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Results of High-Frequency and High-Acceleration Rotary Chair Test in Patients with Acute Unilateral Vestibular Neuritis
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Hwan Seo Lee, Jun Woo Park, Chang Wook Lee, Chan Il Song, Myung Hoon Yoo, Hong Ju Park
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Res Vestib Sci. 2014;13(2):41-46.
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- r neuritis. Materials and Methods: Twenty-four patients who were diagnosed as acute vestibular neuritis and underwent rotational chair and caloric tests during March 2012 to March 2013 were included. Slow harmonic acceleration (SHA) test was performed at 0.01, 0.04, 0.16, 0.64, 1.28, and 2.00 Hz. Step velocity tests at the peak velocity of 100o/sec (low-acceleration) and 240o/sec (high-acceleration) were performed. Gains and phases in SHA test and gains and time constants (Tc) in step velocity test were analyzed. Results: In SHA test, decreased gain and phase lead was observed mostly in low frequencies. Gains (phases) at 0.01, 0.04, 0.16, 0.64, 1.28, and 2.00 Hz were 0.2±0.1 (62.2±15.4), 0.3±0.2 (24.5±13.0), 0.4±0.2 (7.2±18.8), 0.5±0.1 (7.2±11.3), 0.7±0.2 (11.0±7.5), and 0.8±0.3 (4.4±14.4), respectively. In step velocity (SV) test, gains stimulating the lesion side were significantly lower than those stimulating the intact side in both low- and high-acceleration SV test (p＜0.05) and per-rotatory gain stimulating the lesion side in high-acceleration SV test was significantly lower than that in low-acceleration SV test. Tc stimulating the lesion side were significantly shorter than those stimulating the intact side in low- acceleration SV test (p＜0.05) but not in high-acceleration SV test. Per- and post-rotatory Tc in high-acceleration SV test stimulating the intact side was significantly lower than those in low-acceleration SV test (p＜0.05). Conclusion: At high-frequency SHA test, gain was pretty normal and phase lead was observed in some patients. High-acceleration SV test showed shortened Tc regardless of the sides, suggesting that high-acceleration SV test can reveal the impaired velocity storage system in patients with vestibular neuritis more frequently than low-acceleration SV test.
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Management of Benign Paroxysmal Positional Vertigo
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Chan Il Song, Hong Ju Park
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Res Vestib Sci. 2013;12(4):111-120.
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Abstract
- Benign paroxysmal positional vertigo (BPPV) is characterized by brief recurrent episodes of vertigo triggered by head positional changes. BPPV is one of the most common causes of recurrent vertigo. BPPV results from abnormal stimulation of the cupula within any of the three semicircular canals by free-floating otoliths (canalithiasis) or otoliths adhered to the cupula (cupulolithiasis). Spontaneous recovery occurs frequently even with conservative treatment. However, canalith repositioning maneuvers are believed to be the best way to treat BPPV by moving the canaliths from the semicircular canal to the vestibule. Various treatment methods of posterior, superior, and lateral canal BPPV are discussed in this review.
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Multicenter Study on the Clinician’s Diagnostic and Therapeutic Approaches for Benign Paroxysmal Positional Vertigo in Korea
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Eun Ju Jeon, Won Ho Chung, Jeong Hwan Choi, Eui Cheol Nam, Hong Ju Park, Jong Dae Lee, Won Sang Lee, Kyu Sung Kim, Eui Kyung Goh, Ja Won Koo, Min Bum Kim, Min Beom Kim, Se Hyung Kim, Young Jin Kim, Chang Hee Kim, Sung Il Nam, Seog Kyun Mun, Ga Young Park, Sang Yoo Park, Shi Nae Park, Chang Hoon Bae, Sung Hyun Boo, Myung Whan Suh, Jae Hyun Seo, Eun Jin Son, Jae Jun Song, Jae Jin Song, Joong Wook Shin, Dae Bo Shim, Seong Ki Ahn, Hye Youn Youm, Shin Young Yoo, Dong Hee Lee, Seung Hwan Lee, Chang Ho Lee, Hyun Seok Lee, Hwan Ho Lee, Hyo Jeong Lee, Yun Hoon Choung, Seung Hyo Choi, Jee Sun Choi, Seok Min Hong, Sung Kwang Hong
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Res Vestib Sci. 2013;12(3):79-92.
