Motion sickness (MS) occurs when the brain receives conflicting signals about body movement from the visual, vestibular, and proprioceptive systems. The otolith organs play a key role in perceiving verticality, and their function may be influenced by MS susceptibility.
Objective
This study aimed to investigate the effect of MS susceptibility on otolith-mediated verticality perception across different head positions.
Methods
Forty-seven participants were classified into two groups based on the Motion Sickness Susceptibility Questionnaire–Short Form (MSSQ-SF): an MS group (n = 24) and a control group (n = 23). All participants completed static Subjective Visual Vertical (SVV), dynamic Subjective Visual Vertical (DVV), and Rod-and-Frame Test (RFT) using a virtual reality system. Measurements were conducted in three head tilt (upright, 30° left, 30° right). The absolute deviation from true vertical was calculated for each test.
Results
While no significant differences were found in SVV performance between groups across head-tilt angles, the MS group exhibited significantly greater deviations in DVV at all positions and in RFT during 30° head tilts. Higher MSSQ scores correlated with greater deviations in DVV and RFT under tilt conditions.
Conclusions
Although static verticality perception remains intact, individuals with MS exhibit greater deviations under dynamic and visually misleading conditions, suggesting subtle vestibular-perceptual deficits.
ZhangLOuyangSChenL, et al.Evaluation of subjective visual vertical and horizontal in patients with acoustic neuroma based on virtual reality. Front Neurosci2023; 17: 1264585.
5.
HaijoubSHautefortCToupetM, et al.Asymmetry and rehabilitation of the subjective visual vertical in unilateral vestibular hypofunction patients. Front Syst Neurosci2024; 18: 1454637.
6.
Riera-TurLCaballero-GarciaAMartin-MateosAJ, et al.Efficacy of the subjective visual vertical test performed using a mobile application to detect vestibular pathology. J Vestib Res2022; 32: 21–27.
7.
ChetanaNJayeshR. Subjective visual vertical in various vestibular disorders by using a simple bucket test. Indian J Otolaryngol Head Neck Surg2015; 67: 180–184.
8.
DieterichMBrandtT. Perception of verticality and vestibular disorders of balance and falls. Front Neurol2019; 10: 172.
9.
MillerMACraneBT. Static and dynamic visual vertical perception in subjects with migraine and vestibular migraine. World J Otorhinolaryngol Head Neck Surg2016; 2: 175–180.
10.
PrevicFH. Intravestibular balance and motion sickness. Aerosp Med Hum Perform2018; 89: 130–140.
11.
TotilienėMUlozaVLesauskaitėV, et al.Impaired subjective visual vertical and increased visual dependence in older adults with falls. Front Aging Neurosci2021; 13: 667608.
12.
ArdıçFNMetinUGökcanBE. Subjective visual vertical test with the 3D virtual reality system: effective factors and cybersickness. Acta Otolaryngol2023; 143: 570–575.
13.
KlattBNSpartoPJTerhorstL, et al.Relationship between subjective visual vertical and balance in individuals with multiple sclerosis. Physiother Res Int2019; 24: e1757.
14.
WitkinHLewisHHertzmanM. Personality through perception. An experimental and clinical study. Q Rev Biol1954; 29: 413–414.
15.
BagustJ. Assessment of verticality perception by a rod-and-frame test: preliminary observations on the use of a computer monitor and video eye glasses. Arch Phys Med Rehabil2005; 86: 1062–1064.
16.
WitkinHADykRBFattusonH, et al.Psychological differentiation: studies of development. 1962.
17.
DeichRFHodgesPM. Motion sickness, field dependence, and levels of development. Percept Mot Skills1973; 36: 1115–1120.
18.
ChangT-PHongY-CSchubertMC. Visual vertigo and motion sickness is different between persistent postural-perceptual dizziness and vestibular migraine. Am J Otolaryngol2024; 45: 104321.
19.
PavlouMDaviesRABronsteinAM. The assessment of increased sensitivity to visual stimuli in patients with chronic dizziness. J Vestib Res2007; 16: 223–231.
20.
MedendorpWPAlbertsBBVerhagenWI, et al.Psychophysical evaluation of sensory reweighting in bilateral vestibulopathy. Front Neurol2018; 9: 377.
21.
