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Vestibular Rehabilitation for Patient with Bilateral Peripheral Vestibular
Deficit
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Hyun Woo Park, Seong Ki Ahn
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Res Vestib Sci. 2016;15(1):1-4.
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- Bilateral vestibular deficit affects far fewer patients than unilateral deficit, and
thus has been understudied. When bilateral vestibular organs are injured, loss of
input of vestibulo-ocular and vestibulo-spinal reflex that normally stabilize the
eyes and body, affected patients suffer blurred vision during head movement,
postural instability, and disequilibrium. Vestibular rehabilitation therapy is an
exercise-based treatment program designed to promote vestibular adaptation and
substitution. The rationale for the exercises, which originated from the observation
that patients who were active recovered faster, was based on the supposition that
the head movements that provoke the patient’s dizziness play an important role
in hastening the recovery process. Here the author reviews the clinical manifestation
and treatment of bilateral vestibular deficit that include vestibular
rehabilitation therapy and vestibular device that studied today.
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Bilateral Benign Paroxysmal Positional Vertigo Occurred during Dancing
Rehearsal
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Dong Gu Hur, Joon Seok Ko, Jin Yong Kim, Seong Ki Ahn
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Res Vestib Sci. 2015;14(3):93-96.
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- Benign paroxysmal positional vertigo (BPPV) is the most common cause of
recurrent vestibular vertigo. The etiology of BPPV is unidentified in 50%?70%
of patients. However in secondary BPPV, the etiologies are well known a head
injury as an example. And it has been reported that even minor head trauma can
evoke BPPV. The authors experienced a case of bilateral BPPV occurred during
a dancing rehearsal in a school thereby we report the case with a review of the
related literatures.
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Long-Term Follow-Up of Patients with Benign Paroxysmal Positional
Vertigo
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Jin Yong Kim, Joon Seok Ko, Ho Joong Lee, Dong Gu Hur, Seong Ki Ahn
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Res Vestib Sci. 2015;14(3):83-86.
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- Objective: Benign paroxysmal positional vertigo (BPPV) is one of most common
peripheral vestibular disorders. The aim of this study was to identify recurrence
in the long-term follow-up of patients with BPPV after successful canalith
repositioning maneuvers, and to determine which factors contribute to recurrence.
Methods
The authors reviewed the medical records of 202 consecutive patients
with BPPV during the period January 2002 to December 2004 and investigated
112 patients with BPPV treated over the same period. Finally, 71 patients were
enrolled in this study. The estimated risk of recurrence used a Kaplan-Meier
analysis. For long-term follow-up, patients were contacted by telephone for further
information by one experienced doctor.
Results
A total of 71 patients with idiopathic BPPV fulfilled the inclusion criteria.
Forty-two patients had posterior semicircular canal-BPPV and 29 patients
lateral semicircular canal-BPPV. Recurrence rates in the posterior semicircular
canal-and lateral semicircular canal-BPPV were 24% (18/42) and 41% (12/29),
respectively (p＞0.05). Recurrence following successful treatment during a longterm
follow-up period was 23 out of 30 patients within 1 year, 5 patients between
1 and 3 years, 1 patient at between 3 and 5 years, 1 patient after 5 years, respectively.
Conclusion
The authors found no significant difference between the posterior
semicircular canal and lateral semicircular canal-BPPV regarding recurrence.
Recurrence mostly occurred within the first 3 years (93%) following successful
canalith repositioning procedure.
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Clinical Characteristics and Course of Recurrent Vestibulopathy Following Diuretics Medication
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Joon Seok Ko, Ho Yeop Kim, Dong Gu Hur, Seong Ki Ahn
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Res Vestib Sci. 2014;13(1):7-11.
