Research in Vestibular Science

Volume 7 (1); June 2008

Original Articles

Effects of Intrabullar Gentamicin Application on Guinea Pig Vestibulo-Ocular Reflex: Ja Won Koo, Jae Jun Song, Sung Kwang Hong, Ji Soo Kim; J Korean Bal Soc. 2008;7(1):9-16.

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Abstract PDF: Background and Objectives: Unilateral vestibular loss can be induced by intratympanic gentamicin instillation. Despite accumulated reports on the morphologic changes after gentamicin treatment, there are limited reports regarding the effects of gentamicin ototoxicity on the vestibulo-ocular reflex (VOR), in especially unilateral vestibular deficit by local gentamicin instillation. Aim of this study is to provide the functional changes after local gentamicin application in guinea pigs. Materials and Methods: Ten white guinea pigs (5 each for control and gentamicin treatment group) were used. Following surgical exposure of the left bulla, 0.9% saline solution or 40 mg/ml of gentamicin soaking gelfoam were applied on the round window. Horizontal vestibulo-ocular reflex (hVOR) was tested during earth vertical axis (EVA) sinusoidal harmonic acceleration rotation at 4 frequencies (0.04, 0.08, 0.16 and 0.32 Hz, 60 deg/sec of peak velocity). In one gentamicin treated animal, hVOR was tested during step velocity off-vertical axis rotation (OVAR) to clockwise and counterclockwise direction (30° forward tilt from EVA with constant velocity of 100 deg/sec). Every test was repeated before treatment and at 2 days, 5 days and 7 days after treatment. Results: The hVOR gain was significantly lowered after gentamicin treatment at all tested frequencies (p<0.05), while the gain does not change over time in control animals. Loss of bias component was evident and some decrease of modulation component was observed in counter-clockwise (lesion side) rotation after gentamicin treatment. Conclusion: This study provides characteristics of hVOR during EVA rotation and OVAR in unilateral vestibular deficit animal model by intrabullar gentamicin application.

Assessment of Saccular Function in Patients With Noise Induced Hearing Loss: In Kuk Hwang, Ji Hyun Moon, Young Hyo Kim, Kyu Sung Kim, Yun Gun Jung, Hoseok Choi; J Korean Bal Soc. 2008;7(1):17-21.

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Abstract PDF: Background and Objectives: Considering saccular receptors are coupled physically with the auditory receptors, VEMP test may provide the information that in the noise induced hearing loss with or without dizziness, damage to the vestibular system, especially saccule is a potential organ with cochlear damage. Material and Methods: 11 patients (22 ears) with HF-SNHL greater than 55dB and 10 patients (10 ears) with sudden hearing loss of varying degree HL as positive control but without clinical manifestations of vestibular pathology tested for vestibular function test was enrolled. VEMP test was done. The results were compared with those of 9-healthy referents (18 ears) examined in the same way. Results: VEMP wave was significantly abolished as twelve of 22 (54.5%) with HF-SNHL, five of 13 (38.5%) and Control group (100%). Though there was no statistically significant relation with P13, N23 latency delay in each group, NIHL showed P13, N23 latency delay trend compared with controls. Conclusions: Patients with noise induced hearing loss showed significantly more saccular deterioration, estimated as negative VEMP responses than did the controls. This suggests subclinical disturbances of the vestibular system especially of the saccule in noise induced hearing loss.

3-D Model of The Oculomotor Fascicular Arrangement Within The Midbrain Using Brain MRI: Jeong Ho Park, Du Shin Jeong, Sun Ah Park, Tae Kyeong Lee, Ki Bum Sung; J Korean Bal Soc. 2008;7(1):22-32.

