Research in Vestibular Science

Volume 10 (4); December 2011

Review

Clinical Significance of Vibration-induced Nystagmus in Meniere’s Disease: Hyun Woo Lim, Hong Ju Park; Res Vestib Sci. 2011;10(4):107-114.

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Original Articles

Efficacy of Oral Prostaglandin I2 in Patients with Chronic Nonspecific Vertigo: Ji Won Kim, Hyun Woo Lim, Yun Suk An, Seung Hyo Choi, Hong Ju Park, Jong Woo Chung; Res Vestib Sci. 2011;10(4):115-120.

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Abstract PDF: 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.

New Proposal of Functional Status of Vestibular System Based on Vestibular Function Tests Findings in Dizzy Patients with Normal Caloric Response: Hye Youn Youm, Yang Sun Cho, Sung Hwa Hong, Won Ho Chung; Res Vestib Sci. 2011;10(4):121-128.

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Abstract PDF: Background and Objectives: Vestibular function tests are very useful in diagnosing dizzy patients. Among them, bithermal caloric test is most commonly used test for localizing their permanent vestibular loss. However, it causes much discomfort to the patients with non-physiologic stimuli. In addition, it doesn't represent the present functional status of vestibular system. Therefore, normal caloric result does not accurately correspond to normal vestibular function in dizzy patients. Currently, rotation chair test and dynamic posturography have been introduced adjunctly to assess vestibular function accompanied by bithermal caloric test. It has not been elucidated for their specific role in diverse settings of vestibular disorders. So we planned this study to evaluate clinical usefulness of rotation chair test, videonystagmography and computerized dynamic posturogr-phy in dizzy patients with normal caloric response. Materials and Methods: We reviewed clinical records of 46 patients who met their inclusion criteria. They were categorized into five subgroups according to abnormal vestibular function test findings. Results: In each subgroup, we hypothesized its clinical relevance, possible mechanism of dizz-iness and presumed diagnosis. Five categories are as below; visual dependency, imbalance of vestibular tones, chronic peripheral vestibulopathy, abnormality in the vestibulospinal tract and abnormality of oculomotor system. Conclusion: We suggest new classification of abnormal vestibular functional status in dizzy patients with normal caloric results. These are comparable according their clinical features and thought to be helpful in managing and counseling each patient.

Clinical Characteristics of the Benign Paroxysmal Positional Vertigo in the Elderly: Myung Joo Shim, Hyun Woo Lim, Woo Seok Kang, Jong Woo Chung; Res Vestib Sci. 2011;10(4):129-133.

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Abstract PDF: Background and Objectives: Benign paroxysmal positional vertigo (BPPV) is one of the most common peripheral vestibular disorders. It constitutes the most common vestibular disorder in the elderly with vertigo. Purpose of this study to assess the clinical characteristics and treatment outcome of BPPV in elderly patients. Materials and Methods: We reviewed the medical records of 380 patients above age 60 who were treated for BPPV. Collated data of the elderly BPPV patients in terms of involved canals, number of canalith repositioning procedures and their underlying disease were analyzed and compared with the data of national health report in 2008 that represented the general population. Results: Number of BPPV patients was increased along with age. Three hundred and eighty patients (44.9%) of 847 BPPV patients were over 60. Most commonly involved canal was posterior semicircular canal. Lateral semicircular canal was involved much more frequently (46.8%) compared with previous reports. Along the age, involvement of lateral semicircular canal, frequency of multiple canal involvement and cupulolithiasis increased. In patients older than 60, treatment response was worse than younger ages. More canalith reposition procedures were needed in the elderly than younger patients with BPPV. Between patients with BPPV and normal population, no difference was found in prevalence of co‐morbities, such as diabetes, cerebrovascular disease, cardiovascular disease, other otologic disease, and psychiatric disease. Conclusion: We suggest that more careful diagnosis and intervention should be considered in BPPV of old age due to its complicated natures and lower treatment response.

Prognosis of Hearing According to the Presence of Recurrent Vertigo in Meniere’s Disease: Chan Goo Lee, Moo Kyun Park, Jong Dae Lee, Ji Yun Park, Tae Kyeong Lee, Ki Bum Sung; Res Vestib Sci. 2011;10(4):134-137.

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Abstract PDF: Background and Objectives: In Meniere’s disease, the relationship between the vertigo attacks and prognosis of hearing remains unclear. Our study aimed to elucidate the possible role of recurrent vertigo in the prognosis of hearing in Meniere’s disease. Materials and Methods: The medical records of 53 patients with definite Meniere’s disease over 2 years follow-up were analyzed retrospectively and we analyzed the changes of vertigo and hearing over time. Results: While 49% of patients who were treated conservatively experienced recurrent vertigo attacks, 40% of patients did not have an episode of vertigo during the follow-up. Worsening of hearing and fluctuation were found in about 30% and 26%, respectively. There is no obvious coincidence in the course of vertigo and hearing. Conclusion: The prognosis of hearing dose not depend on the the presence of recurrent vertigo in Meniere’s disease.

Case Reports

Recurrent Vertigo Episodes due to Sick Sinus Syndrome: Hyun Jeung Yu, Koo Eun Lee, Hyun Seok Kang, Sook Young Roh; Res Vestib Sci. 2011;10(4):138-140.

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Abstract PDF: Vertigo due to primary cardiac disease, known as cardiogenic vertigo, has been rarely reported. We report one case showing recurrent vertigo episodes due to sick sinus syndrome. A 77-year-old female presented to our department because of long history of intermittent brief episodes of rotatory vertigo and non-vertiginous dizziness. She had no past medical history. There was no abnormal sign in neurological examination. Cardiac murmur, finally confirmed as grade 4 ejection systolic and grade 3 decrescendo diastolic murmurs, was found on physical examination. Brain magnetic resonance imaging and auditory evoked potential did not show any abnormal findings. She was consulted to a cardiologist for the evaluation of cardiac murmur. After the evaluation using electrocardiogram, echocardiography, and holter monitoring, she was diagnosed as sick sinus syndrome. After then, a ventricle ventricle inhibited (VVI) pacemaker was inserted. She did not complain of vertigo and dizziness for 3 months after the insertion of a VVI pacemaker. This case shows the need of auscultation for patients with recurrent vertigo episodes although there is rare cardiogenic vertigo.

Conservative Management of Horizontal Canal Benign Paroxysmal Positional Vertigo Resistant to Treatment: Hye Ran Son, Chung Ku Rhee, Myung Whan Suh, Jae Yun Jung; Res Vestib Sci. 2011;10(4):141-144.

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Abstract PDF: Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo. Although it is easily cured by repositioning maneuvers for the majority of patients, it can be resistant to treatment in rare cases. Surgery can be considered for such patients with intractable BPPV. But surgery may be followed by some side effects such as hearing loss and persistent disequilibrium. We report a 77-year-old-female patients who had positional vertigo for 5 years in despite of repositioning maneuver at several hospitals. We performed repeated repositioning maneuvers twice a day for 1 month. Her symptom and nystagmus finally subsided after 2 months. Repeated aggressive repositioning maneuver may be an alternative for surgery for patients with intractable BPPV.

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