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Vestibulo-Ocular Reflex Recordings of Small Rodents using a Novel
Marker Array
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Mi Joo Kim, Jiyeon Lee, Eui Jae Hong, Eun Ji Lee, Yu Jin Min, Dong Ju Lee, Nam Beom Kim, Gyu Cheol Han
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Res Vestib Sci. 2016;15(1):11-16.
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- Objective: Recording the nystagmus of small experimental rodents is an integral
technique in vestibular research. Theoretically, the size and the shape of markers
strongly affect the analysis of 3 dimensional nystagmus.
Methods
The nystagmus of 6 healthy ICR mice were recorded and their gain
values were compared using 200 μm, 300 μm, 400 μm, and 600 μm isosceles
triangle markers at the peak velocity of 60o/sec and 100o/sec with the rotational
stimulations of 0.1 Hz, 0.2 Hz, and 0.5 Hz.
Results
The gain values of 3 different sizes of the markers showed no significant
differences in horizontal- vertical-torsional component. However, it was unable
to record the nystagmus with 200 μm markers since the markers were too small
to be placed and stayed on the center of the pupils.
Conclusion
Technicians can decide the size of the markers from 200 to 600 ?m
to record the nystagmus of mice, depending on the technicians’ skills.
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Quantification of Vestibulospinal Reflex Under the Stress Condition on Both Soleus Muscles
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Mi Joo Kim, Seo Jin Jang, Eun Ji Lee, Ah Ram Yu, Jong Hyun Hwang, Gyu Cheol Han, Ju Kang Lee
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Res Vestib Sci. 2012;11(1):14-22.
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Abstract
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- Therefore, by establishing method that enables to track and observe quantified VSR, the reliability of experiment is attempted to be increased. Materials and Methods:On five SD Rats to measure electromyogram (EMG), electrodes, in the form of stranded cables composed of seven wires, are chronically implanted on both sides of the soleus muscles. Pre and post operative condition of sitting still, standing, and ladder step walking was compared before, and six and twenty four hours after a unilateral labyrinthectomy with quantified muscle activity in maximal voluntary activity. Simultaneously by using multi modality electric potential plus package, the muscle activity between the two legs was tracked and compared. Results: In the sitting still position, the left/right soleus muscle activities were 25.7/26.0 μV before a unilateral labyrinthectomy which was changed after the surgery with the value of 23.1/8.1 μV and 23.4/14.3 μV when six and twenty four hours passed respectively. In the standing position, 92.8/124.0 μV of preoperative value was changed to 89.6/37.3 μV six hours after the unilateral labyrinthectomy, and it was 97.0/54.7 μV 24 hours after. The preoperative value in ladder step walking test was 56.2/86.0 μV, and postoperative ones were 54.9/21.2 μV and 55.7/38.0 μV after six and twenty four hours respectively. Conclusion: VSR assessment method by using quantitative EMG well reflects the process of vestibular compensation, and to maintain the tension of extensor muscles, ladder step walking test is shown to be useful.
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Diagnostic Dehydration Testings for Endolymphatic Hydrops
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Mi Joo Kim, Gyu Cheol Han
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Res Vestib Sci. 2011;10(2):47-51.
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C-fos Expression of Vestibular Nucleus in C57BL/6 Mouse Under the 7 Tesla Ultra High Magnetic Field
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Mi Joo Kim, Min Joo Jung, Ji Hye Bae, Eun Ji Lee, Duk Hyun Kim, Gyu Cheol Han
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Res Vestib Sci. 2011;10(1):26-29.
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- Background and Objectives: A typical side effect of super high magnetic field is dizziness and it is expected that 7 Tesla (T) super high magnetic field will have temporary influence on vestibular nucleus. Prevalence rate of dizziness generally increases with advancing years, so this study discusses whether the influence of 7 T super high magnetic field differs depending on the age.
Materials and Methods: C57BL/6 mice weighting from 10-40 g were categorized into 4-week-old and 16-week-old groups. They were exposed to 7 T magnetic field and immunohistochemical staining was done to observe expression of c-fos protein in vestibular nucleus of mice.