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Abstract
- Background and Objectives: It is necessary to establish the most efficient diagnostic and therapeutic method for benign paroxysmal positional vertigo (BPPV), which is appropriate for Korean healthcare system. We aimed to evaluate current state of Korean clinician’s diagnostic and therapeutic approaches for BPPV. Materials and Methods: A 16-item survey was emailed to the members of dizziness department of Otology Research Interest Group in the Korean Otologic Society (n=68). 43 were returned and analyzed. Results: All respondents (100%) used Dix-Hallpike test as a diagnostic tool for vertical canal-BPPV. Supine roll test was used for diagnosing lateral canal BPPV in nearly all the respondents (97.7%). Epley maneuver was chosen as otolith repositioning maneuver (ORM) for posterior canal BPPV in all respondents and barbecue rotation (BBQ) was used for treating lateral canal BPPV with geotropic nystagmus in 95.3% of respondents. Extreme variation was noted for therapeutic approach of lateral canal BPPV with ageotropic nystagmus BBQ, with 4 kinds of ORM and adjunctive measures to liberate otolith from cupula, while BBQ was again the most commonly used ORM (76.7%). Conclusion: The development of practical and efficient ORM for lateral canal BPPV with ageotropic nystagmus is necessary.
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Clinical Characteristics of 7 Patients with Lateral Semicircular Canal Dysplasia
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Chang Hee Kim, Jung Eun Shin, Yeo Jin Lee, Hong Ju Park
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Res Vestib Sci. 2012;11(2):64-68.
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- Background and Objectives: Dysplasia of lateral semicircular canal (LSCC) is the most common inner ear malformation, because LSCC is the last single structure to be formed during inner ear embryogenesis. There have been several case reports about the LSCC anomaly which showed clinical spectrum ranging from no symptom to severe sensorineural hearing loss. The authors investigated the clinical characteristics of 7 patients with LSCC dysplasia.
Materials and Methods: The medical records of 7 patients who were diagnosed as LSCC dysplasia from temporal bone computed tomography were retrospectively reviewed. We analysed the findings of history taking, pure tone audiometry, speech audiometry, and caloric tests.
Results: The LSCC dysplasia was observed in all of 7 patients in which 5 showed unilaterally confined LSCC dysplasia, 1 showed bilaterally confined LSCC dysplasia, and 1 exhibited bilateral LSCC dysplasia combined with bilateral posterior semicircular canal dysplasia. From 7 patients, hearing loss was chief complaint only in 2 patients. Pure tone audiometry revealed sensorineural hearing loss in one patient, and conductive hearing loss in the other patient. Two patients complained of whirling type vertigo, and 3 complained of nonspecific dizziness.
Conclusion: The patients with LSCC dysplasia may show variable symptoms such as sensorineural hearing loss, conductive hearing loss, vertigo and nonspecific dizziness.
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Efficacy of Oral Prostaglandin I2 in Patients with Chronic Nonspecific Vertigo
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Ji Won Kim, Hyun Woo Lim, Yun Suk An, Seung Hyo Choi, Hong Ju Park, Jong Woo Chung
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Res Vestib Sci. 2011;10(4):115-120.
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- Background and Objectives: The aim of this study is to evaluate the efficacy of prostaglandin I2 (PGI2) in the patients with chronic nonspecific vertigo using questionnaires of dizziness handicap inventory (DHI) and vertigo symptom scale (VSS). Materials and Methods: Forty two patients with chronic nonspecific vertigo from May to December 2010 were enrolled in this study. We administered Berast (synthetic PGI2, beraprost sodium) 2 tablets (0.04 mg) twice a day to patients. Before and after 2, 4 weeks the end of administration patients underwent DHI and VSS for evaluation of state of the vertigo. Results: Twenty four of 42 patients completed this clinical trial. Mean DHI scale score decreased significantly from 23.00 (±21.75) to 17.75 (±19.78) (p=0.004). All DHI subscales, physical, functional, and emotional factors, decreased after treatment of prostaglandin I2. VSS scale also showed significant decrease from 3.63 (±2.55) to 2.50 (±2.95) (p=0.044). Conclusion: Prostaglandin I2 may be one of the treatments to improve symptoms in the patient s with chronic nonspecific vertigo.
