Research in Vestibular Science

Original Articles

Serum otolin-1 level is specific to benign paroxysmal positional vertigo: Hoon Kim, Eun Ji Kim, Eunjin Kwon, Seong-Hae Jeong; Res Vestib Sci. 2024;23(2):46-52. Published online June 14, 2024; DOI: https://doi.org/10.21790/rvs.2024.008

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Abstract PDF: Objectives
When we see patients with a history of positional vertigo (PV), many patients are diagnosed with benign paroxysmal PV (BPPV) by performing a typical history and nystagmus during a positioning maneuver. Recent studies reported that Otolin-1 can be detected in serum and that its levels significantly increase with age and BPPV. Herein, we tried to study the relationship between serum otolin-1 level and the other clinical aspects in patients with PV.
Methods
We measured the serum levels of otolin-1 in 117 BPPV patients (82 females; age range, 43–92 years; mean age±standard deviation [SD], 68.5±10.5 years), referred to as the BPPV group; and nine patients (seven females; age range, 61–79 years; mean age±SD, 66.9±5.9 years) with PV not compatible with BPPV, referred to as another PV group. All the BPPV patients were treated with an appropriate canal repositioning maneuver followed by blood sampling within 1 week.
Results
The serum levels of otolin-1 were higher in the BPPV group than in another PV group (mean±SD, 350.1±319.1 pg/mL vs. 183.6±134.1 pg/mL, respectively; p=0.037). However, there were no differences in both laboratory findings (serum vitamin D, C-telopeptide of type collagen, and bone mineral density) and clinical findings (age, sex, vertigo duration, ear disease, ear symptom, migraine, motion sickness, trauma, and previous BPPV) between these two groups.
Conclusions
Serum otolin-1 level could help predict the current existence of BPPV in patients with PV. However, further validation studies are needed.

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.

Temporal Relationship between Nystagmus and Perception during Bithermal Alternate Caloric Test: Sooyoung Kim, Eun-Jin Kwon, Hyunjin Jo, Seong-Hae Jeong; Res Vestib Sci. 2021;20(4):134-140. Published online December 15, 2021; DOI: https://doi.org/10.21790/rvs.2021.20.4.134

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Abstract PDF: Objectives
During caloric irritation, the spinning/rotating sensation is predominant. However, there is no report on the temporal relationship between caloric nystagmus and perception.
Methods
Consecutive 57 participants underwent bithermal caloric test in the dizziness clinic of Chungnam National University Hospital from February 2018 to September 2018. For vestibular perception, we asked the subject to report feelings of rotation and/or linear sensation during each warm and cold water irrigation period. Besides routine caloric parameters, the duration of nystagmus and vestibular sensation were analyzed.
Results
In most participants, the caloric nystagmus preceded the vestibular sensation (79.6% in right warm, 83.3% in left warm, 88.5% in right cool, and 84.6% in left cool stimuli). The precedence of perception was observed in 5 normal persons and 15 patients with vestibular migraine (n=4), unilateral vestibulopathy (n=3), and Menière’s disease (n=2), multiple systemic atrophy (n=2), cerebellar ataxia (n=2), vertebrobasilar insufficiency (n=1), and post-earthquake dizziness (n=1). The mean latency between nystagmus and perception was 11.7 seconds. And the duration of nystagmus was longer than that of perception in all conditions. Non-spinning sensations during the caloric test were also observed in some participants (26.8% in right warm, 30.3% in left warm, 29.1% in right cool, and 24.1% in left cool stimuli).
Conclusions
During the bithemal alternate caloric test, various vestibular perception and temporal relationship between perception and nystagmus suggest the bithermal caloric stimulation does not reflect only the signal originating from the horizontal canal pathway. A further validation study is needed.

Locus of Control and Dizziness: Mediation Effect of Self-Efficacy: Yemo Jeong, Won Hwa Jin, Eun-Jin Kwon, In-Sun Kwon, Han Young Yu, Seong-Hae Jeong; Res Vestib Sci. 2021;20(4):126-133. Published online December 15, 2021; DOI: https://doi.org/10.21790/rvs.2021.20.4.126

