Research in Vestibular Science

Original Articles

Otolith Function Tests in Patients with Orthostatic Dizziness: Su Hyun Ahn, Eun Ju Jeon, Yong Soo Park, Dong Hyun Kim, Inn Chul Nam; Res Vestib Sci. 2015;14(1):15-20.

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Abstract PDF: Background
and Objectives: Orthostatic dizziness (OD) is defined as when dizziness is provoked by standing up from a supine or sitting position. It is usually considered as being associated with orthostatic hypotension (OH). On the other hand, it is recently suggested that otolith organ dysfunction and impaired vestibulosympathetic reflex may account for development of OH and OD. Vestibular evoked myogenic potential (VEMP) and subjective visual vertical and horizontal tests (SVV/SVH) are tools for detecting otolith organ dysfunction. We assessed cervical VEMP (cVEMP) and SVV/SVH test results in the patients with OD to evaluate the relationship between OD and otolith organ function. Materials and Methods: Three hundred-eighty-seven patients who visited dizziness clinic were enrolled in this study. Seventy-three patients presented with OD (i.e., group O), while 314 patients did not present OD (i.e., group N). Vestibular function tests including cVEMP and SVV/SVH were performed. Results: cVEMP showed abnormal response in 47.9% of group O and 60.2% of group N. Abnormal SVV was found in 35.6% of group O and 31.5% of group N. Abnormal SVH was highly found in both group O and group N (30.1%, 27.1%). Conclusion: The values of SVV/SVH and cVEMP abnormality from both groups were not significantly different between the groups O and N. This finding suggests that otolithic function may not be related with OD.

Ocular Vestibular Evoked Myogenic Potential in Vestibular Neuritis Patients: Comparative Study with Cervical Vestibular Evoked Myogenic Potential and Subjective Visual Vertical: Su Il Kim, Young Min Ha, Sang Hoon Kim, Ji Hyun Chung, Moon Suh Park, Jae Yong Byun; Res Vestib Sci. 2014;13(4):102-107.

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Abstract PDF: Background
and Objectives: Subjective visual vertical (SVV) reflects utricle and superior vestibular neural functions, and cervical vestibular evoked myogenic potentials (cVEMP) reflect saccule and inferior vestibular neural functions. But, origin and characteristics of ocular VEMP (oVEMP) remain controversial, especially in case of evoked by air conducted sound (ACS). Thus, the aim of this study was to identify the origin and characteristics of oVEMP by comparing with various otolith function tests. Materials and Methods: Forty vestibular neuritis patients were enrolled from September 2012 to January 2013 in this study. We examined cVEMP, oVEMP using 500 Hz air-counducted sounds. And, we measured static and dynamic SVV. Results: Abnormal cVEMP responses were observed in 6 (15%) patients, and abnormal oVEMP responses were observed in 28 (70%) patients. Abnormal static and dynamic SVV were observed in 18 (45%), 35 (87.5%) patients, respectively. There was strong correlation between oVEMP and dynamic SVV (p=0.009). Conclusion: ACS oVEMP responses showed different tendency from cVEMP responses in vestibular neuritis patients, but similar tendency with results of dynamic SVV. The results suggest that origin of oVEMP is different from that of cVEMP and maybe utricle and superior vestibular neuron.

Effect of Preset Angle on Subjective Visual Vertical/Horizontal: Comparison between Normal Subjects and Patients with Dizziness: Tae Hyun Moon, Sung Hyen Bae, Myung Whan Suh, Chung Ku Rhee, Jae Yun Jung; Res Vestib Sci. 2010;9(2):52-57.

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Abstract PDF: Background and Objectives Subjective visual vertical (SVV) and subjective visual horizontal (SVH) are well known otolith function tests. Patients with acute unilateral vestibular weakness have a tendency to set the bar toward the side of the lesion in SVV and SVH tests. The object of this article is to identify the effect of preset angle on SVV and SVH tests in normal subjects and patients with dizziness. Materials and Methods From October 2008 to March 2009, thirty healthy volunteers, twenty eight vestibular neuritis (VN) patients (14-uncompensated, 14-compensated), Twenty five patients who had migrainous vertigo (MV) were enrolled. All subjects performed the test two times in each of the clockwise and counter-clockwise preset angle. Results In normal subjects, there was significant influence by preset angle on SVV test, not on SVH test. In VN patients with nystagmus, both SVH and SVV were not influenced by preset angle. In VN patients without nystagmus and in MV patients, there were significant influence by preset angle on both SVV and SVH tests. Conclusion SVV and SVH values depend on the direction of the preset angle in MV and uncompensated VN patients. The preset angle should be considered in the interpretation of SVV and SVH values.

