Research in Vestibular Science

Case Reports

Positional Vertigo Showing Direction-Changing Positional Nystagmus after Chronic Otitis Media Surgery: Is It Benign Paroxysmal Positional Vertigo?: Seongjun Choi, Jung Eun Shin, Chang-Hee Kim; Res Vestib Sci. 2018;17(1):23-27. Published online March 15, 2018; DOI: https://doi.org/10.21790/rvs.2018.17.1.23

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This case report describes a patient who developed positional vertigo after surgery for chronic otitis media on the right side. Canal wall up mastoidectomy was performed, and the stapes was moderately mobilized during removal of the inflammatory granulation tissues that were attached to it. Immediately after the surgery, positional vertigo developed. The patient showed weakly left-beating spontaneous nystagmus in a seated position. Examination of positional nystagmus revealed geotropic direction-changing positional nystagmus with a prolonged duration and weak intensity in a supine head-roll test, which may be caused by a change in inner ear fluids due to a disruption of inner ear membrane around the oval window or penetration of toxic materials into the labyrinth during surgery.

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
Direction-Changing Positional Nystagmus in Acute Otitis Media Complicated by Serous Labyrinthitis: New Insights into Positional Nystagmus
Jin Woo Choi, Kyujin Han, Hyunjoo Nahm, Jung Eun Shin, Chang-Hee Kim
Otology & Neurotology.2019; 40(4): e393. CrossRef
Dialysis disequilibrium syndrome revisited: Feeling “Disequilibrated” due to inner ear dyshomeostasis?
Chang-Hee Kim, Jung Eun Shin, Jung Hwan Park
Medical Hypotheses.2019; 129: 109262. CrossRef

Delayed Positional Vertigo after Stapes Surgery: Jin Woo Park, Joon Hee Lee, Mee Hyun Song, Dae Bo Shim; Res Vestib Sci. 2015;14(4):147-151.

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Abstract PDF: Postoperative vertigo can occur after stapes surgery in approximately 5% of the patients, which more commonly presents immediately after surgery rather than in the delayed period. Isolated delayed vertigo after stapes surgery is commonly related to perilymphatic fistula. Herein we report a 36-year-old female patient who developed positional vertigo 18 days after stapes surgery demonstrating severe geotropic horizontal positional nystagmus on both sides during supine roll test. This patient was eventually diagnosed as the horizontal semicircular canal benign paroxysmal positional vertigo (BPPV) on the left side. This is a rare case of delayed vertigo following stapes surgery caused by BPPV rather than perilymphatic fistula.

Profound Hearing Loss after Endolymphatic Sac Decompression in Intractable Meniere’s Disease: Pona Park, Kyung Tae Park, Hyun Seok Choi, Ja Won Koo; Res Vestib Sci. 2014;13(3):72-76.

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Abstract PDF: Endolymphatic sac decompression (ESD) is indicated in intractable Meniere’s disease patients with serviceable hearing. A 43-year-old man presented with recurrent vertigo and fluctuating right hearing loss that had been intractable to medical treatment. ESD was performed for the purpose of vertigo control with hearing preservation. Positional vertigo with profound hearing loss developed immediate after surgery and positional vertigo was resolved within days. Following paralytic vestibulopathy with positive sign on head thrust test also resolved after 2 weeks, while sensorineural hearing loss was not recovered to preoperative level during 1 year of follow up. Recurrent vertigo attacks were developed again 1 year after the operation. Hearing preservation was not always guaranteed in ESD. Furthermore, chance of hearing loss should be included in informed consent though the procedure is purposed for hearing preservation.

Review

Surgical Treatments of Benign Paroxysmal Positional Vertigo: Shin Hye Kim, Hyun Seok Choi, Ja Won Koo; Res Vestib Sci. 2014;13(2):29-33.

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Abstract PDF: Benign paroxysmal positional vertigo (BPPV) is the most frequent vestibular disorder. Although it is easily cured with canal repositioning maneuvers for the majority of patients, it can be disabling in rare cases. For these patients, surgical treatments may be proposed. The aim of this article is to discuss their indication in intractable BPPV and review the surgical treatments used, the reported cases in the literature. All the articles from 1972 to 2013 that discussed specific surgical treatments in BPPV were reviewed. Many of them reported cases of operated patients and described original techniques. Some others are studies that discussed the three techniques used: singular neurectomy, posterior semicircular canal occlusion and intratympanic injection of gentamicin. Singular neurectomy and posterior semicircular canal occlusion are the two specific techniques used in intractable BPPV. A very small population of patients requires surgical treatments of BPPV. These procedures are difficult and risk compromising hearing. The intratympanic injection of gentamicin can be useful procedure in BPPV associated with Meniere disease. The surgical treatments of BPPV appear to be limited to exceptional cases. When good examination and appropriate treatment fail to cure patients with intractable BPPV, central positional vertigo should be ruled out before irreversible surgical procedures.

Original Articles

Role of Endolymphatic Sac Decompression in Intractable Meniere’s Disease: Shin Hye Kim, Jihye Rhee, Yoonjong Ryu, Byung Yoon Choi, Ja Won Koo; Res Vestib Sci. 2013;12(1):16-21.

