A Bürgin1, C J Bockisch2, A A Tarnutzer3. 1. Department of Neurology, University Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland. 2. Department of Neurology, University Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland; Department of Otorhinolaryngology, University Hospital Zurich, Zurich, Switzerland; Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland. 3. Department of Neurology, University Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland. Electronic address: alexander.tarnutzer@access.uzh.ch.
Abstract
OBJECTIVE: Gait imbalance in patients with bilateral-vestibular-deficiency (BVD) was linked to increased variability in perceived direction of gravity while upright. We hypothesized this to be true also when roll-tilted. Moreover, as utricular input is essential for spatial orientation, we predicted the variability of perceived vertical to correlate inversely with utricular function. METHODS: Subjective visual vertical (SVV) and haptic vertical (SHV) were measured in various roll-orientations (0°/±45°/±90°) and postural adjustments along earth-vertical/earth-horizontal were collected in patients with partial BVD (n = 10) and healthy controls (n = 11). Patients with bilaterally-absent bone-conducted ocular vestibular-evoked myogenic-potentials (oVEMPs) were compared to those with (partially) preserved oVEMPs. RESULTS: For the SVV (p < 0.001) and SHV (p = 0.004) variability was larger in patients than controls. Compared to those with (partially) preserved oVEMPs, patients with bilaterally-absent oVEMPs had higher SVV (p = 0.024) and SHV (p = 0.006) variability. Self-positioning along earth-horizontal was more variable in BVD-patients compared to controls (p < 0.001). Again, variability was higher in those with bilaterally-absent oVEMPs (p = 0.032). SVV/SHV-variability was correlated (R2 = 0.61, slope = 1.06 [95%-CI = 0.80-1.54]) in BVD-patients. CONCLUSION: With variability correlating amongst the different paradigms and with oVEMP-responses, this emphasizes the role of bilaterally intact utricular input for precise perception of gravity. SIGNIFICANCE: In BVD-patients with bilaterally-absent oVEMPs intensified vestibular rehabilitation should be considered.
OBJECTIVE: Gait imbalance in patients with bilateral-vestibular-deficiency (BVD) was linked to increased variability in perceived direction of gravity while upright. We hypothesized this to be true also when roll-tilted. Moreover, as utricular input is essential for spatial orientation, we predicted the variability of perceived vertical to correlate inversely with utricular function. METHODS: Subjective visual vertical (SVV) and haptic vertical (SHV) were measured in various roll-orientations (0°/±45°/±90°) and postural adjustments along earth-vertical/earth-horizontal were collected in patients with partial BVD (n = 10) and healthy controls (n = 11). Patients with bilaterally-absent bone-conducted ocular vestibular-evoked myogenic-potentials (oVEMPs) were compared to those with (partially) preserved oVEMPs. RESULTS: For the SVV (p < 0.001) and SHV (p = 0.004) variability was larger in patients than controls. Compared to those with (partially) preserved oVEMPs, patients with bilaterally-absent oVEMPs had higher SVV (p = 0.024) and SHV (p = 0.006) variability. Self-positioning along earth-horizontal was more variable in BVD-patients compared to controls (p < 0.001). Again, variability was higher in those with bilaterally-absent oVEMPs (p = 0.032). SVV/SHV-variability was correlated (R2 = 0.61, slope = 1.06 [95%-CI = 0.80-1.54]) in BVD-patients. CONCLUSION: With variability correlating amongst the different paradigms and with oVEMP-responses, this emphasizes the role of bilaterally intact utricular input for precise perception of gravity. SIGNIFICANCE: In BVD-patients with bilaterally-absent oVEMPs intensified vestibular rehabilitation should be considered.
Authors: Laura Riera-Tur; Encarnación Antúnez-Estudillo; Juan M Montesinos-González; Antonio J Martín-Mateos; Alfonso M Lechuga-Sancho Journal: Eur Arch Otorhinolaryngol Date: 2022-07-15 Impact factor: 3.236