Research in Vestibular Science

Pathogenetic Understanding of Migrainous Vertigo: Seong Ki Ahn; J Korean Bal Soc. 2008;7(2):157-163.

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Visualization of endolymphatic hydrops using Magnetic Resonance Imaging after intratympanic Gd-DTPA administration in patients with Meniere’s disease: Young Joon Seo, Dae Bo Shim, Jinna Kim, Won Sang Lee; J Korean Bal Soc. 2008;7(2):167-173.

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Abstract PDF: Background and Objectives: Endolymphatic hydrops are known as major causes of Meniere’s disease. MRI (Magnetic resonance imaging) with contrast tried recently makes it possible to visualize perilymphatic and endolymphatic space without invasive procedures. There are no tryouts in the interior of our country. We attempted MRI after injection of gadolinium-diethylen –triamine pentaacetic acid (Gd-DTPA) in normal adults and patients with Meniere’s disease to make sure 3D-FLAIR (fluid-attenuated inversion recovery) MRI parameters and to visualize endolymphatic spaces. Materials and Methods: Five normal adults and Five patients with Meniere’s disease were included in this study. Twenty-four hours after Gd-DTPA intratympanic injection, we performed 3D-FLAIR and 3D-IR imaging at 3T. MRI region of interest signal intensity was used to determine the diffusion of Gd-DTPA into the perilymphatic fluid spaces over time. Results: Five of five in normal group, using 3D-IR MRI after Gd injection, had enhanced imagings (perilymphatic spaces) of inner ears. Five of five in patients group, using 3D-IR after Gd injection, had enhanced perilymphatic spaces and non-enhanced endolymphatic hydrops. Conclusions: Delayed contrast imaging of the inner ear with 3D-IR MRI after Gd-DTPA intratympanic injection revealed in vivo visualization of endolymphatic hydrops. Key words: Endolymphatic hydrops, 3D-FLAIR MRI, Gd-DTPA, Intratympanic injection

Multicenter study on the treatment pattern of Ménière’s disease in Korea: Sung Kwang Hong, Eui Kyung Koh, Kyu Sung Kim, Kyoung Ho Park, Hong Ju Park, Seong Ki Ahn, Joong Ho Ahn, Won Sang Lee, Gi Jung Im, Jae Yun Jung, Won Ho Chung, Gyu Cheol Han, Sung Won Chae, Ja Won Koo; J Korean Bal Soc. 2008;7(2):174-181.

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Abstract PDF: Background and Objectives: It is hard to determine the efficacy of several treatment options of Ménière’s disease since dynamic course of the disease and diverse rate of recurrence. Few modalities are regarded as ‘effective’ in the viewpoint of evidence based medicine. Study was conducted to know the current status of treatment options for Ménière’s disease. Materials and Methods: A multicenter survey was conducted using questionnaires to collect information on current status of treatment patterns in Ménière’s disease. The questionnaire answered by neurotologic surgeons working at 12 institutes in Korea was analyzed. Results: Low salt diet was always instructed to their patients, but 8 out of 12 responders (67%) did not emphasis on the amount of dietary salt. Duration of pharmacotherapy was ranged from 3 to 12 months. Intratympanic steroid injection was performed in 8 institutes (67%). Every institute agreed on the role of intratympanic gentamicin application. Treatment options for intractable patients were asked. Endolymphatic sac surgery, intratympanic steroid, Meniette device and intratympanic aminoglycoside injection were answered in patients who hope to preserve residual hearing. On the contrary, in patients without serviceable hearing, intratympanic jnjection of aminoglycosides (9/12, 75%) dominated as the next treatment option. Conclusions: Most institutes provide similar patterns of practice in medical treatment. The application of intratympanic aminoglycoside is also agreed in intractable patients without serviceable hearing. However, thoughts about the role and detailed methods of the surgical and adjunctive treatment options were not agreed, especially in intractable patients with good hearing. Further clinical studies and discussions would be necessary to provide consensus for the best treatment of Ménière’s disease in Korea. Key words : Ménière’s disease, Pharmacotherapy, Surgery, Aminoglycosides

Subjective Visual Vertical during Eccentric Rotation in Acute Vestibular Neuritis Patients: Kee Hwan Kwon, Moon Suh Park, Jae Yong Byun; J Korean Bal Soc. 2008;7(2):182-187.

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Abstract PDF: Background and objective: By assessing unilateral utricular function at the acute unilateral vestinuloneuritis (Acute UVN), we sought to determine the ability of the subjective visual vertical (SVV) during eccentric rotation (dynamic SVV) in localizing the site of the lesion in unilateral vestibular neuritis (UVN). Methods: The static SVV and dynamic SVV of fifteen patients diagnosed with acute UVN were enrolled within 10 days of onset (average 7 days). First, the static SVV was measured in a dark booth without rotation. The dynamic SVV was measured during rotation with an eccentric displacement of the head to 3.5 cm from the vertical rotation axis during a constant velocity of 300°/s. Results: In the acute stage of UVN, the static SVV showed an increase in deviation to the side of the lesion compared to those of normal subjects. Also, we found 73% of abnormal findings in Acute UVN patients by assessing static conventional SVV. The dynamic SVV had a statistically significant increase in deviation to the side of the lesion compared to those of normal subjects and 93% patients showed beyond normal range. Conclusions: The dynamic SVV would be an effective method in the diagnosis and localization of acute unilateral vestibularneuritis, Key words: Acute vestibular neuritis, Subjective visual vertical, Eccentric rotation

A Mathematical Consideration on the Dix-Hallpike maneuver: Sung Wan Byun; J Korean Bal Soc. 2008;7(2):188-192.

