Research in Vestibular Science

Management of Benign Paroxysmal Positional Vertigo: Chan Il Song, Hong Ju Park; Res Vestib Sci. 2013;12(4):111-120.

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Abstract: Benign paroxysmal positional vertigo (BPPV) is characterized by brief recurrent episodes of vertigo triggered by head positional changes. BPPV is one of the most common causes of recurrent vertigo. BPPV results from abnormal stimulation of the cupula within any of the three semicircular canals by free-floating otoliths (canalithiasis) or otoliths adhered to the cupula (cupulolithiasis). Spontaneous recovery occurs frequently even with conservative treatment. However, canalith repositioning maneuvers are believed to be the best way to treat BPPV by moving the canaliths from the semicircular canal to the vestibule. Various treatment methods of posterior, superior, and lateral canal BPPV are discussed in this review.

Predictive Value of Rectified Vestibular Evoked Myogenic Potential in Determining Lesion Side in Unilateral Vestibulopathy Patients: Hye Ran Son, Bong Jik Kim, Chung Ku Rhee, Jae Yun Jung; Res Vestib Sci. 2013;12(4):121-126.

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Abstract: Background and Objectives: Rectified vestibular evoked myogenic potential (rVEMP) is a relatively new method that simultaneously measures the muscle contraction power during VEMP recording and corrects the difference of contraction power afterwards. Several studies showed rVEMP is more reliable than non-rectified VEMP (nVEMP). However, those studies evaluated usefulness of rVEMP in patients with normal vestibular function. Thus, we evaluate the effect of rectification to predict lesion side in unilateral vestibulopathy patients. Materials and Methods: One-hundred nine acute unilateral vestibulopathy patients whom VEMP were performed in were included retrospectively. We regarded hearing loss side as lesion side in sudden hearing loss (n=33), meniere’s disease (n=29) and in vestibular neuritis (n=45), the side of positive head thrust test with canal paresis >30% was regarded as a lesion side. We excluded bilateral vestibulopathy. The inter-aural amplitude difference (IAD) ratio was calculated by the nVEMP and rVEMP. Results: Mismatch rate between nVEMP and rVEMP was 36.61%, match rate was 49.54%, opposition rate was 13.76%. rVEMP predicted lesion side on 15 patients of mismatch group correctly, while nVEMP predicted lesion side on 25 patients of mismatch group. There was no significant difference in IAD ratio between nVEMP and rVEMP in patients who showed lesion side weakness on both nVEMP and rVEMP. But, the younger the patient was, the more chance of mismatch was significantly (p=0.03). Conclusion: There was no more corrective role in determining lesion side by rectification in unilateral vestibulopathy. Thus rVEMP might not be helpful for predicting lesion side in unilateral vestibulopathy.

A Case of Ramsay-Hunt Syndrome with Multiple Cranial Nerve Palsies Preceded by Diffuse Inflammatory Exudates in the Fluid Attenuated Inversion Recovery Image: Sook Young Roh, Hyun Soon Jang; Res Vestib Sci. 2013;12(4):127-131.

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Abstract: Ramsay-Hunt syndrome (RHS) is a well known disease caused by varicella-zoster virus infection in the geniculate ganglion of the facial nerve. Although the otic vesicle and facial palsy are easily recognized clinical signs of RHS, cases of associated multiple cranial nerve palsies present a difficult diagnostic challenge and furthermore, the mechanisms is unclear. We report a case of an 86-year-old man with otic crusted vesicles and peripheral typed facial palsy preceded by severe headache and fever. Several days later, he developed diplopia, dysphagia, hiccup and abdominal myoclonus. On fluid attenuated inversion recovery image of brain, diffuse subdural inflammatory exudates, which disappeared after treatment of acyclovir and corticosteroid, and ipsilateral facial nerve enhancement were observed in follow-up imaging.

Superior Semicircular Canal Dehiscence Syndrome Presenting with Sudden Deafness and Vertigo after Trauma: Seong Il Kang, Sunjoo Lee, Ji Soo Kim, Ja Won Koo; Res Vestib Sci. 2013;12(4):132-135.

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Abstract: Superior semicircular canal dehiscence syndrome (SCDS) is characterized by cochleovestibular hyper-responsiveness symptoms including sound- and pressure- evoked vertigo and oscillopsia, autophony, hyperacusis and ear fullness. The typical audiometric feature of SCDS is known as conductive hearing loss at low frequency. A 43-year-old man presented with unilateral sudden deafness after several events of heading during soccer game. High-resolution temporal bone computed tomography revealed a dehiscence of superior canal encased by superior petrous sinus. We reviewed audio-vestibular findings in this patient and speculated potential pathogenic mechanisms of sudden deafness in SCDS with literature review.

A Case of Posterior Inferior Cerebellar Artery Infarction Presenting with Sudden Hearing Loss and Vertigo: Sang Hyo Lee, Go Woon Kim, Bum Ki Cho, Chang Woo Kim; Res Vestib Sci. 2013;12(4):136-139.

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Abstract: Sudden hearing loss and vertigo are the typical presentation of anterior inferior cerebellar artery infarction, but may rarely occur in posterior inferior cerebellar artery (PICA) infarction. Here we describe a 65-year-old man who presented with sudden hearing loss in his left ear and severe vertigo. The diffusion-weighted magnetic resonance imaging revealed acute infarction in the territory of PICA and cerebral angiography showed non-visualization of left vertebral artery. Sudden hearing loss and vertigo may be a presentation of PICA infarction.

Tullio Phenomenon Following Spontaneous Intralabyrinthine Gross Hemorrhage: Jae Won Choi, Jong Jun Kim, Young Hyo Kim, Hyun Woo Lim; Res Vestib Sci. 2013;12(4):140-144.

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Abstract: Tullio phenomenon is a pattern of sound induced unsteadiness, imbalance or vertigo, associated with disturbances of oculomotor and postural control. As a possible cause of sudden sensorineural hearing loss, intralabyrinthine gross hemorrhage has been reported in subjects with bleeding tendency. We report a case of spontaneous intralabyrinthine hemorrhage followed by presentation of Tullio phenomenon. A 35-year-old man presented with sudden left side hearing loss and vertigo. Audiometry results indicated left total deafness and magnetic resonance images revealed left intralabyrinthine hemorrhage. At 1 month after hearing loss, sound and pressure-induced vertigo and disequilibrium newly developed. Follow-up images indicated signs of fibrosis in the left labyrinth and nystagmography results showed induction of nystagmus according to the stapedial reflex. This case suggests possibility of Tullio phenomenon in sudden sensorineural hearing loss patients.

Cavernous Sinus Syndrome Complicating Occlusion of the Internal Carotid Artery by Necrotizing Sinusitis: Yun Ju Choi, Jae Myung Kim, Seung Han Lee, Myeong Kyu Kim; Res Vestib Sci. 2013;12(4):145-148.

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Abstract: Cavernous sinus syndrome is characterized by multiple cranial nerve palsies manifesting with ophthalmoplegia, ptosis, facial sensory loss due to involvement of adjacent cranial nerves. Tumor, trauma, and non-infectious inflammatory disorders are principal causes of cavernous sinus syndrome. Rhinocerebral mucormycosis is one of the fatal causes of cavernous sinus syndrome usually in immunocompromised patients. Here is a case of cavernous sinus syndrome complicating occlusion of the internal carotid artery by necrotizing fungal sinusitis, which is highly suspicious of rhinocerebral mucormycosis with non-immunocompromised state.

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