Research in Vestibular Science

Original Article

Treatment response of calcitonin gene-related peptide monoclonal antibodies in vestibular migraine: a pilot study in a Korean population: Hyesoo Kwon, Ji-Yun Park, Byung-Kun Kim, Hyung Lee, Hyun Ah Kim; Res Vestib Sci. 2025;24(3):189-195. Published online September 15, 2025; DOI: https://doi.org/10.21790/rvs.2025.020

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Abstract PDF: Objectives
Vestibular migraine (VM) is a leading cause of recurrent vertigo, yet effective targeted treatments remain limited. Calcitonin gene-related peptide (CGRP) has been implicated in the pathophysiology of both migraine and vestibular disorders. This study investigates the therapeutic response of CGRP monoclonal antibodies (CGRP mAbs) in Korean patients with VM.
Methods
We conducted a prospective observational study involving 24 Korean patients diagnosed with VM. Of these, 20 patients completed treatment and follow-up and were included in the final analysis. Nine patients received monthly galcanezumab and 11 received fremanezumab, both for a minimum of 2 months. The primary outcome measure was the change in Korean Dizziness Handicap Inventory (KDHI) score from baseline to the end of the treatment period. Secondary outcomes included monthly dizziness days (MDD), dizziness severity on a visual analog scale (VAS), patient-reported global impression of change (PGIC), and tolerability.
Results
The average KDHI score decreased from 43.3 at baseline to 22.6 after treatment, with 75% of patients reporting much or very much improvement on PGIC. MDD dropped from an average of 20.8 to 6.65 days, and VAS dizziness severity declined from 7.2 to 3.8. Improvements were observed across KDHI subdomains. Both treatment groups showed benefit, and no serious adverse events were reported.
Conclusion
CGRP mAbs therapy with galcanezumab or fremanezumab may significantly reduce vestibular symptoms and disability in Korean patients with VM. These findings support the potential role of CGRP mAbs in treating VM, particularly in populations underrepresented in previous studies.

Review Articles

Persistent geotropic direction-changing positional nystagmus: a systematic review: Dong-Han Lee, Chang-Hee Kim; Res Vestib Sci. 2025;24(3):153-176. Published online September 15, 2025; DOI: https://doi.org/10.21790/rvs.2025.002

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Abstract PDF: Persistent geotropic direction-changing positional nystagmus (DCPN) is a unique clinical phenomenon characterized by persistent nystagmus observed during the supine head roll test. Unlike other DCPNs caused by canalolithiasis or cupulolithiasis, this persistent geotropic form is not fully explained by conventional mechanisms. The “light cupula” hypothesis, introduced in the early 2000s, proposes that reduced cupula density relative to the surrounding endolymph is a key explanation for cases of peripheral origin. However, other mechanisms, such as heavier endolymph, light debris, utricular dysfunction, and perilymph-endolymph density difference have also been suggested. Persistent geotropic DCPN may also arise from central lesions, further complicating its diagnosis. This review examines persistent geotropic DCPN with a focus on the peripheral hypothesis, particularly the concept of the light cupula, exploring its origin, clinical characteristics, diagnostic approaches, proposed alternative mechanisms, and treatment. This review also explores cases of persistent geotropic DCPN linked to central lesions and coexisting conditions like vestibular migraine and Ménière disease, focusing on their distinctive characteristics as reported in the literature. The limited effectiveness of available treatments highlights the importance of advancing research to better understand and manage this condition.