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Clinical Features and Treatment Pattern of Migrainous Vertigo in Korea: A Nationwide Prospective Multicenter Study
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Seong Ki Ahn, Kyusik Kang, Ja Won Koo, Kyu Sung Kim, Beom Gyu Kim, Byung Kun Kim, Ji Soo Kim, Kyoung Ho Park, Shi Nae Park, Eun Ho Park, Hong Ju Park, Jae Yong Byun, Myung Whan Suh, Ki Bum Sung, Sun Young Oh, Chung Ku Rhee, Tae Kyeong Lee, Seong Hae Jeong, Won Ho Chung, Chang Il Cha, Sung Won Chae, Eui Kyung Goh
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Res Vestib Sci. 2009;8(2):122-131.
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- Background and Objectives It is being increasing recognized that the morbidities of migraine and balance disorders are interrelated. In fact, migrainous vertigo (MV) is one of frequent causes of recurrent vertigo in patients presenting to specialized dizziness clinics. Nevertheless, not many studies have reported clinical manifestations and treatment. Therefore, the aim of study was designed to assess clinical features and treatment patterns by a nationwide multicenter study. Materials and Methods Patients between 9 and 74 years of age who visited 17 Korean tertiary referral centers and 1 clinic from February to March 2009 were investigated using two forms of questionnaires. Results Overall, 318 patients with MV were enrolled. MV was responsible for ~8.45% of visits to the specialized dizziness clinics. One hundred seventy-five of these patients had definite MV and were included in assessing the clinical features. Vertigo characteristics of patients with definite MV were various. Vertigo was regularly as-sociated with headache in 87% of the patients. The duration of vertigo ranged from seconds to days. For the treatment patterns, an acute and prophylactic therapies were carried in most clinics. There were no differences in either acute or prophylactic therapies between department of neurology and otorhinolaryngology. Conclusions The results of this study suggest that MV the clinical features of MV also varies in Korea. In addition, most clinics provide similar patterns of practice in treatment for MV. The syndrome of MV deserves further research activity as it is relatively common and clinically relevant.
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Effects of Changes of Plateau and Rise/Fall Times on Ocular Vestibular Evoked Myogenic Potentials
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Yeo Jin Lee, Soo Hee Han, Eun Jung Ha, Yong Soo Jung, Hi Boong Kwak, Mun Su Park, Jung Eun Shin, Hong Ju Park
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J Korean Bal Soc. 2008;7(2):193-196.
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- Background and Objectives: The ocular vestibular evoked myogenic potential (OVEMP) is a recently discovered test of labyrinthine function, analogous to the cervical VEMP. Recent works have demonstrated the existence of OVEMPs, which likely reflect otolith-ocular reflex. The purpose of this study was to identify the optimal plateau and rise/fall times of short tone bursts to detect OVEMPs in healthy subjects.
Materials and Methods: Thirteen healthy subjects (26 ears) were included in this study. Surface electromyographic activity was recorded from active electrodes placed inferior to each eye. Stimulation with 500 Hz short tone bursts was used. We used a variety of plateau and rise/fall times. Three different plateau times (1, 2, and 3 ms) and rise/fall times (0.5, 1, and 2 ms) were used. The incidence, amplitudes and latencies were compared.
Results: VEMP responses were clearly observed in all 26 ears at the plateau time of 2 ms and two rise/fall times (0.5 and 1 ms). The amplitudes in the individual ears tested were lower at the rise/fall time of 2 ms than at the other conditions. The amplitudes were lower at the plateau time of 3 ms compared to the other conditions. When the rise/fall time was prolonged from 0.5 to 2 ms, the n1 and p1 latencies were prolonged in parallel. However, there was no such change in latencies according to the plateau times.
Conclusions: Our findings show that the ideal stimulation pattern for evoking OVEMP is at the rise/fall times of 0.5 or 1 ms and the plateau time of 2 ms. The waveform morphology of the VEMP responses observed with this stimulation pattern was simultaneously the most constant and marked.
Key words: Evoked potentials, Ocular VEMP, Vestibulo-ocular reflex, Otolith
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Multicenter study on the treatment pattern of Ménière’s disease in Korea
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Sung Kwang Hong, Eui Kyung Koh, Kyu Sung Kim, Kyoung Ho Park, Hong Ju Park, Seong Ki Ahn, Joong Ho Ahn, Won Sang Lee, Gi Jung Im, Jae Yun Jung, Won Ho Chung, Gyu Cheol Han, Sung Won Chae, Ja Won Koo
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J Korean Bal Soc. 2008;7(2):174-181.
