Research in Vestibular Science

Neurotological Aspect of Cerebellar Infarction: Hyung Lee; Res Vestib Sci. 2009;8(1):3-14.

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Changes in the Gastrointestinal Motility following Unilateral Labyrinthectomy: Jae Hee Lee, Gyoung Wan Lee, Suck Jun Choi, Eun Ho Park; Res Vestib Sci. 2009;8(1):15-22.

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Abstract PDF: Background and Objectives The temporal changes and the role of glutamate receptors in the recovery of vestibulogastrointestinal symptoms following unilateral labyrinthectomy (UL) were investigated in this study. Vestibulogastrointestinal symptoms were evaluated in terms of gastric emptying and intestinal transit. Materials and Methods Expression of the c-Fos protein was observed in the solitary tract nucleus (STN) and rostral ventrolateral medullary nucleus (RVLM). These were measured at 0.5, 2, 6 and 24 h following UL in rats. Results Gastric emptying and intestinal transit were significantly decreased for 6 h post UL and recovered to control levels within 24 h. Pretreatment of UL animals with MK-801 significantly increased the gastric emptying and intestinal transit. Bilateral labyrinthectomy significantly decreased the gastric emptying and intestinal transit compared to the intact labyrinthine animals but significantly increased when compared to UL animals. The expression of c-Fos protein was significantly increased in STN and RVLM compared to the control animals for 6 h post UL and recovered to control levels within 24 h. The expression was significantly decreased in animals that were pretreated with MK-801. Conclusion These results suggest that UL decreases the gastrointestinal motility, which recovers to control levels within 24 h post UL. Glutamate plays an important role in the recovery of vestibulogastrointestinal symptoms following UL. Key Words: Gastric emptying; c-Fos protein; Glutamate; Gastrointestinal Motility; Unilateral labyrinthectomy

Autoantibodies and Complements in Acute Peripheral Vestibulopathy: Mi Joo Kim, Joo Hyun Jung, Chang Hyun Cho, Jung Ho Lee; Res Vestib Sci. 2009;8(1):23-26.

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Abstract PDF: Background and Objectives The etiology and pathophysiology of acute peripheral vestibulopathy are largely unknown. The purpose of this study is to evaluate the manifestation of the autoantibodies and complements in patients with acute peripheral vestibulopathy. Materials and Methods We checked anti-ds-DNA, rheumatoid factor, anti phospholipid IgG and IgM, anti nuclear antibody (ANA), C3, C4 in 72 patients who were diagnosed as acute peripheral vestibulopathy on physical examination and the caloric test. The results of the patients with unilateral acute peripheral vestibulopathy were compared to those of the patients with bilateral acute peripheral vestibulopathy. Results Twelve patients (16.6%) in anti-ds-DNA, 4 patients (5.5%) in C3, 10 patients (13.8%) in C4, 2 patients (2.7%) in anti-phospholipid IgG and 13 patients (18%) in antinuclear antibody (ANA) showed abnormal findings among patients with acute peripheral vestibulpahty. There was no difference in the manifestation of the autoantibodies and complements between the patients with unilateral and bilateral acute peripheral vestibulopathy. Conclusion The autoimmune diseases may be one of etiologic factors in acute peripheral vestibulopathy. Key Words: Autoantibodies; Vestibular Neuronitis; Complement System Proteins

Assessment of Subjective Symptoms Using Dizziness Handicap Inventory in Patients with Vestibular Neuritis: Jin Yong Kim, Dong Gu Hur, Sea Yuong Jeon, Jin Pyeong Kim; Res Vestib Sci. 2009;8(1):27-31.

