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Original Article
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
  • 134 View
  • 4 Download
AbstractAbstract 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.
Case Reports
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
  • 172 View
  • 6 Download
AbstractAbstract PDFSupplementary 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 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
  • 1,899 View
  • 29 Download
AbstractAbstract 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.
Original Article
Comparison of vestibular evoked myogenic potentials between low and high tone idiopathic sudden sensorineural hearing loss
Sang-Wook Park, Sang Yun Lee, Somi Ryu, Jung Woo Lee, Chae Dong Yim, Dong Gu Hur, Seong-Ki Ahn
Res Vestib Sci. 2024;23(1):11-15.   Published online March 15, 2024
DOI: https://doi.org/10.21790/rvs.2024.001
  • 956 View
  • 19 Download
AbstractAbstract PDF
Objectives
Vestibular evoked myogenic potentials (VEMP) have been reported to be useful in evaluating not only vestibular function but also the prognosis of idiopathic sudden sensorineural hearing loss (ISSNHL) patients. Even though low frequency, high frequency, and all frequency-involved ISSNHL groups tend to show varied clinical characteristics, there is a lack of data using VEMP results to analyze these subgroups. We investigated if the VEMP test is a valuable tool to predict recovery from hearing loss in association with different frequencies.
Methods
A total of 26 ISSNHL patients were divided into three different groups impaired with low tone (ascending type), high tone (descending type), and all tones (flat type) based on the initial audiograms. Each group included five, 10, and 11 patents, respectively, and their VEMP results were compared between the three subgroups.
Results
Abnormal VEMP results were found in five of the total 26 ISSNHL patients (19.2%). Two (40.0%), one (10.0%), and two (18.1%) patients of low tone, high tone, and all tone hearing loss groups, respectively, showed abnormal VEMP results. However, there was no statistically significant difference between the three groups.
Conclusions
Even though VEMP is known as a valuable tool for predicting the prognosis of ISSNHL patients, it does not seem to reflect frequency-sensitive aspects of ISSNHL.
Case Reports
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
  • 1,412 View
  • 33 Download
AbstractAbstract 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.
A Case of Delayed Audiovestibulopathy after Posterior Circulation Ischemic Stroke
Hyun Su Lee, Eun Kyung Jeon, Dong Hwan Kwon, Tae Hoon Kong
Res Vestib Sci. 2023;22(3):77-82.   Published online September 15, 2023
DOI: https://doi.org/10.21790/rvs.2023.22.3.77
  • 1,297 View
  • 33 Download
AbstractAbstract PDF
Distinguishing central and peripheral causes of dizziness is vital. A case is presented where a 42-year-old man with a history of posterior circulation ischemic stroke developed acute unilateral vestibulopathy with hearing loss. Clinical examination revealed signs of vestibular dysfunction on the left side. Audiometry confirmed deafness on the left, but imaging ruled out new central issues. The patient was diagnosed with audiovestibulopathy and treated with steroids, antiviral agents, intratympanic injections, and hyperbaric oxygen therapy. Hearing loss persisted, but dizziness improved with vestibular rehabilitation. Poststroke patients should be closely monitored for peripheral complications. Further research should explore the benefits of antiplatelet therapy in vascular-related conditions, even without clear central lesions.
Original Article
Re-fixation Saccade at Video-Head Impulse Test in Patients with Sudden Sensorineural Hearing Loss
Dong Hyuk Jang, Sun Seong Kang, Hyun Joon Shim, Yong-Hwi An
Res Vestib Sci. 2023;22(2):46-51.   Published online June 15, 2023
DOI: https://doi.org/10.21790/rvs.2023.22.2.46
  • 1,302 View
  • 31 Download
AbstractAbstract PDF
Objectives
This study was performed to evaluate characteristics and their prognostic value of video-head impulse test (vHIT) in sudden sensorineural hearing loss (SSNHL) with vertigo.
Methods
