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Corrective Saccades in Unilateral and Bilateral Vestibular Hypofunction During Slow Rotation Expressed by Visually Enhanced VOR and VOR Suppression: Role of the Cerebellum

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Abstract

In clinical practice, the head impulse test paradigm (HIMP) and the suppression head impulse paradigm (SHIMP) stimulate high-frequency head movements so that the visual system is temporarily suppressed. The two tests could also be useful tools for vestibular assessment at low frequencies: VVOR (visually enhanced vestibulo-ocular reflex) and VORS (vestibulo-ocular reflex suppression). The aim of this study is to analyze the eye movements typically found during VVOR and VORS testing in patients with unilateral and bilateral vestibular hypofunction. Twenty patients with unilateral vestibular hypofunction, three patients with bilateral vestibular hypofunction, and ten patients with normal vestibular function (control group) were analyzed through VVOR and VORS testing with an Otometrics ICS Impulse system. During the VVOR test, patients with unilateral vestibular hypofunction exhibited corrective saccades to the same direction of the nystagmus fast phase toward the healthy side when the head rotates toward the affected side, while patients with bilateral vestibular hypofunction exhibited corrective saccades to the opposite side of head movements to each side. During the VORS test, patients with unilateral vestibular hypofunction seem to exhibit larger corrective saccades to the healthy side when the head was moved to this side, while patients with bilateral vestibular hypofunction did not exhibit corrective saccades during head movements to either side. Our data suggest that the VVOR and VORS tests yield the same diagnostic information as the HIMP and SHIMP tests in unilateral and bilateral vestibular hypofunction, and can contribute to the diagnosis of a peripheral vestibular loss as well as the affected side.

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Funding

KPW acts as an unpaid consultant and has received funding for travel from Otometrics.

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Authors and Affiliations

  1. Universidade Federal do Espirito Santo, Vitória, Espirito Santo, Brazil

    Bernardo Faria Ramos

  2. Universidade Federal do Para, Belém, Brazil

    Renato Cal

  3. Universidad Nacional de Rosario, Rosario, Argentina

    Sergio Carmona

  4. Departments of Neurology and Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland

    Konrad P. Weber

  5. Preceptor of ENT Residency Program, PUC-RS, Porto Alegre, Brazil

    Francisco Zuma e Maia

Authors
  1. Bernardo Faria Ramos
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  2. Renato Cal
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  3. Sergio Carmona
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  4. Konrad P. Weber
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  5. Francisco Zuma e Maia
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Corresponding author

Correspondence to Bernardo Faria Ramos.

Ethics declarations

This is a prospective study conducted in accordance with the Declaration of Helsinki and approved by the Research Ethics Committee of Brazilian Lutheran University (ULBRA RS) in Canoas (CAEE 06137012.3.2002.5349). All subjects participated voluntarily and informed consent was obtained from all individual participants included in the study.

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Ramos, B.F., Cal, R., Carmona, S. et al. Corrective Saccades in Unilateral and Bilateral Vestibular Hypofunction During Slow Rotation Expressed by Visually Enhanced VOR and VOR Suppression: Role of the Cerebellum. Cerebellum 20, 673–677 (2021). https://doi.org/10.1007/s12311-019-01066-w

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  • DOI: https://doi.org/10.1007/s12311-019-01066-w

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