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Abstract PDF: Background and Purpose: The oculomotor nerve fascicles arise along its entire length and sweep ventrally to exit the midbrain at the medial edge of the crus cerebri. A rostro-caudal topography among the fascicular fibers is relatively well established. There are, however, some controversies whether medio-lateral topography also exists. Methods: We retrospectively reviewed the clinical records and MRI of the 8 patients showing isolated oculomotor nerve palsy due to midbrain infarction. Brain MRI was performed using a 1.5-T magnet with 2mm thickness and 0.1 mm slice interval. The anterior-posterior axis(X) was defined as the midline crossing the center of the cerebral aqueduct and the medio-lateral axis(Y) as the line crossing the same point. For rostro-caudal measurement, the intercommissural line was used as base line of the Z axis. The location of the lesions was defined by measuring actual distance of the margins of the lesions in millimeter from each axis; anterior, right, and caudal direction was defined as positive values in X, Y and Z coordinates, respectively. Results: The mean values and range of the X, Y and Z are as follows: X=7.56±4.34, 1≤X≤15; Y=3.43±1.37, 0≤Y≤6; Z=6.51±3.91, 0≤Z≤12.5. Conclusions: The distribution of all the MRI lesions was 0≤|Y|≤6 (mm), 0≤|Z|≤12.5 (mm) in mediolateral and rostrocaudal direction respectively, which is almost the same as the previously reported divergent range of the oculomotor fascicles in midbrain tegmentum. We suggest that our method of three dimensional measurements of the MRI lesion in midbrain tegmentum could be a useful tool for the study of oculomotor fascicular arrangement.

Follow-up Changes of Eye Movements by Caloric Stimulation in Patients With Vestibular Neuritis: Mun Su Park, Ga Hyun Park, Yong Soo Jeong, Yeo Jin Lee, Jung Eun Shin, Hong Ju Park; J Korean Bal Soc. 2008;7(1):33-37.

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Abstract PDF: Background and Objectives: A significant recovery of resting activity in the vestibular nuclei ipsilateral to the unilateral labyrinthectomy has been reported by the time symptoms such as spontaneous nystagmus and roll head tilt have largely disappeared. However, the dynamic vestibular response after unilateral vestibular loss to passively imposed vestibular stimuli does not recover. Materials and Methods: We investigated changes of the caloric responses in 32 patients with vestibular neuritis during in- and out-patient visits separated by 2 months in an attempt to identify changes brought about by peripheral and/or central compensation processes. Results: The slow-phase eye velocities stimulated by warm caloric stimulation at acute and follow-up stage were 6.6±6.6°/s, 9.5±9.9°/s in the lesioned side; 28.4±19.1°/s, 24.5±11.6°/s in the intact side. The slow-phase eye velocities stimulated by cold caloric stimulation at acute and follow-up stage were 5.9±7.7°/s, 10.3±8.2°/s in the lesioned side; 19.8±10.3°/s, 18.8±9.9°/s in the intact side. Conclusion: Our findings show that the recovery of caloric responses comes mostly from the recovery of the eye responses to the caloric stimulation in the lesioned side and the eye responses to the caloric stimulation in the intact side does not change over time after vestibular neuritis.

Clinical Significance of Vestibular Evoked Myogenic Potentials in Patients With Benign Paroxysmal Positional Vertigo: Won Sun Yang, Dae Bo Shim, Won Sang Lee; J Korean Bal Soc. 2008;7(1):38-42.

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Abstract PDF: Objectives: To investigate the vestibular evoked myogenic potentials (VEMP) results in benign paroxysmal positional vertigo (BPPV) patients and to verify its clinical applications in BPPV. Subjects and Methods: Forty-one patients with diagnosis of BPPV and 92 healthy volunteers who underwent VEMP testing. Patients were treated by canalith repositioning maneuvers according to the affected canal, and testing of VEMP was performed at diagnosis and after treatment. Results: VEMP results of BPPV patients showed prolonged p13 and n23 latencies compared with those of the control group, and we could not find any significant difference in VEMP latencies between patients with posterior and horizontal canal type of BPPV. The number of times that the maneuver was repeated did not correlate with the degree of latency prolongation, but in the “no response” group, the number of times was considerably greater than those in the “response” group. Conclusions: We found that VEMP latencies are increased in BPPV patients, which may signify neuronal degenerative changes in the macula of the saccule. When an extensive neuronal damage was suspected by VEMP results such as “no response” in VEMP, the disease progress showed a chronic and resistive course. Therefore, we propose that VEMP could be a useful method to determine a clinical prognosis of patients with BPPV.

