Research in Vestibular Science

Volume 11 (1); March 2011

Review

Clinical Manifestations and Neuro-otological Findings of Migrainous Vertigo: Hyun Jung Jung, Seung Han Lee; Res Vestib Sci. 2012;11(1):1-7.

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Abstract PDF: Background and Objectives: Migrainous vertigo (MV) is one of the recurrent vestibular syndromes and may present episodic vestibular and concurrent migraine symptoms. The clinical manifestations and neuro-otological findings of MV have been delineated over the last couple of decades, however, there are still lots of uncertainties. Materials and Methods: We performed a comprehensive literature search regarding the clinical manifestations and neuro-otological findings of MV compatible with the diagnostic criteria proposed by Neuhuaser. We found the published articles that addressed the clinical and neuro-otological findings and we performed a pooled analysis. Results: Even though the duration of MV attack was variable from seconds to days, the most common durations investigated in this study was minutes (range, 5-60 minutes). During MV attack, most patients had a migraine headache, but instead the other migraine symptoms (i.e., photophobia, phonophobia) could be found. There were positional nystagmus which may not meet a stimulated canal plane and spontaneous nystagmus and, less commonly, gaze-evoked nystagmus. Regarding bithermal caloric test, unilateral canal paresis could be found in 15-20% of MV patients as well as hyperexcitability in some patients. Oculomotor tests might show impaired pursuits (mainly saccadic pursuit) and saccadic abnormalities such as delayed latency and hypometric saccade. Conclusion: From the result of the pooled analysis, we have found several clinical and neuro-otological findings. However, vital neuro-otological findings which can provide a clue for the diagnosis of MV are still lacking. So the diagnosis of MV should depend on the clinical manifestations and a process of differential diagnosis.

Original Articles

Can Nitroglycerin Differentiate Benign Recurrent Vertigo From Vestibular Migraine? A Preliminary Study: Jong Wook Shin, Seong Hae Jeong, Ji Eun Oh, Ae Young Lee, Jae Moon Kim, Ji Soo Kim; Res Vestib Sci. 2012;11(1):8-13.

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Abstract PDF: Background and Objectives: Nitroglycerin (NTG), a donor of nitric oxide, is known to provoke migraine attacks in patients with migraine. However, this effect was not explored in patients with benign recurrent vertigo (BRV). To infer the mechanism of BRV, we evaluated provocative effects of NTG in patients with vestibular migraine (VM) and BRV compared with normal controls. Materials and Methods: Thirteen patients with recurrent vertigo, 8 with VM and 5 with BRV, and 5 healthy controls received intravenous infusion of 0.5 μg/kg/min NTG over 20 minutes. Headache intensity (visual analog scale) and associated symptoms were recorded at baseline and every 10 minutes for an hour. And the subjects were also asked to complete a headache diary every hour for another 12 hours. Results: In contrast to normal controls (2/5, 40%, p=0.035) and the patients with BRV (1/5, 20%, p=0.007), all patients with VM (8/8, 100%) had migraine attacks after NTG injection. However, there was no difference in the proportion of the patients with migraine attacks after NTG injection between normal controls and the patients with BRV. Conclusion: In contrast to the patients with VM, patients with BRV are not sensitive to nitric oxide. These results suggest that the pathophysiology of BRV may be different from that of VM.

Quantification of Vestibulospinal Reflex Under the Stress Condition on Both Soleus Muscles: Mi Joo Kim, Seo Jin Jang, Eun Ji Lee, Ah Ram Yu, Jong Hyun Hwang, Gyu Cheol Han, Ju Kang Lee; Res Vestib Sci. 2012;11(1):14-22.

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Abstract PDF: 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.

The Relations of Otholith Function Tests and Risk Factors of Benign Paroxysmal Positional Vertigo: Jae Hoon Joung, Ji Yun Park, Hyeon Mi Park, Tae Kyeong Lee, Ki Bum Sung; Res Vestib Sci. 2012;11(1):23-28.

