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Vestibular unitary responses to visual stimulation in the rabbit.

Vestibular nucleus (VN) neurons, identified by sinusoidal rotation about the vertical axis, were tested for their response to moving visual field, and to electric stimulation on the optic chiasm (OX) and super colliculus (SC). Incremental responses during the rotation were inhibited by visual stimulus in cerebellectomized animals. Single-pulse stimulation applied to the OX was ineffective in producing a positive response in these neurons as well or in any other unit. Thus, such a visual pathway to VN must be located inside the brainstem and contains multi-synapses. Effects of repetitive stimulations (60 Hz) to OX and SC were more predominant in the cerebellectomized animal than in the intact animal. Cerebellar inhibitory control on visual-vestibular kinkage was suggested.

Animals↗

New diagnostic tests for the function of utricles, saccules and somatic graviceptors.

Clinical tests that allow us to discriminate between utricular, saccular and somatic effects on gravity perception and control are desirable but wanting. A new test battery is presented which combines four experimental paradigms based on the subjective horizontal body position (SHP), namely, a test on a tiltable board and on a sled centrifuge under varied leg position, with two paradigms based on the subjective visual vertical (SVV). It is shown by a combination of experiments and deductions, that, why, and how these tests can separate the effects of otoliths from those of somatic graviceptors, the effects of the utricles from those of the saccules, and the effects of the constituents of the somatic graviception from each other. The present study demonstrates the capabilities of the tests as well as their limitations.

Animals↗

Auditory and vestibular defects in the circling (ci2) rat mutant.

The circling rat is an autosomal recessive mutant (homozygous ci2/ci2) that displays lateralized circling behaviour, locomotor hyperactivity, ataxia and stereotypic head-movement. These abnormal behaviours occur in phases or bursts either spontaneously or in response to stress. Heterozygous (ci2/+) littermates display normal spontaneous behaviours. We have previously found that ci2/ci2 rats of both genders have a lower tissue content of dopamine in the striatum ipsilateral to the preferred direction of rotation, indicating that the rats turn away from the brain hemisphere with higher striatal dopaminergic activity. In view of the similarities of the motor syndrome of the ci2/ci2 mutant rat to that of mouse deafness mutants, the present study evaluated the hearing ability of the circling rat mutant by recording brainstem auditory-evoked potentials. To test for vestibular dysfunction, a swimming test was conducted. Histological methods were used to examine the cochlear and vestibular parts of the inner ear and the cochlear and vestibular brainstem nuclei for defects. The absence of auditory-evoked potentials demonstrated a complete hearing loss in the adult ci2/ci2 mutant rat, whereas heterozygous littermates exhibited auditory-evoked potentials with thresholds resembling those of other laboratory strains. Furthermore, the mutant rats were unable to swim. Histological analysis of the inner ear of adult mutants revealed virtually complete loss of the cochlear neuroepithelium, while no such hair cell degeneration was seen in the vestibular parts of the inner ear. However, part of the vestibular hair cells showed protrusions into the endolymphatic space, suggesting alterations in the cytoskeletal architecture. The histological findings in mutant circling rats strongly indicate that the hearing loss of the mutants is of the sensory neural type, the most prevalent type of hearing loss. In the cochlear nuclei of the brain stem of mutant rats, neurons exhibited an abnormal shape, reduced size and increased density compared to controls. In contrast, no abnormal neuronal morphology was seen in the vestibular nuclei, but a significantly reduced neuronal density was found in the medial vestibular nucleus. Abnormal vestibular function would be a likely explanation for the disturbed balance of mutant rats as exemplified by the ataxia and the inability to swim, whereas the previous data on these rats strongly indicate an involvement of the basal ganglia in the abnormal circling behaviour. The genetic defect in the mutant rats, thus, results in a clinical syndrome with features also seen in human genetic disorders with deafness and hyperkinesia, making the ci2/ci2 rat an excellent model for investigating both cochlear/vestibular dysfunction and hyperkinetic movement disorders.

Animals↗

Predictable and pseudo random saccades in patients with acoustic neuroma.