Efficacy of Rotating Chair Test And Caloric Test For The Diagnosis of Acute Unilateral Vestibular Neuritis: Heung Eog Cha, Chae Young Lim, Gyu Cheol Han, Chang Hyun Cho, Byung Ki Yoon, Min Kwan Baek, Ju Hyoung Lee; J Korean Bal Soc. 2008;7(1):43-47.

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Abstract PDF: Background and Objectives: The acute unilateral vestibular neuritis is fairly a common disease and the precise diagnostic tool is needed for the selection of effective treatments. Therefore, we studied the clinical usefulness of the rotatory chair test and caloric test which have been commonly used in patient of acute unilateral vestibular neuritis. Materials and Methods: One hundred and sixty four patients who were diagnosed with acute unilateral vestibular neuritis from August of 2004 to June of 2007 were included. Their medical records of the rotating chair test and caloric test were reviewed retrospectively to study the correlation of the two tests. Results: Of 164 patients, 101 patients (61.6%) and 88 patients (53.7%) showed significant canal paresis (CP) and directional preponderance (DP) on the caloric tests that corresponded with the physical exam. 130 patients (79.3%) and 84 patients (51.2%) showed significant asymmetry and time constant (Tc) on the rotating chair test that corresponded with the predictive direction with spontaneous nystagmus. Conclusions: For acute unilateral vestibular neuritis patients, the asymmetry of the rotatory chair test showed the highest correlation with clinical findings. But physical exam should be preceded because neither rotator chair test nor caloric test yields a specific correlation with the physical exam. Especially, single test only may too many false negative results. For these tests can reduce false positive cases of the physical exam and raise the specificity of the diagnosis, the planning of proper treatments should be followed thereafter.

Benign Recurrent Vertigo: Clinical Manifestations And Vestibular Function Test: Chang Hyo Kim, Kyu Sung Kim, Hoseok Choi, Yun Gun Jung, Seung Chul Lee; J Korean Bal Soc. 2008;7(1):48-54.

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Abstract PDF: Background and Objectives: Benign recurrent vertigo has been defined as recurrent spells of vertigo lasting minutes to hours without cochlear and neurologic signs. The etiology is still unclear, but viral and vasospastic etiology as migraine equivalent has been suggested. We attempt to analyze the symptoms and vestibular function test of Benign recurrent vertigo that has clinically diagnosed. Materials and Methods: We analyzed retrospectively the clinical characteristics and vestibular function test including ocular-motor test, rotation test and computerized dynamic posturography from 100 patients with a Benign recurrent vertigo diagnosis. Results: Eight two percent of the patients were female, mean age was 52 years, and mean duration of prevalence was 47.3 months. In the characteristics of vertigo, 91% of patients have spinning sensation during attack. The vertigo attacks most commonly lasts several hours (57%), and frequency of attack is three to twelve time per year in 47%. A high incidence (40%) of headache was detected, but incidence of other associated symptoms including fluctuating hearing loss (3%), tinnitus (27%), aural fullness (9%) was relatively low. The incidence of spontaneous nystagmus and positional nystagmus was 18% and 10% each. Saccadic undershoot was observed in 21% of patients, but it was not associated with other ocular-motor test abnormalities. In rotation test, low gain, phase lead and asymmetry was observed in 18%, 3% and 9%, respectively. There were no abnormal findings in posturography. Conclusions: Although benign recurrent vertigo did not show any characteristic clinical findings or vestibular function test, it deserves to be considered for differential diagnosis of episodic vertigo.

