Research in Vestibular Science

Original Articles

Comparison of the outcomes of treatment with an oral diuretics with steroid and steroid only for acute low-tone hearing loss: a prospective randomized controlled trial: Seok Min Hong, Yeso Choi, Sung Min Park, Jae Yong Byun; Res Vestib Sci. 2024;23(3):95-100. Published online September 15, 2024; DOI: https://doi.org/10.21790/rvs.2024.012

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Abstract PDF: Objectives
This study aimed to compare the efficacy of a combined steroid and diuretic (isosorbide) treatment with that of steroid-only treatment in patients with acute low-tone sensorineural hearing loss (ALHL).
Methods
A total of 34 patients with ALHL were recruited between January 2018 and December 2019 and randomized into two groups: a steroid-with-diuretic (isosorbide) group and a steroid-only group. The steroid-with-diuretic group received oral methylprednisolone for 10 days and isosorbide for 14 days, while the steroid-only group received methylprednisolone for 10 days. Hearing outcomes were measured using pure-tone audiometry at 8 weeks posttreatment. The outcomes were the absolute hearing gain at low frequencies (125, 250, and 500 Hz) and the recovery rate, which was classified into complete, partial, unchanged, progressive, and fluctuating.
Results
Of 34 patients, 30 (15 in each group) were analyzed. No significant differences were observed in baseline characteristics between the groups. The steroid-with-diuretic group showed higher absolute hearing gains at all three low frequencies than the steroid-only group, but the differences were not statistically significant complete recovery was observed in 13 patients in each group, with partial recovery in two patients in the steroid-with-diuretic group and unchanged outcomes in two patients in the steroid-only group. No patient exhibited disease progression.
Conclusions
Although combined steroid and diuretic therapy yielded better hearing outcomes than steroid-only therapy, the differences were not statistically significant. Further studies with larger sample sizes and extended follow-up periods are necessary to confirm these findings.

Prevalence and preferred medication for vestibular migraine in Menière’s disease: a multicenter retrospective cohort study in Korea: Dong-Han Lee, Hong Ju Park, Kyu-Sung Kim, Hyun Ji Kim, Jae-Yong Byun, Min-Beom Kim, Minbum Kim, Myung-Whan Suh, Jae-Hyun Seo, Jong Dae Lee, Eun-Ju Jeon, Myung Hoon Yoo, Seok Min Hong, Sung-Kwang Hong, Hyo-Jeong Lee, Jung Woo Lee, Se-Joon Oh, Hyun Ah Kim, Hyung Lee, Eek-Sung Lee, Eun-Jin Kwon, Seong-Hae Jeong, Jeong-Yoon Choi, Chang-Hee Kim; Res Vestib Sci. 2024;23(2):37-45. Published online June 14, 2024; DOI: https://doi.org/10.21790/rvs.2024.005

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Abstract PDF Supplementary Material: Objectives
The aim of this study is to categorize headaches associated with definite Menière’s disease (MD) according to diagnostic criteria, to determine their prevalence, and to investigate the preferred medication across participating centers.
Methods
Patients diagnosed with definite MD at 17 university hospitals in otolaryngology or neurology departments in Korea between January 1, 2021 to December 31, 2021 were retrospectively included. Data on the presence of accompanying vestibular migraine (VM), migraine or non-migraine headaches, and clinical information were collected. A survey was conducted to assess preferences for treatment drugs for vertigo and headache control in MD patients with headache.
Results
A total of 435 definite MD patients were included, with a mean age of 57.0±14.9 years. Among them, 135 (31.0%) had accompanying headaches, of whom 48 (11.0% of all definite MD patients) could be diagnosed with VM. The prevalence of comorbid VM (definite and probable) was significantly higher in females (41 of 288, 14.2%) than in males (7 of 147, 4.8%) (p<0.05). There was no significant difference in the prevalence of comorbid VM between unilateral and bilateral MD patients (10.8% and 13.6%, respectively) (p > 0.05). Benzodiazepines, antihistamines, and antiemetics were mainly preferred for acute vertigo control, while nonsteroidal anti-inflammatory drugs, acetaminophen, and triptans were preferred for acute headache control, and topiramate, propranolol, and calcium channel blockers were mainly preferred for headache prevention.
Conclusions
VM is not uncommon in patients with definite MD in Korea. Further research is needed to understand the differences in headache prevalence and preferred medications across different centers.