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- et, and the characteristics of vertigo. Results: Median follow-up was 29 months (range, 27−37 months). Patients had a mean age at onset of 48.2 years and a mean duration of 2.75 years. An obvious female predilection was found, and unilateral caloric paresis (≥25%) was seen in 23.3%. Of the 30 patients, symptoms resolved in 80% but were unchanged in 20%. No patient with RV developed a central nervous system disease or benign paroxysmal positional vertigo during follow-up. Conclusion: The present study shows that in the majority of cases, vertigo resolved following diuretics medication. In cases of the patients with severe or disabling recurrent vestibulopathy, the diuretics medication may be effective in reducing the frequency of vertigo attacks.
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Clinical Characteristics and Natural Course of Benign Paroxysmal Vertigo of Childhood: A Long-Term Follow-Up Study
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Eun Jae Lee, Seong Ki Ahn, Dong Gu Hur, Joon Seok Ko
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Res Vestib Sci. 2013;12(3):93-98.
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- Background and Objectives: It is suggested that some patients with benign paroxysmal vertigo of childhood (BPVC) go on to develop migraine. However, neither the natural course nor the clinical features of BPVC have been determined, and therefore, the aim of this study was to investigate the clinical characteristics and the natural course of BPVC. Materials and Methods: During the period January 2002 to December 2009, we reviewed the clinical records of 58 patients diagnosed with BPVC. All patients were approached by telephone and using a questionnaire. The clinical characteristics of vertigo, such as sex and age distribution, duration and frequency of vertigo, associated symptoms, development of migraine, and neurologic abnormalities, were analyzed. Results: Mean follow- up duration was 73.2 months (range, 31-119 months). Patients had a mean age at onset of 11.8 years and a mean duration of 6.1 years. An obvious female predilection was found, and 40% of BPVC developed to migraine had a family history of migraine. Of the 32 patients, symptoms resolved in 68.7% but were unchanged in five patients (15.6%). BPVC developed to migraine in five patients (15.6%). Conclusion: This study suggests that vertigo spontaneously resolves in the majority of cases. However, the incidence of development to migraine in the BPVC patients is higher than that in general population.
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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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- Background and Objectives: It is necessary to establish the most efficient diagnostic and therapeutic method for benign paroxysmal positional vertigo (BPPV), which is appropriate for Korean healthcare system. We aimed to evaluate current state of Korean clinician’s diagnostic and therapeutic approaches for BPPV. Materials and Methods: A 16-item survey was emailed to the members of dizziness department of Otology Research Interest Group in the Korean Otologic Society (n=68). 43 were returned and analyzed. Results: All respondents (100%) used Dix-Hallpike test as a diagnostic tool for vertical canal-BPPV. Supine roll test was used for diagnosing lateral canal BPPV in nearly all the respondents (97.7%). Epley maneuver was chosen as otolith repositioning maneuver (ORM) for posterior canal BPPV in all respondents and barbecue rotation (BBQ) was used for treating lateral canal BPPV with geotropic nystagmus in 95.3% of respondents. Extreme variation was noted for therapeutic approach of lateral canal BPPV with ageotropic nystagmus BBQ, with 4 kinds of ORM and adjunctive measures to liberate otolith from cupula, while BBQ was again the most commonly used ORM (76.7%). Conclusion: The development of practical and efficient ORM for lateral canal BPPV with ageotropic nystagmus is necessary.
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A Case of Bilateral Vestibular Hypofunction Following Oseltamivir Medication
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Ho Yeop Kim, Seong Ki Ahn, Dong Gu Hur
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Res Vestib Sci. 2013;12(1):27-30.
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- The threat of pandemic influenza has focused attention and resources on virus surveillance, prevention, and containment. The World Health Organization has strongly recommended the use of the antiviral drug, Oseltamivir (TamifluⓇ), to treat and prevent pandemic influenza infection. In recent years, there have been case reports of vestibulocochlear events during or after oseltamivir treatment, other countries. Oseltamivir is generally well-tolerated and its most frequent adverse effects include nausea and vomiting, diarrhea, and abdominal pain. Up to now, bilateral vestibular hypofunction after oseltamivir medication has not been reported. Herein, we report a very rare case of a 36-year-old female with bilateral vestibular hypofunction following oseltamivir medication.