Of the 612 patients with a diagnosis of SSNHL from 2010 to 2018, 110 patients (18.0%) with vertigo and 39 patients (6.4%) with vHIT results were recruited. The patients were evaluated for their pure-tone hearing average (at initial, 1-month, and 6-month visit), the presence of re-fixation saccade and gains at vHIT, the canal paresis (CP) at ccaloric test.
Results
Patients with saccade (+) showed higher pure-tone averages than those with saccade (‒) on initial and follow-up audiograms. The improvement in pure-tone averages was less in the saccade (+) group than in the saccade (‒) group. There was no significant difference of hearing recovery between SSNHL patients with normal gain and those with decreased gain. There was no difference of hearing improvement between CP (+) and CP (‒) groups according to the presence of re-fixation saccade.
Conclusions
Concurrent re-fixation saccade at vHIT is a negative prognostic factor of hearing function in SSNHL. Re-fixation saccade in SSNHL may suggest widespread damages to both the cochlea and the vestibule, leading to the poor prognosis.
Case Report
Bilateral Sudden Hearing Loss Caused by Basilar Artery Dissection: A Case Report
Ho Byung Lee, Jieun Roh, Hyun Min Lee, Jae-Hwan Choi
Res Vestib Sci. 2021;20(4):151-155.   Published online December 15, 2021
DOI: https://doi.org/10.21790/rvs.2021.20.4.151
  • 3,042 View
  • 91 Download
AbstractAbstract PDF
Bilateral sudden sensorineural hearing loss (SNHL) is rare, but a possible symptom of vertebrobasilar ischemia. A 69-year-old female patient with hypertension and atrial fibrillation presented with bilateral sudden hearing loss and vertigo without other neurological symptoms. On examination, she had left-beating horizontal nystagmus with positive head impulse on the left side. Pure tone audiometry revealed severe SNHL on both sides. Brain computed tomography angiography showed a dissection in the proximal portion of the basilar artery (BA) with occlusion of the mid-BA and bilateral anterior inferior cerebellar arteries (AICA), which confirmed on transfemoral cerebral angiography (TFCA). Left common carotid angiography demonstrated retrograde blood flow into the BA and right AICA via the left posterior communicating artery. During TFCA, her right hearing loss dramatically improved. Nine days later, follow-up TFCA showed an improvement of antegrade flow of the BA and AICA. We suggest that vertebrobasilar ischemia can be suspected in patients with bilateral sudden SNHL who present with risk factors for stroke.
Original Articles
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
Res Vestib Sci. 2021;20(3):101-107.   Published online September 15, 2021
DOI: https://doi.org/10.21790/rvs.2021.20.3.101
  • 3,525 View
  • 58 Download
  • 1 Crossref
AbstractAbstract PDF
Objectives
This study was performed to determine characteristics and the prognostic values in idiopathic sudden sensorineural hearing loss (SSNHL) with comorbid ipsilateral canal paresis (CP) and/or benign paroxysmal positional vertigo (BPPV).
Methods
Of the 338 patients with a diagnosis of idiopathic SSNHL, 29 patients (8.6%) with CP and 24 patients (7.1%) with BPPV were recruited and compared to 23 patients with SSNHL and vertigo but without CP or BPPV. The patients were evaluated for their initial hearing threshold, type of canal involved, response to repositioning maneuvers, and hearing outcome for 6 months.
Results
Patients with CP (+) BPPV (‒) showed lower pure-tone averages than those with CP (‒) BPPV (+) on initial and follow-up audiograms. The improvement in pure-tone averages was less in the CP (+) BPPV (‒) group than in the CP (‒) BPPV (+) group. The improvement in speech discrimination scores was less in the CP (+) BPPV (‒) group than in the CP (‒) BPPV (‒) group. BPPV most commonly involved the posterior canal (15 of 24, 62.5%), followed by the horizontal canal (13 of 24, 54.2%). Three of 24 patients (12.5%) had recurrences of BPPV.
Conclusions
CP is a more serious sign for hearing recovery than BPPV, although both CP and BPPV are negative prognostic indicators of auditory function in SSNHL. Concurrent CP and/or BPPV in SSNHL suggest combined damage to the vestibule and may indicate severe and widespread labyrinthine damage, leading to a poor prognosis.

