Research in Vestibular Science

Most read articles are from the articles published during the past two years (2022~).

Review

The Interaction of Hypertension for Vertigo in Audiovestibular Medicine Clinic: Adaobi Elizabeth Osuji; Res Vestib Sci. 2022;21(2):29-39. Published online June 15, 2022; DOI: https://doi.org/10.21790/rvs.2022.21.2.29

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Abstract PDF: As the first audiovestibular medicine physician in the University of Port Harcourt Teaching Hospital, Nigeria, a keen observation revealed that a sizeable proportion of the adult patients presenting to our audiovestibular medicine clinic with vertigo are either known hypertensives, or hypertensives yet to have a formal diagnosis. This aroused an ardent curiosity to find the raison d’être, and to shed light on this pathological association between vertigo and hypertension. In line with this, it became imperative to highlight the dynamics of interaction, and pathophysiology behind the role of hypertension in vertigo.

Review Article

Smartphones versus goggles for video-oculography: current status and future direction: Pouya Barahim Bastani, Shervin Badihian, Vidith Phillips, Hector Rieiro, Jorge Otero-Millan, Nathan Farrell, Max Parker, David Newman-Toker, Ali Saber Tehrani; Res Vestib Sci. 2024;23(3):63-70. Published online September 15, 2024; DOI: https://doi.org/10.21790/rvs.2024.009

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Abstract PDF: Assessment of eye movements is the cornerstone of diagnosing vestibular disorders and differentiating central from peripheral causes of dizziness. Nonetheless, accurate assessment of eye movements is challenging, especially in the emergency department and primary care settings. To overcome this challenge, clinicians objectively measure eye movements using devices like video-oculography (VOG) goggles, which provide a video recording of the eye and quantified eye position traces. However, despite the value of VOG goggles in studying eye movements, barriers such as high prices and the need for dedicated operators have limited their use to subspecialty clinics. Recent advancements in the hardware and software of smartphones have positioned them as potential alternatives to VOG goggles that can reliably record and quantify eye movements. Although currently not as accurate as VOG goggles, smartphones can provide a cheap, widely available tool that can be used in various medical settings and even at home by patients. We review the current state and future directions of the devices that can be used for recording and quantifying eye movements.

Case Reports

Horizontal nystagmus with velocity-increasing waveforms in delayed post-hypoxic leukoencephalopathy: a case report: Eugene Jung, Suk-Min Lee, Seo-Young Choi, Kwang-Dong Choi; Res Vestib Sci. 2024;23(3):111-113. Published online September 15, 2024; DOI: https://doi.org/10.21790/rvs.2024.016

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Abstract PDF Supplementary Material: Abnormal eye movements in unconscious patients serve as crucial diagnostic instruments, offering insights into the function of the central nervous system. Understanding these movements can aid in diagnosing the cause of unconsciousness, localizing brain lesions, and predicting outcomes. We report a patient who presented with spontaneous horizontal nystagmus unaffected by light in delayed post-hypoxic encephalopathy. Video-oculography showed exponentially increasing slow phases, with an amplitude ranging from 3° to 9° and a frequency of 0.5 Hz. Based on the results of oculography and neuroimaging, persistent horizontal nystagmus in our patient may be ascribed to an unstable neural integrator, possibly caused by disrupted cerebellar feedback mechanisms for horizontal gaze holding.

A case of vertebrobasilar dolichoectasia manifesting as sudden sensorineural hearing loss with vertigo: Young Jae Lee, Wonyong Baek, Gi-Sung Nam; Res Vestib Sci. 2024;23(1):32-36. Published online March 15, 2024; DOI: https://doi.org/10.21790/rvs.2024.004

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Abstract PDF: Vertebrobasilar dolichoectasia (VBD) is a rare vascular condition characterized by the elongation, widening, and tortuosity of the vertebrobasilar artery. It can lead to various symptoms due to compression of cranial nerves and brainstem structures. We report a rare case of VBD presenting as sudden sensorineural hearing loss (SSNHL) with vertigo and spontaneous downbeat nystagmus in a 65-year-old woman with a history of hypertension. Magnetic resonance imaging revealed a tortuous and dilated right vertebrobasilar artery compressing the brainstem and left 8th cranial nerve root entry zone, without signs of acute cerebellar stroke. The compression of the anterior inferior cerebellar artery and cervicomedullary junction was also noted, suggesting a vascular cause for her symptoms. Following high-dose steroid treatment, the patient showed significant hearing improvement. This case underscores the importance of considering VBD in patients with unexplained SSNHL and vertigo, highlighting the role of detailed vascular imaging in the diagnosis and management of such cases.