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Abstract PDF: Background and Objectives: At the beginning of the Dix-Hallpike maneuver, one of the two functional pair planes of the vertical canals is presumed to lie in the sagittal plane. However, this presumption is not correct. This paper aims to describe this problem more clearly and speculate on clinical implications. Mathematical and theoretical reasoning will be discussed. Materials and Methods: Two sets, each composed of three perpendicular planes, were modeled for simplified semicircular canals in the anatomical position with a 3D modeler. After a yaw rotation of 45°, the surface normal of the vertical canal plane is compared with that of the true sagittal plane. Results: The angle between the two normals was approximately 21.1 degrees. The theoretical vertical canal plane did not lie in the sagittal plane at the beginning position of Dix-Hallpike maneuver. Conclusions: More exact Dix-Hallpike maneuvers may require a roll tilting about 20° toward the affected side. Key words: Benign paroxysmal positional vertigo, Dix-Hallpike maneuver, Semicircular canals

Effects of Changes of Plateau and Rise/Fall Times on Ocular Vestibular Evoked Myogenic Potentials: Yeo Jin Lee, Soo Hee Han, Eun Jung Ha, Yong Soo Jung, Hi Boong Kwak, Mun Su Park, Jung Eun Shin, Hong Ju Park; J Korean Bal Soc. 2008;7(2):193-196.

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Abstract PDF: Background and Objectives: The ocular vestibular evoked myogenic potential (OVEMP) is a recently discovered test of labyrinthine function, analogous to the cervical VEMP. Recent works have demonstrated the existence of OVEMPs, which likely reflect otolith-ocular reflex. The purpose of this study was to identify the optimal plateau and rise/fall times of short tone bursts to detect OVEMPs in healthy subjects. Materials and Methods: Thirteen healthy subjects (26 ears) were included in this study. Surface electromyographic activity was recorded from active electrodes placed inferior to each eye. Stimulation with 500 Hz short tone bursts was used. We used a variety of plateau and rise/fall times. Three different plateau times (1, 2, and 3 ms) and rise/fall times (0.5, 1, and 2 ms) were used. The incidence, amplitudes and latencies were compared. Results: VEMP responses were clearly observed in all 26 ears at the plateau time of 2 ms and two rise/fall times (0.5 and 1 ms). The amplitudes in the individual ears tested were lower at the rise/fall time of 2 ms than at the other conditions. The amplitudes were lower at the plateau time of 3 ms compared to the other conditions. When the rise/fall time was prolonged from 0.5 to 2 ms, the n1 and p1 latencies were prolonged in parallel. However, there was no such change in latencies according to the plateau times. Conclusions: Our findings show that the ideal stimulation pattern for evoking OVEMP is at the rise/fall times of 0.5 or 1 ms and the plateau time of 2 ms. The waveform morphology of the VEMP responses observed with this stimulation pattern was simultaneously the most constant and marked. Key words: Evoked potentials, Ocular VEMP, Vestibulo-ocular reflex, Otolith

Two Cases of Methyl Bromide Intoxication Mimicking Bickerstaff’s Brainstem Encephalitis: Jin Young Seo, Byoung Soo Shin, Man Wook Seo, Young Hyun Kim, Sun Young Oh; J Korean Bal Soc. 2008;7(2):199-203.

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Abstract PDF: Background: Methyl bromide is toxic to the central and peripheral nervous systems. Two patients with occupational exposure to this agent are described. Case: Two cases of previously healthy young men were involved. They had worked in a fumigating plant spraying fruits using methyl bromide for several months before admission. They showed general weakness, severe ataxia, bilateral dysmetria and bilateral lateral gaze limitation. And gaze-evoked nystagmus was observed in one of them. Brain MRI showed symmetrically increased signal intensity lesions including the brainstem, cerebellum and splenium of corpus callosum. After conservative treatment, they gradually improved over the next few weeks. Conclusions: Symmetry and topography of our patients’ clinical and radiographic abnormalities support the proposal that methyl bromide exposure can produce symptoms similar to Bickerstaff’s brainstem encephalitis. Key words: Methyl bromide, Acute intoxication, Bickerstaff’s brainstem encephalitis

Bilateral Internuclear Ophthalmoplegia Following Spontaneous Subarachnoid Hemorrhage: Se Jin Oh, Kwang Dong Choi, Dae Soo Jung; J Korean Bal Soc. 2008;7(2):204-206.

