and GVS ocular VEMP (oVEMP) and cervical VEMP (cVEMP), caloric test, video head impulse test (vHIT), suppression head impulse paradigm (SHIMP) and pure tone audiometry (PTA).
UNASSIGNED: Seven (26.9%) tumors affected left ear and 19 (73.1%) on the right(p < .05). Response rates in VS group were statistically lower than control except for ACS-cVEMP (p < .05). Response rates of VEMPs in VS patients decreased with the tumor size grows. But not all BCV and GVS VEMPs disappeared in the largest tumor group. Abnormal rates of caloric test, vHIT gains and SHIMP were found.
UNASSIGNED: Response rates of GVS VEMPs decreased with the residual functional nerve fibers. GVS VEMPs help to differentiating labyrinthine and retro-labyrinthine lesions. GVS combined with BCV VEMPs probably reflex the tumor origin from the eighth cranial nerve and/or the remaining vestibular function.

Vestibular migraine (VM) and Menière\'s disease (MD) are characterized by episodes of vertigo of similar duration. It is well known that differentiation between both diseases is not always possible based only on the patient history, physical examination, and audiological testing. In addition, the quantification of the vestibular function can also be helpful since, among patients with MD, there is often a dissociation between a normal/pseudo-normal video head impulse test (vHIT) and reduced caloric testing. The goal of this confirmatory study was to determine the sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of this dissociation to differentiate between MD and VM as well as between MD and other vestibular diseases. We performed a retrospective analysis of 2,101 patients. The examination group consisted of 1,100 patients; of these, 627 (57%) had MD according to the diagnostic criteria of the Bárány Society and 473 (43%) had VM. The comparison group consisted of 1,001 patients with other peripheral, central, or functional vestibular disorders. Statistical analysis revealed the following findings for the dissociation: MD vs. VM: specificity: 83.5%, sensitivity: 58.9%, PPV: 82.6%, and NPV: 60.5%, and MD vs. all other vestibular disorders (VM plus others): specificity: 83.5%, sensitivity: 58.9%, PPV: 60.3%, and NPV: 82.7%. The dissociation between a normal vHIT and a reduced caloric response is due to the high specificity and PPV suited for the differentiation between MD and VM. This part of the study confirms previous findings in a large cohort of patients. When it comes to differentiating between MD and all observed vestibular disorders, if there is no dissociation, the diagnosis of MD is unlikely.

OBJECTIVE: Acoustic neuroma (AN) is a benign tumor that usually affects a patient\'s hearing and balance function. For the screening and diagnosis of AN, the traditional approach mainly relies on audiological examination and magnetic resonance imaging (MRI), often ignoring the importance of vestibular function assessment in the affected area. As an emerging method of vestibular function detection, video head impulse test (vHIT) has been widely used in clinic, but research on its use in AN diagnosis is relatively limited. This study aims to explore the value of vHIT in the diagnosis of AN, vestibular dysfunction assessment, and postoperative compensation establishment in unilateral AN patients undergoing unilateral AN resection through labyrinthine approach.
METHODS: This retrospective study was conducted on 27 AN patients who underwent unilateral AN resection via labyrinthine approach from October 2020 to March 2022 in the Department of Otolaryngology-Head and Neck Surgery, the Second Xiangya Hospital, Central South University. vHIT was performed 1 week before surgery to assess vestibular function, pure tone audiometry (PTA) was used to assess hearing level, and ear MRI was used to assess tumor size. Follow-up vHIT was conducted at 1 week, 1 month, 6 months, and 1 year post-surgery. The correlation of vHIT with hearing and tumor size was analyzed.
RESULTS: Preoperative vHIT showed that the posterior semicircular canal on the affected side was the most common semicircular canal with reduced vestibulo-ocular reflex (VOR) gain. There was a correlation between the VOR gain of vHIT on the affected side and the hearing level (r=-0.47, P<0.05) or tumor size (r=-0.54, P<0.01). The results of vHIT on the affected side showed that the hearing level and mean VOR gain of the anterior semicircular canal increased slightly with time, and the amplitude and saccade percentage of the dominant saccades of the 3 semicircular canals increased, while the latency time decreased, with the most obvious changes occurring 1 week post-surgery.
CONCLUSIONS: vHIT can effectively monitor the changes of vestibular function in AN patients before and after surgery and has application value in assisting the diagnosis of vestibular dysfunction in AN patients.
目的: 听神经瘤(acoustic neuroma，AN)是一种良性肿瘤，通常会影响患者的听觉和前庭功能。对于AN的筛查和诊断，传统方法主要依赖于听力学检查和磁共振成像(magnetic resonance imaging，MRI)，而忽略了对病变部位进行前庭功能评估的重要性。视频头脉冲试验(video head impulse test，vHIT)是一种新兴的前庭功能检测方法，已广泛应用于临床，但其应用于AN诊断的研究相对较少。本研究通过在术前及术后对经迷路入路AN切除术的单侧AN患者采用vHIT进行动态检测，以探究vHIT在AN诊断、前庭功能障碍评估、术后代偿建立中的价值。方法: 回顾性纳入2020年10月至2022年3月中南大学湘雅二医院耳鼻咽喉头颈外科的27例经迷路入路AN切除术单侧患者。术前1周进行vHIT以评估前庭功能，纯音测听(pure tone audiometry，PTA)评估听力水平，耳部MRI评估肿瘤大小；分别于术后1周、1个月、6个月、1年复查vHIT，并分析vHIT与听力、肿瘤大小之间的相关性。结果: 术前vHIT显示患侧后半规管是前庭眼反射(vestibulo-ocular reflex，VOR)增益降低最常见的半规管。术前患侧vHIT的VOR增益与听力水平(r=-0.47，P<0.05)或肿瘤大小(r=-0.54，P<0.01)存在显著相关性。术后患侧vHIT结果显示水平半规管和前半规管的平均VOR增益随时间略有上升；3个半规管显性扫视的振幅和扫视波百分比均增加，而潜伏期时间缩短，并且在术后1周变化最明显。结论: vHIT能有效监测AN患者手术前后的前庭功能变化，对辅助诊断和治疗AN患者前庭功能障碍具有临床应用价值。.

