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Does dimenhydrinate delay recovery of vestibular ocular reflex in acute unilateral vestibulopathy? A retrospective comparative study
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Minah Shin, Chae-Young Kim, Ji Eun Choi, Jae Yun Jung, Min Young Lee
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Res Vestib Sci. 2024;23(3):89-94. Published online September 15, 2024
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DOI: https://doi.org/10.21790/rvs.2024.006
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Abstract
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Acute unilateral vestibulopathy (UVP), also known as vestibular neuritis, is the third most common peripheral vestibulopathy. The acute autonomic symptoms of UVP can be controlled by the H1-receptor antagonist dimenhydrinate. Despite concerns about prolonged recovery from suppressed vestibular compensation when using dimenhydrinate, research is limited. Thus, we investigated the effect of dimenhydrinate on the recovery of UVP patients.
Methods We retrospectively analyzed patients who were diagnosed with UVP from April 2018 to April 2022. The patients were divided into those who were prescribed dimenhydrinate during admission and those who were not. Recovery from UVP was defined subjectively and objectively. Subjective recovery (SR) had occurred in a patient whose dizziness clearly subsided. Objective recovery (OR) was used when the video head-impulse test (VHIT) or rotary chair test (RCT) no longer indicated vestibular dysfunction.
Results Dimenhydrinate was prescribed to 15 patients (19.0%) during admission. The dimenhydrinate group had smaller proportions of SR and OR at 3 months after diagnosis of UVP. In terms of VHIT, the non-dimenhydrinate group had a greater increase in gain for the 3 months than the dimenhydrinate group in the semicircular canals when measured by the VHIT. The difference in gain between the two groups was significant at 0.16 Hz during follow-up RCT.
Conclusion These results suggest that dimenhydrinate should be carefully used in UVP patients as it may have a negative effect on vestibular compensation.
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Unilateral Vestibulopathy Mimicking Inner Ear Ischemia Modeling Using Photothrombosis and Behavioral Assessment Using EthoVision
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Min Seok Song, Min Young Lee, Ji Eun Choi, So-Young Chang, Jae-Hun Lee, John Patrick Cuenca, Nathaniel T. Carpena, Jae Yun Jung
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Res Vestib Sci. 2023;22(4):112-119. Published online December 15, 2023
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DOI: https://doi.org/10.21790/rvs.2023.22.4.112
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Abstract
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Inner ear ischemic animal models using photochemical reactions have been devised in various ways. Localized vascular ischemia occurs with 532-nm laser irradiation after systemic rose bengal injection, a known photothrombotic mechanism. The aim of this study is to evaluate a photothrombosis-induced vestibulopathy mimicking behavioral changes in the inner ear ischemia model.
Methods Seven-week-old male Spraque-Dawley rats were used. Animals were divided into three groups: control group (n=6), sham laser group (n=9), and laser group (n=9). To induce the photothrombosis, animals were injected with rose bengal into the femoral vein and then were irradiated with a 532-nm laser (175 mW for 900 seconds) via transtympanic membrane. To investigate the vestibulopathy after photothrombosis, the behavior tests (tail lift reflex test, air righting reflex test, rotarod test) were performed on the 1st, 3rd, and 7th days after surgery. Additionally, an open field test was conducted and analyzed using EthoVision XT (Noldus).
Results The laser group exhibited significant behavioral change to mimic vestibulopathy in all assessments. Inducing photothrombosis with rose bengal caused severe gait instability, which precluded rotarod testing. In the tail lift reflex test, the laser group displayed vestibular dysfunction with a lower angle formation compared to the control rats. During the open field test, the laser group exhibited reduced mobility, a condition that persisted in the laser groups for 7 days.
Conclusions Noninvasive laser irradiation using rose bengal and a 532-nm laser induces photothrombosis in the inner ear of animals, leading to the development of vestibulopathy mimicking imbalanced behavior.
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A Comparative Analysis of the Vestibulocochlear Function in Patients with Isolated Semicircular Canal Hypofunction Using a Video Head Impulse Test
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Yu Jung Park, Min Young Lee, Ji Eun Choi, Jae Yun Jung, Jung Hwa Bahng
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Res Vestib Sci. 2023;22(2):34-45. Published online June 15, 2023
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DOI: https://doi.org/10.21790/rvs.2023.22.2.34
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The objective of this study was to analyze vestibulocochlear function results in patients identified with isolated semicircular canal (SCC) hypofunction using the video head impulse test (vHIT).
Methods A retrospective review was conducted on the clinical records of 123 patients diagnosed with isolated SCC hypofunction based on vHIT results. Among these patients, 72 had isolated posterior SCC (PSCC) hypofunction, 25 had isolated lateral SCC (LSCC) hypofunction, and 26 had isolated anterior SCC (ASCC) hypofunction. Descriptive analyses were performed on various vestibulocochlear tests including pure tone audiometry, sinusoidal harmonic acceleration (SHA), spontaneous nystagmus (SN), head-shaking nystagmus (HSN), caloric testing, and cervical vestibular evoked myogenic potential, with results analyzed separately for each SCC hypofunction group.
