VOR gain of lateral semicircular canal using video head impulse test in acute unilateral vestibular hypofunction: A systematic review

Abstract

IntroductionAcute unilateral vestibular hypofunction is characterized by sudden onset of vertigo or dizziness, vomiting/nausea, gait instability, and nystagmus. This is commonly described as an acute vestibular syndrome and usually attributed to vestibular neuritis; however, up to 25% of acute vestibular syndrome is caused by a stroke of posterior circulations. The video head impulse test is a recent tool in the vestibular test battery that assesses the vestibule-ocular reflex by measuring the VOR gain and recording overt and covert saccades, these findings have been found to be helpful in the diagnosis of various vestibular disorders.MethodA literature search was conducted in databases, including PubMed Central, PubMed, and Web of Science. All the articles that define video head impulse test (vHIT), acute vestibular hypofunction, and vestibular neuritis were considered for the preliminary search. No limits were placed on the date of publication. The searches were limited to studies with full-text availability, published in English, and including human subjects. Search words such as “head impulse test,” “video head impulse test,” “vestibular ocular reflex,” “acute vestibular syndrome,” “acute vestibular hypofunction,” “vestibular neuritis,” and “vHIT in central vestibular disorders” were entered into different databases in different combinations using boolean operators such as AND, OR, and NOT.ResultsSearches across different databases, including Web of Science, PubMed Central, and PubMed, resulted in a total of 1,790 articles. Title screening was done for all the articles. Out of the 1,790 articles, we found that 245 articles were related to vestibular hypofunction i.e., 1,545 articles were removed at this stage. A further 56 duplicate articles were removed. This led to a final screening of 189 articles. The exclusion criteria included unavailability of full text, studies reported in languages other than English, case reports, reviews, and articles including participants having other comorbid conditions. This final screening led to 133 articles being excluded, which led to the full-text screening of 56 articles. After screening the full-text articles as per the eligibility criteria, 21 articles were found to be eligible for the systematic review. Among the remaining studies, six articles were excluded due to different specific reasons. A total of 15 articles were included in this systematic review. The mean VOR gain for the patients with vestibular neuritis was 0.48 ± 0.14 for the ipsilesional ear, whereas the mean VOR gain was > 0.80 in the contralesional ear for all the patients with acute vestibular neuritis. In patients with PICA lesions, the VOR gain for the ipsilesional ear was 0.90 (range 0.87–0.94) and for the contralesional ear was 0.88 (range 0.84–0.93). In patients with AICA lesions, the mean VOR gain was variable. Based on the above mean VOR gain findings, the authors propose the following adjective description scale of VOR of the lateral canal using vHIT: normal VOR gain above 0.80, mild VOR gain loss for 0.70–0.79, moderate loss for 0.69–0.4, severe loss for 0.39–0.2, and profound loss for < 0.2.

Comparative utility of vestibular function tests in patients with peripheral and central vestibular dysfunction

“…VOR gain was calculated with OTOsuite software (GN Otometrics, Taastrup, Denmark). Abnormal results were defined as a lateral canal VOR gain less than 0.7, based upon previously established clinical cutoffs ( Alfarghal et al, 2022 ).…”

Supervised multicomponent exercise as an adjuvant program for people with unilateral and/or bilateral chronic vestibular hypofunction: EXERVEST study protocol

“…This test collects computerized vestibulo-ocular reflex, measuring the speed of head movement and the ocular response. Two parameters will be measured: the gain (ratio between cephalic and ocular movement, which should be close to 1 and is pathological if it is less than 0.8) and the occurrence of saccades (late responses produced by the central neuronal system indicating pathology) [ 18 , 19 ].…”

“…Participants in the EX group will train for two non-consecutive days per week for eight weeks under the supervision of exercise specialists (sports physical educators). All sessions will start and finish with BP measurements, and participants’ physical effort will be monitored by HR monitors (Polar Electro, Kempele, Finland) and the rate of perceived exertion using the original Borg scale [ [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] ]. Each session ( Appendix A ) will include a standardized 15-min warm-up with joint mobility exercises and gait technique and a 5-min cooldown with basic stretching exercises and controlled breathing.…”

Understanding Benign Paroxysmal Positional Vertigo (BPPV) and Its Impact on Quality of Life: A Systematic Review

“…VRT is another treatment option that can be effective in improving balance and reducing dizziness in patients with BPPV and with affected quality of life [ 33 , 34 ]. VRT involves a series of exercises designed to promote central nervous system compensation for inner ear deficits and improve overall vestibular function [ 33 , 34 ].…”

“…VRT is another treatment option that can be effective in improving balance and reducing dizziness in patients with BPPV and with affected quality of life [ 33 , 34 ]. VRT involves a series of exercises designed to promote central nervous system compensation for inner ear deficits and improve overall vestibular function [ 33 , 34 ]. Studies have shown that VRT can lead to significant improvements in symptoms, which include unsteadiness and fear of falling, which can affect the quality of life for patients with BPPV [ 33 , 34 ].…”