Research in Vestibular Science

Video Report

A Case of Congenital Nystagmus Showing Reversed Optokinetic Nystagmus: Han Cheol Lee, Seungjoon Yang, Sung Huhn Kim, Seong Hoon Bae; Res Vestib Sci. 2023;22(3):95-96. Published online September 15, 2023; DOI: https://doi.org/10.21790/rvs.2023.22.3.95

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Review

Ménièreʼs Disease and Electrophysiology: Sung Huhn Kim; Res Vestib Sci. 2017;16(1):1-9. Published online March 15, 2017; DOI: https://doi.org/10.21790/rvs.2017.16.1.1

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Abstract PDF: Inner ear is composed of cochlea, vestibule, and endolymphatic sac which are enclosed by thin layer of epithelial cells. The enclosed space is filled with fluid named as endolymph where the [K^＋] is high and [Na^＋] is low. This unique ion composition is very important in maintaining normal hearing and balance function by providing K^＋ ions into sensory hair cells, which finally depolarize hair cells to facilitate the transport of sound and acceleration stimulation to central nervous system. The ion composition of inner ear is maintained by various ion transport through ion channels, transporters, and exchangers in the inner ear sensory and extra-sensory epithelium. The disruption of normal endolymphatic ion composition by the deterioration of the function of those ion channels can cause dysfunction of sensory epithelium, which consequently results in hearing and balance disorders. One of the possible pathology from the disruption of inner ear ion homeostasis is endolymphatic hydrops which is a phenomenon of excessive fluid accumulation of inner ear. The dysfunction of ion channels in inner ear epithelium can be an etiology of Ménièreʼs disease since endolymphatic hydrops is a main pathological finding of the disease. In this review, we discussed about the possible pathological mechanism of Ménièreʼs disease as a perspective of channelopathy as well as the role of various ion channels in the regulation of inner ear fluid volume based on the findings revealed by electrophysiological studies.

Original Article

Multicenter Randomized Study on the Efficacy of Isosorbide in Patients with Mèniére's Disease: Hyun Woo Park, Won Ho Chung, Sung Huhn Kim, Kyu Sung Kim, Jong Woo Chung, Sung Won Chae, Ja Won Koo, Bo Gyung Kim, Eui Kyung Goh, Gyu Cheol Han; Res Vestib Sci. 2016;15(2):44-50. Published online June 15, 2016

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Abstract PDF: Objective: Mèniére's disease is one of the most common causes of episodic vestibular syndrome that shows symptom complexes of recurrent vertigo, hearing loss, tinnitus and ear fullness. Isosorbide (Isobide) is a osmotic diuretics which has been used for Meniere's disease to reduce the endolymphatic pressure. The purpose of this study was to evaluate the efficacy of isosorbide in the treatment of Mèniére's disease by comparing the combined therapy of isosorbide and betahistine (Meniace) to betahistine only.
Methods
Among 220 patients enrolled with Mèniére's disease from 9 centers, 187 patients completed this clinical study. Patients were randomly subjected either to betahistine alone therapy at dose of 6 mg three times a day (n=97) or to combined therapy with isosorbide (dose of 30 mL three times a day) and betahistine (n=90) for 12 weeks. Two groups were compared at 4 and 12 weeks after treatment on frequency of vertigo, hearing level (pure tone audiometry, speech audiometry), electocochleography (ECoG), tinnitus (Tinnitus Handicap Inventory, THI) and quality of life (Korean functional level scale, Korean dizziness handicap inventory).
Results
During first 4 weeks after treatment, the frequency of vertigo was not reduced in either betahistine alone therapy group or combined therapy group. However, between 8 and 12 weeks, the frequency of vertigo was significantly reduced in either group, and in the combined group frequency of vertigo was more significantly reduced than in the betahistine alone therapy group (p=0.041). The hearing level, ECoG, tinnitus and quality of life was not significantly different between two groups.
Conclusion
Isosorbide and betahistine combined therapy were more effective for vertigo control than betahistine alone therapy. Isosorbide is an effective diuretic in vertigo control in definite Mèniére's disease.

