What is the potential clinical utility of vHIT when assessing adult patients with dizziness?

Stevens, Madelyn N.; Garrison, Douglas; Kaylie, David M.

doi:10.1002/lary.26774

Cited by 18 publications

(18 citation statements)

References 5 publications

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“…Because the value of caloric asymmetry is thought to be unaffected by central compensation, the asymmetry is likely to remain more stable. 6 It also allows for isolation of the side being tested (left vs right) and for localization of a peripheral lesion. 8 In terms of clinical utility, Batuecas-Caletrio et al 13 found that the degree of caloric weakness influences the time frame of recovery among patients undergoing VS surgery.…”

Section: Discussionmentioning

confidence: 99%

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Associations of Video Head Impulse Test and Caloric Testing among Patients with Vestibular Schwannoma

Brown

Peskoe

Risoli

et al. 2019

Otolaryngol.--head neck surg.

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Objective To determine relationships between caloric testing (CT) and video head impulse testing (vHIT) among patients with unilateral vestibular schwannoma (VS). To describe the distribution of CT and vHIT measurements and assess associations with tumor size and self-perceived handicapping effects. Study Design Retrospective review. Setting Tertiary referral hospital. Subjects and Methods Subjects were adults with presumed unilateral VS between 2014 and 2017. Interventions were CT and vHIT. Primary outcomes were vHIT value (abnormal <0.8) and CT value (abnormal >25%). Secondary outcomes were tumor size and Dizziness Handicap Inventory scores. Results Fifty-one individuals had complete data for CT and vHIT. The odds of abnormal gain increases by 2.18 for every 10% increase in unilateral weakness on CT (range, 1.44-3.34; P < .001). A significant negative correlation between CT and gain exists ( rs = −0.64, P < .001). Odds of observing saccades increased by 2.68 for every 10% increase in unilateral weakness (range, 1.48-4.85; P = .001). This association was larger in magnitude for overt than covert saccades (odds ratios, 2.48 and 1.59, respectively). Tumor size was significantly associated with an increase in caloric weakness (β = 0.135, P < .001). With every 10-mm increase of tumor size, odds of abnormal gain on vHIT increased 4.13 (range, 1.46-11.66; P = .007). Mean Dizziness Handicap Inventory score was 19.7 (σ = 22), without association to caloric weakness, gain, or tumor size. Conclusion CT and vHIT both effectively assess vestibular function for patients with VS and correlate to tumor size. These findings are important as vHIT has a lower overall cost, improved patient tolerance, and demonstrated reliability.

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Section: Discussionmentioning

confidence: 99%

“…These tests evaluate the vestibular system in different frequency ranges and may therefore provide complementary information. 6…”

mentioning

confidence: 99%

Associations of Video Head Impulse Test and Caloric Testing among Patients with Vestibular Schwannoma

Brown

Peskoe

Risoli

et al. 2019

Otolaryngol.--head neck surg.

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“…11 The video head impulse test appears to be a quick and objective tool for assessing individual canal function. 3–5,11,13 Such features can be of great clinical importance. However, care should be taken when interpreting the results.…”

Section: Discussionmentioning

confidence: 99%

Benefits of pre-labyrinthectomy intratympanic gentamicin: contralateral vestibular responses

et al. 2019

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ObjectiveTo determine the impact of pre-operative intratympanic gentamicin injection on the recovery of patients undergoing translabyrinthine resection of vestibular schwannomas.MethodsThis prospective, case–control pilot study included eight patients undergoing surgical labyrinthectomy, divided into two groups: four patients who received pre-operative intratympanic gentamicin and four patients who did not. The post-operative six-canal video head impulse test responses and length of in-patient stay were assessed.ResultsThe average length of stay was shorter for patients who received intratympanic gentamicin (6.75 days; range, 6–7 days) than for those who did not (9.5 days; range, 8–11 days) (p = 0.0073). Additionally, the gentamicin group had normal post-operative video head impulse test responses in the contralateral ear, while the non-gentamicin group did not.ConclusionPre-operative intratympanic gentamicin improves the recovery following vestibular schwannoma resection, eliminating, as per the video head impulse test, the impact of labyrinthectomy on the contralateral labyrinth.

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“…At the same time, using six-canal vHIT we showed the order that the canals respond to IT gentamicin injections. Utilizing the six-canal vHIT technique allowed us to assess all canals in an accurate way, as it has been proven as a quick and repeatable way of assessing all six semicircular canals [8,12,18,19].…”

Section: Discussionmentioning

confidence: 99%

Intratympanic Gentamicin Versus Labyrinthectomy: Inner Ear Sensitivity to Gentamicin and Impact on the Contralateral Labyrinth

Kontorinis

Tailor

Gaggini

et al. 2019

Clin Exp Otorhinolaryngol

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Objectives.To investigate the impact of labyrinthectomy and intratympanic (IT) gentamicin injections on the contralateral labyrinth, we also assessed the response of each individual semicircular canal to each IT gentamicin application.Methods.We performed a pilot observational study on tertiary, referral, academic settings. Thirteen patients with unilateral vestibular pathology were organized into two groups, group I (seven patients) receiving IT gentamicin and group II undergoing labyrinthectomy (six patients). All patients underwent six-canal video-head-impulse test in predetermined time intervals. Patients receiving gentamicin were additionally tested 3 to 5 days after every sequential injection, until all ipsilateral canals were ablated, to determine the order of response to gentamicin. We recorded the vestibular-ocular reflex gains and the presence of covert/overt saccades for each canal.Results.The posttreatment ipsilateral gains were abnormal. No patient from the gentamicin group developed abnormal contralateral responses, while patients undergoing labyrinthectomy had abnormal contralateral responses from at least one canal, even several months posttreatment. Finally, the lateral semicircular canal was the first one to be affected by IT gentamicin followed by the posterior canal: the superior canal was ablated last.Conclusion.In our study, labyrinthectomy had an impact on the responses recorded from the contralateral ear, while IT gentamicin ablated the ipsilateral labyrinthine function without affecting the contralateral responses, possibly because of a milder, more gradual impact. We also show for the first time the order that IT gentamicin application affects the semicircular canals, with the lateral being the first to be affected.

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What is the potential clinical utility of vHIT when assessing adult patients with dizziness?

Cited by 18 publications

References 5 publications

Associations of Video Head Impulse Test and Caloric Testing among Patients with Vestibular Schwannoma

Associations of Video Head Impulse Test and Caloric Testing among Patients with Vestibular Schwannoma

Benefits of pre-labyrinthectomy intratympanic gentamicin: contralateral vestibular responses

Intratympanic Gentamicin Versus Labyrinthectomy: Inner Ear Sensitivity to Gentamicin and Impact on the Contralateral Labyrinth

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