Research in Vestibular Science

Volume 13 (4); December 2014

Original Articles

Residual Vestibulo-Ocular Reflex Result in Better Functional Outcomes in Bilateral Vestibulopathy: Ji Eun Choi, Gwanghui Ryu, Young Sang Cho, Won Ho Chung; Res Vestib Sci. 2014;13(4):89-95.

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Abstract PDF: Background
and Objectives: The patients with bilateral vestibulopathy (BV) suffer from unsteadiness and oscillopsia, and despite of appropriate rehabilitation, permanent disability is inevitable. However, the level of functional outcomes could be influenced by whether there is residual vestibulo-ocular reflex (VOR) or not. Under the hypothesis that residual VOR function could result in better performances, we tried to compare in functional outcomes between complete and incomplete BV. Materials and Methods: Fifty patients who have been diagnosed with BV in our institution were retrospectively reviewed retrospectively between 2008 and 2012. We classified them into complete BV group (n=19) and incomplete BV (n=31) group according to the presence of residual VOR. Among them, 31 patients responded to telephone survey (6 in complete group and 25 in incomplete group). The survey includes 5 categories such as the subjective dizziness restriction on daily life, oscillopsia, unsteadiness and depression. Each score ranged from 0 to 4 and patients were asked twice in different time period.
Results
There was no difference in etiology between complete and incomplete group. Incomplete group showed significant improvement in dizziness, restriction on daily life, oscillopsia and unsteadiness compared to complete group. Among 5 catergories, dizziness score was significantly improved in incomplete group (each mean improved sore±standard deviation; dizziness 1.84±0.83, oscillopsia 0.44±0.64, unsteadiness 1±1.09, depression 0.24±0.86 restriction on daily life 1.16±0.97). Conclusion: The presence of residual VOR function had better functional outcomes in bilateral vestibulopathy.

Comparison of Audiovestibular Dysfunction in Patients of Acute Unilateral Peripheral Vestibulopathy with and without Vascular Risk Factors: Jun Hyun Kim, Tae Kyeong Lee, Ki Bum Sung; Res Vestib Sci. 2014;13(4):96-101.

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Abstract PDF: Background
and Objectives: Etiology of acute unilateral peripheral vestibulopathy (AUPV) includes virus, ischemia, and autoimmune. As anatomical distribution is similar between vasculature and innervation, AUPV with vascular risk factors could be ischemic origin. We investigated the pattern of audiovestibular dysfunction to explore the influence of risk factors on AUPV. Materials and
Methods
We collected records of 162 AUPV patients from 2011 to 2013 who were admitted within 7 days from vertigo onset and diagnosed as AUPV by caloric test and neuro-otologic examination. Vascular risk factors are stroke history, hypertension, diabetes, body mass index ＞25, age ＞60, and vertebrobasilar stenosis. Bedside examination includes spontaneous nystagmus grade, head impulse test, head shaking test. Results of rotatory chair test (n=125), caloric test (n=162), cervical (n=33) and ocular (n=23) vestibular evoked myogenic potential (VEMP), subjective visual vertical (SVV) (n=91), and pure tone audiometry (PTA) (n=62) are collected. Results: Abnormalities of PTA are found more in patients with vascular risk factor than without any risk factor. Specifically, hypertension (p=0.008) and old age (p=0.025) are associated with PTA abnormality (p=0.006). Tilt angle of vertical is larger in risk factor group (p=0.019). The number of vascular risk factor correlates with abnormalities of PTA (p=0.025) and tilt angle of SVV. Results of bedside examination, rotatory chair test, caloric test, cervical and ocular VEMP are not associated with vascular risk factors. Conclusion: AUPV patients with vascular risk factors have more extensive involvement of audiovestibular function. Ischemic etiology may contribute to pathogenesis of extensive AUPV.

