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Subjective visual vertical in peripheral unilateral vestibular diseases
D Vibert1, R Häusler, A B Safran
1University Clinic of ENT, Head and Neck Surgery, Inselspital, Berne, Switzerland. dominique.vibert@insel.ch
Summary
Abnormalities in subjective visual vertical (SVV) are common in peripheral vestibular diseases like viral labyrinthitis and vestibular neuritis. These findings highlight the crucial role of otolithic organs in maintaining vertical perception.
Area of Science:
- Neuroscience
- Ophthalmology
- Otolaryngology
Background:
- Perception of vertical relies on visual, eye movement, proprioceptive, and vestibular inputs.
- Subjective visual vertical (SVV) abnormalities are known in brainstem lesions and peripheral vestibular damage.
- Peripheral vestibular lesions, especially otolithic, can cause deviations in SVV.
Purpose of the Study:
- To prospectively measure SVV in patients with peripheral vestibular diseases.
- To determine the influence of otolithic organs in conditions like viral labyrinthitis (VL) and vestibular neuritis (Ne).
- To compare findings with surgical deafferentations (vestibular neurectomy - VN, labyrinthectomy - Lab).
Main Methods:
- Prospective study measuring SVV using a vertical frame and Maddox rod.
- Patients included those with VL, Ne, VN, and Lab.
- Comparison of SVV measurements against normative data.
Main Results:
- SVV tilt observed in VN and Lab patients (10-30 degrees vertical frame, 5-15 degrees Maddox rod).
- Significant SVV tilt (>2 degrees vertical frame, >4 degrees Maddox rod) found in 47% of VL and 37% of Ne patients.
- Tilt direction consistently towards the affected ear in all patient groups.
Conclusions:
- SVV is frequently tilted in acute peripheral vestibulopathies (VL, Ne).
- Results suggest otolithic organ dysfunction contributes to SVV deficits.
- The extent and location of peripheral vestibular lesions influence SVV abnormalities.