Citations

Citations to this article as recorded by  
  • Re-fixation Saccade at Video-Head Impulse Test in Patients with Sudden Sensorineural Hearing Loss
    Dong Hyuk Jang, Sun Seong Kang, Hyun Joon Shim, Yong-Hwi An
    Research in Vestibular Science.2023; 22(2): 46.     CrossRef
Positional Audiometry in Patients with Light Cupula: A Preliminary Study
Jiyeon Lee, Dong-Han Lee, Jung Eun Shin, Chang-Hee Kim
Res Vestib Sci. 2020;19(3):89-94.   Published online September 15, 2020
DOI: https://doi.org/10.21790/rvs.2020.19.3.89
  • 4,909 View
  • 86 Download
  • 1 Crossref
AbstractAbstract PDF
Objectives
Light cupula is characterized by persistent geotropic direction-changing positional nystagmus in a supine head-roll test. The purpose of this study is to investigate if hearing level is influenced by the change of head position in light cupula under the assumption that relative density difference similarly occurs between the tectorial membrane and endolymph.
Methods
Twelve patients with unilateral light cupula who underwent positional audiometry were included in this study. Pure tone thresholds were compared among three head positions.
Results
Hearing threshold in pure tone audiometry (PTA) of the affected ear was not different from that of the healthy ear. PTA thresholds of the affected side were not significantly different in three head positions; upright seating, cochlear apex-up, and cochlear apex-down positions.
Conclusions
Although positional change of nystagmus direction is the most significant clinical feature of light cupula, positional change of hearing level was not observed in those patients. The lack of positional influence on hearing may be explained as follows: (1) the heavier endolymph phenomenon occurs only in the vestibular end organ without involving the cochlea; (2) the light cupula phenomenon is more likely to occur due to light debris mechanism rather than heavier endolymph or lighter cupula mechanism; and (3) the effects of light cupula could be modified by outer hair cells, which work for tuning in the cochlea, even though light tectorial membrane or heavy endolymph occurs.

Citations

Citations to this article as recorded by  
  • Light cupula phenomenon: a systematic review
    Nilüfer Bal, Melike Altun, Elif Kuru, Meliha Basoz Behmen, Ozge Gedik Toker
    The Egyptian Journal of Otolaryngology.2022;[Epub]     CrossRef
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
  • 5,515 View
  • 121 Download
  • 1 Crossref
AbstractAbstract 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
Comparison of Predictive Parameters between the Video Head Impulse Test and Caloric Test
Chun Han, Seung Won Paik, Hui Joon Yang, Sang Yoo Park, Ji Hyeon Lee, Young Joon Seo
Res Vestib Sci. 2020;19(2):55-61.   Published online June 15, 2020
DOI: https://doi.org/10.21790/rvs.2020.19.2.55
  • 6,328 View
  • 113 Download
  • 1 Crossref
AbstractAbstract PDF
Objectives
The aim of this paper was to determine if a correlation exists between video head impulse test (vHIT) and electronystagmography with caloric test (ENG). More specifically, comparison of covert and overt value from vHIT test with cold and warm stimulation value from ENG test.
Methods
Retrospective study of our single institue from the period of January 2015 to January 2017 enrolled 91 patients. Patients were divided into 3 groups by their diagnosis of either vestibular neuritis (VN), Meniere disease, or sudden sensorineural loss with vertigo accordingly. Each of the patients’ both ENG and vHIT data were recorded and parameters were evaluated.
Results
VN group was the only group to show a significant correlation between canal paresis (CP) with covert and overt saccades. Further analysis was done in the VN group and result showed covert saccade showing a larger area under the receiver operation characteristic curve value (0.77) compared to overt saccades (0.70), implying that covert saccade is a more accurate parameter for the prediction of the CP value. Furthermore, a positive correlation was seen between the gain value and the cold caloric stimulation value as well as between warm caloric stimulation value.
Conclusions
The value of our study lies in the fact that we have attempted to find a correlation between different parameters of 2 different vestibular tests. We concluded that the evaluation of overt nystagmus by the bedside head thrust test is inappropriate for predicting CP, and a vHIT is required to accurately evaluate vestibular function.