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- Background and Objectives: It is hard to determine the efficacy of several treatment options of Ménière’s disease since dynamic course of the disease and diverse rate of recurrence. Few modalities are regarded as ‘effective’ in the viewpoint of evidence based medicine. Study was conducted to know the current status of treatment options for Ménière’s disease.
Materials and Methods: A multicenter survey was conducted using questionnaires to collect information on current status of treatment patterns in Ménière’s disease. The questionnaire answered by neurotologic surgeons working at 12 institutes in Korea was analyzed.
Results: Low salt diet was always instructed to their patients, but 8 out of 12 responders (67%) did not emphasis on the amount of dietary salt. Duration of pharmacotherapy was ranged from 3 to 12 months. Intratympanic steroid injection was performed in 8 institutes (67%). Every institute agreed on the role of intratympanic gentamicin application. Treatment options for intractable patients were asked. Endolymphatic sac surgery, intratympanic steroid, Meniette device and intratympanic aminoglycoside injection were answered in patients who hope to preserve residual hearing. On the contrary, in patients without serviceable hearing, intratympanic jnjection of aminoglycosides (9/12, 75%) dominated as the next treatment option.
Conclusions: Most institutes provide similar patterns of practice in medical treatment. The application of intratympanic aminoglycoside is also agreed in intractable patients without serviceable hearing. However, thoughts about the role and detailed methods of the surgical and adjunctive treatment options were not agreed, especially in intractable patients with good hearing. Further clinical studies and discussions would be necessary to provide consensus for the best treatment of Ménière’s disease in Korea.
Key words : Ménière’s disease, Pharmacotherapy, Surgery, Aminoglycosides
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Two Cases of Successful Treatment With Topiramate in Patients With Meniere’s Disease With Migraine
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Hong Ju Park, Mun Su Park, Jin Seok Yoo
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J Korean Bal Soc. 2008;7(1):96-100.
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- Objective: To investigate the effects of topiramate on vestibular symptoms in patients with Meniere’s disease and migraine
Case Reports: We present two patients with Meniere’s disease and migraine, who did not respond to the salt reduction diet and diuretics. Topiramate was given and maintained for several months. Frequency and severity of headache and vestibular symptoms decreased after initiation of the topiramate.
Conclusions: Topiramate can be used satisfactorily for the patients with Meniere’s disease and migraine, who are refractory to regular conservative treatment for Meniere’s disease, when vertigo attacks are accompanied by migraine.
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Follow-up Changes of Eye Movements by Caloric Stimulation in Patients With Vestibular Neuritis
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Mun Su Park, Ga Hyun Park, Yong Soo Jeong, Yeo Jin Lee, Jung Eun Shin, Hong Ju Park
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J Korean Bal Soc. 2008;7(1):33-37.
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- Background and Objectives: A significant recovery of resting activity in the vestibular nuclei ipsilateral to the unilateral labyrinthectomy has been reported by the time symptoms such as spontaneous nystagmus and roll head tilt have largely disappeared. However, the dynamic vestibular response after unilateral vestibular loss to passively imposed vestibular stimuli does not recover.
Materials and Methods: We investigated changes of the caloric responses in 32 patients with vestibular neuritis during in- and out-patient visits separated by 2 months in an attempt to identify changes brought about by peripheral and/or central compensation processes.
Results: The slow-phase eye velocities stimulated by warm caloric stimulation at acute and follow-up stage were 6.6±6.6°/s, 9.5±9.9°/s in the lesioned side; 28.4±19.1°/s, 24.5±11.6°/s in the intact side. The slow-phase eye velocities stimulated by cold caloric stimulation at acute and follow-up stage were 5.9±7.7°/s, 10.3±8.2°/s in the lesioned side; 19.8±10.3°/s, 18.8±9.9°/s in the intact side.
Conclusion: Our findings show that the recovery of caloric responses comes mostly from the recovery of the eye responses to the caloric stimulation in the lesioned side and the eye responses to the caloric stimulation in the intact side does not change over time after vestibular neuritis.