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Abstract PDF: Background and Objectives Vestibular neuritis (VN) is one of critical life events that can affect physical, emotional, and function aspects of quality of life. Most patients recover well from VN within 6 months following the onset of the disease. However, they can still interfere with their daily lives in some patient with VN. Dizziness Handicap Inventory (DHI) was developed to assess the self-perceived handicapping effects imposed by vestibular system diseases. The aim of study was to evaluate subjective symptoms among the pre-VN, at the time of onset of VN, and post-VN using DHI questionnaire, respectively. Materials and Methods Twenty patients with VN were asked to complete the DHI by mailed survey. Each of the DHI was scored. We also evaluated the relationship between the DHI scores and degree of the canal paresis on the caloric test. Results Almost every patients had substantially improved its subjective symptoms in 6 months after VN. There was no correlation between the canal paresis in the lesion ear and DHI scores at the time of VN. Conclusion The results of this study suggest that most patients recovery well from VN without any handicap, but the emotional support in combination with physical and/or functional rehabilitation should be required to provide early resumption of normal activity. Key Words: Vertigo; Vestibular Neuronitis; Questionnaires

Effect of Intratympanic Chemical Labyrinthectomy with Streptomycin on Auditory Symptoms: Hyun Su Kim, Sung Huhn Kim, Dae Bo Shim, Sang Cheol Kim, Won Sun Yang; Res Vestib Sci. 2009;8(1):32-36.

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Abstract PDF: Background and Objectives Background and Objectives: Intratympanic treatment with aminoglycosides for Ménière’s disease has been used, trying to eliminate vertigo complaints, while preserving hearing. This study was undertaken to evaluate the therapeutic outcomes for auditory symptoms in Ménière’s disease patients after intratympanic application with single low-dose streptomycin powder. Materials and Methods Ninty-eight patients diagnosed with definite Ménière’s disease who underwent chemical labyrinthectomy with streptomycin at Yonsei University Medical Center from March 1997 to June 2006 were enrolled. Low dose streptomycin powder (10 mg) was applied into the round window niche directly. Changes of hearing threshold, tinnitus and aural fullness were evaluated postoperatively according to Committee on Hearing and Equilibrium guidelines for the diagnosis and evaluation of therapy in Ménière’s disease of American Academy of Otolaryngology–Head and Neck Surgery. Results Hearing threshold was not changed significantly after the procedure (from 65.5±19.1 to 69.3±20.0 p>0.05) and was improved in 7% of the patients. Hearing deterioration after the procedure was detected only in 17%. Tinnitus and aural fullness was improved in 51% and 25% respectively. Conclusion Single application of streptomycin powder filling round window niche showed minimal deterioration of hearing threshold. It is the useful method to improve or prevent the progress of auditory symptoms in patients with Ménière’s disease. Key Words: Streptomycin; Hearing loss; Tinnitus; Meniere Disease; Aural fullness

Clinical Implication of Dissociation between Subjective Visual Horizontal and Subjective Visual Vertical: Tae Hyun Moon, Sung Hyen Bae, Il Kwon Cho, Myung Whan Suh, Chung Ku Rhee, Jae Yun Jung; Res Vestib Sci. 2009;8(1):37-42.

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Abstract PDF: Background and Objectives Subject visual vertical (SVV) and subject visual horizontal (SVH) is well known otolith function test. Patients with acute unilateral vestibular weakness fail to set the test bar within normal range in SVH/SVV showing abnormal deviation toward lesion side. In some cases, SVH and SVV are deviated towards different directions, and analysis of these findings is rarely reported. The authors analyzed correlation of SVH/SVV and other vestibular function tests in patients with various vestibular diseases. Materials and Methods From April 2005 to July 2007, total 234 patients who had admitted for dizziness were enrolled. All patients were divided in two groups, non-dissociation group (n=215) and dissociation group (n=19). Correlation of SVH, SVV, Videonystagmography (VNG), the rotating chair test was compared. Results 8.1% of patients showed dissociation between SVH and SVV. Clinical features did not showed significant difference between groups. In non-dissociation group, SVH/SVV showed correlation with VNG, rotating chair test. However in dissociation group, VNG and rotating chair test revealed high rate of consistency with deviation of SVH than that of SVV. Also direction of SVH and dizziness had higher consistency (88.9%) than that of SVV (11.1%). Conclusion The SVH showed consistency with other vestibular function test and may be more reliable than SVV when the result is dissociated. Key Words: Subjective visual vertical; Subjective visual horizontal; Dissociation

A Case of Selective Inferior Vestibular Neuritis Showing Normal Caloric Test: Eun Goo Kang, Kyu Rin Hwang, Jong Dae Lee, Ki Bum Sung; Res Vestib Sci. 2009;8(1):45-48.

