-
Clinical Characteristics of Pediatric Dizziness
-
Jae Eun Kim, Kyu Sung Kim, Young Hyo Kim, Jeong Seok Choi, Hoseok Choi
-
Res Vestib Sci. 2011;10(3):88-91.
-
-
-
 Abstract
 PDF
- Background and Objectives: Pediatric dizziness is difficult to diagnose because of the nonspecific nature of symptom, and difficulty in history taking, physical examination or diagnostic tests. The authors tried to analyze the proportion of diseases in children suffering from dizziness, and introduce cases with atypical clinical characteristics and uncommon diagnosis. Materials and Methods: The medical records of 53 pediatric patients suffering from dizziness were analyzed retrospectively. We analyzed the findings of history taking, physical examination for nystagmus and cerebellar function, pure tone audiogram and caloric tests in all patients. Results: Diagnosis of migrainous vertigo was most common (32.7%), followed by psychological cause (11.5%) and labyrinthitis due to the otitis media (7.7%). Cases of cerebellar hemangioblastoma, neurofibromatosis and drug intoxication were also found. Conclusion: The clinical characteristics and causative diseases of pediatric dizziness are different from those of adults. Appropriate history taking and diagnostic tests are improtant for differential diagnosis.
-
Influence of Head Position in Rotation Test
-
Jeong Seok Choi, Jae Eun Kim, Kyu Sung Kim, Hoseok Choi
-
Res Vestib Sci. 2011;10(2):52-55.
-
-
-
Abstract
PDF
- Background and Objectives: Rotation test is a widely used method to evaluate the function of the vestibular system. Generally, the head position to be tilted forwards 30° during rotation is preferred in order to bring the horizontal semicircular canals into the plane of rotation, thus ensuring maximum response. However literatures do not provide a clear reference concerning head position during the rotation test. So, we evaluated the vestibuloocular reflex (VOR) induced by sinusoidal rotation in the horizontal plane in the two different head positions: the head tilted forward 30° and with the head upright. Materials and Methods: A total of 20 men with no known neuro-otological disorders and 9 guinea pigs were studied. The rotations of slow harmonic acceleration on various frequencies were performed with the subject’s head in the upright position and in the 30 pitched down position. Computerized electronystagmography in human and magnetic coil in guinea pigs were used to measure the maximum velocity of slow component of horizontal nystagmus and to calculate gain, phase and symmetry of VOR responses. Results: In both groups, results showed no significant differences in gain, phase and symmetry. Conclusion: In the two different head positions, there were no significant differences in gain, phase and symmetry. The posture of head upright is more comfortable for the patient and gives enough response for the evaluation of vestibular function.
-
Age and Gender Specific Reference Value of Ocular Torsion by Using Funduscope in Korean
-
Byoung Youn Ko, Jeong Seok Choi, Kyu Sung Kim, Hoseok Choi
-
Res Vestib Sci. 2011;10(1):30-33.
-
-
-
Abstract
PDF
- Background and Objectives: Ocular torsion may be a result of vestibulopathy. The funduscopy is the most reliable method of measuring an ocular torsion. However, the reference value of ocular torsion in Korean is available at only limited ages. Therefore, we analyzed the angle of ocular torsion more age-specific than previous study.
Materials and Methods: We used the fundus photograph of health check-up visitor. And age and sex specific average angle of ocular torsion was measured.
Results: The right and left average angle of ocular torsion were 7.7±3.6°, 5.3±3.0°, respectively. In addition, there was no significant difference in age or sex specific angle of ocular torsion.
Conclusion: This result might give an aid to evaluating the function of otolithic organ by measurement of ocular torsion.
-
A Case of Lermoyez’ Syndrome
-
Jeong Seok Choi, Seung Ho Shin, Hoseok Choi, Kyu Sung Kim
-
Res Vestib Sci. 2010;9(3):118-120.
