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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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Clinical Features and Treatment Pattern of Migrainous Vertigo in Korea: A Nationwide Prospective Multicenter Study
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Seong Ki Ahn, Kyusik Kang, Ja Won Koo, Kyu Sung Kim, Beom Gyu Kim, Byung Kun Kim, Ji Soo Kim, Kyoung Ho Park, Shi Nae Park, Eun Ho Park, Hong Ju Park, Jae Yong Byun, Myung Whan Suh, Ki Bum Sung, Sun Young Oh, Chung Ku Rhee, Tae Kyeong Lee, Seong Hae Jeong, Won Ho Chung, Chang Il Cha, Sung Won Chae, Eui Kyung Goh
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Res Vestib Sci. 2009;8(2):122-131.
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Abstract
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- Background and Objectives It is being increasing recognized that the morbidities of migraine and balance disorders are interrelated. In fact, migrainous vertigo (MV) is one of frequent causes of recurrent vertigo in patients presenting to specialized dizziness clinics. Nevertheless, not many studies have reported clinical manifestations and treatment. Therefore, the aim of study was designed to assess clinical features and treatment patterns by a nationwide multicenter study. Materials and Methods Patients between 9 and 74 years of age who visited 17 Korean tertiary referral centers and 1 clinic from February to March 2009 were investigated using two forms of questionnaires. Results Overall, 318 patients with MV were enrolled. MV was responsible for ~8.45% of visits to the specialized dizziness clinics. One hundred seventy-five of these patients had definite MV and were included in assessing the clinical features. Vertigo characteristics of patients with definite MV were various. Vertigo was regularly as-sociated with headache in 87% of the patients. The duration of vertigo ranged from seconds to days. For the treatment patterns, an acute and prophylactic therapies were carried in most clinics. There were no differences in either acute or prophylactic therapies between department of neurology and otorhinolaryngology. Conclusions The results of this study suggest that MV the clinical features of MV also varies in Korea. In addition, most clinics provide similar patterns of practice in treatment for MV. The syndrome of MV deserves further research activity as it is relatively common and clinically relevant.
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Tinnitus: Recent Treatment
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Shi Nae Park
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Res Vestib Sci. 2009;8(1):108-116.
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Therapeutic Efficacy and Prognostic Factors of Canalith Repositioning Maneuver in the Patients with Benign Paroxysmal Positional Vertigo
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Shi Nae Park, Kyoung Ho Park, Ji Hong Kim, Jong Hoon Kim, Bong Jin Choi, Ji Hyeon Shin, Min Ah Han, Sang Won Yeo
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J Korean Bal Soc. 2007;6(1):9-15.
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Abstract
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- Background and Objectives: The purpose of this study were to evaluate the therapeutic efficacy of canalith repositioning maneuver (CRP) according to accompanying mastoid percussion and to investigate the prognostic factors that may affect successful repositioning maneuver and the recurrence of benign paroxysmal positional vertigo.
Materials and Method: A total of 70 patients with canalith type BPPV visiting the dizziness clinic of Kangnam St. Mary's Hospital were included in this study. Variables identified for statistical analysis were patient's age, sex,maneuver method, number of involved canal, number of CRP and dizziness handicap inventory.
Result: Overall success rate of CRP was 90%. The mean number of maneuver was 1.6 and the recurrence rate was 25.7% during the follow up period. Success rate of CRP (94.9%) was higher than maneuver without mastoid percussion (83.9%) though it was not statistically significant. Successful CRP group showed the significant less number of maneuvers at initial treatment session and less number of involved canal than failed CRP group at the time of one week-follow up visit. Patients with recurrence of BPPV had the more number of CRP during the period of previous BPPV.
Conclusion: Therapeutic efficacy of CRP with mastoid percussion was higher than CRP without mastoid percussion though it was not statistically significant. Suggesting prognostic factors for effective CRP and recurrence were number of CRP and number of involved canal.
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Recurrent Vestibulopathy: Clinical Characteristics and Efficacy of Combination Therapy
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Shi Nae Park, Kyoung Ho Park, Dong Jae Im, Jong Hoon Kim, Jun Yop Kim, Sang Won Yeo
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J Korean Bal Soc. 2006;5(2):262-268.
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Abstract
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- Background
and Objectives: Recurrent vestibulopathy is defined a disease characterized by more than a single episode of vertigo of duration characteristic of endolymphatic hydrops but without auditory or clinical neurological symptoms or signs. To investigate the clinical characteristics and the efficacy of combination therapy, we analyzed the clinical records of the patients diagnosed as recurrent vestibulopathy.
Materials and Method: Clinical records of sixty four patients diagnosed as recurrent vestibulopathy were retrospectively reviewed. The data on age, sex distribution, natural history, family history of recurrent vestibulopathy, concurrent headache, caloric response was analyzed. The efficacy of combination therapy for vertigo control in the patients with a minimum 24-month follow-up was also evaluated.
Results
Mean onset age of recurrent vestibulopathy was 43 years and there was a female preponderance. Concurrent headache and elevated SP/AP ratio in electrocochleogram was frequently observed in these patients. After the combination medical therapy, patients with severe recurrent vestibulopathy showed significant decrease in the number of vertigo spells with 37.5% of complete control of vertigo.
