The subjective horizontal at different angles of roll-tilt in patients with unilateral vestibular impairment

doi:10.1016/0361-9230(96)00131-1

Brain Research Bulletin

Volume 40, Issues 5–6, 1996, Pages 385-390

https://doi.org/10.1016/0361-9230(96)00131-1 Get rights and content

Abstract

The subjective visual horizontal is mainly dependent on the otolithic system. A group of 11 patients with sudden unilateral vestibular impairment were asked to set a dimly illuminated bar according to their subjective horizontal when they were seated upright and tilted 10, 20, and 30 degrees to the right and left in a completely darkened room (Bias test). The patients were examined within 1 week, after 3 and 6 weeks, and 9 patients consented to the 11-week follow-up. The results were compared with ENG examinations. In the acute stage of the disease all patients, when they were in upright position, set the light bar tilted towards the affected side. At roll tilt to the affected side, 9 of the 11 patients set the light bar in the same direction as their body tilt (undercorrection). At a tilt to the unaffected side 6 of the 11 patients made an undercorrection. For the group of patients the magnitude of undercorrection was larger at tilt to the affected side than to the unaffected side. The patients' ability to correctly align the light bar with the true horizontal gradually improved but was found normal in both upright and tilted positions in only three of the nine patients at the last follow-up. In four of the six patients who still demonstrated pathologic results, these were met only in tilted positions. No significant correlation was found between the intensity of spontaneous nystagmus or the degree of caloric side difference and the deviation in setting of the light bar in upright or tilted positions. The large asymmetric perceptual responses at tilt found at onset might be explained by the two-directional organisation of the utricle.

References (23)

G.M. Halmagyi et al.
Diagnosis of unilateral otolith hypofunction
Neurol. Clin.
(1990)
J. Bergenius et al.
Audio-vestibular findings in patients with vestibular neuritis
Acta Otolaryngol.
(1983)
A. Böhmer et al.
The subjective visual vertical as a clinical parameter of vestibular function in peripheral vestibular diseases
J. Vestib. Res.
(1995)
U.J. Bucher et al.
An analysis of ocular counterrolling in response to body positions in three-dimensional space
J. Vestib. Res.
(1992)
B. Clark et al.
Visual perception of the horizontal during exposure to radial acceleration on a centrifuge
J. Comp. Physiol. Psychol.
(1951)
I.S. Curthoys et al.
Human otolithic function before and after unilateral vestibular neurorectomy
J. Vestib. Res.
(1991)
I.S. Curthoys et al.
Human ocular torsional position before and after unilateral vestibular neurectomy
Exp. Brain Res.
(1991)
M.J. Dai et al.
Linear acceleration perception in the roll plane before and after unilateral vestibular neurectomy
Exp. Brain Res.
(1989)
C. Fernandez et al.
Physiology of peripheral neurons innervating otolith organs of the squirrel monkey
J. Neurophysiol.
(1976)
M. Fetter et al.
Recovery from unilateral labyrinthectomy in rhesus monkey
J. Neurophysiol.
(1988)

E. Fluur et al.

Vestibular bidirectional sensitivity

Acta Otolaryngol.

(1970)

Cited by (36)