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Vibration-Induced Nystagmus in Patients with Vestibular Disorders
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Yeo Jin Lee, Hong Ju Park, Jung Eun Shin, Jae Yoon Ahn, Ga Hyun Park, Yong Soo Jung, Hi Boong Kwak, Jin Seok Yoo
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J Korean Bal Soc. 2007;6(2):192-195.
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- Background and Objectives: It has been reported that vibration applied either on the mastoid or the sternocleidomastoid (SCM) muscles induces nystagmus in patients after unilateral vestibular neuritis. The aims of the study were to characterize the vibration-induced nystagmus (VIN) in patients with various vestibular disorders and to compare the results of VIN to unilateral weakness in caloric test.
Materials and Methods: Fifthy-four patients with Meniere’s disease, 58 patients with unilateral vestibular neuritis, 170 patients with migraine-associated dizziness, and 78 patients with chronic recurrent vestibulopathy were included. We recorded eye movements during unilateral 100-Hz vibration on the mastoids and SCM muscles. The bithermal caloric test was also performed. Abnormal criteria of VIN were slow-phase slow-phase velocity (SPV) at 4 all different conditions ≥ 2°/s with the same directions or mean of SPV at vibration on both mastoids or both SCM muscles ≥ 5°/s with the same directions.
Results: In Meniere’s disease, 28 of 57 (49.1%) of patients show pathologic VIN, 21 of 57 (36.8%) show pathologic canal paresis. 14 of 57 (24.6%) show abnormalities in both tests, and 35 of 57 (61.4%) show any abnormalities in either test. In unilateral vestibular neuritis, 43 of 58 (77.6%) showed pathologic VIN, 58 of 58 (100%) show canal paresis. In migraine-associated dizziness, 48 of 170 (28.2%) showed pathologic VIN, 58 of 170 (18.8%) show canal paresis. 15 of 170 (8.8%) showed abnormalities in both tests, and 65 of 170 (38.2%) show any abnormalities in either test. In chronic recurrent vestibulopathy, 23 of 78 (29.5%) of patients show pathologic VIN and 17 of 78 (21.8%) show pathologic canal paresis. Seven of 78 (9.0%) showed abnormalities in both tests, and 33 of 78 (42.3%) show any abnormalities in either test.
Conclusion: VIN test can increase the sensitivity in detecting vestibular imbalance in vestibular disorders when combined with caloric test.
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Changes of Vibration-Induced Nystagmus by Age in Normal Subjects
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Yong Soo Jung, Hong Ju Park, Jung Eun Shin, Jae Yoon Ahn, Ga Hyun Park, Hi Boong Kwak, Yeo Jin Lee, Jin Seok Yoo
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J Korean Bal Soc. 2007;6(2):186-191.
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- Background and Objectives: It has been reported that vibration applied either on the mastoid or on the sternocleidomastoid (SCM) muscles induces nystagmus in normal subjects. The aims of the study were to characterize the direction and velocity of slow-phase eye movement which is induced by vibration in normal subjects and to propose the mechanism of vibration-induced nystagmus (VIN) in normal subjects.
Materials and Method: We recorded eye movements during unilateral 100-Hz vibration on the mastoid bone and SCM muscles in 56 normal subjects. The subjects were divided into 4 groups in ages (20s, 30s, 40s, 50~60s). The directions of VIN, the degree of maximal slow-phase eye velocities were analyzed according to age. Positive value means slow-phase velocity (SPV) to the right side.
Results: In 20s, vibration on right/left mastoids induced SPV of 1.2±2.0°/sec, 0±2.1°/sec and on right/left SCM muscles, 1.1±1.9°/sec, -1.2±2.5°/sec. In 30s, vibration on right/left mastoids induced SPV of 3.3±3.8°/sec, -0.3± 1.4°/sec and on right/left SCM muscles, 2.8±4.2°/sec, -1.0±1.5°/sec. In 40s, vibration on right/left mastoids induced SPV of 0±1.7°/sec, -0.2±1.2°/sec and on right/left SCM muscles, 0±1.8°/sec, 0±1.0°/sec. In 50~60s, vibration on the right/left mastoids induced SPV of -1.3±1.3°/sec, 1.2±1.3°/sec and on right/left SCM muscles, -0.6±0.9°/sec, 0.9 ±1.5°/sec. The directional preponderance of the slow-phase eye movement to the vibrated side was statistically significant in 20s and 30s, however, the preponderance of the slow-phase eye movement changed into the non-vibrated side in 50~60s.