The Correlation of Benign Paroxysmal Vertigo of Childhood And Migraine: Jae Yun Jung, Hye Young Kim, Myung Whan Suh, Chung Ku Rhee; J Korean Bal Soc. 2008;7(1):55-59.

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Abstract PDF: Background and Objectives: Many authors have suggested close relationship between benign paroxysmal vertigo of childhood (BPVC) and migraine. But the relationship between the two is not clearly determined. Therefore we investigate clinical features and the course in children with BPVC and the possibility of evolution of migraine in BPVC. Materials and Methods: We interviewed 30 subjects having enough medical records and fitted to BPVC category who visited otorhinolaryngology for vertigo from 1995 to 2006 year. Results: The BPVC was the most common diagnosis in our hospital and migraine associated vertigo was followed. The main features of the children with BPVC were in agreement with previous reports. The major differences were later age of onset, having trigger factor and non-spinning type of vertigo. During the follow up, 8 children developed migraine. Females were dominant duration of illness was longer in this group. Almost of them suffered from motion sickness and had more family history of migraine, which was maternal dominant. Conclusions: The long term close follow-up may be needed in BPVC having possibility of evolution to migraine.

Case Reports

Two Cases of Congenital Ocular Motor Apraxia Associated With Cerebellar Vermian Dysplasia: Jin Young Seo, Yeon Hee Lee, Byoung Soo Shin, Man Wook Seo, Young Hyun Kim, Sun Young Oh; J Korean Bal Soc. 2008;7(1):63-67.

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Abstract PDF: Congenital ocular motor apraxia is a rare syndrome characterized by rotational head thrusts that attempt to compensate for the lack of voluntary eye movements. We describe the clinical, oculographic and magnetic resonance imaging features of two children with congenital ocular motor apraxia.

Herpes Zoster Oticus Involving Superior And Inferior Vestibular Nerve Without Facial Nerve Palsy: Hung Soo Kang, Sea Yuong Jeon, Dong Gu Hur, Seong Ki Ahn; J Korean Bal Soc. 2008;7(1):68-72.

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Abstract PDF: Herpes zoster oticus (HZO) is characterized by auricular vesicles, facial palsy and vestibulocochlear dysfunction. The 8th cranial nerve can be most frequently involved. Rarely, it may be associated with the involvement of 5th, 6th, 9th, 11th or 12th cranial nerve. However, only few cases of HZO involving vestibular nerve without facial nerve palsy have been previously reported. We experienced an unusual case of 38-year-old woman who presented with auricular vesicles, otalgia, and vertigo of whilrling nature but not with facial palsy. Vestibular evoked myogenic potential (VEMP) and caloric tests that were performed to determine which division of vestibular nerve was involved demonstrated that decreased responses in this case. We report a case of HZO involving superior and inferior vestibular nerve without facial palsy that was confirmed by VEMP and caloric tests with a review of literature.

A Case of Apogeotropic Positional Nystagmus Associated With Anti-GD1b IgG Antibody: Seong Hae Jeong, Gun Sei Oh, Dong Ick Shin, Ji Soo Kim; J Korean Bal Soc. 2008;7(1):73-76.

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Abstract PDF: The binding of anti-GD1b IgG antibody to the cerebellar granular area or spinocerebellar Ia fibers in the peripheral nerves may cause the prominent cerebellar ataxia, mild quadriparesis and sensory dominant neuropathy. A 31-year woman presented with severe cerebellar ataxia and prominent apogeotropic positional nystagmus/vertigo. Increased anti-GD1b antibody IgG in her serum was noted. 18F-flurodeoxyglucose positron emission tomography (FDG-PET) showed decreased uptake in cerebellum. It is the first case of central positional nystagmus with anti-GD1b IgG antibody.