-
-
-
Abstract
PDF
- Lermoyez’s syndrome is usually regarded as a rare variant of Meniere’s disease which is characterized by the disappearance of aural symptoms after vertiginous attacks. It is recognized as an uncommon paroxysmal clinical syndrome caused by pathological endolymphatic change in the labyrinth. It is thought that the cause of Lermoyez’s syndrome is due to cochlea hydrops which result from endolymphatic blockage of the ductus reunions. With its distinct characteristic manifestations, the diagnosis is not difficult, but Lermoyez’s syndrome has been rarely reported universally. Otologists are in a whirl about its rare occurrence. We report a unique case of a 46-year-old woman, who showed typical clinical features of Lermoyez’s syndrome with review of literatures. We focused on the sequential clinical change during our observation.
-
A Case of Tumarkin Otolithic Crisis: Failed to Treat with Intratympanic Gentamicin Injection
-
Young Hyo Kim, Hoseok Choi, Kyu Sung Kim, Young Mo Kim
-
Res Vestib Sci. 2010;9(2):76-79.
-
-
-
Abstract
PDF
- Tumarkin otolithic crisis is an unusual manifestation of Meniere’s disease that shows sudden falling without loss of consciousness. As a kind of life-threatening otologic emergency due to high risk of injury, the surgical ablation therapy rather than the medical one is preferred. Intratympanic injection of gentamicin (ITIG) is being introduced as a treatment by chemical ablation of vestibular function. The authors report a case of life-threatening Tumarkin otolithic crisis in 76-year-old female, after onset of Meniere’s disease, failed to treat with multiple application of ITIG, and successfully eradicated the symptom with total labyrinthectomy after then. Also we introduce her clinical feature of Tumarkin otolithic crisis. A 76-year-old female visited clinic suffering from recurrent rotatory vertigo accompanied with fluctuating hearing loss and tinnitus on her left ear, and diagnosis of Meniere’s disease was made. Four months after medical treatment, the patient experienced sudden drop attack during walking on the street without any prodromes, and her right wrist and skull base were fractured as a result. She denied to got surgery and ITIG was applied. During 1 year after initial drop attack, she experienced 7 times of severe drop attack and 4 times of ITIG, and finally she accepted to get surgery. The patient no longer suffered from drop attack after total labyrinthectomy later. Tumarkin otolithic crisis is an otologic emergency, may cause life-threatening falling. Our experience from this case is that vestibular ablation by surgical method is needed for safety and quality of life of patients.
-
Acute Low Tone Sensorineural Hearing Loss: Consideration for Progression to Meniere’s Disease
-
Yoon Suk Oh, Kyu Sung Kim, Hoseok Choi, Kyu Jin Kim
-
Res Vestib Sci. 2010;9(1):16-20.
-
-
-
Abstract
PDF
- Background and Objectives Low tone sensorineural hearing loss is deterioration in audiometric low frequencies (250 and 500 Hz), preservation of high frequencies (2, 4, and 8 kHz). The aim of this study is to find out differences of clinical manifestation and prognosis of acute low tone sensorineural hearing loss (ALHL), a subtype of sudden sensorineural hearing loss, and potential progression to Meniere’s diseases.
Materials and Methods Among 465 patients with unilateral hearing loss initially diagnosed with sudden sensorineural hearing loss, we analyzed clinical characteristics of 96 patients who had acute low tone sensorineural hearing loss, but had no history of previous ALHL.
ResultsThe clinical features of ALHL include a predominance of female suffers (72.9%), more dizziness (36%), high incidence of sound perception change (16.7%), tinnitus (42.8%), and ear fullness (20.8%). The prognosis shows recovery in 67.7% of patients. However, 24.0% of patients show recurrence of low tone loss, and 15.6% develop Meniere’s disease. Specially, if the dizziness symptoms were accompanied, progression to Meniere’s disease was more common (31.4%).