Vestibulo-ocular reflex findings in key subtypes of hereditary cerebellar ataxia: a review: Jae-Myung Kim, Alexander Andrea Tarnutzer, Seung-Han Lee; Res Vestib Sci. 2025;24(2):79-88. Published online June 15, 2025; DOI: https://doi.org/10.21790/rvs.2025.003

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Abstract PDF: Vestibulo-ocular reflex (VOR) impairments are common in central vestibular disorders and may provide critical insights into disease-specific pathophysiology and diagnosis. Recent advances in quantitative VOR and oculomotor measurement techniques, such as video head impulse testing and video-oculography, have further enhanced the accuracy and efficiency of these assessments. This is particularly important in the field of hereditary cerebellar ataxia, where definitive diagnosis still depends on genetic testing due to significant overlap in clinical phenotypes and considerable variability. This review focuses on four representative subtypes selected based on both global prevalence and the predominance of vestibular dysfunction, as evaluated by quantitative assessments: spinocerebellar ataxia type 3 (SCA3), SCA6, Friedreich ataxia (FRDA), and cerebellar ataxia with neuropathy and vestibular areflexia syndrome (CANVAS). Quantitative vestibular assessments revealed distinct patterns of VOR impairment. SCA3 and CANVAS consistently show markedly reduced angular VOR (aVOR) gains across all stimulation frequencies and measurement techniques. In contrast, FRDA demonstrates aVOR impairments primarily during high-frequency stimuli, with inconsistent low-frequency responses. SCA6 is characterized by frequent high-frequency aVOR impairments, predominantly affecting horizontal and posterior canals, while low-frequency responses remain variable. Notably, aVOR suppression (VOR cancellation) is severely impaired in SCA6 and in approximately half of FRDA cases, but relatively preserved in SCA3 and CANVAS, offering a potential marker for differential diagnosis. An integrated assessment of vestibular and oculomotor findings may provide valuable diagnostic clues. This review aims to assist clinicians and researchers in understanding the characteristic VOR profiles of key hereditary cerebellar ataxias.

Original Article

Associations between Dizziness Handicap Inventory scores and vestibular function tests: a cross-sectional survey: Eun-Ju Jeon, Chae-Hyun Lim, Eun-Jin Son, Chang-Yeong Jeong, Ji Hyung Lim, Hyun Jin Lee; Res Vestib Sci. 2024;23(4):156-164. Published online December 15, 2024; DOI: https://doi.org/10.21790/rvs.2024.023

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Abstract PDF: Objectives
This study aims to evaluate the relationship between subjective dizziness disability, as assessed by the Dizziness Handicap Inventory (DHI), and objective vestibular function test (VFT) results in patients presenting with dizziness.
Methods
We conducted a retrospective review of 177 patients who completed the DHI, vertigo visual analog scale, and disability scale at their initial visit. Objective VFTs included videonystagmography with caloric testing, cervical vestibular evoked myogenic potential (cVEMP), and the sensory organization test (SOT). Statistical analyses were conducted to assess correlations and differences in DHI scores based on VFT results and clinical characteristics.
Results
The DHI scores indicated a higher perceived dizziness handicap among female patients compared to males (p=0.012). Chronic dizziness was associated with elevated DHI scores in specific items (DHI-2, DHI-12, and DHI-21; p<0.05). Patients with abnormal caloric responses exhibited higher scores in several DHI items and subscales (DHI-4, DHI-12, DHI-14, DHI-17, DHI-19, DHI-23, physical, emotional, and functional; p<0.05). No significant differences were found in cVEMP results. Only one SOT condition (equilibrium score 5) showed a statistically significant but weak association with DHI scores (r=–0.151, p=0.045).
Conclusions
There were limited correlations between objective vestibular test outcomes and subjective dizziness disability. These findings underscore the multidimensional nature of dizziness and the importance of integrating subjective and objective measures for a comprehensive clinical assessment.

Review

Understanding Vestibular Information Processing in Velocity-Storage Circuit and Application to Interpreting Clinical Manifestation of Vestibular Disorders: Jeong-Yoon Choi; Res Vestib Sci. 2021;20(3):81-92. Published online September 15, 2021; DOI: https://doi.org/10.21790/rvs.2021.20.3.81

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Abstract PDF: The velocity-storage circuit comprised of bilateral vestibular nucleus complexes, commissural fiber, and nodulus and uvula functions in refining the raw vestibular signal to estimate rotational velocity, gravity direction, and inertia. In this review, we pursued the functional significance of this velocity-storage circuit and how this physiologic knowledge could help us understand the clinical symptoms and signs of patients with vestibular disorders.

