STUDY DESIGN: Observational cross-sectional study.
SETTING: Tertiary care center.
PATIENTS: Adult survivors of cancer who had completed cisplatin treatment.
MAIN OUTCOME MEASURES: Patient-reported balance symptoms were evaluated by a semistructured clinical interview. Patients underwent bedside clinical tests including Dynamic Visual Acuity test, Modified Clinical Testing of Sensory Interaction and Balance (CTSIB-m), and vibration sense testing to detect peripheral neuropathy. The video Head Impulse Test (vHIT) of all semicircular canals was performed.
RESULTS: Eleven of 65 patients (17%) reported some balance symptoms after cisplatin therapy, including vertigo, dizziness, unsteadiness, and falls. Vertigo was the most common balance symptom, reported by six patients (9.2%), and the clinical histories of these patients were consistent with benign paroxysmal positional vertigo. Three patients (5%) had abnormal results of the CTSIB-m test, and they were the same patients who reported falls. There was a significant association of peripheral neuropathy detected by vibration test and balance symptoms. All patients had normal vHIT results in all semicircular canals.
CONCLUSIONS: Balance symptoms after cisplatin treatment occurred in 17% of adult cancer survivors. Patients with peripheral neuropathy were more likely to have balance symptoms. The CTSIB-m test is a useful bedside physical examination to identify patients with a high risk of fall. Though there was no vestibular dysfunction detected by the vHIT in cancer survivors after cisplatin therapy, benign paroxysmal positional vertigo was relatively prevalent in this group of patients.
METHODS: Sixty healthy adult subjects aged 22-76-year-old (mean ± standard deviation=47.27 ± 18.29) participated in the head impulse paradigm and suppression head impulse paradigm using the video head impulse test. The Head impulse paradigm was used to assess all 6 semicircular canals, while suppression head impulse paradigm measured only the horizontal canals. Twenty subjects aged 22-40-year-old (25.25 ± 4.9) underwent a second session for the test-retest reliability.
RESULTS: There were good test-retest reliability for both measures (right horizontal head impulse paradigm, intraclass correlation coefficient=0.80; left horizontal head impulse paradigm, intraclass correlation coefficient=0.77; right anterior head impulse paradigm, intraclass correlation coefficient=0.86; left anterior head impulse paradigm, intraclass correlation coefficient=0.78; right posterior head impulse paradigm, intraclass correlation coefficient=0.78; left posterior head impulse paradigm, intraclass correlation coefficient=0.75; right horizontal suppression head impulse paradigm, intraclass correlation coefficient=0.76; left horizontal suppression head impulse paradigm, intraclass correlation coefficient=0.79). The test-retest reliability for suppression head impulse paradigmanti-compensatory saccade latency and amplitude were moderate (right latency, intraclass correlation coefficient=0.61; left latency, intraclass correlation coefficient=0.69; right amplitude, intraclass correlation coefficient=0.69; left amplitude, intraclass correlation coefficient=0.58). There were no significant effects of age on head impulse paradigm and suppression head impulse paradigm vestibulo-ocular reflex gain values and suppression head impulse paradigmsaccade latency. However, the saccade amplitude became smaller with increasing age, P < .001. The horizontal suppression head impulse paradigm vestibuloocular reflex gain values were significantly lower than the head impulse paradigm for both sides (right, P = .004; left, P = .004).
CONCLUSION: There was good test-retest reliability for both measures, and the gain values stabilized with age. However, suppression head impulse paradigm anti-compensatory saccade latency and amplitude had lower test-retest reliability than the gain. The suppression head impulse paradigm vestibulo-ocular reflex gain was lower than the head impulse paradigm and its anti-compensatory saccade amplitude reduced with increasing age.