Research in Vestibular Science

Review Articles

Disentangling vestibulo-ocular reflex cancellation and vestibulo-ocular reflex suppression in vestibular testing: definitions, mechanisms, and clinical applications: Leonardo Manzari; Res Vestib Sci. 2026;25(1):1-13. Published online March 17, 2026; DOI: https://doi.org/10.21790/rvs.2026.002

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Abstract PDF: The terms “vestibulo-ocular reflex (VOR) cancellation” and “VOR suppression” are often used interchangeably in vestibular research and clinical testing, despite probing distinct computations. This review provides operational definitions that separate cancellation from suppression across common paradigms (visually enhanced VOR, VOR suppression, head-impulse paradigm/translational VOR, and suppression head-impulse paradigm/head-fixed target) by linking each task to the appropriate outcome measure (eye-in-head versus gaze-in-space) and to explicit timing windows (early [approximately 0–150 msec] reflex vs. later task-dependent modulation). Cancellation is framed as the goal to minimize eye-in-head motion when foveating a head-fixed target, whereas suppression reflects visually driven eye velocity (fixation/pursuit) that counteracts vestibular drive to stabilize gaze on a space-fixed target. We integrate vestibular-nuclear and vestibulo cerebellar mechanisms, including the influence of velocity storage, to explain frequency/velocity dependence and dissociations in peripheral vestibulopathies and central (cerebellar/brainstem) disorders. Finally, we propose a pragmatic reporting checklist and a decision algorithm to harmonize interpretation and to guide rehabilitation targets (adaptation, suppression training, substitution, and predictive cueing).

Multimodal diagnostic evaluation in Ménière disease: a narrative review of vestibular function tests and gadoliniumenhanced magnetic resonance imaging for endolymphatic hydrops: Tae Hoon Kong, Young Joon Seo; Res Vestib Sci. 2025;24(4):205-214. Published online December 15, 2025; DOI: https://doi.org/10.21790/rvs.2025.014

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Abstract PDF: Objectives
Ménière disease (MD) is a complex inner ear disorder marked by episodic vertigo, fluctuating hearing loss, and tinnitus. Despite established clinical diagnostic criteria, definitive diagnosis remains challenging due to symptom overlap and lack of objective biomarkers. This review examines the diagnostic utility of advanced vestibular function tests (VFTs)—caloric testing, video head impulse test (vHIT), vestibular evoked myogenic potentials (VEMPs), and rotatory chair testing—alongside three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) magnetic resonance imaging (MRI) imaging of endolymphatic hydrops (EHs). We propose an integrated diagnostic model that improves sensitivity, specificity, and clinical decision-making.
Methods
Evidence from recent cohort studies, meta-analyses, and high-resolution MRI protocols is synthesized. Sensitivity, specificity, and functional target profiles are compared across modalities. Test concordance and discordance patterns are reviewed, and a stratified risk algorithm is presented.
Results
Triple test concordance (caloric+vHIT+cervical VEMP [cVEMP]) provides 78% sensitivity and 92% specificity for definite MD. Gadolinium-enhanced 3D-FLAIR MRI detects cochlear EHs with sensitivities reported up to 95% and specificities commonly ranging from 85% to 90%, while vestibular hydrops detection shows comparatively lower sensitivity across studies. In our synthesis, combined strategies—operationalized as triple vestibular testing (caloric+vHIT+cVEMP) with selective MRI when indicated—improve overall diagnostic performance relative to single-modality testing (65% with a single test to 88% to 90% when ≥2 VFTs are abnormal, and MRI corroborates hydrops).
Conclusions
Multimodal assessment may serve as an objective adjunct to clinical criteria. In practice, we use MRI selectively—for atypical or refractory cases, or when VFTs are inconclusive—to complement the stepwise diagnostic pathway.

Original Articles

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.

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; Res Vestib Sci. 2023;22(2):34-45. Published online June 15, 2023; DOI: https://doi.org/10.21790/rvs.2023.22.2.34

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Abstract PDF: Objectives
The objective of this study was to analyze vestibulocochlear function results in patients identified with isolated semicircular canal (SCC) hypofunction using the video head impulse test (vHIT).
Methods
A retrospective review was conducted on the clinical records of 123 patients diagnosed with isolated SCC hypofunction based on vHIT results. Among these patients, 72 had isolated posterior SCC (PSCC) hypofunction, 25 had isolated lateral SCC (LSCC) hypofunction, and 26 had isolated anterior SCC (ASCC) hypofunction. Descriptive analyses were performed on various vestibulocochlear tests including pure tone audiometry, sinusoidal harmonic acceleration (SHA), spontaneous nystagmus (SN), head-shaking nystagmus (HSN), caloric testing, and cervical vestibular evoked myogenic potential, with results analyzed separately for each SCC hypofunction group.
Results
The study found that 66.0% of the evaluated patients exhibited abnormal results in at least one vestibulocochlear function test. PSCC hypofunction patients showed a significantly higher incidence of hearing loss compared to ASCC and LSCC hypofunction patients. LSCC hypofunction patients exhibited higher rates of corrective saccade, phase asymmetry of SHA, and SN abnormalities compared to other SCC hypofunction patients. Additionally, the rates of corrective saccade and phase asymmetry of SHA were also higher in LSCC hypofunction patients. ASCC hypofunction patients demonstrated significantly higher rates of normal corrective saccade, phase lead of SHA, and SN.
Conclusions
The analysis of this study suggests that even in cases where vHIT indicates isolated SCC hypofunction, additional vestibulocochlear function tests should be conducted to identify any associated vestibulocochlear dysfunctions. This highlights the importance of comprehensive evaluation to accurately diagnose and manage patients with SCC hypofunction.