Original Articles

Impact of Vestibular Function on Health-Related Quality of Life: A Cross-Sectional Study Based on Korea National Health and Nutrition Examination Survey: Hyun Jung Kim, Soo Bin Lee, Michelle J. Suh; Res Vestib Sci. 2021;20(1):17-23. Published online March 11, 2021; DOI: https://doi.org/10.21790/rvs.2021.20.1.17

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Abstract PDF Supplementary Material: Objectives
This study was performed to investigate whether vestibular dysfunction affects health-related quality of life in Korean adults.

Methods
This retrospective cross-sectional study was performed with data from the 2010 to 2011 Korea National Health and Nutrition Survey for adults aged 40 years or more. The modified Romberg test and health-related quality of life evaluation using the EuroQoL 5-dimensional (EQ-5D) questionnaires were performed. Data were analyzed using a complex-sample chi-square test of independence and multivariate linear regression analysis. The main outcome measures were vestibular dysfunction and the calculated health-related quality of life questionnaire score.

Results
The overall prevalence of vestibular dysfunction was 3.4% (95% confidence interval, 2.5%–4.3%). In adults aged more than 40 years, multivariate linear regression analyses showed a significant reverse correlation between vestibular function and health-related quality of life since the EQ-5D index showed a lower score than normal (B coefficient=‒0.09, R²=0.299, p=0.003) for a decrease in balance function, and the scores for mobility, self-care, general activities, and pain/discomfort were worse, except for anxiety/depression. On the other hand, subjective dizziness was significantly associated with the EQ-5D index and all its subcategories.

Conclusions
Since adults with vestibular dysfunction have poor health-related quality of life, active monitoring and rehabilitation are necessary.

Comparison of Suppression Head Impulse and Conventional Head Impulse Test Protocols: Kyung Jin Roh, Ju Young Kim, Eun Jin Son; Res Vestib Sci. 2019;18(4):91-97. Published online December 15, 2019; DOI: https://doi.org/10.21790/rvs.2019.18.4.91

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Abstract PDF

Objectives
The head impulse test paradigm (HIMP) assesses semicircular canal function by measuring compensatory saccades during head movements as an indication of an impaired vestibulo-ocular reflex (VOR). The recently introduced suppression head impulse test paradigm (SHIMP) examines anticompensatory saccades after head movements as a measure of intact VOR. Thus, HIMP measures a decrease in vestibular function, whereas SHIMP measures residual function. We evaluated the effectiveness of SHIMP, compared HIMP and SHIMP results in the same subjects, and examined the relationship between the 2 tests.
Methods
HIMP and SHIMP protocols were performed in 73 patients. The patients were instructed to maintain their gaze on a fixed target for the HIMP, or a moving target for the SHIMP during head impulses. The VOR gain and saccade parameters were compared.
Results
HIMP and SHIMP data were obtained for all ears except in 3 patients. The VOR gain with SHIMP was smaller than for HIMP, but showed significant correlation (r=0.8356, p＜0.001) and substantial agreement (k=0.79). However, neither the percentage of saccades (appearance of HIMP compensatory saccades and reduction of SHIMP anticompensatory saccades) nor their amplitudes were correlated between the 2 tests.
Conclusions
The HIMP and SHIMP protocols are valuable tools to evaluate VOR during high-velocity head movements. Our results confirm their agreement as measures of VOR gain during head impulses, but also show that the relationship between compensatory and anticompensatory saccades is not straightforward. Thus, care should be taken during clinical interpretation of either protocol.

