The diagnosis of central vestibular disorders based on the complementary examination of the vestibulospinal reflex

Objectives:Stance and gait unsteadiness along with vertigo contribute to a central vestibular disorder.For objective analysis ultrasound-computer-craniocorpography(US-COMP-CCG)can be used.Aim of the study was to characterize the unsteadiness in central vestibular disorders and discuss the possible diagnostic usage of US-COMP-CCG.Methods and results:Hundred-and-ninety patients(70 male and 120 female,mean age±SD,58.94±15.27)suffering from central vestibular disorder and 230 healthy control patients(78 male and 152 female,mean age±SD,50.94±15.27)were enrolled.Stance and gait analysis was according to vestibulospinal tests of US-COMPCCG.IBM SPSS V24 software was used for statistical analysis.Mann-Whitney U test and Chi-square test were used,along with sensitivity and specificity categorization.The significance level was p<0.05.According to schematic and statistical analysis instability and postural sway were increased in the vertigo population and statistically significant difference was shown.Upon categorical analysis significant correlation was detected[standing test:longitudinal sway(p<0.00001),lateral sway(p<0.00001),forehead covering area parameters(p=0.0001);stepping test:longitudinal deviation(p=0.05),lateral sway(p=0.011)parameters].Conclusions:Clinicians should consider that postural instability is prominently present in this population and might be of a diagnostic importance.

The prevalence of isolated otolith dysfunction in a local tertiary hospital

Objective:Patients with dizziness may present with symptoms of tilting,swaying,rocking,floating or with disequilibrium.This may be suggestive of an isolated otolithic dysfunction yet,there is little emphasis on this emerging clinical entity.To characterize and describe the prevalence of isolated otolith dysfunction in a local tertiary hospital and correlate them with clinical diagnosis.Methodology:Retrospective medical chart review of patients who presented with dizziness to the specialist outpatient Otolaryngology clinic,who required vestibular laboratory investigation.Results:Of the 206 patients,more than half of them(52.4%)fulfilled the criteria for either probable or definite isolated otolith dysfunction.When there are clinical symptoms of otolith dysfunction reported,there is a 1.62 odds of a remarkable laboratory otolith finding.The most common clinical finding was“no clear diagnosis”(65.5%)followed by Vestibular Migraine(13.6%).Conclusion:The prevalence of isolated otolith dysfunction is quite high.Laboratory tests of otolith function should be performed more routinely.This can be done in a sequential way to optimize cost effectiveness in countries with no insurance reimbursement.Prospective cohort studies on isolated otolith dysfunction,will lay the groundwork for achieving diagnostic consensus and formulating rehabilitation plans to aid this group of patients。

Evaluation on Effectiveness of a New System as well as Analysis on Optimal Horizontal Eye Position for Vertical Video Head Impulse Test

Objective To compare the performances among three different systems for video head impulse test(vHIT),and to identify an optimal target angle for precisely evaluating the function of vertical semicircular canals in vHIT.Methods A two-center prospective study was done.Participants were sit 1.2 m away from the wall in a noise-proved room that dedicated for vHIT experiments.During the comparison experiments,similar settings were ensured in both hospitals,with the same distance to wall and angle of staring.For each equipment,the procedures followed the developers’recommendations.The same examiner performed the comparison between two systems in one location.For the eye-position projects,targets were placed on the wall sequentially at the pre-marked lines for different angles.For the comparison projects,9 and 13 participants were recruited,respectively.Any participant with otologic or vestibular disorders was excluded.A total of 26 healthy participants were recruited in the eye-position experiments,16 of which were further involved in inter-examiner tests.Results Our evaluations of three different systems showed that a new vHIT system,VertiGoggles®ZT-VNG-I(VG)performed as good as the long-tested Otometrics®ICS impulse(Oto)and EyeSeeCam®(ESC).During the comparison,we validated 25-degree,instead of right ahead at 0 degree,is a better place to set the targets when torsion was applied at vertical semicircular canal planes.Conclusion The new VG system is good for clinical practices.Furthermore,we proposed a new protocol to set the targets 25 degrees from right ahead after tilting head 45 degrees to evaluate vertical canals during vHIT.