Clinical Implication of Dissociation between Subjective Visual Horizontal and Subjective Visual Vertical: Tae Hyun Moon, Sung Hyen Bae, Il Kwon Cho, Myung Whan Suh, Chung Ku Rhee, Jae Yun Jung; Res Vestib Sci. 2009;8(1):37-42.

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Abstract PDF: Background and Objectives Subject visual vertical (SVV) and subject visual horizontal (SVH) is well known otolith function test. Patients with acute unilateral vestibular weakness fail to set the test bar within normal range in SVH/SVV showing abnormal deviation toward lesion side. In some cases, SVH and SVV are deviated towards different directions, and analysis of these findings is rarely reported. The authors analyzed correlation of SVH/SVV and other vestibular function tests in patients with various vestibular diseases. Materials and Methods From April 2005 to July 2007, total 234 patients who had admitted for dizziness were enrolled. All patients were divided in two groups, non-dissociation group (n=215) and dissociation group (n=19). Correlation of SVH, SVV, Videonystagmography (VNG), the rotating chair test was compared. Results 8.1% of patients showed dissociation between SVH and SVV. Clinical features did not showed significant difference between groups. In non-dissociation group, SVH/SVV showed correlation with VNG, rotating chair test. However in dissociation group, VNG and rotating chair test revealed high rate of consistency with deviation of SVH than that of SVV. Also direction of SVH and dizziness had higher consistency (88.9%) than that of SVV (11.1%). Conclusion The SVH showed consistency with other vestibular function test and may be more reliable than SVV when the result is dissociated. Key Words: Subjective visual vertical; Subjective visual horizontal; Dissociation

Subjective Visual Vertical during Eccentric Rotation in Acute Vestibular Neuritis Patients: Kee Hwan Kwon, Moon Suh Park, Jae Yong Byun; J Korean Bal Soc. 2008;7(2):182-187.

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Abstract PDF: Background and objective: By assessing unilateral utricular function at the acute unilateral vestinuloneuritis (Acute UVN), we sought to determine the ability of the subjective visual vertical (SVV) during eccentric rotation (dynamic SVV) in localizing the site of the lesion in unilateral vestibular neuritis (UVN). Methods: The static SVV and dynamic SVV of fifteen patients diagnosed with acute UVN were enrolled within 10 days of onset (average 7 days). First, the static SVV was measured in a dark booth without rotation. The dynamic SVV was measured during rotation with an eccentric displacement of the head to 3.5 cm from the vertical rotation axis during a constant velocity of 300°/s. Results: In the acute stage of UVN, the static SVV showed an increase in deviation to the side of the lesion compared to those of normal subjects. Also, we found 73% of abnormal findings in Acute UVN patients by assessing static conventional SVV. The dynamic SVV had a statistically significant increase in deviation to the side of the lesion compared to those of normal subjects and 93% patients showed beyond normal range. Conclusions: The dynamic SVV would be an effective method in the diagnosis and localization of acute unilateral vestibularneuritis, Key words: Acute vestibular neuritis, Subjective visual vertical, Eccentric rotation

Comparison of Air Caloric Test and Vibration-Induced Nystagmus Test in Patients with Unilateral Chronic Otitis Media without Vertigo: Jae Yoon Ahn, Hong Ju Park, Jung Eun Shin, Ga Hyun Park, Yong Soo Jung, Hi Boong Kwak, Yeo Jin Lee, Jin Seok Yoo; J Korean Bal Soc. 2007;6(2):167-171.

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Abstract PDF: Background and Objectives: The aims of the study were to characterize the vibration-induced nystagmus (VIN) and air caloric test in patients with unilateral chronic otitis media, and to clarify the clinical availability of VIN by comparing the results of VIN test with those of air caloric test. Materials and Methods: Nineteen patients with unilateral chronic otitis media who had had no vestibular symptoms in past history were investigated. Pure tone audiometry (PTA), air caloric, VIN and subjective visual vertical (SVV) tests were done and the results were analyzed to estimate the utility for investigating vestibular imbalance. Results: If we consider a patient with abnormal results from two or more tests as a patient with latent vestibular imbalance, because they had no previous vestibular symptoms, 3 patients was considered to have latent asymmetric vestibular function. False positive rate were 32% in air caloric test, 5% in VIN test and 0% in SVV test. Conclusion: Our findings show that vestibular imbalance in patients with chronic otitis media should be determined through various tests and vibration-induced nystagmus test can be more useful than air caloric test in estimating the vestibular imbalance.