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Abstract PDF: Objectives
An attention to psychological aspects can clarify the understanding and management of patients with unresolved dizziness/vertigo. Thus, we study the locus of control and the mediation effect of self-efficacy for assessing the relationship between locus of control and dizziness/vertigo in a referral-based dizziness clinic.
Methods
We analyzed the dizziness-specific locus of control and self-efficacy using the modified questionnaire in 117 consecutive dizzy patients (34 males; age range, 20–74 years). In addition to the visual analogue scale-dizziness for evaluation of subjective dizziness, the following items were further evaluated; Korean Dizziness Handicap Inventory, Korean Beck Depression Inventory II, and Korean Beck Anxiety Inventory. According to the verification procedure proposed by Hayes, the mediation effect of self-efficacy verifies the relationship between the locus of control and dizziness through analysis.
Results
Except the scale of emotion such as anxiety and depression, sex, age, duration of illness, and diagnosis all did not significantly affect the dependent variables. Vestibular migraine (39.3%), vestibulopathy (15.4%), and dizziness associated with anxiety and depression (14.5%) were the most common diagnoses. On all scales, Cronbach’s α ranged from 0.72 to 0.94. In the direct effect, the internal locus of control had a tendency of aggravation of dizziness/vertigo, but in the indirect effect, the higher the internal locus of control, the higher the self-efficacy, and the higher the self-efficacy, the lower the dizziness.
Conclusions
In our study, we can assume that the locus of control can impart ambivalent effects on dizziness/vertigo. And the modulation of self-efficacy could be another treatment for patients with unresolved dizziness.

양온교대온도안진검사에서 안진과 전정지각의 시간적 관계: Sooyoung Kim, Eun-Jin Kwon, Hyunjin Jo, Seong-Hae Jeong; Received October 30, 2021 Accepted November 17, 2021 Published online November 17, 2021; [Accepted]

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Abstract: Purpose
During caloric irritation, the spinning/rotating sensation is predominant. However, there is no report on temporal relationship between the caloric nystagmus and perception.
Method
Consecutive 57 participants underwent bithermal caloric test in dizziness clinic of Chungnam National University Hospital from Feb 2018 to Sep 2018. For vestibular perception, we asked the subject to report feelings of rotation and/or linear sensation during each warm and cold water irrigation period. Besides routine caloric parameters, the duration of nystagmus and vestibular sensation were analyzed.
Results
In most participants, the caloric nystagmus preceded the vestibular sensation (79.6 % in right warm, 83.3% in left warm, 88.5% in right cool, and 84.6% in left cool stimuli). The precedence of perception was observed in 5 normal persons and 15 patients with vestibular migraine (n=4), unilateral vestibulopathy (n=3), and Meniere’s disease (n=2), multiple systemic atrophy (n=2), cerebellar ataxia (n=2), vertebrobasilar insufficiency (n=1) and post-earthquake dizziness (n=1). The mean latency between nystagmus and perception was 11.7s. And the duration of nystagmus was longer than that of perception in all conditions. Non-spinning sensations during caloric test were also observed in some participants (26.8% in right warm, 30.3% in left warm, 29.1% in right cool, and 24.1% in left cool stimuli).
Conclusion
During bithemal alternate caloric test, various vestibular perception and temporal relationship between perception and nystagmus suggests the bithermal caloric stimulation does not reflect only the signal originating from horizontal canal pathway. Further validation study is needed.

Case Report

Neurotological Findings in a Patient with Glufosinate Ammonium Intoxication: Ji Young Kim, Joo Yeon Ham, Seong-Hae Jeong; Res Vestib Sci. 2020;19(4):138-140. Published online December 15, 2020; DOI: https://doi.org/10.21790/rvs.2020.19.4.138

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Abstract PDF Supplementary Material: The upward deviation could be explained by loss of inhibitory inputs from the cerebellum onto the brainstem anterior semicircular canal projections for upward vestibulo-ocular reflex, which would lead to an upward bias in static eye position. Therefore, upward gaze deviation has been reported in comatose patients after resuscitation and diffuse cerebrocerebellar damage sparing the brainstem. Herein, we report a patient with ingestion of glufosinate ammonium presented with cerebellar ataxia and ocular motor findings suggestive of cerebellum involvement such as upward gaze tendency, spontaneous downbeat, gaze-evoked nystagmus, perverted head impulse test, and impaired smooth pursuit.

