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Most read articles are from the articles published during the past two years (2022~).

Review
The Interaction of Hypertension for Vertigo in Audiovestibular Medicine Clinic
Adaobi Elizabeth Osuji
Res Vestib Sci. 2022;21(2):29-39.   Published online June 15, 2022
DOI: https://doi.org/10.21790/rvs.2022.21.2.29
  • 10,803 View
  • 255 Download
AbstractAbstract PDF
As the first audiovestibular medicine physician in the University of Port Harcourt Teaching Hospital, Nigeria, a keen observation revealed that a sizeable proportion of the adult patients presenting to our audiovestibular medicine clinic with vertigo are either known hypertensives, or hypertensives yet to have a formal diagnosis. This aroused an ardent curiosity to find the raison d’être, and to shed light on this pathological association between vertigo and hypertension. In line with this, it became imperative to highlight the dynamics of interaction, and pathophysiology behind the role of hypertension in vertigo.
Case Report
Arnold-Chiari Malformation Presented with Spontaneous Down-Beating Nystagmus and Gait Disturbance
Minbum Kim, Youn Jin Cho
Res Vestib Sci. 2023;22(4):132-136.   Published online December 15, 2023
DOI: https://doi.org/10.21790/rvs.2023.22.4.132
  • 896 View
  • 13 Download
AbstractAbstract PDFSupplementary Material
Arnold Chiari malformation is a disease which is characterized by herniation of a portion of the cerebellum through the foramen magnum. Symptoms vary depending on the extent of the affected area, including posterior neck pain, upper limb pain, paralysis, paresthesia, weakness, dizziness, and ataxia. Among the patients presenting with dizziness, nystagmus is frequently observed, which is primarily characterized by down-beating nystagmus. We experienced a 42- years-old female patient presented with vertigo and gait disturbance, who were diagnosed with type 1 Arnold-Chiari malformation and treated by surgical decompression.
Original Articles
Clinical Outcomes of Endolymphatic Sac Decompression Surgery in Menière’s Disease
Hee Won Seo, Young Sang Cho, Won-Ho Chung
Res Vestib Sci. 2023;22(4):97-105.   Published online December 15, 2023
DOI: https://doi.org/10.21790/rvs.2023.22.4.97
  • 805 View
  • 54 Download
AbstractAbstract PDF
Objectives
Endolymphatic sac decompression surgery (ESDS) is one of the surgical methods for intractable Menière’s disease (MD), and it is known as a relatively safe treatment that does not cause hearing loss. However, the effectiveness and the degree of vertigo control rate of ESDS are still controversial. In this study, we aimed to evaluate the clinical outcomes of ESDS in intractable MD.
Methods
We retrospectively reviewed 33 patients who underwent ESDS for intractable MD from January 2002 to March 2022. Clinical characteristics of patients, pure tone threshold, medical treatment method, and number of vertigo attacks before and after surgery were assessed. The improvement of hearing and vertigo was evaluated according to the 1995 American Academy of Otolaryngology-Head and Neck Surgery criteria.
Results
Of the 33 patients, the average follow-up period was 21.2 months, with immediate follow-up within 2 months (28 patients), short term between 2 and 6 months (27 patients), and long term at 12 months or later (29 patients). In the immediate hearing threshold, both air conduction and bone conduction showed slight deterioration, but there was no significant change in the long-term hearing threshold. At long-term follow-up, 12 patients (41.4%) were able to live without medication, and 18 patients (62.1%) showed improvement in their vertigo symptoms. In addition, patients who showed improvement in hearing also showed improvement in vertigo at the same time.
Conclusions
ESDS in intractable MD is a relatively safe and effective treatment method for reducing vertigo attack without worsening hearing threshold.
