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Effect of Intensity Level and Speech Stimulus Type on the Vestibulo-Ocular Reflex DOI: 10.3766/Jaaa.18016

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Effect of Intensity Level and Speech Stimulus Type on the Vestibulo-Ocular Reflex DOI: 10.3766/Jaaa.18016 J Am Acad Audiol 30:792–801 (2019) Effect of Intensity Level and Speech Stimulus Type on the Vestibulo-Ocular Reflex DOI: 10.3766/jaaa.18016 Mary Easterday* Patrick N. Plyler* James D. Lewis* Steven M. Doettl* Abstract Background: Accurate vestibulo-ocular reflex (VOR) measurement requires control of extravestibular suppressive factors such as visual fixation. Although visual fixation is the dominant suppressor and has been extensively studied, the mechanisms underlying suppression from nonvisual factors of attention and auditory stimulation are less clear. It has been postulated that the nonvisual suppression of the VOR is the result of one of two mechanisms: (1) activation of auditory reception areas excites efferent pathways to the vestibular nuclei, thus inhibiting the VOR or (2) cortical modulation of the VOR results from directed attention, which implies a nonmodality-specific process. Purpose: The purpose of this research was to determine if the VOR is affected by the intensity level and/ or type of speech stimulus. Research Design: A repeated measures design was used. The experiment was single-blinded. Study Sample: Participants included 17 adults (14 females, three males) between the ages of 18–34 years who reported normal oculomotor, vestibular, neurological, and musculoskeletal function. Data Collection and Analysis: Each participant underwent slow harmonic acceleration testing in a ro- tational chair. VOR gain was assessed at 0.02, 0.08, and 0.32 Hz in quiet (baseline). VOR gain was also assessed at each frequency while a forward running speech stimulus (attentional) or a backward running speech stimulus (nonattentional) was presented binaurally via insert earphones at 42, 62, and 82 dBA. The order of the conditions was randomized across participants. VOR difference gain was calculated as VOR gain in the auditory condition minus baseline VOR gain. To evaluate auditory efferent function, the medial olivocochlear reflex (MOCR) was assayed using transient-evoked otoacoustic emissions (right ear) measured in the presence and absence of broadband noise (left ear). Contralateral acoustic reflex thresholds were also assessed using a broadband noise elicitor. A three-way repeated measures anal- ysis of variance was conducted to evaluate the effect of frequency, intensity level, and speech type on VOR difference gain. Correlations were conducted to determine if difference gain was related to the strength of the MOCR and/or to the acoustic reflex threshold. Results: The analysis of variance indicated that VOR difference gain was not significantly affected by the intensity level or the type of speech stimulus. Correlations indicated VOR difference gain was not sig- nificantly related to the strength of the MOCR or the acoustic reflex threshold. Conclusions: The results were in contrast to previous research examining the effect of auditory stim- This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited. ulation on VOR gain as auditory stimulation did not produce VOR suppression or enhancement for most of the participants. Methodological differences between the studies may explain the discrepant results. The removal of an acoustic target from space to attend to may have prevented suppression or enhance- ment of the VOR. Findings support the hypothesis that VOR gain may be affected by cortical modulation through directed attention rather than due to activation of efferent pathways to the vestibular nuclei. *Department of Audiology and Speech Pathology, University of Tennessee Health Science Center, Knoxville, TN Corresponding author: Mary Easterday, Department of Audiology and Speech Pathology, University of Tennessee Health Science Center, Knox- ville, TN 37996-0740; Email: [email protected] This research was supported by a student investigator award from the American Academy of Audiology Foundation. Poster presentation at the 29th Annual American Academy of Audiology National Convention (Indianapolis, IN, April 7, 2017). 