Change of Subjective Visual Vertical (SVV) in Patients of Vestibular Neuritis: Heil Noh, Sayong Chae; J Korean Bal Soc. 2007;6(2):143-149.

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Abstract PDF: Background and Objectives: Measurement of subjective visual vertical (SVV) in darkness with the head upright is one of the static function test of the otolithic system and is simple to perform in the patients. Changes of SVV were measured during the recovery period of vestibular neuritis to investigate the relation between SVV and the subjective improvements reported by the patients. Material and Methods: Sixty-two patients with unilateral vestibular neuritis were investigated. All the patients were diagnosed by physical examination with electronystagmography and the SVV were assessed during the acute period and sequentially followed during the recovery period. At the same time, the subjects were questioned in five scale of symptom improvement which were “Level 5: I am so dizzy to open my eyes”, “Level 4: I am dizzy not moving my head”, “Level 3: I am not dizzy if I don’t move my head”, “Level 2: I am not dizzy with head moving”, “Level 1: I am not dizzy at all”. Results: The calibrated mean values were 5.72±4.77 degree in vertical deviated toward the lesion side. There was no relation between the canal paresis and the tilt of SVV. As the SVV reaches the normal value, the symptom scale improved to level 2 (p=0.018). The mean recovery time could be obtained by calculating the regression curve of the well compensated groups. Conclusion: These results show that SVV correlated with clinical improvement of dizziness symptoms in vestibular neuritis. Therefore, this method can be used to evaluate vestibular neuritis during the follow up.

Otolith Function Tests in Patient with Meniere’s Disease: Hong Ju Park, Jung Eun Shin, Jae Yoon Ahn, Ga Hyun Park, Yong Soo Jung, Hi Boong Kwak, Yeo Jin Lee, Jin Seok Yoo; J Korean Bal Soc. 2007;6(2):127-131.

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Abstract PDF: Background and Objectives: The aims of this study were to measure otolith function using subjective visual vertical (SVV) test and vestibular evoked myogenic potential (VEMP) test in patients with unilateral Meniere’s disease, and to see the relationship of the otolithic impairment with caloric and audiologic results. Materials and Methods: Twenty two patients with unilateral Meniere’s disease who received treatment and also had been tested for pure tone, caloric, SVV and VEMP tests were enrolled. All the tests were done simultaneously. Results: Five of 22 (23%) patients showed abnormal tilt to the lesion side in SVV test, and 13 of 22 (59%) patients showed abnormal VEMP results on the affected side. There was no correlation between SVV tilts and unilateral weakness (UW) in caloric tests or pure-tone average. There was also no difference of UW in patients with or without VEMP abnormalities. Two patients showed abnormal finding in both SVV & VEMP tests. One patient showed UW (47%) and SVV tilt (3.08°) to the lesion side, and the other showed normal UW and SVV tilt (3.22°) to the lesion side. Conclusion: Our results demonstrate that the otolith system was implicated in 16 out of 22 (73%) patients with Meniere’s disease. However, there was no correlation between the abnormal results of the three tests and these findings suggest that impairment of the otolithic function is depending on the extent and/or the localization of Meniere’s disease, suggesting vestibular rehabilitation for the specific lesion might be helpful.

Results of Vestibular Function Tests in Patients with Cerebello-Pontine Aangle Tumors: Hyang Ae Shin, Yong Soo Jeong, Jin Suk Yoo, HongJu Park; J Korean Bal Soc. 2006;5(2):253-261.