Unilateral Vestibulopathy Mimicking Inner Ear Ischemia Modeling Using Photothrombosis and Behavioral Assessment Using EthoVision
Min Seok Song, Min Young Lee, Ji Eun Choi, So-Young Chang, Jae-Hun Lee, John Patrick Cuenca, Nathaniel T. Carpena, Jae Yun Jung
Res Vestib Sci. 2023;22(4):112-119.   Published online December 15, 2023
DOI: https://doi.org/10.21790/rvs.2023.22.4.112
  • 727 View
  • 16 Download
AbstractAbstract PDF
Objectives
Inner ear ischemic animal models using photochemical reactions have been devised in various ways. Localized vascular ischemia occurs with 532-nm laser irradiation after systemic rose bengal injection, a known photothrombotic mechanism. The aim of this study is to evaluate a photothrombosis-induced vestibulopathy mimicking behavioral changes in the inner ear ischemia model.
Methods
Seven-week-old male Spraque-Dawley rats were used. Animals were divided into three groups: control group (n=6), sham laser group (n=9), and laser group (n=9). To induce the photothrombosis, animals were injected with rose bengal into the femoral vein and then were irradiated with a 532-nm laser (175 mW for 900 seconds) via transtympanic membrane. To investigate the vestibulopathy after photothrombosis, the behavior tests (tail lift reflex test, air righting reflex test, rotarod test) were performed on the 1st, 3rd, and 7th days after surgery. Additionally, an open field test was conducted and analyzed using EthoVision XT (Noldus).
Results
The laser group exhibited significant behavioral change to mimic vestibulopathy in all assessments. Inducing photothrombosis with rose bengal caused severe gait instability, which precluded rotarod testing. In the tail lift reflex test, the laser group displayed vestibular dysfunction with a lower angle formation compared to the control rats. During the open field test, the laser group exhibited reduced mobility, a condition that persisted in the laser groups for 7 days.
Conclusions
Noninvasive laser irradiation using rose bengal and a 532-nm laser induces photothrombosis in the inner ear of animals, leading to the development of vestibulopathy mimicking imbalanced behavior.
Efficacy of the Fixation Index of Bithermal Caloric Test for Differentiating Brain Lesions in Vestibular Disoder
Young Jae Lee, Wonyong Baek, Sung-Il Cho, Gi-Sung Nam
Res Vestib Sci. 2023;22(4):106-111.   Published online December 15, 2023
DOI: https://doi.org/10.21790/rvs.2023.22.4.106
  • 685 View
  • 25 Download
AbstractAbstract PDF
Objectives
This study was performed to investigate the efficacy of the fixation index (FI) of the bithermal caloric test for differentiating brain lesions in vestibular disorder.
Methods
We reviewed the medical records of 286 consecutive dizzy patients who underwent brain magnetic resonance imaging (MRI) and the bithermal caloric test at department of otorhinolarnygology. Central vestibulopathy (CVP) was defined as when corresponding lesion was identified on brain MRI, otherwise peripheral vestibulopathy (PVP) was defined. The FI was defined as the mean slow phase velocity (SPV) with fixation divided by the mean SPV without fixation, and failure was indicated when the FI exceeded 70%.
Results
The CVP confirmed by brain MRI and PVP were 16.8% and 83.2%, respectively. The most common CVPs were cerebellopontine angle tumor (n=19, 39.6%) and chronic cerebellar infarction (n=18, 37.5%). There were 23 cases of CVP (47.9%) and 47 cases of PVP (19.7%) with abnormal number of FI in at least two of the four caloric irrigations. The FI score of right cool (RC), left cool (LC), and right warm (RW) were also increased significantly in patients with CVP (p=0.031 at RCFI, p=0.014 at LCFI, p=0.047 at RWFI, and p=0.057 at LWFI; Mann-Whitney U-test).
Conclusions
If two or more abnormal FIs are detected during bithermal caloric testing, there is a high likelihood of CVP. Consequently, additional brain MRI may be necessary for further evaluation.
