Research in Vestibular Science

Ju Hyoung Lee

12 Articles

Efficacy of Rotating Chair Test And Caloric Test For The Diagnosis of Acute Unilateral Vestibular Neuritis: Heung Eog Cha, Chae Young Lim, Gyu Cheol Han, Chang Hyun Cho, Byung Ki Yoon, Min Kwan Baek, Ju Hyoung Lee; J Korean Bal Soc. 2008;7(1):43-47.

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Abstract PDF: Background and Objectives: The acute unilateral vestibular neuritis is fairly a common disease and the precise diagnostic tool is needed for the selection of effective treatments. Therefore, we studied the clinical usefulness of the rotatory chair test and caloric test which have been commonly used in patient of acute unilateral vestibular neuritis. Materials and Methods: One hundred and sixty four patients who were diagnosed with acute unilateral vestibular neuritis from August of 2004 to June of 2007 were included. Their medical records of the rotating chair test and caloric test were reviewed retrospectively to study the correlation of the two tests. Results: Of 164 patients, 101 patients (61.6%) and 88 patients (53.7%) showed significant canal paresis (CP) and directional preponderance (DP) on the caloric tests that corresponded with the physical exam. 130 patients (79.3%) and 84 patients (51.2%) showed significant asymmetry and time constant (Tc) on the rotating chair test that corresponded with the predictive direction with spontaneous nystagmus. Conclusions: For acute unilateral vestibular neuritis patients, the asymmetry of the rotatory chair test showed the highest correlation with clinical findings. But physical exam should be preceded because neither rotator chair test nor caloric test yields a specific correlation with the physical exam. Especially, single test only may too many false negative results. For these tests can reduce false positive cases of the physical exam and raise the specificity of the diagnosis, the planning of proper treatments should be followed thereafter.

Dandy-Walker Syndrome Confused with Peripheral Vestibular Neuronitis: Heung Eog Cha, Joo Hyun Jung, Jin Ho Yoon, Ju Hyoung Lee; J Korean Bal Soc. 2007;6(1):57-59.

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Abstract PDF: Dandy-Walker syndrome is congenital malformation characterized by cystic enlargement of the fourth ventricle and agenesis or hypogenesis of the cerebellar vermis. The major clinical symptoms of the disease are hydrocephalus, weakening of physical strenth and athletic abilities, macrocephaly, cerebellar disorders like ataxia, nystagmus and irritability, vomiting from IICP. The syndrome usually occurs in early infancy and is barely diagnosed in adult. A fifty six aged female patient whose chief complaints were dizziness with right nystagmus and right hearing disturbance visited our outpatient clinic and showed ninety three/fifty six dB in right pure tone audiometry. So we prescribed PO medication on the assumption that she had right sudden sensoryneural hearing loss with vertigo, however left nystagmus was seen in her physical examination after discharge. We present this case that she was diagnosed as Dandy-Walker syndrome in brain MRI after all.

Morphologic Change of the Vestibular Organ in the Na+-K+-2Cl- Cotransporter Deficiency Mouse: Ju Hyoung Lee, Jae Young Choi, Sang Ho Jung, Won Sang Lee; J Korean Bal Soc. 2006;5(1):21-28.

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Abstract PDF: Background
and Objectives: The Na+-K+-2Cl- cotransporter-1 (NKCC1) is a member of the cation-coupled chloride transporter that participates in salt transport and cell volume regulation in diverse tissues. NKCC1 deficient mice exhibit deafness, and have structural alterations in the cochlea. In addition to hearing loss, NKCC1-deficient mice show a shaker-waltzer behavior, which suggests a vestibular system defect. This study investigated the morphology of the vestibular system of NKCC1-deficient mice. In addition, this study evaluated whether NKCC1 mRNA and its protein are expressed in human vestibular end organs. Materials and Method: NKCC1-deficient and wild type mice aged 4~5 weeks were sacrificed. Their heads were cut in the midsagittal plane, fixed and decalcified. For light microscopy, 5 m sections were cut, and stained with hematoxylin and eosin. Human vestibular end organs were harvested during acoustic tumor surgery via translabyrinthine approach. Some of these end organs were used for the total mRNA extraction and the remainder was used for immunostaining. RT-PCR was performed for NKCC1.
Results
The scala media of the cochlear of the NKCC1-deficient mice were collapsed but the bony labyrinth of the cochlea appeared unaffected. However, the semicircular canals (SCCs) were much smaller than those in the wild type. Furthermore, the SCCs were completely missing in some NKCC1-deficient mice. NKCC1 mRNA was expressed in both human macula and crista ampullaris and its protein was expressed mainly in the transitional and dark cell area of the human crista ampullaris.
Conclusion
NKCC1 may be essential for maintaining the vestibular morphology and its function in mice and NKCC1 is well expressed in human vestibular end organs. Key Words : Ion transport, Vestibule, Knockout mouse

The Analysis of Post Traumatic Benign Paroxysmal Positional Vertigo: Chang Hyun Cho, Dong Kyu Kim, Gyu Cheol Han, Eun Jeong Lee, Joo Hyun Woo, Ju Hyoung Lee; J Korean Bal Soc. 2005;4(1):17-25.