Symposium II

Education in Vestibular Rehabilitation Therapy: 2011 Ad Hoc Committee on Vestibular Rehabilitation Therapy's Guideline: Sung Huhn Kim; Res Vestib Sci. 2013;12:S53-S54. Published online June 1, 2013

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Review

Model Experiment of Benign Paroxysmal Positional Vertigo: Sung Huhn Kim; Res Vestib Sci. 2013;12(2):39-46.

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Abstract: Benign paroxysmal positional vertigo (BPPV) is a most common cause of vertigo. Although endolymphatic flow which is caused by movement of detached-otoconia from otolithic organs has been suggested as a cause of positional vertigo, none has proved it in the human inner ear. Therefore, there were many trials to explain the anatomical characteristics of cupula, physiology of cupula deviation, pathologic mechanisms of BPPV, and clinical characteristics of BPPV using animal membranous labyrinth. In this review, results of basic animal experimental studies to understand anatomical structures and pathological mechanisms related to BPPV are introduced. In addition, future directions for experimental studies to elucidate the mechanism of BPPV will be suggested.

Case Report

A Case of Otosclerosis with Meniere’s Symptom: Dong Woo Hyun, Se Ra Park, Sung Huhn Kim, Won Sang Lee; Res Vestib Sci. 2009;8(2):174-177.

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Abstract PDF: It has been postulated that otosclerosis may produce vertigo by several mechanisms. An association between otosclerosis and Meniere’s disease has been proposed on both a clinical and histopathologic basis but the causal relationship is controversial. We report a case of bilateral otosclerosis in a man manifesting vertiginous symptoms. Fifty one year-old man was examined for rotational vertigo and poor hearing in his both ear for ten years. The audiogram revealed left sided hearing loss of a conductive type and right sided sensorineural hearing loss, and caloric asymmetry. Meniere’s disease was suspected, but temporal bone CT showed low attenuated lesion around bilateral cochlear and semicircular canal. A diagnosis of otosclerosis was made. He was recommended sodium fluoride therapy. Severe endolymphatic hydrops manifesting itself as Meniere’s disease can be the result of otosclerosis, so vertiginous and concurrent hearing symptoms should not be overlooked.

Original Article

Effect of Intratympanic Chemical Labyrinthectomy with Streptomycin on Auditory Symptoms: Hyun Su Kim, Sung Huhn Kim, Dae Bo Shim, Sang Cheol Kim, Won Sun Yang; Res Vestib Sci. 2009;8(1):32-36.

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Abstract PDF: Background and Objectives Background and Objectives: Intratympanic treatment with aminoglycosides for Ménière’s disease has been used, trying to eliminate vertigo complaints, while preserving hearing. This study was undertaken to evaluate the therapeutic outcomes for auditory symptoms in Ménière’s disease patients after intratympanic application with single low-dose streptomycin powder. Materials and Methods Ninty-eight patients diagnosed with definite Ménière’s disease who underwent chemical labyrinthectomy with streptomycin at Yonsei University Medical Center from March 1997 to June 2006 were enrolled. Low dose streptomycin powder (10 mg) was applied into the round window niche directly. Changes of hearing threshold, tinnitus and aural fullness were evaluated postoperatively according to Committee on Hearing and Equilibrium guidelines for the diagnosis and evaluation of therapy in Ménière’s disease of American Academy of Otolaryngology–Head and Neck Surgery. Results Hearing threshold was not changed significantly after the procedure (from 65.5±19.1 to 69.3±20.0 p>0.05) and was improved in 7% of the patients. Hearing deterioration after the procedure was detected only in 17%. Tinnitus and aural fullness was improved in 51% and 25% respectively. Conclusion Single application of streptomycin powder filling round window niche showed minimal deterioration of hearing threshold. It is the useful method to improve or prevent the progress of auditory symptoms in patients with Ménière’s disease. Key Words: Streptomycin; Hearing loss; Tinnitus; Meniere Disease; Aural fullness

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