Research in Vestibular Science

Volume 10 (2); June 2011

Review

Diagnostic Dehydration Testings for Endolymphatic Hydrops: Mi Joo Kim, Gyu Cheol Han; Res Vestib Sci. 2011;10(2):47-51.

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Original Articles

Influence of Head Position in Rotation Test: Jeong Seok Choi, Jae Eun Kim, Kyu Sung Kim, Hoseok Choi; Res Vestib Sci. 2011;10(2):52-55.

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Abstract PDF: Background and Objectives: Rotation test is a widely used method to evaluate the function of the vestibular system. Generally, the head position to be tilted forwards 30° during rotation is preferred in order to bring the horizontal semicircular canals into the plane of rotation, thus ensuring maximum response. However literatures do not provide a clear reference concerning head position during the rotation test. So, we evaluated the vestibuloocular reflex (VOR) induced by sinusoidal rotation in the horizontal plane in the two different head positions: the head tilted forward 30° and with the head upright. Materials and Methods: A total of 20 men with no known neuro-otological disorders and 9 guinea pigs were studied. The rotations of slow harmonic acceleration on various frequencies were performed with the subject’s head in the upright position and in the 30 pitched down position. Computerized electronystagmography in human and magnetic coil in guinea pigs were used to measure the maximum velocity of slow component of horizontal nystagmus and to calculate gain, phase and symmetry of VOR responses. Results: In both groups, results showed no significant differences in gain, phase and symmetry. Conclusion: In the two different head positions, there were no significant differences in gain, phase and symmetry. The posture of head upright is more comfortable for the patient and gives enough response for the evaluation of vestibular function.

Clinical Review of Dizziness Patients Who Visited Emergency Room: Ki Yong Kim, Hyun Jung Min, Seung Hwan Lee, Chul Won Park; Res Vestib Sci. 2011;10(2):56-62.

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Abstract PDF: Background and Objectives: As most dizziness symptoms are vaigue, and misdiagnosis of central dizziness can be life threatening, diagnosis of the dizziness is difficult. Especially, in the emergency room with a restricted environment, it must be more difficult. The aim of this study is to find out and correct the aspects requiring a modification for diagnosis in patients of dizziness who visited emergency room. Materials and Methods: The authors retrospectively have reviewed the charts of 458 patients with dizziness who visited the emergency room at Hanyang University Guri Hospital from April 2008 to March 2009 and researched the various informations such as diagnosis, clinical feature, physical findings, present illness, past history, consulted department, and visiting season, etc. Results: The average age of patients was 61 years old. Even though there was a difference at the diagnosis distribution between age groups, non specific dizziness and benign paroxysmal positional vertigo was the most frequent diagnosis. Checking the dizziness characters like whirling sense, autonomic symptoms and progressing features was important. And vestibular function tests such as nystagmus test and rotatory test like post head shaking or head thrust test were helpful for differential diagnosis of dizziness in emergency room. Patients with central vertigo were older (71.2 year) and had more past medical histories. But there was no seasonal frequency difference of dizziness.Conclusion: As at emergency room, the differential diagnosis of dizziness is important but difficult, integrated medical knowledge of several departments associated with dizziness is required.

Relationship Between Clinical Features and Recurrence in Benign Paroxysmal Positional Vertigo of Posterior Semicircular Canal: Ji Yun Park, Tae Kyeong Lee, Du Shin Jeong, Ki Bum Sung; Res Vestib Sci. 2011;10(2):63-67.

