Decompression Sickness Clinical Trial
Official title:
A Prospective and Retrospective Observational Study of Symptoms and Mechanisms of Recovery in People With Inner Ear Decompression Sickness (IEDS)
NCT number | NCT06370897 |
Other study ID # | 337421 |
Secondary ID | |
Status | Not yet recruiting |
Phase | |
First received | |
Last updated | |
Start date | June 2024 |
Est. completion date | September 2028 |
Verified date | May 2024 |
Source | University of Plymouth |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Observational |
Inner Ear Decompression sickness (IEDS) accounts for 20% of all types of decompression sickness (the bends) in divers. The condition commonly affects the peripheral vestibular system (inner ear). IEDS results in acute symptoms of dizzyness (vertigo) and imbalance. Even with the recommended treatment of hyperbaric oxygen therapy some people do not recovery fully. However, even in the presence of a permanent vestibular deficit many people can show a behavioural recovery where symptoms improve over time. Recovery can be aided by vestibular rehabilitation (VR) which is now routine for acute IEDS but was not provided before 2021, and is not widespread across the UK (United Kingdom) or world, meaning people may have a suboptimal recovery. This project will investigate if and how people recover after an acute episode of IEDS and whether people who had IEDS in the past show changes in the central (brain) processing of vestibular function and in symptoms of dizziness, balance and posture. This project has two main parts. Part one is a prospective observational study where people with an acute onset of IEDS are serially monitored while they are receiving hyperbaric treatment and VR over 10-14 days. Part two is a retrospective observational study where who have had IEDS in the past 15 years are re-assessed in a one-off session. The tests in both parts involve clinical tests and specialist eye movement recordings that assess vestibular function. We will also determine the site of any vestibular pathology by using selective stimulation of the vestibular end organ or nerve and assess whether there are any changes in how the structure and function of central vestibular pathways in the brain. In people with chronic IEDS with vestibular symptoms we will offer participants a course of VR over 12 weeks and assess whether this is associated with any improvement in symptoms.
Status | Not yet recruiting |
Enrollment | 41 |
Est. completion date | September 2028 |
Est. primary completion date | April 2028 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years to 85 Years |
Eligibility | Prospective Study : Inclusion • Divers admitted with suspected IEDS Exclusion - Medically unstable - Unstable orthopaedic deficits Retrospective study : Inclusion • Divers diagnosed with IEDS at DDRC within past 10 years Exclusion • We will include all co-morbidities as these could affect prognosis and recovery following IEDS. Healthy control comparator group : Normative data will be gathered on an age matched group. There will be at least 10 participants for each decade (<30yrs ,30-40yrs, 40-50 yrs,50-60yrs,60-70 yr.) Inclusion criteria: • Adults over 18 years Exclusion criteria: • Neurological, sensory or orthopaedic conditions that could affect balance. |
Country | Name | City | State |
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n/a |
Lead Sponsor | Collaborator |
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University of Plymouth |
Bense S, Bartenstein P, Lochmann M, Schlindwein P, Brandt T, Dieterich M. Metabolic changes in vestibular and visual cortices in acute vestibular neuritis. Ann Neurol. 2004 Nov;56(5):624-30. doi: 10.1002/ana.20244. — View Citation
Curthoys IS, Halmagyi GM. Vestibular compensation: a review of the oculomotor, neural, and clinical consequences of unilateral vestibular loss. J Vestib Res. 1995 Mar-Apr;5(2):67-107. — View Citation
Darlington CL, Smith PF. Molecular mechanisms of recovery from vestibular damage in mammals: recent advances. Prog Neurobiol. 2000 Oct;62(3):313-25. doi: 10.1016/s0301-0082(00)00002-2. — View Citation
Gempp E, Louge P, de Maistre S, Morvan JB, Vallee N, Blatteau JE. Initial Severity Scoring and Residual Deficit in Scuba Divers with Inner Ear Decompression Sickness. Aerosp Med Hum Perform. 2016 Aug;87(8):735-9. doi: 10.3357/AMHP.4535.2016. — View Citation
Gempp E, Louge P. Inner ear decompression sickness in scuba divers: a review of 115 cases. Eur Arch Otorhinolaryngol. 2013 May;270(6):1831-7. doi: 10.1007/s00405-012-2233-y. Epub 2012 Oct 26. — View Citation
Helmchen C, Klinkenstein J, Machner B, Rambold H, Mohr C, Sander T. Structural changes in the human brain following vestibular neuritis indicate central vestibular compensation. Ann N Y Acad Sci. 2009 May;1164:104-15. doi: 10.1111/j.1749-6632.2008.03745.x. — View Citation
Hong SK, Kim JH, Kim HJ, Lee HJ. Changes in the gray matter volume during compensation after vestibular neuritis: a longitudinal VBM study. Restor Neurol Neurosci. 2014;32(5):663-73. doi: 10.3233/RNN-140405. — View Citation