We studied predictive and pseudo random saccades in patients with cerebellopontine angle tumor. Target for the saccades was a laser beam which was reflected on the wall in front of the subject, and the stimulus was controlled by a computer. The fixed target was spaced at a distance of +/- 30 to each side of the subject. The random saccades jumped 20 degrees/40 degrees/60 degrees in an unpredictable manner. The saccade analysis program was based on pattern recognition. In the random saccade test none of the mean values of saccadic reaction time (SRT), saccadic accuracy (SA) and saccadic peak velocity (SPV) to the right or left differed significantly between the two groups. In the predictable saccade test there was statistically significant differences for certain variables: in right SRT (p < 0.01) and in left SRT (p < 0.01); in right SA (0.001 < p < 0.01) and in left SA (p < 0.001). The mean peak velocity (right SPV and left SPV) did not differ significantly between the two groups. When the stimulus is predictable, the saccades in a healthy subject are more timely spaced and accurate than in a patient. When the stimulus is unpredictable, "the memory of the past" has no importance and cannot help in saccade programming, and variability in the healthy subjects increases.

Adult↗

The active head-impulse test in unilateral peripheral vestibulopathy.

BACKGROUND: The head-impulse test, which is sensitive and specific for detecting severe unilateral peripheral vestibulopathy, is an accepted part of the neurological examination, especially in patients with vertigo and balance disorders. OBJECTIVE: To discover if the head-impulse test is just as useful diagnostically when patients are asked to rotate their own heads, the active head-impulse test, rather than when the clinician does so as in the standard passive head-impulse test. METHODS: Clinical observation of compensatory saccades and search coil measurement of compensatory eye rotations, during active and passive horizontal head-impulses in 6 patients with total unilateral vestibular deafferentation. RESULTS: Clinical observation showed the expected compensatory saccades with rotations toward the side with the lesion with passive head-impulses but not with active head-impulses. Search coil recordings revealed 2 reasons for this. With active head-impulses not only was vestibulo-ocular reflex gain higher, but compensatory saccade latency was shorter resulting in an occult saccade that occurred during, rather than after, head rotation. CONCLUSIONS: Passive head-impulses are necessary to detect a severe unilateral peripheral vestibulopathy; active head-impulses will produce a false-negative result.

Adult↗

Follow-up of square drawing test in vestibular neuronitis.

The square drawing test (SDT) devised by Sekitani (1975), which is a modification of Fukuda's vertical writing test, was performed to evaluate vestibular dysfunction in 15 patients with vestibular neuronitis followed up for a long period. In particular, two parameters (distance and total length) were analyzed in the present study. Distance was analyzed by dividing the 15 cases into 3 groups. The largest group showed a tendency to shorten at an early stage. Total length was examined by dividing the 15 cases into 3 groups. The largest group showed a tendency towards macrographism at an early stage. It was found that as the degree of caloric responses recovered, the range of distance and total length decreased. Considering the correlation between parameters of the SDT (distance and total length) and caloric responses we concluded that the SDT is a feasible method to evaluate and follow up patients with vestibular dysfunction.

Adolescent↗

[Clinical significance of cervico-ocular reactions].

Cervically induced eye movements consist of a nystagmus and a deviation of the mean eye position (shift). They show in relation to different neck torsion velocities maximum reactions at slow velocities. The clinical significance of these cervico-ocular reactions is discussed controversially. Therefore we investigated 40 healthy subjects without any neurootological findings, who, in addition, underwent a manual examination. The neck torsion test was performed automatically with quantifiable stimulus parameters and a complete head fixation by means of individual dental casts. It could be shown that at a constant chair velocity of 5 degrees/s every healthy subject exhibits cervical nystagmus and/or shift deviations. In comparison a group of 30 patients with an upper cervical spine syndrome also showed similar cervico-ocular reactions without significant difference. It can be concluded that a muscle hypertonus in the deep neck region does not lead to pathological, cervically induced eye movements and that the cervical nystagmus itself is not a pathognomonic sign for cervical, proprioceptive vertigo.

Adult↗

Vestibular plasticity following orbital spaceflight: recovery from postflight postural instability.

