Search

Objectives  The aim of this article was to evaluate the relationship between signal intensity of the labyrinth and vestibulocochlear function and morphologic features of vestibular schwannoma (VS). Design  Cross-sectional Study. Setting  Tertiary referral center. Participants  Fifty-four patients with sporadic, untreated VS. Main Outcome Measure  Signal intensity of the cochlea and vestibule (SIRc and SIRv: signal intensity of cochlea/vestibule compared with cerebellar signal intensity; AURc and AURv: SIRc/SIRv of the affected side compared with the unaffected side) in 1.5T T2-weighted images was correlated with size (Hannover classification), cystic status, distance from the fundus of the internal auditory canal, video head impulse test (vHIT), and audiometry. Results  Signal intensity of the vestibule was higher than that of the cochlea (p  < 0.01). Large tumors had lower SIRc than smaller tumors (p  = 0.03); Hannover T1 tumors had higher SIRc (p  < 0.01), SIRv (p  < 0.01), AURc (p  < 0.01) and AURv (p  < 0.01) than the rest; heterogenous and cystic tumors had higher SIRv than solid large tumors (p  = 0.02); superior vestibular nerve pattern on vHIT had higher SIRv and AURv than inferior vestibular nerve and mixed patterns (p  = 0.03 and 0.004, respectively); and there was a weak correlation between AURv and speech discrimination (r  = 0.33, p  = 0.04). Conclusion  A more abnormal signal intensity of the labyrinth is associated with larger size and solid status of VS. There was a positive relationship between signal intensity of the labyrinth and speech discrimination scores on audiogram. [ABSTRACT FROM AUTHOR]

Over 30 years ago, the head impulse test (HIT) was measured with search coil recordings and it provided robust evidence for a new test of vestibular function that could detect impairment of a single semicircular canal, that is, the lateral canal. Over the next two decades, the diagnostic spectrum of HIT was expanded to the testing of vertical canals, differentiation of central from peripheral vestibulopathy, and incorporation of visual interaction—the suppressed head impulse. However, HIT measurement was limited to very few specialized laboratories that were able to maintain the time-consuming and expensive operation of the scleral search coil system, which is the gold standard in eye movement recording. The video HIT (vHIT) was validated for the first time over 10 years ago, against the search coils, and its introduction into dizzy clinics worldwide has revolutionized the practice of neuro-otology. Here we review the basic physiology, practical aspects, and clinical application of the vHIT. [ABSTRACT FROM AUTHOR]

Background: The video head impulse test (vHIT) is a new tool being used in vestibular clinics to assess the function of all six semicircular canals (SCCs) by measuring the gain of the vestibulo-ocular reflex (VOR) in response to rapid head turns. Whereas vHIT has been validated in adults for all SCCs, there are few studies describing the normal response in children, particularly for stimulation of the vertical canals. Purpose: The purpose of this study was to characterize the normal vHIT response for all six SCCs in children aged 4-12 years. Research Design: A cross-sectional prospective descriptive study. Study Sample: Forty-one participants were categorized into one of four groups based on their age (4-6 years, 7-9 years, 10-12 years, and adults) with at least ten participants in each age group. Data Collection and Analysis: The ICS Impulse system (GN Otometrics, Schaumburg, IL) was used to perform vHIT on each participant. Lateral, anterior, and posterior SCCs were stimulated by thrusting the head in the plane of the canal being evaluated and resulting VOR gain measures were calculated as eye velocity divided by head velocity. VOR gain of the pediatric age groups was compared with adults for all SCCs. Results: There were no significant differences in mean VOR gain between the three pediatric age groups for any SCC measured; thus, the pediatric data were combined into one group of 30 children for comparison with the adult group. Results showed that the pediatric group had significantly higher mean VOR gain than the adult group during left lateral SCC testing. A significantly lower mean VOR gain, however, was observed for the children compared with the adult participants for left anterior and right posterior (LARP) impulses. There was a large amount of variability in the data during right anterior and left posterior (RALP) impulse testing for both the pediatric and the adult groups, which was at least partially attributed to large pupil diameter in the younger participants. Test time decreased with an increase in age for all impulse conditions (lateral, RALP, and LARP). Several modifications were necessary to obtain adequate data on the pediatric participants. Conclusions: vHIT can be used to successfully measure the function of the lateral SCC in children as young as 4 years of age. Our results provide normative gain values that can be used when testing children with lateral vHIT. Care must be taken to obtain the most accurate measures and reduce variability when testing children, particularly with LARP and RALP. Our data would suggest that lower gain cutoffs should be used for LARP and RALP testing in children than the cutoffs used for lateral vHIT. Further research is warranted to study LARP and RALP response reliability and validity in children because of the highly variable VOR gains found in this population. Pediatric modifications for successfully administering vHIT and obtaining reliable results are discussed. [ABSTRACT FROM AUTHOR]

Background: The observation or measurement of eye movement can aid in the detection and localization of vestibular pathology due to the relationship between the function of the vestibular sensory receptors in the inner ear and the eye movements produced by the vestibulo-ocular reflex (VOR). The majority of bedside and laboratory tests of vestibular function involve the observation or measurement of horizontal eye movements (i.e., horizontal VOR) produced by stimuli that activate the horizontal semicircular canals (SCCs) and the superior vestibular nerve. The video head impulse test (vHIT) is a new clinical test of dynamic SCO function that uses a high-speed digital video camera to record head and eye movement during and immediately after passive head rotations. The SYNAPSYS Inc. vHIT device measures the “canal deficit” (deviation in gaze) during passive head impulses in the horizontal and diagonal (vertical) planes. There is, however, a paucity of data that has been reported using this device. Purpose: The purpose of this study was to obtain normative data and assess the test-retest reliability of the SYNAPSYS vHIT (version 2.0). Research Design: A prospective repeated measures design was utilized. Study Sample: Thirty young adults with normal hearing, normal caloric test results, and a negative history of vestibular disorder, neurological disease, open or closed head injury, or cervical spine injury participated in the study. Data Collection and Analysis: A single examiner manually rotated each participant’s head in the horizontal and diagonal planes in two directions (left and right in the horizontal plane; downward and upward in each diagonal plane) resulting in the stimulation of each of the six SCCs. Each participant returned for repeat testing to assess test-retest reliability. The effects of ear, session, and semicircular canal (horizontal, anterior, posterior) on the magnitude of canal deficit during the vHIT were assessed using repeated measures analysis of variance. Results: The mean canal deficit of the horizontal canals (8.3%) was significantly lower than the mean canal deficit of the anterior canals (16.5%) and the posterior canals (15.2%); there was no significant difference between the mean canal deficits of the anterior and posterior canals. The main effects of session and ear on canal deficit were not significant, and there were no significant interaction effects. There was no significant difference between the mean canal deficit for session 1 and session 2 for the horizontal, anterior, and posterior canals. The 95th percentiles for canal deficit were 19, 26, and 22% for the horizontal, anterior, and posterior SCCs, respectively. Conclusions: Testing of all six SCCs was completed in most participants in ~10 min and was well-tolerated. The vHIT has some important advantages relative to more established laboratory tests of horizontal SCC function including the ability to assess the vertical SCCs, lower cost, shorter test time, greater portability, minimal space requirements, and increased patient comfort. Additional data, however, should be obtained from older participants with normal vestibular function and from patients with vestibular disorders. Within-subject comparisons between the results of the vHIT and the caloric and rotary chair tests will be important in determining the role of the vHIT in the vestibular test battery. [ABSTRACT FROM AUTHOR]