Case Report
Dural Arteriovenous Fistula Presenting as Acute Unilateral Vestibulopathy
Won Jeong Son, Jieun Roh, Eun Hye Oh, Jae-Hwan Choi
Res Vestib Sci. 2023;22(4):127-131.   Published online December 15, 2023
DOI: https://doi.org/10.21790/rvs.2023.22.4.127
  • 557 View
  • 11 Download
AbstractAbstract PDF
Intracranial dural arteriovenous fistula (dAVF) is characterized by an abnormal connection between branches of arteries and veins in the dura mater. Clinical manifestations of dAVF vary depending on their location, feeder arterial supply, amount of shunting, and most importantly, their venous drainage pattern. Acute vertigo has been rarely reported as an initial presentation of dAVF due to venous congestion in the brainstem. We report a patient who presented with acute right vestibulopathy without any brainstem signs in dAVF involving the transversesigmoid sinus. The patient showed abnormal caloric response but normal head impulse in the affected ear. Without any treatment, the patient’s symptoms gradually improved with a normalization of right canal paresis. Follow-up cerebral angiography also revealed a spontaneous regression of the shunt flow and reduction of venous drainage at the right transverse-sigmoid sinus. Based on the results of vestibular function tests and cerebral angiography, acute vertigo in our patient may be ascribed to impaired reabsorption of endolymph by focal venous congestion.
Original Article
Auto-Pattern Recognition for Diagnosis in Benign Paroxysmal Positional Vertigo Using Principal Component Analysis: A Preliminary Study
O-Hyeon Gwon, Tae Hoon Kong, Jaehong Key, Sejung Yang, Young Joon Seo
Res Vestib Sci. 2022;21(1):6-18.   Published online March 15, 2022
DOI: https://doi.org/10.21790/rvs.2022.21.1.6
  • 3,706 View
  • 76 Download
  • 1 Crossref
AbstractAbstract PDF
Objectives
The aim of this study was to develop a filtering algorithm for raw nystagmus images and a diagnostic assistive algorithm using a principal component analysis (PCA) to distinguish the different types of benign paroxysmal positional vertigo (BPPV).
Methods
Fifteen video clips of clinical data with typical nystagmus patterns of BPPV (13 cases) and with normal nystamgmus (two cases) were preprocessed when applied the thresholding, morphology operation, residual noise filtering, and center point extraction stages. We analyzed multiple data clusters in a single frame via a PCA; in addition, we statistically analyzed the horizontal and vertical components of the main vector among the multiple data clusters in the canalolithiasis of the lateral semicircular canal (LSCC) and the posterior semicircular canal (PSCC).
Results
We obtained a clear imaginary pupil and data on the fast phases and slow phases after preprocessing the images. For a normal patient, a round shape of clustered dots was observed. Patients with LSCC showed an elongated horizontal shape, whereas patients with PSCC showed an oval shape at the (x, y) coordinates. The scalar values (mm) of the horizontal component of the main vector when performing a PCA between the LSCC- and PSCC-BPPV were substantially different (102.08±20.11 vs. 32.36±12.52 mm, respectively; p=0.0012). Additionally, the salar ratio of horizontal to vertical components in LSCC and PSCC exhibited a significant difference (16.11±10.74 mm vs. 2.61±1.07 mm, respectively; p=0.0023).
Conclusions
The data of a white simulated imaginary pupil without any background noise can be a separate monitoring option, which can aid clinicians in determining the types of BPPV exhibited. Therefore, this analysis algorithm will provide assistive information for diagnosis of BPPV to clinicians.

Citations

Citations to this article as recorded by  
  • Development of An Algorithm for Slippage-Induced Motion Artifacts Reduction in Video-Nystagmography
    Yerin Lee, Young Joon Seo, Sejung Yang
    Research in Vestibular Science.2022; 21(4): 104.     CrossRef
Corrigendum
Correction: A Case of Patient with Bilateral Cochleovestibular Function Loss due to Infratentorial Superficial Siderosis
Gyuman Lee, Youngmin Mun, Dae Bo Shim
Res Vestib Sci. 2023;22(4):137.   Published online December 15, 2023
DOI: https://doi.org/10.21790/rvs.2023.22.4.137
Corrects: Res Vestib Sci 2023;22(3):83
  • 495 View
  • 8 Download
PDF
Review
Light Cupula: Recent Updates
Dong-Han Lee, Chang-Hee Kim
Res Vestib Sci. 2023;22(2):23-33.   Published online June 15, 2023
DOI: https://doi.org/10.21790/rvs.2023.22.2.23
  • 1,465 View
  • 84 Download
AbstractAbstract PDF
Benign paroxysmal positional vertigo (BPPV) is the most common cause of positional vertigo and nystagmus. Direction-changing positional nystagmus (DCPN), which refers to the change in the direction of nystagmus with different head positions, is a well-known characteristic of horizontal semicircular canal BPPV. The supine head roll test is commonly used to diagnose horizontal canal BPPV. However, persistent geotropic DCPN observed during this test cannot be explained by conventional mechanisms of canalolithiasis or cupulolithiasis. The concept of a “light cupula” has been proposed to account for this unique nystagmus. In this review, we summarize the historical background, clinical features and diagnostic methods, presumed mechanisms, and treatment approaches of the light cupula phenomenon based on the available literatures up to date.
