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Volume 9 (3); September 2010
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Review
Original Articles
Clinical Study of Benign Paroxysmal Positional Vertigo
Chang Hee Bae, In Hyo Lee, Dong Yook Park, Jung Eun Kim, Hyuk Soon Chang, Dong Wook Kim
Res Vestib Sci. 2010;9(3):93-99.
  • 1,754 View
  • 19 Download
AbstractAbstract PDF
Background and Objectives: Benign paroxysmal positional vertigo (BPPV) was the most frequent peripheral type vertigo. It has been well controlled with canalith repositioning procedure. Canalith repositioning procedure provides rapid and long-lasting relief of symptoms in most patients with BPPV. However, some patients express nonspecific symptoms such as anxiety or discomfort after canalith repositioning procedure, even after the disappearance of nystagmus and vertigo. The purpose of this study is to assess type distribution of BPPV and relationship between recurrence and subjective residual dizziness after canalith repositioning procedure in patients. Materials and Methods: Ninety-five BPPV patients of 501 patients with dizziness who visited Dizziness Clinic in the Department of Otolaryngology at Soonchunhyang University Hospital from July 2005 to June 2008 were included in this study. These patients were retrospectively reviewed based on clinical charts. In the case of BPPV, repositioning procedure was performed. We analyzed the recurrence, the relationship between recurrence and subjective residual dizziness after canalith repositioning procedure. Results: Overall recurrence rate was 13.6%. Lateral canal origin was more common than posterior canal origin. All cases except 1 were recovered by canalith repositioning procedure. There was no correlation between recurrence and origin, type, subjective residual dizziness of patients. Conclusion: Patients showed various origin, type and recurrence. After the successful canalith repositioning procedure, residual subjective symptoms of patients were presented sometimes, but was no relation to recurrence. Thus, additional follow up and emotional management may be needed.
New Views of the Translational Vestibulo-ocular Reflex in Healthy Human Subjects and in Patients with Neurological Disease who Fall
R John Leigh, Ke Liao, Jae Il Kim
Res Vestib Sci. 2010;9(3):100-107.
  • 1,710 View
  • 13 Download
AbstractAbstract PDF
Background and Objectives: The vestibulo-ocular reflexes (VOR) act a short latency to optimize vision during locomotion. The angular VOR (aVOR) has been widely studied in human subjects and preserves clear, stable vision during rotational head perturbations by generating eye movements that hold the line of sight on the target of interest. Less is known about the properties of the linear or translational VOR (tVOR), mainly due to technical difficulties posed by testing head or body translations. Geometric considerations indicate that different properties should be expected of tVOR, which can only provide stable vision of objects lying in one depth plane. Materials and Methods: We studied the human tVOR using a moving platform to translate normal human subjects vertically at frequencies similar to those occurring during locomotion. We found that, whereas aVOR is concerned with holding retinal images fairly stable to optimize clear vision, tVOR seems best suited to minimize relative motion of retinal images belonging to objects lying in different depth planes-and thereby to optimize motion parallax information. We also investigated whether the tVOR functioned abnormally in patients with neurological disorders causing falls-progressive supranuclear palsy (PSP) and cerebellar ataxia. Results: Both groups of patients showed impaired ability to modulate their tVOR during viewing of near targets; in PSP this might be attributed to failure of convergence, but cerebellar patients failed to modulate tVOR at near despite intact convergence. Conclusion: In both disorders, an impaired ability to adjust tVOR for viewing distance points to central disturbance of otolithic vestibular reflexes, which may also contribute to postural instability.
Prediction of Successful Repositioning of Horizontal Canal Benign Positional Vertigo in Gufoni’s Maneuver: A Preliminary Study
Jeong Soo Moon, Jong Wook Shin, Hyun Jung Kim, In Chul Baek, Eung Seok Oh, Ji Eun Oh, Kyung Jae Lee, Ji Hee Lee, Jae Moon Kim, Seong Hae Jeong
Res Vestib Sci. 2010;9(3):108-113.
  • 1,790 View
  • 16 Download
AbstractAbstract PDF
Background and Objectives: Although several methods of repositioning maneuver have been introduced for the benign paroxysmal positional vertigo involving horizontal canal (HC-BPPV), no study has investigated the nystagmus pattern during the repositioning maneuver and its correlation with the repositioning results. Therefore, we evaluated the predictive value of the nystagmus for successful repositioning by studying the nystagmus pattern during the position of the Gufoni’s maneuver. Materials and Methods: Seventeen consecutive patients (age range=36~76 years, median age=64), with a diagnosis of HC-BPPV were recruited between July and August 2010. The Gufoni's maneuver for apogeotropic and geotropic nystagmus was performed. After 30 minutes, the treatment outcome was evaluated according to the nystagmus pattern at the individual stage of Gufoni’s maneuver. Successful treatment was defined by the resolution of positional vertigo in geotropic HC-BPPV and nystagmus shifted from apogeotropic to geotropic in apogeotropic HC-BPPV. Results: In the successfully treated patients, 4 of 6 patients had the contralesional nystagmus between 1st and 2nd position of Gufoni’s maneuver. Ipsilesional nystagmus in 1st position of Gufoni’s maneuver was observed in 1 patient with apogeotropic nystagmus. And the other 1 patient with Geotropic HC-BPPV showed no nystagmus in 2nd position after contralesional nystagmus in 1st position of Gufoni’s maneuver. Unsuccessfully treated 11 patients had a conversion of nystagmus direction in 2nd position after 1st step. Conclusion: During the 2nd position of the Gufoni’s maneuver, a nystagmus toward unaffected side predicts a successful repositioning, whereas reversed nystagmus is suggestive of poor response to repositioning.
Case Reports
Nystagmus in the Ictal Period of Vertebrobasilar Insufficiency
Kun Woo Kim, Chang Min Lee, Jae Yun Jung, Myung Whan Suh
Res Vestib Sci. 2010;9(3):114-117.
  • 1,726 View
  • 24 Download
AbstractAbstract PDF
The nystagmus of vertebrobasilar insufficiency (VBI) patients is not clearly understood. In this article we report a videonystagmography (VNG) result which had been recorded in a VBI patient during his ictal period. The spontaneous nystagmus was purely torsional toward the left side. During the various positional tests, up beating left torsional and right horizontal nystagmus was found. Right beating horizontal nystagmus was stronger when the head was turned to the left side. But we were not able to explain the exact mechanism of this nystagmus. Although the mechanism is not fully understood the pattern of nystagmus reported in this article may be helpful in distinguishing VBI from other diseases by means of VNG recording.
A Case of Lermoyez’ Syndrome
Jeong Seok Choi, Seung Ho Shin, Hoseok Choi, Kyu Sung Kim
Res Vestib Sci. 2010;9(3):118-120.
  • 6,475 View
  • 167 Download
AbstractAbstract PDF
Lermoyez’s syndrome is usually regarded as a rare variant of Meniere’s disease which is characterized by the disappearance of aural symptoms after vertiginous attacks. It is recognized as an uncommon paroxysmal clinical syndrome caused by pathological endolymphatic change in the labyrinth. It is thought that the cause of Lermoyez’s syndrome is due to cochlea hydrops which result from endolymphatic blockage of the ductus reunions. With its distinct characteristic manifestations, the diagnosis is not difficult, but Lermoyez’s syndrome has been rarely reported universally. Otologists are in a whirl about its rare occurrence. We report a unique case of a 46-year-old woman, who showed typical clinical features of Lermoyez’s syndrome with review of literatures. We focused on the sequential clinical change during our observation.

Res Vestib Sci : Research in Vestibular Science