Original Article

The Feasibility and Utility of a Mobile-Based Eye Movement Recording Application: A Randomized Trial: Hee Jin Chang, Sooyoung Kim, In-Sun Kwon, Han Young Yu, Seong-Hae Jeong; Res Vestib Sci. 2020;19(4):120-126. Published online December 15, 2020; DOI: https://doi.org/10.21790/rvs.2020.19.4.120

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Abstract PDF Supplementary Material: Objectives
This study was performed to assess the efficacy and feasibility of mobile application-based Frenzel tests in dizziness clinics.
Methods
We performed an investigator-initiated, blinded-outcome assessor, parallel, randomized controlled crossover trial at Chungnam National University Hospital between August 2019 and October 2019. Certified medical staffs were randomly assigned to the intervention group (i.e., a mobile application-based Frenzel glass system, n=15) or the observation group (i.e., a conventional desktop-based Frenzel glass system, n=15); the groups applied the respective systems for the preparation of eye movement recording and switched systems. The primary outcome was the elapsed time in seconds it took the participants to prepare the system for eye recording simulation. The secondary outcomes were perceived stress and satisfaction scores after completion of the operation, as measured by a questionnaire using 10-point Likert scales.
Results
The mean time of machine preparation for eye recording simulation was reduced by 50% in the mobile application group compared to the desktop group in both study periods (38.0±7.1 sec vs. 76.0±8.7 sec). We detected no carryover effect. Participants also reported lower stress while using application than while using the desktop system (2.3±1.3 vs. 4.6±2.4; p＜0.001). The application obtained a mean overall satisfaction score of 9.2 out of 10.
Conclusions
The implementation of an eye movement recording application in a dizziness examination was well adopted by users and decreased the time and stress related to machine operation.

Review

Dizziness in Traumatic Brain Injury: Visual-Vestibular Dysfunction, Neurotological Approach: Seong-Hae Jeong; Res Vestib Sci. 2019;18(2):27-31. Published online June 15, 2019; DOI: https://doi.org/10.21790/rvs.2019.18.2.27

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Abstract PDF: Traumatic brain injury (TBI) could give rise to variable clinical manifestations based on the involved structures of our bodies. Although there are no structural abnormalities proven, the patients with mild TBI suffer from chronic dizziness and imbalance. Herein, I will discuss the visuo-vestibular interaction and neurotological finding in TBI, which could demonstrate the clue to the diagnosis and management in dizzy patients with TBI.

Dizziness in traumatic brain injury : visual-vestibular dysfunction, neuro-otologic finding: Seong-Hae Jeong; Received May 29, 2019 Accepted June 12, 2019 Published online June 12, 2019; [Accepted]

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Abstract: Traumatic brain injury (TBI) could give rise to variable clinical manifestations based on the involved structures of our bodies. Interestingly, the patients with mild TBI suffer from chronic dizziness and imbalance, which could be caused by abnormal visuo-vestibular interaction. Herein, I will discuss the visuo-vestibular interaction and neurotological finding in TBI.

Case Report

Postprandial Dizziness/Syncope Relieved by Alfa-Glucosidase Inhibitor: A Case Report: Hakyeu An, Seong-Hae Jeong, Hyun Jin Kim, Eun Hee Sohn, Ae Young Lee, Jae Moon Kim; Res Vestib Sci. 2018;17(2):67-70. Published online June 15, 2018; DOI: https://doi.org/10.21790/rvs.2018.17.2.67

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Abstract PDF: A 74-year-old man presented with positional vertigo and prandial dizziness and syncope. He had experienced episodes of frequent dizziness and loss of consciousness for several months. He underwent total gastrectomy with esophagojejunostomy and brown anastomosis 30 years ago. Thirteen years ago, subtotal colectomy with ileo-descending colostomy was done due to colon cancer. And he also had mitral valve replacement and maze operation due to severe mitral valve stenosis and atrial fibrillation. After cardiac operation, he has suffered from sudden dizziness with diaphoresis and chalky face, which usually occurs especially within 30 minutes from the onset of eating. Sometimes, this event was followed by several seconds of loss of consciousness, which caused recurrent events of falling. Neurological examination showed positional nystagmus compatible with benign paroxysmal positional vertigo arising from posterior semicircular canal of the right ear. The positional vertigo disappeared immediately after canalith repositioning maneuver. We tried to monitor vital signs and serum level of glucose during eating. Hyperglycemia (range, 210–466 mg/dL) was noted during eating, which was accompanied by postprandial and prandial hypotension, up to 60/40 mmHg. The patient was prescribed 100 mg of the alfa-glucosidase, acarbose to be taken half an hour before each meal. Eventually, the treatment with acarbose ameliorated the prandial dizziness and hypotension associated with hyperglycemia. Our patient suggests the acarbose could prevent postprandial dizziness and hypotension.