Results: Control group with normal vestibular system did not show c-fos protein. However, mice exposed to 7 T magnetic field showed c-fos expression selectively on medial and lateral parts of vestibular nucleus and there was no significant difference of c-fos expression between both sides (p<0.05). There was statistically significant difference between the different age group: 16-week-old mice group showed higher number of cells expressing c-fos protein than 4-week-old mice group did (p<0.05).
Conclusion: It is statistically significant that 7 T super high magnetic field is more influential to older age group.
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Measuring the Behavioral Parameters of Mouse Following Unilateral Labyrinthectomy in Round Free Field Using an Infrared Lamp and a Simple Webcam Camera
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Mi Joo Kim, Hyun Jung Hwang, Seung Won Chung, Gyu Cheol Han
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Res Vestib Sci. 2011;10(1):12-18.
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Abstract
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- Background and Objectives: In this research, movements of mouse after labyrinthectomy were analyzed to determine the degree of vestibular dysfunction and compensation. Materials and Methods: By using an infrared lamp, mouse movements were recorded for 100 seconds in a dark room. The experimental area was manufactured as a circular space with a diameter of 60 cm. The movements of five mice labyrinthectomized on right side were observed and recorded at 3 hours, 9 hours and 120 hours after the operation, and also the ten mice of control group. Results: The differences between the total moving distances and the rotating angle from the origin that set the center of round field between groups were analyzed with pictures of 1 frame per second. It is concluded that all 4 groups show significant differences between its mean rotation angle and total moving distances statistically. At 9 hours after right labyrinthectomy, mice tended to turn clockwise; but at 120 hours, there was no significant difference between clockwise and counter-clockwise rotation. Conclusion: Measuring the movement of mouse in round free field can be the proper method to determine the degree of vestibular dysfunction and vestibular compensation. This test was time-saving and cost-effective method.
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A Case of Multiple Perilymph Fistula Induced by Tympanostomy Tube Insertion
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Seung Won Chung, Mi Joo Kim, Gyu Cheol Han
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Res Vestib Sci. 2010;9(1):32-37.
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- This controversial diagnosis centers around the phenomenon of perilymph leaking from the inner ear into the middle ear cleft through the oval window, round window or other fissures in the bony labyrinth that may be abnormally patent. A perilymph fistula may develop after stapedectomy surgery, penetrating middle ear trauma, head trauma, barotrauma, or possibly spontaneously. Uncertainty regarding the clinical criteria for the diagnosis and the inability to document the presence of a microfistula at surgery contribute to the problematic nature of this diagnosis. However, this condition should be seriously considered in the patient with vertigo after head trauma, barotrauma injury, or previous middle ear surgery. It is particularly likely in patients with penetrating middle ear trauma with vertigo. Most authors agree that perilymph fistulas generally heal spontaneously, therefore a few days of bed rest is appropriate in acute cases. Cases suspected after penetrating trauma should be explored early if symptoms persist. Here, authors report a case of multiple perilymph fistula possibly caused by tympanostomy tube insertion in a 48-year-old man with a review of the literature.
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The Comparison of the Magnetic Resonance Images in the Patient With Definite Meniere’s Disease Before and After Endolymphatic Sac Decompression
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Mi Joo Kim, Gyu Cheol Han, Seung Won Chung
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Res Vestib Sci. 2009;8(2):152-155.
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- Endolymphatic hydrops is believed to be underlying pathophysiology of Meniere’s disease. The degree of endolymphatic hydrops observed by MRI (magnetic resonance imaging) in patients with Meniere’s disease offers a new method to study the progression of Meniere’s disease. There have been multiple attempts to diagnose Meniere’s disease with the help of radiologic tests including MRI in Korea. We describe a case report of a patient with Meniere’s who showed changes of endolymphatic sac in MRI after endolymphatic sac decompression.
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Multicanal Benign Paroxysmal Positional Vertigo: Concurrent Bilateral Posterior Canalolithiasis and Unilateral Lateral Cupulolithiasis
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Seung Won Chung, Chang Hyun Cho, Gyu Cheol Han
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Res Vestib Sci. 2009;8(2):142-146.