Case Report
A Case of Ramsay Hunt Syndrome Showing Central Findings due to Brainstem Involvement
Min Hyuk Lee, Min-Beom Kim
Res Vestib Sci. 2023;22(4):120-126.   Published online December 15, 2023
DOI: https://doi.org/10.21790/rvs.2023.22.4.120
  • 478 View
  • 19 Download
AbstractAbstract PDF
Ramsay Hunt syndrome occurs when the varicella zoster virus reactivates. Classic findings include the triad of facial paralysis, otic pain and herpetic lesions due to the pathogenesis associated with anterograde axonal reactivation of the varicella zoster virus in the geniculate ganglion. In addition to the classic triad, rare features such as a central type of vestibular function test may be observed due to the retrograde spread of the varicella zoster virus from the geniculate ganglion into the brain stem, including involvement of the vestibular nucleus. We present a case of Ramsay Hunt syndrome in a 57-year-old male patients, manifesting not only the typical triad of symptoms but also the unique features associated with brain stem involvement. This presented as direction-changing gaze-evoked nystagmus and a decrease in gain on both sides on video head impulse test. And brain magnetic resonance imaging showed a lesion in the vestibular nucleus of the brain stem.
Review
Clinical Significance and Update of Postural Orthostatic Tachycardia Syndrome
Jung A Park, Jae Han Park
Res Vestib Sci. 2022;21(1):1-5.   Published online March 15, 2022
DOI: https://doi.org/10.21790/rvs.2022.21.1.1
  • 2,606 View
  • 248 Download
AbstractAbstract PDF
Postural orthostatic tachycardia syndrome (POTS) is a cerebrovascular autonomic dysfunction that is common in young women. POTS can cause dizziness due to orthostatic intolerance. In patients with orthostatic intolerance, it can be diagnosed when the heart rate increases by more than 30 beats per minute within 10 minutes of standing up through the head-up tilt test. However, even a neuro-otologist has difficulty in diagnosing POTS due to the high possibility of misdiagnosis if not paying attention. In this paper, the clinical symptoms, pathophysiology, diagnosis, and treatment of POTS are investigated. In addition, the latest knowledge of POTS is searched to help diagnose and treat POTS.
Original Article
Quantifying the Prevalence of Acute Vestibular Neuritis through Big Data Analysis
Chul Young Yoon, Seulgi Hong, Ji-Yun Park, Young Joon Seo
Res Vestib Sci. 2023;22(3):68-76.   Published online September 15, 2023
DOI: https://doi.org/10.21790/rvs.2023.22.3.68
  • 1,082 View
  • 43 Download
AbstractAbstract PDFSupplementary Material
Objectives
Big data analytics in healthcare research have gained momentum, offering unprecedented opportunities to investigate complex medical conditions like acute vestibular neuritis (AVN). However, an inappropriate definition can introduce bias and inaccuracies into prevalence estimation, making the results unreliable and hindering cross-study comparisons. The Health Insurance data in South Korea will be used to create a robust operational definition for AVN.
Methods
The study utilized the National Patients Sample dataset from the Health Insurance Review and Assessment Service (HIRA) of the Republic of Korea. The operational definition of AVN was defined using the HIRA data, which includes specific codes for diagnosis, testing, and medications. The revised categorization scheme for AVN was presented as case 1 through case 5, with criteria for each category.