Different studies have tried to establish a relationship between dyslexia and the vestibular system function. Subjective Visual Vertical/Horizontal (SVV and SVH) and Video Head Impulse Test (VHIT) are useful for studying the vestibular system and can be easily performed in children. Our aim was to evaluate the vestibular function in dyslexic children by SVV/SVH and VHIT. We enrolled 18 dyslexic children (10M/8F; mean age 10.7 ± 2.3 years; range 7-14 years) and 18 age-matched children with typical development of learning abilities. All children performed VHIT, SVV and SVH. We found normal gain and symmetry of vestibulo-ocular-reflex both in dyslexic and typically developing children. Fifteen out of 18 dyslexic children (83.3%) showed a difference of at least one amongst SVV or SVH. The mean value of SVV was 2.3° and the mean value of SVH was 2.6°. Statistical analysis showed a significant difference between typically developing and dyslexic children for both SVV and SVH. We confirm a relationship between dyslexia and the alteration of SVV and SVH. Our results could be related to the pathogenetic hypothesis of a visual processing impairment related to a dysfunction of the magnocellular pathway or to a general deficit related to a multimodal cortical network.

OBJECTIVE: The objective of this study is to investigate the potential influence of refractive error on Video Head Impulse Test outcomes.
METHODS: Eighty-two patients were included in the study, and all patients underwent video head impulse testing. Patients were divided into four groups according to their refractive error: myopia, myopia-astigmatism, astigmatism, and emmetropia as control.
RESULTS: Patients with myopia are younger than patients with astigmatism and controls; similarly, patients with myopia-astigmatism are younger than patients with astigmatism. The right and left lateral, anterior, and posterior gain values were statistically significantly lower in the control group compared with myopia and myopia-astigmatism patients (p < 0.05). There was a statistically significant relationship between the right and left lateral, anterior, and posterior gain values and the degree of myopia in the patients (p < 0.05).
CONCLUSIONS: The results of the Video Head Impulse Test gain in myopia patients are higher than that in patients without refractive error. In addition, age may have an effect on gain values. It is important to consider this factor when evaluating the results of the Video Head Impulse Test in patients, and corrections should be made if necessary.
METHODS: Level 3 Laryngoscope, 2024.

Otitis media with effusion (OME) is a common presentation to the Otorhinolaryngology clinic. Besides hearing impairment, recent evidence shows that approximately 30% of these children have some degree of vestibular and balance impairment. To assess the presence of vestibular dysfunction among children with OME. Children between 4 and 17, with and without OME, underwent vestibular assessment using video head impulse test (VHIT), subjective visual subjective (SVV), and single leg raising test (SLS). Data were recorded and analysed. 24 OME children were included with male predominance. No statistical significance was found between the VOR gain (p > 0.05), SVV (p = 0.056) and SLS (p = 0.06). Simple linear regression analysis showed that age and gender are potential factors for VOR gain. Our study found that children with OME have normal vestibular function.