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Immunohistochemical Study on β1- and β2-Adrenergic Receptors in Rat Vestibular Nuclei
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Seong Ki Ahn, Roza Khalmuratova, Dong Gu Hur, Ho Yeop Kim, Hyun Woo Park, Yeon Hee Joo, Hung Soo Kang
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Res Vestib Sci. 2012;11(2):59-63.
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- Background and Objectives: The aim of this study was to examine the localizations of β1- and β2-adrenergic receptors (ARs) in rat vestibular nuclei by immunohistochemical staining procedure.
Materials and Methods: Twelve male Sprague- Dawley rats were used in this study. Primary antibodies for the β1- and β2-ARs were used. The sections were treated with a biotinylated goat anti-rabbit antibody. The sections were then incubated in avidin-biotin-peroxidase reagent and processed with immunoperoxidase using 3.3’-diaminobenzidine tetrahydrochloride.
Results: β1-AR and β2-AR immunopositive neurons were found to be distributed throughout the four major vestibular nuclei. Both receptors were primarily detected in neuronal somata and their proximal dendrites. β1-AR and β2-AR were moderately expressed in the superior vestibular nucleus, lateral vestibular nucleus, medial vestibular nucleus, and spinal vestibular nucleus.
Conclusion: The present study demonstrates, for the first time, that β1-AR and β2-AR receptors are localized in rat vestibular nuclei. Furthermore, this study may provide additional speculation into the role of ARs during vestibular signal processing. Further studies are needed to clarify the roles played by β1-ARs and β2-ARs through physiologic and functional studies.
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Contrivance of Management for Intractable Vertigo
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Dong Gu Hur, Eun Jae Lee, Hung Soo Kang, Seong Ki Ahn
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Res Vestib Sci. 2012;11:69-70.
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Two Cases of Central Origin Vertigo Mimicking Acute Vestibular Neuritis
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Hung Soo Kang, Seong Ki Ahn, Dong Gu Hur, Seong Yong Ahn
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Res Vestib Sci. 2011;10(2):77-81.
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- Vestibular neuritis (VN) is characterized by the acute onset of vertigo, nausea and vomiting, in the absence of hearing loss or tinnitus. Cerebellar and brain stem infarction represents approximately 2.3% of acute strokes overall. Those can result from occlusion of the superior cerebellar artery, anterior inferior cerebellar artery, or the posterior inferior cerebellar artery. Central vertigo such as cerebellar or brain stem infarction may present with nonspecific symptoms similar to those of VN. Patients with isolated vertigo due to cerebral infarction may pose a significant diagnostic challenge to the neurotologists. It is know n for being frequently misdiagnosed, often with consequent disability. We report 2 cases of cerebral infarction mimicking VN initially with a review of the related literatures.
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A Case of Acute Serous Labyrinthitis Complicated by Chronic Otitis Media Showing Atypical Nystagmus Pattern
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Hyun Woo Park, Seong Ki Ahn, Dong Gu Hur
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Res Vestib Sci. 2011;10(1):42-45.
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- Serous or suppurative labyrinthitis is one of the intratemporal complications of acute or chronic otitis media. Labyrinthitis can occur by meningogenic or hematogenous infection. Major symptoms of labyrinthitis are vertigo and hearing loss. The disease progresses in two phases; serous labyrinthitis, so called toxic labyrinthitis, and suppurative labyrinthitis. If labyrinthitis treated at serous phase, hearing could be saved. But, if the disease progressed to suppurative phase, hearing loss is difficult to recover. Therefore it is very important to distinguish these two phases of labyrinthitis when treating the patient. In general, the direction of nystagmus during labyrinthitis is helpful sign to distinguish these two phases. We report here on an unusual case of acute serous labyrinthitis complicated with chronic otitis media showing atypical pattern with a review of the related literatures.