Results
The optimal conditions are deemed to be those that encompass the outcomes of both case 5 and case 1-1, encompassing all conditions. The study also provided prevalence estimates for subgroups based on demographic factors (age, sex), and found a consistent pattern throughout all years, sex, and age.
Conclusions
The study analyzed the prevalence of AVN in case 1 and case 5, which were similar to the reference prevalence of 3.5 per 100,000 people reported in other countries. The study’s results are encouraging for several reasons, including the validity of the operational definitions used, and the agreement between the study’s prevalence estimates and the reference prevalence. The operational definition in statistics, in the context of big data, serves as a precise and standardized criterion.
Case Reports
A Rare Case of Isolated Infarcts of the Pons with Sudden Vertigo: Clinical Features and Imaging Findings
Dong Hwan Kwon, Eun kyung Jeon, Young Joon Seo
Res Vestib Sci. 2023;22(3):89-94.   Published online September 15, 2023
DOI: https://doi.org/10.21790/rvs.2023.22.3.89
  • 903 View
  • 32 Download
AbstractAbstract PDF
Isolated infarcts of the pons (IIP) are a rare subtype of ischemic stroke, accounting for less than 1% of all strokes. It refers to a specific type of ischemic stroke that occurs within the pons region of the brain. IIP can be associated with vertebrobasilar insufficiency in certain cases. This case report describes a 64-year-old female patient who presented with acute vertigo and spontaneous nystagmus to the lesion side, ultimately diagnosed with IIP in the posterior right side of pons. Tegmental pontine infarcts typically manifest as oblique small (lacunar) infarctions that are localized in the mediolateral tegmental area of the middle to upper pons. The patient’s symptoms resolved spontaneously, but a 2-mm infarct was confirmed by brain diffusion magnetic resonance imaging. This case highlights the distinctive symptoms associated with IIP and emphasizes the importance of careful neurological examination and advanced neuroimaging techniques for accurate diagnosis.
A Case of Patient with Bilateral Cochleovestibular Function Loss due to Infratentorial Superficial Siderosis
Gyuman Lee, Youngmin Mun, Dae Bo Shim
Res Vestib Sci. 2023;22(3):83-88.   Published online September 15, 2023
DOI: https://doi.org/10.21790/rvs.2023.22.3.83
Correction in: Res Vestib Sci 2023;22(4):137
  • 828 View
  • 30 Download
AbstractAbstract PDF
Superficial siderosis (SS) is a rare neurodegenerative condition characterized by hemosiderin deposition in the central nervous system, which sometimes leads to sensorineural hearing loss and vestibular dysfunction. This case report details the diagnosis and treatment of a 63-year-old female patient presenting with a yearlong history of postural instability and recent symptoms of sudden right-sided hearing loss and imbalance. Physical examination and imaging revealed bilateral deafness and infratentorial SS. Treatment, including medication, vestibular exercises, high-dose steroids, and hyperbaric oxygen therapy, led to a significant alleviation of dizziness but no improvement in hearing. This case emphasizes the need for clinicians to consider SS in patients presenting with sudden-onset hearing loss and dizziness, even without prior any medical history or trauma, to accurately identify the underlying cause.
Review
Vestibular Migraine: A Recent Update on Diagnosis and Treatment
Young Seo Kim, Hak Seung Lee
Res Vestib Sci. 2022;21(3):67-74.   Published online September 15, 2022
DOI: https://doi.org/10.21790/rvs.2022.21.3.67
  • 2,818 View
  • 198 Download
AbstractAbstract PDF
Vestibular migraine (VM) is a variant of migraine resulting in vestibular symptoms in addition to symptoms typical of migraine. However, without a biomarker or a complete understanding of the pathophysiology, VM remains underrecognized and underdiagnosed. Therefore, the diagnosis of VM is still challenging. Meanwhile, VM should be clearly differentiated from other similar diseases. Here, we highlight these challenges, discuss common vestibular symptoms and clinical presentations in VM, and review the current aspects of its clinical diagnosis and evaluation. The concepts related to the treatment of VM are also discussed.

Res Vestib Sci : Research in Vestibular Science