Conclusion: The proprioceptive input, changing major rotator from the inferior oblique muscle to the sternocleidomastoid muscles might explain the change of the directional preponderance of the slow-phase eye movements in normal subjects according to ages. Although this directional preponderance is not consistent in all age groups, it is still important in discriminating normal responses from abnormal responses which can be induced by vibration.
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Follow-up Examination of Vibration-Induced Nystagmus in Patients with Unilateral Vestibular Neuritis
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Hong Ju Park, Jung Eun Shin, Jae Yoon Ahn, Ga Hyun Park, Yong Soo Jung, Hi Boong Kwak, Yeo Jin Lee, Jin Seok Yoo
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J Korean Bal Soc. 2007;6(2):172-175.
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- Background and Objectives: The aim of this study was to verify if vibration-induced nystagmus in patients with vestibular neuritis changed over time and to compare the results of vibration-induced nystagmus (VIN) test to those of caloric test.
Materials and Method: We compared VIN results with those of caloric testing in 23 patients (M:F = 11:12, 15~67 years old) with unilateral vestibular neuritis seen at onset and in follow-up for around 2 months. The eye movement recordings were made and the maximum slow-phase eye velocities (SPV) were calculated during vibration. If spontaneous nystagmus was present, it was subtracted from the slow-phase eye velocities of VIN.
Results: In acute stage, VIN of which SPV was directed towards the lesioned side was observed in 21 (91%). In follow-up, VIN of which SPV was directed towards the lesioned side was observed in 19 (83%). There was a significant decrease of the SPV of VIN over time. Significant correlations were observed in between canal paresis & SPV of VIN in both acute and follow-up stages.
Conclusion: Our findings show that VIN test can predict the severity of vestibular asymmetry not only in acute stage but also in follow-up stage. Our results suggest that vibration-induced nystagmus might represent the peripheral vestibular asymmetry in patients with vestibular neuritis.
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Comparison of Air Caloric Test and Vibration-Induced Nystagmus Test in Patients with Unilateral Chronic Otitis Media without Vertigo
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Jae Yoon Ahn, Hong Ju Park, Jung Eun Shin, Ga Hyun Park, Yong Soo Jung, Hi Boong Kwak, Yeo Jin Lee, Jin Seok Yoo
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J Korean Bal Soc. 2007;6(2):167-171.
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- Background and Objectives: The aims of the study were to characterize the vibration-induced nystagmus (VIN) and air caloric test in patients with unilateral chronic otitis media, and to clarify the clinical availability of VIN by comparing the results of VIN test with those of air caloric test.
Materials and Methods: Nineteen patients with unilateral chronic otitis media who had had no vestibular symptoms in past history were investigated. Pure tone audiometry (PTA), air caloric, VIN and subjective visual vertical (SVV) tests were done and the results were analyzed to estimate the utility for investigating vestibular imbalance.
Results: If we consider a patient with abnormal results from two or more tests as a patient with latent vestibular imbalance, because they had no previous vestibular symptoms, 3 patients was considered to have latent asymmetric vestibular function. False positive rate were 32% in air caloric test, 5% in VIN test and 0% in SVV test.
Conclusion: Our findings show that vestibular imbalance in patients with chronic otitis media should be determined through various tests and vibration-induced nystagmus test can be more useful than air caloric test in estimating the vestibular imbalance.
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Otolith Function Tests in Patient with Meniere’s Disease
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Hong Ju Park, Jung Eun Shin, Jae Yoon Ahn, Ga Hyun Park, Yong Soo Jung, Hi Boong Kwak, Yeo Jin Lee, Jin Seok Yoo
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J Korean Bal Soc. 2007;6(2):127-131.
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- Background and Objectives: The aims of this study were to measure otolith function using subjective visual vertical (SVV) test and vestibular evoked myogenic potential (VEMP) test in patients with unilateral Meniere’s disease, and to see the relationship of the otolithic impairment with caloric and audiologic results.
Materials and Methods: Twenty two patients with unilateral Meniere’s disease who received treatment and also had been tested for pure tone, caloric, SVV and VEMP tests were enrolled. All the tests were done simultaneously.
