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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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Effects of Intrabullar Gentamicin Application on Guinea Pig Vestibulo-Ocular Reflex
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Ja Won Koo, Jae Jun Song, Sung Kwang Hong, Ji Soo Kim
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J Korean Bal Soc. 2008;7(1):9-16.
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Abstract
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- Background and Objectives: Unilateral vestibular loss can be induced by intratympanic gentamicin instillation. Despite accumulated reports on the morphologic changes after gentamicin treatment, there are limited reports regarding the effects of gentamicin ototoxicity on the vestibulo-ocular reflex (VOR), in especially unilateral vestibular deficit by local gentamicin instillation. Aim of this study is to provide the functional changes after local gentamicin application in guinea pigs.
Materials and Methods: Ten white guinea pigs (5 each for control and gentamicin treatment group) were used. Following surgical exposure of the left bulla, 0.9% saline solution or 40 mg/ml of gentamicin soaking gelfoam were applied on the round window. Horizontal vestibulo-ocular reflex (hVOR) was tested during earth vertical axis (EVA) sinusoidal harmonic acceleration rotation at 4 frequencies (0.04, 0.08, 0.16 and 0.32 Hz, 60 deg/sec of peak velocity). In one gentamicin treated animal, hVOR was tested during step velocity off-vertical axis rotation (OVAR) to clockwise and counterclockwise direction (30° forward tilt from EVA with constant velocity of 100 deg/sec). Every test was repeated before treatment and at 2 days, 5 days and 7 days after treatment.
Results: The hVOR gain was significantly lowered after gentamicin treatment at all tested frequencies (p<0.05), while the gain does not change over time in control animals. Loss of bias component was evident and some decrease of modulation component was observed in counter-clockwise (lesion side) rotation after gentamicin treatment.
Conclusion: This study provides characteristics of hVOR during EVA rotation and OVAR in unilateral vestibular deficit animal model by intrabullar gentamicin application.
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Analysis of Parameters of Vestibular-Evoked Myogenic Potentials in Sudden Sensorineural Hearing Loss without Vertigo
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Min Hyun Park, Woo Jin Jeong, Jae Jun Song, Ji Soo Kim, Ja Won Koo
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J Korean Bal Soc. 2005;4(2):206-211.
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Abstract
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- Background
and Objective: Vestibular evoked myogenic potentials (VEMP) has been promoted as a means of assessing the integrity of saccular function. Even though sacculospinal reflex may not be influenced by abnormality of cochlear pathway, saccule is closely related with cochlea in its embryological development and also in geographic location. So authors hypothesized the presence of functional alterations of saccule in patients with sudden sensorineural hearing loss who do not complain of vertigo, since saccular dysfunction may not induce subjective vestibular symptoms or signs. Authors tested saccular function in those patients using VEMP and analyzed the parameters according to other clinical indicators.
Materials and Method: From July to September 2005, 22 patients who diagnosed with unilateral sudden sensorineural hearing loss without vertigo were enrolled. The patients who had vertigo as initial symptom or showed spontaneous nystagmus were excluded. All patients received conventional audiometry, tone-burst VEMP test, and caloric test. We analyzed P13 and N23 latency, interpeak amplitude and asymmetric ratio of amplitude. The patients divided to complete hearing recovery, partial recovery, and no response group according to treatment outcome. The correlation between parameters and treatment result was analyzed.
Results
In 2 out of 22 patients (9.1%), VEMP waves were not detected. There was no latency delay in affected ear. But the interpeak amplitude of the affected ear was significantly smaller than that of healthy side (paired t test, p=0.02). Patients who did not respond to treatment showed smaller interpeak amplitude than those who showed complete recovery.
Conclusion
Most patients of idiopathic sudden sensorineural hearing loss without vertigo seem to show normal VEMP waves. But some parameters regarding amplitude had abnormal findings in affected ear. Further studies with larger sample size seem to be necessary to elucidate such outcomes.
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A Case of Bilateral Otosyphilis in the Patient with HIV Infection
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Jae Jun Song, Hyun Su Jun, Sung Won Chae, Soon Jae Hwang
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J Korean Bal Soc. 2004;3(2):424-427.
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Abstract
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- Syphilis was a common cause of progressive or sudden sensorineural hearing loss. After introduction of penicillin, the incidence of syphilis decreased in general population. However, with the prevalence of HIV infection, it's incidence is increasing. Many studies have substantiated the aggressive and rapidly progressive behavior of neurosyphilis, including otosyphilis, in the presence of HIV infection . We report a case of 38-year-old man HIV infected patient with bilateral sensorineural hearing loss and bilateral total vestibular loss caused by otosyphilis which was resistant to treatment.
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Clinical Analysis of Down Beat Nystagmus in Atypical Positional/ing Vertigo
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Gyu Cheol Han, Ju Hyoung Lee, Eun Jung Lee, Jae Jun Song
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J Korean Bal Soc. 2004;3(1):150-155.
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Abstract
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- Background
and Objectives : Traditionally, down beat nystagmus is regarded as a sign of central nervous system
dysfunction. But, several years has passed since Herdman et al reported the down beat nystagmus developed during
treatment maneuvers for posterior semicircular canal benign paroxysmal positional vertigo(BPPV). We undertook this
study to evaluate the character and clinical analysis of the positional or positioning down beat nystagmus, to discuss
the clinical significance of positional or positioning down beat nystagmus as a diagnostic criteria of superior
semicircular canal BPPV, and to propose the new treatment method.
Materials and Method : From November 1999 to March 2004, we sampled the 103 patients with positional or
positioning down beat nystagmus. Of these patients, we selected 16 patients except for the patients with central nervous
system dysfunction, nonspecific or artifact result, idiopathic origin.
Results
: All of 16 patients had no sign and radiologic result of central nervous system disorder. 10 patients was
reported or suspected the diagnosis of posterior semicircular canal BPPV. Fatigability was reported in 9 patients and
reversibility was reported in 1 patient. Average latency was checked less than 2 seconds.
Conclusion
: Although the diagnostic criteria of superior semicircular canal BPPV that we reported was not
controversial, we expect that this criteria is useful in diagnosis for patients with atypical positional or positioning down
beat nystagmus. And the new treatment method that we reported will has the better results than previous method.
Key Words : Benign paroxysmal vertigo, Positional vertigo, Superior semicircular cana
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