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Abstract PDF: Vestibular neuritis is commonly diagnosed by demonstrating of peripheral vestibular failure as a unilateral loss of the caloric response. It is a sudden, spontaneous, unilateral loss of vestibular function without simultaneous hearing loss or brainstem signs. In most patients with vestibular neuritis, the process is thought to involve the superior vestibular nerve. Very rarely, vestibular neuritis involves only the inferior vestibular nerve. We experienced a 56-year-old male with inferior vestibular neuritis. The patient had vertigo and spontaneous nystagmus, but a normal caloric test. Brain magnetic resonance imaging was normal, while vestibular evoked myogenic potentials had absent amplitudes on the lesion side. The patient was thought to suffer from pure inferior nerve vestibular neuritis. Key Words: Vestibular neuronitis; Vestibular function tests

Periodic Alternating Nystagmus in Vestibulocochlear Disorder: Seong Hae Jeong, Eung Seok Oh, Ji Hee Lee, Jae Moon Kim; Res Vestib Sci. 2009;8(1):49-51.

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Abstract PDF: Periodic alternating nystagmus (PAN) is characterized by horizontal nystagmus that reverses direction periodically. PAN can occur in both congenital and acquired conditions. We report a 58-year old man with peripheral vertigo and hearing impairment showing PAN in darkness. Key Words: Vertigo; Hearing loss; Nystagmus, Pathologic; Meniere Disease

A Case of Lateral Medullary Syndrome with Ipsilesional Nystagmus due to Intramedullary Hemorrhage: Ki Bum Sung, Ji Yun Park, Sun Ah Park, Tae Kyeong Lee; Res Vestib Sci. 2009;8(1):52-55.

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Abstract PDF: We report a rare case of primary dorsal medullary hemorrhage showing lateral medullary syndrome with ipsilesional nystagmus. A 41-year woman, presented with the first degree horizontal vestibular nystagmus and ocular tilt reaction to the left in lateral medullary hemorrhagic lesion. Primary medullary hemorrhage is rare and details of the abnormal eye movement in the lesion have never been described well. While most of the reported vestibular nystagmus in the lateral medullary infarction was contralesional., the nystagmus in this case was ipsilesional. This ipsilesional beating of the nystagmus might be explained that either destruction of the rostral part of vestibular nuclei or irritative effect of blood to vestibular nuclei is responsible. In addition, ocular tilt reaction (OTR) can be more important in deciding the side of the lesion in medullary hemorrhage. Key Words: Lateral medullary syndrome; Medulla oblongata, Hemorrhage; Nystagmus, Pathologic

Recurrent Vertigo after Cochlear Implantation: Kyu Hee Han, Sung Kwang Hong, Chang Myeon Song, Ja Won Koo; Res Vestib Sci. 2009;8(1):56-59.

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Abstract PDF: Post-operative dizziness and vertigo have been variously reported from 30 to 60% after cochlear implantation. There have been reported that delayed vertigo is the most common type and characterized by similarities with dizziness in Meniere’s syndrome. Authors experienced a man who had delayed onset of vertigo, which developed six months after cochlear implantation on the left side. Postoperative left caloric response was decreased in both warm and cold stimulation. The direction of spontaneous nystagmus during spell was right side with torsional down beat and definite catch up saccades were observed during head thrust test on the plane of the left horizontal canal and posterior canal, which was resolved on the next day. These episodic and recurrent spells of vertigo might suggest that the hydropic changes of labyrinth corresponding to the pathology of Meniere’s disease occurred in this patient. Key Words: Vertigo; Cochlear implantation; Endolymphatic hydrops

Auditory Neuropathy Accompanying Unilateral Vestibulopathy: Hye Young Kim, Jae Yun Jung, Chung Ku Rhee, Myung Whan Suh; Res Vestib Sci. 2009;8(1):60-65.