Development of An Algorithm for Slippage-Induced Motion Artifacts Reduction in Video-Nystagmography: Yerin Lee, Young Joon Seo, Sejung Yang; Res Vestib Sci. 2022;21(4):104-110. Published online December 15, 2022; DOI: https://doi.org/10.21790/rvs.2022.21.4.104

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Abstract PDF: Objectives
The slippage of the video-nystagmography devices causes motion artifacts in the trajectory of the pupil and thus results in distortion in the nystagmus waveform. In this study, the moving average was proposed to reduce slippage-induced motion artifacts from the real-world data obtained in the field.
Methods
The dataset consists of an infrared video of positional tests performed on eight patients with a lateral semicircular canal benign paroxysmal positional vertigo. The trajectories of the pupil were obtained from the video with binarization, morphological operation, and elliptical fitting algorithm. The acquired data was observed and the section where the slippage occurred was labeled by an otolaryngologist. The moving average with windows of various lengths was calculated and subtracted from the original signal and evaluated to find the most adequate parameter to reduce the motion artifact.
Results
The period of nystagmus in the given data was found to be ranged from 0.01 to 4 seconds. The slippages that appeared in the data can be categorized into fast and slow slippages. The length, distance, and speed of trajectories in the slippage ranges were also measured to find the characteristics of the motion artifact in video-nystagmography data. The shape of the nystagmus waveform was preserved, and the motion artifacts were reduced in both types of slippages when the length of the window in moving average was set to 1 second.
Conclusions
The algorithm developed in this study is expected to minimize errors caused by slippage when developing a diagnostic algorithm that can assist clinicians.

Impairment of Vestibular Function in Patients with Vestibular Schwannoma According to the Presence of Dizziness: Youngjeong Lee, Se A Lee, Eek-Sung Lee, Tae-Kyeong Lee, Jong Dae Lee; Res Vestib Sci. 2022;21(3):75-79. Published online September 15, 2022; DOI: https://doi.org/10.21790/rvs.2022.21.3.75

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Abstract PDF: Objectives
Vestibular schwannoma (VS) is a benign Schwann cell-derived slow growing tumor originating from the vestibular nerve. Here, we aimed to investigate the correlation between the presence of the dizziness symptoms and several vestibular function test results.
Methods
We analyzed 32 patients who diagnosed with VS from 2010 to 2021 in our hospital. Caloric test, cervical vestibular-evoked myogenic potential (cVEMP) test, and video head impulse test (vHIT) were analyzed.
Results
Age, sex, pure tone audiometry, and tumor size did not show any statistical significance according to the presence or absence of dizziness. There was also no association between the presence of dizziness symptom or dizziness type and the results of the caloric test, vHIT, and cVEMP test, respectively. However, patients with dizziness had a higher rate of tumors confined to the inner auditory canal than those without dizziness.
Conclusions
In this study, the rate of complaints of dizziness was higer in patients with intracanalicular VS. The diagnostic role of vestibulsr function tests in VS is limited. The dissociation of the results of caloric test, vHIT, and cVEMP test suggest that these test are complementary.

Laboratory Management Status of Vestibular Function Test in Korea: Tae Su Kim, Mi Joo Kim, Byung-Kun Kim, Hyun Ah Kim, Dae Woong Bae, Miran Bae, Seong-Cheon Bae, Eeksung Lee, Eun-Ju Jeon; Res Vestib Sci. 2018;17(4):160-166. Published online December 21, 2018; DOI: https://doi.org/10.21790/rvs.2018.17.4.160

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Abstract PDF Supplementary Material

Objectives
This study was conducted to assess the current management status of the vestibular function test laboratories in Korea.
Methods
Questionnaire about the management status of the vestibular function test laboratories was sent by email to the entire members of the Korean Balance Society. The contents of questionnaire included situation of employees who perform the tests, the types of vestibular function tests and equipment, frequency of the test and types of dizziness related questionnaires.
Results
Forty-nine hospitals and clinics responded. All the 49 respondents answered that they have videonystagmography. Spontaneous nystagmus analysis by videonystagmogrphy was the most frequently tests for patients with dizziness. Questionnaires for dizziness were used by 27 respondents (55.1%) for initial evaluation of the dizziness patients. The Korean version of dizziness handicap inventory was the most frequently used dizziness related questionnaire. Conclusions: We analyzed the current management status of vestibular function test laboratories to comprehend the present condition of the vestibular function test. We think that these results will help to provide a standard for laboratory operations and prepare for the education, focusing on high-demand tests.

Citations

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The impact examination of the head tilt size on the subjective visual vertical (SVV) among the normal individuals with ages ranged from 18 to 35 years
Mahmoud Rezvani Amin, Hadi Behzad
Hearing, Balance and Communication.2022; 20(2): 129. CrossRef

The Clinical Efficacy of Vestibular Function Tests in Patients with Acute Unilateral Vestibulopathy: Bong-Hui Kang, Jae-Il Kim; Res Vestib Sci. 2018;17(2):49-54. Published online June 15, 2018; DOI: https://doi.org/10.21790/rvs.2018.17.2.49

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Abstract PDF: Objectives
Aim of this study is to investigate the clinical efficacy of the vestibular function tests (VFTs) and the predictability of lesion side of vestibular asymmetry parameters in acute unilateral peripheral vestibulopathy.
Methods
Medical records and results of VFTs (caloric, rotatory chair, and head impulse tests) of 57 patients with acute unilateral vestibulopathy were reviewed retrospectively. The VFTs were examined within 7 days after the clinical onset.
Results
For the caloric test, 74% showed significant canal paresis and the predictability of lesion side was 88%. For the sinusoidal harmonic acceleration test, 91% had low gain in at least 1 Hz, phase lead showed 70%, 89% showed phase asymmetry and the predictability of lesion side was 90%. For velocity step test, 67% had abnormal Tc asymmetry and the predictability of lesion side was 95%. In bedside head impulse test (HIT), abnormal catch up saccades were observed in 89% and the predictability of lesion side was 100%. For the video HIT, cover or overt catch-up saccades were observed in 95% and the predictability of lesion side was 100%. One hundred percent (100%) had low gain on the video HIT, but the lesion sides were uncertain because of bilateral involvements or artifacts.
Conclusions
The most important things in the diagnosis of acute unilateral vestibulopathy are typical clinical symptoms and spontaneous nystagmus. A combination of rotatory, caloric, and HITs will result in a more complete examination of the vestibular system. Among them, HIT is recommended as the best tool in acute unilateral vestibulopathy.

