Research in Vestibular Science

Volume 4 (2); December 2005

Original Articles

Role of Central Vestibular Pathway on Control of Blood Pressure During Acute Hypotension in Rats: Yuan Zhe Jin, Guang Shi Jin, Min Sun Kim, Byung Rim Park; J Korean Bal Soc. 2005;4(2):189-200.

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Abstract PDF: Background
and Objectives: Central role of the vestibular system on control of blood pressure and interrelationships between the vestibular nucleus and solitary nucleus during acute hypotension were investigated in bilateral labyrinthectomized (BLX) or sinoaortic denervated (SAD) rats. Changes of electrical activity in the medial vestibular nucleus (MVN), solitary tract nucleus (STN), and rostral ventrolateral medullary nucleus (RVLM) were investigated in rats in while acute hypotension was induced by sodium nitroprusside (SNP).
Results
Evoked potential in MVN neuron caused by electrical stimulation of the peripheral vestibular system was composed of 3 waves with latencies of 0.48±0.10 ms, 1.04±0.09 ms and 1.98±0.19 ms. Electrical stimulation to MVN or RVLM increased blood pressure. MVN at the induction of acute hypotension showed excitation in 61% of type I neurons and inhibition in 68% of type II neurons. In STN, acute hypotension produced excitation in 62.1% of neurons recorded in intact abyrinthine animals, inhibition in 72.3% of neurons recorded in BL animals, and excitation in 60% of recorded neurons in SAD animals. In RVLM, acute hypotension produced excitation in 66.7% of neurons recorded in intact labyrinthine animals and inhibition in 64.9% of neurons recorded in BL animals. In spatial distribution of STN neurons responded to acute hypotension, excitatory responses were mainly recorded in rostral and ventral portion, and inhibitory responses were mainly recorded in caudal and lateral portion. In RVLM, excitatory responses were mainly recorded in rostral and dorsomedial portion, and inhibitory responses were mainly recorded in caudal and ventrolateral portion.
Conclusion
These results suggest that afferent signals from the peripheral vestibular receptors are transmitted to STN through the vestibular nuclei and assist to the baroreceptors for controlling blood pressure following acute hypotension.

The Effect of Somatosensory Input on Subjective Visual Vertical in Normal Subjects: Dae Bo Shim, Hyun Jong Jang, Hyang Ae Shin, Jae Yoon Ahn, In Bum Lee, Jung Eun Shin, Hong Ju Park; J Korean Bal Soc. 2005;4(2):201-205.

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Abstract PDF: Background
and Objectives: Aims of the study were to determine if the somatosensory input influences on vertical perception by comparing the results with the head or body tilted (15°) to the right and to the left, and to examine the influence of tactile sensation in the perception of verticality in head lateral positions. Materials and Method: We tested 34 normal subjects in their ability to set a straight line to the perceived gravitational vertical. Measurements were taken in static conditions, sitting upright, head tilted (15°), body tilted (15°), and head lateral positions (90°) on the right/left sides with or without physical support under the head.
Results
The normal range of the subjective visual vertical (SVV) was 0.65°±1.23° in upright position. The normal ranges of SVV in head-tilts 15° to the left/right sides were -0.47°±1.76° and 1.88°±2.94°, which were significantly different from those in upright position (E-effect). But the normal ranges of SVV in body-tilts 15° to the left/right were not different from those in upright position. And the normal ranges of SVV in head lateral positions maintained actively and passively were not different each other, but significantly larger than that in upright position (A-effect).
Conclusion
Our results support that neck somatosensory input plays a part in the perception of verticality. In contrast, tactile sensation of the head had no effect on the settings of a visual line to visual vertical in head lateral positions.

Analysis of Parameters of Vestibular-Evoked Myogenic Potentials in Sudden Sensorineural Hearing Loss without Vertigo: Min Hyun Park, Woo Jin Jeong, Jae Jun Song, Ji Soo Kim, Ja Won Koo; J Korean Bal Soc. 2005;4(2):206-211.

