Head impulses reveal loss of individual semicircular canal function.
ABSTRACT We studied individual semicircular canal responses in three dimensions to high-acceleration head rotations ("head impulses") in subjects with known surgical lesions of the semicircular canals, and compared their results to those of normal subjects. We found that vestibular-ocular reflex (VOR) gains at close to peak head velocity in response to yaw, pitch and roll impulses were reliable indicators of semicircular canal function. When compared to normals, lateral canal function showed a 70-80% decrease in VOR gain at peak of yaw head velocity during ipsilesional yaw impulses. After the loss of one vertical canal function there was a 30-50% decrease in vertical and torsional VOR gain in response to ipsilesional pitch and roll impulses respectively. Bilateral deficits in anterior or posterior canal function resulted in a 80-90% decrease in vertical VOR gain during ipsilesional pitch impulses, while the loss of ipsilateral anterior and posterior canal functions will result in a 80-90% decrease in torsional VOR gain in response to ipsilesional roll impulses. Three-dimensional vector analysis and animation of the VOR responses in a unilateral vestibular deafferented subject to yaw, pitch and roll impulses further demonstrated the deficits in magnitude and direction of the VOR responses following the loss of unilateral lateral, anterior and posterior canal functions.
- SourceAvailable from: Leonardo ManzariThe Laryngoscope 08/2012; · 1.98 Impact Factor
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ABSTRACT: OBJECTIVE: The video head impulse test (vHIT) is a useful clinical tool to detect semicircular canal dysfunction. However, so far, vHIT has been limited to measurement of the function of the horizontal semicircular canals. The goal of this study was to determine if vHIT can detect vertical semicircular canal dysfunction. STUDY DESIGN: Horizontal and vertical eye movements were recorded in response to abrupt, passive, unpredictable head turns (head impulses) in the planes of the vertical semicircular canals by high-speed video (250-Hz sampling rate) together with measures of the head movement. Head impulses were delivered diagonally in the plane of the vertical semicircular canals, whereas gaze was directed along the same plane. Patients with known vestibular loss as shown by previous scleral search coil recording were tested to identify if the vHIT testing could detect the loss. RESULTS: The results of patients with unilateral, bilateral, and individual semicircular canal dysfunction were compared with the results of a healthy control subject. The patient with bilateral vestibular loss had no compensatory slow eye movements in any direction. The patient with unilateral vestibular loss showed reduced response for head impulses activating the canals in their affected right ear (right anterior, right posterior, and right horizontal head impulses). The patient with isolated canal loss showed reduced response for head impulses activating the affected right posterior canal. CONCLUSION: vHIT detects peripheral deficits of both vertical and horizontal semicircular canal function and is a new tool for measuring dysfunction of individual semicircular canals in vestibular patients.Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 05/2013; · 1.44 Impact Factor