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Abstract PDF: Background and Objectives: The role of endolymphatic sac decompression (ELSD) for the treatment of intractable Meniere disease (MD) has been debated. However, considering few treatment options for medically intractable MD with serviceable hearing or intractable bilateral MD, ELSD has shown reasonable treatment results without ablating inner ear function. The aims of this study are to review the role of ELSD in the treatment of MD and clinical course and long-term outcome after ELSD. Materials and Methods: The ELSD was performed in 7 patients among 603 definite Meniere disease patients between May 2003 and December 2010. Patient’s medical history and clinical courses after surgery were obtained by medical record review and telephone interview. Results: Mean duration of follow up until receiving ELSD was 575 days since initial visit. Six patients showed complete control or substantial control of vertigo, but one patient suffered from sustained vertigo attacks even after ELSD, the vertigo was controlled after intratympanic gentamicin injection (ITGI) at 20 months after ELSD. Another patient had recurrence of vertigo after 30 months, which was successfully controlled by ITGI. The preoperatively mean monthly vertigo was 4.8 and it was significantly decreased to 1.5 after postoperatively 1 year, 0 after postoperatively 2 years (p<0.001). Hearing was preserved in 6 patients during the follow-up period. Conclusion: Most patients who were uncontrolled vertigo with 3 to 6 months medication showed significantly reduced vertigo and hearing preservation after ELSD. The ELSD seems to be a beneficial treatment option for intractable MD.

Multicenter study on the treatment pattern of Ménière’s disease in Korea: Sung Kwang Hong, Eui Kyung Koh, Kyu Sung Kim, Kyoung Ho Park, Hong Ju Park, Seong Ki Ahn, Joong Ho Ahn, Won Sang Lee, Gi Jung Im, Jae Yun Jung, Won Ho Chung, Gyu Cheol Han, Sung Won Chae, Ja Won Koo; J Korean Bal Soc. 2008;7(2):174-181.

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Abstract PDF: Background and Objectives: It is hard to determine the efficacy of several treatment options of Ménière’s disease since dynamic course of the disease and diverse rate of recurrence. Few modalities are regarded as ‘effective’ in the viewpoint of evidence based medicine. Study was conducted to know the current status of treatment options for Ménière’s disease. Materials and Methods: A multicenter survey was conducted using questionnaires to collect information on current status of treatment patterns in Ménière’s disease. The questionnaire answered by neurotologic surgeons working at 12 institutes in Korea was analyzed. Results: Low salt diet was always instructed to their patients, but 8 out of 12 responders (67%) did not emphasis on the amount of dietary salt. Duration of pharmacotherapy was ranged from 3 to 12 months. Intratympanic steroid injection was performed in 8 institutes (67%). Every institute agreed on the role of intratympanic gentamicin application. Treatment options for intractable patients were asked. Endolymphatic sac surgery, intratympanic steroid, Meniette device and intratympanic aminoglycoside injection were answered in patients who hope to preserve residual hearing. On the contrary, in patients without serviceable hearing, intratympanic jnjection of aminoglycosides (9/12, 75%) dominated as the next treatment option. Conclusions: Most institutes provide similar patterns of practice in medical treatment. The application of intratympanic aminoglycoside is also agreed in intractable patients without serviceable hearing. However, thoughts about the role and detailed methods of the surgical and adjunctive treatment options were not agreed, especially in intractable patients with good hearing. Further clinical studies and discussions would be necessary to provide consensus for the best treatment of Ménière’s disease in Korea. Key words : Ménière’s disease, Pharmacotherapy, Surgery, Aminoglycosides

Case Reports

Delayed Postoperative Vertigo After Tympanomastoidectomy Due to Simultaneous Serous Labyrinthitis and BPPV: Yun Ho Kim, Jae Yun Jung, Chung Ku Rhee, Myung Whan Suh; J Korean Bal Soc. 2008;7(1):89-95.

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Abstract PDF: Postoperative vertigo after tympanomastoidectomy can be attributed to several causes such as inner ear damage due to excessive ossicle handling, labyrinthitis, BPPV resulting from vibration of drilling, iatrogenic lateral semicircular canal damage, and perilymphtic fistula. Differential diagnosis is critical for the proper management and prognosis of accompanied sensorineural hearing loss, but it may be difficult in some cases. Especially it is quite difficult to distinguish between the serous and suppurative labyrinthitis. In this article we present a case with simultaneous serous labyrinthitis and BPPV. The patient developed whirling vertigo and hearing loss on the 5th day after tympanomastoidectomy. After conservative treatment with steroid and antibiotics, his hearing recovered to preoperative level. We retrospectively reviewed the pitfalls to make a correct diagnosis in this patient and the serial change in nystagmus during the treatment period. The usefullness of the rotation chair test to predict the prognosis of sensorineural hearing loss in labyrinthitis was also discussed.

A Case of Contralateral Benign Paroxysmal Positional Vertigo after Mastoidectomy: Sung Lyong Hong, Ji Soo Kim, Ja Won Koo; J Korean Bal Soc. 2005;4(1):45-48.

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Abstract PDF: hors suggest plausible mechanisms of the contralateral side BPPV after mastoid surgery as follows. Surgical position during mastoid surgery (contralateral ear down) and postoperative bulky mastoid compressive dressing usually kept the patient’s head to the contralateral side can be precipitating factors for migration of detached particles into the semicircular canal of dependent position. Anyway, appropriate differential diagnosis and management plans should be prompted using bed side vestibular evaluation, since serious irreversible inner ear complications are more frequent cause of postoperative vertigo than BPPV.

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