Research in Vestibular Science

Physiology and Recording Methods of Eye Movement: Yun-Hoon Choung, DDS; J Korean Bal Soc. 2004;3(2):245-253.

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Spontaneous Eye Movements: Nystagmus and Saccadic Oscillations: Ji Soo Kim, M.D.; J Korean Bal Soc. 2004;3(2):254-265.

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Evoked Nystagmus: Kyu Sung Kim, M.D.; J Korean Bal Soc. 2004;3(2):266-272.

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Saccadic Eye Movement: Kim Jae-Il, M.D., Ph; J Korean Bal Soc. 2004;3(2):275-280.

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Smooth Pursuit and Optokinetic System: Hyung Lee, M.D.; J Korean Bal Soc. 2004;3(2):281-288.

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Vestibulo-Ocular Reflex Test: Caloric and Rotatory Test: Heung-Youp Lee, M.D.; J Korean Bal Soc. 2004;3(2):289-304.

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The Study of Standardization for a Korean Adaptation of Self-report Measures of Dizziness: Gyu Cheol Han, M.D.1; J Korean Bal Soc. 2004;3(2):307-325.

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Recurrent Dizziness and Headache: Ja-Won Koo, M.D.; J Korean Bal Soc. 2004;3(2):329-337.

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Anticonvulsants Responded: In Soo Moon, M.D.1,2; J Korean Bal Soc. 2004;3(2):341-348.

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Abstract PDF: Episodic brief spinning sensation is presented occasionally by patients who visit dizziness clinic and described as an one of the most common clinical manifestations of 8th nerve compression syndrome. We have experienced 15 patients who mainly complained multiple spontaneous biref spins or 'quick spins'. The clinical characteristics of 'quick spins' are paroxysmal brief rotational sensations which are rarely accompanied by auditory or caloric test abnormalities, and generally not associated auditory symptom or triggers. These patients can have a good response to anticonvulsants such as carbamazepine and oxcarbazepine. We suggest that the syndrome of 'quick spins' is commonly a sign of vestibular nerve hyperexcitability that could be caused by several underlying pathologies.

Comparison of Vestibule-ocular Reflex of Eccentric Rotation with Centric Rotation in Normal Subjects: Byung Han Cho, Seung Yeun Jang, Ho Suk Choi, Seung Chul Lee, Kyu Sung Kim; J Korean Bal Soc. 2004;3(2):351-335.

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Abstract PDF: Background
and Objectives : Conventional vestibular rotation testing with the head centered on the axis stimulates the semicircular canals evoking compensatory eye movements. By placing subjects off from the axis of rotation, the otolithic organ may also be simultaneously stimulated by additional linear acceleration forces. In the present study, we compared the rotation with subjects placed on axis to those placed in an eccentric position. Materials and Method : In the eccentric rotation, the head of subject was facing outward and placed eccentrically for 33cm on naso-occipital axis. Slow harmonic acceleration test and velocity step test were performed.
Results
: The sinusoidal eccentric rotation at 0.32, 0.64 Hz produced a significantly higher vestibulo-ocular reflex gain than did on axis rotation. In velocity step test, initial slow component velocity was significantly higher in eccentric rotation than in centric rotation.
Conclusion
: These finding suggest that the gain enhancement due to eccentric rotation is a result of tangentiallinear acceleration, probably sensed by the otolithic organ. This study raises the possibility of using eccentric rotation for the diagnosis of the patients with otolithic dysfunction.

Vestibular Evoked Myogenic Potential Generated by 500 Hz Tone Burst in Unilateral Peripheral Vestibulopathy: Ja Won Koo, Dong Hwan Roh, Chang Hee Kim, Jin Young Kim, Ji Yeon Yu, Kwang Dong Choi, Ji Soo Kim; J Korean Bal Soc. 2004;3(2):356-361.

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Abstract PDF: Background
and Objectives : Vestibular evoked myogenic potential (VEMP) has become a valuable diagnostic tool evaluating the integrity of sacculocollic reflex and has been done using click sound in most previous clinical trials. This study aims to investigate VEMP responses generated by 500 Hz tone burst in unilateral peripheral vestibulopathy and compare the response with caloric test and subjective visual vertical (SVV). Materials and Method : Clinical records of 37 patients (18 men and 19 women, aged 14-80 years) with unilateral peripheral vestibulopathy were reviewed. Diagnoses were Meniere's disease (n=13), vestibular schwannoma (n=4) and acute peripheral unilateral vestibulopathy (n=20). They underwent 500Hz tone burst VEMP, caloric test and SVV test. Thirteen healthy volunteers (26 ears, 8 men and 5 women, 25~41 years) with normal hearing were enrolled as control group.
Results
: VEMP response was present in every control ear using 500 Hz tone burst stimuli. In Meniere's disease, VEMPs were positive in 57% (4/7) of patients with abnormal caloric response group and 83% (5/6) with normal caloric response. In acute peripheral vestibulopathy, VEMPs were positive in 47% (9/19) of patients with abnormal caloric response, 0% (0/1) with normal caloric response. The average of CP (canal paresis) in positive VEMP group was 62.4% and that in negative VEMP group was 48.2% (P>0.05).
Conclusion
: Reliable and reproducible test results can be obtained using 500 Hz tone burst stimuli. VEMP results were not in concordance with other vestibular tests, which reflects the dynamic process of dizziness and variable extent of pathology in each case.