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- Multicanal BPPV (benign paroxysmal positional vertigo), especially BPPV affecting both labyrinths, is uncommon. A review of the literature revealed that the majority of reported cases of multiple BPPV either involved a combination of two different canals limited to one labyrinth or two different canals in both labyrinths, although one case of multicanal BPPV was reported to involve three canals bilaterally. Here, the authors report a case of bilateral posterior canalolithiasis and unilateral horizontal canal cupulolithiasis in a 54-year-old man, and include a review of the literature.
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Multicenter study on the treatment pattern of Ménière’s disease in Korea
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Sung Kwang Hong, Eui Kyung Koh, Kyu Sung Kim, Kyoung Ho Park, Hong Ju Park, Seong Ki Ahn, Joong Ho Ahn, Won Sang Lee, Gi Jung Im, Jae Yun Jung, Won Ho Chung, Gyu Cheol Han, Sung Won Chae, Ja Won Koo
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J Korean Bal Soc. 2008;7(2):174-181.
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- Background and Objectives: It is hard to determine the efficacy of several treatment options of Ménière’s disease since dynamic course of the disease and diverse rate of recurrence. Few modalities are regarded as ‘effective’ in the viewpoint of evidence based medicine. Study was conducted to know the current status of treatment options for Ménière’s disease.
Materials and Methods: A multicenter survey was conducted using questionnaires to collect information on current status of treatment patterns in Ménière’s disease. The questionnaire answered by neurotologic surgeons working at 12 institutes in Korea was analyzed.
Results: Low salt diet was always instructed to their patients, but 8 out of 12 responders (67%) did not emphasis on the amount of dietary salt. Duration of pharmacotherapy was ranged from 3 to 12 months. Intratympanic steroid injection was performed in 8 institutes (67%). Every institute agreed on the role of intratympanic gentamicin application. Treatment options for intractable patients were asked. Endolymphatic sac surgery, intratympanic steroid, Meniette device and intratympanic aminoglycoside injection were answered in patients who hope to preserve residual hearing. On the contrary, in patients without serviceable hearing, intratympanic jnjection of aminoglycosides (9/12, 75%) dominated as the next treatment option.
Conclusions: Most institutes provide similar patterns of practice in medical treatment. The application of intratympanic aminoglycoside is also agreed in intractable patients without serviceable hearing. However, thoughts about the role and detailed methods of the surgical and adjunctive treatment options were not agreed, especially in intractable patients with good hearing. Further clinical studies and discussions would be necessary to provide consensus for the best treatment of Ménière’s disease in Korea.
Key words : Ménière’s disease, Pharmacotherapy, Surgery, Aminoglycosides
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Efficacy of Rotating Chair Test And Caloric Test For The Diagnosis of Acute Unilateral Vestibular Neuritis
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Heung Eog Cha, Chae Young Lim, Gyu Cheol Han, Chang Hyun Cho, Byung Ki Yoon, Min Kwan Baek, Ju Hyoung Lee
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J Korean Bal Soc. 2008;7(1):43-47.
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- 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.
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The Analysis of Post Traumatic Benign Paroxysmal Positional Vertigo
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Chang Hyun Cho, Dong Kyu Kim, Gyu Cheol Han, Eun Jeong Lee, Joo Hyun Woo, Ju Hyoung Lee
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J Korean Bal Soc. 2005;4(1):17-25.
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Abstract
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- 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.
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Possible Mechanism of Seesaw Nystagmus in Internuclear Ophthalmoplegia
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Ji Soo Kim, Kwang Dong Choi, Ja Won Koo, Kyungmi Oh, Jae Hong Chang, Kun Woo Park, Dae Hie Lee, Gyu Cheol Han
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J Korean Bal Soc. 2004;3(2):413-416.
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- The authors report jerky seesaw nystagmus, extorsional downbeating in the ipsilesional eye and intorsional upbeating in the contralesional eye, in a patient with internuclear ophthalmoplegia (INO) from focal pontine lesion. This pattern of nystagmus may occur by disrupting pathways from contralateral posterior and anterior semicircular canals by a lesion in the medial longitudinal fasciculus. Depending on the pathways involved, various patterns of dissociated
torsional-vertical nystagmus may accompany INO.
