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Patients with a vestibular deficit, either badly compensated or complete, are unable to produce perfectly accurate eye movements during passive head rotations, for instance while walking or driving a car. This deficit causes oscillopsies and vision instability which deeply affect their everyday life. In order to counteract this vestibulo-ocular reflex deficit, the patients develop compensatory saccadic eye movements, either with short latency while the head is still in motion (covert saccades), or with longer latency which occur after the motion of the head (over saccades). Due to their longer latency, covert saccades appear to contribute to the stabilization of sight. The dynamic visual acuity (DVA) refers to the ability to clearly see objects while your head is in motion. This faculty is evaluated thanks to the "DVA Test". In healthy subjects, the visual acuity is identical whether the head is stationary or in motion. However, patients suffering from a vestibular deficit lack gaze balance resulting in deteriorated performance in the DVA test when the head is moving. This clinical research thesis is divided in three steps. First of all, we reviewed scientific articles about the DVA, its evaluation and contribution to the evaluation and care of patients suffering from vestibular pathologies. This review of the literature showcases the differences between various test methods and the use of a specific training of the DVA for the revalidation of vestibular disorder. The second step is a retrospective study of all the patients who had had a DVA test at the Audio-Phonology Centre of the Cliniques Universitaires Saint-Luc' between 2012 and 2016. The results of the DVA tests of the patients were compared to the results of other vestibular exanimations in order to establish a possible link between them. A total of 164 DVA tests were analyzed and showed a couple of statistical trends. For instance, the loss of horizontal dynamic visual acuity is correlated to a poor postural control in difficult conditions, soliciting a lot of information from the vestibular system, as shown by the Postural Instability Index (IIP) of the Balance Multitest (MTT test) in condition F (loss of somesthetic information andpresence of optokinetic stimulation interfering with visual data). The Joss of acuity is also linked to a loss in the gain of the vestibulo-ocular reflex (VOR), as proved by the statistically significant correlation between the DVA test results and the results of the VHIT (Video Head Impulse Test with EyeSeeCam) at 80m sec stimulating the right semi-circular channel. However, on the left channel, no significant correspondence was found between those two tests in our study. From these results, we can infer that the dynamic visual acuity is less impacted by left horizontal channel damage than a right one. This may be caused by the normal central vestibular asymmetry and the central vestibular restructuring which differs in right or left peripheral vestibular infringement, as M. Dietrich and T. Brandt reported in 2015.The third and final step is a prospective study at the audio-phonology Centre between October 2015 and June 2017 on 33 patients with acute unilateral vestibular disorders. In this context, we compared the results of revalidation through a specific training of the DVA to those of a revalidation through usual postural exercises. Despite the lack of compliance of several patients, reducing the amount of disposable results, some major trends which deserve further investigation broke through the study of our population. Les patients présentant un déficit vestibulaire, mal compensé ou complet, sont incapables de produire des mouvements oculaires parfaitement adaptés lors de rotations passives de la tête, par exemple, lors de la marche ou de la conduite automobile. Ce déficit cause des oscillopsies et une instabilité de la vision, très invalidantes dans la vie quotidienne. Pour contrer ce déficit du réflexe vestibulo-oculaire (VOR), les patients développent des saccades oculaires compensatoires, soit de courte latence, lorsque la tête est encore en mouvement (over saccades), soit de latence plus longue et qui apparaissent après le mouvement de la tête (over saccades). De par leur latence plus courte, les covert