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Abstract PDF: Background
and Objectives: Acoustic neuroma (AN) is commonly encountered in the cerebello-pontine angle (CPA) and AN arises principally from the vestibular division of the nerve, which can show not only hearing disturbance but also various vestibular symptoms and laboratory findings by affecting central and peripheral vestibular system. Vestibular testing is reported not to be a useful screening test for AN, but can be helpful in defining whether the tumor arises from the superior or inferior division and identifying the cause of dizziness or vertigo. Materials and Method: We are presenting four patients with CPA tumors accompanied by various abnormal findings of vestibular function tests including head-shaking nystagmus, vibration-induced nystagmus, hyperventilation- induced nystagmus and vestibular evoked myogenic potential and subjective visual vertical, which can enable us to understand the pathomechanism of the abnormal results.
Results
All patients presented hearing loss and mild dizziness. Caloric test, head thrust test and vibration-induced nystagmus was helpful in localizing the disease, but head-shaking nystagmus and hyperventilation-induced nystagmus was less helpful. Otolith tests did not always show abnormal results.
Conclusion
We should consider abnormal results of the vestibular function tests in a whole to estimate the status of vestibular compensation in patients with CPA tumors. Key Words : Nystagmus, Subjective visual vertical, Acoustic neuroma

Otolith Function Tests in Patient with Vestibular Neuritis: Hong Ju Park, Jung Eun Shin, Dae Bo Shim, Hyang Ae Shin, Sang Kyun Lim, Jae Yoon Ahn, Yong Soo Jung, Jin Suk Yu; J Korean Bal Soc. 2006;5(1):49-54.

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Abstract PDF: Background
and Objectives: Vestibular evoked myogenic potentials (VEMP) test provides a useful method for assessment of saccule function and the functional integrity of the inferior vestibular nerve, and subjective visual vertical (SVV) abnormalities are presumably related to a lesion of the utricle. The aim(s) of this study were to measure otolith function using SVV and VEMP tests, and to define the influence of the otolithic organs in patients suffering from vestibular neuritis. Materials and Method: From September 2005 to January 2006, twelve patients who received treatment in hospital and also had been tested for caloric test, subjective visual vertical (SVV) and vestibular evoked myogenic potential (VEMP) tests with unilateral vestibular neuritis were enrolled. All the tests were done within 8 days after the onset of their symptoms, simultaneously. The SVV was measured in 34 normal subjects as well as in patients.
Results
Eight of 12 patients showed abnormal tilt to the lesion side in SVV test, and five of 8 patients showed no VEMP on the affected side. There was no correlation between SVV tilts and unilateral weakness (UW) in caloric tests. Two patients with abnormal UW (54, 82%) showed normal finding in SVV & VEMP tests. One patient with abnormal UW (83%) and SVV tilts (18.04˚) to the lesion side was normal in VEMP test. Two patients with abnormal UW (28, 37%) and no response in VEMP test were normal in SVV test.
Conclusion
Our results demonstrate that the incidence of abnormal results were 62.5, 66.7% in VEMP and SVV tests in acute stage of vestibular neuritis, respectively. There was no correlation between the abnormal results of the tests and these findings suggest that impairment of the otolithic function is depending on the extent and/or the localization of vestibular neuritis. Key Words : Vestibular neuritis, Otolith, Vestibular function tests, Subjective visual vertical, Vestibular evoked myogenic potentials

The Effect of Somatosensory Input on Subjective Visual Vertical in Normal Subjects: Dae Bo Shim, Hyun Jong Jang, Hyang Ae Shin, Jae Yoon Ahn, In Bum Lee, Jung Eun Shin, Hong Ju Park; J Korean Bal Soc. 2005;4(2):201-205.

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Abstract PDF: Background
and Objectives: Aims of the study were to determine if the somatosensory input influences on vertical perception by comparing the results with the head or body tilted (15°) to the right and to the left, and to examine the influence of tactile sensation in the perception of verticality in head lateral positions. Materials and Method: We tested 34 normal subjects in their ability to set a straight line to the perceived gravitational vertical. Measurements were taken in static conditions, sitting upright, head tilted (15°), body tilted (15°), and head lateral positions (90°) on the right/left sides with or without physical support under the head.
Results
The normal range of the subjective visual vertical (SVV) was 0.65°±1.23° in upright position. The normal ranges of SVV in head-tilts 15° to the left/right sides were -0.47°±1.76° and 1.88°±2.94°, which were significantly different from those in upright position (E-effect). But the normal ranges of SVV in body-tilts 15° to the left/right were not different from those in upright position. And the normal ranges of SVV in head lateral positions maintained actively and passively were not different each other, but significantly larger than that in upright position (A-effect).
Conclusion
Our results support that neck somatosensory input plays a part in the perception of verticality. In contrast, tactile sensation of the head had no effect on the settings of a visual line to visual vertical in head lateral positions.

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