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Abstract PDF: Background
and Objective: Vestibular evoked myogenic potentials (VEMP) has been promoted as a means of assessing the integrity of saccular function. Even though sacculospinal reflex may not be influenced by abnormality of cochlear pathway, saccule is closely related with cochlea in its embryological development and also in geographic location. So authors hypothesized the presence of functional alterations of saccule in patients with sudden sensorineural hearing loss who do not complain of vertigo, since saccular dysfunction may not induce subjective vestibular symptoms or signs. Authors tested saccular function in those patients using VEMP and analyzed the parameters according to other clinical indicators. Materials and Method: From July to September 2005, 22 patients who diagnosed with unilateral sudden sensorineural hearing loss without vertigo were enrolled. The patients who had vertigo as initial symptom or showed spontaneous nystagmus were excluded. All patients received conventional audiometry, tone-burst VEMP test, and caloric test. We analyzed P13 and N23 latency, interpeak amplitude and asymmetric ratio of amplitude. The patients divided to complete hearing recovery, partial recovery, and no response group according to treatment outcome. The correlation between parameters and treatment result was analyzed.
Results
In 2 out of 22 patients (9.1%), VEMP waves were not detected. There was no latency delay in affected ear. But the interpeak amplitude of the affected ear was significantly smaller than that of healthy side (paired t test, p=0.02). Patients who did not respond to treatment showed smaller interpeak amplitude than those who showed complete recovery.
Conclusion
Most patients of idiopathic sudden sensorineural hearing loss without vertigo seem to show normal VEMP waves. But some parameters regarding amplitude had abnormal findings in affected ear. Further studies with larger sample size seem to be necessary to elucidate such outcomes.

Analysis of the Vestibular Function in Children with Otitis Media with Effusion: in Jung Cho, Keehyun Park, You Ree Shin, Yun Hoon Choung; J Korean Bal Soc. 2005;4(2):212-218.

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Abstract PDF: Otitis media with effusion (OME) is one of the most common diseases in children and may be frequently related with dizziness. Background and Objectives: However, the association between OME and dizziness seems to be not clear and remains controversy. The purpose of this study was to determine the incidence of dizziness in children with long lasting OME, and to investigate the difference in vestibular functions between children with long lasting OME and the control group. Materials and Method: Thirty one children who had long-lasting OME over than 6 months (study group) and 28 normal hearing children without OME who were scheduled for adenotonsillectomy (control group), were given questionnaires and vestibular function tests (VFT) including electronystagmography (ENG) and rotation chair test(RCT). Statistical analysis was performed with chi-square test.
Results
Dizziness was found in 7 (22.6%) of 31 children in the study group and 2 (7.1%) of 28 children in the control group (p>0.05). The difference of abnormal findings in VFT between the study group and the control was not significant except visual vestibulo-ocular reflex (VVOR) in RCT. Most of the correlations in the study group, bilateral vs. unilateral OME, OME with dizziness vs. OME without dizziness, and preoperative vs. postoperative, were not significant.
Conclusion
We did not find any evidences of significant difference of the incidence of dizziness and findings of VFT between children with long lasting OME and children without OME. However, there was a significant abnormal response in VVOR in RCT in children with long-lasting OME, suggesting the children with OME may be more dependent on the nonvestibular system including visual compensation to maintain balance.

The Effectiveness of Physical Therapy for the Horizontal Canal Cupulolithiasis: Byung Kun Kim, Hee Jun Bae, Ja Seong Koo, Oh Hyun Kwon, Jong Moo Park; J Korean Bal Soc. 2005;4(2):219-224.