Citations

Citations to this article as recorded by

Normalization of the Suppression Head Impulse Test (SHIMP) and its correlation with the Head Impulse Test (HIMP) in healthy adults
Suheda Baran, Gulce Kirazli, Pelin Pistav Akmese, Nese Celebisoy, Tayfun Kirazli
Journal of Vestibular Research.2024; 34(1): 15. CrossRef
Test-retest reliability of suppression head impulse paradigm (SHIMP) in healthy individuals
Aishwarya Nagarajan, Shashish Ghimire, Varsha Sam Elizabeth, Sujeet Kumar Sinha
Hearing, Balance and Communication.2023; 21(4): 312. CrossRef
A nystagmus extraction system using artificial intelligence for video-nystagmography
Yerin Lee, Sena Lee, Junghun Han, Young Joon Seo, Sejung Yang
Scientific Reports.2023;[Epub] CrossRef
Efeito da idade no equilíbrio corporal e nos resultados do vídeo teste do impulso cefálico em pacientes com insuficiência cardíaca
Gizele Francisco Ferreira do Nascimento, José Diniz Júnior, Rosiane Viana Zuza Diniz, Miguel Angelo Hyppolito, Erika Barioni Mantello
Audiology - Communication Research.2023;[Epub] CrossRef
Effect of age on body balance and on the results of the video head impulse test in patients with heart failure
Gizele Francisco Ferreira do Nascimento, José Diniz Júnior, Rosiane Viana Zuza Diniz, Miguel Angelo Hyppolito, Erika Barioni Mantello
Audiology - Communication Research.2023;[Epub] CrossRef
Development of An Algorithm for Slippage-Induced Motion Artifacts Reduction in Video-Nystagmography
Yerin Lee, Young Joon Seo, Sejung Yang
Research in Vestibular Science.2022; 21(4): 104. CrossRef
VOR gain of lateral semicircular canal using video head impulse test in acute unilateral vestibular hypofunction: A systematic review
Mohamad Alfarghal, Mohammed Abdullah Algarni, Sujeet Kumar Sinha, Aishwarya Nagarajan
Frontiers in Neurology.2022;[Epub] CrossRef
Evaluation of high frequency horizontal VOR parameters in patients with chronic bilateral and unilateral peripheral vestibulopathy: a preliminary study
Gulce Kirazli, Sevinc Hepkarsi, Tayfun Kirazli
Acta Oto-Laryngologica.2020; 140(12): 1007. CrossRef

Review

Dizziness in Traumatic Brain Injury: Visual-Vestibular Dysfunction, Neurotological Approach: Seong-Hae Jeong; Res Vestib Sci. 2019;18(2):27-31. Published online June 15, 2019; DOI: https://doi.org/10.21790/rvs.2019.18.2.27

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Abstract PDF: Traumatic brain injury (TBI) could give rise to variable clinical manifestations based on the involved structures of our bodies. Although there are no structural abnormalities proven, the patients with mild TBI suffer from chronic dizziness and imbalance. Herein, I will discuss the visuo-vestibular interaction and neurotological finding in TBI, which could demonstrate the clue to the diagnosis and management in dizzy patients with TBI.

Original Article

The Effect, Compliance and Satisfaction of Customized Vestibular Rehabilitation: A Single Center Experience: Hyung Lee, Hyun Ah Kim; Res Vestib Sci. 2019;18(1):14-18. Published online March 15, 2019; DOI: https://doi.org/10.21790/rvs.2019.18.1.14

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Abstract PDF

Objectives
Over the last decades, numerous studies on the effect of vestibular rehabilitation (VR) have been reported in western countries, but there has been no report about real experiences of customized VR in Korea. The aim of this study was to analyze of the efficacy, compliance and satisfaction in patients with acute and chronic dizziness.
Methods
Patients with dizziness were treated with a customized VR at least 4 weeks. Subjects were assessed before and after at least 4 weeks of customized VR for visual analogue scale (VAS) and disability scale (DS). Patients were asked to score the satisfaction of their treatment as 1 (very poor) to 5 (excellent). Compliance to exercise program were graded as 1 (regularly performed), 2 (frequently performed), or 3 (rarely performed).
Results
Thirty-two patients with dizziness were included. Diagnosis of patients were vestibular migraine (n=5), Meniere’s disease (n=2), vestibular neuritis (n=10), persistent perceptual positional dizziness (n=10), bilateral vestibulopathy (n=3), and central dizziness (n=2). Mean VAS and DS before VR were 15.3 and 2.4, respectively. Mean VAS and DS after VR were 4.5 and 0.7, respectively. Significant improvements in VAS and DS were observed after VR (p=0.00). Mean treatment satisfaction score was 3.3±1.0 and mean compliance score was 2.3±0.8. Satisfaction to VR showed positive correlation with patient’s compliance. (p=0.00, r=0.644)
Conclusions
Significant improvements were seen in symptom and disability in patients with acute and chronic dizziness after customized VR. Patients showed moderate compliance to exercise program and overall satisfaction was fair.