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The Design of Subjective Visual Vertical and Horizontal Measurement Method in Normal Peoples
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Gyu Cheol Han, Jong Su Ha, Sun Young Kim, Joo Hyoung Lee, Chang Hyun Cho, Dong Young Kim, Seon Tae Kim
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J Korean Bal Soc. 2004;3(2):395-403.
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Abstract
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- Background
and Objectives : Subjective visual vertical and horizontal presented as test that evaluate otolithic organ. However, was not discussed about condition that is factor influencing in examination or position at examination. Therefore, we wished to evaluate effect of subjective visual vertical and horizontal in each test condition and find repletion item.
Materials and Method : Measured subjective visual vertical and horizontal dividing by gender and three age group to 45 normal persons. Do so that there may be axis of rotation of 0.3×20 cm size candlepin on center of screen and lower part of screen to 18 inch LCD monitor at subjective visual vertical. Do so that may be center of screen and left middle at subjective visual horizontal and gave change length and axis of rotation of candlepin. Measured subjective visual vertical and horizontal each 3 times in standing, sitting, supine position in darkroom.
Results
: There are no statistical differences in each positions and distinction of gender and axis of rotation. But there are statistical differences in age groups.
Conclusion
: Difference in age groups means that examination method or control of number of test, preliminary
education of patients, assistance need rather than is caused change or abnormality of otolithic organ. Therefore, is
thought to be representative test that evaluate function of otolithic organ as clinical test.
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The Optimization of Galvanic Vestibular Stimulation according to Evoked Nystagmus
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Gyu Cheol Han, Dong Kyu Kim, Ju Hyoung Lee, Chang Hyoun Cho, Dong Young Kim, Heung Eok Cha
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J Korean Bal Soc. 2004;3(2):386-394.
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Abstract
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- 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.
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Chicken Embryo as a Model of Inner Ear Study
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Gyu Cheol Han, Youn Kyu Lee, Jin Ho Yoon, Kyung Kun Min, Ju Hyoung Lee
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J Korean Bal Soc. 2004;3(2):379-385.
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Abstract
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- 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.
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Vestibuloneuritis Developed Concurrently in Ipsilateral Site with Herpes-Zoster Oticus Syndrome
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Gyu Cheol Han, Ju Hyoung Lee, Joo Hyun Woo, Jung Kook Yoo, Sun Hwa Lim
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J Korean Bal Soc. 2004;3(1):187-191.
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Abstract
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- 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.
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One Case of Downbeat Nystagmus with Compression of Vestibulocochlear Nerve by Vertebral Arteries
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Gyu Cheol Han, Ju Hyoung Lee, Jong Su Ha, Hee Young Hwang, Cheol Wan Park
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J Korean Bal Soc. 2004;3(1):184-186.
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- 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
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Clinical Analysis of Down Beat Nystagmus in Atypical Positional/ing Vertigo
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Gyu Cheol Han, Ju Hyoung Lee, Eun Jung Lee, Jae Jun Song
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J Korean Bal Soc. 2004;3(1):150-155.
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- 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
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Retrospective Study of Magnetic Resonance Imaging & Vestibular Function Testing in Patients Suggestive of Central Vestibular Disorders
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Gyu Cheol Han, Ju Hyoung Lee, Dong Kyu Kim, Hee Young Hwang, Jin Myoung Heo
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J Korean Bal Soc. 2004;3(1):141-149.
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Abstract
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- 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
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Clinical Analysis of the Dizzy Patients in a Department of Emergency Medicine
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Gyu Cheol Han, Eun Jung Lee, Jong Su Ha, Dong Kyu Kim
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J Korean Bal Soc. 2003;2(2):206-210.
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- Background
and Objectives: The patient presenting to the emergency department with the complaint of dizziness is one of the most common as well as most challenging problems confronting the emergency physician today. Dizziness is a vague symptom of disease ranging from serious to benign. The differential diagnosis and proper management of dizziness in a department of emergency medicine are the most important things. We undertook this study to evaluate the character and clinical analysis of the dizzy patients and to discuss the significance and necessity of primary care in a department of emergency medicine.