Kurata N, Kawashima Y, Ito T, Fujikawa T, Nishio A, Honda K, Kanai Y, Terasaki M, Endo I, Tsutsumi T. Advanced Magnetic Resonance Imaging Sheds Light on the Distinct Pathophysiology of Various Types of Acute Sensorineural Hearing Loss. Otol Neurotol. 2023 Aug 1;44(7):656-663. doi: 10.1097/MAO.0000000000003930. Epub 2023 Jun 29. — View Citation
Landolt JP, Money KE, Topliff ED, Ackles KN, Johnson WH. Induced vestibular dysfunction in squirrel monkeys during rapid decompression. Acta Otolaryngol. 1980;90(1-2):125-9. doi: 10.3109/00016488009131707. — View Citation
Landolt JP, Money KE, Topliff ED, Nicholas AD, Laufer J, Johnson WH. Pathophysiology of inner ear dysfunction in the squirrel monkey in rapid decompression. J Appl Physiol Respir Environ Exerc Physiol. 1980 Dec;49(6):1070-82. doi: 10.1152/jappl.1980.49.6.1070. — View Citation
McDonnell MN, Hillier SL. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database Syst Rev. 2015 Jan 13;1:CD005397. doi: 10.1002/14651858.CD005397.pub4. — View Citation
Mitchell SJ, Doolette DJ. Pathophysiology of inner ear decompression sickness: potential role of the persistent foramen ovale. Diving Hyperb Med. 2015 Jun;45(2):105-10. — View Citation
Song CI, Pogson JM, Andresen NS, Ward BK. MRI With Gadolinium as a Measure of Blood-Labyrinth Barrier Integrity in Patients With Inner Ear Symptoms: A Scoping Review. Front Neurol. 2021 May 20;12:662264. doi: 10.3389/fneur.2021.662264. eCollection 2021. — View Citation
Tremolizzo L, Malpieri M, Ferrarese C, Appollonio I. Inner-ear decompression sickness: 'hubble-bubble' without brain trouble? Diving Hyperb Med. 2015 Jun;45(2):135-6. — View Citation
Vargas-Figueroa VM, Caceres-Chacon M, Labat EJ. Scuba Diving-Induced Inner-Ear Pathology: Imaging Findings of Superior Semicircular Canal and Tegmen Tympani Dehiscence. Am J Case Rep. 2024 Jan 2;25:e941558. doi: 10.12659/AJCR.941558. — View Citation
* Note: There are 15 references in all — Click here to view all references
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Side of peripheral vestibular damage: Prospective cohort | Side (left or right) of vestibular dysfunction as determine by video head impulse test (v HIT) testing | T0=baseline within 24 hours of IEDS in the prospective cohort | |
Primary | Site of peripheral vestibular damage: Prospective cohort | Site of dysfunction: semi-circular canals affected as determine by v HIT testing. One or a combination of Horizontal, anterior or posterior canals. | T0=baseline within 24 hours of IEDS in the prospective cohort | |
Primary | Extent of peripheral vestibular damage: Prospective cohort | VOR gain (unit less) as measured by v HIT at T0 (Range 0-1 higher values are better outcome) | T0=baseline within 24 hours of IEDS in the prospective cohort | |
Primary | Side of peripheral vestibular damage: Retrospective cohort | Side (left or right) of vestibular dysfunction as determine by video head impulse test (v HIT) testing | 1 time point: 0-10 years post injury | |
Primary | Site of peripheral vestibular damage:Retrospective cohort | Site of dysfunction: semi-circular canals affected as determine by v HIT testing.One or a combination of Horizontal, anterior or posterior canals. | 1 time point: 0-10 years post injury | |
Primary | Extent of peripheral vestibular damage:Retrospective cohort | VOR gain (unit less) at T0 (Range 0-1 higher values are better outcome) | 1 time point: 0-10 years post injury | |
Secondary | VOR gain v HIT: Prospective Study | Change from baseline (T0) in VOR gain assessed through V HIT test . Gain is unit less and range from 0-1 where higher values indicate a better clinical outcome. | 7-10 days , 3 months and 12 months post injury | |
Secondary | VOR gain: Prospective Study | Change from baseline (T0) in VOR gain assessed through sinusoidal rotation in the dark . Gain is unit less and range from 0-1 where higher values indicate a better clinical outcome. | 7-10 days , 3 months and 12 months post injury | |
Secondary | VOR Time constant:Prospective Study | Change from baseline (T0)in VOR time constant in response to a step rotation (initial 140°/s acceleration/deceleration and a 60°/s fixed-chair velocity) stimulus . Time constant (seconds) where a higher time constant is clinically better. Range 0-40s. | 7-10 days , 3 months and 12 months post injury | |
Secondary | Patient reported outcome measure: Prospective Study | Change from baseline (T0) in PROM (patient reported outcome measure) vertigo severity scale.15 questions rated 0-4. Score range =0-60 where lower scores indicate a better clinical outcome | 7-10 days , 3 months and 12 months post injury | |
Secondary | Clinical measure of walking: Prospective Study | Change from baseline (T0) in Dynamic Gait Assessment (DGA). Eight tasks scored 0-3. Total range = 0-24 with a higher score indicating better walking ability. | 7-10 days , 3 months and 12 months post injury | |
