Research in Vestibular Science

Case Report

A Case of Patient with Bilateral Cochleovestibular Function Loss due to Infratentorial Superficial Siderosis: Gyuman Lee, Youngmin Mun, Dae Bo Shim; Res Vestib Sci. 2023;22(3):83-88. Published online September 15, 2023; DOI: https://doi.org/10.21790/rvs.2023.22.3.83; Correction in: Res Vestib Sci 2023;22(4):137

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Abstract PDF: Superficial siderosis (SS) is a rare neurodegenerative condition characterized by hemosiderin deposition in the central nervous system, which sometimes leads to sensorineural hearing loss and vestibular dysfunction. This case report details the diagnosis and treatment of a 63-year-old female patient presenting with a yearlong history of postural instability and recent symptoms of sudden right-sided hearing loss and imbalance. Physical examination and imaging revealed bilateral deafness and infratentorial SS. Treatment, including medication, vestibular exercises, high-dose steroids, and hyperbaric oxygen therapy, led to a significant alleviation of dizziness but no improvement in hearing. This case emphasizes the need for clinicians to consider SS in patients presenting with sudden-onset hearing loss and dizziness, even without prior any medical history or trauma, to accurately identify the underlying cause.

Review

Medical Treatment of Nonvascular Central Vertigo: Seo-Young Choi, Kwang-Dong Choi; Res Vestib Sci. 2021;20(3):75-80. Published online September 15, 2021; DOI: https://doi.org/10.21790/rvs.2021.20.3.75

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Abstract PDF: Central vertigo is the common symptom resulting from abnormalities in the central nervous system, caused by various diseases, which include neurodegenerative, vascular, inflammation, infection, tumor, paraneoplastic, toxic, or metabolic disorders. Since the treatment of central vertigo depends on the causes, an accurate diagnosis should be preceded the treatment through a detailed neurotologic examination and laboratory evaluation. Also, it is important to identify and document the neurologic findings accompanied by central vertigo, because some medication focuses on the ocular motor abnormalities as nystagmus or saccadic intrusion. Here, we will review the medical treatment for central vertigo.

Original Articles

Satisfaction and Effect Research on Virtual Reality-Based Vestibular Exercise for the Elderly Patients with Chronic Unilateral Vestibulopathy: Kwang-Dong Choi, Seo-Young Choi; Res Vestib Sci. 2020;19(4):127-132. Published online December 15, 2020; DOI: https://doi.org/10.21790/rvs.2020.19.4.127

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Abstract PDF: Objectives
To survey the satisfaction of customized vestibular exercise using virtual reality system with mobile head-mounted display (HMD) in the elderly patients with chronic unilateral vestibulopathy, we analyzed questionnaires before and after exercise.
Methods
Sixteen patients (male, 6; median age, 69 years [interquartile range, 65–75 years]) with chronic unilateral vestibulopathy were prospectively enrolled from March 1 to December 31 in 2018. They exercised once a week for 20 to 25 minutes for 4 weeks using the HMD inserted the virtual reality exercise program. Dizziness visual analogue scale (DAS), Korean vestibular disorders activities of daily living scale (ADL), and visual vertigo analogue scale (VVAS) were performed before and after the exercise. After all of the program, the patients were surveyed to measure the satisfaction for the tool and effect of exercise.
Results
DAS, ADL, and VVAS were significantly improved after the vestibular exercise. No one answered unsatisfactory, and at least 62.5% of the patients satisfied the used tool and exercise program. The patients of 50% answered that they satisfied or very satisfied to the efficacy of exercise program. The patients who recovered VVAS more after the exercise were more satisfied to our tools and efficacy of exercise program.
Conclusions
Customized vestibular exercise using virtual reality system with HMD can not only improve dizziness and quality of life, but also made more satisfied to the elderly patients with chronic unilateral vestibulopathy.

The Clinical Efficacy of Vestibular Function Tests in Patients with Acute Unilateral Vestibulopathy: Bong-Hui Kang, Jae-Il Kim; Res Vestib Sci. 2018;17(2):49-54. Published online June 15, 2018; DOI: https://doi.org/10.21790/rvs.2018.17.2.49

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Abstract PDF: Objectives
Aim of this study is to investigate the clinical efficacy of the vestibular function tests (VFTs) and the predictability of lesion side of vestibular asymmetry parameters in acute unilateral peripheral vestibulopathy.
Methods
Medical records and results of VFTs (caloric, rotatory chair, and head impulse tests) of 57 patients with acute unilateral vestibulopathy were reviewed retrospectively. The VFTs were examined within 7 days after the clinical onset.
Results
For the caloric test, 74% showed significant canal paresis and the predictability of lesion side was 88%. For the sinusoidal harmonic acceleration test, 91% had low gain in at least 1 Hz, phase lead showed 70%, 89% showed phase asymmetry and the predictability of lesion side was 90%. For velocity step test, 67% had abnormal Tc asymmetry and the predictability of lesion side was 95%. In bedside head impulse test (HIT), abnormal catch up saccades were observed in 89% and the predictability of lesion side was 100%. For the video HIT, cover or overt catch-up saccades were observed in 95% and the predictability of lesion side was 100%. One hundred percent (100%) had low gain on the video HIT, but the lesion sides were uncertain because of bilateral involvements or artifacts.
Conclusions
The most important things in the diagnosis of acute unilateral vestibulopathy are typical clinical symptoms and spontaneous nystagmus. A combination of rotatory, caloric, and HITs will result in a more complete examination of the vestibular system. Among them, HIT is recommended as the best tool in acute unilateral vestibulopathy.

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