Research in Vestibular Science

Volume 19 (4); December 2020

Review

Benign Paroxysmal Positional Vertigo: Diagnostic Criteria and Updated Practice Guideline in Diagnosis: Dae Bo Shim; Res Vestib Sci. 2020;19(4):111-119. Published online December 15, 2020; DOI: https://doi.org/10.21790/rvs.2020.19.4.111

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Abstract PDF: Benign paroxysmal positional vertigo (BPPV) is the most common cause of recurrent vertigo that is characterized by sudden onset of vertigo elicited by positional change. American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) and American Academy of Neurology provided clinical practice guideline for BPPV in 2008. Since then, Bárány Society has published BPPV diagnostic criteria in 2015, and AAO-HNS has revised BPPV clinical practice guideline in 2017 to publish update version. This article reviewed recent diagnostic criteria for BPPV included in the International Classification of Vestibular Disorders of Bárány Society and updated practice guideline in the BPPV diagnosis presented by AAO-HNS.

Original Articles

The Feasibility and Utility of a Mobile-Based Eye Movement Recording Application: A Randomized Trial: Hee Jin Chang, Sooyoung Kim, In-Sun Kwon, Han Young Yu, Seong-Hae Jeong; Res Vestib Sci. 2020;19(4):120-126. Published online December 15, 2020; DOI: https://doi.org/10.21790/rvs.2020.19.4.120

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Abstract PDF Supplementary Material: Objectives
This study was performed to assess the efficacy and feasibility of mobile application-based Frenzel tests in dizziness clinics.
Methods
We performed an investigator-initiated, blinded-outcome assessor, parallel, randomized controlled crossover trial at Chungnam National University Hospital between August 2019 and October 2019. Certified medical staffs were randomly assigned to the intervention group (i.e., a mobile application-based Frenzel glass system, n=15) or the observation group (i.e., a conventional desktop-based Frenzel glass system, n=15); the groups applied the respective systems for the preparation of eye movement recording and switched systems. The primary outcome was the elapsed time in seconds it took the participants to prepare the system for eye recording simulation. The secondary outcomes were perceived stress and satisfaction scores after completion of the operation, as measured by a questionnaire using 10-point Likert scales.
Results
The mean time of machine preparation for eye recording simulation was reduced by 50% in the mobile application group compared to the desktop group in both study periods (38.0±7.1 sec vs. 76.0±8.7 sec). We detected no carryover effect. Participants also reported lower stress while using application than while using the desktop system (2.3±1.3 vs. 4.6±2.4; p＜0.001). The application obtained a mean overall satisfaction score of 9.2 out of 10.
Conclusions
The implementation of an eye movement recording application in a dizziness examination was well adopted by users and decreased the time and stress related to machine operation.

Satisfaction and Effect Research on Virtual Reality-Based Vestibular Exercise for the Elderly Patients with Chronic Unilateral Vestibulopathy: Kwang-Dong Choi, Seo-Young Choi; Res Vestib Sci. 2020;19(4):127-132. Published online December 15, 2020; DOI: https://doi.org/10.21790/rvs.2020.19.4.127

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Abstract PDF: Objectives
To survey the satisfaction of customized vestibular exercise using virtual reality system with mobile head-mounted display (HMD) in the elderly patients with chronic unilateral vestibulopathy, we analyzed questionnaires before and after exercise.
Methods
Sixteen patients (male, 6; median age, 69 years [interquartile range, 65–75 years]) with chronic unilateral vestibulopathy were prospectively enrolled from March 1 to December 31 in 2018. They exercised once a week for 20 to 25 minutes for 4 weeks using the HMD inserted the virtual reality exercise program. Dizziness visual analogue scale (DAS), Korean vestibular disorders activities of daily living scale (ADL), and visual vertigo analogue scale (VVAS) were performed before and after the exercise. After all of the program, the patients were surveyed to measure the satisfaction for the tool and effect of exercise.
Results
DAS, ADL, and VVAS were significantly improved after the vestibular exercise. No one answered unsatisfactory, and at least 62.5% of the patients satisfied the used tool and exercise program. The patients of 50% answered that they satisfied or very satisfied to the efficacy of exercise program. The patients who recovered VVAS more after the exercise were more satisfied to our tools and efficacy of exercise program.
Conclusions
Customized vestibular exercise using virtual reality system with HMD can not only improve dizziness and quality of life, but also made more satisfied to the elderly patients with chronic unilateral vestibulopathy.