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Abstract PDF: Background and Objectives: The aim of this study is to evaluate the relationship between the recurrence and clinical features of posterior canal benign paroxysmal positional vertigo (p-BPPV). Materials and Methods: Eighty one consecutive patients with p-BPPV in 1 year period were selected and traced for 2 years by telephone interview and chart review. We reviewed the clinical chart to confirm the lesional side of semicircular canals when 13 patients of the recurrent groups had readmitted. We compared clinical characters between the recurrent group and the nonrecurrent group. Results: The recurrence rate after the successful treatment in the p-BPPV is 28% (23/81) patients. There was no difference in the age, sex, and days prior to visit between the recurrent group and the nonrecurrent group (72%, 58/81). The interval to recurrences were ranged from 8 days to 24 months. In the patients we could confirm the side of recurrences (13/23), there was a tendency of recurring on the same side in the early recurrences (within 14 days) (4/13). Conclusion: In considering the causes, the fact that early recurrences tend to be on the same side may be related to unilateral otolith dysfunction as the cause of recurrences in p-BPPV. But the late recurrence may be related to systemic condition because recurrent BPPV developed equally on both sides.

Clinical Comparison Between Ocular and Cervical Vestibular Evoked Myogenic Potentials: Il Kwon Cho, Myung Whan Suh, Tae Hyun Moon, Chung Ku Rhee, Jae Yun Jung; Res Vestib Sci. 2011;10(2):68-73.

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Abstract PDF: Background and Objectives: The goal of this study was to compare the outcome between cervical vestibular-evoked myogenic potential (cVEMP) and ocular VEMP (oVEMP) in the patients with definite vestibular dysfunction. Also, the subjective discomfort level was compared between cVEMP, classic oVEMP and head positioned oVEMP (a new method designed by the authors). Materials and Methods: Eighteen patients with dizziness associated with unilateral vestibular hypofunction were included in this study. Vestibular neuritis, Ramsay-hunt syndrome and sudden sensorineural hearing loss with vertigo were included in unilateral vestibular hypofunction disease. cVEMP, classic oVEMP, and head positioned oVEMP were assessed and compared. To compare the subjective discomfort during the tests, visual analogue scale on discomfort was checked. Results: There was a discrepancy between the cVEMP and classic oVEMP in 31.3% of the cases. The classic oVEMP were associated with more discomfort than the cVEMP. But, there was no difference between the classic and head positioned oVEMP. Conclusion: Since a substantial discrepancy was identified between the cVEMP and oVEMP, the pathways involved in cVEMP and oVEMP are likely different even with the same air conduction tone stimuli. The head positioned oVEMP may be an alternative to the classic oVEMP which has similar results and subjective discomfort levels.

Case Reports

Sudden Deafness Concurrent with Ipsilateral Benign Paroxysmal Positional Vertigo: Youn Ho Kim, Dong Kuck Lee, Jung Im Seok; Res Vestib Sci. 2011;10(2):74-76.

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Abstract PDF: Benign paroxysmal positional vertigo (BPPV) is a disorder caused by otoconia in the inner ear. Its symptoms are repeated episodes of positional vertigo, that is, of a spinning sensation caused by changes in the position of the head. BPPV with simultaneous ipsilateral sudden deafness is rare. A 82-year-old woman was admitted due to acute onset of right ear hearing impairment, tinnitus, and vertigo for a day. She had a history of hypertension for 5 years. On neurologic examination, spontaneous nystagmus was not observed. However, roll test showed direction-changing horizontal geotrophic nystagmus. Vestibular function test showed positional nystagmus compactable with right horizontal semicircular canal-BPPV (canalolithiasis). Brain MRI was unremarkable. Neuro-otologic evaluation reveals right ear sensorineural deafness. Barbecue maneuver was applied for treatment for BPPV. Dexamethasone 10 mg intravenous for 5 days after then methylprednisolone orally for 5 days was done. Vertigo improved after treatment, but deafness still remain. We report a case of sudden deafness concurrent with ipsilateral BPPV and consider the mechanisms of this lesion.

Two Cases of Central Origin Vertigo Mimicking Acute Vestibular Neuritis: Hung Soo Kang, Seong Ki Ahn, Dong Gu Hur, Seong Yong Ahn; Res Vestib Sci. 2011;10(2):77-81.

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Abstract PDF: 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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