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Abstract PDF: Background
and Objectives: Recently many reports suggest the horizontal canal benign paroxysmal positional vertigo (h-BPPV) is not rare. However there have been few reports on physical therapy for horizontal canal cupulolithiasis, while horizontal canal canalithiasis has a relatively well defined and effective therapy. To evaluate the efficacy of different methods of treating horizontal canal cupulolithiasis, we conducted prospective study. Materials and Method: We enrolled 104 consecutive patients who were diagnosed with h-BPPV. During that period, patients with posterior canal BPPV numbered 112. Patients with h-BPPV were diagnosed when lateral head rotation in the supine position resulted in geotropic or apogeotropic bilateral horizontal nystagmus. In patients presenting with apogeotropic variant (n=40), following maneuvers was performed sequentially. First of all, we performed head shaking and applied vibrator to the mastoid bone to detach otolith from cupula. If they failed to detach otolith from cupula, we performed barbecue rotation and forced prolonged position (FPP). The treatment outcome was considered as responsive when, immediately after each physical therapy, nystagmus shifted from apogeotropic to geotropic or no nystagmus was elicited by provocation test and symptoms of positional vertigo abated.
Results
There were 27 women and 13 men from ages 30 to 80 (mean 55) years. The average duration of symptoms before intervention was 0 to 12 (mean 0.6) days. In 4 cases, symptoms resolved spontaneously after provocation test. Of the 36 patients treated with headshaking, 6 were responsive. Of the 30 patients treated with vibrator after failure of head shaking, only 1 were responsive. In the barbecue rotation, none obtained relief after barbecue rotation. Of the 9 patients treated with FPP after failure of the barbecue rotation, 4 were symptom free after FPP. Twenty five patients, including 5 non-responders with FPP, underwent no more rehabilitation maneuver. In most of cases (n=24), horizontal canal cupulolithiasis resolved spontaneously within a week.
Conclusion
The direct effectiveness of physical therapy for horizontal canal cupulolithiasis is largely unsatisfactory. However, in many cases, horizontal canal cupulolithiasis resolved spontaneously in a few days.

Effect of Low Power Laser Irradiation on Gentamicin-Damaged Vestibular System in Guinea Pigs: Chung Ku Rhee, Myoung Chan Kim, Eun Seok Lim, Young Saeng Kim; J Korean Bal Soc. 2005;4(2):225-229.

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Abstract PDF: Background
and Objectives:The purpose of this study was to investigate the characteristics of gentamicin-induced vestibulotoxicity of otolith organs and preventive effect of low power laser to vestibulotoxicity by assessing the result of earth vertical and the off vertical axis rotation tests. Materials and Method: Twenty guinea pigs were grouped into two groups, laser and no laser group. Vestibulotoxicity was induced by intratympanic injection of gentamicin. Prevention of the vestibulotoxicity was studied by irradiation of low power laser. Off vertical axis rotation tilted 30 degree relative to the earth vertical axis was applied to evaluate the otolithic function.
Results
Gentamicin induced vestibulotoxicity was confirmed by gain decreasing in slow harmonic acceleration test and modulation decreasing in the off vertical axis rotation test. Prevention effect of low power laser to gentamicin induced vestibulotoxicity was confirmed by modulation maintaining in the off vertical axis rotation test and gain maintaining in the earth vertical axis rotation.

Factors Affecting Treatment of Benign Paroxysmal Positional Vertigo: Yoon Kyoung So, Won Ho Chung, Sung Hyun Boo, Young Jun Chung, Hyun Seok Lee, Woo Young Lee, Ki Nam Park; J Korean Bal Soc. 2005;4(2):230-237.

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Abstract PDF: al vestibular loss, accompanying sudden SNHL, underlying disease such as hypertension or diabetes, change of involved canal during treatment course and number of treatment visits. Statistical analysis using Pearson χ2 test was performed.
Results
Three hundred thirty-one patients with BPPV who received treatment were identified from 2001 to 2005. 85.2% required one treatment visit, 12.4% required a second treatment visit, and 98.2% were successfully treated after three treatment visits. Variables such as bilateral disease, anterior canal BPPV, post-traumatic BPPV, duration of symptom before treatment and change of involved canal during treatment were significantly related with number of treatments.
Conclusion
Patients with anterior semicircular canal BPPV or bilateral BPPV or with recent head trauma or longer duration of symptom are more likely to require multiple visits for canalith repositioning.