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Assessment of Anxiety using Beck's Anxiety Inventory in Patients with Vestibular Neuritis
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Jin Yong Kim, Seong Ki Ahn, Oh Jin Kwon, Soo Yeon Cho, Dong Gu Hur, Sea Yuong Jeon, Dae Woo Kim
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Res Vestib Sci. 2010;9(2):70-75.
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- Background and Objectives The intimate relationship of vertigo and anxiety has been previously recognized. Anxiety may have an important influence on recovery of symptoms in vestibular neuritis (VN). The aim of study was to evaluate subjective anxiety of the pre-VN, at the time of onset of VN, and just after vestibular rehabilitation therapy (VRT) using Beck Anxiety Inventory (BAI) questionnaire, respectively.
Materials and Methods Twenty-eight patients with VN were asked to complete the BAI and dizziness handicap inventory (DHI). Each of the BAI and DHI was scored. We also evaluated the relationship between the DHI and BAI scores.
Results The VN patients at the time of attack had significantly more anxiety with vertigo and related symptoms (p<0.05). In most patients, anxiety level decreased following VRT. Conclusion These findings indicate that almost every VN patients can recovery from anxiety as vertigo regressed. However, the emotional support as well as physical and/or functional rehabilitation may be required to provide a more rapid and complete return to normal daily lives for these patients.
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Effect of Elderly Organized Vestibular Rehabilitation for Presbystasis
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Tae Hoo Kim, Beom Gyu Kim, Chul Young Heo, Jae Seok Lee, Il Seok Park, Yong Bok Kim, Tae Won Jang, Seong Ki Ahn
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Res Vestib Sci. 2010;9(2):58-63.
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- Background and Objectives Recently, The number of patients who have been complaining of the vertigo or dizziness has been increasing due to rapid growth of the elderly population and senile change. Aging is associated with decreased balance abilities, resulting in an increased risk of fall. The purpose of this study is to analyze the result of elderly organized vestibular rehabilitation therapy for presbystasis.
Materials and Methods A prospective study was performed on elderly population over sixty-five years. 148 dizzy patients who were admitted to Hallym University Medical Center. We recruited 64 consecutive patients with a diagnosis of presbystasis and treatment of rehabilitation. They were asked to complete the Korean vestibular disorders activities of daily living scale (K-VADL) for the functional aspect before and two to twelve weeks after elderly organized vestibular rehabilitation therapy. The result was analyzed by statistical methods.
Results The K-VADL scores were decreased in patient of presbystasis compared with first questionnaire. There were statistically significant differences in the K-VADL scores between before and after rehabilitation therapy.
Conclusion Most patients can effectively and safely utilize the modified vestibular rehabilitation therapy. Our results suggest that the vestibular rehabilitation therapy could provide a recovery for dizzy symptoms in presbystasis.
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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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- 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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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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Pathogenetic Understanding of Migrainous Vertigo
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Seong Ki Ahn
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J Korean Bal Soc. 2008;7(2):157-163.
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Herpes Zoster Oticus Involving Superior And Inferior Vestibular Nerve Without Facial Nerve Palsy
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Hung Soo Kang, Sea Yuong Jeon, Dong Gu Hur, Seong Ki Ahn
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J Korean Bal Soc. 2008;7(1):68-72.
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- Herpes zoster oticus (HZO) is characterized by auricular vesicles, facial palsy and vestibulocochlear dysfunction. The 8th cranial nerve can be most frequently involved. Rarely, it may be associated with the involvement of 5th, 6th, 9th, 11th or 12th cranial nerve. However, only few cases of HZO involving vestibular nerve without facial nerve palsy have been previously reported. We experienced an unusual case of 38-year-old woman who presented with auricular vesicles, otalgia, and vertigo of whilrling nature but not with facial palsy. Vestibular evoked myogenic potential (VEMP) and caloric tests that were performed to determine which division of vestibular nerve was involved demonstrated that decreased responses in this case. We report a case of HZO involving superior and inferior vestibular nerve without facial palsy that was confirmed by VEMP and caloric tests with a review of literature.
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