Clinical Significance of Perverted Head-Shaking Nystagmus: Tae-Ho Yang, Byung-Soo Shin, Man-Wook Seo, Sun-Young Oh; Res Vestib Sci. 2017;16(4):119-128. Published online December 15, 2017; DOI: https://doi.org/10.21790/rvs.2017.16.4.119

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Abstract PDF: Objectives
We investigated clinical significance of head shaking nystagmus (HSN) and perverted HSN (pHSN) in patients with peripheral and central vestibular disorders. Methods: We reviewed medical records of 822 consecutive subjects who were referred to a dizziness clinic. We performed neurologic examination including video-oculography in darkness for 60 seconds before, during and for 100 seconds after head-shaking. HSN was considered to develop when post-head-shaking nystagmus last at least 5 beats with latency from end of head-shaking of no more than 5 seconds, and a velocity at least 3°/sec. Results: In control group (n=45), there were observed spontaneous nystagmus (SN) in 2.2%, HSN in 17.8%, pHSN in 6.7%. In patients with peripheral vestibular disorder group (n=397), there were observed SN in 14.1%, HSN in 40.6%, pHSN in 9.8%. In patients with central vestibular disorder group (n=217), there were observed SN in 17.5%, HSN in 24.0%, pHSN in 13.4%. In unspecified dizziness group (n=208), there were observed SN in 1.9%, HSN in 13.0%, pHSN in 1.9%. pHSN was frequently observed in central vestibular disorders such as stroke, vestibular migraine, cerebellar ataxia, and vertebro-basilar insufficiency. However, pHSN was also observed at higher rate than expected in peripheral vestibular disorders including benign paroxysmal positional vertigo especially involving vertical canals, Meniere disease and even in unilateral vestibulopathy. Conclusions: Our results show that perverted HSN in dizzy populations was frequently observed not only in cases of central vestibular disorders but also in peripheral disorders. Perverted HSN can develop by any conditions that cause difference in vestibular velocity storage in vertical component of vestibular-ocular reflex.

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.

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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

Original Article

Vestibular Dysfunctions in Vestibular Migraine Evaluated by Rotatory Chair Test: Ji Yun Park, Byeong Cheo Oh, Tae Kyeong Lee, Ki Bum Sung; Res Vestib Sci. 2015;14(4):123-131.

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Abstract PDF: Objective: There have been several efforts to elucidate the pathophysiology of the vestibular migraine (VM). But, there is no consistent result. This study was to identify the possible pathophysiology of VM by comparing vestibulo-ocular reflex (VOR) parameters between VM, and the tension type headache (TTH) patients. In addition, we compared VOR parameters between ictal and interictal period in the VM group.
Methods
Seventy eight patients were included: 44 having VM and 34 TTH. Three parameters (gain, asymmetry, and phase) of the horizontal VOR rotating at 60 degrees were measured. In 10 VM patients VOR parameters were obtained twice sequentially first in the ictal and second in the interictal period.
Results
Although the average of the VOR gain in VM group was lower than that of TTH group but there was no statistical significance. An asymmetry of the VOR was significantly higher in VM group. There were various changes in other VOR parameters between ictal and interictal periods with no consistent trends.
Conclusion
We could deduce that VM patients might have subclinical vestibular dysfunction from the reduced gain and increased asymmetry of the VOR in the interictal period. Dynamic changes of the VOR in the ictal period could be responsible for dizziness in VM patients, which are caused by the pathological alteration of the physiologic plasticity of the VOR.

Review

The Principle and Methodology of Vestibular Evoked Myogenic Potential: Min Young Lee, Myung Whan Suh; Res Vestib Sci. 2015;14(1):9-14.

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Abstract PDF: Vestibular evoked myogenic potential (VEMP) has developed as a broadly applied vestibular function test in clinics from its introduction in 1992. In the past, there was only one well known VEMP protocol, which is cervical VEMP, however recently ocular VEMP is also popular. Therefore, clarifying the VEMP recording protocol (cervical VEMP or ocular VEMP) before discussing the VEMP
result
has become essential. There is considerable difference regarding this VEMP test from other vestibular function tests. VEMP is thought to be assessing the functions of the otolith organs (utricle and saccule) which are evoked by acoustic stimulus. Cervical VEMP is valuable since this is the only available test method which could speculate the function of the saccule and inferior vestibular nerve. Still, there’s less clearly understood part regarding the central pathway of VEMP. However, many clinicians and researchers participating in vestibular research speculate that this functional test will have a more dominant role in the near future. Here we describe the basic principles and methodological considerations regarding VEMP recording.

Original Article

Eye Movement Abnormalities and Neuroimaging Findings of Disequilibrium of Unknown Origin: Jae Yong Go, Jung Im Seok, Dong Kuck Lee; Res Vestib Sci. 2014;13(4):108-113.

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Abstract PDF: Background
and Objectives: Although disequilibrium is common type of dizziness in older people, it is sometimes difficult to identify a specific cause for this problem. The diffuse brain pathology including subcortical ischemia and atrophy can be a cause for patients with disequilibrium of unknown cause. Aim of this study is to identify the eye movements and neuroimaging features in patients with disequilibrium. Materials and Methods: We performed a prospective investigation in patients with disequilibrium of unknown cause. We collected information on demographic characteristics and clinical features of disequilibrium. The impact of dizziness on everyday life was assessed by 25-item dizziness handicap inventory (DHI). Vestibular function test (VFT) includes smooth pursuit, saccade, optokinetic nystagmus, and rotatory chair test. Subcortical white matter lesions and brain atrophy were graded from brain magnetic resonance image (MRI).
Results
This study included 14 patients (12 female and 2 male), aged between 64 and 84 years, mean age 74.01±6.02 years. The score of DHI was 39.4±11.8 (20?58). Eye movements were abnormal in 13 patients and normal in only one patient. The degree of subcortical ischemia was mild in 7, moderate in 4, and severe in 3 patients. Ventricular brain ratio was 0.23±0.03. However, there was no significant relationship between MRI findings and the degree of oculomotor alterations (result of VFT). Conclusion: Patients with disequilibrium of unknown cause are usually elderly women. Alterations in oculomotor movements and diffuse brain pathology including white matter lesions and atrophy were observed in patients with disequilibrium of unknown cause.