Jongkees’ Formula Reevaluated: Mathematical Significance of CP and Negative SCV Value: Sung Wan Byun; J Korean Bal Soc. 2005;4(2):238-242.

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Abstract PDF: Background
and Objectives: In caloric test, the CP (canal paresis) value was derived from Jongkees formula. The input parameters of the formula were initially nystagmus duration (seconds), which were replaced later with more stable parameters : slow component velocity (SCV, deg/sec). The nystagmus duration cannot be negative value, but SCV can be, especially in acute vestibular loss with excessive spontaneous nystagmus (SN) which is not overcome by caloric nystagmus. This study aims to investigate the occurrence of negative SCV, to check proper processing of negative SCV values in nystagmography software, and to consider the athematical significance of CP and negative SCV values. Materials and Method: Tests with negative SCV values were examined in 690 alternate binaural bithermal caloric tests (open loop system).
Results
Nine percents (62 of 690 tests) showed negative SCV values. The reported CP was erroneously calculated from debased zero SCV values instead of negative SCV values. The underestimated CP (mean 52.1%, SD 21.8%) can be corrected (mean 80.9%, SD 21.8%) by recalculations with negative SCV values.
Conclusion
To produce correct CP values in caloric tests, negative values should be properly processed about the SCV value of caloric nystagmus with opposite direction of physiologic response. The mathematical significance of CP was horizontal coordinate of intersection point of the warm line (LW-RW) and cold line (LC-RC) in butterfly patterncalorigram. Detailed description is presented in figures.

Expression of Caveolin-1 in the Differentiated Vestibular Cell Line (UB/UE-1) after Gentamicin Toxicity: Byung Han Cho, Kyu Sung Kim, Min Wook Kim, Min Sun Kim, Byung Rim Park; J Korean Bal Soc. 2005;4(2):243-249.

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Abstract PDF: Background
and Objectives: The caveolin is known as a mediator of cell death or survival of injured cell and inhibitor of various signaling pathways. We examined expression of caveolin-1 involved by protein kinase A(PKA) signaling pathway in the differentiated mouse vestibular cell line(UB/UE-1) after gentamicin toxicity. Materials and Method: We observed caveolae in the vestibular hair cell of healthy guinea pig through electron microscope. UB/UE-1 cells were cultured at 95% CO2, 5% O2, 33℃ for 2days and at 95% CO2, 5% O2, 39℃ for 24 hours for differentiation. Cells were treated with 1 mM of gentamicin, 0.02 mM H89 (PKA inhibitor), and then incubated for 24 hours. Caveolin-1 expression was examined by western blot and PKA activity by PepTagⓇ assay.
Results
Caveolae were observed in the vestibular hair cell of healthy guinea pig by electron microscope. Caveolin-1 was expressed spontaneously in differentiated UB/UE-1 cells and increased after gentamicin treatment. PKA is overactivated by gentamicin treatment. The gentamicin induced caveolin-1 expression and PKA overactivation was inhibited by H89.
Conclusion
Our results indicate that gentamicin induced caveolin-1 expression is mediated by PKA signaling pathway. We conclude that the caveolae/caveolin through a PKA signaling pathway is the important mechanism of gentamicin induced ototoxicity.

Implementation of a Critical Pathway to the Dizzy Patients in the Emergency Center: Shi Nae Park, Young Min Kim, Joong Seok Kim, Min Sik Kim, Won Jae Lee, Kwang Soo Lee, Chung Soo Kim, Hong Jin Park, Sang Won Yeo; J Korean Bal Soc. 2005;4(2):250-256.