OBJECTIVE: Resection of the vestibular schwannoma causes acute peripheral vestibular loss. The process of central compensation starts immediately afterward. The rehabilitation goal is to support this process and restore the quality of life.
METHODS: In this prospective single-center study, 67 consecutive patients underwent vestibular schwannoma resection (40 females, mean age 52 ± 12 years). The patients were divided into three groups: the prehabilitation with intratympanic gentamicin group, the virtual reality group (optokinetic stimulation via virtual reality goggles in the first ten days after the surgery), and the control group. All patients were examined with objective methods and completed questionnaires before the prehabilitation, before the surgery, at the hospital discharge, and after three months.
RESULTS: Intratympanic gentamicin prehabilitation leads ipsilaterally to a significant aVOR reduction in all semicircular canals (p < 0.050), the increase of the unilateral weakness in air calorics (p = 0.026), and loss of cVEMPs responses (p = 0.017). Prehabilitation and postoperative exposure to virtual reality scenes improved the patient\'s perception of vertigo problems according to Dizziness Handicap Inventory (p = 0.039 and p = 0.076, respectively). These findings conform with the optokinetic testing results, which showed higher slow phase velocities at higher speeds (40 deg/s) in both targeted groups compared to the control group.
CONCLUSIONS: Preoperative intratympanic gentamicin positively affects peripheral vestibular function, influencing balance perception after VS resection. In long-term follow-up, prehabilitation and postoperative exposure to virtual reality improve patients\' quality of life in the field of vertigo problems.

BACKGROUND: Acute and complete unilateral vestibular deafferentation induces a significant change in ipsilateral vestibuloocular reflex gain, making the patient unable to stabilize gaze during active or passive head movements. This inability creates the illusion that the visual environment is moving, resulting in persistent visual discomfort during rapid angular or linear acceleration of the head. This is known as oscillopsia. Our objective was to understand if the spontaneous sensation of oscillopsias after complete unilateral vestibular deafferentation by vestibular neurotomy at 5 days (D5) and at 3 months (M3) is correlated with the loss of vestibuloocular reflex gain and dynamic visual acuity.
METHODS: Retrospective cohort study was conducted in an otolaryngology tertiary care center (2019-2022) on patients with complete unilateral vestibular loss by vestibular neurotomy. They were divided into 2 groups according to the presence (group G1) or absence (group G2) of a spontaneous complaint of oscillopsia assessed at M3. Severity of oscillopsias evaluated by Oscillopsia Severity Questionnaire. Vestibuloocular reflex gain based on video head impulse test (vHIT) and the dynamic visual acuity were measured for each group at D5 and M3. Categorical variables were compared using χ2 test and quantitative variables using the nonparametric Wilcoxon-Mann-Whitney test.
RESULTS: All patients have a complete vestibular deafferentation at D5 and M3. At D5 (G1 = 8 patients, G2 = 5 patients), there is no significant difference for ipsilateral and contralateral vestibuloocular reflex gains and dynamic visual acuity losses. The Oscillopsia Severity Questionnaire was 2.68 ± 1.03 in G1 and 1.23 ± 1.03 in G2 (P < .05). At M3 (G1 = 9 patients, G2 = 6 patients), there is no significant difference between groups for epidemiologic and clinical data and for vestibuloocular reflex and dynamic visual acuity losses. The Oscillopsia Severity Questionnaire was 2.10 ± 0.63 in G1 and 1.24 ± 0.28 in G2 (P < .05).
CONCLUSIONS: The spontaneous disabling sensation of oscillopsia after complete unilateral vestibular loss is well assessed by the Oscillopsia Severity Questionnaire but cannot be explained by objective vestibular tests assessing vestibuloocular reflex gain (vHIT) or dynamic visual acuity loss at D5 or M3. Further studies are needed to measure the sensation of oscillopsia under real-life conditions and to identify the factors responsible for its persistence.
UNASSIGNED: Retrospectively registered.

OBJECTIVE: To explore the efficacy of diagnostic tests in accurately reclassifying patients initially diagnosed with probable Meniere\'s disease (MD) into either definite or non-MD categories.
METHODS: A retrospective cohort study was conducted at a neurotology clinic between 1/2016 and 5/2022. Patients underwent a battery of tests, from which sensitivity, specificity, positive and negative predictive values, as well as positive and negative likelihood ratios, were calculated. Additionally, prediction nomograms were developed.
RESULTS: Of the 69 patients, 25 (36.2 %) were initially classified as definite MD, 21 (30.4 %), probable MD, and 23 (33.4 %) non-MD. The mean follow-up was 3.5 years. The sensitivity of electrocochleography (ECochG) was the highest (92 %), with a negative likelihood ratio of 15 %. Magnetic resonance imaging (MRI) with MD-protocol had the highest specificity (100 %), with a positive likelihood ratio of 100 %. Videonystagmography, video head impulse test, and cervical vestibular-evoked myogenic potentials, had lower sensitivity and specificity. We were able to reclassify 18 (86 %) patients with probable MD: 12 (57 %) were diagnosed with definite MD, and 6 (29 %) were diagnosed with non-MD, consistent with their clinical course.
CONCLUSIONS: The combination of ECochG and MRI with MD-protocol provides the most reliable approach to reclassify patients with Probable MD, ensuring a precise and accurate diagnosis. Vestibular tests express the functional status of the labyrinth and may not be reliable. Our findings provide valuable insights into clinical decision-making for patients with Probable MD and raise the consideration of additional diagnostic tests as supplementary to the existing clinical-only diagnosis criteria.