Case Report

A Case of Bilateral Vestibular Hypofunction Following Oseltamivir Medication: Ho Yeop Kim, Seong Ki Ahn, Dong Gu Hur; Res Vestib Sci. 2013;12(1):27-30.

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Abstract PDF: The threat of pandemic influenza has focused attention and resources on virus surveillance, prevention, and containment. The World Health Organization has strongly recommended the use of the antiviral drug, Oseltamivir (TamifluⓇ), to treat and prevent pandemic influenza infection. In recent years, there have been case reports of vestibulocochlear events during or after oseltamivir treatment, other countries. Oseltamivir is generally well-tolerated and its most frequent adverse effects include nausea and vomiting, diarrhea, and abdominal pain. Up to now, bilateral vestibular hypofunction after oseltamivir medication has not been reported. Herein, we report a very rare case of a 36-year-old female with bilateral vestibular hypofunction following oseltamivir medication.

Review

Clinical Manifestations and Neuro-otological Findings of Migrainous Vertigo: Hyun Jung Jung, Seung Han Lee; Res Vestib Sci. 2012;11(1):1-7.

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Abstract PDF: Background and Objectives: Migrainous vertigo (MV) is one of the recurrent vestibular syndromes and may present episodic vestibular and concurrent migraine symptoms. The clinical manifestations and neuro-otological findings of MV have been delineated over the last couple of decades, however, there are still lots of uncertainties. Materials and Methods: We performed a comprehensive literature search regarding the clinical manifestations and neuro-otological findings of MV compatible with the diagnostic criteria proposed by Neuhuaser. We found the published articles that addressed the clinical and neuro-otological findings and we performed a pooled analysis. Results: Even though the duration of MV attack was variable from seconds to days, the most common durations investigated in this study was minutes (range, 5-60 minutes). During MV attack, most patients had a migraine headache, but instead the other migraine symptoms (i.e., photophobia, phonophobia) could be found. There were positional nystagmus which may not meet a stimulated canal plane and spontaneous nystagmus and, less commonly, gaze-evoked nystagmus. Regarding bithermal caloric test, unilateral canal paresis could be found in 15-20% of MV patients as well as hyperexcitability in some patients. Oculomotor tests might show impaired pursuits (mainly saccadic pursuit) and saccadic abnormalities such as delayed latency and hypometric saccade. Conclusion: From the result of the pooled analysis, we have found several clinical and neuro-otological findings. However, vital neuro-otological findings which can provide a clue for the diagnosis of MV are still lacking. So the diagnosis of MV should depend on the clinical manifestations and a process of differential diagnosis.

Original Article

Inferior Vestibular Neuritis: Absence of Vestibular Evoked Myogenic Potentials in the Presence of Normal Caloric Responses: Kyoung Rok Kim, Bo Kyoung Kim, Seong Ah Hong, Ho Young Lim, Eun Jin Son; Res Vestib Sci. 2010;9(4):139-143.

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Abstract PDF: Background and Objectives: To report the clinical features of six patients diagnosed with cases of inferior vestibular neuritis based on abnormal vestibular evoked myogenic potential (VEMP) responses with normal caloric test results. Materials and Methods: We retrospectively reviewed 62 patients presenting with dizziness. All patients underwent a battery of audiovestibular testing, including hearing tests, caloric test and VEMP test. Results: Six patients were diagnosed as inferior vestibular neuritis. All patients presented with acute onset of prolonged vertigo. The pure tone audiograms and caloric test results were normal. VEMP response was absent unilaterally, and normal in the contralateral ear. Conclusion: Inferior vestibular neuritis should be considered in patients presenting with acute vertigo, but normal caloric responses. Comprehensive vestibular testing including VEMP is necessary.

Case Report

A Case of Selective Inferior Vestibular Neuritis Showing Normal Caloric Test: Eun Goo Kang, Kyu Rin Hwang, Jong Dae Lee, Ki Bum Sung; Res Vestib Sci. 2009;8(1):45-48.

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Abstract PDF: Vestibular neuritis is commonly diagnosed by demonstrating of peripheral vestibular failure as a unilateral loss of the caloric response. It is a sudden, spontaneous, unilateral loss of vestibular function without simultaneous hearing loss or brainstem signs. In most patients with vestibular neuritis, the process is thought to involve the superior vestibular nerve. Very rarely, vestibular neuritis involves only the inferior vestibular nerve. We experienced a 56-year-old male with inferior vestibular neuritis. The patient had vertigo and spontaneous nystagmus, but a normal caloric test. Brain magnetic resonance imaging was normal, while vestibular evoked myogenic potentials had absent amplitudes on the lesion side. The patient was thought to suffer from pure inferior nerve vestibular neuritis. Key Words: Vestibular neuronitis; Vestibular function tests

Original Articles

Benign Recurrent Vertigo: Clinical Manifestations And Vestibular Function Test: Chang Hyo Kim, Kyu Sung Kim, Hoseok Choi, Yun Gun Jung, Seung Chul Lee; J Korean Bal Soc. 2008;7(1):48-54.

