Research Article

Relationship between vestibulo-ocular reflex gain and dizziness handicap inventory score to predict effectiveness of vestibular rehabilitation


Background and Aim: Evaluating the effectiveness of vestibular rehabilitation (VR) in patients with vestibular lesions has always been a challenge. The questionnaires that are used for this purpose mostly show the degree of vestibular disability rather than providing information about improvement of vestibular dysfunction. This study aimed to evaluate whether video head impulse test (vHIT) that is used for the examination of vestibulo-ocular reflex (VOR), is a useful method for predicting the effectiveness of VR and has a correlation with dizziness handicap inventory (DHI) score.
Methods: Participants were 42 patients with unilateral peripheral vestibular hypofunction (UPVH) undergoing VR. Patients were assessed before and after rehabilitation by the vHIT in all ipsilesional and contralesional semicircular can­als (SCCs) and the DHI. The changes in DHI score and VOR gain before and after rehabili­tation, were shown as ΔDHI and ΔVOR and their correlation was evaluated.
Results: VOR gain from ipsilesional and contralesional SCCs was improved significantly after VR. There was a significant strong negative correlation between ΔVOR gain from ipsilesional SCCs and ΔDHI score but no significant correlation was found between the ΔDHI score and ΔVOR gain from contralesional SCCs.
Conclusion: vHIT test is a useful tool to evaluate the effectiveness of VR. VOR gain is correlated with the DHI score. Therefore, the improvement in vHIT results in all three SCCs after VR may be a good predictor of the degree of improvement in dizziness-related disability.