Clinical Characteristics of Sudden Sensorineural Hearing Loss Accompanying Benign Paroxysmal Positional Vertigo: Sung Min Park, Bin Kwon, Sung Won Li, Seok Min Hong, Sung Kyun Kim; Res Vestib Sci. 2020;19(2):71-78. Published online June 15, 2020; DOI: https://doi.org/10.21790/rvs.2020.19.2.71

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Abstract PDF

Objectives
Idiopathic unilateral sudden sensorineural hearing loss (SSNHL) with simultaneous benign paroxysmal vertigo (BPPV) is known to be associated with poor hearing recovery. We aimed to investigate clinical findings in patients with SSNHL with BPPV and analyze prognostic factors including presence of BPPV related to hearing outcome.
Methods
We retrospectively reviewed the electronic medical data of 14 patients with concurrent SSNHL and BPPV (combined group). We selected 52 patients without BPPV as a control group who have matched initial threshold of pure tone audiometry and age of each patient in the combined group. We evaluated clinical characteristics of all participants and compared hearing outcomes between the 2 groups. A multivariate logistic regression analysis was performed to investigate the factors related to hearing recovery.
Results
Initial mean pure tone audiometry (PTA) threshold of combined group was 90.36±26.2 dB. Posterior canal was most commonly involved (n=7, 50%), and 8 (57%) patients showed abnormal video head impulse test results. There was no significant difference between hearing recovery rates of combined and control group (p=0.237) and mean pure tone audiometry threshold changes were not significantly different between the 2 groups (p=0.942). Old age (≥60 years), high initial PTA threshold (＞90 dB), and obesity (body mass index ≥ 25 kg/m²) were poor prognostic predictors.
Conclusions
There was no difference between hearing outcomes of combined group and profound SSNHL only group. BPPV was not a significant prognostic factor of SSNHL patients.

Citations

Citations to this article as recorded by

Which Is More Important for the Prognosis of Sudden Sensorineural Hearing Loss with Vertigo, Canal Paresis or Benign Paroxysmal Positional Vertigo?
Yong-Hwi An, Hyun Joon Shim
Research in Vestibular Science.2021; 20(3): 101. CrossRef

Review

Vestibular Rehabilitation after Traumatic Head Injury with Dizziness: Sung Kyun Kim, Seok Min Hong; Res Vestib Sci. 2019;18(2):32-37. Published online June 15, 2019; DOI: https://doi.org/10.21790/rvs.2019.18.2.32

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Abstract PDF: The vestibular symptoms such as dizziness and imbalance that occurred after traumatic head/brain injury were caused by a combination of central factors such as abnormalities of white matter, diffuse axonal injury and microhemorrhage, and peripheral factors like decreased vestibulo-ocular reflex caused by the energy transmitted to the semicircular canal and otolith organs. These symptoms can affect on the patient's overall physical, cognitive, emotional, and quality of life. There have been reports that vestibular rehabilitation for the treatment of dizziness and imbalance after head trauma can promote vestibular compensation, stabilize of the gaze movements, and also affect the treatment outcomes of the associated injuries. The frequency, duration, and number of people participating in vestibular rehabilitation varied with each study, and physical therapy, occupational therapy, cognitive counseling, medication treatment, duration of treatment for associated injuries were also variable. Most studies have shown that many patients who get the vestibular rehabilitation have a significantly reduced time to return to work and sports activities, and may be able to speed up the recovery of vestibular symptoms. However, further research is needed on its long-term effects. In addition, patients with traumatic head/brain injuries are more susceptible to injuries of other organs as well as vestibular disorders, therefore consideration of treatment planning for associated injuries including precise evaluation mental support, and cognitive therapy is expected to be more effective with vestibular rehabilitation therapy.