saccades semblent avantageuses dans la stabilisation du regard. L'acuité visuelle dynamique (AVD) fait référence à la capacité de voir nettement les objets lors de mouvements de la tête. L'évaluation de cette faculté se réalise grâce au "test de l'AVD". Chez les personnes saines, l'acuité visuelle est identique lorsque la tête est au repos ou en mouvement. A l'opposé, les patients souffrant d'un déficit vestibulaire présentent un manque d'équilibre du regard qui se traduit par une détérioration des résultats au test de l'AVD lorsque la tête est mobile. Ce mémoire de recherche clinique s'est déroulé en trois étapes. Nous avons tout d'abord revu les articles scientifiques publiés. Au sujet de l'AVD, son évaluation et son apport dans le bilan et la prise en charge des personnes souffrant de vestibulopathies. Cette synthèse de la littérature actuelle met en évidence de nombreuses différences dans la méthode de test et dans l'utilisation d'un entrainement spécifique par l'AVD pour la revalidation des troubles vestibulaires. La deuxième étape fut une étude rétrospective de toutes les personnes ayant bénéficié d'un test de l'AVD au centre d'audiophonologie des Cliniques Universitaires Saint-Luc entre 2012 et 2016. Les résultats des tests de l'AVD ont été comparés aux résultats des autres examens vestibulaires que les sujets avaient subis, afin d'établir un lien éventuel entre eux. Cent soixante-quatre tests de l'AVD ont été analysés et ont montré quelques tendances statistiques. Ainsi, la perte de l'AVD horizontale est statistiquement corrélée à un mauvais contrôle postural dans les conditions difficiles, faisant le plus appel aux informations vestibulaires, comme montré par l'Indice d'Instabilité Posturale (IIP) du test Multitest Equilibre (MTT) en condition F (perte des informations somesthésiques et présence d'une stimulation opto-cinétique interférant avec les données visuelles). Elle est également liée à une perte de gain du VOR, comme l'indique la corrélation statistiquement significative entre les résultats du test de l'AVD vers la droite et ceux du Video Head Impulse Test (VHIT) par EyeSeeCam à 80m sec stimulant le canal semi-circulaire droit. Par contre, cette correspondance significative entre les deux tests n'a pas été retrouvée du côté gauche dans la population de notre étude. A partir de ces résultats, nous pouvons inférer que l'AVD est moins impactée par une atteinte canalaire horizontale gauche que droite. Ceci pourrait être en lien avec l'asymétrie vestibulaire centrale normale et la réorganisation vestibulaire centrale, différente en cas d'atteinte vestibulaire périphérique droite ou gauche, précédemment rapportées par M. Dieterich et T. Brandt en 2015.Enfin, nous avons réalisé une étude prospective au centre d'audiophonologie entre octobre 2015 et juin 2017 chez trente-trois personnes souffrant de troubles vestibulaires unilatéraux aigus. Dans ce cadre, nous avons comparé les résultats d'une revalidation par un entrainement spécifique de l'AVD à ceux d'une réadaptation utilisant les exercices posturaux habituels. Malgré le manque de compliance de certains patients, ayant altéré la quantité de nos résultats, des tendances se dégagent de l'étude de notre population, qu'il serait intéressant d'approfondir.

Visual Acuity --- Gait Disorders, Neurologic --- Conduct Disorder --- Vestibular Diseases --- Vestibulocochlear Nerve Diseases

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Vestibular apparatus --- Auditory pathways --- Skull Neoplasms --- Vestibulocochlear Nerve --- Retrocochlear Diseases --- Cranial Nerve Diseases --- Nervous System Diseases --- Ear Diseases --- Bone Neoplasms --- Cranial Nerves --- Diseases --- Peripheral Nerves --- Neoplasms by Site --- Otorhinolaryngologic Diseases --- Bone Diseases --- Neoplasms --- Peripheral Nervous System --- Musculoskeletal Diseases --- Nervous System --- Anatomy --- Vestibulocochlear Nerve Diseases --- Vestibular Nerve --- Skull Base Neoplasms --- Medicine --- Health & Biological Sciences --- Otorhinolaryngology --- Neoplasms, Skull Base --- Neoplasm, Skull Base --- Skull Base Neoplasm --- Scarpa's Ganglion --- Ganglion, Scarpa's --- Nerve, Vestibular --- Nerves, Vestibular --- Scarpa Ganglion --- Scarpas Ganglion --- Vestibular Nerves --- Acoustic Nerve Disorders --- Cochlear Nerve Disorders --- Cochlear Neuritis --- Cranial Nerve VIII Disorders --- Eighth Cranial Nerve Diseases --- Vestibular Nerve Disorders --- Acoustic Nerve Diseases --- Cochlear Nerve Diseases --- Cranial Nerve VIII Diseases --- Vestibular Nerve Diseases --- Acoustic Nerve Disease --- Acoustic Nerve Disorder --- Cochlear Nerve Disease --- Cochlear Nerve Disorder --- Cochlear Neuritides --- Neuritides, Cochlear --- Neuritis, Cochlear --- Vestibular Nerve Disease --- Vestibular Nerve Disorder --- Vestibulocochlear Nerve Disease --- Hearing Loss, Central --- Cranial Nerve Injuries --- Anatomies --- Nervous Systems --- System, Nervous --- Systems, Nervous --- Orthopedic Disorders --- Musculoskeletal Disease --- Orthopedic Disorder --- Nervous System, Peripheral --- Nervous Systems, Peripheral --- Peripheral Nervous Systems --- System, Peripheral Nervous --- Systems, Peripheral Nervous --- Benign Neoplasms --- Malignancy --- Malignant Neoplasms --- Neoplasia --- Neoplasm --- Neoplasms, Benign --- Cancer --- Tumors --- Benign Neoplasm --- Cancers --- Malignancies --- Malignant Neoplasm --- Neoplasias --- Neoplasm, Benign --- Neoplasm, Malignant --- Neoplasms, Malignant --- Tumor --- Medical Oncology --- Bone Disease --- Disease, Bone --- Diseases, Bone --- ENT Diseases --- Otolaryngological Diseases --- Otorhinolaryngologic Disease --- Otorhinolaryngological Disease --- Otolaryngologic Diseases --- Disease, ENT --- Disease, Otolaryngologic --- Disease, Otolaryngological --- Disease, Otorhinolaryngologic --- Disease, Otorhinolaryngological --- Diseases, ENT --- Diseases, Otolaryngologic --- Diseases, Otolaryngological --- Diseases, Otorhinolaryngologic --- Diseases, Otorhinolaryngological --- ENT Disease --- Otolaryngologic Disease --- Otolaryngological Disease --- Otorhinolaryngological Diseases --- Otolaryngology --- Neoplasms by Sites --- Site, Neoplasm --- Sites, Neoplasm --- Neoplasm Site --- Neoplasm Sites --- Endoneurium --- Epineurium --- Perineurium --- Endoneuriums --- Epineuriums --- Nerve, Peripheral --- Nerves, Peripheral --- Perineuriums --- Peripheral Nerve --- Cranial Nerve --- Nerve, Cranial --- Nerves, Cranial --- Cancer of the Bone --- Neoplasms, Bone --- Bone Cancer --- Cancer of Bone --- Bone Neoplasm --- Neoplasm, Bone --- Otological Diseases --- Otologic Diseases --- Disease, Ear --- Disease, Otologic --- Disease, Otological --- Ear Disease --- Otologic Disease --- Otological Disease --- Nervous System Disorders --- Neurological Disorders --- Neurologic Disorders --- Disease, Nervous System --- Diseases, Nervous System --- Disorder, Nervous System --- Disorder, Neurologic --- Disorder, Neurological --- Disorders, Nervous System --- Disorders, Neurologic --- Disorders, Neurological --- Nervous System Disease --- Nervous System Disorder --- Neurologic Disorder --- Neurological Disorder --- Neurology --- Cranial Nerve Disorders --- Cranial Nerve Palsies --- Nervus Cranialis Disorders --- Cranial Neuropathies --- Cranial Neuropathies, Multiple --- Neuropathies, Cranial --- Cranial Nerve Disease --- Cranial Nerve Disorder --- Cranial Nerve Palsy --- Cranial Neuropathy --- Cranial Neuropathy, Multiple --- Multiple Cranial Neuropathies --- Multiple Cranial Neuropathy --- Nervus Cranialis Disorder --- Neuropathies, Multiple Cranial --- Neuropathy, Cranial --- Neuropathy, Multiple Cranial --- Palsies, Cranial Nerve --- Palsy, Cranial Nerve --- Meningitis, Cryptococcal --- Neuroaspergillosis --- Retrocochlear Hearing Loss --- Disease, Retrocochlear --- Diseases, Retrocochlear --- Hearing Loss, Retrocochlear --- Retrocochlear Disease --- Cochleovestibular Nerve --- Statoacoustic Nerve --- Cranial Nerve VIII --- Eighth Cranial Nerve --- Cochleovestibular Nerves --- Cranial Nerve VIIIs --- Cranial Nerve, Eighth --- Cranial Nerves, Eighth --- Eighth Cranial Nerves --- Nerve VIIIs, Cranial --- Nerve, Cochleovestibular --- Nerve, Eighth Cranial --- Nerve, Statoacoustic --- Nerve, Vestibulocochlear --- Nerves, Cochleovestibular --- Nerves, Eighth Cranial --- Nerves, Statoacoustic --- Nerves, Vestibulocochlear --- Statoacoustic Nerves --- VIIIs, Cranial Nerve --- Vestibulocochlear Nerves --- Neoplasms, Skull --- Neoplasm, Skull --- Skull Neoplasm --- Auditory system --- Afferent pathways --- Hearing --- Equilibrium (Physiology) --- Labyrinth (Ear) --- Surgery --- Neurotology.