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Abstract PDF: Background
and Objectives :Benign paroxysmal positional vertigo (BPPV) has a lot of causes. Except idiopathic BPPV, the most common cause of BPPV was trauma. The aim of this study was to study its character, diagnosis, prognosis and treatment. Materials and Method : We retrospectively collected the 14 patients by reviewing charts, analyzing vestibular function tests.
Results
: Post traumatic BPPV had characters different from idiopathic BPPV in patient' sex ratio and age distribution. The mean age of patients was 40 years old, men were 11 women were 3. In the mechanisms of trauma, traffic accidents were 11, assault was 1, and fall down were 2. In types, posterior semicircular canal were 10, horizontal semicircular canal were 4. In origins, cupulolithiasis were 8, canalolithiasis were 6. Treatment and prognosis were similar to those of idiopathic BPPV.
Conclusion
: But origin, diagnostic criteria, treatment and prognosis are identical with idiopathic BPPV. Therefore, in evaluating post traumatic BPPV patients, we need correct diagnosis and treatment together by history taking, physical examination and vestibular function tests. And by this, we can treat idiopathic BPPV accurately, reduce expense and time for patients to return daily life.

The Optimization of Galvanic Vestibular Stimulation according to Evoked Nystagmus: Gyu Cheol Han, Dong Kyu Kim, Ju Hyoung Lee, Chang Hyoun Cho, Dong Young Kim, Heung Eok Cha; J Korean Bal Soc. 2004;3(2):386-394.

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Abstract PDF: Background
and Objectives : The aim of this study were to observe the nystagmus of normal general populations on galvanic vestibular stimulation, to set a new korean standard for galvanic vestibular stimulation. Materials and Method : We recruited 10 healthy adults and they were stimulated by 1,2,3 mA monaural monopolar, monaural bipolar, binaural monopolar, binaural bipolar galvanic vestibular stimulation through carbon-rubber electrode and Ag-AgCl electrode. We evaluated galvanic stimulating nystagmus and after galvanic stimulating nystagmus on sitting position through Frenzel goggle and video-nystagmography.
Results
: We detect stimulating and after-stimulating nystagmus on 1,2,3 mA monaural monopolar, monaural bipolar, binaural monopolar, binaural bipolar galvanic vestibular stimulation. The nystagmus on galvanic vestibular stimulation was directed to the negative electrode side and after-galvanic stimulating nystagmus was directed to opposite side. The greater current, the more occurrence of nystagmus was found. We detect nystagmus mostly on monaural bipolar vestibular stimulation through carbon-rubber electrode. We thought most effective Galvanic vestibular stimulation was 2 mA monaural bipolar vestibular stimulation through carbon-rubber electrode in consideration of increased pain and discomfort on 3 mA monaural bipolar vestibular stimulation in spite of high occurrence of nystagmus.
Conclusion
: Galvanic vestibular stimulation evoked different nystagmus according to stimulation, stimulated site. We thought 2 mA monaural bipolar vestibular stimulation through carbon-rubber electrode was most effective, stable galvanic stimulation. Specifity and sensitivity of 2 mA monaural bipolar vestibular stimulation were 100%, 100% respectively. Galvanic vestibular stimulation is useful to evaluate vestibular function.

Chicken Embryo as a Model of Inner Ear Study: Gyu Cheol Han, Youn Kyu Lee, Jin Ho Yoon, Kyung Kun Min, Ju Hyoung Lee; J Korean Bal Soc. 2004;3(2):379-385.

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Abstract PDF: Background
and Objectives : Nowdays, numbers of patient who suffers from inner ear disease are increased and we need to completely understand about inner ear anatomy and embryology. But we have many problems to use human itself as a model, so it is difficult for us to study. Instead of using human as a model, recent days, many doctors use mammalians and birds. In this study, we used chicken embryo as a model whose inner ear was thought to be similar with human's inner ear and we made effort to get inner ear images by light microscope. Materials and Method : We incubated Gallus domesticus in auto-incubator for 12days. In each embryonic day (4th to 12th days), we got the chicken embryo and made paraffin block. Next, with micro-tomb, we made slice section and fixed to slide. Using micro-digital camera system, we took the picture of the inner ear of chicken embryo.
Results
: We observed the structures of inner ear of chicken embryo from 4th embryonic day to 12th embryonic day. In 4th day and 5th day, we could not get the definite clear image. But from 6th to 12th day, we got the clear images of utricle, saccule, semicircular canals, etc. In several micro-section methods, making oblique coronal section was showed the best images of inner ear.
Conclusion
: This study was the start point of chicken inner ear embryology and anatomy. Hereafter, we should make the deeper study about chicken inner ear with these results and investigate the genetic and extrinsic factors which influence to inner ear disease. So we should solve the fundamental problem of inner ear disease based on this study.