Vestibular rehabilitation after traumatic head injury with dizziness: Sung Kyun Kim, Seok Min Hong; Received May 7, 2019 Accepted June 1, 2019 Published online June 1, 2019; [Accepted]

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Abstract: The vestibular symptoms such as dizziness and imbalance that occurred after traumatic head/brain injury were caused by a combination of central factors such as abnormalities of white matter, diffuse axonal injury and micro-hemorrhage, and peripheral factors like decreased vestibulo-ocular reflex caused by the energy transmitted to the semicircular canal and otolith organs. These symptoms can affect on the patient's overall physical, cognitive, emotional, and quality of life. There have been reports that vestibular rehabilitation for the treatment of dizziness and imbalance after head trauma can promote vestibular compensation, stabilize of the gaze movements, and also affect the treatment outcomes of the associated injuries. The frequency, duration, and number of people participating in vestibular rehabilitation varied with each study, and physical therapy, occupational therapy, cognitive counseling, medication treatment, duration of treatment for associated injuries were also variable. Most studies have shown that many patients who get the vestibular rehabilitation have a significantly reduced time to return to work and sports activities, and may be able to speed up the recovery of vestibular symptoms. However, further research is needed on its long-term effects. In addition, patients with traumatic head/brain injuries are more susceptible to injuries of other organs as well as vestibular disorders, therefore consideration of treatment planning for associated injuries including precise evaluation mental support, and cognitive therapy is expected to be more effective with vestibular rehabilitation therapy.

Original Articles

Outcome of Canalith Repositioning Procedure in Patients with Persistent and Transient Geotropic Direction-Changing Positional Nystagmus: Short-term Follow-up Evaluation: Seung Sik Jeon, Sung Won Li, Sung Kyun Kim, Yong Bok Kim, Il-Seok Park, Seok Min Hong; Res Vestib Sci. 2018;17(3):109-115. Published online September 18, 2018; DOI: https://doi.org/10.21790/rvs.2018.17.3.109

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Abstract PDF: Objectives
Patients, who showed persistent geotropic-direction changing positional nystagmus (p-DCPN) tend to have different clinical manifestations from those who showed transient geotropic DCPN (t-DCPN). We investigated the clinical characteristics between p-DCPN and t-DCPN patients, and its recovery rate after canalith repositioning procedure (CRP).
Methods
Based on the duration of nystagmus, 117 geotropic DCPN patients were classified to 2 groups, p-DCPN and t-DCPN. Barbeque maneuver had been introduced towards the opposite direction of null plane for the p-DCPN patients, and to the opposite direction of stronger nystagmus for the t-DCPN patients.
Results
Seventy-four patients showed t-DCPN and 43 patients were classified to the p-DCPN cases. No p-DCPN patient showed prompt improvement after the 1st canalolith reposition therapy. Among the t-DCPN patients, 18 canal switch cases were found , but, there was no canal switch cases found among the p-DCPN The CRP has showed less effective for the p-DCPN patients than the t-DCPN patients (after the 1st CRP, 37 in 74 improved, p＜0.001).
Conclusions
Due to its distinguishing clinical manifestation, p-DCPN may have different pathogenesis and clinical mechanisms from t-DCPN. And for the p-DCPN patients, the CRP seems not an efficient treatment compared to the t-DCPN patients. Further study with larger number of enrolled subjects is necessary.

Dizzy and Psychological Scales in Benign Paroxysmal Positional Vertigo: Suspicious Patients without Characteristic Nystagmus: Seok Min Hong, Sung Kyun Kim, Heejin Kim, Seok Jin Hong, Yong Bok Kim, Il-Seok Park, Dawoon Oh; Res Vestib Sci. 2017;16(3):80-84. Published online September 15, 2017; DOI: https://doi.org/10.21790/rvs.2017.16.3.80

