Research in Vestibular Science

Volume 15 (2); June 2016

Reviews

Review for Update on Vestibular Rehabilitation: Eun Ju Jeon; Res Vestib Sci. 2016;15(2):31-38. Published online June 15, 2016

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Abstract PDF: Vestibular rehabilitation (VR) is valuable tool to manage balance problem in various kinds of diseases. Over the last decades, numerous studies on the effect of VR have been reported. Recently, systematic analysis integrating the individual studies have been tried and the results suggest that VR is safe and effective management for the acute/chronic and unilateral/bilateral peripheral vestibular dysfunction, and also for the elderly people. VR relieves dizziness and improves gaze stability, postural stability, parameters of gait, and activities of daily living. Currently released "Clinical practice guideline of VR on peripheral vestibular dysfunction" support and assist the use of VR in clinical field. More research is needed to develop uniform evaluation tool to measure the symptomatic and functional status of the patients and individualized efficient rehabilitation programs. It is expected that device for VR incorporating new technologies such as virtual reality will be developed in near future.

Updates in Intractable Benign Paroxysmal Positioning Vertigo: Yoon Gi Choi, Young Joo Ko, Hyun Ji Kim, Kyu Sung Kim; Res Vestib Sci. 2016;15(2):39-43. Published online June 15, 2016

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Abstract PDF: Benign paroxysmal positioning vertigo (BPPV) is the most common disease that causes dizziness which is usually resolved spontaneously or by office-based physical therapy. However, clinicians sometimes encounter atypical or intractable BPPV cases which show poor effect with physical therapy including canalith reposition therapy and liberative maneuvers and frequent recurrence. There is no common definition, diagnosis and treatment protocols for intractable BPPV. Various types of intractable BPPV and reported treatment methods are discussed in this review.

Original Articles

Multicenter Randomized Study on the Efficacy of Isosorbide in Patients with Mèniére's Disease: Hyun Woo Park, Won Ho Chung, Sung Huhn Kim, Kyu Sung Kim, Jong Woo Chung, Sung Won Chae, Ja Won Koo, Bo Gyung Kim, Eui Kyung Goh, Gyu Cheol Han; Res Vestib Sci. 2016;15(2):44-50. Published online June 15, 2016

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Abstract PDF: Objective: Mèniére's disease is one of the most common causes of episodic vestibular syndrome that shows symptom complexes of recurrent vertigo, hearing loss, tinnitus and ear fullness. Isosorbide (Isobide) is a osmotic diuretics which has been used for Meniere's disease to reduce the endolymphatic pressure. The purpose of this study was to evaluate the efficacy of isosorbide in the treatment of Mèniére's disease by comparing the combined therapy of isosorbide and betahistine (Meniace) to betahistine only.
Methods
Among 220 patients enrolled with Mèniére's disease from 9 centers, 187 patients completed this clinical study. Patients were randomly subjected either to betahistine alone therapy at dose of 6 mg three times a day (n=97) or to combined therapy with isosorbide (dose of 30 mL three times a day) and betahistine (n=90) for 12 weeks. Two groups were compared at 4 and 12 weeks after treatment on frequency of vertigo, hearing level (pure tone audiometry, speech audiometry), electocochleography (ECoG), tinnitus (Tinnitus Handicap Inventory, THI) and quality of life (Korean functional level scale, Korean dizziness handicap inventory).
Results
During first 4 weeks after treatment, the frequency of vertigo was not reduced in either betahistine alone therapy group or combined therapy group. However, between 8 and 12 weeks, the frequency of vertigo was significantly reduced in either group, and in the combined group frequency of vertigo was more significantly reduced than in the betahistine alone therapy group (p=0.041). The hearing level, ECoG, tinnitus and quality of life was not significantly different between two groups.
Conclusion
Isosorbide and betahistine combined therapy were more effective for vertigo control than betahistine alone therapy. Isosorbide is an effective diuretic in vertigo control in definite Mèniére's disease.

Correlation between Rotating Chair Test and Dizziness Handicap Inventory in Patients with Acute Unilateral Vestibular Neuritis: Hyeong Joo Lee, Jin Yong Kim, Dong Gu Hur, Seong Ki Ahn; Res Vestib Sci. 2016;15(2):51-54. Published online June 15, 2016

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Abstract PDF: OBJECTIVE: Vestibular neuritis (VN) is one of the most common causes of acute spontaneous vertigo. However, such dizziness symptoms in patients with VN vary among patients, and various methods are used to evaluate subjective vestibular symptoms following attack of VN. Studies on correlation between subjective vestibular symptom changes and result of rotation chair test after vestibular rehabilitation therapy (VRT) have not been reported. Therefore, we compared change of dizziness handicap inventory (DHI) and results of rotation chair test in patients with VN between attack and 3 month later following VRT.
METHODS
Forty-seven patients were included in this study. In patients with VN, DHI and rotation chair test were performed at the time of VN attack and recovery time of 3 months after VN attack.
RESULTS
In general, the DHI score and the percentage of directional preponderance (DP) in a rotation chair test performed on patients with VN have all decreased. However, the changes in these results were not statistically significant. DP% difference and DHI score were compared to each other among patients with VN and showed no relational significance to each other (r=0.326).
CONCLUSION
The degree of improvement in a rotation chair test done on patients with VN did not reflect the severity of improvement for symptom like dizziness.

Clinical Significance of Spontaneous Nystagmus Frequency in Vestibular Neuronitis: Sang Hyun Park, Min Young Lee, Jae Yun Jung; Res Vestib Sci. 2016;15(2):55-59. Published online June 15, 2016

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Abstract PDF: OBJECTIVE: Spontaneous nystagmus is typical sign in vestibular neuronitis. However, the clinical significance of spontaneous nystagmus frequency remains unclear. The aim of this study is to analyze the spontaneous nystagmus frequency in patients with vestibular neuronitis.
METHODS
Twenty-five patients with vestibular neuronitis were included. Patients were divided good (≥20%) and poor (<20%) group according to change of spontanous nystagmus frequency. Frequency and velocity of spontaneous nystagmus were analyzed by using video-nystagmography. Caloric test and slow harmonic acceleration test were also performed.
RESULTS
There was a positive linear correlation between frequency and velocity in initial and follow test (R²=0.51, 0.43, p<0.01, p<0.01). Also, there was a strong positive linear correlation betweeng change of frequency and change of velocity (R²=0.64, p<0.01). The phase lead of slow harmonic acceleration test of good group was smaller compared with poor group, and this was statistically significant in 0.04 Hz.
CONCLUSION
We suggested that frequency of spontaneous nystagmus may be a useful clinical factor in vestibular neuronitis.

Case Report

A Case of Unilateral Internal Carotid Artery Stenosis Presenting with Chronic Isolated Dizziness: Ju Heon Lee, Seong Hae Jeong, Young Gi Lim, Joo Yeon Ham, Hye Seon Jeong, Jae Moon Kim; Res Vestib Sci. 2016;15(2):60-63. Published online June 15, 2016

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Abstract PDF: It is customary that the dizziness related to cerebral perfusion might be caused by insufficient posterior circulation. The occurrence and nature of dizziness originating from anterior circulation has not been well-known. Here, we report a chronic dizzy woman presenting with severe internal carotid artery stenosis, which improved after carotid artery stenting.

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