Spatial orientation in patients with chronic unilateral vestibular hypofunction is ipsilesionally distorted
2016, Clinical Neurophysiology
Citation Excerpt :
Alternatively, as a strategy to compensate for acute UVH, the brain could rely more on body-fixed orientation cues, resulting in an increased A-effect and a decreased E-effect on both sides (Tarnutzer et al., 2011b). The few studies that have addressed adjustment errors in chronic UVH while roll-tilted suggest a tendency towards roll under-compensation at small angles (Dai et al., 1989; Böhmer and Rickenmann, 1995; Bergenius et al., 1996; Betts et al., 2000), while no data is available for larger angles. The aim of this study was to characterize both the accuracy and precision of SVV adjustments in chronic UVH over a larger range of roll-tilted positions.
Acute unilateral peripheral–vestibular hypofunction (UVH) shifts the subjective visual vertical (SVV) ipsilesionally, triggering central compensation that usually eliminates shifts when upright. We hypothesized that compensation is worse when roll-tilted.
We quantified SVV errors and variability in different roll-tilted positions (0°, ±45°, ±90°) in patients with chronic UVH affecting the superior branch (SVN; n = 4) or the entire (CVN; n = 9) vestibular nerve.
Errors in SVN and CVN were not different. When roll-tilted ipsilesionally 45° (9.6 ± 5.4° vs. −0.2 ± 6.4°, patients vs. controls, p < 0.001) and 90° (23.5 ± 5.7° vs. 16.8 ± 8.8°, p = 0.003), the patient’s SVV was shifted significantly towards the lesioned ear. When upright, only a trend was noted (3.6 ± 2.2° vs. 0.0 ± 1.2°, p = 0.099); for contralesional roll-tilts shifts were not different from controls. Variability was larger for CVN than SVN (p = 0.046). With increasing disease-duration, adjustment errors decayed for ipsilesional roll-tilt and upright (p ⩽ 0.025).
The reason verticality perception was distorted for ipsilesional roll-tilts, may be the insufficient integration of contralesional otolith-input. Similar errors in SVN and CVN suggest a dominant utricular role in verticality perception, albeit the sacculus may improve precision of SVV estimates.
With deficiencies in central compensation being roll-angle dependent, extending SVV-testing to roll-tilted positions may improve identifying patients with chronic UVH.
Role of subjective visual vertical test during eccentric rotation in the recovery phase of vestibular neuritis
2010, Auris Nasus Larynx
By assessing unilateral utricular function at the acute and subacute stages, we sought to determine the ability of the subjective visual vertical (SVV) during eccentric rotation (dynamic SVV) in detecting latent abnormality of otolith dysfunction in unilateral vestibular neuritis. In addition, we compared the validity of the dynamic SVV with static SVV during the compensated recovery phase.
The static SVV and dynamic SVV of 19 patients diagnosed with acute unilateral vestibular neuritis and 31 patients diagnosed with the subacute stage of vestibular neuritis were determined in this study. First, the static SVV was measured in a dark booth without rotation. The dynamic SVV was measured during rotation with an eccentric displacement of the head to 3.5 cm from the vertical rotation axis during a constant velocity of 300°/s.
In the acute stage of vestibular neuritis, the static SVV showed an increase in deviation to the side of the lesion compared to findings in normal subjects. In the subacute stage, it did not differ significantly from that of the normal subjects. The dynamic SVV, however, had a statistically significant increase in deviation to the side of the lesion compared to normal subjects in both the acute and subacute stages.
The dynamic SVV would be an effective method in detecting latent abnormality of otolith dysfunction in unilateral vestibular neuritis, compared to static SVV, especially compensated unilateral vestibular neuritis.
How body position changes visual vertical perception after unilateral vestibular loss
2008, Neuropsychologia
Visual vertical perception, posture and equilibrium are impaired in patients with a unilateral vestibular loss. The present study was designed to investigate whether body position (standing upright, sitting on a chair and lying supine) influences the visual vertical perception in Menière's patients tested before and after a unilateral vestibular neurotomy. Data were compared with sex- and age-matched healthy participants. During the first postoperative month the body position strongly influences the visual vertical perception. The ipsilesional deviation of the visual vertical judgment gradually increased from standing upright to sitting and to lying supine. The present data indicate that visual vertical perception improves when postural control is more demanding. This suggests that postural balance is a key reference for vertical perception, at least up to one month after vestibular loss.
The impact examination of the head tilt size on the subjective visual vertical (SVV) among the normal individuals with ages ranged from 18 to 35 years
2022, Hearing, Balance and Communication
The effect of head tilt angle in the roll plane on the virtual subjective visual vertical results in healthy adults
2021, Auditory and Vestibular Research
Subjective visual vertical in virtual reality (Curator SVV): validation and normative data
2018, Virtual Reality

View all citing articles on Scopus

View full text

The subjective horizontal at different angles of roll-tilt in patients with unilateral vestibular impairment

Abstract

Neurol. Clin.

Audio-vestibular findings in patients with vestibular neuritis

Acta Otolaryngol.

The subjective visual vertical as a clinical parameter of vestibular function in peripheral vestibular diseases

J. Vestib. Res.

An analysis of ocular counterrolling in response to body positions in three-dimensional space

J. Vestib. Res.

Visual perception of the horizontal during exposure to radial acceleration on a centrifuge

J. Comp. Physiol. Psychol.

Human otolithic function before and after unilateral vestibular neurorectomy

J. Vestib. Res.

Human ocular torsional position before and after unilateral vestibular neurectomy

Exp. Brain Res.

Linear acceleration perception in the roll plane before and after unilateral vestibular neurectomy

Exp. Brain Res.

Physiology of peripheral neurons innervating otolith organs of the squirrel monkey

J. Neurophysiol.

Recovery from unilateral labyrinthectomy in rhesus monkey

J. Neurophysiol.

Vestibular bidirectional sensitivity

Acta Otolaryngol.