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Bilateral Inversion of Initial Nystagmus in Benign Paroxysmal Positional Vertigo of Horizontal Canal
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Myung Whan Suh, Sang Wook Kim, Min Hyun Park, Ji Soo Kim, Ja Won Koo
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J Korean Bal Soc. 2006;5(2):299-306.
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 Abstract
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- Horizontal canal benign paroxysmal positional vertigo (HC-BPPV) is characterized by direction-changing nystagmus of the horizontal component induced by lateral head turning in supine position. Yet, some patients with HC-BPPV show nystagmus inversion during head turning to one side. And, mostly, the nystagmus started in a geotropic direction and the inversion was observed only when the head is turned to the lesion side. Reversal of the clot movement in the canal and sensory adaptation were suggested as the hypothesis for such finding. However, bilateral inversion of geotropic nystagmus into apogeotropic nystagmus in HC-BPPV has seldom been described before. In this paper, the authors presented the characteristic features and progression during reposition of a patient with bilateral nystagmus inversion and speculated its mechanisms.
Key Words : Positional vertigo, Semicircular canal, Diagnosis, Nystagmus
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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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Immunologic Screening Test and Type II Collagen Autoimmunity in Meniere's Disease
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Ja Won Koo, Min Hyun Park, Seung Ha Oh, Tai June Yoo, Sun O Chang, Chong Sun Kim
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J Korean Bal Soc. 2005;4(1):13-16.
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Abstract
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- Background
and Objectives :Altered immunity against one’s own tissue, especially inner ear, is in part responsible for the development of Meniere’s disease (MD). Since immunologic screening test results are usually nonspecific, even if tested for those patients suspicious of autoimmune inner ear disease, they do not seem to provide valuable information. The aim of this study is to evaluate the validity of immunologic screening laboratory tests for MD patients with type II collagen (CII) autoimmunity and to discuss the diagnostic role in this localized immunologic disease.
Materials and Method : Thirty-six patients of MD in which immunologic screening laboratory test result was available were included in this study and their clinical features were described according to the criteria of AAO-HNS(1995). They were divided into two groups, CII(+) (N=8) or CII(-) (N=28) according to the presence of anti-CII antibody determined by ELISA method as described earlier. Rheumatoid factor (RF), Fluorescent antinuclear antibody (FANA), immunoglobulin G, M and A, and complement 3 and 4 were included for immunologic screening test. Individual test and clinical features were compared between groups.
Results
: Any single test did not show significant correlation between groups. But RF, total IgG and the proportion of patients more than at least one marker are higher in CII(+) group with borderline significance.
Conclusion
: Higher positive rate of immunologic screening test may support the immunologic involvement in CII(+) group. However the role of this screening test seems to be limited in a localized disease like MD compared systemic immunologic disorder, such as rheumatoid arthritis.
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