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Delayed Positional Vertigo after Stapes Surgery
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Jin Woo Park, Joon Hee Lee, Mee Hyun Song, Dae Bo Shim
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Res Vestib Sci. 2015;14(4):147-151.
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 Abstract
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- Postoperative vertigo can occur after stapes surgery in approximately 5% of the
patients, which more commonly presents immediately after surgery rather than
in the delayed period. Isolated delayed vertigo after stapes surgery is commonly
related to perilymphatic fistula. Herein we report a 36-year-old female patient
who developed positional vertigo 18 days after stapes surgery demonstrating severe
geotropic horizontal positional nystagmus on both sides during supine roll test.
This patient was eventually diagnosed as the horizontal semicircular canal benign
paroxysmal positional vertigo (BPPV) on the left side. This is a rare case of
delayed vertigo following stapes surgery caused by BPPV rather than perilymphatic
fistula.
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Clinical Characteristics of Horizontal Canal Benign Paroxysmal Positional
Vertigo with Persistent Geotropic Direction Changing Positional
Nystagmus
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Kyung Min Ko, Mee Hyun Song, Jin Woo Park, Joon Hee Lee, Yong Gook Shin, Dae Bo Shim
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Res Vestib Sci. 2015;14(4):117-122.
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Abstract
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- Objective: The purpose of this study was to identify the clinical characteristics of
horizontal canal benign paroxysmal positional vertigo (h-BPPV) with persistent geotropic
direction changing positional nystagmus (DCPN).
Methods
One hundred thirty two patients diagnosed as the geotropic subtype of
h-BPPV were analyzed retrospectively. Patients were classified into two groups:
persistent h-BPPV (ph-BPPV) group which means h-BPPV showing persistent (＞1
minute) geotropic DCPN and short duration h-BPPV (sh-BPPV) group that means
h-BPPV with short duration (≤1 minute) geotropic DCPN. We compared the clinical
characteristics and treatment outcomes between the two groups.
Results
The study included 34 patients with ph-BPPV and 98 patients with sh-BPPV.
There were no differences between the two groups in age, distribution of sex and the
affected side. The ph-BPPV group had higher secondary BPPV preponderance and
dizziness handicap index (DHI) score compared to the sh-BPPV group. The ph-BPPV
group required higher number of canalith repositioning procedures (CRPs) until
resolution and higher multiple/single CRP ratio than the sh-BPPV group. In addition,
the ph-BPPV group showed longer duration until the remission of subjective symptoms
(vertigo, dizziness) compared to the sh-BPPV group.
Conclusion
ph-BPPV was more frequently associated with secondary causes of BPPV
and demonstrated higher DHI score, total number of CRP, and longer remission
duration of subjective symptoms compared to sh-BPPV. This information may be
helpful for clinicians in counseling and managing the patients with persistent geotropic
DCPN h-BPPV.
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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
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- 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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Effect of Intratympanic Chemical Labyrinthectomy with Streptomycin on Auditory Symptoms
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Hyun Su Kim, Sung Huhn Kim, Dae Bo Shim, Sang Cheol Kim, Won Sun Yang
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Res Vestib Sci. 2009;8(1):32-36.
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Abstract
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- 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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Visualization of endolymphatic hydrops using Magnetic Resonance Imaging after intratympanic Gd-DTPA administration in patients with Meniere’s disease
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Young Joon Seo, Dae Bo Shim, Jinna Kim, Won Sang Lee
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J Korean Bal Soc. 2008;7(2):167-173.
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Abstract
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- Background and Objectives: Endolymphatic hydrops are known as major causes of Meniere’s disease. MRI (Magnetic resonance imaging) with contrast tried recently makes it possible to visualize perilymphatic and endolymphatic space without invasive procedures. There are no tryouts in the interior of our country. We attempted MRI after injection of gadolinium-diethylen –triamine pentaacetic acid (Gd-DTPA) in normal adults and patients with Meniere’s disease to make sure 3D-FLAIR (fluid-attenuated inversion recovery) MRI parameters and to visualize endolymphatic spaces.
Materials and Methods: Five normal adults and Five patients with Meniere’s disease were included in this study. Twenty-four hours after Gd-DTPA intratympanic injection, we performed 3D-FLAIR and 3D-IR imaging at 3T. MRI region of interest signal intensity was used to determine the diffusion of Gd-DTPA into the perilymphatic fluid spaces over time.
Results: Five of five in normal group, using 3D-IR MRI after Gd injection, had enhanced imagings (perilymphatic spaces) of inner ears. Five of five in patients group, using 3D-IR after Gd injection, had enhanced perilymphatic spaces and non-enhanced endolymphatic hydrops.
Conclusions: Delayed contrast imaging of the inner ear with 3D-IR MRI after Gd-DTPA intratympanic injection revealed in vivo visualization of endolymphatic hydrops.