Results of previous studies suggested that the vestibular mediated postural instability observed in astronauts upon return to earth from orbital spaceflight may be exacerbated by an increased weighting of visual inputs for spatial orientation and control of movement. This study was performed to better understand the roles of visual and somatosensory contributions to recovery of normal sensori-motor postural control in returning astronauts. Preflight and postflight, 23 astronaut volunteers were presented randomly with three trials of six sensory organization test (SOT) conditions in the EquiTest system test battery. Sagittal plane center-of-gravity (COG) excursions computed from ground reaction forces were significantly higher on landing day than preflight for those test conditions presenting sway-referenced visual and/or somatosensory orientation cues. The ratio of summed peak-to-peak COG sway amplitudes on the two sway-referenced vision tests (SOTs 3 + 6) compared to the two eyes closed tests (SOTs 2 + 5) was increased on landing day, indicating an increased reliance on visual orientation cues for postural control. The ratio of peak-to-peak COG excursions on sway-referenced surfaces (SOTs 4, 5 & 6) to an earth fixed support surfaces (SOTs 1, 2 & 3) increased even more after landing suggesting primary reliance on somatosensory orientation cues for recovery of postflight postural stability. Readaptation to sway-referenced support surfaces took longer than readaptation to sway-referenced vision. The increased reliance on visual and somatosensory inputs disappeared in all astronauts 4-8 days following return to earth.

Astronauts↗

[Compensation deficits in posture and kinetics following unilateral vestibular neurectomy in cats. The role of sensorimotor activity].

The role of sensorimotor activity in compensating deficits following unilateral vestibular neurectomy was studied in four adult cats using behavioral tests. Disturbances in posture and equilibrium were quantified and their subsequent compensation was described in both sensorimotor restrained and unrestrained cats. Sensorimotor restriction (S.M.R.) lasted 7 days and was performed in different postoperative periods. In the unrestrained animal, postural asymmetry compensation followed a 3-phase time course leading to preoperative criteria after about 40 days. Recovery of equilibrium developed by steps and was achieved after about 50 postoperative days. A first week applied S.M.R. was most effective in stopping postural symmetry recovery, while a later S.M.R. had no effect on the recovery time course and did not produce decompensation. On the contrary, S.M.R. (1st week or 3rd week) prevented and delayed equilibrium recovery, the earlier S.M.R. producing maximal effects. These observations suggest a CNS "sensitive period" to vicariant inputs.

Animals↗

Cupulolithiasis and posterior ampullary nerve transection.

Schuknecht's description of a degenerated otoconial mass embedded in the cupula of the posterior canal crista of the downmost ear in the Hallpike test has been termed cupulolithiasis to reflect the pathophysiology in the syndrome described by Barany. The hypothesis that the otoconial mass renders the cupula of the posterior canal gravity-sensitive has received considerable experimental and clinical support. Clinical support is provided here by the observation that complete relief of the paroxysmal positional vertigo followed transection of the posterior ampullary nerve (singular nerve) in 31 ears of 29 patients complaining of chronic cupulolithiasis. Two patients in the series exhibited bilateral cupulolithiasis and were relieved by sequential bilateral singular neurectomies. Twenty-seven patients were relieved by unilateral singular neurectomy. Although there were three instances of sensorineural hearing loss following surgery in the first 15 patients, no hearing loss has been observed following surgery in the last 16 operations. This low incidence of sensorineural hearing loss has resulted from modifications in surgical technique.

Adult↗

[The significance of the interaural latency difference of VEMP].

OBJECTIVE: To investigate the significance of the interaural latency (IAL) difference of the latency of VEMP and to raise the sensitivity of the test. METHOD: Vestibular evoked myogenic potentials (VEMP) were tested in 20 healthy subjects; 13 patients with acoustic neuromaor cerebellopontile angle occupying lesions and 1 patient with multiple sclerosis. IAL differences of the wave p13,n23 and p13-n23 (abbreviatd as /delta p13/, /delta n23/ and /delta p13-n23/, respectively) were analysed to determine the normal range and the upper limit of the norm data. Four illustrative cases with the abnormality of the IAL difference were given as examples. RESULT: The upper limit of the IAL of /delta p13/ was 1.13 ms; that of the /delta n23/ was 1.38 ms and that of /delta p13-n23/ was 1.54 ms. The /p13-n23/ latency between the right and left side had no significant difference (P > 0.05). CONCLUSION: /delta p13/, /delta n23/ and /delta p13-n23/, especially /delta p13/ of VEMP can suggest abnormality in the neural pathway and it may be applicable in practice.