SugawaraTWadaYItoT, et al.Bilateral asymmetry in ocular counter-rolling reflex is associated with individual motion sickness susceptibility. Front Neurol2021; 12: 759764.
GoldingJF. Predicting individual differences in motion sickness susceptibility by questionnaire. Pers Indiv Differ2006; 41: 237–248.
24.
BlesWde GraafBKrolJ. Space adaptation syndrome and sickness induced by centrifugation-vestibular consequences of Earth anomalous gravity. Report TNO-TM1995.
25.
AlbertsBBSelenLPBertoliniG, et al.Dissociating vestibular and somatosensory contributions to spatial orientation. J Neurophysiol2016; 116: 30–40.
26.
WinnickAAWangC-HKoY-H, et al.Subjective visual vertical imprecision during lateral head tilt in patients with chronic dizziness. Exp Brain Res2022; 240: 1–8.
27.
BronsteinAM. The interaction of otolith and proprioceptive information in the perception of verticality: the effects of labyrinthine and CNS disease. Ann N Y Acad Sci1999; 871: 324–333.
28.
ClemensIADe VrijerMSelenLP, et al.Multisensory processing in spatial orientation: an inverse probabilistic approach. J Neurosci2011; 31: 5365–5377.
29.
KlėgėrisTKaskiDBalnytėR, et al.Verticality perception in patients with active multiple sclerosis: the applicability of subjective visual vertical test and its modifications. Mult Scler Relat Disord2025; 94: 106234.
30.
BurnsJKBlohmG. Multi-sensory weights depend on contextual noise in reference frame transformations. Front Hum Neurosci2010; 4: 221.
31.
TagliabueMMcIntyreJ. Necessity is the mother of invention: reconstructing missing sensory information in multiple, concurrent reference frames for eye-hand coordination. J Neurosci2011; 31: 1397–1409.
32.
FaralliMRicciGMoliniE, et al.Determining subjective visual vertical: dynamic versus static testing. Otol Neurotol2007; 28: 1069–1071.
33.
YardleyL. Motion sickness susceptibility and the utilisation of visual and otolithic information for orientation. Eur Arch Otorhinolaryngol1990; 247: 300–304.
34.
MaireRMallinsonACeyteH, et al.Discussion about visual dependence in balance control: European society for clinical evaluation of balance disorders. J Int Adv Otol2017; 13: 404–406.
35.
AgarwalKBronsteinAMFaldonME, et al.Visual dependence and BPPV. J Neurol2012; 259: 1117–1124.
36.
NairMAMulavaraAPBloombergJJ, et al.Visual dependence and spatial orientation in benign paroxysmal positional vertigo. J Vestib Res2018; 27: 279–286.
37.
PogsonJMTaylorRLMcGarvieLA, et al.Head impulse compensatory saccades: visual dependence is most evident in bilateral vestibular loss. PLoS One2020; 15: e0227406.
38.
AzulayJPMesureSAmblardB, et al.Increased visual dependence in Parkinson's disease. Percept Mot Skills2002; 95: 1106–1114.
39.
UlozienėITotilienėMBalnytėR, et al.Subjective visual vertical and visual dependency in patients with multiple sclerosis. Mult Scler Relat Disord2020; 44: 102255.
40.
KuldavletovaOTanguySDeniseP, et al.Vestibulo-Ocular responses, visual field dependence, and motion sickness in aerobatic pilots. Aerosp Med Hum Perform2020; 91: 326–331.
41.
MirabileJCharlesSGlueckBC, et al.Susceptibility to motion sickness and field dependence-independence as measured with the rod and frame test. Neuropsychobiology1976; 2: 45–51.
42.
BarrettGVThorntonCL. Relationship between perceptual style and simulator sickness. J Appl Psychol1968; 52: 304–308.
43.
KitajimaNSugita-KitajimaA. Ocular counter-rolling in scuba divers with motion sickness. Auris Nasus Larynx2021; 48: 214–220.
44.
PropperREBonatoFWardL, et al.Findings of an effect of gender, but not handedness, on self-reported motion sickness propensity. Biopsychosoc Med2018; 12: 1–4.
45.
ChangEKimHTYooB. Virtual reality sickness: a review of causes and measurements. Int J Hum Comput Interact2020; 36: 1658–1682.
