Research in Vestibular Science

Impairment of Vestibular Function in Patients with Vestibular Schwannoma According to the Presence of Dizziness: Youngjeong Lee, Se A Lee, Eek-Sung Lee, Tae-Kyeong Lee, Jong Dae Lee; Res Vestib Sci. 2022;21(3):75-79. Published online September 15, 2022; DOI: https://doi.org/10.21790/rvs.2022.21.3.75

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Abstract PDF: Objectives
Vestibular schwannoma (VS) is a benign Schwann cell-derived slow growing tumor originating from the vestibular nerve. Here, we aimed to investigate the correlation between the presence of the dizziness symptoms and several vestibular function test results.
Methods
We analyzed 32 patients who diagnosed with VS from 2010 to 2021 in our hospital. Caloric test, cervical vestibular-evoked myogenic potential (cVEMP) test, and video head impulse test (vHIT) were analyzed.
Results
Age, sex, pure tone audiometry, and tumor size did not show any statistical significance according to the presence or absence of dizziness. There was also no association between the presence of dizziness symptom or dizziness type and the results of the caloric test, vHIT, and cVEMP test, respectively. However, patients with dizziness had a higher rate of tumors confined to the inner auditory canal than those without dizziness.
Conclusions
In this study, the rate of complaints of dizziness was higer in patients with intracanalicular VS. The diagnostic role of vestibulsr function tests in VS is limited. The dissociation of the results of caloric test, vHIT, and cVEMP test suggest that these test are complementary.

Vestibular Function and Prognosis of Sudden Sensorineural Hearing Loss with Vertigo: Se A Lee, Hyo Jun Kim, Bo Gyung Kim, Jong Dae Lee; Res Vestib Sci. 2018;17(3):90-94. Published online September 18, 2018; DOI: https://doi.org/10.21790/rvs.2018.17.3.90

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Abstract PDF: Objectives
Vertigo combined with sudden sensorineural hearing loss (SSNHL) is known as a poor prognostic factor. We investigated clinical findings and vestibular function tests in patients of SSNHL with vertigo to find the prognostic factors.
Methods
We retrospectively evaluated data on the patients diagnosed with SSNHL with vertigo at Bucheon Soonchunhyang University Hospital from March 2009 to February 2018. We reviewed medical records and the results of vestibular function tests and audiometry.
Results
Of the 68 patients, 30 (44.1%) showed profound hearing loss and 53 (77.9%) showed poor recovery. Age and the degree of initial hearing loss showed negative prognostic factor in hearing recovery. Abnormal results of cervical vestibular evoked myogenic potentials (cVEMP) also showed significantly differences between good and poor recovery groups.
Conclusions
In this study, most of the patients of SSNHL with vertigo showed poor recovery. Age, degree of initial hearing loss, and the abnormal result of the cVEMP have a negative effect on the prognosis of hearing recovery.

A Case of Recurrent Vertigo in Vestibular Schwannoma Treated with Chemical Labyrinthectomy: Seung Jae Lee, Eun Sang Lee, Bo Gyung Kim, Jong Dae Lee; Res Vestib Sci. 2017;16(4):147-150. Published online December 15, 2017; DOI: https://doi.org/10.21790/rvs.2017.16.4.147

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Abstract PDF

Vestibular schwannoma (VS) can have various symptoms and almost half of the patients have balance problems. Some patients with VS can suffer from recurrent vertigo mimicking Meniere’s disease. We present the case of a 61-year-old male patient who was suffering from recurrent vertigo due to VS while symptoms improved by chemical labyrinthectomy with gentamicin. We consider that chemical labyrinthectomy can be an option in the treatment of patients with recurrent vertigo for VS.

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Diagnosis and Management of Vestibular Schwannoma: Focus on Dizziness
Sung Il Nam
Research in Vestibular Science.2021; 20(4): 119. CrossRef

화학적 미로절제술로 치료한 전정신경초종에 의한 재발성 어지럼: Seung Jae Lee, Eun Sang Lee, Bo Gyung Kim, Jong Dae Lee; Received November 8, 2017 Accepted November 27, 2017 Published online November 27, 2017; [Accepted]

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Abstract: Vestibular schwannoma (VS) can have various symptoms and almost half of the patients have balance problems. Some patients with VS can suffer from recurrent vertigo mimicking Meniere’s disease. We present the case of a 61-year-old male patient who was suffering from recurrent vertigo due to VS while symptoms improved by chemical labyrinthectomy with gentamicin. We consider that chemical labyrinthectomy can be an option in the treatment of patients with recurrent vertigo for VS.

Persistent Postural-Perceptual Dizziness: Jong Dae Lee; Res Vestib Sci. 2016;15(3):70-73. Published online September 15, 2016; DOI: https://doi.org/10.21790/rvs.2016.15.3.70

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Abstract PDF

Persistent postural-perceptual dizziness (PPPD) was derived from phobic postural vertigo and chronic subjective dizziness. Two key physical symptoms of PPPD are postural unsteadiness and visually induced dizziness. Although the underlying mechanism of PPPD is still enigmatic, the prognosis is good with adequate treatment. In this paper, diagnostic criteria, pathophysiology and treatment regarding PPPD will be reviewed.

