Research in Vestibular Science

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

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Abstract PDF Supplementary 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 cerebellopontine angle meningioma presenting as neurovascular compression syndrome of the 8th cranial nerve: Jeongin Jang, Sung Kwang Hong, Joonho Song, Hyung-Jong Kim, Hyo-Jeong Lee; Res Vestib Sci. 2024;23(1):28-31. Published online March 15, 2024; DOI: https://doi.org/10.21790/rvs.2023.141

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Abstract PDF: A 54-year-old female patient presented with paroxysmal tinnitus and vertigo for 2 years, which have repeatedly occurred while rotating her neck, and lasted about 10 seconds. An anticonvulsant medication was prescribed with a diagnosis of microvascular compression syndrome on the 8th cranial nerve and audiovestibular evaluation and magnetic resonance imaging (MRI) scan were appointed a week later. In her next visit, she reported the disappearance of paroxysmal audiovestibular symptoms after medication. In the left ear, canal paresis and abnormal auditory brainstem response were observed. In MRI, a large meningioma in the cerebellopontine angle in the vicinity of the internal auditory canal orifice was detected, that was surgically resected by a neurosurgeon. After surgical removal of the tumor, she reported continuous dizziness due to vestibular nerve injury, but the paroxysmal attack of tinnitus and vertigo disappeared without anticonvulsant medication. This case suggests that an imaging study is mandatory when diagnosing microvascular compression syndrome on the 8th cranial nerve.

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

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Abstract 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.

Review

Diagnostic Criteria for M?nier?’s Disease: Jose A Lopez-Escamez, John Careyb, Won Ho Chung, Joel A Goebeld, Mans Magnusson, Marco Mandala, David E Newman-Tokerg, Michael Strupp, Mamoru Suzuki, Franco Trabalzini, Alexandre Bisdorff; Res Vestib Sci. 2015;14(3):67-74.

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Abstract PDF: This paper presents diagnostic criteria for M?nier?’s disease jointly formulated by the Classification Committee of the B?r?ny Society, The Japan Society for Equilibrium Research, the European Academy of Otology and Neurotology, the Equilibrium Committee of the American Academy of Otolaryngology-Head and Neck Surgery, and the Korean Balance Society. The classification includes two categories: definite M?ni?re's disease and probable Meni?re's disease. The diagnosis of definite M?ni?re's disease is based on clinical criteria and requires the observation of an episodic vertigo syndrome associated with low- to medium- frequency sensorineural hearing loss and fluctuating aural symptoms (hearing, tinnitus and/or fullness) in the affected ear. Duration of vertigo episodes is limited to a period between 20 minutes and 12 hours. Probable M?nier?'s disease is a broader concept defined by episodic vestibular symptoms (vertigo or dizziness) associated with fluctuating aural symptoms occurring in a period from 20 minutes to 24 hours.

Case Report

Acute Sensorineural Hearing Loss and Tinnitus with Aspirin: A Case Report: Hyun Cho, Jee Hyun Kwon, Hyun Jin Seo; Res Vestib Sci. 2009;8(1):74-76.

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Abstract PDF: Salicylate (aspirin) causes ototoxic side effects in some patients, such as bilateral mild to moderate sensorineural hearing loss and tinnitus although its ototoxic mechanisms still remain largely unclear. We report about one case with acute sensorineural hearing loss anf tinnitus after one week of low dose aspirin therapy. Audiogram revealed a mild sensorineural hearing loss at 35.0 dBHL in the right ear. Tinnitus became louder more and more, and sounded like a unilateral or bilateral high-pitch noise with each recurrence persisting for five minutes or longer. Audiologic problem of this case resolve within two or three days after the aspirin is discontinued. Generally, ototoxicity of salicylate manifests as bilateral, flat to high-frequency sensorineural hearing loss, and the risk of ototoxicity increases with higher doses and prolonged treatment course. But our case tend to suggest that symptoms of ototoxicity also might be occur in patients in even low dose salicylate with variable audiologic finding case tend to suggest that symptoms of ototoxicity also can occur in patients in even low dose salicylate use with variable audiologic finding. Further work on the relationships between plasma salicylate concentrations and ototoxicity is required. Key Words: Tinnitus; Sodium Salicylate; Hearing Loss, Sensorineural