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Abstract PDF: Background and Objectives: Benign recurrent vertigo has been defined as recurrent spells of vertigo lasting minutes to hours without cochlear and neurologic signs. The etiology is still unclear, but viral and vasospastic etiology as migraine equivalent has been suggested. We attempt to analyze the symptoms and vestibular function test of Benign recurrent vertigo that has clinically diagnosed. Materials and Methods: We analyzed retrospectively the clinical characteristics and vestibular function test including ocular-motor test, rotation test and computerized dynamic posturography from 100 patients with a Benign recurrent vertigo diagnosis. Results: Eight two percent of the patients were female, mean age was 52 years, and mean duration of prevalence was 47.3 months. In the characteristics of vertigo, 91% of patients have spinning sensation during attack. The vertigo attacks most commonly lasts several hours (57%), and frequency of attack is three to twelve time per year in 47%. A high incidence (40%) of headache was detected, but incidence of other associated symptoms including fluctuating hearing loss (3%), tinnitus (27%), aural fullness (9%) was relatively low. The incidence of spontaneous nystagmus and positional nystagmus was 18% and 10% each. Saccadic undershoot was observed in 21% of patients, but it was not associated with other ocular-motor test abnormalities. In rotation test, low gain, phase lead and asymmetry was observed in 18%, 3% and 9%, respectively. There were no abnormal findings in posturography. Conclusions: Although benign recurrent vertigo did not show any characteristic clinical findings or vestibular function test, it deserves to be considered for differential diagnosis of episodic vertigo.

Comparative Analysis of Vestibular Asymmetry Parameters in Acute Unilateral Peripheral Vestibulopathy: Hoseok Choi, Kyu Sung Kim, Young Hyo Kim, In Kuk Hwang, Seung Yeon Jang, Seung Chul Lee; J Korean Bal Soc. 2007;6(2):202-206.

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Abstract PDF: Background and Objectives: There are known parameters that indicate vestibular asymmetry, such as directional preponderance (DP) on caloric test, asymmetry on slow harmonic acceleration (SHA) test, asymmetry of time constant (Tc) and slow cumulative eye position (SCEP) on velocity step test. Aim of this study is investigate the sensitivity and predictability of the vestibular asymmetry parameters among them. Materials & Methods: Twenty six patients who were diagnosed as acute unilateral peripheral vestibulopathy were enrolled in this study. We compared each parameter with site of lesion based on the direction of spontaneous nystagmus and canal paresis (CP) which were totally correlated in this group of patients. Results: Positive predictability of each parameter showed 58% in DP, 62% in SHA asymmetry, 62% in SCEP, 38% in Tc. In the cases that each parameter showed positive result, all of DP and SHA asymmetry indicated site of lesion, and showed high correlation coefficient(r=0.89). But in 27% of SCEP and 23% of Tc did not indicate site of lesion. Conclusion: All parameters showed low sensitivity for identifying laterality of lesion even the tests were performed with in one week after vertigo attack. DP and VOR asymmetry showed high positive predictability for indicating lesion site.

Follow-up Examination of Vibration-Induced Nystagmus in Patients with Unilateral Vestibular Neuritis: 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):172-175.

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Abstract PDF: Background and Objectives: The aim of this study was to verify if vibration-induced nystagmus in patients with vestibular neuritis changed over time and to compare the results of vibration-induced nystagmus (VIN) test to those of caloric test. Materials and Method: We compared VIN results with those of caloric testing in 23 patients (M:F = 11:12, 15~67 years old) with unilateral vestibular neuritis seen at onset and in follow-up for around 2 months. The eye movement recordings were made and the maximum slow-phase eye velocities (SPV) were calculated during vibration. If spontaneous nystagmus was present, it was subtracted from the slow-phase eye velocities of VIN. Results: In acute stage, VIN of which SPV was directed towards the lesioned side was observed in 21 (91%). In follow-up, VIN of which SPV was directed towards the lesioned side was observed in 19 (83%). There was a significant decrease of the SPV of VIN over time. Significant correlations were observed in between canal paresis & SPV of VIN in both acute and follow-up stages. Conclusion: Our findings show that VIN test can predict the severity of vestibular asymmetry not only in acute stage but also in follow-up stage. Our results suggest that vibration-induced nystagmus might represent the peripheral vestibular asymmetry in patients with vestibular neuritis.

The Effect of Balance Exercise Using Exercise Ball on Balance Function of Elderly: Suk Joon Lee, Jai Hwan Hyun, Yong Soo Lee, Hyun Ju Lee, Hyun Jung Lee, Jae Yun Jung, Chung Ku Rhee; J Korean Bal Soc. 2007;6(2):132-137.

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Abstract PDF: Background and Objectives: Vestibular rehabilitation is an important therapy to treat dizziness in elderly. The aim of this study is to evaluate the effect of balance and resistance exercises in improving balance function in elderly. Methods: Sixty elderlies between the age of 65 to 80 years old were divided into two groups; the control group and exercise group. The exercise group carried out balance and resistance exercises using an exercise ball for 60 minutes each time, 3 times/week for 16 weeks. The elderlies in both groups went through sensory organization test (SOT) and motor control test (MCT) of Equi test pre-series of exercise and post-series of exercise. Results: Conditions 4 and 6 of SOT in control group and conditions 3, 4, 5, and 6 of exercise group showed significantly higher scores in post-exercise compared to those of pre-exercise status. In condition 4, the score was significantly higher in exercise group compared to that of control group. In sensory analysis, the visual and vestibule analyses ratio of post-exercise were significantly higher compared to those of pre-exercise status. The visual analysis ratio of exercise group was significantly higher compared to that of control group. In MCT, the latency of medium forward of exercise group was significantly decreased compared to that of control group in post-exercise status. Conclusion: The results of this study showed that the balance and resistance exercises using an exercise ball was effective in improving various scores and ratio of SOT and sensory analyses in the elderly. This kind of exercises appears to improve balance function in the elderly. The balance and resistance exercises using exercise ball may be effective exercises to improve balance function of chronic dizziness including presbyastasis.

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.

Case Report

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.

Original Articles

Correlation between Spontaneous Nystagmus and Vestibular Function Test Parameters according to Gender and Age in Vestibular Neuritis: Jae Yun Jung, Eun Seok Lim, Young Saeng Kim, Min Young Lee, Yong Won Chung, Chung Ku Rhee; J Korean Bal Soc. 2006;5(2):248-252.