Ocular Vestibular Evoked Myogenic Potential in Vestibular Neuritis Patients: Comparative Study with Cervical Vestibular Evoked Myogenic Potential and Subjective Visual Vertical: Su Il Kim, Young Min Ha, Sang Hoon Kim, Ji Hyun Chung, Moon Suh Park, Jae Yong Byun; Res Vestib Sci. 2014;13(4):102-107.

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Abstract PDF: Background
and Objectives: Subjective visual vertical (SVV) reflects utricle and superior vestibular neural functions, and cervical vestibular evoked myogenic potentials (cVEMP) reflect saccule and inferior vestibular neural functions. But, origin and characteristics of ocular VEMP (oVEMP) remain controversial, especially in case of evoked by air conducted sound (ACS). Thus, the aim of this study was to identify the origin and characteristics of oVEMP by comparing with various otolith function tests. Materials and Methods: Forty vestibular neuritis patients were enrolled from September 2012 to January 2013 in this study. We examined cVEMP, oVEMP using 500 Hz air-counducted sounds. And, we measured static and dynamic SVV. Results: Abnormal cVEMP responses were observed in 6 (15%) patients, and abnormal oVEMP responses were observed in 28 (70%) patients. Abnormal static and dynamic SVV were observed in 18 (45%), 35 (87.5%) patients, respectively. There was strong correlation between oVEMP and dynamic SVV (p=0.009). Conclusion: ACS oVEMP responses showed different tendency from cVEMP responses in vestibular neuritis patients, but similar tendency with results of dynamic SVV. The results suggest that origin of oVEMP is different from that of cVEMP and maybe utricle and superior vestibular neuron.

Eye Movement Abnormalities and Neuroimaging Findings of Disequilibrium of Unknown Origin: Jae Yong Go, Jung Im Seok, Dong Kuck Lee; Res Vestib Sci. 2014;13(4):108-113.

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Abstract PDF: Background
and Objectives: Although disequilibrium is common type of dizziness in older people, it is sometimes difficult to identify a specific cause for this problem. The diffuse brain pathology including subcortical ischemia and atrophy can be a cause for patients with disequilibrium of unknown cause. Aim of this study is to identify the eye movements and neuroimaging features in patients with disequilibrium. Materials and Methods: We performed a prospective investigation in patients with disequilibrium of unknown cause. We collected information on demographic characteristics and clinical features of disequilibrium. The impact of dizziness on everyday life was assessed by 25-item dizziness handicap inventory (DHI). Vestibular function test (VFT) includes smooth pursuit, saccade, optokinetic nystagmus, and rotatory chair test. Subcortical white matter lesions and brain atrophy were graded from brain magnetic resonance image (MRI).
Results
This study included 14 patients (12 female and 2 male), aged between 64 and 84 years, mean age 74.01±6.02 years. The score of DHI was 39.4±11.8 (20?58). Eye movements were abnormal in 13 patients and normal in only one patient. The degree of subcortical ischemia was mild in 7, moderate in 4, and severe in 3 patients. Ventricular brain ratio was 0.23±0.03. However, there was no significant relationship between MRI findings and the degree of oculomotor alterations (result of VFT). Conclusion: Patients with disequilibrium of unknown cause are usually elderly women. Alterations in oculomotor movements and diffuse brain pathology including white matter lesions and atrophy were observed in patients with disequilibrium of unknown cause.

Case Report

Lateral Medullary Infarction with Ipsilesional Gaze-Evoked and Head-Shaking Nystagmus: Taesuk Kyung, Minbum Kim; Res Vestib Sci. 2014;13(4):114-116.

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Abstract PDF: For differential diagnosis between vestibular neuritis and lateral medullary infarction with similar clinical features, bedside examination of nystagmus is important. We report a 45-year-old male who presented with acute vertigo for two days. He showed spontaneous right-beating nystagmus. However, left-beating nystagmus was evoked during bilateral horizontal gaze and by horizontal head oscillation. Brain MRI revealed an acute infarction in the left lateral medulla.

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