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Binocular Alignment Changes Between Sitting and Supine Positions in Patients with Dizziness

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Abstract

Vertical and torsional ocular misalignment can occur from mild traumatic brain injury or inner ear pathology, which may vary depending on head position. Here, we evaluate differences in a behavioral measure of binocular alignment in both upright and supine head position. Ocular perception of vertical and torsional alignment was measured using the torsional and vertical alignment nulling (TAN, VAN) task in N = 52 veterans with dizziness (N = 38 with traumatic brain injury), N = 41 civilians with vestibular schwannoma resection (UVD), and N = 33 healthy controls for both positions. The interquartile range within each group, regardless of head position, was greater for torsional compared to vertical misalignment. We use generalized estimating equations to compare average TAN (torsional) scores and VAN (vertical) scores between groups and test position. Compared to the healthy controls, TAN was significantly increased by + 0.4186° in veterans (P = 0.030) and by + 0.5747° in UVD (P = 0.010), but there was no difference with head position. For VAN, no difference was found between the three groups, but the misalignment did worsen by 0.0888° (P = 0.0070) as the head position moved from upright to supine. Head position had negligible effects on this behavioral measure of vertical and torsional binocular misalignment, and torsional misalignments were worse than controls in both veterans with dizziness and patients with vestibular nerve resection although neither reported torsional diplopia. Our data suggests that the tolerance for roll misalignment may be abnormally large in patients with dizziness. Alternatively, perceptual roll misalignments may be a manifest cause for dizziness, and therefore a useful proxy for distinguishing differences in putative otolith function in veterans with dizziness.

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Funding

This work was supported in part by the Department of Defense under the Neurosensory and Rehabilitation Research Award Program (Grant Award Number: W81XWH-15–1-0442).

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Authors and Affiliations

  1. Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 N. Caroline Street, 6th Floor, Baltimore, MD, 21287-0910, USA

    Matthew Ryan Tan & Michael C. Schubert

  2. Department of Biomedical Engineering, Rutgers New Jersey Medical School, Newark, NJ, USA

    Jorge Serrador

  3. Department of Pharmacology, Physiology and Neuroscience, Rutgers Biomedical Health Sciences, Newark, NJ, USA

    Jorge Serrador

  4. Bloomberg School of Public Health, Department of International Health, Johns Hopkins University, Baltimore, MD, USA

    Jamie Perin

  5. Department of Physical Therapy, Faculty of Social Welfare & Health Studies, University of Haifa, Haifa, Israel

    Yoav Gimmon

  6. Department of Otolaryngology-Head and Neck Surgery, Sheba Medical Center, Tel-Hashomer, Israel

    Yoav Gimmon

  7. Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA

    Jennifer Millar & Michael C. Schubert

  8. Department of Veteran Affairs, War Related Illness and Injury Study Center, Veterans Biomedical Institute, East Orange, NJ, USA

    Kelly Brewer

  9. Department of Neurology, Johns Hopkins University, Baltimore, MD, USA

    Dan Gold

  10. Department of Ophthalmology, Johns Hopkins University, Baltimore, MD, USA

    Dan Gold

  11. Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA

    Dan Gold

  12. Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA

    Dan Gold

  13. Department of Medicine, Johns Hopkins University, Baltimore, MD, USA

    Dan Gold

Authors
  1. Matthew Ryan Tan
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  2. Jorge Serrador
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  3. Jamie Perin
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  4. Yoav Gimmon
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  5. Jennifer Millar
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  6. Kelly Brewer
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  7. Dan Gold
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  8. Michael C. Schubert
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Correspondence to Michael C. Schubert.

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Tan, M.R., Serrador, J., Perin, J. et al. Binocular Alignment Changes Between Sitting and Supine Positions in Patients with Dizziness. JARO 23, 427–433 (2022). https://doi.org/10.1007/s10162-022-00845-3

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  • DOI: https://doi.org/10.1007/s10162-022-00845-3

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