Vestibuloneuritis Developed Concurrently in Ipsilateral Site with Herpes-Zoster Oticus Syndrome: Gyu Cheol Han, Ju Hyoung Lee, Joo Hyun Woo, Jung Kook Yoo, Sun Hwa Lim; J Korean Bal Soc. 2004;3(1):187-191.

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Abstract PDF: Background
: Acute vestibular neuronitis is the disease of which the etiology and pathophysiology are largely unknown . But the viral infection and ischemia of the labyrinth and the vestibular nerve are considered as general etiology. This study was performed to support the viral infection rather than the ischemic theory. Materials & Methods : We studied seventy years old female patient who showed painful vesicles on left auricle and vertigo with spontaneous nystagmus to the right side. We performed physical examination, serologic test, ENG test, pure tone audiogram, brain magnetic resonance imaging and polymerase chain reaction.
Results
: We found small vesicles and vascular injection in left EAC, herpes zoster IgG positive, spontaneous right beating in electronystagmograpy, 54% left canal paresis in Caloric test , decreasing left side Tc in velocity step rotatory test, decresed gain, deviation to left in symmetry and phase lead in sinusoidal harmonic acceleration test, normal range hearing in pure tone audiogram, microangiopathy on cortex in brain MRI and negative PCR.
Conclusion
: This case supports viral infection etiology rather than ischemia in vestibular neuritis. But more studies to find the etiology of vestibular neuronitis are required. Key Words : Herpes zoster oticus, Vestibular neuronitis.

One Case of Downbeat Nystagmus with Compression of Vestibulocochlear Nerve by Vertebral Arteries: Gyu Cheol Han, Ju Hyoung Lee, Jong Su Ha, Hee Young Hwang, Cheol Wan Park; J Korean Bal Soc. 2004;3(1):184-186.

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Abstract PDF: A case is reported of downbeat nystagmus associated with compression of the root of vestibulocochlear nerve by vertebral arteries, which was revealed by magnetic resonance imaging. Chief complain of the patient was positional vertigo, which aggrevated at left decubitus position. Downbeat nystagmus was increased in left Dix-hall pike test. Tetsuo et al, reported downbeat nystagmus with compression of dolichoectatic vertebral arteries to the medulla oblongata and surgical neurovascular decompression of the dolichoectasia reverses the progression of symptoms if permanent neurologic damage has not already occurred. Key Words : Vertical nystagmus, Vertebrobasilar dolichoectasia, Vestibulocochlear nerve

Clinical Analysis of Down Beat Nystagmus in Atypical Positional/ing Vertigo: Gyu Cheol Han, Ju Hyoung Lee, Eun Jung Lee, Jae Jun Song; J Korean Bal Soc. 2004;3(1):150-155.

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Abstract PDF: Background
and Objectives : Traditionally, down beat nystagmus is regarded as a sign of central nervous system dysfunction. But, several years has passed since Herdman et al reported the down beat nystagmus developed during treatment maneuvers for posterior semicircular canal benign paroxysmal positional vertigo(BPPV). We undertook this study to evaluate the character and clinical analysis of the positional or positioning down beat nystagmus, to discuss the clinical significance of positional or positioning down beat nystagmus as a diagnostic criteria of superior semicircular canal BPPV, and to propose the new treatment method. Materials and Method : From November 1999 to March 2004, we sampled the 103 patients with positional or positioning down beat nystagmus. Of these patients, we selected 16 patients except for the patients with central nervous system dysfunction, nonspecific or artifact result, idiopathic origin.
Results
: All of 16 patients had no sign and radiologic result of central nervous system disorder. 10 patients was reported or suspected the diagnosis of posterior semicircular canal BPPV. Fatigability was reported in 9 patients and reversibility was reported in 1 patient. Average latency was checked less than 2 seconds.
Conclusion
: Although the diagnostic criteria of superior semicircular canal BPPV that we reported was not controversial, we expect that this criteria is useful in diagnosis for patients with atypical positional or positioning down beat nystagmus. And the new treatment method that we reported will has the better results than previous method. Key Words : Benign paroxysmal vertigo, Positional vertigo, Superior semicircular cana

Retrospective Study of Magnetic Resonance Imaging & Vestibular Function Testing in Patients Suggestive of Central Vestibular Disorders: Gyu Cheol Han, Ju Hyoung Lee, Dong Kyu Kim, Hee Young Hwang, Jin Myoung Heo; J Korean Bal Soc. 2004;3(1):141-149.