Case Reports

Developmental Venous Anomalies of the Brainstem Associated with Spontaneous Vertigo: A Case Report: Min Pyo Hong, Young Kyun Hur, Yeon Su Jeong, Gi-Sung Nam; Res Vestib Sci. 2020;19(4):133-137. Published online December 15, 2020; DOI: https://doi.org/10.21790/rvs.2020.19.4.133

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Abstract PDF: Developmental venous anomalies (DVAs), previously known as central nervous system venous angioma, are the commonly encountered benign vascular malformations. Unlike cerebellar DVAs, isolated brainstem DVAs is a rare condition, and there have been limited case reports of symptomatic and uncomplicated DVAs of the brainstem described in the literature. We present the exceptional case of spontaneous vertigo accompanied by moderate temporal headache associated with pontine DVAs. To the best of our knowledge, this is one of the first documented cases of DVAs as a possible cause of spontaneous recurrent vertigo.

Neurotological Findings in a Patient with Glufosinate Ammonium Intoxication: Ji Young Kim, Joo Yeon Ham, Seong-Hae Jeong; Res Vestib Sci. 2020;19(4):138-140. Published online December 15, 2020; DOI: https://doi.org/10.21790/rvs.2020.19.4.138

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Abstract PDF Supplementary Material: The upward deviation could be explained by loss of inhibitory inputs from the cerebellum onto the brainstem anterior semicircular canal projections for upward vestibulo-ocular reflex, which would lead to an upward bias in static eye position. Therefore, upward gaze deviation has been reported in comatose patients after resuscitation and diffuse cerebrocerebellar damage sparing the brainstem. Herein, we report a patient with ingestion of glufosinate ammonium presented with cerebellar ataxia and ocular motor findings suggestive of cerebellum involvement such as upward gaze tendency, spontaneous downbeat, gaze-evoked nystagmus, perverted head impulse test, and impaired smooth pursuit.

Anti-GQ1b Antibody Syndrome Presenting with Severe Headache: Seo-Young Choi, Kyeung-Hae Kim, Jong Kuk Kim, Nam Jun Kim, Young Hee Kim, Kwang-Dong Choi; Res Vestib Sci. 2020;19(4):141-143. Published online December 15, 2020; DOI: https://doi.org/10.21790/rvs.2020.19.4.141

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Abstract PDF: Anti-GQ1b antibody syndrome, including Miller Fisher syndrome, Guillain-Barré syndrome with ophthalmoplegia, Bickerstaff’s brainstem encephalitis, and acute ophthalmoplegia without ataxia, has overlapped clinical symptoms and mostly associated with anti-GQ1b immunoglobulin (Ig) G antibody. We report two cases of anti-GQ1b antibody syndrome mainly presenting with a severe headache. The 60-year-old man was admitted for severe headache and gait disturbance. Neurological examination revealed limb and truncal ataxia, areflexia, nystagmus, and ophthalmoplegia. Serum IgG anti-GQ1b antibody was positive. He recovered after intravenous (IV) immunoglobulin and steroid. The 23-year-old man suffered from severe headache (visual analogue scale=10) within the periorbital area. Ophthalmoplegia with gaze-evoked nystagmus were revealed. Serum IgG anti-GQ1b and anti-GT1a antibodies were positive. Headache was improved by IV immunoglobulin and steroid. The pathophysiology of headache in anti-GQ1b antibody syndrome is largely unknown. The affected nerve or structures in the brainstem including the trigeminovascular system may induce intractable severe headache.

Unilateral Vestibular Neuritis after Snakebite: Is There a Causal Relationship?: Jae-Myung Kim, Hyeon-Joong Park, Shina Kim, Seung-Han Lee; Res Vestib Sci. 2020;19(4):144-148. Published online December 15, 2020; DOI: https://doi.org/10.21790/rvs.2020.19.4.144

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Abstract PDF: Vast majority of triggering factors preceding vestibular neuritis (VN) are unknown, although many cases are associated with viral infection. A 55-year-old woman was bitten by a viper on her right hand, and she was treated with antivenom at the primary clinic. Three days later, acute persistent vertigo was developed. Neuro-otologic examinations revealed spontaneous left-beating nystagmus and abnormal head impulse test in the right side. Taken together with negative result of brain magnetic resonance imaging, she was diagnosed with a right VN. Various neurological complications such as paralysis, optic neuritis, and stroke can occur after snakebite envenoming. In this case, given the time interval between snakebite and development of dizziness, snakebite envenoming might be a possible predisposing factor of VN as a proinflammatory condition rather than a direct cause of VN. Furthermore, the VN of this case was probably caused by late adverse reactions after antivenom administration. Since about 10% of the snake-bitten patients have complained dizziness, detailed neuro-otologic evaluations may lead to a proper understanding of pathomechanism and a correct diagnosis.

Retraction

Retraction of “Factors Associated with Patient Satisfaction in Customized Vestibular Exercise: A Pilot Study”: Hye Soo Ryu, Min Young Lee, Jae Yun Jung, Ji Eun Choi; Res Vestib Sci. 2020;19(4):149-149. Published online December 15, 2020; DOI: https://doi.org/10.21790/rvs.2020.19.4.149; Retracts: Res Vestib Sci 2019;18(3):71

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