Conclusion
As a distinctive clinical disorder with unknown cause, recurrent vestibulopathy should be always considered to the patients complaining recurrent episodic vertigo. Combination therapy individualized to the symptoms and signs of the patients with recurrent vestibulopathy might be effective in reducing the frequency of vertigo attacks. Further case-control studies with large population should be necessary.
Key Words : Recurrent vestibulopathy, Therapy
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Possibility of Epithelial Sodium Channelopathy as a Pathogenesis of Meniere's Disease
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Shi Nae Park, Byung Hoon Lee, Kyung Ho Park, Myoung Hwa Hong, Heung Youp Lee, Ki Hong Chang, Sang Won Yeo
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J Korean Bal Soc. 2006;5(1):9-14.
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Abstract
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- Background
and Objectives: Meniere's disease is a paroxysmal disorder with vertigo and hearing loss. Its episodic nature of vertigo attacks and responsiveness to diuretics is similar to several neurologic disorders with channelopathy.
We performed this study to identify the possibility sodium channelopathy in the patients with Meniere's disease.
Materials and Method: Thirty patients with definite Meniere's disease and 25 normal controls were included in this study. Clinical features of the patients with Meniere's disease were collected using dizziness chart. Whole blood was taken from all the patients with Meniere's disease and normal controls and used for DNA testing. α-ENaC gene was screened for mutations using direct DNA sequencing.
Results
Patients with Meniere's disease in this study showed the various clinical features of onset age, number of attacks and hearing levels. Many of them showed the caloric response reduction and abnormal electrocochleogram. Genetic analysis did not identify any mutations or differences in α-ENaC gene in normal controls and the patients with Meniere's disease.
Conclusion
Na channelopathy due to α-ENaC gene mutation might not be a pathogenesis of Meniere's disease. Further studies with other subunits of ENaC and other ion channel genes are needed to explore the possibility of channelopathy as a pathogenesis of Meniere's disease.
Key Words : Meniere's disease, Channelopathy.
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Implementation of a Critical Pathway to the Dizzy Patients in the Emergency Center
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Shi Nae Park, Young Min Kim, Joong Seok Kim, Min Sik Kim, Won Jae Lee, Kwang Soo Lee, Chung Soo Kim, Hong Jin Park, Sang Won Yeo
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J Korean Bal Soc. 2005;4(2):250-256.
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Abstract
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- Background
and Objectives: Dizziness and vertigo are frequent causes of presentation in the emergency center. Nevertheless, the practice guideline for the primary care doctor in the emergency center has not been reported yet. Considering its complex approach for diagnosis, we developed critical pathway for dizzy patients who visited emergency center. We performed this study to show the process of development and the result of implementation of critical pathway.
Materials and Method: A critical pathway was developed following the analysis of dizzy patients visiting emergency center by retrospective chart review and in the basis of questionnaire for knowing the needs for critical pathway to the primary care doctor in emergency center. Specialists for caring dizzy patients joined to make the flow sheet and practice guideline for dizzy patients and also made educational materials for doctors in emergency center. The critical pathway was then implemented and its results were analyzed by estimating the practice time and the degree of satisfaction of the patients and doctors.
Results
Most of the primary care doctors in emergency center reported the difficulty in diagnostic approach for dizzy patients and the need for critical pathway. More than half of the dizzy patients were diagnosed as peripheral vertigo and the commonest disease was benign paroxysmal positional vertigo. All of the patients with vertigo diagnosed as central origin showed the neurologic deficit. After the implementation of critical pathway, practice time was significantly decreased and many of the dizzy patients and doctors were satisfied.
Conclusion
Development and implementation of a critical pathway for dizzy patient in emergency center was possible, valuable and effective for the patients and doctors, though the process was not easy and needed interdisciplinary cooperation of involving departments.
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Characteristics of the Extratympanic Electrocochleography in the Patients with Meniere's Disease
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Shi Nae Park, Hyun Jin Oh, Kyung Ho Park, Sang Won Yeo
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J Korean Bal Soc. 2004;3(2):367-371.
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Abstract
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- Background
and Objectives : Electrocochleography is the only proven investigation and diagnostic tool to demonstrate the endolymphatic hydrops at this time. We designed this study to assess the characteristics of transtympanic electrocochleographic findings and to estimate the clinical value of the test results in the patients with Meniere's disease.
Materials and Method : Electrocochleographic duration and amplitude were measured in a clinically defined definite Meniere's disease group and the results were compared with those from a normal hearing control group.
Results
: The summating potential (SP) / action potential (AP) amplitude ratio was significantly different among study groups with 0.40±0.10 in the bilateral Meniere's group, 0.34±0.08 in the unilateral Meneire's group and 0.22±0.08 in the normal group (p<0.01). The elevated SP/AP ratio in the patients with such a relatively long duration of Meniere's disease in this study was mainly due to the decreased AP amplitude rather than the enhanced SP amplitude.
Conclusion
: Measuring electrocochleography and demonstrating the elevated SP/AP ratio could be quite valuable to diagnose the patients with Meniere's disease. The recognition of decreased AP amplitude might be helpful to understand the cochlear pathologic status in the patients with Meniere's disease.
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