Clin Exp Otorhinolaryngol.  2021 May;14(2):192-199. 10.21053/ceo.2020.01739.

Importance of High-Frequency Vestibular Function in the Prognosis of Bilateral Vestibulopathy

Affiliations
  • 1Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea

Abstract


Objectives
. The aim of this study was to investigate whether preserved vestibular function in the high-frequency range influences the prognosis of patients with bilateral vestibulopathy (BVP) after vestibular rehabilitation.
Methods
. Twenty-four patients followed up with vestibular rehabilitation were recruited. The enrolled patients were divided into two groups according to the preservation of the high-frequency vestibulo-ocular reflex (VOR) based on the video head impulse test (vHIT). The results of computerized dynamic posturography and the Dizziness Handicap Inventory (DHI) survey collected at baseline and at the 6-month follow-up after vestibular rehabilitation therapy were analyzed.
Results
. Both groups showed significantly increased composite and DHI scores after follow-up with vestibular rehabilitation. The group with preserved high-frequency VOR showed a better composite score (p=0.064) and vestibular score (p= 0.008) than the group with lost high-frequency VOR at the 6-month follow up. The DHI score significantly decreased only in the group with lost high-frequency VOR (p=0.047). Among the three vestibular function tests (caloric test, rotary chair test, and vHIT) used to diagnose BVP, only vHIT showed a significant correlation (p=0.015) with a favorable prognosis (composite score ≥70).
Conclusion
. Better treatment outcomes are likely in patients with BVP with preserved vestibular function in response to high-frequency stimulation, as measured by the vHIT.

Keyword

Bilateral Vestibulopathy; Head Impulse Test; Vestibular Function Tests; Semicircular Canals; Rehabilitation

Figure

  • Fig. 1 Changes in subjective symptoms and objective parameters of balance function after rehabilitation. A simple boxplot of the computerized dynamic posturography and Dizziness Handicap Inventory (DHI) scores for bilateral vestibulopathy patients at baseline and follow-up. G1 (group 1, video head impulse test [vHIT] gain in the lateral semicircular canal [LSCC] ≥0.6 in one or both ears) patients showed a better outcome than G2 (group 2, vHIT gain in the LSCC <0.6 in both ears) patients. (A) Composite score, (B) vestibular score, (C) DHI total score, (D) DHI physical score, (E) DHI emotional score, and (F) DHI functional score. The line in the middle is the median. The top and bottom box lines show the first and third quartiles, respectively. The whiskers show the maximum and minimum values. NS, not significant. *P<0.05.

  • Fig. 2 Distribution of patients according to the final composite score after vestibular rehabilitation. The cumulative graph of the final composite score showed a double peak at 45–50 and 70–75.


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