Predictive Monitoring of High-frequency Vestibulo-ocular Reflex Rehabilitation Following Gentamicin Ototoxicity

Abstract

Nine patients exposed to gentamicin ototoxicity were tested with active head movements to determine their high-frequency (2-6 Hz) horizontal and vertical vestibulo-ocular reflex (VOR) responses. Results showed a common pattern documenting patients' reports of oscillopsia during walking: gains of 0.5 or less, and phases less than 180° A subset of these patients undergoing exercise rehabilitation therapy were tested repeatedly during follow-up visits to monitor changes in their VORs. VOR improvements toward reduced oscillopsia were correlated with patients' reported reduction of symptoms. Each patient's VOR changes over time were monitored with a quantitative least-squares method which predicted results of the next test. based on trends from three or more previous tests. The method was tested by comparing predicted results with actual test results, following the next test. Preliminary results show relatively accurate predictions up to 6 weeks in advance of actual tests, at least when trends of recent, previous tests were in a consistent direction. We conclude that predictive monitoring of changing VOR states can be useful for continuing, or modifying, the course of vestibular rehabilitation therapy, by providing quantitative prediction estimates of future results.

Key Words:

• active head movement
• autorotation testing