Adolescent↗

Validity of a new feedback method for the VEMP test.

CONCLUSIONS: We used a feedback method, based on a blood pressure manometer with inflatable cuff, to control the sternocleidomastoid muscle (SCM) contraction. To obtain comparable left-right VEMP responses, it is necessary (1) to determine which cuff pressures on both sides yield identical mean rectified voltage (MRV) values of the SCM contraction and (2) to apply these cuff pressures during the VEMP test. OBJECTIVE: To investigate the effect of the SCM muscle contraction variability on the VEMP variables when applying the feedback method. MATERIALS AND METHODS: Subjects pushed with their jaw against the hand-held inflated cuff to generate cuff pressures of subsequently 30, 40 and 50 mmHg during a MRV and VEMP measurement. RESULTS: When analyzing the relationship between the applied cuff pressures and the MRV values/VEMP amplitudes, we showed that (1) there was a linear relationship, (2) there was no side effect and (3) there was an interaction effect between 'side' and 'subject'. There was neither a side effect, nor an effect of the applied cuff pressure when considering the p13 latencies. As for the n23 values, there was no side effect but there was a significant difference when comparing the n23 latencies at cuff pressures of 30 vs 40 mmHg/50 mmHg.

Acoustic Stimulation↗

A new neurotological test for detecting cerebellar dysfunction.

The adaptation of the vestibulo-ocular reflex (VOR) was studied in 26 normal subjects and 26 patients with cerebellar lesions, using horizontal vision-reversal prisms. In normal subjects, the adaptation of gain after wearing prisms for one hour was approximately 50% of the VOR value in the dark. In contrast to this, patients with cerebellar lesions showed less adaptation--approximately 20% after a one-hour forced adaptation task. These were type A, higher gain in the initial level and abnormal adaptation (10 cases); type B, higher gain in the initial level and normal adaptation (5 cases); and type C, normal initial level and abnormal adaptation (11 cases). The cases showing the typical type-A responses tended to have severe widespread or midline lesions of the cerebellum. Typical type-B cases had mild cerebellar lesions, and typical type-C cases tended to have lesions restricted to one side of the cerebellum. From these results, it can be speculated that reduction of VOR adaptation occurs when one side of the cerebellum has severe lesions, but it is sufficient to produce a normal vestibulo-ocular reflex if at least half of the cerebellum is intact.

Adult↗

Flexibility of vestibulo-ocular reflex adaptation to modified visual input in human.