Results The study found that 66.0% of the evaluated patients exhibited abnormal results in at least one vestibulocochlear function test. PSCC hypofunction patients showed a significantly higher incidence of hearing loss compared to ASCC and LSCC hypofunction patients. LSCC hypofunction patients exhibited higher rates of corrective saccade, phase asymmetry of SHA, and SN abnormalities compared to other SCC hypofunction patients. Additionally, the rates of corrective saccade and phase asymmetry of SHA were also higher in LSCC hypofunction patients. ASCC hypofunction patients demonstrated significantly higher rates of normal corrective saccade, phase lead of SHA, and SN.
Conclusions The analysis of this study suggests that even in cases where vHIT indicates isolated SCC hypofunction, additional vestibulocochlear function tests should be conducted to identify any associated vestibulocochlear dysfunctions. This highlights the importance of comprehensive evaluation to accurately diagnose and manage patients with SCC hypofunction.
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Can Cupulolithiasis Affect the Time Constant or Gain of the Velocity Step Test?
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Min Tae Kim, Ji Eun Choi, Min Young Lee, Jae Yun Jung
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Res Vestib Sci. 2019;18(4):98-102. Published online December 15, 2019
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DOI: https://doi.org/10.21790/rvs.2019.18.4.98
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Abstract
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The nystagmus evoked by an angular velocity step is influenced by the cupula dynamics and the status of velocity storage mechanisms. This study questioned whether the cupulolithiasis of horizontal canal benign paroxysmal positional vertigo (HC-BPPV) affects the time constant or gain of the velocity step test.
Methods We performed a retrospective study of 30 patients who diagnosed with HC-BPPV and performed rotary chair test at Dankook University Hospital from June 2010 to May 2017. All patients had normal vestibular function on the sinusoidal harmonic acceleration test. According to the direction of nystagmus on the head roll test, we further divided the patients into “geotrophic” (canalolithiasis) and “apogeotrophic” (cupulolithiasis) groups. We compared the time constant (Tc), gain, and directional preponderance (DP) between the 2 groups. We also compared the time constant and gain between lesion side of BPPV and normal side in each group.
Results In the supine head roll, geotrophic nystagmus observed in 14 patients and apogeotrophic nystagmus observed in 16 patients. When parameters of the velocity step test compared according to lesion side of BPPV (per-rotary of lesion side, postrotary of lesion side, per-rotary of normal side, and postrotary of normal side), there were no significant differences in Tc, gain, and DP between the 2 groups. There were also no significant differences in Tc and gain between lesion side and normal side in each group.
Conclusions We assumed that cupulolithiasis of HC-BPPV could affect the cupular deflection evoked by an angular velocity step, but there were no significant differences in Tc and gain between patients with cupulolithiasis and canalolithiasis.
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Citations
Citations to this article as recorded by
- Influence of Otoliths on the Vestibulo-Ocular Reflex in Horizontal Canal Benign Paroxysmal Positional Vertigo
Hee Soo Yoon, Jae Yeong Jeong, Jae Ho Chung, Ha Young Byun, Chul Won Park, Seung Hwan Lee Research in Vestibular Science.2020; 19(2): 49. CrossRef
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Factors associated with patient satisfaction in customized vestibular exercise : pilot study
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Hye Soo Ryu, Min Young Lee, Jae Yun Jung, Ji Eun Choi
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Received June 20, 2019 Accepted August 26, 2019 Published online August 26, 2019
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[Accepted]
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Abstract
- Numerous studies have been reported on the effect of customized vestibular exercise (VE), but little study has been reported on the satisfaction of customized VE. Therefore, this study aims to investigate the factors that affect the satisfaction of customized VE.
A telephone survey was conducted on 37 patients who underwent customized vestibular exercise from January to November 2018. The questionnaire consisted of a total of 10 items, including subjective symptom, compliance and satisfaction of exercise, preferred methods of exercise, and appropriate costs. Based on the questionnaire of satisfaction, the clinical features, improvement of symptom, compliance, preferred methods of exercise were compared between satisfactory and unsatisfactory groups.
Of the 20 patients who responded to the telephone survey (response rate 57%), 10 patients were included in the satisfactory group and the remaining ten were included in the unsatisfactory group. There were not significant differences between two groups in age, sex, severity of subjective symptom before customized VE, preferred methods of exercise. subjective dizziness after customized VE was significantly decreased in the satisfactory group, but there was no significant difference in the unsatisfactory group.
The satisfaction of customized VE was significantly lower in patients with chronic uncompensated vestibulopathy, postural instability, less improvement of dizziness, or poor compliance. The satisfaction of the customized vestibular movement is thought to be closely related to the treatment effect and compliance. Thus, in addition to prescribing appropriate customized exercise, it is necessary to educate the patients and to provide a variety of ways to improve compliance.
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