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Abstract PDF: Background
and Objectives: There are caloric test, SCEP, DP in Step velocity and VOR asymmetry in SHA test as parameters for evaluation in unilateral peripheral vestibulopathy in parameter of vestibular function test. The aim of this study is to assess the correlation between these parameters and intensity of spontaneous nystagmus in vestibular neuritis. Materials and Method: We evaluated 75 patients who were diagnosed as vestibular neuritis with 3 degree spontaneous nystagmus at vestibular function test lab from January 2000 to July 2005 in Dankook university hospital. The correlations between direction and intensity of spontaneous nystagmus and monothermal caloric test, SCEP and DP in step velocity, VOR asymmetry (0.01, 0.04, 0.16 Hz) in SHA test were analysed. And correlations according to sex, age were also analysed.
Results
The correlation coefficient between intensity of spontaneous nystagmus and monothermal caloric test was 0.60. The correlation coefficient between intensity of spontaneous nystagmus and SCEP was 0.35. The correlation coefficient between intensity of spontaneous nystagmus and Tc DP was 0.36 and it showed no significant correlation. The correlation coefficient between intensity of spontaneous nystagmus and VOR asymmetry (0.01, 0.04, 0.16) was 0.57, 0.46, 0.51, respectively and there was higher correlation in man, age under 60.
Conclusion
Intensity of spontaneous nystagmus showed close relations to monothermal caloric test, VOR asymmetry of SHA, Tc DP, SCEP DP in sequence. In addition, young male patients tends to be closely related to intensity of spontaneous nystagmus. Key Words : Spontaneous nystagmus, Vestibular function test, Vestibular neuritis

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

Analysis of the Vestibular Function in Children with Otitis Media with Effusion: in Jung Cho, Keehyun Park, You Ree Shin, Yun Hoon Choung; J Korean Bal Soc. 2005;4(2):212-218.

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Abstract PDF: Otitis media with effusion (OME) is one of the most common diseases in children and may be frequently related with dizziness. Background and Objectives: However, the association between OME and dizziness seems to be not clear and remains controversy. The purpose of this study was to determine the incidence of dizziness in children with long lasting OME, and to investigate the difference in vestibular functions between children with long lasting OME and the control group. Materials and Method: Thirty one children who had long-lasting OME over than 6 months (study group) and 28 normal hearing children without OME who were scheduled for adenotonsillectomy (control group), were given questionnaires and vestibular function tests (VFT) including electronystagmography (ENG) and rotation chair test(RCT). Statistical analysis was performed with chi-square test.
Results
Dizziness was found in 7 (22.6%) of 31 children in the study group and 2 (7.1%) of 28 children in the control group (p>0.05). The difference of abnormal findings in VFT between the study group and the control was not significant except visual vestibulo-ocular reflex (VVOR) in RCT. Most of the correlations in the study group, bilateral vs. unilateral OME, OME with dizziness vs. OME without dizziness, and preoperative vs. postoperative, were not significant.
Conclusion
We did not find any evidences of significant difference of the incidence of dizziness and findings of VFT between children with long lasting OME and children without OME. However, there was a significant abnormal response in VVOR in RCT in children with long-lasting OME, suggesting the children with OME may be more dependent on the nonvestibular system including visual compensation to maintain balance.

Analysis of Parameters of Vestibular-Evoked Myogenic Potentials in Sudden Sensorineural Hearing Loss without Vertigo: Min Hyun Park, Woo Jin Jeong, Jae Jun Song, Ji Soo Kim, Ja Won Koo; J Korean Bal Soc. 2005;4(2):206-211.

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Abstract PDF: Background
and Objective: Vestibular evoked myogenic potentials (VEMP) has been promoted as a means of assessing the integrity of saccular function. Even though sacculospinal reflex may not be influenced by abnormality of cochlear pathway, saccule is closely related with cochlea in its embryological development and also in geographic location. So authors hypothesized the presence of functional alterations of saccule in patients with sudden sensorineural hearing loss who do not complain of vertigo, since saccular dysfunction may not induce subjective vestibular symptoms or signs. Authors tested saccular function in those patients using VEMP and analyzed the parameters according to other clinical indicators. Materials and Method: From July to September 2005, 22 patients who diagnosed with unilateral sudden sensorineural hearing loss without vertigo were enrolled. The patients who had vertigo as initial symptom or showed spontaneous nystagmus were excluded. All patients received conventional audiometry, tone-burst VEMP test, and caloric test. We analyzed P13 and N23 latency, interpeak amplitude and asymmetric ratio of amplitude. The patients divided to complete hearing recovery, partial recovery, and no response group according to treatment outcome. The correlation between parameters and treatment result was analyzed.
Results
In 2 out of 22 patients (9.1%), VEMP waves were not detected. There was no latency delay in affected ear. But the interpeak amplitude of the affected ear was significantly smaller than that of healthy side (paired t test, p=0.02). Patients who did not respond to treatment showed smaller interpeak amplitude than those who showed complete recovery.
Conclusion
Most patients of idiopathic sudden sensorineural hearing loss without vertigo seem to show normal VEMP waves. But some parameters regarding amplitude had abnormal findings in affected ear. Further studies with larger sample size seem to be necessary to elucidate such outcomes.

The Analysis of Post Traumatic Benign Paroxysmal Positional Vertigo: Chang Hyun Cho, Dong Kyu Kim, Gyu Cheol Han, Eun Jeong Lee, Joo Hyun Woo, Ju Hyoung Lee; J Korean Bal Soc. 2005;4(1):17-25.

