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Multicenter Study on the Clinician’s Diagnostic and Therapeutic Approaches for Benign Paroxysmal Positional Vertigo in Korea
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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
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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.
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A Case of Herpes Zoster Oticus without Facial Nerve Palsy Associated with Vertigo and Hearing Loss
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Jee Min Choi, Jung Eun Shin, Chang Hee Kim
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Res Vestib Sci. 2012;11(4):138-141.
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Abstract
- Herpes zoster oticus (HZO) is characterized by facial nerve palsy, otalgia and auricular vesicles on the affected side and accepted to be caused by the reactivation of varicella zoster virus (VZV) in the geniculate ganglion. Vestibulocochlear deficits are known to be frequently accompanied by HZO. Unusual clinical manifestations such as only vertigo without facial nerve palsy or hearing loss has been reported. We report a case of 27-year-old man presented with vertigo, sensorineural hearing loss and vesicular eruptions on the left auricle without facial nerve palsy. Serologic test revealed that the patient was positive for immunoglobulin G (IgG) and IgM antibodies against VZV.
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Clinical Characteristics of 7 Patients with Lateral Semicircular Canal Dysplasia
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Chang Hee Kim, Jung Eun Shin, Yeo Jin Lee, Hong Ju Park
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Res Vestib Sci. 2012;11(2):64-68.
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Abstract
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- Background and Objectives: Dysplasia of lateral semicircular canal (LSCC) is the most common inner ear malformation, because LSCC is the last single structure to be formed during inner ear embryogenesis. There have been several case reports about the LSCC anomaly which showed clinical spectrum ranging from no symptom to severe sensorineural hearing loss. The authors investigated the clinical characteristics of 7 patients with LSCC dysplasia.
Materials and Methods: The medical records of 7 patients who were diagnosed as LSCC dysplasia from temporal bone computed tomography were retrospectively reviewed. We analysed the findings of history taking, pure tone audiometry, speech audiometry, and caloric tests.
Results: The LSCC dysplasia was observed in all of 7 patients in which 5 showed unilaterally confined LSCC dysplasia, 1 showed bilaterally confined LSCC dysplasia, and 1 exhibited bilateral LSCC dysplasia combined with bilateral posterior semicircular canal dysplasia. From 7 patients, hearing loss was chief complaint only in 2 patients. Pure tone audiometry revealed sensorineural hearing loss in one patient, and conductive hearing loss in the other patient. Two patients complained of whirling type vertigo, and 3 complained of nonspecific dizziness.
Conclusion: The patients with LSCC dysplasia may show variable symptoms such as sensorineural hearing loss, conductive hearing loss, vertigo and nonspecific dizziness.
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Vestibular Evoked Myogenic Potential Generated by 500 Hz Tone Burst in Unilateral Peripheral Vestibulopathy
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Ja Won Koo, Dong Hwan Roh, Chang Hee Kim, Jin Young Kim, Ji Yeon Yu, Kwang Dong Choi, Ji Soo Kim
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J Korean Bal Soc. 2004;3(2):356-361.
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Abstract
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- Background
and Objectives : Vestibular evoked myogenic potential (VEMP) has become a valuable diagnostic tool evaluating the integrity of sacculocollic reflex and has been done using click sound in most previous clinical trials. This study aims to investigate VEMP responses generated by 500 Hz tone burst in unilateral peripheral vestibulopathy and compare the response with caloric test and subjective visual vertical (SVV).
Materials and Method : Clinical records of 37 patients (18 men and 19 women, aged 14-80 years) with unilateral peripheral vestibulopathy were reviewed. Diagnoses were Meniere's disease (n=13), vestibular schwannoma (n=4) and acute peripheral unilateral vestibulopathy (n=20). They underwent 500Hz tone burst VEMP, caloric test and SVV test. Thirteen healthy volunteers (26 ears, 8 men and 5 women, 25~41 years) with normal hearing were enrolled as control group.
Results
: VEMP response was present in every control ear using 500 Hz tone burst stimuli. In Meniere's disease, VEMPs were positive in 57% (4/7) of patients with abnormal caloric response group and 83% (5/6) with normal caloric response. In acute peripheral vestibulopathy, VEMPs were positive in 47% (9/19) of patients with abnormal caloric response, 0% (0/1) with normal caloric response. The average of CP (canal paresis) in positive VEMP group was
62.4% and that in negative VEMP group was 48.2% (P>0.05).
Conclusion
: Reliable and reproducible test results can be obtained using 500 Hz tone burst stimuli. VEMP results were not in concordance with other vestibular tests, which reflects the dynamic process of dizziness and variable extent of pathology in each case.
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