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A Case Report of Persistent Postural-Perceptual Dizziness Treated with Korean Medicine
Min-hwa Kim, Gi-yoon Heo, Hee-kyung Kang, I-rang Nam, Maria Kim, In Lee, Jung-nam Kwon, So-yeon Kim, Young-ju Yun, Jun-yong Choi, Chang-woo Han, So-jung Park, Jin-woo Hong
The Journal of Internal Korean Medicine.2022; 43(4): 769. CrossRef
Pitfalls in the Diagnosis of Vertigo
Hyun Ah Kim, Hyung Lee
Journal of the Korean Neurological Association.2018; 36(4): 280. CrossRef

A Case of Cerebellar Arteriovenous Malformation with Positional Down Beat Nystagmus: Kong Geun Bae, Jeong Yeop Lee, Bo Gyung Kim, Jong Dae Lee; Res Vestib Sci. 2014;13(3):68-71.

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Abstract: Brain arteriovenous malformation (AVM) is an abnormal connection between arteries and veins, bypassing the capillary system in the central nervous system. The first symptom of AVM is intracranial hemorrhage, followed by headache and seizure. However, dizziness as a symptom of AVM is very rare. We report a 16-year-old female patient who presented with disequilibrium. She showed down-beating nystamgus on Dix-Hallpike test and falling tendency on Romberg test with eyes open. Magnetic resonance image showed cerebellar AVM.

Multicenter Study on the Clinician’s Diagnostic and Therapeutic Approaches for Benign Paroxysmal Positional Vertigo in Korea: Eun Ju Jeon, Won Ho Chung, Jeong Hwan Choi, Eui Cheol Nam, Hong Ju Park, Jong Dae Lee, Won Sang Lee, Kyu Sung Kim, Eui Kyung Goh, Ja Won Koo, Min Bum Kim, Min Beom Kim, Se Hyung Kim, Young Jin Kim, Chang Hee Kim, Sung Il Nam, Seog Kyun Mun, Ga Young Park, Sang Yoo Park, Shi Nae Park, Chang Hoon Bae, Sung Hyun Boo, Myung Whan Suh, Jae Hyun Seo, Eun Jin Son, Jae Jun Song, Jae Jin Song, Joong Wook Shin, Dae Bo Shim, Seong Ki Ahn, Hye Youn Youm, Shin Young Yoo, Dong Hee Lee, Seung Hwan Lee, Chang Ho Lee, Hyun Seok Lee, Hwan Ho Lee, Hyo Jeong Lee, Yun Hoon Choung, Seung Hyo Choi, Jee Sun Choi, Seok Min Hong, Sung Kwang Hong; Res Vestib Sci. 2013;12(3):79-92.

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Abstract: Background and Objectives: It is necessary to establish the most efficient diagnostic and therapeutic method for benign paroxysmal positional vertigo (BPPV), which is appropriate for Korean healthcare system. We aimed to evaluate current state of Korean clinician’s diagnostic and therapeutic approaches for BPPV. Materials and Methods: A 16-item survey was emailed to the members of dizziness department of Otology Research Interest Group in the Korean Otologic Society (n=68). 43 were returned and analyzed. Results: All respondents (100%) used Dix-Hallpike test as a diagnostic tool for vertical canal-BPPV. Supine roll test was used for diagnosing lateral canal BPPV in nearly all the respondents (97.7%). Epley maneuver was chosen as otolith repositioning maneuver (ORM) for posterior canal BPPV in all respondents and barbecue rotation (BBQ) was used for treating lateral canal BPPV with geotropic nystagmus in 95.3% of respondents. Extreme variation was noted for therapeutic approach of lateral canal BPPV with ageotropic nystagmus BBQ, with 4 kinds of ORM and adjunctive measures to liberate otolith from cupula, while BBQ was again the most commonly used ORM (76.7%). Conclusion: The development of practical and efficient ORM for lateral canal BPPV with ageotropic nystagmus is necessary.

Cervical Vestibular Evoked Myogenic Potential and Ocular Vestibular Evoked Myogenic Potential in Patients With Vestibular Neuritis and Acute Viral Labyrinthitis: Il Ha Moon, Chan Goo Lee, Moo Kyun Park, Jong Dae Lee; Res Vestib Sci. 2012;11(3):92-96.

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Abstract: Background and Objectives: Vestibular neuritis predominantly affects the superior branch of the vestibular nerve, resulting in vertigo. Acute viral labyrinthitis occurs when an infection affects both vestibulo-cochlear nerve and labyrinth, resulting in hearing changes as well as vertigo. The purpose of study is to identify there is a difference of cervical vestibular evoked myogenic potentials (cVEMP) and ocular VEMP (oVEMP) in patients with vestibular neuritis and acute viral labyrinthitis. Materials and Methods: cVEMP and oVEMP tests using 500-Hz tone-burst stimuli were performed on patients with vestibular neuritis and acute viral labyrinthitis. Pure tone audiometry, caloric test and subjective visual vertical (SVV) were performed in all patients. We compared the VEMP results, SVV, caloric test in patients with vestibular neuritis and acute viral labyrinthitis. Results: Abnormal cVEMP responses were detected in 2 (20%) patients with vestibular neuritis and 5 (100%) patients with labyrinthitis. Abnormal oVEMP responses were detected in 9 patients (90%) with vestibular neuritis and 5 (100%) patients with labyrinthitis. oVEMP abnormalities is correlated with caloric test and subjective visual vertical in patients with vestibular neuritis and labyrinthits. Conclusion: Our results shows that the response of cVEMP and oVEMP between patients with vestibular neuritis and acute viral labyrinthitis is different. We can infer that oVEMP response to air-conducted sound is different vestibular origin compared to cVEMP and may originate from utricle.