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Abstract PDF: Background and Objectives: Since the liberated otoconia from the degenerated utricle has been postulated as the cause of the benign paroxysmal positional vertigo (BPPV), the relationship of the utricular function and the generation of BPPV have been studied. In addition, abnormal bone metabolism and vascular risk factors resulting insufficient circulation to utricle has been reported to be related to the utricular degeneration in BPPV. We investigated the relationship between the vascular risk factors, bone mineral density (BMD) and recurrence for the BPPV and otholith function tests of BPPV. Materials and Methods: Consecutive patients 84 with BPPV were recruited in a dizziness clinic. Caloric test, ocular vestibular evoked myogenic potentials (oVEMPs) were tested in all the patients in acute phase of BPPV. At the same time, vascular risk factors and BMD were performed. Vascular risk factors were history of hypertension, diabetes mellitus, hyperlipidemia and ischemic heart disease. All the data were analyzed for the relationship between abnormal results of vestibular function tests and the risk factors. Results: Patients 58 (69%) showed abnormal cervical VEMPs that were related to decreased bone density, having more than one vascular risk factor, and older age (>55 years). Abnormal oVEMPs were showed in 53 patients (63%) that were related to older age and vascular risk factors, but not statistically related to bone mineral density. Caloric tests failed to show any statistically significant results. Conclusion: We found abnormal results of cVEMPs and oVEMPs is related to the BMD, vascular risk factors and age. VEMPs could be used for the demonstration of presumptive otolith degeneration in BPPV.

Reliability of Air Caloric Response in Healthy Volunteers and Patients With Chronic Otitis Media: Sung Kwang Hong, Ji Soo Kim, Jin Woong Choi, Ja Won Koo; Res Vestib Sci. 2012;11(1):29-36.

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Abstract PDF: Background and Objectives: To investigate reliability of the air caloric test compared to the water caloric test and to determine whether anatomical alterations due to chronic otitis media (COM) influence air caloric response. Materials and Methods: Fifty-six subjects without vestibulopathy (24 healthy individuals as control group and 32 patients with unilateral COM as experimental group) were included. The bithermal water and air caloric test were sequentially conducted in control group. The bithermal air caloric tests, high-resolution temporal bone computed tomography and endoscopic photography of the ear drum were obtained from experimental group. Results: Although maximal slow phase velocities and time to reach peak velocity using water irrigation were significantly higher and shorter, respectively, than those by air irrigation in normal subjects, caloric parameters on air caloric test agreed well with those of water caloric testing. However, inverted nystagmus occurred in 16 ears of 16 subjects, which was predominantly presented during warm air stimulation in the com patient group. The large tympanic membrane perforation and asymmetrical mastoid pneumatization were significant parameters affecting caloric response. The presented prediction model for cold-induced mspvs corresponded with observed values according to mastoid pneumatization. Conclusion: Although the air caloric stimuli resulted in a reliable response in healthy subjects, air caloric results among com patients affected by anatomical alteration as well as irrigation temperature. Presented mathematical model for cold induced mspv could serve as a good reference in measuring true vestibular function in com patients.

Vestibular Function Test of Dizziness Patients by Vestibular Evoked Myogenic Potential: You Jae Lee, Chan Goo Lee, Sang Hyuck Cho, Young Joo Park, Hyo Jin Kim, Koen Hyeong Lee, Byung Don Lee; Res Vestib Sci. 2012;11(1):37-43.

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Abstract PDF: Background and Objectives: Because the saccule, next to the cochlea, is the second most frequent site of hydrops formation, we evaluated whether vestibular evoked myogenic potential (VEMP) responses can reflect the diagnosis and the stage of Meniere’s disease. And we studied about other vestibular disease such as vestibular neuritis and benign paroxysmal positional vertigo. Materials and Methods: Retrospectively, we analyzed the results of VEMP in 22 patients (12 men and 10 women) with unilateral definite Meniere’s disease, 21 patients (5 men and 16 women) with vestibular neuritis, and 23 patient (4 men and 19 women) with benign paroxysmal positional vertigo (BPPV). All subjects underwent VEMP testing using ipsilateral 1 KHz-tone burst sound with 105 dB nHL. Results: VEMP was present in 86% of Meniere affected ear. The latency of p13 of affected ears in patients with Meniere’s disease, vestibular neuritis (VN), BPPV was not significantly prolonged than that of normal ears in the control group except left n23 latency in meniere’s disease. In the patients with Meniere’s disease, the amplitude-ratio was larger than that of the control group, statistically (p=0.006). And relationship was found in amplitude ratio among groups classified by the stage of Meniere’s disease. Conclusion: This study shows that amplitude ratio of VEMP response is useful method to determine the severity and prognosis of Meniere’s disease. We recommend VEMP to explain to the patient about severity of Meniere’s disease quantitatively.

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