Conclusion Our results appear that clinical characteristics were different in the ALHL patients compared to the idiopathic sensorineural hearing loss patients. Therefore, when dizziness, ear fullness and tinnitus are accompanied with low tone hearing loss, an appropriate patient education on possible progression to Meniere’s disease is necessary.
-
Recurrent Dizziness of Cardiac Origin Confirmed by Holter Monitoring
-
Seung Ho Shin, Kyu Sung Kim, Hoseok Choi, Seong Hye Choi
-
J Korean Bal Soc. 2008;7(2):218-221.
-
-
-
Abstract
PDF
- Ineffective cerebral perfusion by low cardiac output may cause various types of dizziness like mild lightheadedness, vertigo or presyncope, and sometimes it can be the only heralding symptom. Differential diagnosis with other causes of dizziness is important because the symptom may progress into life-threatening bradyarrythmia and loss of consciousness. There are several literatures that reporting the association between cardiac disease and dizziness and their improvement with treatment of cardiac problem including pacemaker placement. But these are only indirect evidences to explain the cause-symptom relationship. We experienced 48-year old woman who has had recurrent dizziness of rotatory type lasting for about 5 seconds since first year, and then diagnosed atrioventricular block after. She has been having anti-hypertension medications for 2 years. She didn’t have any abnormalities in electrocardiography, chest x-ray, or routine blood tests. There were no abnormalities in vestibular function test and electronystgmography. Her result of 24-hour Holter monitoring clearly elucidated temporal relationship between arrhythmia and her episodic symptoms of dizziness. The authors report a case with review of literatures about cardiogenic dizziness.
Key words: Dizziness, Syncope, Arrhythmias, Cardiac, Electrocardiography, Ambulatory
-
Benign Recurrent Vertigo: Clinical Manifestations And Vestibular Function Test
-
Chang Hyo Kim, Kyu Sung Kim, Hoseok Choi, Yun Gun Jung, Seung Chul Lee
-
J Korean Bal Soc. 2008;7(1):48-54.
-
-
-
Abstract
PDF
- Background and Objectives: Benign recurrent vertigo has been defined as recurrent spells of vertigo lasting minutes to hours without cochlear and neurologic signs. The etiology is still unclear, but viral and vasospastic etiology as migraine equivalent has been suggested. We attempt to analyze the symptoms and vestibular function test of Benign recurrent vertigo that has clinically diagnosed.
Materials and Methods: We analyzed retrospectively the clinical characteristics and vestibular function test including ocular-motor test, rotation test and computerized dynamic posturography from 100 patients with a Benign recurrent vertigo diagnosis.
Results: Eight two percent of the patients were female, mean age was 52 years, and mean duration of prevalence was 47.3 months. In the characteristics of vertigo, 91% of patients have spinning sensation during attack. The vertigo attacks most commonly lasts several hours (57%), and frequency of attack is three to twelve time per year in 47%. A high incidence (40%) of headache was detected, but incidence of other associated symptoms including fluctuating hearing loss (3%), tinnitus (27%), aural fullness (9%) was relatively low. The incidence of spontaneous nystagmus and positional nystagmus was 18% and 10% each. Saccadic undershoot was observed in 21% of patients, but it was not associated with other ocular-motor test abnormalities. In rotation test, low gain, phase lead and asymmetry was observed in 18%, 3% and 9%, respectively. There were no abnormal findings in posturography.
Conclusions: Although benign recurrent vertigo did not show any characteristic clinical findings or vestibular function test, it deserves to be considered for differential diagnosis of episodic vertigo.
-
Assessment of Saccular Function in Patients With Noise Induced Hearing Loss
-
In Kuk Hwang, Ji Hyun Moon, Young Hyo Kim, Kyu Sung Kim, Yun Gun Jung, Hoseok Choi
-
J Korean Bal Soc. 2008;7(1):17-21.
