Journal of Vestibular Research

An unbiased stereological method was used to assess the effect of aging on the number of neurons in the human medial vestibular nucleus. We studied 13 normal brainstem specimens (age at death from 40 to 93 years) that were part of a prior study that counted neuronal profiles and used a correction factor to estimate the number of neurons in the human vestibular nucleus. On average, we found 151 · 10 3 ( CV = 0.15 ) neurons in the medial vestibular nucleus, which is 18% significant decrease in the number of neurons with aging. This age-related neuronal loss in the vestibular nucleus could have important functional implications regarding the well-known deterioration in balance that occurs with aging.

This study assessed visual-otolith interaction in healthy older humans and compared responses from older subjects to those of younger subjects. Using off-vertical axis rotation (OVAR) to stimulate the otolith organs, eye movement responses, measured using electro-oculography, were recorded during rotation in the dark, rotation with an earth-fixed lighted visual surround, and rotation with a subject-fixed fixation target. Results indicated that older subjects, like young subjects, exhibit a modulation component that was as large during rotation with a lighted earth-fixed visual surround as that seen in the dark and a modulation component during rotation with a subject-fixed visual target that was incompletely suppressed. The modulation component was, in general, larger in the older subjects. This study confirms findings from a previous study of visual-otolith interaction in young subjects and suggests that older subjects, like young subjects, have difficulty visually suppressing the modulation component induced by off-vertical axis rotation.

Twelve subjects, 6 bilateral vestibular-loss (3 well compensated and 3 poorly compensated) and 6 controls, attempted to maintain balance during anterior-posterior sinusoidal surface translation at 6 different frequencies. For frequencies ≤ 0.25 Hz well compensated and control subjects rode the platform by fixing the head and upper-trunk with respect to the support surface, and for frequencies ≥ 0.75 Hz, these subjects fixed their head/upper-trunk in space. Poorly compensated vestibular subjects showed large head and center of mass variability and were unable to balance at frequencies requiring a head fixed in space pattern. All vestibular subjects were less stable with vision than the controls. Without vision, vestibular subjects experienced more falls than the controls at all frequencies, with falls observed in 61% trials and 16% information is important in stabilizing head and upper-trunk motion in space. Visual and somatosensory information can compensate, in part, for vestibular-loss. The results are discussed in light of models that characterize postural control in a vestibular/visual top-down and somatosensory bottom-up manner.

Although patient symptoms and an audiogram can typically identify the affected ear or ears in Ménière's disease, there are some cases where this differentiation is problematic. This paper concentrates on the sole use of vestibular test data to discriminate between unilateral and bilateral Ménière's disease. Patients that were known to have peripheral unilateral vestibular hypofunction (n = 104) were used as learning groups to define a region in multidimensional measurement space consisting of four vestibular test scores which summarized data from electronystagmography, sinusoidal harmonic acceleration, and computerized dynamic posturography tests. A multivariate boundary was created from the unilateral learning group that determined thresholds for identifying bilateral vestibular hypofunction. Patients with bilateral Ménière's disease (n = 23) and with bilateral ototoxicity (n = 19) were then used as test subjects to determine the sensitivity of the multivariate boundary. Results showed up to a increase in estimated test sensitivity (specificity = 95%) bilateral vestibular hypofunction.

This paper discusses the use of vestibular testing to discriminate between right (n = 29) and left (n = 27) Ménière's disease. We examined reduced vestibular response (RVR), directional preponderance, and spontaneous and positional nystagmus measurements from electronystagmography, as well as the asymmetry measurements from the sinusoidal harmonic acceleration test, to determine whether multivariate logistic regression could improve upon the discrimination performance of RVR alone. We found that patients with a spontaneous or positional nystagmus often had a “recovery nystagmus”, beating in the opposite direction of that predicted for an acute lesion. When present, the direction and magnitude of such nystagmus could be used in the classification algorithm to increase the discriminatory power over RVR alone, but in these patients the rotation test asymmetry measurements were rendered useless. In the absence of spontaneous or positional nystagmus, asymmetry measurements significantly enhanced right/left discrimination. Directional preponderance was insignificant in determining the side of lesion.