Materials and Method: From September 1999 to October 2003, we sampled the 1,371 dizzy patients who visited the Emergency Department(ED). Of these patients, the 650 patients performed electronystagmography(ENG) and rotatory chair test were selected, except for the patients with loss of consciousness, known psychiatric disease or direct brain injury.
Results
The 650 patients were attributed to acute peripheral vestibulopathy in 88.5% (575 patients) of patients, benign paroxysmal positional vertigo in 9.5% (62 patients) of patients, central origin in 1.4% (9 patients) of patients, other organic origin in 0.6% (4 patients) of patients. In a retrospective analysis of patients with central origin, the symptoms estimated at central origin, for example, persistent headache, were found.
Conclusion
The exact diagnosis and management for the dizzy patients in a department of emergency medicine require the primary physician's concern and understanding for dizziness.
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Evaluation of Vestibular Function in Ramsay Hunt Syndrome
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Gyu Cheol Han, Jung Kook Yoo, Kyu Sung Kim
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J Korean Bal Soc. 2003;2(2):202-205.
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- Background
and Objectives: Ramsay Hunt syndrome is herpes zoster of the facial nerve, frequently associated with VIII cranial nerve involvement, but on rare occasions other cranial nerves are affected as well. We tried to show that Ramsay Hunt symdrome should be recognized as a cranial polyneuropathy characterized by damage to cranial nerves, especially the facial nerve and the auditory-vestibular nerve.
Materials and Method: 11patients suffered from auricular vesicles, otalgia, facial palsy, and vertigo. Group A included 8 patients of acute peripheral vestibulopathy with Ramsay Hunt syndrome. Group B included only 3patients of Ramsay Hunt syndrome. Each patient received a battery of tests, including neurological examination, audiometry, vestibular function test.
Results
The lesion site of Ramsay HHhhunt syndrome was right in 5cases and left in 6cases. Electronystagmography showed 3cases of right acute peripheral vestibulopathy, 5cases of left, and 3cases of disequilibrium. Site of Ramsay hunt syndrome and that of vestibulopathy was same in 8cases of Group A. 3cases was observed in Ramsay Hunt syndrome patients that hearing loss and vestibulopathy was same site. Facail nerve palsy improved without recovery of vestibular function. Cranial examination and imaging study like brain CT or temporal MRI showed no abnormal finding.
Conclusion
Although Ramsay Hunt syndrome usually presents with the classical triad of pain, vesicles and facial nerve paralysis, it must be kept in mind that it is a cranial polyneuropathy. In our study, there was few association between facial nerve palsy recovery and acute peripheral vestibulopathy.
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Analysis of Vertigo in Labyrinthine Fistula Secondary to Cholesteatoma
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Gyu Cheol Han, Joo Hyun Woo
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J Korean Bal Soc. 2003;2(2):198-201.
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- Background
and Objectives: Labyrinthine fistula is one of the common complication of the chronic otitis media with cholesteatoma. Disruption of the labyrinthine bone can lead to hearing loss and/or vestibular disturbance. This study aimed to evaluate postoperative vertigo result in patient with labyrinthine fistula and efficacy of vestibular function test for diagnosis.
Materials and Method: A retrospective study of the clinical records of 13 patients who were operated for chronic otitis media with cholesteatoma, suspected to have secondary labyrinthine fistula, from January 2001 through June 2003 in Gachon medical school Gil hospital. All patients were evaluated by Fistular test, Vestibular function test, high resolution Temporal bone CT, Pure tone audiometry preoperatively. Vertigo was assessed by Disability Scale.
Results
Canal wall down mastoidectomy were applied in all ears. Labyrinthine fistulas were confirmed in 8 patients during operation. Fistular group had higher rate of peripheral vestibular injury than no-fistular group's in vestibulo-ocular reflex. Fistula cases have high average score (2.9) than non-fistula's (1.6) in Vertigo scale preoperatively. In post-operation, the average score was 0.25 in fistular cases and 0.4 in non-fistula cases. 2 cases presented positive fistular test result (25.0%)
Conclusion
Although Vertigo was more severe in patients who had fistula, in post-operation, symptoms could be relieved a lot. Vestibular function test had efficacy for diagnosis of labyrinthine fistula in preoperative.