Secondary | Clinical measure of balance: Prospective Study | Change from baseline (T0) in Clinical measures of balance sharpened Romberg (tandem stance). The length of time a person is able to stand in the eyes open, tandem stance position is recorded up to a maximum of 30 seconds. | 7-10 days , 3 months and 12 months post injury | |
Secondary | Posturography: Prospective Study | Change from baseline (T0) in Postural sway quotient. Postural sway (mm/s) is measured via force plates. The ratio of the sway with eyes open and eyes closed is calculated (unitless ratio). | 7-10 days , 3 months and 12 months post injury | |
Secondary | Perception of verticality: Prospective Study | Change from baseline (T0) in Rod and Disk test: The ability to orientate a line to vertical is assessed with / without visual distractors. The error from vertical is recorded in degrees. Outcomes range from 0-180 degrees where lower numbers indicate better verical perception. | 7-10 days , 3 months and 12 months post injury | |
Secondary | Functional MRI response to an optokinetic stimulus: Prospective Study | Change from baseline (T0) in Regions of interest will also assess changes in activation with an optokinetic stimulus compared to rest in cortical and subcortical sites that process vestibular information namely the insulo-parietal cortex and hippocampus and sites that process other sensory information namely the visual cortex and somatosensory cortex | 7-10 days , 3 months and 12 months post injury | |
Secondary | Vestibular Evoked myogenic Potentials latency: Prospective Study | Change from baseline (T0) in Galvanic and Auditory Vestibular Evoked myogenic Potentials (VEMPs) will be assessed and the latency of evoked responses measured in milliseconds. | 7-10 days , 3 months and 12 months post injury | |
Secondary | Vestibular Evoked myogenic Potentials amplitude: Prospective Study | Change from baseline (T0) in Galvanic and Auditory Vestibular Evoked myogenic Potentials (VEMPs) will be assessed and the amplitude of evoked responses measured in millivolts. | 7-10 days , 3 months and 12 months post injury | |
Secondary | VOR gain: Retrospective Study | VOR gain assessed through sinusoidal rotation in the dark . Gain is unit less and range from 0-1 where higher values indicate a better clinical outcome. | 7-10 days , 3 months and 12 months post injury | |
Secondary | VOR Time constant: Retrospective Study | VOR time constant in response to a step rotation (initial 140°/s acceleration/deceleration and a 60°/s fixed-chair velocity) stimulus . Time constant (seconds) where a higher time constant is clinically better. Range 0-40s. | 1 time point: 0-10 years post injury | |
Secondary | Patient reported outcome measure: Retrospective Study | PROM (patient reported outcome measure) vertigo severity scale.15 questions rated 0-4. Score range =0-60 where lower scores indicate a better clinical outcome | 1 time point: 0-10 years post injury | |
Secondary | Clinical measure of walking: Retrospective Study | Dynamic Gait Assessment (DGA). Eight tasks scored 0-3. Total range = 0-24 with a higher score indicating better walking ability. | 1 time point: 0-10 years post injury | |
Secondary | Clinical measure of balance: Retrospective Study | Clinical measures of balance sharpened Romberg (tandem stance). The length of time a person is able to stand in the eyes open, tandem stance position is recorded up to a maximum of 30 seconds. | 1 time point: 0-10 years post injury | |
Secondary | Posturography: Retrospective Study | Postural sway quotient. Postural sway (mm/s) is measured via force plates. The ratio of the sway with eyes open and eyes closed is calculated (unitless ratio). | 1 time point: 0-10 years post injury | |
Secondary | Perception of verticality: Retrospective Study | Rod and Disk test: The ability to orientate a line to vertical is assessed with / without visual distractors. The error from vertical is recorded in degrees. Outcomes range from 0-180 degrees where lower numbers indicate better verical perception. | 1 time point: 0-10 years post injury | |
Secondary | Functional MRI response to an optokinetic stimulus: Retrospective Study | Regions of interest will also assess changes in activation with an optokinetic stimulus compared to rest in cortical and subcortical sites that process vestibular information namely the insulo-parietal cortex and hippocampus and sites that process other sensory information namely the visual cortex and somatosensory cortex | 1 time point: 0-10 years post injury | |
Secondary | Vestibular Evoked myogenic Potentials latency: Retrospective Study | Galvanic and Auditory Vestibular Evoked myogenic Potentials (VEMPs) will be assessed and the latency of evoked responses measured in milliseconds. | 1 time point: 0-10 years post injury | |
Secondary | Vestibular Evoked myogenic Potentials amplitude: Retrorospective Study | Galvanic and Auditory Vestibular Evoked myogenic Potentials (VEMPs) will be assessed and the amplitude of evoked responses measured in millivolts. | 1 time point: 0-10 years post injury |
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