Different time course of compensation of subjective visual vertical and ocular torsion after acute unilateral vestibular
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OTOLOGY
Different time course of compensation of subjective visual vertical and ocular torsion after acute unilateral vestibular lesion Mario Faralli1 · Giampietro Ricci1 · Leonardo Manzari2 · Giulia Zambonini1 · Ruggero Lapenna1 · Vito Enrico Pettorossi3 Received: 27 June 2020 / Accepted: 19 August 2020 © The Author(s) 2020
Abstract Purpose Time course of the recovery of otolithic dis-function caused by superior vestibular neuritis has been examined in fifteen patients. Methods The subjective visual vertical (SVV) and the ocular cyclotorsion (OT) have been measured four times after the acute episode up to 1 year Results In most of the patients the SVV tilt returned to control values within few months (3–6 months) after the acute episode, while OT remained out of normal range in almost all patients a year later. Conclusion The abnormal OT observed after 1 year from the acute episode of vestibular neuritis, suggests that the otolithic receptors remained altered for several months and the OT may be a good indicator of the entity of the residual peripheral otolithic lesion. Moreover, the dissociation between the SVV tilt recovery and that of OT supports the issue that the two signs of the otolithic disfunction are only partially linked each other with centrally or peripherally distinct re-balancing circuits. Keywords Subjective visual vertical · Ocular cyclotorsion · Vestibular neuritis · Vestibular compensation · Otolithic receptors · Ocular tilt reaction
Introduction Ocular nystagmus, posture instability and vertigo are common symptoms after unilateral vestibular lesion [1–3]. Thereafter, the vestibular static and dynamic symptoms gradually attenuated together with the improvement of the quality of life [4, 5]. This process is due to peripheral recovery of the afferent activity or vestibular compensation, due to central adaptation taking place in the central nervous system. Vestibular clinical examinations among these patients have been traditionally based on the assessment of the signs of semicircular canal disfunction. However, the alteration of the otolithic receptors is also taken into consideration for * Vito Enrico Pettorossi [email protected] 1
Department of Surgical and Biomedical Sciences, Section of Otorhinolaryngology, University of Perugia, Perugia, Italy
2
MSA ENT Academy Center, Cassino, Italy
3
Department of Experimental Medicine, Section of Physiology and Biochemistry, University of Perugia, Via Gambuli 1, Perugia, Italy
fully evaluating the vestibular damage and the subsequent compensation [6]. The subjective visual vertical (SVV) [7, 8], the ocular tilt reaction [head tilt, skew deviation and ocular cyclotorsion (OT)] [9–12], vestibular evoked myogenic potentials (oVEMPs, cVEMPs) [12, 13] and the linear vestibulo-ocular reflex (LVOR) [14] are used for investigating the otolithic function, in combination with the test of the equilibrium using stabilometry tests. How otolithic functions recover overtime after unilateral vestibular damage or compensates the imbalan
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