Misperception of Visual Vertical in Peripheral Vestibular Disorders. A Systematic Review With Meta‐Analysis

Abstract

Objective The main aim was to assess the misperception of visual verticality (VV) in patients with peripheral vestibular disorders (PVD) in comparison with healthy controls. As secondary objectives, we checked if vestibular, visual, and somatosensory postural pathways can be affected in patients with PVD as well as the characteristics of PVD that could influence on the VV perception. Methods A systematic review with meta‐analysis was carried out. The bibliographic search was performed in January, 2020 in PubMed, Scopus, Web of Science (WOS), CINAHL, SciELO. Two reviewers selected the studies that met the inclusion criteria, extracted data, and assessed the methodological quality using the Newcastle‐Ottawa Scale (NOS). The VV perception was assessed in two meta‐analysis according the used test: The Subjective Visual Vertical test (SVV) or the Rod and Frame Test (RFT) in comparison with healthy subjects. The Standardized Mean Difference (SMD) and its 95% Confidence Interval (95% CI) was used to estimate the pooled effect. Publication bias was assessed using the Egger's test and Trim and Fill Method. Results Thirty‐four studies were included reporting 3,524 participants. PVD patients showed a misperception of the VV with SVV (SMD = 1.510; 95%CI: 1.190–1.830) and the RFT (SMD = 0.816; 95% CI: 0.234–1.398) respect healthy controls. A subgroup of patients in the acute phase (SMD = 2.5; 95%CI: 2.022–2.978) and who underwent a vestibular surgery (SMD = 2.241; 95%CI: 1.471–3.011) had the greater misperception of VV. Conclusion Patients with PVD show an alteration in the perception of VV, being greater in the acute phase and after a vestibular surgery. Laryngoscope, 131:1110–1121, 2021

Virtual reality-based therapy improves balance and reduces fear of falling in patients with multiple sclerosis. a systematic review and meta-analysis of randomized controlled trials

“…Patients with MS (PwMS) present motor and sensory disturbances (vestibular and visual), producing balance disorders, that are one of the most disabling consequences, affecting approximately 75% of the cases [ 4 ]. It has been reported that balance requires vestibular, visual and somatosensory inputs (both proprioceptive and exteroceptive information) [ 5 ]. Therefore, vestibular deficits (vertigo or dizziness, for example) [ 6 ], visual impairments (such as, diplopia) [ 7 ], and proprioceptive disorders due to fatigue and muscle weakness [ 8 ] may impair balance in PwMS [ 9 ].…”

Vestibuläre Migräne

“…Auch diese Untersuchung eignet sich nicht als Marker für die VM. In einer Metaanalyse wurde gezeigt, dass Abweichungen der SVV v. a. bei Migräneerkrankungen, aber auch beim Spannungskopfschmerz bestehen 58 . VM-Patienten zeigten im Vergleich zu gesunden Kontrollen unter statischen Bedingungen eine höhere Fehlerraten, aber nicht bei Kopfneigung nach rechts und links 59 .…”

Perspectives: Evaluation of Older Adult Cochlear Implant Candidates for Fall Risk in a Developing Country Setting

“…Of interest for older CI candidates, some researchers suggest that the SVV can be helpful in the chronic phase of Ménière's disease ( 64 ) although, as with all the screening tests in this section, there have been questions regarding SVV's sensitivity and specificity ( 73 ). A recent meta-analysis has gone some way to refine the role of SVV in patients with peripheral vestibular disorder, and pooled results recommend SVV for the evaluation of vestibular function in patients undergoing vestibular surgery, such as vestibular schwannoma removal ( 74 ). Moreover, as discussed, VEMPs are not practical in an older and hearing-impaired population, so at least the clinical SVV gives some information regarding the otolith-ocular reflex.…”