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Abstract PDF: Background
and Objectives :Benign paroxysmal positional vertigo (BPPV) has a lot of causes. Except idiopathic BPPV, the most common cause of BPPV was trauma. The aim of this study was to study its character, diagnosis, prognosis and treatment. Materials and Method : We retrospectively collected the 14 patients by reviewing charts, analyzing vestibular function tests.
Results
: Post traumatic BPPV had characters different from idiopathic BPPV in patient' sex ratio and age distribution. The mean age of patients was 40 years old, men were 11 women were 3. In the mechanisms of trauma, traffic accidents were 11, assault was 1, and fall down were 2. In types, posterior semicircular canal were 10, horizontal semicircular canal were 4. In origins, cupulolithiasis were 8, canalolithiasis were 6. Treatment and prognosis were similar to those of idiopathic BPPV.
Conclusion
: But origin, diagnostic criteria, treatment and prognosis are identical with idiopathic BPPV. Therefore, in evaluating post traumatic BPPV patients, we need correct diagnosis and treatment together by history taking, physical examination and vestibular function tests. And by this, we can treat idiopathic BPPV accurately, reduce expense and time for patients to return daily life.

Clinical Trial

Vestibular Evoked Myogenic Potential Generated by 500 Hz Tone Burst in Unilateral Peripheral Vestibulopathy: Ja Won Koo, Dong Hwan Roh, Chang Hee Kim, Jin Young Kim, Ji Yeon Yu, Kwang Dong Choi, Ji Soo Kim; J Korean Bal Soc. 2004;3(2):356-361.

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Abstract PDF: Background
and Objectives : Vestibular evoked myogenic potential (VEMP) has become a valuable diagnostic tool evaluating the integrity of sacculocollic reflex and has been done using click sound in most previous clinical trials. This study aims to investigate VEMP responses generated by 500 Hz tone burst in unilateral peripheral vestibulopathy and compare the response with caloric test and subjective visual vertical (SVV). Materials and Method : Clinical records of 37 patients (18 men and 19 women, aged 14-80 years) with unilateral peripheral vestibulopathy were reviewed. Diagnoses were Meniere's disease (n=13), vestibular schwannoma (n=4) and acute peripheral unilateral vestibulopathy (n=20). They underwent 500Hz tone burst VEMP, caloric test and SVV test. Thirteen healthy volunteers (26 ears, 8 men and 5 women, 25~41 years) with normal hearing were enrolled as control group.
Results
: VEMP response was present in every control ear using 500 Hz tone burst stimuli. In Meniere's disease, VEMPs were positive in 57% (4/7) of patients with abnormal caloric response group and 83% (5/6) with normal caloric response. In acute peripheral vestibulopathy, VEMPs were positive in 47% (9/19) of patients with abnormal caloric response, 0% (0/1) with normal caloric response. The average of CP (canal paresis) in positive VEMP group was 62.4% and that in negative VEMP group was 48.2% (P>0.05).
Conclusion
: Reliable and reproducible test results can be obtained using 500 Hz tone burst stimuli. VEMP results were not in concordance with other vestibular tests, which reflects the dynamic process of dizziness and variable extent of pathology in each case.

Review

Retrospective Study of Magnetic Resonance Imaging & Vestibular Function Testing in Patients Suggestive of Central Vestibular Disorders: Gyu Cheol Han, Ju Hyoung Lee, Dong Kyu Kim, Hee Young Hwang, Jin Myoung Heo; J Korean Bal Soc. 2004;3(1):141-149.

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Abstract PDF: Background
and Objectives : There were many tools to evaluate dizzy patients with various causes. Our aim was to find the relationship between the magnetic resonance imaging(MRI) and vestibular function testing(VFT) in patients who are supposed of central vestibular disorders and to evaluate their effects. Materials and Methods : We selected 183 patients retrospectively by standardized questionnaires, physical examinations ,chart reviews from 3,825 patients who visited otorhinolaryngology via department of emergency and out patient clinic with chief complaints of dizziness. Among them, 13 patients were supposed to have MRI in relation to dizziness. We analyzed the result of VFT, MRI findings and then classified them in according to lesion locations, pathologic findings in MRI & optokinetic tests, caloric tests, step velocity tests, vestibulo-ocular tests, visual fixation tests in VFT.
Results
: There were 9 ischemic findings, 1 hemorrhagic finding, 3 neoplasms in pathologic findings. There were 5 pons lesions, 4 cerebellum lesions, 3 thalamus lesions, 2 medulla lesions, 2 pituitary lesions and 1 caudate nucleus lesions in locations.
Conclusions
: Dizzy patients visiting otorhinolaryngology OPD had 0.34%(13/3825) central origin vertigo, and vascular disease is most common. Therefore we supported that careful readings of VFT findings in identifying central vestibular disorders were valuable and might well represent the gold standard. MRI was an important tool for evaluating the central nervous system, and we should use MRI to assess central vestibular dysfunction. We concluded MRI correlated well with VFT findings of central vestibular dysfunction. Key Words : Vestibular function testing, Magnetic resonance imaging, Dizziness

Original Articles

The Clinical Significance of Head-shaking Nystagmus in the Patients with Acute Unilateral Peripheral Vestibular Loss: Jun Sun Shin, Bo Young Kim, Kyu Sung Kim, Seung Chul Lee; J Korean Bal Soc. 2003;2(2):181-186.

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Abstract PDF: Background
and Objectives: In unilateral peripheral vestibular loss patients, head-shaking induce a bias from remaining asymmetric vestibular sensor and cause the imbalance in velocity-storage mechanisms. Head-shaking nystagmus(HSN) is the transient nystagmus induced by shaking the head in the horizontal plane, and have slow phases directed toward the side of vestibular loss. We evaluated the usefulness of the HSN in acute unilateral peripheral vestibular loss patient with reference to spontaneous nystagmus SN), bithermal caloric test, and slow harmonic acceleration(SHA) test. Materials and Methods: 18 patients of acute unilateral peripheral vestibular loss who had SN and symptoms of acute prolonged vertigo were analyzed retrospectively. The examiner performed passive head rotation in 30 degree anteflexed position with eyes closed and oscillated about 60 degree to each side, 2 Hz for 20 cycles, and the nystagmus was observed with Frenzel glasses immediately after head was stopped. Prevalence and direction of HSN were analyzed with SN, caloric test and SHA test during the follow up period.
Results
The prevalence of HSN was 89%(16/18). During follow-up period, direction of nystagmus was changed 28%(13/18) in SN, but in HSN, direction was fixed in all subjects. SN and HSN directed toward the same side in 75%(12/16) but in four cases(25%), direction could not compared because the direction of SN was changed during follow up peroid. In 69%(11/16) of subjects, HSN persisted after the disappearance of SN. In comparison of HSN with bithermal caloric test, direction of CP was highly correlated with direction of HSN(92%) than SN(64%). HSN was more prevalent(92%) than DP(67%) in caloric test and asymmetry(78%) in SHA test.
Conclusions
HSN test, easily performed office maneuvers, is very useful method to identify the laterality of acute unilateral peripheral vestibular loss, especially in chronic stage.