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Hearing Recovery in Patients of Sudden Hearing Loss with Vertigo ; Incheon
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Eun Jung Lee, Gyu Cheol Han, Kyu Sung Kim
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J Korean Bal Soc. 2003;2(1):103-106.
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Abstract
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- Background
and Objectives: In the past studies, it was reported that vertigo was accompanied by sudden deafness patients from 25% to 47% and it increased to 56% when electronystagmography was used. They also reported that when sudden deafness patients showed vertigo symptom. The initial hearing losses were severe and their prognoses were poor. But they divided the sudden deafness patients simply by whether vertigo existed, not considering the extent of hearing loss. So we compared the prognosis between the sudden deafness patients showing the same level of hearing loss.
Materials and Method: We sampled 157 sudden deafness patients (Feb 1999 - Mar 2002). Of these, 17 patients with acute vertigo (group A) and 17 control patients without vertigo (group B) having the same level of mean air conduction as group A were selected.
Results
Group A showed frequent flat form of audiogram, poor response to treatment regardless of the age than group B.
Conclusion
In sudden deafness patients, objectively proven acute vertigo symptom is a prognostic factor of hearing recovery.
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The Significance of Head-Shaking Nystagmus in the Vestibular Evaluation of the Chronic Dizzy Patient
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Si Ho Yang, Gyu Cheol Han
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J Korean Bal Soc. 2002;1(2):253-258.
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Abstract
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- Objectives
: Nystagmus after rapid head-shaking (head-shake nystagmus) is transient horizontal nystagmus which is observed after passive horizontal headshake by yaw axis. It has been used for the evaluation of the remnant vestibular function. This study compared one patient group complaining of chronic vertigo with another normal group with no symptom. We tried to confirm the efficacy as a tool for the evaluation of the vestibular function in the old who had less knowledge of diasease itself, by searching the occurrence rate of head-shake nystagmus by age.
Materials and Methods : Of dizzy patients under Vertigo Index III, 19 patients with normal ENG and 20 patients showing only the decrease of the gain on the rotatory test were selected, and head-shake nystagmus was evaluated. Normal control (n=12) were all the heathy patients without any history of the otologic illness after consideration of their age. Eye movement was recorded with ENG testing and Frenzel glasses for 1minute in the dark room after vigorous head shaking at a frequency of 2Hz. Presence or absence of the head-shake nystagmus was judged by two otolaryngologist.
Results
: Only 41% (16/39) of the dizzy patients showed headshake nystagmus. On the other hand, 8% (1/12) of normal control group revealed headshake nystagmus(p < 0.03). 50% (10/20) of the patient group showing the decrease of the gain, and 31% (6/19) of the another group with normal vestibular function revealed headshake nystagmus. When the detection rate of the nystagmus is compared according to the testing methods, it is 33% (17/51) by ENG testing, 12% (6/51) by Franzel glass test. Incidence rate of the headshake nystagmus by age is 25% (5/20) in the dizzy patient group under 50 years old, 58% (11/19) in the group over 50 years old(p < 0.03).
Conclusion
: Head-shake nystagmus showed some difference according to the vestibular compensatory periods, but Its sensitivity was 41% and it is thought to be used convenient just in the old. However, attention should be paid to observe the nystagmus in case of using the Frenzel glasses.
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A New Treatment Strategy of Ageotrophic Horizontal Canal Benign Paroxysmal Positional Vertigo
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Gyu Cheol Han, Hyung Gyu Jeon, Jin Myung Huh
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J Korean Bal Soc. 2002;1(1):113-117.
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Abstract
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- Background
and Objectives : Ageotrophic nystagmus in the horizontal canal BPPV has been explained as a result of cupulolithiasis theory, and has been reported to have the less therapeutic response to conservative rehabilitations than the other type BPPV . Though methods to detach the debris with vibrator have been introduced, the effect has been questioned and it’s not physiologic.
Materials and Method : We introduce a new head shaking-forced prolonged position method as a more convenient method, and report typical 2 cases of ageotrophic horizontal canal BPPV managed with it and analyzed results of 25 cases all told.
Results
and conclusion : The average number of rehabilitation was less than two, and loss of direction changing positional nystagmus could be observed immediately after rehabilitation.
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