Citations

Citations to this article as recorded by

A Survey of Educational, Clinical Background in Vestibular Rehabilitation Therapy of Korean Physical Therapists
Migyoung Kweon, Youn Bum Sung
The Journal of Korean Academy of Physical Therapy .2023; 30(2): 65. CrossRef
Factors Associated with Patient Satisfaction in Customized Vestibular Exercise: A Pilot Study
Hye Soo Ryu, Min Young Lee, Jae Yun Jung, Ji Eun Choi
Research in Vestibular Science.2019; 18(3): 71. CrossRef

Case Report

Extremely Long Latency Benign Paroxysmal Positional Vertigo: Emil Riis Abrahamsen, Dan Dupont Hougaard; Res Vestib Sci. 2017;16(2):64-68. Published online June 15, 2017; DOI: https://doi.org/10.21790/rvs.2017.16.2.64

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Abstract PDF

Case history of a 67-year-old man diagnosed with posterior benign paroxysmal positional vertigo (BPPV) with extremely long latencies after holding the Dix-Hallpike position for five minutes. Additional vestibular assessment indicated partial unilateral hypofunction. The patient had a history compatible with classic BPPV. This patient, however, did not have any positional nystagmus after doing standard positional testing. With extremely prolonged Dix-Hallpike testing (five minutes), the patient experienced nausea and vertigo. Concomitantly classic peripheral nystagmus was observed. After a total of seventeen treatments in a reposition chair a total relief of symptoms was obtained. The extremely long latencies observed in this patient were ascribed to otoconial adherence and/or otoconial size. This type of BPPV has not previously been described.

Citations

Citations to this article as recorded by

Upbeat and Direction-Changing Torsional Nystagmus While Straight Head Hanging: A New Sign of Benign Paroxysmal Positional Vertigo Involving Bilateral Posterior Semicircular Canals
Hyun-Jae Kim, Sang Jin Park, Ji-Soo Kim
Journal of Clinical Neurology.2024; 20(1): 100. CrossRef

Reviews

Vestibular Rehabilitation for Patient with Bilateral Peripheral Vestibular Deficit: Hyun Woo Park, Seong Ki Ahn; Res Vestib Sci. 2016;15(1):1-4.

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Abstract PDF: Bilateral vestibular deficit affects far fewer patients than unilateral deficit, and thus has been understudied. When bilateral vestibular organs are injured, loss of input of vestibulo-ocular and vestibulo-spinal reflex that normally stabilize the eyes and body, affected patients suffer blurred vision during head movement, postural instability, and disequilibrium. Vestibular rehabilitation therapy is an exercise-based treatment program designed to promote vestibular adaptation and substitution. The rationale for the exercises, which originated from the observation that patients who were active recovered faster, was based on the supposition that the head movements that provoke the patient’s dizziness play an important role in hastening the recovery process. Here the author reviews the clinical manifestation and treatment of bilateral vestibular deficit that include vestibular rehabilitation therapy and vestibular device that studied today.

Vestibular Rehabilitation for Patients with Unilateral Peripheral Vestibular Deficit: Chang Geun Song, Sung Kwang Hong; Res Vestib Sci. 2015;14(3):61-66.