24 hr Ambulatory ECG and Schellong Test for the Diagnosis of Cardiovascular Origin Dizziness: Ji Hwan Yun, Jae Ho Ban, Seung Suk Lee; J Korean Bal Soc. 2004;3(2):362-366.

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Abstract PDF: Background
and Objectives : Dizziness is a vague symptom of disease. Dizziness of cardiovascular origin is associated with decreased cardiac output and usually presented as light-headed sensation of an impending faint. This study aims to provide the clinician with a logical approach to identifying the cardiovascular causes of dizziness. Materials and Method : From February 2002 to June 2004, we sampled the 30 dizzy patients who complained light-headed sensation of an impending faint with underlying disease of arrhythmia or abnormal blood pressure. The 11 patients with arrhythmia were monitored by 24 hr ambulatory ECG monitoring and all were examined with Schellong test.
Results
: Among the 11 patients with arrhythmia, 7 patients were diagnosed as cardiovascular origin dizziness by 24hr ambulatory ECG monitoring and 10 patients as orthostatic hypotension by Schellong test.
Conclusion
: The results of this study indicated that 24hr ambulatory ECG monitoring and Schellong test had efficacy for the diagnosis of dizzy patients who complained light-headed sensation of an impending faint with underlying disease of arrhythmia or abnormal blood pressure.

Characteristics of the Extratympanic Electrocochleography in the Patients with Meniere's Disease: Shi Nae Park, Hyun Jin Oh, Kyung Ho Park, Sang Won Yeo; J Korean Bal Soc. 2004;3(2):367-371.

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Abstract PDF: Background
and Objectives : Electrocochleography is the only proven investigation and diagnostic tool to demonstrate the endolymphatic hydrops at this time. We designed this study to assess the characteristics of transtympanic electrocochleographic findings and to estimate the clinical value of the test results in the patients with Meniere's disease. Materials and Method : Electrocochleographic duration and amplitude were measured in a clinically defined definite Meniere's disease group and the results were compared with those from a normal hearing control group.
Results
: The summating potential (SP) / action potential (AP) amplitude ratio was significantly different among study groups with 0.40±0.10 in the bilateral Meniere's group, 0.34±0.08 in the unilateral Meneire's group and 0.22±0.08 in the normal group (p<0.01). The elevated SP/AP ratio in the patients with such a relatively long duration of Meniere's disease in this study was mainly due to the decreased AP amplitude rather than the enhanced SP amplitude.
Conclusion
: Measuring electrocochleography and demonstrating the elevated SP/AP ratio could be quite valuable to diagnose the patients with Meniere's disease. The recognition of decreased AP amplitude might be helpful to understand the cochlear pathologic status in the patients with Meniere's disease.

Otologic Causes of Drop Attacks in Elderly Patients: Hyung Lee, Hyon Ah Yi, Jeong Geung Lim, Byung Hoon Ahn, Byung Rim Park; J Korean Bal Soc. 2004;3(2):372-378.

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Abstract PDF: Background
and Objectives : Many neurologists are unaware of the drop attack that may occur from an inner ear dysfunction especially in elderly. We performed this study to investigate the clinical features and results of quantitative audiovestibular tests in six elderly patients (≥65 years of age) who presented with drop attacks attributable to an inner ear pathology. Materials and Method : Group was divided into Meniere's syndrome (4) or non-Meniere peripheral vestibulopathy (2). Standard dizziness questionnaire and quantitative audiovestibular function testing were performed.
Results
: Episodes were described as a sudden push to the ground in four or a violent illusionary movement of environment leading to a fall in two. All cases gave a history of prior vertiginous episodes and vestibular testing revealed unilateral caloric paresis. Ipsilateral hearing loss was documented in four cases.
Conclusions
: Our results suggest that otologic causes should be considered in the differential diagnosis of the drop attack in elderly, even if the symptoms and signs were not consistent with Meniere's syndrome.

Chicken Embryo as a Model of Inner Ear Study: Gyu Cheol Han, Youn Kyu Lee, Jin Ho Yoon, Kyung Kun Min, Ju Hyoung Lee; J Korean Bal Soc. 2004;3(2):379-385.

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Abstract PDF: Background
and Objectives : Nowdays, numbers of patient who suffers from inner ear disease are increased and we need to completely understand about inner ear anatomy and embryology. But we have many problems to use human itself as a model, so it is difficult for us to study. Instead of using human as a model, recent days, many doctors use mammalians and birds. In this study, we used chicken embryo as a model whose inner ear was thought to be similar with human's inner ear and we made effort to get inner ear images by light microscope. Materials and Method : We incubated Gallus domesticus in auto-incubator for 12days. In each embryonic day (4th to 12th days), we got the chicken embryo and made paraffin block. Next, with micro-tomb, we made slice section and fixed to slide. Using micro-digital camera system, we took the picture of the inner ear of chicken embryo.
Results
: We observed the structures of inner ear of chicken embryo from 4th embryonic day to 12th embryonic day. In 4th day and 5th day, we could not get the definite clear image. But from 6th to 12th day, we got the clear images of utricle, saccule, semicircular canals, etc. In several micro-section methods, making oblique coronal section was showed the best images of inner ear.
Conclusion
: This study was the start point of chicken inner ear embryology and anatomy. Hereafter, we should make the deeper study about chicken inner ear with these results and investigate the genetic and extrinsic factors which influence to inner ear disease. So we should solve the fundamental problem of inner ear disease based on this study.

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