A case of postprandial dizziness/syncope relieved by alfa-glucosidase inhibitor: Hakyeu An, Seong-Hae Jeong, Hyun Jin Kim, Eun Hee Sohn, Ae Young Lee, Jae Moon Kim; Received February 15, 2018 Accepted March 7, 2018 Published online March 7, 2018; [Accepted]

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Abstract: A 74 year-old man presented with positional vertigo and prandial dizziness and syncope. He had experienced episodes of frequent dizziness and loss of consciousness for several months. He underwent total gastrectomy with esophagojejunostomy and brown anastomosis 30 year ago. Thirteen years ago, subtotal colectomy with ileo-descending colostomy was done due to colon cancer. And he also had mitral valve replacement and maze operation due to severe mitral valve stenosis and atrial fibrillation. After cardiac operation, he has sudden dizziness with diaphoresis and chalky face usually occurs especially within 30 minutes from the onset of eating. Sometimes this event was followed by several seconds of loss of consciousness, which caused recurrent events of falling. Neurological examination showed positional nystagmus compatible with benign paroxysmal positional vertigo arising from posterior semicircular canal of the right ear. The positional vertigo disappeared immediately after canalith repositioning maneuver. We tried to check vital signs and serum level of glucose during eating. Hyperglycemia (range: 210-466) was noted during eating, which is accompanied by her postprandial and prandial hypotension, up to 60/40 mmHg. The patient was prescribed 100 mg of the alfa-glucosidase, acarbose to be taken half an hour before each meal. Eventually, the treatment with acarbose controlled the prandial dizziness and hypotension associated with hyperglycemia followed by hypotension. Our patient suggests the acarbose could prevent postprandial dizziness and hypotension.

Case Report

Gaze-Evoked and Perverted Head-Shaking Nystagmus in a Patient with Polycythemia Vera: Yong Soo Kim, Ik-Chan Song, Seong-Hae Jeong, Ae Young Lee, Jae Moon Kim; Res Vestib Sci. 2017;16(4):142-146. Published online December 15, 2017; DOI: https://doi.org/10.21790/rvs.2017.16.4.142

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Abstract PDF: Polycythemia vera (PV) is well known chronic myeloproliferative neoplasm, caused by clonal expansion of an abnormal hematopoietic stem cell. Patients with PV may present diverse neurologic symptoms including headache, dizziness or vertigo, tinnitus. However, the attention has not been directed to the neurootological findings in patients with PV. Here, we present a 71-year-old male patient with PV suffered from vertigo and headache. He demonstrated gaze-evoked nystagmus and perverted head shaking nystagmus. Transcranial Doppler showed decrement of blood flow velocity in posterior circulation. The patient’s neuro-otologic findings were normalized as polychethemia and blood flow improved with repetitive phlebotomy and medications such as hydroxyurea and aspirin. Considering the neurological and hemodynamic findings in our patient, the mechanism of vertigo in PV could be explained by central vestibulopathy because of vascular insufficiency rather than peripheral vestibulopathy because of inner ear blood hyperviscosity.

Gaze-evoked and Perverted Head-Shaking Nystagmus In a Patient with Polycythemia Vera: Yongsoo Kim, Ik-Chan Song, Seong-Hae Jeong, Ae Young Lee, Jae Moon Kim; Received November 8, 2017 Accepted November 27, 2017 Published online November 27, 2017; [Accepted]

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Abstract: Polycythemia vera (PV) is well known chronic myeloproliferative neoplasm, caused by clonal expansion of an abnormal hematopoietic stem cell. Patients with PV may present diverse neurologic symptoms including headache, dizziness or vertigo, tinnitus. However, the attention has not been directed to the neuro-otological findings in patients with PV. Here, we present a 71-year-old male patient with PV suffered from vertigo and headache. He demonstrated gaze-evoked nystagmus and perverted head shaking nystagmus. Transcranial Doppler showed decrement of blood flow velocity in posterior circulation. The patient’s neuro-otologic findings were normalized as polychethemia and blood flow improved with repetitive phlebotomy and medications such as hydroxyurea and aspirin. Considering the neurological and hemodynamic findings in our patient, the mechanism of vertigo in PV could be explained by central vestibulopathy because of vascular insufficiency rather than peripheral vestibulopathy because of inner ear blood hyperviscosity.

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