Key words: Endolymphatic hydrops, 3D-FLAIR MRI, Gd-DTPA, Intratympanic injection
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Clinical Significance of Vestibular Evoked Myogenic Potentials in Patients With Benign Paroxysmal Positional Vertigo
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Won Sun Yang, Dae Bo Shim, Won Sang Lee
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J Korean Bal Soc. 2008;7(1):38-42.
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Abstract
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- Objectives: To investigate the vestibular evoked myogenic potentials (VEMP) results in benign paroxysmal positional vertigo (BPPV) patients and to verify its clinical applications in BPPV.
Subjects and Methods: Forty-one patients with diagnosis of BPPV and 92 healthy volunteers who underwent VEMP testing. Patients were treated by canalith repositioning maneuvers according to the affected canal, and testing of VEMP was performed at diagnosis and after treatment.
Results: VEMP results of BPPV patients showed prolonged p13 and n23 latencies compared with those of the control group, and we could not find any significant difference in VEMP latencies between patients with posterior and horizontal canal type of BPPV. The number of times that the maneuver was repeated did not correlate with the degree of latency prolongation, but in the “no response” group, the number of times was considerably greater than those in the “response” group.
Conclusions: We found that VEMP latencies are increased in BPPV patients, which may signify neuronal degenerative changes in the macula of the saccule. When an extensive neuronal damage was suspected by VEMP results such as “no response” in VEMP, the disease progress showed a chronic and resistive course. Therefore, we propose that VEMP could be a useful method to determine a clinical prognosis of patients with BPPV.
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Otolith Function Tests in Patient with Vestibular Neuritis
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Hong Ju Park, Jung Eun Shin, Dae Bo Shim, Hyang Ae Shin, Sang Kyun Lim, Jae Yoon Ahn, Yong Soo Jung, Jin Suk Yu
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J Korean Bal Soc. 2006;5(1):49-54.
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Abstract
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- Background
and Objectives: Vestibular evoked myogenic potentials (VEMP) test provides a useful method for assessment of saccule function and the functional integrity of the inferior vestibular nerve, and subjective visual vertical (SVV) abnormalities are presumably related to a lesion of the utricle. The aim(s) of this study were to measure otolith function using SVV and VEMP tests, and to define the influence of the otolithic organs in patients suffering from vestibular neuritis.
Materials and Method: From September 2005 to January 2006, twelve patients who received treatment in hospital and also had been tested for caloric test, subjective visual vertical (SVV) and vestibular evoked myogenic potential (VEMP) tests with unilateral vestibular neuritis were enrolled. All the tests were done within 8 days after the onset of their symptoms, simultaneously. The SVV was measured in 34 normal subjects as well as in patients.
Results
Eight of 12 patients showed abnormal tilt to the lesion side in SVV test, and five of 8 patients showed no VEMP on the affected side. There was no correlation between SVV tilts and unilateral weakness (UW) in caloric tests. Two patients with abnormal UW (54, 82%) showed normal finding in SVV & VEMP tests. One patient with abnormal UW (83%) and SVV tilts (18.04˚) to the lesion side was normal in VEMP test. Two patients with abnormal UW (28, 37%) and no response in VEMP test were normal in SVV test.
Conclusion
Our results demonstrate that the incidence of abnormal results were 62.5, 66.7% in VEMP and SVV tests in acute stage of vestibular neuritis, respectively. There was no correlation between the abnormal results of the tests and these findings suggest that impairment of the otolithic function is depending on the extent and/or the localization of vestibular neuritis.
Key Words : Vestibular neuritis, Otolith, Vestibular function tests, Subjective visual vertical, Vestibular evoked myogenic potentials
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The Effect of Somatosensory Input on Subjective Visual Vertical in Normal Subjects
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Dae Bo Shim, Hyun Jong Jang, Hyang Ae Shin, Jae Yoon Ahn, In Bum Lee, Jung Eun Shin, Hong Ju Park
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J Korean Bal Soc. 2005;4(2):201-205.
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Abstract
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- Background
and Objectives: Aims of the study were to determine if the somatosensory input influences on vertical perception by comparing the results with the head or body tilted (15°) to the right and to the left, and to examine the influence of tactile sensation in the perception of verticality in head lateral positions.
Materials and Method: We tested 34 normal subjects in their ability to set a straight line to the perceived gravitational vertical. Measurements were taken in static conditions, sitting upright, head tilted (15°), body tilted (15°), and head lateral positions (90°) on the right/left sides with or without physical support under the head.
Results
The normal range of the subjective visual vertical (SVV) was 0.65°±1.23° in upright position. The normal ranges of SVV in head-tilts 15° to the left/right sides were -0.47°±1.76° and 1.88°±2.94°, which were significantly different from those in upright position (E-effect). But the normal ranges of SVV in body-tilts 15° to the left/right were not different from those in upright position. And the normal ranges of SVV in head lateral positions maintained actively and passively were not different each other, but significantly larger than that in upright position (A-effect).
Conclusion
Our results support that neck somatosensory input plays a part in the perception of verticality. In contrast, tactile sensation of the head had no effect on the settings of a visual line to visual vertical in head lateral positions.
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