Erin G. Piker

Background: The impact of dance training on brainstem-mediated vestibular reflexes remains unclear. This study examined the vestibulo-ocular reflex (VOR) and its suppression during high-speed head movements, which may closely resemble the head-turning speeds used in dancers’ spotting techniques, using the video head impulse test. Methods: Eighteen female college students (mean age: 21 years) were divided into two groups—nine trained dancers (≥six years of dance training) and nine age-matched non-dancers—all without a history of hearing, vestibular, or neurological disorders. VOR function was assessed using the head impulse paradigm (HIMP) and the suppression head impulse paradigm (SHIMP) for right and left lateral stimulation, with minimum head velocities of 150°/s. Results: All participants exhibited VOR measures within normal limits and the VOR gain of dancers did not significantly differ from that of non-dancers. However, most dancers reported a preference for right-sided pirouettes and the right-side SHIMP gain negatively correlated with years of training, suggesting a link between preferred turning direction and VOR suppression ability. Furthermore, dancers with over 15 years of training exhibited earlier anti-compensatory saccade latencies (~75 ms) during SHIMP. Conclusions: Trained dancers maintain a healthy VOR and may develop enhanced voluntary control, enabling more effective VOR suppression. The earlier onset of anti-compensatory saccades suggests neural adaptations in eye–head coordination for high-velocity movements. Given the study’s small sample size and the inclusion of non-fulltime dancers, future research with larger samples of professional dancers is needed for enhanced generalizability. These findings provide preliminary evidence of dance-related neuroplasticity in brainstem-mediated vestibular reflexes and open new research avenues.

Purpose: This mixed-methods design (a) quantitatively describes the symptom cluster assignments of patients with chronic dizziness who completed a dizziness triage questionnaire and (b) qualitatively explains patient-reported themes associated with the most frequently assigned symptom cluster. Method: A retrospective hybrid explanatory mixed-methods design was implemented to examine an artificial intelligence dizziness triage questionnaire posted online in a vestibular disorders support group from June 2021 to November 2022. Symptom cluster assignments are described in 791 participants. In the qualitative analysis, emerging codes were identified in the dominant symptom cluster in 50 participants. Results: Quantitative analysis identified a total of 301 symptom cluster combinations. The analysis from 791 participants revealed that females exhibited more symptom clusters than males, age impacted symptoms inversely, and longer duration of symptom history exhibited more symptom clusters. “Positional” was the most common symptom cluster among 50 participants. Of those 50, six major themes emerged from the data: (a) physical symptoms, (b) cognitive symptoms, (c) triggers, (d) temporal information, (e) management, and (f) emotions. Conclusions: The results from this study emphasize the complexity and variability of chronic dizziness. Comprehensive patient assessments that combine questionnaires with clinical expertise and patient dialogue are needed to improve diagnosis and management.

Purpose: An increase in the 1000/500 Hz frequency amplitude ratio (FAR) of the cervical and ocular vestibular evoked myogenic potentials (cVEMP and oVEMP, respectively) may serve as a potential biomarker for diagnosing Meniere's disease (MD). However, the aging process can also result in an increased FAR for VEMPs. In older patients, distinguishing whether changes in VEMP FAR are due to MD or aging processes becomes difficult. We aimed to investigate the effects of age on VEMP FARs and establish a FAR-normative range for different age groups. Method: cVEMP and oVEMP were recorded from a total of 106 participants grouped as young, middle-aged, and older adults using air-conducted tone bursts at 500, 750, and 1000 Hz at 125 dB pSPL. The FAR was calculated for the cVEMP and oVEMP for the following frequencies: FAR1 = 1000/500, FAR2 = 1000/750, and FAR3 = 750/500. Results: A significant age-related effect was observed on the cVEMP FAR. Although the oVEMP FAR showed an increasing trend with age, it was not statistically significant. Age-based normative FAR values are provided. Conclusions: Drawing from the normative FAR from this study, there is evidence that the existing MD diagnostic criteria would misidentify a considerable number of older adults. Therefore, to reduce false positives, we recommend a more stringent cVEMP and oVEMP FAR criterion in older adults.

Objective: The purpose of this investigation was to determine the relationship between the horizontal semicircular canal video head impulse test (hvHIT) and the caloric test in a sample of school-age children evaluated due to complaints of dizziness or imbalance. In adults, these two tests provide different but complementary information regarding vestibular function and/or pathology. However, the most common causes of vestibular loss in children are different than those in adults, and it is not clear how these two tests of horizontal semicircular canal function are related in a pediatric population. Method: This is a retrospective study of electronic records of pediatric patients (< 18 years old) who were referred for vestibular function testing and completed both hvHIT and caloric testing. Agreement between both test results was evaluated by examining measures of sensitivity, specificity, and calculating Cohen's kappa. Results: Results from 117 patients (mean age = 13.7 years, age range: 8–17 years, 37 males) were analyzed. Most patients (97/115 [84.3%]) demonstrated both normal hvHIT and caloric test results. Compared to caloric testing, the hvHIT had poor sensitivity (38.9%) and excellent specificity (98.0%). Cohen's kappa analysis revealed moderate agreement between the methods (coefficient = 0.49 [0.24, 0.73]). Where disagreement between the two tests occurred, the final diagnosis was not contingent on either test result. Conclusions: There is a moderate agreement between the hvHIT and the caloric test in pediatric patients presenting to a tertiary care medical center for a vestibular evaluation. Most patients in this cohort presented with normal findings. The specificity of hvHIT was excellent, although the sensitivity was low. This may be related to the low prevalence of peripheral vestibular system disease in this study cohort, and these results do not generalize to centers that serve populations of children where vestibular disorders are more prevalent (e.g., children with sensorineural hearing loss).

The otolith balance organs of humans are assessed for basic science and clinical applications by using vestibular-evoked myogenic potentials (VEMPs). Traditionally, VEMPs are elicited with brief, transient sounds to study onset responses. We used long-duration sounds to elicit steady-state VEMPs. This allowed us to measure nonlinear distortion products, consistent with nonlinear processing in vestibular hair cells. This new approach may help to better understand links between otolith organs and balance function.

Cervical vestibular evoked myogenic potentials (cVEMPs) are usually elicited by transient tonebursts, but when elicited by amplitude-modulated (AM) tones, they can provide new information about cVEMPs. Previous reports of cVEMPs elicited by AM tones, or AMcVEMPs, have not systematically examined the effects of tonic EMG activation on their response properties. Fourteen young, healthy female adults (ages 20–24) with clinically normal audiograms participated in this study. AMcVEMPs were elicited with bone-conducted 500 Hz tones amplitude modulated at a rate of 37 Hz and recorded for five different EMG targets ranging from 0 to 90 μV. Amplitude increased linearly as tonic EMG activation increased. Signal-to-noise ratio (SNR) was minimal at 0 μV, but robust and with equivalent values from 30 to 90 μV; phase coherence and EMG-corrected amplitude had findings similar to SNR across EMG target levels. Interaural asymmetry ratios for SNR and phase coherence were substantially lower than those for raw or corrected amplitude. AMcVEMP amplitude scaled with tonic EMG activation similar to transient cVEMPs. Signal-to-noise ratio, phase coherence, and EMG-corrected amplitude plateaued across a range of EMG values, suggesting that these properties of the response reach their maximum values at relatively low levels of EMG activation and that higher levels of EMG activation are not necessary to record robust AMcVEMPs.