Completed Research Projects in 2015:
Subjective Visual Vertical iPhone App Validation for detecting Vestibular Dysfunction
The subjective visual vertical (SVV) test is the primary test available to assess for dysfunction of the utricle, one of the 2 otolith organs. Unfortunately, the SVV test, like other vestibular tests, requires complex and expensive equipment in a specialized vestibular lab, greatly limiting its accessibility to most health care practitioners. An iPhone application has been developed to provide a practical and relatively easy method for testing the SVV without any specialized equipment. In this study, we formally validated use of this iPhone app compared to the standard SVV testing technique in both healthy control subjects and those with vestibular dysfunction in a pediatric age group. We tested 39 patients between the ages of 7 and 18 and found that the iPhone app SVV is a simple, office-based tool for detecting peripheral vestibular loss in children.
Brodsky JR, Cusick BA, Kawai K, Kenna MA, Zhou G. Peripheral Vestibular Loss Detected in Pediatric Patients using a Smartphone-based Test of the Subjective Visual Vertical. International Journal of Pediatric Otorhinolaryngology 2015; Epub ahead of print.
Using VHIT for Vestibular Migraine and BPPV testing
Vestibular migraine (VM) is a common disorder that causes vestibular symptoms, such as vertigo and imbalance, in conjunction with migraine symptoms such as headache, vision changes, and sound sensitivity. Benign paroxysmal vertigo of childhood (BPVC) is another vestibular disorder that is thought to have a close relationship to migraine. This disorder presents with intermittent, brief episodes of severe vertigo in children with onset of symptoms typically beginning prior to five years of age and resolving by the age of nine in nearly all cases. The fact that there is a close relationship between migraines and vestibular dysfunction is well established, yet the specific nature of this relationship is unknown. It is particularly unclear whether this dysfunction occurs at the level of the brain, the peripheral vestibular sensory organs in the inner ear, or both. We used the Interacoustics VHIT device to evaluate the function of each individual semicircular canal in children with VM and BPVC as well as healthy children to determine whether interictal impairments in peripheral vestibular function do occur in children with these vestibular migraine variant disorders.
Hamilton SS, Zhou G, Brodsky JR. Video Head Impulse Testing (VHIT) in the Pediatric Population. International Journal of Pediatric Otorhinolaryngology 2015;79(8):1283-7.
Vestibular migraine variants are disorders that present with dizziness or vertigo that are thought to be attributable to migraine-like processes in the brain. There is no standard approach to the medical work-up of children with vestibular migraine. Specifically, it is unclear when certain expensive and time-consuming ancillary tests are necessary, including MRI, EEG, and vestibular testing. This study aimed to determine how often children that are labeled with this diagnosis actually fit the clinical criteria for this disorder and how often their diagnosis may actually be contradicted by ancillary test findings that suggest an alternative diagnosis. We hoped that this would provide evidence of a need for a modified version of the clinical diagnostic criteria for this disorder designed for the pediatric population. We retrospectively reviewed children 18 years of age or younger who were seen at Boston Children’s Hospital in the past 2 years for both headache and vertigo/dizziness and looked for degrees of variability adequate to warrant the creation of a modified set of clinical diagnostic criteria for vestibular migraine variant in children.
Brodsky JR, Cusick BA, Zhou G. Evaluation and Management of Vestibular Migraine in Children: Experience from a Pediatric Vestibular Clinic. European Journal of Paediatric Neurology 2015; Epub ahead of print.
Objective Vestibular Testing of Children with Dizziness and Balance Complaints Following Sports-Related Concussions
The goal of this study was to conduct an objective assessment of children with balance and vestibular complaints following sports-related concussions and identify the underlying deficits by analyzing laboratory test outcomes retrospectively. We found that vestibular impairment is common among children with protracted dizziness or imbalance following sports-related concussion. Our study demonstrated that proper and thorough evaluation is imperative to identify these underlying deficits and laboratory tests were helpful in the diagnosis and recommendation of following rehabilitations.
Zhou G, Brodsky JR. Objective Vestibular Testing of Children with Dizziness and Balance Complaints Following Sports-Related Concussions. Otolaryngology – Head & Neck Surgery 2015;152(6):1133-9.
Subjective visual vertical testing in children and adolescents
Subjective visual vertical (SVV) is a vestibular test commonly used in adults that has not been well studied in children. In this test, the patient aligns a projected line with the perceived true vertical. Deviation of >2° is usually associated with utricular dysfunction and may also be seen with central vestibular lesions. The goal of this study was to determine the efficacy of SVV in children. We studied children between the ages of 7 and 18 years with and without dizziness and tested them with SVV in addition to other routine vestibular testing. We found that SVV is a simple, noninvasive test that provides a valuable contribution to the assessment of peripheral vestibular function in children.
Brodsky JR, Cusick BA, Kenna MA, Zhou G. Subjective visual vertical testing in children and adolescents. Laryngoscope 2015; Epub ahead of print.
Completed Research Projects in 2014:
Otologic outcomes after blast injury
Otologic trauma was the most common physical injury sustained after the April 15, 2013, Boston Marathon bombings. The goal of this study was to describe the resultant otologic morbidity and to report on early outcomes. Children and adults seen for otologic complaints related to the Boston Marathon bombings comprised the study population. Participants completed symptom assessments, quality-of-life questionnaires, and audiograms at initial and 6-month visits. Otologic evaluation and treatment, including tympanoplasty results, were reviewed. We found that Blast-related otologic injuries constituted a major source of ongoing morbidity after the Boston Marathon bombings. Continued follow-up and care of this patient population are warranted.
Remenschneider AK, Lookabaugh S, Aliphas A, Brodsky JR, Devaiah AK, Dagher W, Grundfast KM, Heman-Ackah SE, Rubin S, Sillman J, Tsai AC, Vecchiotti M, Kujawa SG, Lee DJ, Quesnel AM. Otologic outcomes after blast injury: the Boston Marathon experience. Otology – Neurotology 2014;35(10):1825-34.
Completed Research Projects in 2013:
Impaired habituation of the auditory brainstem response in migrainous vertigo
In this study, we sought to evaluate the auditory brain stem response (ABR) in migrainous vertigo (MV). We tested subjects who met criteria for non-migrainous vertigo, migrainous vertigo, and control subjects. We found that the habituation of IV-V amplitude is reduced during MV attacks. This finding suggests impaired brain stem inhibition at the level of the inferior colliculus, which shares serotonergic connections with the dorsal raphe nucleus, an area hyperactive in migraine.
Brodsky JR, Mejico , Giraud A, and Woods CI. Impaired habituation of the auditory brainstem response in migrainous vertigo. Annals of Otology, Rhinology, and Laryngology 2013;122(5):308-15.