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Abstract PDF: A 44-year-old woman presented with horizontal diplopia 2 days after spontaneous subarachnoid hemorrhage. Neurological examination disclosed bilateral internuclear ophthalmoplegia and neck stiffness. Neurovascular imagings documented subarachnoid and intraventriclar hemorrhage with an aneurysm arising from the left superior cerebellar artery, and vasogenic edema in the bilateral pontomesencephalic junction. Parenchymal vasogenic edema due to microvascular damage may give rise to bilateral internuclear ophthalmoplegia during the acute stage of spontaneous subarachnoid hemorrhage. Key words: Bilateral internuclear ophthalmoplegia, Spontaneous subarachnoid hemorrhage, Vasogenic edema

Bilateral Vestibular Hypofunction Induced by Unilateral Herpes Zoster Oticus: Sung Won Chung, Jae Yun Jung, Chung Ku Rhee, Myung Whan Suh; J Korean Bal Soc. 2008;7(2):207-212.

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Abstract PDF: Herpes zoster oticus usually accompanies vestibulopathy on the ipsilateral ear. However we have encountered two herpes zoster oticus patients with bilateral vestibulopathies. Bilateral vestibulopathy was detected on the 2nd month and 19th day of herpes zoster oticus, respectively. While the contralateral vestibulopathy was detected 2 month after the ipsilateral vestibulopathy in the first patient, the vestibular function deteriorated simultaneously on the 19th day in the second patient. It seems that the bilateral vestibulopathy was caused by an autoimmune process in both cases, but the initiating event is different. The ipsilateral vestibular damage may have sensitized the immune system in the first patient resulting in sympathetic vestibulopathy. But in the second patient, the ipsilateral cochlear damage may have sensitized the immune system resulting in simultaneous bilateral vestibulopathy. Key words: Herpes zoster oticus, Bilateral vestibulopathy, Autoimmune, Sympathetic vestibulopathy

A Case of inferior vestibular schwannoma which was lately diagnosed due to normal hearing level: Chang Jae Choi, Hyung Jin Chun, Hak Chun Lee, Sung Won Chae; J Korean Bal Soc. 2008;7(2):213-217.

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Abstract PDF: Vestibular schwannoma is a benign tumor arising from the Schwann cells in the vestibular nerve. It causes unilateral hearing loss, tinnitus, vertigo and unsteadiness. The most common symptom is reduced hearing on the affected side. In most cases patients present complaining of hearing impairment or vertigo from which the otologist can get a clue to diagnose vestibular schwannoma. We experienced an unusual case of 45-year-old woman presented with recurrent mild dizziness without any hearing loss so the patient initially diagnosed with recurrent vestibulopathy. However, subsequent neurotologic evaluation and posterior fossa MRI scanning confirmed diagnosis of huge vestibular schwannoma originated from inferior vestibular nerve. Key words: Vestibular schwannoma, Dizziness, Hearing loss, Auditory brainstem response

Recurrent Dizziness of Cardiac Origin Confirmed by Holter Monitoring: Seung Ho Shin, Kyu Sung Kim, Hoseok Choi, Seong Hye Choi; J Korean Bal Soc. 2008;7(2):218-221.

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Abstract PDF: Ineffective cerebral perfusion by low cardiac output may cause various types of dizziness like mild lightheadedness, vertigo or presyncope, and sometimes it can be the only heralding symptom. Differential diagnosis with other causes of dizziness is important because the symptom may progress into life-threatening bradyarrythmia and loss of consciousness. There are several literatures that reporting the association between cardiac disease and dizziness and their improvement with treatment of cardiac problem including pacemaker placement. But these are only indirect evidences to explain the cause-symptom relationship. We experienced 48-year old woman who has had recurrent dizziness of rotatory type lasting for about 5 seconds since first year, and then diagnosed atrioventricular block after. She has been having anti-hypertension medications for 2 years. She didn’t have any abnormalities in electrocardiography, chest x-ray, or routine blood tests. There were no abnormalities in vestibular function test and electronystgmography. Her result of 24-hour Holter monitoring clearly elucidated temporal relationship between arrhythmia and her episodic symptoms of dizziness. The authors report a case with review of literatures about cardiogenic dizziness. Key words: Dizziness, Syncope, Arrhythmias, Cardiac, Electrocardiography, Ambulatory

Neuro-otological aspects of cerebellar stroke: Hyung Lee; J Korean Bal Soc. 2008;7(2):227-227.

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Regional Distribution of 5-HT1A, 1B, and 1D Receptors in Rat Vestibular Nuclei (Vn) and Inner Ear: Seong Ki Ahn, Carey D Balaban; J Korean Bal Soc. 2008;7(2):228-228.

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Acute spontaneous vertigo: Sung Won Chae; J Korean Bal Soc. 2008;7(2):231-238.

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Recurrent Spontaneous Vertigo: Kyu Sung Kim; J Korean Bal Soc. 2008;7(2):239-243.

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