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Abstract PDF: Auditory neuropathy is a term used to describe abnormal auditory brain stem response (ABR) in the presence of preserved cochlear outer hair cell functions which can be measured by otoacoustic emissions (OAE). We report a case of auditory neuropathy accompanying unilateral vestibular hypofunction and benign paroxysmal positional vertigo. The patient was a 50-year-old man who had experienced hearing loss and tinnitus which started two weeks ago. He had taken several medicines for the last few months due to his lung cancer and tuberculosis. ABR and OAE were checked and the results were compatible with auditory neuropathy. To evaluate his vestibular function, video nystagmography, rotatory chair and oculomotor test were checked. The results were compatible with left unilateral vestibular loss and left lateral canal cupulolithiasis. But the patient experienced nearly no vertigo during his daily life. As presented in this case, most of the auditory neuropathy patients do not complain of vertigo. This is probably due to long term central compensation or maybe due to the decreased nerve conduction of the vertiginous sensation. Vestibular evaluation may be crucial in order to detect masked vestibular dysfunction and to protect these patients from imbalance accidents. Key Words: Auditory neuropathy; Vestibular Neuronitis; Evoked Potentials, Auditory, Brain Stem; Otoacoustic Emissions

A Case of Cerebellopontine Angle Osteoma Causing Sudden Hearing Loss with Vertigo: Woo Jin Bae, Seung Hern Ha, Sun Min Park, Chang Woo Kim; Res Vestib Sci. 2009;8(1):66-69.

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Abstract PDF: Osteomas arising from the internal auditory canal (IAC) and locating in the cerebellopontine angle (CPA) are rare. These tumors may cause compression of the IAC with varying degree of hearing loss, vertigo, and tinnitus but sometimes asymptomatic. Here we present a 60-year-old female patient presented with a hearing loss of sudden onset in her right ear and recurrent dizziness of whirling type. Magnetic resonance imaging and computed tomography revealed CPA osteoma arising from the porus of the IAC. Osteomas should be considered as differential diagnosis in patients with sudden hearing loss and vertigo. Key Words: Osteoma; Cerebellopontine angle; Hearing Loss, Sudden

A Case of Sjögren’s Syndrome Presented with Vertigo as a Initial Manifestation: Ji Yun Park, Jong Dae Lee, Tae Kyeong Lee, Ki Bum Sung; Res Vestib Sci. 2009;8(1):70-73.

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Abstract PDF: Sjögren’s syndrome (SS) can shows various neurologic symptoms as it involves the central, peripheral and autonomic nervous system. However, CNS involvement as a initial manifestation is rare. We report a 21-year old woman who presented with vertigo, gait ataxia, and hiccup lasted about one month due to a discrete dosal medullary lesion in primary SS. The symptoms and lesions improved by the intravenous methylprednisolone therapy. Key Words: Sjogren’s Syndrome; Nystagmus, Physiologic; Nervous System Diseases

Acute Sensorineural Hearing Loss and Tinnitus with Aspirin: A Case Report: Hyun Cho, Jee Hyun Kwon, Hyun Jin Seo; Res Vestib Sci. 2009;8(1):74-76.

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Abstract PDF: Salicylate (aspirin) causes ototoxic side effects in some patients, such as bilateral mild to moderate sensorineural hearing loss and tinnitus although its ototoxic mechanisms still remain largely unclear. We report about one case with acute sensorineural hearing loss anf tinnitus after one week of low dose aspirin therapy. Audiogram revealed a mild sensorineural hearing loss at 35.0 dBHL in the right ear. Tinnitus became louder more and more, and sounded like a unilateral or bilateral high-pitch noise with each recurrence persisting for five minutes or longer. Audiologic problem of this case resolve within two or three days after the aspirin is discontinued. Generally, ototoxicity of salicylate manifests as bilateral, flat to high-frequency sensorineural hearing loss, and the risk of ototoxicity increases with higher doses and prolonged treatment course. But our case tend to suggest that symptoms of ototoxicity also might be occur in patients in even low dose salicylate with variable audiologic finding case tend to suggest that symptoms of ototoxicity also can occur in patients in even low dose salicylate use with variable audiologic finding. Further work on the relationships between plasma salicylate concentrations and ototoxicity is required. Key Words: Tinnitus; Sodium Salicylate; Hearing Loss, Sensorineural

The Past, Present and Future of Bionic Devices Restoring Cranial Nerve Function: Charles C Della Santina; Res Vestib Sci. 2009;8(1):81-82.

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