Research in Vestibular Science

Volume 16 (1); March 2017

Reviews

Ménièreʼs Disease and Electrophysiology: Sung Huhn Kim; Res Vestib Sci. 2017;16(1):1-9. Published online March 15, 2017; DOI: https://doi.org/10.21790/rvs.2017.16.1.1

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Abstract PDF: Inner ear is composed of cochlea, vestibule, and endolymphatic sac which are enclosed by thin layer of epithelial cells. The enclosed space is filled with fluid named as endolymph where the [K^＋] is high and [Na^＋] is low. This unique ion composition is very important in maintaining normal hearing and balance function by providing K^＋ ions into sensory hair cells, which finally depolarize hair cells to facilitate the transport of sound and acceleration stimulation to central nervous system. The ion composition of inner ear is maintained by various ion transport through ion channels, transporters, and exchangers in the inner ear sensory and extra-sensory epithelium. The disruption of normal endolymphatic ion composition by the deterioration of the function of those ion channels can cause dysfunction of sensory epithelium, which consequently results in hearing and balance disorders. One of the possible pathology from the disruption of inner ear ion homeostasis is endolymphatic hydrops which is a phenomenon of excessive fluid accumulation of inner ear. The dysfunction of ion channels in inner ear epithelium can be an etiology of Ménièreʼs disease since endolymphatic hydrops is a main pathological finding of the disease. In this review, we discussed about the possible pathological mechanism of Ménièreʼs disease as a perspective of channelopathy as well as the role of various ion channels in the regulation of inner ear fluid volume based on the findings revealed by electrophysiological studies.

Risk of Falls in Dizzy Patients: Sung Kyun Kim, Gi Jung Im; Res Vestib Sci. 2017;16(1):10-16. Published online March 15, 2017; DOI: https://doi.org/10.21790/rvs.2017.16.1.10

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1 Crossref

Dizziness is the most common symptom in elderly patients and has been identified as a risk factor for falls. They can affect objectively the ability to achieve a stable gaze, posture, and gait. Research on the relationship between vestibular hypofunction and falls in elderly people has been rarely performed and the evidence is controversial. Because falls result from various combinations of many factors, validated tools should be used for assessment of falling. Many of the tests and numerous parameters associated with the risk of falling have already been introduced, however guidance on which test is most appropriate for use in a specific setting still lack in the medical community. Therefore, developement of comprehensive fall risk management guideline and assessment tool including physical, psychosocial, environmental factors are necessary to prevent falls in the elderly. Establishment of validity and reliability for relationship among several vestibular function test are more important to evaluate efficiently risk of falls in the dizzy patients. Also we can expect that decreasing risk of fall when conduct the developement of additional customized intervention method using verified assessment tools.

Citations

Citations to this article as recorded by

Exploratory fall risk and preventive intervention in acute vestibular neuritis
Euyhyun Park, Sung Kyun Kim, Jinnyeong Jang, Hye Min Han, Jae Jun Song, Sung Won Chae, Hak Hyun Jung, Gi Jung Im
Journal of International Medical Research.2021; 49(9): 030006052110442. CrossRef

Original Articles

Usefulness Assessment of Cochlear Hydrops Analysis Masking Procedure Test in Progress of Ménièreʼs Disease: Young-Joo Ko, Hyun Ji Kim, Dae-Young Kim, Tae-Suk Kyung, Kyu-Sung Kim; Res Vestib Sci. 2017;16(1):17-22. Published online March 15, 2017; DOI: https://doi.org/10.21790/rvs.2017.16.1.17

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Abstract PDF: Objective: There were few recent study concern about usefulness of cochlear hydrops analysis masking procedure (CHAMP) in progression of Ménièreʼs disease. The purpose of this study is to analyze changes in the CHAMP as advancement of Ménièreʼs disease.
Methods
We studied 19 cases of ‘Definite’ group of Ménièreʼs disease. We assumed progression of Ménièreʼs disease would be checked by pure tone threshold by four tone average (4PTA), low tone average (LPTA). We also compared electrocochleography (ECoG), dizziness handicap inventory (DHI), tinnitus handicap inventory (THI) as parameters for progression of Ménièreʼs disease to CHAMP latency delay and amplitude ratio. Chi-square test was used as a statistical method.
Results
In the group of patients had abnormal amplitude ratio, ECoG value were not improved, but there was not statistically significant (odds ratio [OR]=5.727, p＞0.05). Better DHI and THI score were not necessarily construed as the improvement value in the CHAMP (p＞0.05). In amplitude ratio abnormal group, 4PTA was aggravated, but not statistically significant (OR=1.5, p＞0.05). In the group of patient had abnormality in both latency delay and amplitude ratio, LPTA was relatively aggravated (OR in latency delay: 2, OR in amplitude ratio: 10); however, reveals no statistically significance between them (p＞0.05). Change of ECoG, hearing threshold including 4PTA and LPTA with progression of Ménièreʼs disease were not correlated significantly with latency delay or amplitude ratio of CHAMP.
Conclusion
We conclude that CHAMP does not reflect clinical features with progression of Ménièreʼs disease.