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Abstract PDF: Objectives
Patients, who have had a history of benign paroxysmal positional vertigo (BPPV)-like symptoms, but no characteristic nystagmus, were often present. They are diagnosed as having a resolved state from BPPV or normal, and tend to be overlooked. We investigated the dizzy and psychological scales in BPPV-suspicious patients. Methods: Thirty-nine patients, which they had vertigo of a short duration at the specific head position, and clinically suspicious BPPV, but no nystagmus in positional tests, were enrolled. We compared dizzy and psychological scales of suspicious BPPV patients with 138 BPPV patients, using dizziness handicap inventory (DHI), the beck depression inventory (BDI), and the Spielberger state-trait anxiety inventory. Additionally, among the BPPV-suspicious group, patients with a BPPV history were compared with those with no previous BPPV. Results: No differences in the all scales were found between the two groups. However, DHI scores of patients with a previous BPPV attack were significantly higher than those of patients with no BPPV-like symptoms; in particular, there was a significant difference in emotional scores. Conclusion: Although the patients had no characteristic nystagmus, if they have a BPPV-like history and symptoms, emotional support and periodic follow up are needed. In particular, careful observation should be performed in patients with previous BPPV attack.

Dizzy and psychological scales in BPPV-suspicious patients without characteristic nystagmus: Seok Min Hong, Sung Kyun Kim, Heejin Kim, Seok Jin Hong, Yong Bok Kim, Il-seok Park, Dawoon Oh; Received July 29, 2017 Accepted August 19, 2017 Published online August 19, 2017; [Accepted]

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Abstract: Objectives
Patients, who have had a history of BPPV-like symptoms, but no characteristic nystagmus, were often present. They are diagnosed as having a resolved state from BPPV or normal, and tend to be overlooked. We investigated the dizzy and psychological scales in BPPV-suspicious patients. Study Design : prospective study
Methods
Thirty-nine patients, which they had vertigo of a short duration at the specific head position, and clinically suspicious BPPV, but no nystagmus in positional tests, were enrolled. We compared dizzy and psychological scales of suspicious BPPV patients with 138 BPPV patients, using DHI, BDI and STAI. Additionally, among the BPPV-suspicious group, patients with a BPPV history were compared with those with no previous BPPV.
Results
No differences in the all scales were found between the two groups. However, DHI scores of patients with a previous BPPV attack were significantly higher than those of patients with no BPPV-like symptoms; in particular, there was a significant difference in emotional scores.
Conclusion
Although the patients had no characteristic nystagmus, if they have a BPPV-like history and symptoms, emotional support and periodic follow up are needed. In particular, careful observation should be performed in patients with previous BPPV attack.

Case Reports

Tumarkin Otolithic Crisis Controlled by Endolymphatic Sac Surgery: Seok Min Hong, Il Seok Park, Jae Ho Ban; Res Vestib Sci. 2015;14(1):32-35.

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Abstract PDF: Turmarkin otolithic crisis is a rare feature of Meniere’s disease. It shows sudden falling to the ground with no warning sign. It is an otologic emergency because of the risk of falling, and it has traditionally been treated with labyrinthectomy or vestibular neurectomy. We experienced a 49-year-old male suffering from recurrent drop attack, and found that he had hearing loss, tinnitus or recurrent vertigo on his left ear, and could make a diagnosis him as Tumarkin otolithic crisis. We have performed the endolymphatic sac decompression, considering the hearing preservation and therapeutic opinion of patients. Two years after surgery, he showed intermittent, mild dizzy symptoms, without further drop attack. Therefore, we report our clinical experience with a brief review of literature.

Vestibular Paroxysmia in a 7-Year-Old Child: Seok Min Hong, Sung Ho Choi, Il Seok Park, Yong Bok Kim; Res Vestib Sci. 2014;13(1):19-23.

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Abstract PDF: Neurovascular cross-compression of the eighth cranial nerve is characterized by brief attacks of vertigo, unilateral audiologic symptoms such as tinnitus, ear fullness and hearing disturbance and relatively rare disease, in particular, in children. We report a 7-year-old female patient who presented with recurrent spontaneous vertigo, lasting 15 seconds and occuring up to 40 times per day and often associated with physical activity. Her symptoms were developed by hyperventilation. Associated aural symptoms are not founded. Magnetic resonance image showed the eighth cranial nerve compression caused by the vascular loop. She was treated with oxcarbazepine and showed improving symptoms. Therefore we report our clinical experience with a brief review of literature.