Fluctuating high-frequency hearing loss with vertigo: is it Menière’s disease? A case report: Minho Jang, Dong-Han Lee, Jiyeon Lee, Chang-Hee Kim; Res Vestib Sci. 2024;23(3):106-110. Published online September 15, 2024; DOI: https://doi.org/10.21790/rvs.2024.011

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Abstract PDF Supplementary Material: This study describes an unusual case of fluctuating unilateral high-frequency hearing loss with vertigo resembling Menière’s disease. The current diagnostic criteria for definite Menière’s disease include audiometrically documented low- to medium-frequency sensorineural hearing loss on at least one occasion before, during, or after an episode of vertigo. This case presented a diagnostic dilemma. Brain MRI was nonspecific, and a bithermal caloric test showed unilateral weakness of 44% on the affected side. The results of electrocochleography and cervical vestibular evoked myogenic potential tests were within the normal ranges. Persistent geotropic or ageotropic positional nystagmus was observed during each vertigo attack; the mechanism underlying this characteristic nystagmus needs further investigation.

A Rare Case of Isolated Infarcts of the Pons with Sudden Vertigo: Clinical Features and Imaging Findings: Dong Hwan Kwon, Eun kyung Jeon, Young Joon Seo; Res Vestib Sci. 2023;22(3):89-94. Published online September 15, 2023; DOI: https://doi.org/10.21790/rvs.2023.22.3.89

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Abstract PDF: Isolated infarcts of the pons (IIP) are a rare subtype of ischemic stroke, accounting for less than 1% of all strokes. It refers to a specific type of ischemic stroke that occurs within the pons region of the brain. IIP can be associated with vertebrobasilar insufficiency in certain cases. This case report describes a 64-year-old female patient who presented with acute vertigo and spontaneous nystagmus to the lesion side, ultimately diagnosed with IIP in the posterior right side of pons. Tegmental pontine infarcts typically manifest as oblique small (lacunar) infarctions that are localized in the mediolateral tegmental area of the middle to upper pons. The patient’s symptoms resolved spontaneously, but a 2-mm infarct was confirmed by brain diffusion magnetic resonance imaging. This case highlights the distinctive symptoms associated with IIP and emphasizes the importance of careful neurological examination and advanced neuroimaging techniques for accurate diagnosis.

Review Article

Virtual reality simulators for temporal bone dissection: overcoming limitations of previous models: Temuulen Batsaikhan, Young Joon Seo; Res Vestib Sci. 2024;23(1):1-10. Published online March 15, 2024; DOI: https://doi.org/10.21790/rvs.2024.002

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Abstract PDF: Temporal bone dissection is a critical skill for otolaryngology trainees: however, it is challenging to master due to the complex anatomy and limited exposure to cadaveric specimens. The aim of this review was to develop and evaluate a novel virtual reality (VR) simulator for temporal bone dissection, addressing the limitations of previous simulators reported in the literature. A comprehensive literature search was conducted in the PubMed, Embase, and Cochrane Library databases from inception to September 2022. The search was limited to studies that evaluated the effectiveness of VR simulators for temporal bone dissection. The quality of the included studies was assessed using the Cochrane Risk of Bias Tool. The results showed that VR simulators can significantly improve temporal bone dissection skills, including anatomical knowledge, instrument handling, and surgical performance. Compared to traditional training methods, VR simulation was associated with faster learning curves, better retention of skills, and greater confidence among trainees. However, some limitations of current VR models were identified, including the lack of haptic feedback, limited realism, and short duration of practice. VR simulators are a valuable adjunct to traditional methods for temporal bone dissection training. The recently developed VR simulator addressed the limitations of previous simulators and demonstrated its potential to enhance the training of clinicians in temporal bone dissection. Future directions for research include further validation of the simulator and exploration of its potential for use in clinical settings.

Review

Light Cupula: Recent Updates: Dong-Han Lee, Chang-Hee Kim; Res Vestib Sci. 2023;22(2):23-33. Published online June 15, 2023; DOI: https://doi.org/10.21790/rvs.2023.22.2.23

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Abstract PDF: Benign paroxysmal positional vertigo (BPPV) is the most common cause of positional vertigo and nystagmus. Direction-changing positional nystagmus (DCPN), which refers to the change in the direction of nystagmus with different head positions, is a well-known characteristic of horizontal semicircular canal BPPV. The supine head roll test is commonly used to diagnose horizontal canal BPPV. However, persistent geotropic DCPN observed during this test cannot be explained by conventional mechanisms of canalolithiasis or cupulolithiasis. The concept of a “light cupula” has been proposed to account for this unique nystagmus. In this review, we summarize the historical background, clinical features and diagnostic methods, presumed mechanisms, and treatment approaches of the light cupula phenomenon based on the available literatures up to date.