1. Agrawal Y, Ward BK, Minor LB. Vestibular dysfunction: prevalence, impact and need for targeted treatment. J Vestib Res. 2013;23(3):113-7. doi: 10.3233/VES-130498
2. Bronstein AM, Golding JF, Gresty MA, Mandalà M, Nuti D, Shetye A, et al. The social impact of dizziness in London and Siena. J Neurol. 2010;257(2):183-90. doi: 10.1007/s00415-009-5287-z
3. Herdman SJ, Blatt P, Schubert MC, Tusa RJ. Falls in patients with vestibular deficits. Am J Otol. 2000;21(6):847-51.
4. Herdman SJ, Schubert MC, Das VE, Tusa RJ. Recovery of dynamic visual acuity in unilateral vestibular hypofunction. Arch Otolaryngol Head Neck Surg. 2003;129(8):819-24. doi: 10.1001/archotol.129.8.819
5. Strupp M, Magnusson M. Acute unilateral vestibulopathy. Neurol Clin. 2015;33(3):669-85, x. doi: 10.1016/j.ncl.2015.04.012
6. Schubert MC, Migliaccio AA, Clendaniel RA, Allak A, Carey JP. Mechanism of dynamic visual acuity recovery with vestibular rehabilitation. Arch Phys Med Rehabil. 2008;89(3):500-7. doi: 10.1016/j.apmr.2007.11.010
7. Sjögren J, Fransson PA, Karlberg M, Magnusson M, Tjernström F. Functional head impulse testing might be useful for assessing vestibular compensation after unilateral vestibular loss. Front Neurol. 2018;9:979. doi: 10.3389/fneur.2018.00979
8. Herdman SJ. Vestibular rehabilitation. Current opinion in neurology. 2013;26(1):96-101. doi: 10.1097/WCO.0b013e32835c5ec4
9. Rosiak O, Szczepanik M, Woszczak M, Lucas-Grzelczyk W, Józefowicz-Korczyńska M. [Effectiveness of vestibular rehabilitation in patients with vestibular dysfunction]. Med Pr. 2019;70(5):545-53. Polish. doi: 10.13075/mp.5893.00853
10. Yip CW, Strupp M. The dizziness handicap inventory does not correlate with vestibular function tests: a prospective study. J Neurol. 2018;265(5):1210-18. doi: 10.1007/s00415-018-8834-7
11. Viziano A, Micarelli A, Augimeri I, Micarelli D, Alessandrini M. Long-term effects of vestibular rehabilitation and head-mounted gaming task procedure in unilateral vestibular hypofunction: a 12-month follow-up of a randomized controlled trial. Clin Rehabil. 2019;33(1):24-33. doi: 10.1177/0269215518788598
12. Topuz O, Topuz B, Ardiç FN, Sarhus M, Ögmen G, Ardiç F. Eficacy of vestibular rehabilitation on chronic unilateral vestibular dysfunction. Clin Rehabil. 2004;18(1):76-83. doi: 10.1191/0269215504cr704oa
13. Son EJ, Lee DH, Oh JH, Seo JH, Jeon EJ. Correlation between the dizziness handicap inventory and balance performance during the acute phase of unilateral vesti¬bulopathy. Am J Otolaryngol. 2015;36(6):823-7. doi: 10.1016/j.amjoto.2015.07.011
14. Formeister EJ, Krauter R, Kirk L, Zhu TR, Rizk HG, Sharon JD. Understanding the dizziness handicap inventory (DHI): a cross sectional analysis of symptom factors that contribute to DHI variance. Otol Neurotol. 2020;41(1):86-93. doi: 10.1097/MAO.0000000000002438
15. Navari E, Cerchiai N, Casani AP. Assessment of vestibulo-ocular reflex gain and catch-up saccades during vestibular rehabilitation. Otol Neurotol. 2018;39(10):e1111-7. doi: 10.1097/MAO.0000000000002032
16. McCaslin DL, Jacobson GP, Bennett ML, Gruenwald JM, Green AP. Predictive properties of the video head impulse test: measures of caloric symmetry and self-report dizziness handicap. Ear Hear. 2014;35(5):e185-91. doi: 10.1097/AUD.0000000000000047
17. Robertson DD, Ireland DJ. Dizziness handicap inventory correlates of computerized dynamic posturography. J Otolaryngol. 1995;24(2):118-24.
18. Halmagyi GM, Curthoys IS. The video head impulse test in clinical practice. Neurol Sci Neurophysiol. 2018;35(1):1-5.
19. Herdman SJ, Schubert MC, Das VE, Tusa RJ. Recovery of dynamic visual acuity in unilateral vestibular hypofunction. Arch Otolaryngol Head Neck Surg. 2003;129(8):819-24. doi: 10.1001/archotol.129.8.819
20. Jafarzadeh S, Bahrami E, Pourbakht A, Jalaie S, Daneshi A. Validity and reliability of the Persian version of the dizziness handicap inventory. J Res Med Sci. 2014;19(8):769-75.
21. Jacobson GP, Newman CW. The development of the dizziness handicap inventory. Arch Otolaryngol Head Neck Surg. 1990;116(4):424-7. doi: 10.1001/archotol.1990.01870040046011
22. Murnane O, Mabrey H, Pearson A, Byrd S, Akin F. Normative data and test-retest reliability of the SYNAPSYS video head impulse test. J Am Acad Audiol. 2014;25(3):244-52. doi: 10.3766/jaaa.25.3.3
23. Curthoys IS, Manzari L. Clinical application of the head impulse test of semicircular canal function. Hearing Balance Commun. 2017;15(3):113-26. doi: 10.1080/21695717.2017.1353774
24. Redondo-Martínez J, Bécares-Martínez C, Orts-Alborch M, García-Callejo FJ, Pérez-Carbonell T, Marco-Algarra J. Relationship between video head impulse test (vHIT) and caloric test in patients with vestibular neuritis. Acta Otorrinolaringol Esp. 2016;67(3):156-61. doi: 10.1016/j.otorri.2015.07.005
25. Jacobson GP, McCaslin DL. Agreement between functional and electrophysiologic measures in patients with unilateral peripheral vestibular system impairment. J Am Acad Audiol. 2003;14(5):231-8.
26. Batuecas-Caletrio A, Santacruz-Ruiz S, Muñoz-Herrera A, Perez-Fernandez N. The vestibulo-ocular reflex and subjective balance after vestibular schwannoma surgery. Laryngoscope. 2014;124(6):1431-5. doi: 10.1002/lary.24447
27. Eravcı FC, Yılmaz M, Uğur MB, Tutar H, Karamert R, Şansal E, et al. The Relationship of vestibulo-ocular reflex with self-reported dizziness handicap in patients with vestibular deafferentation. Ear Nose Throat J. 2019;145561319880028. doi: 10.1177/0145561319880028
IssueVol 30 No 4 (2021) QRcode
SectionResearch Article(s)
Vestibular rehabilitation follow-up unilateral vestibular hypofunction video head impulse test dizziness handicap inventory

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How to Cite
Hamidi Nahrani M, Akbari M, Maarefvand M. Relationship between vestibulo-ocular reflex gain and dizziness handicap inventory score to predict effectiveness of vestibular rehabilitation. Aud Vestib Res. 2021;30(4):273-279.