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Abstract PDF: Background
and Objectives : There were many tools to evaluate dizzy patients with various causes. Our aim was to find the relationship between the magnetic resonance imaging(MRI) and vestibular function testing(VFT) in patients who are supposed of central vestibular disorders and to evaluate their effects. Materials and Methods : We selected 183 patients retrospectively by standardized questionnaires, physical examinations ,chart reviews from 3,825 patients who visited otorhinolaryngology via department of emergency and out patient clinic with chief complaints of dizziness. Among them, 13 patients were supposed to have MRI in relation to dizziness. We analyzed the result of VFT, MRI findings and then classified them in according to lesion locations, pathologic findings in MRI & optokinetic tests, caloric tests, step velocity tests, vestibulo-ocular tests, visual fixation tests in VFT.
Results
: There were 9 ischemic findings, 1 hemorrhagic finding, 3 neoplasms in pathologic findings. There were 5 pons lesions, 4 cerebellum lesions, 3 thalamus lesions, 2 medulla lesions, 2 pituitary lesions and 1 caudate nucleus lesions in locations.
Conclusions
: Dizzy patients visiting otorhinolaryngology OPD had 0.34%(13/3825) central origin vertigo, and vascular disease is most common. Therefore we supported that careful readings of VFT findings in identifying central vestibular disorders were valuable and might well represent the gold standard. MRI was an important tool for evaluating the central nervous system, and we should use MRI to assess central vestibular dysfunction. We concluded MRI correlated well with VFT findings of central vestibular dysfunction. Key Words : Vestibular function testing, Magnetic resonance imaging, Dizziness

Results of otolith reposition therapy in posterior semicircular canal BPPV: Sung Hun Kim, Ju Hyoung Lee, Mi Ran Bae, Chang Woo Kim, Soo Young Lee, Won Sang Lee; J Korean Bal Soc. 2003;2(1):107-112.

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Abstract PDF: Background
and objectives: Benign paroxysmal positional vertigo (BPPV) has been well controlled with otolith reposition therapy. Posterior canal is known as the most common site of BPPV. The purpose of this study was to study the therapeutic result of reposition therapy in posterior canal BPPV, to investigate the unusual cases such as recurred cases and type changed cases during the reposition maneuver, and to figure out the therapeutic strategy. Materials and methods: One hundred and ten patients diagnosed posterior canal BPPV were included in this study. Epley maneuver was performed once a day until nystagmus disappeared. We analyzed the number of treatment, changing type, recurrence and the relationship between recurrence and age or sex of patients.
Result
All cases except 2 were recovered by Epley maneuver. In 11 cases, the type of disease was changed, and the treatment of these cases were changed according to new type and origin. Overall recurrence rate was 15%, and they were completely treated with reposition therapy. There was no correlation between recurrence and age, sex of patients.
Conclusion
All most cases were cured with Epley maneuver. The type of the disease was possibly changeable. Recurrence rate was relative high, and close follow up was required.

Galvanic Nystagmus in Normal Person: Woon Kyo Chung, Ju Hyoung Lee, Soo Chan Kim, Ki Chang Nam, Deok Won Kim, Won Sang Lee; J Korean Bal Soc. 2002;1(1):108-112.

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Abstract PDF: Background
and objectives: Vestibulo-ocular reflex and vestibulo-spinal reflex are induced by transmatoid galvanic stimulation of vestibular system. Nystagmus and body sway are result of each reflex. Recently, videooculograph possible to record a minute ocular movement was commonly used, vestibulo-ocular reflex induced by galvanic simualtion is easily documented. The purposes of this study are to evaluate the galvanic nystagmus in nomal persons in order to better understand the physiology of the vestibular system. Materials and methods: Eye movement of 20 neurootologic normal subjects by both side transmstoid galvanic stimulation (40cases) were analyzing by videonystagmography.
Result
The direction of nystagmus in fast phase was to the negative electrode. Galvanic nystagmus was occured all normal subjects when stimulus intensity was more than 2mA. There was positive correlation between slow phase velocity(SPV) and electric current but negative correlation was noted between asymmery of SPV and electric current.
Conclusion
It is suggested that the galvanic nystagmus test could be a new diagnostic tool for evaluation of vestibular status.

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