Original Article

Auto-Pattern Recognition for Diagnosis in Benign Paroxysmal Positional Vertigo Using Principal Component Analysis: A Preliminary Study: O-Hyeon Gwon, Tae Hoon Kong, Jaehong Key, Sejung Yang, Young Joon Seo; Res Vestib Sci. 2022;21(1):6-18. Published online March 15, 2022; DOI: https://doi.org/10.21790/rvs.2022.21.1.6

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1 Crossref

Abstract PDF

Objectives
The aim of this study was to develop a filtering algorithm for raw nystagmus images and a diagnostic assistive algorithm using a principal component analysis (PCA) to distinguish the different types of benign paroxysmal positional vertigo (BPPV).
Methods
Fifteen video clips of clinical data with typical nystagmus patterns of BPPV (13 cases) and with normal nystamgmus (two cases) were preprocessed when applied the thresholding, morphology operation, residual noise filtering, and center point extraction stages. We analyzed multiple data clusters in a single frame via a PCA; in addition, we statistically analyzed the horizontal and vertical components of the main vector among the multiple data clusters in the canalolithiasis of the lateral semicircular canal (LSCC) and the posterior semicircular canal (PSCC).
Results
We obtained a clear imaginary pupil and data on the fast phases and slow phases after preprocessing the images. For a normal patient, a round shape of clustered dots was observed. Patients with LSCC showed an elongated horizontal shape, whereas patients with PSCC showed an oval shape at the (x, y) coordinates. The scalar values (mm) of the horizontal component of the main vector when performing a PCA between the LSCC- and PSCC-BPPV were substantially different (102.08±20.11 vs. 32.36±12.52 mm, respectively; p=0.0012). Additionally, the salar ratio of horizontal to vertical components in LSCC and PSCC exhibited a significant difference (16.11±10.74 mm vs. 2.61±1.07 mm, respectively; p=0.0023).
Conclusions
The data of a white simulated imaginary pupil without any background noise can be a separate monitoring option, which can aid clinicians in determining the types of BPPV exhibited. Therefore, this analysis algorithm will provide assistive information for diagnosis of BPPV to clinicians.

Citations

Citations to this article as recorded by

Development of An Algorithm for Slippage-Induced Motion Artifacts Reduction in Video-Nystagmography
Yerin Lee, Young Joon Seo, Sejung Yang
Research in Vestibular Science.2022; 21(4): 104. CrossRef

Review Article

Review on the impact of spaceflight stressors on the vestibular system: beyond microgravity to space radiation: Hui Ho Vanessa Chang, Kyu-Sung Kim; Res Vestib Sci. 2024;23(3):71-78. Published online September 15, 2024; DOI: https://doi.org/10.21790/rvs.2024.013

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Abstract PDF: Understanding the effects of microgravity on the vestibular system has been a primary focus of space research, driven by the need to counteract the often-debilitating impacts of altered gravity environments and maintain operational performance in space. Research using both space-based and ground-based models has identified structural and functional changes in the vestibular system, highlighting its significant capacity for sensorimotor adaptation. As human space exploration progresses towards missions beyond low Earth orbit for extended periods, additional stressors, such as space radiation, may impact the vestibular system. Early studies on space radiation using animal models and insights from radiotherapy have shown that the vestibular system is more vulnerable to radiation than previously understood. This paper provides a brief review of (1) dysfunctions in spatial orientation, gaze stabilization, posture, and locomotion observed in astronauts; (2) ground-based experiments on animals that likely explain these vestibular and sensorimotor dysfunctions; and (3) studies examining the effects of radiation on the vestibular system and its implications for vestibular function in space.

Original Article

Saccadic oscillations as a possible indicator of dizziness due to choline esterase inhibitors: an observational study with video-oculography: Ileok Jung, Moon-Ho Park, Ji-Soo Kim; Res Vestib Sci. 2024;23(3):101-105. Published online September 15, 2024; DOI: https://doi.org/10.21790/rvs.2024.015

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Abstract PDF Supplementary Material: Introduction: Cholinesterase inhibitors (ChEIs) are widely used to treat mild to moderate Alzheimer disease and vascular dementia. Even though dizziness due to medication of ChEIs has been ascribed to adverse effects on the cardiovascular or central nervous system, the mechanisms remain unclear and objective indicators are not available.
Methods
We recorded the eye movements using video-oculography in three patients who developed dizziness and unsteadiness after initiation or increment of ChEI, donepezil (Aricept).
Results
The patients showed frequent saccadic oscillations that improved after discontinuation of ChEI.
Conclusions
Frequent saccadic oscillations may be an indicator of dizziness in patients taking ChEIs.