-
-
-
Abstract
PDF
- Background and Objectives: Considering saccular receptors are coupled physically with the auditory receptors, VEMP test may provide the information that in the noise induced hearing loss with or without dizziness, damage to the vestibular system, especially saccule is a potential organ with cochlear damage.
Material and Methods: 11 patients (22 ears) with HF-SNHL greater than 55dB and 10 patients (10 ears) with sudden hearing loss of varying degree HL as positive control but without clinical manifestations of vestibular pathology tested for vestibular function test was enrolled. VEMP test was done. The results were compared with those of 9-healthy referents (18 ears) examined in the same way.
Results: VEMP wave was significantly abolished as twelve of 22 (54.5%) with HF-SNHL, five of 13 (38.5%) and Control group (100%). Though there was no statistically significant relation with P13, N23 latency delay in each group, NIHL showed P13, N23 latency delay trend compared with controls.
Conclusions: Patients with noise induced hearing loss showed significantly more saccular deterioration, estimated as negative VEMP responses than did the controls. This suggests subclinical disturbances of the vestibular system especially of the saccule in noise induced hearing loss.
-
Cerebellopontine Metastatic Carcinoma of Small Cell Lung Cancer Mimiking Vestibular Neuritis
-
Young Hyo Kim, Kyu Sung Kim, Yoon Seok Oh, Hoseok Choi
-
J Korean Bal Soc. 2007;6(2):226-229.
-
-
-
Abstract
PDF
- A 77-year-old man visited our department because of dizziness from one month ago. Dizziness was continuous and non-whirling and this type of dizziness was the first time. He also complained of tinnitus and hearing impairment of the right ear. On physical examination, he showed spontaneous left-beating horizontal and torsional nystagmus and rightward head thrust was positive. He was admitted under the first impression of right vestibular neuritis.
On inner ear MRI, there was a well-demarcated 2.5×2.3 cm sized mass of right cerebellopontine angle. This mass showed somewhat low signal intensity in both T1 and T2-weighted image and modest enhancement with Gadolinum.
And approximately 4.5×3 cm sized mass could be seen in the simple chest roentgenogram.
On chest CT, there was a poorly demarcated 3×2.5 cm sized mass in left lower lobe of lung. The patient was diagnosed as small cell lung cancer with brain metastasis by Per-Cutaneous Needle Aspiration of lung. In spite of radiotherapy and concurrent chemotherapy, he expired after 5 months.
-
Comparative Analysis of Vestibular Asymmetry Parameters in Acute Unilateral Peripheral Vestibulopathy
-
Hoseok Choi, Kyu Sung Kim, Young Hyo Kim, In Kuk Hwang, Seung Yeon Jang, Seung Chul Lee
-
J Korean Bal Soc. 2007;6(2):202-206.
-
-
-
Abstract
PDF
- Background and Objectives: There are known parameters that indicate vestibular asymmetry, such as directional preponderance (DP) on caloric test, asymmetry on slow harmonic acceleration (SHA) test, asymmetry of time constant (Tc) and slow cumulative eye position (SCEP) on velocity step test. Aim of this study is investigate the sensitivity and predictability of the vestibular asymmetry parameters among them.
Materials & Methods: Twenty six patients who were diagnosed as acute unilateral peripheral vestibulopathy were enrolled in this study. We compared each parameter with site of lesion based on the direction of spontaneous nystagmus and canal paresis (CP) which were totally correlated in this group of patients.
Results: Positive predictability of each parameter showed 58% in DP, 62% in SHA asymmetry, 62% in SCEP, 38% in Tc. In the cases that each parameter showed positive result, all of DP and SHA asymmetry indicated site of lesion, and showed high correlation coefficient(r=0.89). But in 27% of SCEP and 23% of Tc did not indicate site of lesion.
Conclusion: All parameters showed low sensitivity for identifying laterality of lesion even the tests were performed with in one week after vertigo attack. DP and VOR asymmetry showed high positive predictability for indicating lesion site.
|
KBS
