Bilateral Vestibular Hypofunction: Challenges in Establishing the Diagnosis in Adults

Berg, Raymond van de; Tilburg, Mark van; Kingma, Herman

doi:10.1159/000433549

Cited by 85 publications

(121 citation statements)

References 138 publications

Supporting

Mentioning

109

Contrasting

Unclassified

Order By: Relevance

“…Outside specialized balance centers, the diagnosis of BVL is often delayed or missed (153), because the characteristic symptoms of postural imbalance and oscillopsia (154–156)—often without vertigo—are not recognized. Once the suspicion has been raised, the clinical diagnosis is often straightforward based on three simple clinical bedside tests: the HIT, dynamic visual acuity, and the Romberg test on rubber foam (157).…”

Section: New Clinical Disease Patterns Emerging From 3d Video Head Immentioning

confidence: 99%

The Video Head Impulse Test

et al. 2017

View full text Add to dashboard Cite

In 1988, we introduced impulsive testing of semicircular canal (SCC) function measured with scleral search coils and showed that it could accurately and reliably detect impaired function even of a single lateral canal. Later we showed that it was also possible to test individual vertical canal function in peripheral and also in central vestibular disorders and proposed a physiological mechanism for why this might be so. For the next 20 years, between 1988 and 2008, impulsive testing of individual SCC function could only be accurately done by a few aficionados with the time and money to support scleral search-coil systems—an expensive, complicated and cumbersome, semi-invasive technique that never made the transition from the research lab to the dizzy clinic. Then, in 2009 and 2013, we introduced a video method of testing function of each of the six canals individually. Since 2009, the method has been taken up by most dizzy clinics around the world, with now close to 100 refereed articles in PubMed. In many dizzy clinics around the world, video Head Impulse Testing has supplanted caloric testing as the initial and in some cases the final test of choice in patients with suspected vestibular disorders. Here, we consider seven current, interesting, and controversial aspects of video Head Impulse Testing: (1) introduction to the test; (2) the progress from the head impulse protocol (HIMPs) to the new variant—suppression head impulse protocol (SHIMPs); (3) the physiological basis for head impulse testing; (4) practical aspects and potential pitfalls of video head impulse testing; (5) problems of vestibulo-ocular reflex gain calculations; (6) head impulse testing in central vestibular disorders; and (7) to stay right up-to-date—new clinical disease patterns emerging from video head impulse testing. With thanks and appreciation we dedicate this article to our friend, colleague, and mentor, Dr Bernard Cohen of Mount Sinai Medical School, New York, who since his first article 55 years ago on compensatory eye movements induced by vertical SCC stimulation has become one of the giants of the vestibular world.

show abstract

Section: New Clinical Disease Patterns Emerging From 3d Video Head Immentioning

confidence: 99%

The Video Head Impulse Test

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Unfortunately, the picture is completely different for other conditions. The handicap suffered by patients with a complete loss of the vestibular function is significantly underestimated and the pathway to diagnosis is full of hurdles [46,64]. However, recent studies have unambiguously revealed that the complete loss of the vestibular function has a dramatic impact on the quality of life of affected patients [22].…”

Section: Introductionmentioning

confidence: 99%

The vestibular implant: A probe in orbit around the human balance system

Fornos

Cavuscens

Ranieri

et al. 2017

VES

Self Cite

View full text Add to dashboard Cite

The primary goal of the vestibular implant is to restore the vestibular function in patients with a disabling bilateral vestibular loss for whom there is currently no available treatment. The prototype developed by our team is a hybrid system consisting of a modified cochlear implant incorporating additional vestibular electrodes. Therefore, in addition of delivering sound information it is also capable of delivering motion information to the central nervous system using electrical stimulation. To date, thirteen patients have been implanted with such vestibular implant prototypes. For ethical reasons, only deaf ears were implanted and all patients experienced a clinical benefit from the hearing rehabilitation. The recent demonstration of partial restoration of the vestibulo-ocular and the vestibulo-collic reflexes in implanted patients suggests that gaze stabilization and postural control, fundamental functions of the balance system, can be artificially restored using a vestibular implant. This allows us to glimpse a useful clinical application in a near future. In parallel, we show how the vestibular implant provides a unique opportunity to explore the integration of the vestibular sensory input into the multisensory, multimodal balance system in humans, since it is able to selectively stimulate the vestibular system.

show abstract

“…It can lead to blurred vision (oscillopsia) and impaired balance and spatial orientation (2, 3). A significant decrease in quality of life and considerable high physical and socio-economic impacts have been reported (4, 5).…”

Section: Introductionmentioning

confidence: 99%

The Vestibular Implant: Hearing Preservation during Intralabyrinthine Electrode Insertion—A Case Report

et al. 2017

Self Cite

View full text Add to dashboard Cite

ObjectiveThe vestibular implant seems feasible as a clinically useful device in the near future. However, hearing preservation during intralabyrinthine implantation remains a challenge. It should be preserved to be able to treat patients with bilateral vestibulopathy and (partially) intact hearing. This case study investigated the feasibility of hearing preservation during the acute phase after electrode insertion in the semicircular canals.MethodsA 40-year-old woman with normal hearing underwent a translabyrinthine approach for a vestibular schwannoma Koos Grade IV. Hearing was monitored using auditory brainstem response audiometry (ABR). ABR signals were recorded synchronously to video recordings of the surgery. Following the principles of soft surgery, a conventional dummy electrode was inserted in the lateral semicircular canal for several minutes and subsequently removed. The same procedure was then applied for the posterior canal. Finally, the labyrinthectomy was completed, and the schwannoma was removed.ResultsSurgery was performed without complications. No leakage of endolymph and no significant reduction of ABR response were observed during insertion and after removal of the electrodes from the semicircular canals, indicting no damage to the peripheral auditory function. The ABR response significantly changed when the semicircular canals were completely opened during the labyrinthectomy. This was indicated by a change in the morphology and latency of peak V of the ABR signal.ConclusionElectrode insertion in the semicircular canals is possible without acutely damaging the peripheral auditory function measured with ABR, as shown in this proof-of-principle clinical investigation.

show abstract

Bilateral Vestibular Hypofunction: Challenges in Establishing the Diagnosis in Adults

Cited by 85 publications

References 138 publications

The Video Head Impulse Test

The Video Head Impulse Test

The vestibular implant: A probe in orbit around the human balance system

The Vestibular Implant: Hearing Preservation during Intralabyrinthine Electrode Insertion—A Case Report

Contact Info

Product

Resources

About