The vestibulo-ocular reflex (VOR) serves to keep images relatively stable on the retina. To maintain appropriate performance and minimize image slip throughout life, VOR is subjected to long-term adaptive regulation by visual input. It has been reported that adaptive changes in VOR gain (eye velocity/head velocity) are evoked either by fitting subjects with magnifying, miniaturizing, or reversing spectacles during normal behavior, or by moving a large visual field in or out of phase relative to the subject's head movement. The changes in VOR gain are frequency selective. Here, we examine the extent of VOR gain flexibility by causing VORs of similar direction to undergo different behavioral gain changes. Nine healthy adults participated in the study, ranging in age from 24 to 38 years (mean: 26 years) and with no history of neurotological symptoms. All subjects were clinically normal according to a screening battery that included combined neurologic and otologic physical examinations. Horizontal and vertical eye positions were recorded by bitemporal DC-coupled electro-oculography (EOG). The subject sat in a rotating chair. The axis of rotation of the body was always earth-vertical, with the interaural axis crossing the axis of rotation of the chair. The head was pointed 20 degrees downwards in all experiments and stabilized in this position using a chin rest. The chair was surrounded by a half-cylindrical optokinetic screen (78 cm in diameter) placed in front of the subject, onto which random dot patterns were projected. Goggles were used to ensure that the subject was in complete darkness during both pre- and postadaptation periods. The chair was rotated sinusoidally at maximum amplitude of 30 degrees or 60 degrees : for 30 degrees the stimulation was at 0.1, 0.2, 0.3, and 0.4 Hz; for 60 degrees it was at 0.1, 0.2, and 0.3 Hz. VOR adaptation was obtained by inducing a retinal slip velocity by short-term alteration of the visual input of the large field; this change was produced by a combination of sinusoidal head rotation and the random dot patterns. In each adaptation session, the sinusoidal head rotation was either at 0.1 or 0.3 Hz and the amplitude was 30 degrees. The random dot pattern was synchronized with sinusoidal head rotation in the same direction (x0 experiment) to make the retinal slip zero, and in the opposite direction to make the retinal slip twofold (x2 experiment). Therefore, a total of four adaptation protocols were tested. The subjects were asked to fixate on a single dot with the eyes straight-ahead in the x0 experiment, and follow it within random dot patterns in the x2 experiment. Each adaptation session lasted for 30 min. Two adaptation experiments were performed on each subject once per day. The averages of VOR gain and phase lag were calculated using Fourier analysis. Seven of the subjects who participated in the x2 adaptation experiment at 0.3 Hz and 30 degrees amplitude showed a steady increase of VOR gain within a couple of trials. One of the remaining two subjects showed a decrease in VOR gain in all the three trials, and the other subject showed a VOR gain increase in three trials and decrease in two trials. In the x2 adaptation experiment at 0.3 Hz and 30 degrees amplitude (peak velocity: 28 degrees /s), the percentage gain change ((post-pre)/pre) was 133% at the same stimulation and 100% at 0.4 Hz (peak velocity: 37 degrees /s). The gain change was 65% at 0.1 Hz and 60 degrees amplitude (peak velocity: 18 degrees /s), and 64% at 0.2 Hz and 60 degrees amplitude (peak velocity: 37 degrees /s). In the x1 adaptation experiment (30 degrees at 0.3 Hz), the percentage gain change was -62% under the same conditions, -50% at 0.1 Hz and 60 degrees amplitude, and -30% at 0.2 Hz and 60 degrees amplitude. No change of VOR gain was observed at other frequencies, and the subject was not adapted at 0.1 Hz and 30 degrees amplitude. The larger VOR gain increase in the x2 adaptation experiment for the faster head angular acceleration leads to the conclusion that the VOR gain mechanism can set vuite similar in terms of the head acceleration.

Adult↗

Permanent gentamicin vestibulotoxicity.

OBJECTIVE: To determine the natural history of permanent gentamicin vestibulotoxicity. STUDY DESIGN: Retrospective; comparison of retrospective and prospective studies. SETTING: Tertiary neurotology clinic. Clinical research and technology center. SUBJECTS: Thirty-three subjects with permanent gentamicin-induced vestibulotoxicity. INTERVENTIONS: Medical records review, neurotologic examination, and vestibular and auditory function tests. MAIN OUTCOME MEASURES: Vestibular and auditory function test results at least 1 year after discontinuation of gentamicin, clinical examination results, serum gentamicin levels, and serum creatinine levels. RESULTS: Thirty-three subjects had vestibular function test results consistent with permanent gentamicin ototoxicity. All complained of dysequilibrium, 32 described oscillopsia, and 23 had tinnitus. All 33 subjects had complained of symptoms consistent with ototoxicity within 1 to 3 weeks of initiation of gentamicin therapy; however, gentamicin vestibulotoxicity was not recognized before hospital discharge in 32 of 33 subjects. Serum peak and trough gentamicin levels did not correlate with the development of vestibulotoxicity, nor did observance of recommended "safe" dosage ranges. Of 17 subjects whose serum creatinine levels were recorded, 6 experienced abnormal elevations in serum creatinine in conjunction with gentamicin use. CONCLUSION: Gentamicin can cause permanent vestibular and auditory ototoxicity. There is no safe dose of gentamicin. Serum gentamicin levels are of no value in predicting the onset, occurrence, or severity of vestibulotoxicity or cochleotoxicity. Termination of gentamicin on appearance of signs or symptoms of ototoxicity may reduce the incidence of permanent vestibular ototoxicity. When possible, other antibiotics should be administered.

Adult↗

Cupulolithiasis.

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Aged↗