Research in Vestibular Science

Recent Research Trend for Ménièreʼs Disease: Sung-Il Nam; Res Vestib Sci. 2017;16(2):39-46. Published online June 15, 2017; DOI: https://doi.org/10.21790/rvs.2017.16.2.39

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Abstract PDF: Ménièreʼs disease is a poorly understood disorder of the inner ear characterized by intermittent episodic vertigo, fluctuating hearing loss, ear fullness and tinnitus. In this paper, we present a review of the histopathology, cytochemistry, gene, blood-labyrinthine barrier and imaging of Ménièreʼs disease. Histopathology is significant for neuroepithelial damage with hair cell loss, basement membrane thickening, perivascular damage and microvascular damage. Cytochemical alterations are significant for altered AQP4 and AQP6 expression in the supporting cell, and altered cochlin and mitochondrial protein expression. Since the discovery of aquaporin water channels (AQP1, AQP2, AQP3, AQP4, AQP5, AQP6, AQP7 and AQP9), it has become clear that these channels play a crucial role in inner ear fluid homeostasis. Several gene studies related to Ménièreʼs disease have been published, but there is no clear evidence that Ménièreʼs disease is associated with a special gene. Currently, imaging techniques to determine the extent and presence of endolymphatic hydrops are being studied, and further studies are needed to correlate the visualization of the endolymphatic hydrops with clinical symptoms.

Update of Treatment for Horizontal Canal Benign Paroxysmal Positional Vertigo: Evidence-Based Approach: Dae Bo Shim; Res Vestib Sci. 2017;16(2):47-52. Published online June 15, 2017; DOI: https://doi.org/10.21790/rvs.2017.16.2.47

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Abstract PDF: Horizontal canal benign paroxysmal positional vertigo (HC-BPPV) can be classified as either the geotropic or apogeotropic subtype by the pattern of nystagmus triggered by supine head roll test. Most studies have reported the geotropic subtype as a more common pathophysiology in HC-BPPV than the apogeotropic subtype. According to the BPPV clinical practice guideline provided by the American Academy of Otolaryngology-Head and Neck Surgery and American Academy of Neurology in 2008, variations of the roll maneuver (Lempert maneuver of barbecue roll maneuver) are the most widely published treatments for HC-BPPV. In addition, various treatment techniques including Gufoni maneuver, Vannuchi-Asprella liberatory maneuver and forced prolonged positioning have been applied for HC-BPPV. However, the guideline failed to provide specific treatment guidelines for HC-BPPV based on evidence-based researches since only Class IV data on HC-BPPV treatment were available at the point of 2008 when the BPPV clinical practice guideline was published. This review article focused on the evidences of the efficacy of various maneuvers in the treatment of HC-BPPV published after the BPPV clinical practice guidelines of 2008.

Cervical Vestibular Evoked Myogenic Potential as a Prognostic Indicator of Benign Paroxysmal Positional Vertigo Recurrence: Min Su Kang, Hyun Ju Han, Min Young Lee, Jae Yung Jung; Res Vestib Sci. 2017;16(2):53-56. Published online June 15, 2017; DOI: https://doi.org/10.21790/rvs.2017.16.2.53

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Abstract PDF: Objectives
Recently there was hypothesis that relates the otolith dysfunction to the recurrence of benign paroxysmal positional vertigo (BPPV). Therefore in the present study, we assessed relationship between cervical vestibular evoked myogenic potential (cVEMP) and BPPV recurrence and raise the possibility of cVEMP as a recurrence indicator of BPPV. Methods: A retrospective review of patient from November 2009 to June 2014 was carried out. Ninety-four patients who suffered from BPPV were enrolled. Medical record review and telephone survey was done to check BPPV recurrence. Results: In medical record review, normal cVEMP group showed 18.9% recurrence rate and abnormal cVEMP group showed 25%. In telephone survey, normal cVEMP group showed 39.19% recurrence rate and abnormal cVEMP group showed 60%. There was no significant statistical difference. Conclusions: cVEMP abnormality was not a risk factor of BPPV recurrence. Further study with larger number of enrolled subjects is necessary.

Four Cases of Wernicke’s Encephalopathy with Impaired Horizontal Vestibular Ocular Reflexes: Hyuk-Su Jang, Byoung-Soo Shin, Man-Wook Seo, Sun-Young Oh; Res Vestib Sci. 2017;16(2):57-63. Published online June 15, 2017; DOI: https://doi.org/10.21790/rvs.2017.16.2.57

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Abstract PDF: Wernicke’s encephalopathy (WE) is a neurological disorder induced by a dietary vitamin B1 (thiamine) deficiency which is characterized by encephalopathy, gait ataxia, and variant ocular motor dysfunction. In addition to these classical signs of WE, a loss of the horizontal vestibulo-ocular reflex (VOR) is being reported as the major underdiagnosed symptoms in WE. In this retrospective single center study, we report four cases of WE initially presented with impaired horizontal VOR in addition to the classical clinical presentations, and imaging and neurotological laboratory findings were described.

Extremely Long Latency Benign Paroxysmal Positional Vertigo: Emil Riis Abrahamsen, Dan Dupont Hougaard; Res Vestib Sci. 2017;16(2):64-68. Published online June 15, 2017; DOI: https://doi.org/10.21790/rvs.2017.16.2.64

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Abstract PDF

Case history of a 67-year-old man diagnosed with posterior benign paroxysmal positional vertigo (BPPV) with extremely long latencies after holding the Dix-Hallpike position for five minutes. Additional vestibular assessment indicated partial unilateral hypofunction. The patient had a history compatible with classic BPPV. This patient, however, did not have any positional nystagmus after doing standard positional testing. With extremely prolonged Dix-Hallpike testing (five minutes), the patient experienced nausea and vertigo. Concomitantly classic peripheral nystagmus was observed. After a total of seventeen treatments in a reposition chair a total relief of symptoms was obtained. The extremely long latencies observed in this patient were ascribed to otoconial adherence and/or otoconial size. This type of BPPV has not previously been described.

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Upbeat and Direction-Changing Torsional Nystagmus While Straight Head Hanging: A New Sign of Benign Paroxysmal Positional Vertigo Involving Bilateral Posterior Semicircular Canals
Hyun-Jae Kim, Sang Jin Park, Ji-Soo Kim
Journal of Clinical Neurology.2024; 20(1): 100. CrossRef

Bacterial Meningitis Initially Presenting as Labyrinthitis: Bon Min Koo, Sung Il Nam, Soon Hyung Park; Res Vestib Sci. 2017;16(2):69-72. Published online June 15, 2017; DOI: https://doi.org/10.21790/rvs.2017.16.2.69

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Abstract PDF: Labyrinthitis causes damage to inner ear structure, and in turn hearing loss and vertigo. Labyrinthitis is classified as otogenic labyrinthitis and meningogenic labyrinthitis. Otogenic labyrinthitis can be diagnosed early through otoscopic examination. However, when there are no characteristic neurologic symptoms in patients with meningogenic labyrinthitis, clinicians can overlook the underlying meningitis and this may lead to the peripheral vertigo. We encountered an unusual case of meningogenic labyrinthitis that is misdiagnosed as peripheral dizziness.

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