Eight-And-a-Half Syndrome in Pontine Infarction: Hyun Jung Jung, Seung Han Lee, Myeong Kyu Kim, Ki Hyun Cho; J Korean Bal Soc. 2008;7(1):77-80.

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Abstract PDF: Eight-and-a-half syndrome is a clinical syndrome with the combination of a one-and-a-half syndrome and an ipsilateral seventh cranial nerve palsy usually due to a paramedian pontine tegmental lesion. A 57-year-old man presented with dizziness, diplopia, and a left facial palsy. Ocular motor manifestations showed combined left conjugate horizontal gaze palsy and left internuclear ophthalmoplegia (one-and-a-half syndrome). In addition, he had a left lower motor neuron pattern of facial palsy. Brain MR images showed an acute infarction in the left paramedian pontine tegmentum.

A Case of Cerebellar Hemangioma Mimicking Peripheral Vestibulopathy: Jae Ho Ban, Nam Hoon Lee, Hyun Jin Choi, You Sam Won; J Korean Bal Soc. 2008;7(1):81-84.

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Abstract PDF: Central vertigo of cerebellar origin may present the syndromes similar to those of peripheral vertigo such as vestibular neuronitis. The character of those vertigo syndrome depend on the location, extent, and the etiology of the lesion such as stroke, inflammation, mass. Cavernous hemangioma may be clinically silent, but can cause variable neurologic manifestations including central vertigo if it affects the vestibular system. We report a rare case of cerebellar cavernous hemangioma with the vertigo syndrome closely mimicked vestibular neuronitis.

Two Cases of Sudden Hearing Loss With Vertigo as an Isolated Symptom of Anterior Inferior Cerebellar Artery Infarction: See Young Park, Joong Wook Shin, Yong Jin Cho, Keun Sik Hong; J Korean Bal Soc. 2008;7(1):85-88.

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Abstract PDF: Isolated sudden hearing loss with vertigo is usually peripheral origin. We report two cases with anterior inferior cerebellar artery infarction (AICA) manifesting sudden hearing loss with vertigo as an isolated symptom. Patient 1 was a 64-year-old man presented with right sided sudden hearing loss and vertigo accompanying horizontal beating nystagmus to the left. He had no other neurologic symptoms. MRI showed right AICA infarction involving lateral pons and middle cerebellar peduncle. Patient 2 was a hypertensive 56-year-old man. Left sided sudden hearing loss with vertigo was as an initial manifestation. Two days later, left sided facial palsy developed and MRI showed acute infarction in left lateral pons, middle cerebellar peduncle, and cerebellum. AICA infarction can be presented the hearing loss and vertigo as an isolated symptom and mimic the syndrome of peripheral origin.

Delayed Postoperative Vertigo After Tympanomastoidectomy Due to Simultaneous Serous Labyrinthitis and BPPV: Yun Ho Kim, Jae Yun Jung, Chung Ku Rhee, Myung Whan Suh; J Korean Bal Soc. 2008;7(1):89-95.

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Abstract PDF: Postoperative vertigo after tympanomastoidectomy can be attributed to several causes such as inner ear damage due to excessive ossicle handling, labyrinthitis, BPPV resulting from vibration of drilling, iatrogenic lateral semicircular canal damage, and perilymphtic fistula. Differential diagnosis is critical for the proper management and prognosis of accompanied sensorineural hearing loss, but it may be difficult in some cases. Especially it is quite difficult to distinguish between the serous and suppurative labyrinthitis. In this article we present a case with simultaneous serous labyrinthitis and BPPV. The patient developed whirling vertigo and hearing loss on the 5th day after tympanomastoidectomy. After conservative treatment with steroid and antibiotics, his hearing recovered to preoperative level. We retrospectively reviewed the pitfalls to make a correct diagnosis in this patient and the serial change in nystagmus during the treatment period. The usefullness of the rotation chair test to predict the prognosis of sensorineural hearing loss in labyrinthitis was also discussed.

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