Citations

Citations to this article as recorded by  
  • A Comparative Analysis of the Vestibulocochlear Function in Patients with Isolated Semicircular Canal Hypofunction Using a Video Head Impulse Test
    Yu Jung Park, Min Young Lee, Ji Eun Choi, Jae Yun Jung, Jung Hwa Bahng
    Research in Vestibular Science.2023; 22(2): 34.     CrossRef
Does 125-Hz Pure-Tone Thresholds Have Prognostic Value in Patients with Sudden Sensorineural Hearing Loss and Vertigo?
Yong-Hwi An, Hyun Joon Shim
Res Vestib Sci. 2020;19(1):6-11.   Published online March 15, 2020
DOI: https://doi.org/10.21790/rvs.2020.19.1.6
  • 4,733 View
  • 150 Download
AbstractAbstract PDF
Objectives
To analyze 125-Hz pure-tone thresholds in dizzy patients with sudden sensorineural hearing loss (SSNHL) and to investigate the relationship between 125-Hz thresholds and the prognosis of SSNHL with vertigo.
Methods
Hearing and vestibular function tests including 125-Hz pure-tone were performed in 132 patients with SSNHL and 65 subjects with normal hearing. Audiometric follow-up was performed at 6 months after initial visit. Intergroup and intragroup comparison of 125 Hz was made between SSNHL and control groups.
Results
Twenty-four patients (18.2%) had normal thresholds at 125 Hz in SSNHL group, whereas all subjects showed normal at 125 Hz in control group. None with average hearing threshold at 250 and 500 Hz≥30 dB had normal threshold at 125 Hz. There was no significant relationship between 125-Hz threshold and results of vestibular function test. There was no correlation between 125-Hz threshold and hearing recovery in SSNHL group.
Conclusions
There might be no need to assess 125-Hz pure-tone threshold in patients with SSNHL, because it is enough to evaluate thresholds of 250 and 500 Hz for low frequency.
Case Report
Delayed Audio-Vestibular Symptoms in Spontaneous Intracranial Hypotension
Han-Sol Choi, Jae-Myung Kim, Hong Chan Kim, Hyong-Ho Cho, Seung-Han Lee
Res Vestib Sci. 2020;19(1):29-33.   Published online March 15, 2020
DOI: https://doi.org/10.21790/rvs.2020.19.1.29
  • 6,554 View
  • 68 Download
AbstractAbstract PDF
Intracranial hypotension (IH) is a neurological disorder characterized by orthostatic headache due to cerebrospinal fluid (CSF) volume depletion. IH usually results from CSF leak caused by either spontaneous or traumatic dural injury and may also present nausea, neck stiffness, tinnitus or dizziness. We experienced a 52-year-old woman presenting with acute spontaneous vertigo, tinnitus and hearing impairment on both ears with right side predominancy which mimicked Meniere’s disease. Video-oculography revealed spontaneous left-beating nystagmus which was modulated by position change. There was binaural low-frequency sensorineural hearing loss (SNHL) in pure tone audiometry. Other neuro-otologic evaluations including caloric test, vestibular evoked myogenic potential, video head impulse tests were unremarkable. Of interest, she had been treated of orthostatic headache due to spontaneous IH 10 days before admission. Taken together the clinical and laboratory findings, audio-vestibular symptoms of the patient were thought to be related with insufficient treatment of IH. After massive hydration and bed rest, her symptoms were markedly improved and SNHL was also disappeared in the follow-up pure tone audiometry. IH should be considered as a differential diagnosis in dizzy patient with tinnitus, hearing impairment even the typical orthostatic headache is not accompanied.
Original Article
Comparison of Treatment Outcomes between Intratympanic Steroid Injection and Oral Diuretics in Patients with Acute Low Frequency Sensorineural Hearing Loss with Vertigo
Yong-Hwi An, Hyun Joon Shim
Res Vestib Sci. 2019;18(4):111-117.   Published online December 15, 2019
DOI: https://doi.org/10.21790/rvs.2019.18.4.111
  • 6,165 View
  • 87 Download
AbstractAbstract PDF
Objectives
Sudden sensorineural hearing loss and Meniere disease can be managed with intratympanic steroid injection (ITSI) as a primary treatment. The aim of this study was to compare the effectiveness of ITSI versus oral diuretics for acute low frequency sensorineural hearing loss (LFHL) with vertigo.
Methods
A total 76 patients with LFHL that had developed within previous 2 weeks were enrolled and categorized into 2 groups: treated with ITSI four times on 4 consecutive days (ITSI group; 42 patients) and treated with diuretics orally for 2 weeks (diuretics group; 34 patients). After 6 months, we analyzed treatment outcomes using subjective improvement and audiometric change.
Results
Hearing thresholds at low frequencies ≤500 Hz were significantly improved in both ITSI and diuretics group (p<0.05). The cure rate of ITSI group was not significantly higher than that of diuretics group (54.8% vs. 52.9%, p>0.05). For subjective symptoms, there were no significant differences of improvement rate in both groups (ITSI 64.3% vs. diuretics 61.8%, p>0.05). In pure tone audiometry, the improvement rate of ITSI group was not significantly different from that of diuretics group (78.6% vs. 70.6%, p>0.05). There was a significant correlation between the cure rate and duration of symptoms.
Conclusions
Both ITSI and diuretics are effective treatment modalities for acute LFHL with vertigo within 2 weeks of development. There is no difference of treatment outcomes between ITSI and diuretics in patients with acute LFHL and vertigo.

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