Results: Five of 22 (23%) patients showed abnormal tilt to the lesion side in SVV test, and 13 of 22 (59%) patients showed abnormal VEMP results on the affected side. There was no correlation between SVV tilts and unilateral weakness (UW) in caloric tests or pure-tone average. There was also no difference of UW in patients with or without VEMP abnormalities. Two patients showed abnormal finding in both SVV & VEMP tests. One patient showed UW (47%) and SVV tilt (3.08°) to the lesion side, and the other showed normal UW and SVV tilt (3.22°) to the lesion side.
Conclusion: Our results demonstrate that the otolith system was implicated in 16 out of 22 (73%) patients with Meniere’s disease. However, there was no correlation between the abnormal results of the three tests and these findings suggest that impairment of the otolithic function is depending on the extent and/or the localization of Meniere’s disease, suggesting vestibular rehabilitation for the specific lesion might be helpful.
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Otolith Function Tests in Patient with Vestibular Neuritis
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Hong Ju Park, Jung Eun Shin, Dae Bo Shim, Hyang Ae Shin, Sang Kyun Lim, Jae Yoon Ahn, Yong Soo Jung, Jin Suk Yu
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J Korean Bal Soc. 2006;5(1):49-54.
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- Background
and Objectives: Vestibular evoked myogenic potentials (VEMP) test provides a useful method for assessment of saccule function and the functional integrity of the inferior vestibular nerve, and subjective visual vertical (SVV) abnormalities are presumably related to a lesion of the utricle. The aim(s) of this study were to measure otolith function using SVV and VEMP tests, and to define the influence of the otolithic organs in patients suffering from vestibular neuritis.
Materials and Method: From September 2005 to January 2006, twelve patients who received treatment in hospital and also had been tested for caloric test, subjective visual vertical (SVV) and vestibular evoked myogenic potential (VEMP) tests with unilateral vestibular neuritis were enrolled. All the tests were done within 8 days after the onset of their symptoms, simultaneously. The SVV was measured in 34 normal subjects as well as in patients.
Results
Eight of 12 patients showed abnormal tilt to the lesion side in SVV test, and five of 8 patients showed no VEMP on the affected side. There was no correlation between SVV tilts and unilateral weakness (UW) in caloric tests. Two patients with abnormal UW (54, 82%) showed normal finding in SVV & VEMP tests. One patient with abnormal UW (83%) and SVV tilts (18.04˚) to the lesion side was normal in VEMP test. Two patients with abnormal UW (28, 37%) and no response in VEMP test were normal in SVV test.
Conclusion
Our results demonstrate that the incidence of abnormal results were 62.5, 66.7% in VEMP and SVV tests in acute stage of vestibular neuritis, respectively. There was no correlation between the abnormal results of the tests and these findings suggest that impairment of the otolithic function is depending on the extent and/or the localization of vestibular neuritis.
Key Words : Vestibular neuritis, Otolith, Vestibular function tests, Subjective visual vertical, Vestibular evoked myogenic potentials
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The Effect of Somatosensory Input on Subjective Visual Vertical in Normal Subjects
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Dae Bo Shim, Hyun Jong Jang, Hyang Ae Shin, Jae Yoon Ahn, In Bum Lee, Jung Eun Shin, Hong Ju Park
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J Korean Bal Soc. 2005;4(2):201-205.
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- Background
and Objectives: Aims of the study were to determine if the somatosensory input influences on vertical perception by comparing the results with the head or body tilted (15°) to the right and to the left, and to examine the influence of tactile sensation in the perception of verticality in head lateral positions.
Materials and Method: We tested 34 normal subjects in their ability to set a straight line to the perceived gravitational vertical. Measurements were taken in static conditions, sitting upright, head tilted (15°), body tilted (15°), and head lateral positions (90°) on the right/left sides with or without physical support under the head.
Results
The normal range of the subjective visual vertical (SVV) was 0.65°±1.23° in upright position. The normal ranges of SVV in head-tilts 15° to the left/right sides were -0.47°±1.76° and 1.88°±2.94°, which were significantly different from those in upright position (E-effect). But the normal ranges of SVV in body-tilts 15° to the left/right were not different from those in upright position. And the normal ranges of SVV in head lateral positions maintained actively and passively were not different each other, but significantly larger than that in upright position (A-effect).
Conclusion
Our results support that neck somatosensory input plays a part in the perception of verticality. In contrast, tactile sensation of the head had no effect on the settings of a visual line to visual vertical in head lateral positions.
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