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Fulltext Considerations when Analyzing Vestibular Evoked Myogenic Potential (VEMP) Outcomes Elicited by Chirp Stimulus in Healthy Participants

Zakaria MN, Zainun Z, Cheu Lih A

J Int Adv Otol, 2015 Dec;11(3):271-2.
PMID: 26915164 DOI: 10.5152/iao.2015.1703
Fulltext Clinical use of Malay Version of Vertigo Symptom Scale (MWSS) in patients with peripheral vestibular disorder (PVD)

Zainun Z, Zakaria MN, Sidek D, Ismail Z

Med J Malaysia, 2012 Aug;67(4):386-9.
PMID: 23082446

The Vertigo symptom scale (VSS) is a well established tool for the evaluation of vestibular disorders and the associated symptoms of autonomic arousal and somatosensation. By using a validated Malay version of vertigo symptom scale (MVVSS) questionnaire, the severity of the vertigo from patients' perspective can be determined and rated. Before MVVSS can be applied clinically among Malaysians, it was of interest to determine its clinical value in identifying vestibular disorders.
The influences of age, gender and geometric pattern of visual image on the verticality perception: A subjective visual vertical (SVV) study among Malaysian adults

Zakaria MN, Salim R, Tahir A, Zainun Z, Mohd Sakeri NS

Clin Otolaryngol, 2019 03;44(2):166-171.
PMID: 30411501 DOI: 10.1111/coa.13255

OBJECTIVES: Subjective visual vertical (SVV) is a simple, quick and reliable test for measuring utricular function. The literature on the effects of fundamental demographic variables such as age and gender on SVV is inconclusive and should be supported by research with larger samples. The aim of the present study was to determine the influences of age, gender and geometric pattern of visual image on SVV among healthy adults.
STUDY DESIGN: This study employed a repeated measures design.
SETTINGS: Otorhinolaryngology Clinic, Hospital Universiti Sains Malaysia, Malaysia.
PARTICIPANTS: Eligible Malaysian adults (N = 187, aged 21-75 years) were recruited and categorised into young (N = 60), middle-aged (N = 66) and older (N = 61) groups. Most of them were Malay, and 51.3% were men.
MAIN OUTCOME MEASURES: Subjective visual vertical angles (in degrees) were determined from each participant in a static upright condition using a computerised SVV device. They were asked to indicate their verticality perception for three types of visual images (solid line, dotted line and arrow pattern).
RESULTS: Three-way mixed ANOVA revealed insignificant influences of age and gender on SVV results (P > 0.05). In contrast, mean SVV angles were significantly higher for the arrow pattern than for other visual images (P = 0.004).
CONCLUSION: While the insignificant influences of age and gender on static SVV are further ascertained with larger samples, the perception of verticality is less accurate when aligning a more geometrically complex visual image (ie, arrow pattern). Further SVV research on vestibular-disordered patients is beneficial, particularly to verify the normative data obtained with this complex visual image.
Fulltext The Test-Retest Reliability of Subjective Visual Horizontal Testing: Comparisons between Solid and Dotted Line Images

Zakaria MN, Wahat NHA, Zainun Z, Sakeri NSM, Salim R

J Audiol Otol, 2020 Apr;24(2):107-111.
PMID: 31995977 DOI: 10.7874/jao.2019.00297

The present study aimed to determine the test-retest reliability of subjective visual horizontal (SVH) testing when tested with solid and dotted line images. In this repeated measures study, 36 healthy young Malaysian adults (mean age=23.3±2.3 years, 17 males and 19 females) were enrolled. All of them were healthy and had no hearing, vestibular, balance, or vision problems. The SVH angles were recorded from each participant in an upright body position using a computerized device. They were asked to report their horizontality perception for solid and dotted line images (in the presence of a static black background). After 1 week, the SVH procedure was repeated. The test-retest reliability of SVH was found to be good for both solid line [intraclass correlation (ICC)=0.80] and dotted line (ICC=0.78). As revealed by Bland-Altman plots, for each visual image, the agreements of SVH between the two sessions were within the clinically accepted criteria (±2°). The SVH testing was found to be temporally reliable, which can be clinically beneficial. Both solid and dotted lines in the SVH testing are reliable to be used among young adults.
The influence of type of visual image and gender on the perception of horizontality: a subjective visual horizontal (SVH) study

Zakaria MN, Tahir A, Zainun Z, Salim R, Mohd Sakeri NS, Abdul Wahat NH

Acta Otolaryngol, 2021 Jan;141(1):62-65.
PMID: 32957810 DOI: 10.1080/00016489.2020.1817552

BACKGROUND: The graviceptive otolith function can be measured using subjective visual horizontal (SVH) testing. Nevertheless, more research efforts are required to understand the essential variables affecting SVH.
OBJECTIVE: The aim of the present study was to determine the effects of type of visual image and gender on subjective visual horizontal (SVH) perception among healthy adults.
MATERIALS AND METHODS: In this comparative study, 50 healthy young adults were enrolled. While in an upright body position, they were required to report their perception of horizontality for two types of visual images (solid line and arrow pattern) using a computerized SVH device.
RESULTS: The arrow pattern produced significantly bigger SVH angles than the solid line (p < .001). In contrast, no significant influence of gender was found on SVH results (p = .743), Based on the statistical outcomes, the preliminary normative data for SVH were established.
CONCLUSIONS AND SIGNIFICANCE: The arrow pattern (a more complex visual image) produced bigger SVH deviations than the simple solid line image. In contrast, the horizontality perception does not appear to be affected by gender. The preliminary normative SVH data gathered from the present study can be beneficial for clinical and future research applications.
Home-based Vestibular Rehabilitation: A Feasible and Effective Therapy for Persistent Postural Perceptual Dizziness (A Pilot Study)

Teh CS, Abdullah NA, Kamaruddin NR, Mohd Judi KB, Fadzilah I, Zainun Z, et al.

Ann Otol Rhinol Laryngol, 2023 May;132(5):566-577.
PMID: 35794811 DOI: 10.1177/00034894221111408

INTRODUCTION: Persistent postural-perceptual dizziness (PPPD) is a chronic functional vestibular disorder where there is persistent dizziness or unsteadiness occurring on most days for more than 3 months duration. Treatment recommendations for PPPD include vestibular rehabilitation therapy (VRT) with or without medications and/or cognitive behavioral therapy.
OBJECTIVES: This paper is a pilot study designed to compare the effects of Bal Ex as a home-based VRT on the quality of life (EQ-5D), dizziness handicap (DHI) and mental health (DASS-21) against hospital-based VRT.
DESIGN: This was an assessor-blinded, randomized controlled pilot study where PPPD patients were randomly selected to undergo Bal Ex, the home-based VRT (intervention group) or hospital-based (control group) VRT. The participants were reviewed at 4 weeks and 12 weeks after the start of therapy to assess the primary endpoints using the subjective improvement in symptoms as reported by patients, changes in DHI scores, DASS-21 scores and EQ5D VAS scores.
RESULTS: Thirty PPPD patients successfully completed the study with 15 in each study group. Within 4 weeks, there were significant improvements in the total DHI scores as well as anxiety levels. By the end of 12 weeks, there were significant improvements in the DHI, DASS-21 and EQ5D. The degree of improvement between Bal Ex and the control was comparable.
CONCLUSION: VRT is an effective modality in significantly improving quality of life, dizziness handicap, depression, and anxiety levels within 3 months in PPPD. Preliminary results show Bal Ex is as effective as hospital-based VRT and should be considered as a treatment option for PPPD.