Review Article

Treatment of hemodynamic orthostatic dizziness/vertigo: Hyun Ah Kim; Res Vestib Sci. 2024;23(3):79-88. Published online September 15, 2024; DOI: https://doi.org/10.21790/rvs.2024.017

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Abstract PDF: Orthostatic dizziness occurs when a person feels dizzy or lightheaded upon standing up. Hemodynamic orthostatic dizziness can result from autonomic dysfunction, such as orthostatic hypotension or postural tachycardia syndrome. The International Classification of Vestibular Disorders has established diagnostic criteria for hemodynamic orthostatic dizziness/vertigo. These criteria help clinicians understand the terminology associated with orthostatic dizziness/vertigo and differentiate it from dizziness caused by global brain hypoperfusion and other etiologies. Effective treatment involves interpreting the results of autonomic function tests, which can lead to improvements in orthostatic dizziness and help prevent falls related to this condition. This paper discusses general management strategies and specific treatments for orthostatic hypotension and postural tachycardia syndrome, highlighting the importance of tailored care based on the most recent clinical insights.

Original Articles

Clinical Outcomes of Endolymphatic Sac Decompression Surgery in Menière’s Disease: Hee Won Seo, Young Sang Cho, Won-Ho Chung; Res Vestib Sci. 2023;22(4):97-105. Published online December 15, 2023; DOI: https://doi.org/10.21790/rvs.2023.22.4.97

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Abstract PDF: Objectives
Endolymphatic sac decompression surgery (ESDS) is one of the surgical methods for intractable Menière’s disease (MD), and it is known as a relatively safe treatment that does not cause hearing loss. However, the effectiveness and the degree of vertigo control rate of ESDS are still controversial. In this study, we aimed to evaluate the clinical outcomes of ESDS in intractable MD.
Methods
We retrospectively reviewed 33 patients who underwent ESDS for intractable MD from January 2002 to March 2022. Clinical characteristics of patients, pure tone threshold, medical treatment method, and number of vertigo attacks before and after surgery were assessed. The improvement of hearing and vertigo was evaluated according to the 1995 American Academy of Otolaryngology-Head and Neck Surgery criteria.
Results
Of the 33 patients, the average follow-up period was 21.2 months, with immediate follow-up within 2 months (28 patients), short term between 2 and 6 months (27 patients), and long term at 12 months or later (29 patients). In the immediate hearing threshold, both air conduction and bone conduction showed slight deterioration, but there was no significant change in the long-term hearing threshold. At long-term follow-up, 12 patients (41.4%) were able to live without medication, and 18 patients (62.1%) showed improvement in their vertigo symptoms. In addition, patients who showed improvement in hearing also showed improvement in vertigo at the same time.
Conclusions
ESDS in intractable MD is a relatively safe and effective treatment method for reducing vertigo attack without worsening hearing threshold.

Quantifying the Prevalence of Acute Vestibular Neuritis through Big Data Analysis: Chul Young Yoon, Seulgi Hong, Ji-Yun Park, Young Joon Seo; Res Vestib Sci. 2023;22(3):68-76. Published online September 15, 2023; DOI: https://doi.org/10.21790/rvs.2023.22.3.68

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Abstract PDF Supplementary Material: Objectives
Big data analytics in healthcare research have gained momentum, offering unprecedented opportunities to investigate complex medical conditions like acute vestibular neuritis (AVN). However, an inappropriate definition can introduce bias and inaccuracies into prevalence estimation, making the results unreliable and hindering cross-study comparisons. The Health Insurance data in South Korea will be used to create a robust operational definition for AVN.
Methods
The study utilized the National Patients Sample dataset from the Health Insurance Review and Assessment Service (HIRA) of the Republic of Korea. The operational definition of AVN was defined using the HIRA data, which includes specific codes for diagnosis, testing, and medications. The revised categorization scheme for AVN was presented as case 1 through case 5, with criteria for each category.
Results
The optimal conditions are deemed to be those that encompass the outcomes of both case 5 and case 1-1, encompassing all conditions. The study also provided prevalence estimates for subgroups based on demographic factors (age, sex), and found a consistent pattern throughout all years, sex, and age.
Conclusions
The study analyzed the prevalence of AVN in case 1 and case 5, which were similar to the reference prevalence of 3.5 per 100,000 people reported in other countries. The study’s results are encouraging for several reasons, including the validity of the operational definitions used, and the agreement between the study’s prevalence estimates and the reference prevalence. The operational definition in statistics, in the context of big data, serves as a precise and standardized criterion.

Video

A Case of Vertebral Artery Compression Syndrome Showing Characteristic Nystagmus during Head Rotation: Eun-Ju Jeon; Res Vestib Sci. 2022;21(4):111-112. Published online December 15, 2022; DOI: https://doi.org/10.21790/rvs.2022.21.4.111

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PDF Supplementary Material

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