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A Clinical Significance of AAO-HNS guidelines for Meniere's Disease
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Jun Ho Lee, Yun Hoon Choung, Keehyun Park, Min Jung Cho, Jinseok Lee, Yong Ro Yoon, Yun Tae Kim
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J Korean Bal Soc. 2005;4(1):26-32.
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 Abstract
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- Background
and Objectives :The guidelines for Meniere's disease recommended from the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) in 1995, provided a basis for reporting results of the treatment used in Meniere's disease. However, these guidelines are sometimes not all inclusive and appropriate for management and reporting for some patients clinically considered having Meniere's disease. The objectives of this study is to review and analyze the symptoms, vertiginous episodes, audiometry, vestibular function test and results of the treatment in Meniere's disease and to evaluate the significance of AAO-HNS guidelines.
Materials and Method : This study consisted of the patients with Meniere symptoms who visited the Dizziness Clinic of Ajou University Hospital between 1994 and 2001 were included in this study. The characteristics of dizziness (duration, frequency, and episodes), pure tone audiometry, vestibular function tests, and treatment results were carefully analyzed according to AAO-HNS guidelines.
Results
: Of 550 patients with Meniere symptoms, 198 patients were in the criteria for Meniere's disease. They were classified to 75 (37.9%) of the “definite”, 120 (60.6%) of the “possible”, and only 3 (1.5%) of the “probable”. In the “definite” group, the pure tone average (PTA) was 54.3 dB and canal paresis (CP) was showed in 33 patients (44%) with a mean CP of 53.6%, and the peak and descending types of the pure tone audiogram were dominant (62%). In the “possible” group, the PTA was 19.4dB and CP was found in 30 patients (25%) with mean CP of 50.1%.
Conclusion
: Even though AAO-HNS guidelines for Meniere's disease are helpful for communication between doctors, they should be considered to have limitations for the diagnosis and treatment in clinical practices.
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The Comparison of Benign Paroxysmal Vertigo of Childhood and Migraine Related Vertigo in Children
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Yun Hoon Choung, Min Jung Cho, Ho Seok Choi, Seung Joo Lee, Jinseok Lee, Jeong Min Jeon, Sung Su Baik
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J Korean Bal Soc. 2003;2(2):191-197.
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Abstract
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- Background
and Objectives: Benign paroxysmal vertigo of childhood (BPVC) and migraine related vertigo (MRV) are most common causes of vertigo in children. Some authors suggested that BPVC may be an early manifestation of migraine. However there is few articles about relationship between BPVC and MRV. The purpose of this study is to compare the clinical characteristics, audiological and vestibular findings, treatment and prognosis of BPVC and MRV and to provide the helpful information for relationship between BPVC and MRV.
Materials and Method: The twenty four children (less than 16 years old) with BPVC and 23 children with MRV, who visited the Dizziness Clinic in the Department of Otolaryngology, Ajou University Hospital, Suwon, Korea between January 2001 and August 2003 were selected for this study. These excluded the patients with abnormal eardrums/tympanograms or those that did not perform questionnaires, audiological, or vestibular evaluations. They were retrospectively analyzed for clinical symptoms, audiograms, vestibular functions, and treatment results.
Results
BPVC was frequently detected in younger children than MRV. Spinning sensation was frequently associated with BPVC. Aural symptoms, headache, photophobia, phonophobia, and visual symptoms were frequently associated with MRV. Abnormalities in vestibular function tests were 14 (58%) in BPVC and 15 (62%) in MRV. BPVC & MRV had good prognosis. But medication was sometimes more needed in MRV than in BPVC.
Conclusions
BPVC and MRV show some different features in the age of onset, clinical features, treatment and prognosis, but also have some features of MRV. Further studies are needed to find their relationship between them.
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Various Causes of Vertigo in Children with Normal Eardrums
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Yun Hoon Choung, Sang Jun Ryu, Min Jung Cho, Sung Kyun Moon, Keehyun Park
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J Korean Bal Soc. 2003;2(1):121-126.
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Abstract
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- Background
and Objectives: The differential diagnosis of vertigo in children is extensive. Otitis media and middle ear effusion could be most common causes of vertigo in children, but there are some problems in detecting the other causes for vertigo because they are one of most popular diseases in childhood. The purpose of this study is to review the clinical characteristics and both the audiological and vestibular findings of vertigo in children with normal eardrums, who do not show otitis media or middle ear effusion, and assist in making a differential diagnosis of vertigo.
Materials and Method: The sixty eight children (less than 16 years old) with vertigo, who visited the Department of Otolaryngology, Ajou University Hospital, Suwon, Korea between January 1995 and April 2003 were selected for this study. These excluded the patients with abnormal eardrums/tympanograms or those that did not perform questionnaires, audiological, or vestibular evaluations. They were retrospectively analyzed for clinical symptoms, audiograms, vestibular functions, and differential diagnosis.
Results
The most common causes for vertigo in children were benign paroxysmal vertigo of childhood (BPVC) in 21 (30.9%) and migraine in 20 (29.4%). Other less frequent causes included four cases of trauma, three cases of acute vestibular neuritis. two cases each of Meniere's disease, delayed endolymphatic hydrops, benign positional vertigo, and one case only for cerebellopontine angle tumor, seizure, juvenile rheumatoid arthritis, leaving eleven cases (16.2%) as unclassified. Abnormal findings were noted in 14 (20.6%) in pure tone audiogram, 3 (4.4%) in positioning test, 11 (16.2%) in bithermal caloric test, and 47 (69.1%) in rotation chair test.
Conclusions
The vertigo in children with normal eardrums, who did not show otitis media or middle ear effusion, was most commonly caused by BPVC and migraine. These findings have shown to be very different from those with adult vertigo. The evaluation of vertigo in children requires a questionnaire for extensive and complete history taking, audiograms and vestibular function tests. And in selected cases, electroencephalography, hematological evaluation, imaging of the brain or temporal bone should be performed.
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