Original Articles

Effect of Intratympanic Chemical Labyrinthectomy with Streptomycin on Auditory Symptoms: Hyun Su Kim, Sung Huhn Kim, Dae Bo Shim, Sang Cheol Kim, Won Sun Yang; Res Vestib Sci. 2009;8(1):32-36.

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Abstract PDF: Background and Objectives Background and Objectives: Intratympanic treatment with aminoglycosides for Ménière’s disease has been used, trying to eliminate vertigo complaints, while preserving hearing. This study was undertaken to evaluate the therapeutic outcomes for auditory symptoms in Ménière’s disease patients after intratympanic application with single low-dose streptomycin powder. Materials and Methods Ninty-eight patients diagnosed with definite Ménière’s disease who underwent chemical labyrinthectomy with streptomycin at Yonsei University Medical Center from March 1997 to June 2006 were enrolled. Low dose streptomycin powder (10 mg) was applied into the round window niche directly. Changes of hearing threshold, tinnitus and aural fullness were evaluated postoperatively according to Committee on Hearing and Equilibrium guidelines for the diagnosis and evaluation of therapy in Ménière’s disease of American Academy of Otolaryngology–Head and Neck Surgery. Results Hearing threshold was not changed significantly after the procedure (from 65.5±19.1 to 69.3±20.0 p>0.05) and was improved in 7% of the patients. Hearing deterioration after the procedure was detected only in 17%. Tinnitus and aural fullness was improved in 51% and 25% respectively. Conclusion Single application of streptomycin powder filling round window niche showed minimal deterioration of hearing threshold. It is the useful method to improve or prevent the progress of auditory symptoms in patients with Ménière’s disease. Key Words: Streptomycin; Hearing loss; Tinnitus; Meniere Disease; Aural fullness

Acute hearing symptoms as a prodrome of anterior inferior cerebellar artery infarction: Hyung Lee, Yong Won Cho, Sung Il Sohn; J Korean Bal Soc. 2003;2(1):95-102.

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Abstract PDF: Objectives
An acute auditory symptom (AAS) without any other neurological symptoms or signs suggests a lesion in the peripheral auditory system. Blood supply to the peripheral auditory system arises from the internal auditory artery, ordinarily a branch of the anterior inferior cerebellar artery (AICA), therefore a partial ischemia in the AICA distribution may manifest with an AAS and/or vertigo. The aim of this study was to investigate the clinico-radiologic features of patients who presented with an AAS as a prodromal symptom of the AICA infarction.
Methods
Sixteen consecutive cases of the AICA infarction diagnosed by brain MRI completed a standardized audiovestibular questionnaire and underwent a neurotological evaluation by an experienced neurotologist.
Results
Five patients (31%) had an AAS as a prodrome of the AICA infarction 1-10 days prior to onset of other brainstem and/or cerebellar symptoms. Two types of AAS were found: recurrent transient hearing loss and/or tinnitus (n=3) or a single episode of prolonged hearing loss and/or tinnitus (n=2). The episodic symptoms were brief, lasting only minutes. The tinnitus preceding infarction was identical to the tinnitus experienced at the time of infarction. At the time of the infarction, all patients developed hearing loss, tinnitus, vertigo, and an ipsilateral hemiataxia. The most common affected site was the middle cerebellar peduncle (n=5). Four of 5 patients had an incomplete hearing loss and all patients had an absence of vestibular function to caloric stimulation on affected side, respectively.
Conclusions
AAS may be a warning sign of an impending pontocerebellar infarction in the distribution of the AICA. The AAS preceding an AICA infarction may result from an ischemia of the inner ear or the vestibulocochlear nerve.

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