792 VOR/Easterday et al Key Words: assessment, MOCR, medial olivocochlear reflex, tasking, TEOAE, transient evoked otoacoustic emissions, vestibular, vestibulo-ocular reflex, VNG, VOR Abbreviations: CD 5 critical difference; MOCR 5 medial olivocochlear reflex; RCT 5 rotary chair testing; RMS 5 root mean square; SHS 5 sinusoidal harmonic acceleration; SPV 5 slow-phase velocity; TEOAEs 5 transient-evoked otoacoustic emissions; VOR 5 vestibulo-ocular reflex INTRODUCTION consists of a slow compensatory phase as eyes drift away from center as the head moves followed by a fast he vestibular system is responsible for translat- corrective phase as eyes quickly return to center. The ing afferent biological signals associated with relationship between the slow phase velocity of the T head rotation and gravitational forces into effer- nystagmus and the speed of the head/body movement ent biological signals for motor control of the muscu- is known as the VOR gain (VOR gain 5 slow phase loskeletal and ocular systems. The resulting motor velocity/velocity of rotation). A gain of 1 or 100% corre- responses are responsible for maintaining postural sponds to nystagmus that is equal in magnitude but and ocular stability (i.e., balance and spatial orienta- opposite in direction of the rotational head movement. tion; Baloh et al, 2011). Thus, normal balance function Although the VOR is responsive to vestibular input, it and maintenance depend on the vestibular sensory can be overridden (suppressed) by visual input, as at periphery sending the proper afferent signals to the times the VOR is an inappropriate response to maintain central vestibular system and the central vestibular proper vision. For example, in the case of visually track- system sending the proper efferent motor signals to ing a moving target, such as tracking a ball that has the ocular muscles and/or spinal cord. There are three been thrown, the VOR is suppressed by the visual input motor reflexes directly related to the vestibular periph- as it would be counterintuitive to initiate a movement in eral input and central regulation: the vestibulo-ocular the opposite direction of the movement of the head when reflex (VOR), vestibulo-spinal reflex, and vestibulo-colic the goal is to keep the eyes moving with the head to reflex. The VOR specifically is useful for evaluation of track the flight of the ball (Halmagyi and Gresty, vestibular function because of more direct innervation 1979). However, clinical vestibular evaluations require of the peripheral vestibular projections into the oculo- measurement of the VOR free of any amount of sup- motor pathway (Bronstein et al, 2015). pression to ensure accurate results. Therefore, visual The VOR is responsible for stabilizing stationary im- suppression is prevented during vestibular assess- ages on the fovea of the retina during active high inten- ment by conducting testing with the eyes closed or in to- sity (,2Hzor80°/sec) head rotation. In other words, the tal darkness. With visual suppression controlled, the VOR is necessary for clear and stable foveal vision during VOR is induced through head/body movement and mea- motion (Goebel et al, 2000). The stabilization of the im- sured quantitatively. Whereas visual input suppresses age is achieved through the head rotation activating the the VOR, the effect of nonvisual input is less clear (Barr vestibular end organs. The end organs then send the af- et al, 1976; Moller et al, 1990; Jacobson et al, 2012). ferent signals to the vestibular nuclei, which routes the Barr et al (1976) assessed VOR gain using RCT in the information to the ocular motor pathways to generate following nonvisual conditions on adults: imaginary the efferent motor reflex. The VOR functions through stationary target, mental arithmetic, and imaginary a three-neuron arc system with sensory, inter, and motor moving target. Results indicated the imaginary station- neurons. The pathway runs via cranial nerves VIII ary target had the highest VOR gain (0.94–0.96), fol- (vestibulocochlear), III (oculomotor), and VI (abducens) lowed by mental arithmetic (0.65–0.97), and then the (Purves et al, 2001; Bronstein et al, 2015). The vestibular imaginary moving target (0.32–0.64). These findings in- nuclei operate as a pair between ears. The side that is dicated significant VOR gain reduction for mental ar- This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited. being stimulated/excited extends the excitatory signals ithmetic and imaginary moving targets, but minimal to the contralateral oculomotor nuclei while also sending VOR gain change for the imaginary stationary target. inhibitory signals ipsilaterally, thus eliciting the motor The authors noted high interparticipant and intrapar- reflex of the eye. Ideally, the reflex results in eye movement ticipant variability, with some individuals going from that is opposite in direction and equal in magnitude relative significant suppression to full enhancement simply by to the head movement, which fixates the eye on a visual changing their imagined frame of reference from a tar- target and maintains foveal vision (Goumans et al, 2010). get that moved or rotated with the chair to a target that When the vestibular system is stimulated with ro- was fixed or stationary in space. tational head or body movement as with rotary chair Moller et al (1990) assessed VOR gain using RCT in testing (RCT), the VOR presents as a nystagmic eye similar conditions as Barr et al (1976) but added acous- movement as it aims to maintain
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