Decrease of Horizontal Canal Vestibulo-Oculomotor Reflex Gain in the Elderly with Dysequilibrium without Lifetime Vertigo

ORL J Otorhinolaryngol Relat Spec. 2017;79(3):178-184. doi: 10.1159/000473894. Epub 2017 May 10.

Abstract

Background/aims: Unsteadiness in the elderly is a frequent complaint and a strong predictor of falls and psychological distress. Although there is a general consensus that it is a multifactorial condition, recent studies have focused on the role of aging of the vestibular system as a possible cofactor. The aim of our work was to assess horizontal canal function in the elderly.

Methods: We evaluated the gain of horizontal vestibulo-ocular reflex (VOR) with a video head impulse test on a sample of 58 subjects aged >70 years without lifetime episodes of vertigo and correlated the value with different clinical conditions (hypertension, diabetes, prior cardiovascular and vascular disorders of the central nervous system, and falls).

Results: The mean value of the gain was 0.86 ± 0.12, and people aged between 70 and 80 years presented higher values (0.90 ± 0.1) compared to those >80 years (0.81 ± 0.13; p = 0.025). Previous vascular disorders of the central nervous system were a predictor of decreased VOR gain (p = 0.0003). A nonparametric analysis demonstrated that sex, age, and VOR gain (p ˂ 0.0001) were predictive of falls.

Conclusions: Our data support the hypothesis of a decrease of VOR gain in the elderly. The decrease of canal function may therefore play a role in the risk of falls in the elderly.

Keywords: Dysequilibrium; Elderly; Presbystasis; Vestibular function; Vestibulo-ocular reflex; Video head impulse test.

MeSH terms

  • Accidental Falls / prevention & control
  • Accidental Falls / statistics & numerical data*
  • Aged
  • Aged, 80 and over
  • Cerebellar Ataxia / diagnosis*
  • Cerebellar Ataxia / epidemiology
  • Cohort Studies
  • Female
  • Geriatric Assessment / methods
  • Head Impulse Test / methods*
  • Humans
  • Incidence
  • Intellectual Disability / diagnosis*
  • Intellectual Disability / epidemiology
  • Male
  • Predictive Value of Tests
  • Reflex, Vestibulo-Ocular*
  • Retrospective Studies
  • Risk Assessment
  • Semicircular Canals / physiopathology
  • Vertigo / diagnosis*
  • Vertigo / epidemiology

Supplementary concepts

  • Dysequilibrium syndrome