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.

A Case of Posterior Fossa Meningioma Mimicking Meniere’s Disease: Sol Kil Oh, Sunchul Hwang, Mookyun Park, Jong Dae Lee; Res Vestib Sci. 2010;9(2):80-83.

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Abstract PDF: Posterior fossa meningioma constitute approximately 10% of meningiomas. It can rarely involve the endolymphatic sac and produce symptoms of Meniere’s disease. We present the case of a 41-year-old male patient who was suffering from recurrent vertigo. The pure tone audiogram revealed low tone hearing loss on right side and temporal magnetic resonance image revealed a meningioma in posterior fossa. Posterior fossa meningioma should be considered in the differential diagnosis of patients with signs and symptoms of Meniere’s disease.

A Case of Vestibular Schwannoma Mimicking Acute Labyrinthitis: Dong Yeol Han, Won Ik Jang, Jong Dae Lee; Res Vestib Sci. 2009;8(2):164-167.

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Abstract PDF: Acute labyrinthitis is clinically characterized by cochlear symptom like sudden hearing loss, tinnitus and aural fullness and vestibular symptom like vertigo and spontaneous nystagmus. Several disease entities may mimic labyrinthitis when the disease does not manifest its own characteristic findings. We present the case of a 43-year-old female patient who was suffering from the acute vertigo and sudden hearing loss in her right ear. The speech discrimination score in right side was 24% and brain magnetic resonance imagine revealed a mass in internal auditory canal and minimally extending cerebellopontine angle. Removal of mass was performed via translabyrinthine approach and rapid vestibular compensation was accomplished after surgery.

A Case of Sjögren’s Syndrome Presented with Vertigo as a Initial Manifestation: Ji Yun Park, Jong Dae Lee, Tae Kyeong Lee, Ki Bum Sung; Res Vestib Sci. 2009;8(1):70-73.

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Abstract PDF: Sjögren’s syndrome (SS) can shows various neurologic symptoms as it involves the central, peripheral and autonomic nervous system. However, CNS involvement as a initial manifestation is rare. We report a 21-year old woman who presented with vertigo, gait ataxia, and hiccup lasted about one month due to a discrete dosal medullary lesion in primary SS. The symptoms and lesions improved by the intravenous methylprednisolone therapy. Key Words: Sjogren’s Syndrome; Nystagmus, Physiologic; Nervous System Diseases

A Case of Selective Inferior Vestibular Neuritis Showing Normal Caloric Test: Eun Goo Kang, Kyu Rin Hwang, Jong Dae Lee, Ki Bum Sung; Res Vestib Sci. 2009;8(1):45-48.

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Abstract PDF: Vestibular neuritis is commonly diagnosed by demonstrating of peripheral vestibular failure as a unilateral loss of the caloric response. It is a sudden, spontaneous, unilateral loss of vestibular function without simultaneous hearing loss or brainstem signs. In most patients with vestibular neuritis, the process is thought to involve the superior vestibular nerve. Very rarely, vestibular neuritis involves only the inferior vestibular nerve. We experienced a 56-year-old male with inferior vestibular neuritis. The patient had vertigo and spontaneous nystagmus, but a normal caloric test. Brain magnetic resonance imaging was normal, while vestibular evoked myogenic potentials had absent amplitudes on the lesion side. The patient was thought to suffer from pure inferior nerve vestibular neuritis. Key Words: Vestibular neuronitis; Vestibular function tests

A Case of Benign Paroxysmal Positional Vertigo and Sudden Hearing Loss during Recovery Phase of Vestibular Neuritis: Jong Dae Lee, Shi Chan Kim, Tae Kyeong Lee, Ki Bum Sung; J Korean Bal Soc. 2007;6(2):222-225.

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Abstract PDF: Although vestibular neuritis is defined as acute peripheral vestibulopathy without associated hearing loss, a handful of cases reported sudden hearing loss without concurrent vertigo during follow-up of vestibular neuritis. In addition, some patients show benign paroxysmal postional vertigo(BPPV) ipsilateral to the lesion side with various interval after vestibular neuritis, and they are considered to be “secondary” BPPV. Viral and vascular etiologies have been assumed for the vestibular neuritis but, both of those failed to explain exact pathomechanism so far. Authors experienced a case of sudden hearing loss with simultaneous ipsilateral BPPV after vestibular neuritis. There has been no report of concurrent of BPPV and sudden hearing loss after vestibular neuritis. Sequential viral activations are considered to be responsible for this case.

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