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Abstract PDF: Background
and Objectives: Dizziness and vertigo are frequent causes of presentation in the emergency center. Nevertheless, the practice guideline for the primary care doctor in the emergency center has not been reported yet. Considering its complex approach for diagnosis, we developed critical pathway for dizzy patients who visited emergency center. We performed this study to show the process of development and the result of implementation of critical pathway. Materials and Method: A critical pathway was developed following the analysis of dizzy patients visiting emergency center by retrospective chart review and in the basis of questionnaire for knowing the needs for critical pathway to the primary care doctor in emergency center. Specialists for caring dizzy patients joined to make the flow sheet and practice guideline for dizzy patients and also made educational materials for doctors in emergency center. The critical pathway was then implemented and its results were analyzed by estimating the practice time and the degree of satisfaction of the patients and doctors.
Results
Most of the primary care doctors in emergency center reported the difficulty in diagnostic approach for dizzy patients and the need for critical pathway. More than half of the dizzy patients were diagnosed as peripheral vertigo and the commonest disease was benign paroxysmal positional vertigo. All of the patients with vertigo diagnosed as central origin showed the neurologic deficit. After the implementation of critical pathway, practice time was significantly decreased and many of the dizzy patients and doctors were satisfied.
Conclusion
Development and implementation of a critical pathway for dizzy patient in emergency center was possible, valuable and effective for the patients and doctors, though the process was not easy and needed interdisciplinary cooperation of involving departments.

Case Report

Bell’s Palsy associated with Acute Vestibulopathy: Ja Won Koo, Jae Jin Song, Dong Yeop Chang, Ji Soo Kim; J Korean Bal Soc. 2005;4(2):259-263.

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Abstract PDF: Bell’s palsy is acute idiopathic peripheral facial nerve palsy which is diagnosed after all the possible causes are ruled out. Several symptoms and signs of polyneuropathy, such as hypesthesia of cranial nerve IX or V, vagal motor weakness, retroauricular pain, and hearing impairment were frequently accompanied with Bell’s palsy. However, association of vertigo has been rarely reported, and moreover, associated vestibulopathy was not characterized in detail in those cases. We report a 35 year-old male patient with Bell’s palsy accompanying acute peripheral vestibular loss, which eventually evolved to benign paroxysmal positional vertigo.

Original Articles

Clinical Application of Vestibular Research: Search-Coil Head Thrust Test: HongJu Park, M.D.; J Korean Bal Soc. 2005;4(2):269-275.

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Abstract PDF: The method with the highest temporal and spatial resolution is the magnetic search coil technique. Using this method, measuring eye rotations in 3D has developed into a stage where routine clinical application is realistic. This article describes some clinical pplications of search coil head thrust test. It has been reported that vestibular neuritis can affect the superior and inferior vestibular nerves together or selectively, and that Meniere's disease may differentially affect the low-frequency sensitivity of the canals and the effect of intratympanic gentamicin is probably the reduction of vestibular function through damage to hair cells. Also, individual canal function could be evaluated in subjects with posterior canal occlusion or superior canal dehiscence syndrome. Thus, the analysis of 3D movements not only provides an improved understanding of how the brain organizes movement in 3D space, but also has the potential to significantly improve our diagnostic capabilities.

Eye Movements in Benign Paroxysmal Positional Vertigo: Ki-Bum Sung, M.D.; J Korean Bal Soc. 2005;4(2):279-296.

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PDF

Symposiums

Epidemiology and Pathogenesis of Benign Paroxysmal Positional Vertigo (BPPV): Kim Jae-Il, M.D.; J Korean Bal Soc. 2005;4(2):299-306.

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Abstract PDF: .

Diagnosis of Vertical Canal Benign Paroxysmal Positional Vertigo: 이현석, 소윤경; J Korean Bal Soc. 2005;4(2):307-311.

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Abstract PDF: .

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