Vestibular Perception and the Vestibulo-Ocular Reflex in Young and Older Adults

Chang, Nai Yuan N.; Hiss, Meghan M.; Sanders, Mark C.; Olomu, Osarenoma U.; MacNeilage, Paul R.; Uchanski, Rosalie M.; Hullar, Timothy E.

doi:10.1097/aud.0000000000000052

Cited by 27 publications

(32 citation statements)

References 33 publications

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“…Finally, Chang and colleagues compared VOR response characteristics between a group of young (20 to 26 years) and old (63 to 84 years) individuals. 88 In contrast to other reports, these authors found no significant group differences in VOR gain or VOR phase for rotational frequencies between 0.025 to 0.5 Hz (using a standard 60 degrees per second peak velocity stimulus). Additionally, Chang and colleagues investigated whether psychophysical differences in the detection and discrimination thresholds for earth-vertical axis rotations existed between young and old individuals.…”

Section: Rotational Vestibular Testingcontrasting

confidence: 72%

Aging of the Human Vestibular System

Zalewski

2015

Semin Hear

110

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Aging affects every sensory system in the body, including the vestibular system. Although its impact is often difficult to quantify, the deleterious impact of aging on the vestibular system is serious both medically and economically. The deterioration of the vestibular sensory end organs has been known since the 1970s; however, the measurable impact from these anatomical changes remains elusive. Tests of vestibular function either fall short in their ability to quantify such anatomical deterioration, or they are insensitive to the associated physiologic decline and/or central compensatory mechanisms that accompany the vestibular aging process. When compared with healthy younger individuals, a paucity of subtle differences in test results has been reported in the healthy older population, and those differences are often observed only in response to nontraditional and/or more robust stimuli. In addition, the reported differences are often clinically insignificant insomuch that the recorded physiologic responses from the elderly often fall within the wide normative response ranges identified for normal healthy adults. The damaging economic impact of such vestibular sensory decline manifests itself in an exponential increase in geriatric dizziness and a subsequent higher prevalence of injurious falls. An estimated $10 to $20 billion dollar annual cost has been reported to be associated with falls-related injuries and is the sixth leading cause of death in the elderly population, with a 20% mortality rate. With an estimated 115% increase in the geriatric population over 65 years of age by the year 2050, the number of balanced-disordered patients with a declining vestibular system is certain to reach near epidemic proportions. An understanding of the effects of age on the vestibular system is imperative if clinicians are to better manage elderly patients with balance disorders, dizziness, and vestibular disease.

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Section: Rotational Vestibular Testingcontrasting

confidence: 72%

Aging of the Human Vestibular System

Zalewski

2015

Semin Hear

110

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“…At the central level, findings concerning the changes to vestibular perception with age are consistent: there is no effect of age on self-motion perception ( 17 , 18 ), but there is an increase in the variability of the perception threshold ( 19 ). In that context, it is also interesting that there is a very large literature on canal-otolith interaction – demonstrating that modulating otolithic input modifies canal-induced nystagmus and also canal-induced subjective sensations ( 20 , 21 ).…”

Section: Introductionmentioning

confidence: 83%

“…Only the thresholds for surge and sway for sinusoidal rotation at 0.5 and 1 Hz were found to be significantly higher in subjects >50 years old. Chang et al ( 18 ) failed to detect any correlation between vestibular perception threshold, gain of VOR, and age using a rotational chair. A correlation has been found between horizontal perceptual threshold and oVEMP amplitude in the otolith system.…”

Section: Discussionmentioning

confidence: 98%

Absence of Rotation Perception during Warm Water Caloric Irrigation in Some Seniors with Postural Instability

et al. 2016

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Falls in seniors are a major public health problem. Falls lead to fear of falling, reduced mobility, and decreased quality of life. Vestibular dysfunction is one of the fall risk factors. The relationship between objective measures of vestibular responses and age has been studied. However, the effects of age on vestibular perception during caloric stimulation have not been studied. Twenty senior subjects were included in the study, and separated in two groups: 10 seniors reporting postural instability (PI) and exhibiting absence of vestibular perception when they tested with caloric stimulation and 10 sex- and age-matched seniors with no such problems (controls). We assessed vestibular perception on a binary rating scale during the warm irrigation of the caloric test. The function of the various vestibular receptors was assessed using video head impulse test (vHIT), caloric tests, and cervical and ocular vestibular-evoked myogenic potentials. The Equitest was used to evaluate balance. No horizontal canal dysfunction assessed using both caloric test and vHIT was detected in either group. No significant difference was detected between PI and control groups for the peak SPV of caloric-induced ocular nystagmus or for the HVOR gain. All the controls perceived rotation when the maximal SPV during warm irrigation was equal to or ≥15°/s. None of the subjects in the PI group perceived rotation even while the peak SPV exceeded 15°/s, providing objective evidence of normal peripheral horizontal canal function. All the PI group had abnormal Equitest results, particularly in the two last conditions. These investigations show for the first time that vestibular perception can be absent during a caloric test despite normal horizontal canal function. We call this as dissociation vestibular neglect. Patients with poor vestibular perception may not be aware of postural perturbations and so will not correct for them. Thus, falls in the elderly may result, among other factors, from a vestibular neglect due to an inappropriate central processing of normal vestibular peripheral inputs. That is, failure to perceive rotation during caloric testing when the SPV is >15°/s, should prompt the clinician to envisage preventive actions to avoid future falls such as rehabilitation.

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“…The effects of age on vestibular perceptual thresholds are unclear, since several studies found no age effects for yaw rotation (e.g., Chang et al 2014) but possible effects for translational movements (Kingma 2005;Roditi and Crane 2012). Although agerelated changes could contribute to the threshold elevation in the older AG1 relative to the younger AG2 for Y-axis translation (see below), it is notable that no similar pattern was evident for the other nine motions (3 axes ϫ 3 frequencies), with higher threshold values almost equally distributed between the two agenesis subjects.…”

Section: Discussionmentioning

confidence: 99%