Prevalence of Peripheral Vestibular Impairment in Adults with Human Immunodeficiency Virus

Background and Objectives: Globally, the human immunodeficiency virus (HIV) is responsible for one of the most serious pandemics to date. The vulnerability of the vestibular system in individuals with HIV has been confirmed, and central vestibular impairments have been frequently reported. However, there are disagreements on the impact of HIV on peripheral vestibular function. Thus, the current study aimed to determine the prevalence of peripheral vestibular impairment, specifically related to the semi-circular canals (SCCs), in HIV-positive individuals receiving antiretroviral (ARV) treatment.Subjects and Methods: A total of 92 adults between the ages of 18 and 50 years (divided into two groups) participated in the study. The first group comprised HIV-positive individuals receiving ARV treatment (n1=60), and the second group comprised HIV-negative participants (n2=32). The video head impulse test was used to conduct the head impulse paradigm (HIMP).Results: Bilateral normal HIMP results were obtained in 95% of the HIV-positive participants and all HIV-negative participants. The gain of the left posterior SCCs was significantly lower in the HIV-positive group, while the gains of all other canals between the two groups were comparable.Conclusions: The prevalence of peripheral vestibular impairment in the HIV-positive group was not significantly different from that of the HIV-negative group. The reduced prevalence in the current study may be attributed to participant characteristics, the test battery employed, and the central compensation of the vestibular dysfunctions at the later stages of infection.

Utilization of an Application in Dizziness Treatment: Pilot Study

Vestibular Rehabilitation (VR), a method of therapy for dizziness, aims at reestablishing body balance and also at facilitating central compensation by means of adaptation and substitution mechanisms. With technological advance, the feasibility of a device which aided in VR process took place, both for stimulating and monitoring patients. In that sense, an application called Dizziness APP was developed in order to simplify and automatize dizziness therapy process performed by the phonoaudiology professional. The aim of the present study was to report a Dizziness APP experience of usage as therapeutic strategic towards dizziness, besides comparing dizziness impact on quality of life before and after using that application. It is a descriptive, exploratory study with a qualitative approach. A subject, age 29, female gender, took participation in the present study being solely subjected to Vestibular-Ocular-Reflex (VOR) Exercises by means of vertical, horizontal and oblique optokinetic stimulation during a period of six months. The scores obtained on Dizziness Handicap Inventory (DHI), monthly, expressed by the utilization of an automatized and simplified digital process available on the Dizziness APP application, were used. Initial DHI score achieved 46 points and, upon treatment conclusion, 0 point. Using Dizziness APP as a therapeutic resource enabled the following up, monitoring and remission of dizziness symptom demonstrating the beneficial effects by means of optokinetic exercise during the Dizziness APP process of validation.

Lindsay-Hemenway Syndrome: Review of the literature and case report

OBJECTIVES. Reviewing the literature data related to Lindsay – Hemenway syndrome.MATERIAL AND METHODS. We searched PubMed and Google Scholar with the key words of “Lindsay-Hemenway syndrome”, “benign positional vertigo”, “vestibular rehabilitation”RESULTS. Lindsay-Hemenway syndrome is characterized by an association between vestibular neuronitis and BPPV. The specificity of the syndrome consists in the existence of an initial episode of acute vestibular neuropathy manifested by intense vertigo and nystagmus, followed in a variable time frame by episodes of posterior canal BPPV. The treatment of the syndrome consists in a combination of otolith repositioning manoeuvres and vestibular rehabilitation therapy. The physicians involved in treating patients with vestibular disorders should be aware of the existence of this syndrome in order to diagnose and treat the patients accordingly.CONCLUSION. The Lindsay-Hemenway syndrome is a challenge for the physician. In order to establish a diagnosis, a careful investigation of clinical history and objective examination are needed. The clinician should take into consideration the presence of a sudden vertigo without deafness followed by postural nystagmus, and unilateral labyrinthine hyporeflexia or absence of reflectivity. For a successful therapeutic approach, we should be able to combine manoeuvres of repositioning for BPPV with an appropriate vestibular rehabilitation therapy in order to ensure a correct central compensation of the peripheral unilateral deficit.

Measurements of Trunk Sway for Stance and Gait Tasks 2 Years after Vestibular Neurectomy

The aim of this study was to investigate changes in balance control for stance and gait tasks in patients 2 years before and after vestibular neurectomy (VN) performed to alleviate intractable Meniere’s disease. Amplitudes of trunk sway in roll and pitch directions were measured for stance and gait tasks in 19 patients using gyroscopes mounted at the lower-back. Measurements before VN and 2 years later were compared to those of healthy age-matched controls (HC). We also examined if changes in trunk sway amplitudes were correlated with patients’ subjective assessment of disability using the AAO-HNS scale. For patients with low AAO-HNS scores 0–2 (n = 14), trunk roll and pitch sway velocities, standing eyes closed on foam, increased 2 years post VN compared to HC values (p < 0.01). Trunk sway amplitudes remained at levels of HC for simple gait tasks, but task durations were longer and therefore gait slower. For complex gait tasks (stairs), balance control remained impaired at 2 years. In patients with AAO-HNS high scores level 6 (n = 5), balance control remained abnormal, compared to HC, 2 years postoperatively for all stance, several simple and all complex gait tasks. Trunk sway in the pitch and roll directions for stance tasks was correlated with clinical (AAO-HNS) scores (p ≤ 0.05). These results indicate that VN leads to chronic balance problems for stance and complex gait tasks. The problems are greater for patients with high compared to low AAO-HNS scores, thereby explaining the different symptoms reported by these patients. The lack of balance recovery in VN patients to levels of HCs after 2 years contrasts with the 3 months average recovery period for acute vestibular neuritis patients and is indicative of the effects of neurectomy on central compensation processes.

Vertigo and Imbalance

Electrophysiologic testsests can be used to evaluate the function of each of the five vestibular sensory receptors in the labyrinth, in patients with dizziness and imbalance. Tests of semicircular canal function concentrate on vestibular ocular reflex behavior and include the bilateral, bi-thermal caloric test, video head impulse tests (vHIT), and rotary chair tests. Otolith function tests focus on changes in muscle tone and include the cervical and ocular vestibular evoked myogenic potentials (cVEMP and oVEMP). Interpreting vestibular tests requires an understanding of the underlying anatomy and physiology, and an appreciation of central compensation processes and their effects on each test. This chapter reviews the techniques and interpretation of vestibular testing to assess semicircular canal and otolith function and postural control.