Objective: To evaluate the influence of asymmetry of vestibular caloric response and age on balance and perceived symptoms after acute unilateral vestibular loss.
Design: Prospective study.
Setting: Ear, nose and throat departments in three hospitals.
Subjects: Fifty-four patients (mean age 52 years) with acute unilateral vestibular loss participating in a randomized controlled training study were included.
Main measures: Electronystagmography testing was performed within one week after onset of symptoms and after 10 weeks. The outcome measures clinical static balance tests (sharpened Romberg's test with eyes closed, standing on foam with eyes closed, and standing on one leg with eyes open and closed) and subjective symptom ratings on a visual analogue scale were done after one week, 10 weeks and six months. The correlation between age and asymmetry of vestibular caloric response, respectively, and the outcome measures were analysed.
Results: Greater caloric asymmetry correlated with poorer performance at the sharpened Romberg's test and standing on one leg with eyes closed at all three follow-ups (rho=-0.31 to -0.54), and with higher symptom ratings at the 10-week and six-month follow-ups (rho=0.30-0.60). Higher age was associated with poorer performance on the sharpened Romberg's test and standing on one leg at all three follow-ups (rho=0.31-0.64), but did not change over time. Higher age was also associated with higher ratings of vertigo at the six-month follow-up, and less reduction of vertigo between the 10-week and six-month follow-ups (rho=0.29-0.48).
Conclusions: A higher degree of asymmetry of vestibular caloric response and high age seem to be associated with poor outcome in balance and perceived symptoms after acute unilateral vestibular loss.
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References
1.
1 Strupp M, Brandt T. Vestibular neuritis. Adv Otorhinolaryngol1999; 55: 111–136.
3 Okinaka Y, Sekitani T, Okazaki H, Miura M, Tahara T. Progress of caloric response of vestibular neuronitis. Acta Otolaryngol Suppl1993; 503: 18–22.
4.
4 Curthoys IS, Halmagyi GM. Vestibular compensation: a review of the oculomotor, neural, and clinical consequences of unilateral vestibular loss. J Vestib Res1995; 5: 67–107.
5.
5 Shepard NT, Solomon D. Functional operation of the balance system in daily activities. Otolaryngol Clin North Am2000; 33: 455–469.
6.
6 Herdman SJ, Blatt PJ, Schubert MC. Vestibular rehabilitation of patients with vestibular hypo-function or with benign paroxysmal positional vertigo. Curr Opin Neurol2000; 13: 39–43.
7.
7 Kammerlind A, Ledin T, Ö dkvist L, Skargren EIB. Effects of home training and additional physical therapy on recovery after acute unilateral vestibular loss-a randomized study. Clin Rehabil2005; 19: 54–62.
8.
8 Paige GD. Senescence of human visual-vestibular interactions. 1. Vestibulo-ocular reflex and adaptive plasticity with aging. J Vestib Res1992; 2: 133–151.
9.
9 Bhansali SA, Honrubia V. Current status of electro-nystagmography testing. Otolaryngol Head Neck Surg1999; 120: 419–426.
10.
10 Franchignoni F, Tesio L, Martino MT, Ricupero C. Reliability of four simple, quantitative tests of balance and mobility in healthy elderly females. Aging (Milano)1998; 10: 26–31.
11.
11 Briggs RC, Gossman MR, Birch R, Drews JE, Shaddeau SA. Balance performance among non-148 A-SC Kammerlind et al. institutionalized elderly women. Phys Ther1989; 69: 748–756.
12.
12 Weber PC, Cass SP. Clinical assessment of postural stability. Am J Otol1993; 14: 566–569.
13.
13 Herdman SJ, Clendaniel RA, Mattox DE, Holliday MJ, Niparko JK. Vestibular adaptation exercises and recovery: acute stage after acoustic neuroma resection. Otolaryngol Head Neck Surg1995; 113: 77–87.
14.
14 Whitney SL, Wrisley DM, Brown KE, Furman JM. Physical therapy for migraine-related vestibulopathy and vestibular dysfunction with history of migraine. Laryngoscope2000; 110: 1528–1534.
15.
15 Williams F. Reasoning with statistics. Harcourt Brace Jovanovich College Publishers, 1992.
16.
16 Bergenius J, Perols O. Vestibular neuritis: a follow-up study. Acta Otolaryngol1999; 119: 895–899.
17.
17 Konrad HR, Girardi M, Helfert R: Balance and aging. Laryngoscope1999; 109: 1454–1460.
18.
18 Herdman SJ, Schubert MC, Das VE, Tusa RJ. Recovery of dynamic visual acuity in unilateral vestibular hypofunction. Arch Otolaryngol Head Neck Surg2003; 129: 819–824.
19.
19 Shepard NT, Telian SA, Smith-Wheelock M, Raj A. Vestibular and balance rehabilitation therapy. Ann Otol Rhinol Laryngol1993; 102: 198–205.
20.
20 Allum JHJ, Ledin T. Recovery of vestibulo-ocular reflex-function in subjects with an acute unilateral peripheral vestibular deficit. J Vestib Res1999; 9: 135–144.
21.
21 Silvoniemi P. Vestibular neuronitis. An otoneuro logical evaluation. Acta Otolaryngol Suppl1988; 453: 1–72.