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Abstract PDF: Unilateral peripheral vestibular deficit can occur from a different etiology including viral infection, trauma, ear surgery or idiopathic. Patients with sudden unilateral vestibular deficit usually complain of whirling vertigo, postural imbalance and ipsilesional lateropulsion, which gradually recover over a few weeks by vestibular compensation mechanism. Vestibular rehabilitation therapy has been accepted as helpful exercise based training program with strong evidence for acceleration of vestibular compensation in unilateral vestibular deficit. Here the authors described the current issue regarding vestibular rehabilitation in unilateral vestibular hypofunction from the informative literature review.

Case Reports

Possibility of Misdiagnosing the Lesion Side in Unilateral Vestibular Weakness: Il Kwon Cho, Jae Yun Jung, Chung Ku Rhee, Myung Whan Suh; Res Vestib Sci. 2009;8(2):168-173.

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Abstract PDF: Sudden sensorineural Hearing Loss with Vertigo (SHLV) is characteristic of sudden onset vertigo and unilateral hearing loss, due to acute and profound deterioration in a vestibular and cochlear system. It is relatively easy to determine the lesion side in SHLV, because the patient will complain of unilateral hearing loss. But, it might not beapplicable to vestibular neuritis case, and several vestibular function tests may be helpful in deciding the lesion side. We have recently encountered a patient with SHLV whose caloric and SHA did not match with the lesion side. We speculated that the uncompensated dynamic defect and imbalance of the cerebellar clamping has been implicated in this lab finding. Although the exact mechanism of this curious finding cannot be explained by this single case report, we should consider that one could make a mistake to determine the involved site just only by lab finding in vestibular neuritis.

Benign Paroxysmal Positional Vertigo in Bilateral Vestibular Loss: Jeong Hun Jang, Sung Kwang Hong, Ji Soo Kim, Ja Won Koo; J Korean Bal Soc. 2007;6(1):53-56.

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Abstract PDF: Usual presentations of bilateral vestibular loss are ataxia and oscillopsia. However, fluctuating dizziness is also observed in bilateral vestibulopathy patient. Fluctuating vestibular function in bilateral vestibular loss patients may suggest asymmetric progression of functional loss after compensation is partially accomplished. Because labyrinthine lesion causing vestibular loss is a predisposing factor of benign paroxysmal positional vertigo (BPPV), secondary BPPV can also be developed in bilateral vestibular loss patients. However, BPPV has been hardly noticed in bilateral vestibulopathy patients as a cause of fluctuating dizziness. Authors experienced two cases of BPPV developed in bilateral vestibular loss, one of which showed complete dead labyrinth on ice water caloric test and no significant vestibule-ocular reflex on rotation test. These cases show recurrent BPPV can be the cause of recurrent vertigo in bilateral vestibular loss patients.

Randomized Controlled Trial

Treatment outcome of two different methods of canalith repositioning maneuver: Byung-Kun Kim, M.D.; J Korean Bal Soc. 2002;1(1):97-102.

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Abstract PDF: Background
and Objectives: Canalith repositioning procedure described by Epley is an effective treatment of benign paroxysmal positional vertigo (BPPV) based on the theory of canalithiasis. Although there are many modifications of Epley's maneuver, they have much similarity and are usually composed of 4 steps. However there is considerable variation of pause at each position from 6 seconds to 4 minutes. The purpose of this study is to determine treatment outcome of short and long pause at each position. Materials and Methods: This is a randomized prospective study of patients with posterior canal type BPPV. One hundred patients were randomized to one of two groups at their first clinic visit between March 1999 and September 2000. The diagnosis was based on typical findings of vertigo and nystagmus by Dix-Hallpike maneuver and head turning in supine position. The authors treated patients with two different methods of the canalith repositioning procedure. One group maintained each position until the nystagmus stopped. If no nystagmus was observed, the position was maintained for 5 to 10 seconds. The other group maintained each position for 3 minutes. We assessed treatment outcomes of two methods.
Results
We can not find the difference of a success rate between two groups.
Conclusion
It takes less than one minute with rapid head position changing method, so this method is more feasible in out-patients clinics.

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