Original Article

Multicenter Study on the Clinician’s Diagnostic and Therapeutic Approaches for Benign Paroxysmal Positional Vertigo in Korea: Eun Ju Jeon, Won Ho Chung, Jeong Hwan Choi, Eui Cheol Nam, Hong Ju Park, Jong Dae Lee, Won Sang Lee, Kyu Sung Kim, Eui Kyung Goh, Ja Won Koo, Min Bum Kim, Min Beom Kim, Se Hyung Kim, Young Jin Kim, Chang Hee Kim, Sung Il Nam, Seog Kyun Mun, Ga Young Park, Sang Yoo Park, Shi Nae Park, Chang Hoon Bae, Sung Hyun Boo, Myung Whan Suh, Jae Hyun Seo, Eun Jin Son, Jae Jun Song, Jae Jin Song, Joong Wook Shin, Dae Bo Shim, Seong Ki Ahn, Hye Youn Youm, Shin Young Yoo, Dong Hee Lee, Seung Hwan Lee, Chang Ho Lee, Hyun Seok Lee, Hwan Ho Lee, Hyo Jeong Lee, Yun Hoon Choung, Seung Hyo Choi, Jee Sun Choi, Seok Min Hong, Sung Kwang Hong; Res Vestib Sci. 2013;12(3):79-92.

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Abstract PDF: Background and Objectives: It is necessary to establish the most efficient diagnostic and therapeutic method for benign paroxysmal positional vertigo (BPPV), which is appropriate for Korean healthcare system. We aimed to evaluate current state of Korean clinician’s diagnostic and therapeutic approaches for BPPV. Materials and Methods: A 16-item survey was emailed to the members of dizziness department of Otology Research Interest Group in the Korean Otologic Society (n=68). 43 were returned and analyzed. Results: All respondents (100%) used Dix-Hallpike test as a diagnostic tool for vertical canal-BPPV. Supine roll test was used for diagnosing lateral canal BPPV in nearly all the respondents (97.7%). Epley maneuver was chosen as otolith repositioning maneuver (ORM) for posterior canal BPPV in all respondents and barbecue rotation (BBQ) was used for treating lateral canal BPPV with geotropic nystagmus in 95.3% of respondents. Extreme variation was noted for therapeutic approach of lateral canal BPPV with ageotropic nystagmus BBQ, with 4 kinds of ORM and adjunctive measures to liberate otolith from cupula, while BBQ was again the most commonly used ORM (76.7%). Conclusion: The development of practical and efficient ORM for lateral canal BPPV with ageotropic nystagmus is necessary.

Case Report

A Case of Facial Palsy Developed after Vestibular Neuritis Involving Superior Vestibular Nerve: Young Gil Ko, Seok Min Hong, Chan Hum Park, Jun Ho Lee; Res Vestib Sci. 2011;10(1):34-37.

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Abstract PDF: Vestibular neuritis is generally thought to be caused by a viral or postviral inflammatory disorder of vestibular structures. But there is no definite evidence to explain this pathophysiological mechanism until now. We experienced an unusual case of 34-year-old man who presented with facial paralysis several days after vertigo of a whirling nature. We report a case of facial palsy developed in succession of ipsilateral vestibular neuritis involving superior vestibular nerve which may infer the viral pathophysiology for the vestibular neuritis with a brief literature review.

Original Article

Expression of Glutamate Receptors in the Medial Vestibular Nuclei following Acute Hypotension: Jae Hee Lee, Myoung Ae Choi, Dong Ok Choi, Bo Kyoung Kim, Seok Min Hong, Byung Rim Park; J Korean Bal Soc. 2007;6(1):29-35.

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Abstract PDF: Acute hypotension induced excitation of electrical activities and expression of c-Fos protein and pERK in the vestibular nuclei. In this study, to investigate the excitatory signaling pathway in the vestibular nuclei following acute hypotension, expression of NR2A and NR2B subunits of glutamate NMDA receptor and GluR1 subunit of glutamate AMPA receptor was determined by RT-PCR and Western blotting in the medial vestibular nucleus 30 min after acute hypotension in rats. Acute hypotension increased expression of NR2A, NR2B, and pGluR1 in the medial vestibular nuclei. These results suggest that both of NMDA and AMPA glutamate receptors take part in transmission of excitatory afferent signals following acute hypotension.

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