Long-Term Results of CyberKnife Radiosurgery for Vestibular Schwannoma: Ho Joong Lee, Chae Dong Yim, Hyun Woo Park, Dong Gu Hur, Ho Jin Jeong, Seong-Ki Ahn; Res Vestib Sci. 2017;16(1):23-28. Published online March 15, 2017; DOI: https://doi.org/10.21790/rvs.2017.16.1.23

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Abstract PDF: Objective: Since the 2000s, CyberKnife radiosurgery (CKRS) is either a primary or an adjunct management approach used to treat patients with vestibular schwannoma (VS). The goals of CKRS are prevention of tumor growth, preservation of cranial nerve function and prevention of new neurologic deficiencies. The aim of this study was to assess the efficacy and safety of CKRS, in terms of tumor control, hearing preservation, and complications.
Methods
Forty patients with VS underwent CKRS as a treatment modality for from January 2010 to February 2016. The long term results of 32 patients were evaluated who received CKRS as primary treatment. 8 patients presented with previously performed surgical resection. Information related to clinical history, Brain MRI and outcomes of patients with VS collected retrospectively by reviewing patient’s chart and telephone survey.
Results
The mean tumor volume was 3.3 cm³ and the mean follow-up was 41 months. The most recent follow-up showed that tumor size decreased in 17 patients (42.5%), displayed no change in 19 patients (47.5%), and increased in 4 patients (10%). Progression-free survival rates after CKRS at 1, 3, and 5 years were 95%, 90%, and 90%. After CKRS, 13 patients experienced hearing degradation. The overall rate of preservation of serviceable hearing at the long-term follow-up was 60%. Vertigo, ataxia, and headache were improved after CKRS compared with pretreated status. But, facial weakness, trigeminal nerve neuropathy, and tinnitus were worsen.
Conclusion
CKRS provide an excellent tumor control rate and a comparable hearing preservation rate in VS patients. Also CKRS is associated with low rate of cranial neuropathy, other complications.

Case Reports

Rapidly Progressive Ophthalmoplegia and Brainstem-Cerebellar Dysfunction in Rhombencephalitis Caused by Listeria monocytogenes: Sung-Sik Kim, Jong-Hun Kim, Jin-Heui Lee, Seung-Han Lee; Res Vestib Sci. 2017;16(1):29-33. Published online March 15, 2017; DOI: https://doi.org/10.21790/rvs.2017.16.1.29

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Abstract PDF: Listeria monocytogenes (L. monocytogenes) is a rare, but important bacterial pathogen causing central nervous system infection in the elderly, pregnant women, and immunocompromised patients. A 60-year-old man with diabetes presented with headache, fever and rapidly progressive ophthalmoplegia. Based on serological and MRI studies, he was diagnosed with rhombencephalitis due to L. monocytogenes. The patient recovered without complications with urgent initiation of empirical antibiotics and the pathogen-specific antibiotic treatment. L. monocytogenes should be considered as a cause of rhombencephalitis presenting as external ophthalmoplegia.

Opsoclonus-Myoclonus Syndrome Associated with Scrub Typhus: You Jin Choi, Seo Young Choi, Jae-Hwan Choi, Kwang-Dong Choi; Res Vestib Sci. 2017;16(1):34-37. Published online March 15, 2017; DOI: https://doi.org/10.21790/rvs.2017.16.1.34

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Abstract PDF

Scrub typhus is an infective acute febrile disorder caused by the intracellular parasite Orientia tsutsugamushi. Neurological manifestations of scrub typhus are meningoencephalitis, cerebellitis, transverse myelitis, papilledema, and cranial nerve palsy. However, opsoclonus-myoclonus syndrome associated with scrub typhus has been rarely reported. A 59-year-old man developed vertigo, nausea, vomiting, and imbalance following scrub typhus infection for eight days. Examination showed eschar at the axilla, decreased mentality, and opsoclonus- myoclonus syndrome. Video-oculography disclosed opsoclonus with an amplitude of 15°–20° and a frequency of 6–8 Hz. The serum antibody titers to Orientia tsutsugamushi were 1:5,120, and cerebrospinal fluid analysis revealed pleocytosis. Brain magnetic resonance imaging was normal. Neurological symptoms and signs completely improved by systemic steroid and antibiotics treatment. Various mechanisms including direct disseminating inflammation or indirect immune modulation may give rise to neurological complications following scrub typhus.

Citations

Citations to this article as recorded by

Scrub typhus meningoencephalitis presenting as opsoclonus myoclonus syndrome: A video-based case
Laxmikant Ramkumarsingh Tomar, Dhrumil Jatinbhai Shah, Utkarsh Agarwal, Atul Gogia, Anshu Rohatgi, CS Agrawal
Tropical Doctor.2022; 52(1): 192. CrossRef
Neurological Manifestations of Scrub Typhus
Sagar Basu, Ambar Chakravarty
Current Neurology and Neuroscience Reports.2022; 22(8): 491. CrossRef
Neurological facets of scrub typhus: A comprehensive narrative review
Divyani Garg, Abi Manesh
Annals of Indian Academy of Neurology.2021; 24(6): 849. CrossRef

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