Various Causes of Vertigo in Children with Normal Eardrums: Yun Hoon Choung, Sang Jun Ryu, Min Jung Cho, Sung Kyun Moon, Keehyun Park; J Korean Bal Soc. 2003;2(1):121-126.

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Abstract PDF: Background
and Objectives: The differential diagnosis of vertigo in children is extensive. Otitis media and middle ear effusion could be most common causes of vertigo in children, but there are some problems in detecting the other causes for vertigo because they are one of most popular diseases in childhood. The purpose of this study is to review the clinical characteristics and both the audiological and vestibular findings of vertigo in children with normal eardrums, who do not show otitis media or middle ear effusion, and assist in making a differential diagnosis of vertigo. Materials and Method: The sixty eight children (less than 16 years old) with vertigo, who visited the Department of Otolaryngology, Ajou University Hospital, Suwon, Korea between January 1995 and April 2003 were selected for this study. These excluded the patients with abnormal eardrums/tympanograms or those that did not perform questionnaires, audiological, or vestibular evaluations. They were retrospectively analyzed for clinical symptoms, audiograms, vestibular functions, and differential diagnosis.
Results
The most common causes for vertigo in children were benign paroxysmal vertigo of childhood (BPVC) in 21 (30.9%) and migraine in 20 (29.4%). Other less frequent causes included four cases of trauma, three cases of acute vestibular neuritis. two cases each of Meniere's disease, delayed endolymphatic hydrops, benign positional vertigo, and one case only for cerebellopontine angle tumor, seizure, juvenile rheumatoid arthritis, leaving eleven cases (16.2%) as unclassified. Abnormal findings were noted in 14 (20.6%) in pure tone audiogram, 3 (4.4%) in positioning test, 11 (16.2%) in bithermal caloric test, and 47 (69.1%) in rotation chair test.
Conclusions
The vertigo in children with normal eardrums, who did not show otitis media or middle ear effusion, was most commonly caused by BPVC and migraine. These findings have shown to be very different from those with adult vertigo. The evaluation of vertigo in children requires a questionnaire for extensive and complete history taking, audiograms and vestibular function tests. And in selected cases, electroencephalography, hematological evaluation, imaging of the brain or temporal bone should be performed.

Psychogenic Dizziness : The psychiatric diagnosis and vestibular function tests: Chung Ku Rhee, Geun Hwan Park, Chang Hoon Lee, Sang Yong Chung, Phil Sang Jung; J Korean Bal Soc. 2003;2(1):73-77.

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Abstract PDF: Background
and Objectives: Psychogenic dizziness has not been studied extensively in Korea while it is seen frequently. We investigated the prevalence of psychiatric diagnosis and the results of vestibular function testings in patients with the diagnosis of psychogenic dizziness at a Korean tertiary university hospital. Materials and Methods: The study was conducted on 38 patients with the diagnosis of psychogenic dizziness. They all received vestibular function testings (ENG, rotating chair test and posturography). Patients with central or vestibular organic disease were excluded from this study.
Results
Somatoform disorder was the most common psychiatric disorder causing psychogenic vertigo(47.4%) in this study. Anxiety disorder(21.1%) and depression(21.1%) were the next common causes. The vestibular function testings were abnormal in 19 patients(50.0%). The electronystagmography in 11, rotating chair test in 6, and posturography in 14 patients were abnormal.
Conclusions
Somatoform disorder was the most common psychiatric disorder and vestibular function tests were abnormal in 50% of psychogenic dizziness patients. It implies that the patients with psychogenic dizziness have functional abnormalities in vestibular system.

The clinical characteristics of dizzy patients with normal vestibular function tests: Won Ho Chung, Eun Guk Bang, Sung Hwa Hong, Chi Kyou Lee, Hyun Seok Lee; J Korean Bal Soc. 2002;1(2):259-265.

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Abstract PDF: Background
and Objectives : Dizziness is a very common complaint in every day practice. The prevalence of dizziness ranges from 1.8 % in young adults to 30% in the elderly. The sensitivity of vestibular function tests is limited. It was reported that the sensitivity of electronystagmography for diagnosing peripheral vestibular disorders was variable, ranging from 46 to 74%. The objective of this study is to analyse the causes and clinical characteristics of dizzy patients who show normal vestibular function tests. Materials and methods : From January 1999 to June 2001, 375 dizzy patients with normal vestibular function tests(mean age, 49.7 years; range, 8 to 79 years) were assessed with the medical records and typed questionnaires about dizziness.
Results
: Dizzy patients with normal vestibular function tests were attributed to an unknown cause in 20.0% of patients, benign paroxysmal positional vertigo in 19.5%, migrainous dizziness in 11.7%, psychogenic dizziness in 10.4%, Meniere's disease in 9.6% and vertebrobasilar insufficiency in 7.2%.
Conclusion
: Dizzy patients with normal vestibular function tests can be evaluated by careful history taking and combined multidisciplinary approach with neurologist, psychiatrist and cardiologist and strict diagnostic criteria are necessary.

The Significance of Head-Shaking Nystagmus in the Vestibular Evaluation of the Chronic Dizzy Patient: Si Ho Yang, Gyu Cheol Han; J Korean Bal Soc. 2002;1(2):253-258.

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Abstract PDF: Objectives
: Nystagmus after rapid head-shaking (head-shake nystagmus) is transient horizontal nystagmus which is observed after passive horizontal headshake by yaw axis. It has been used for the evaluation of the remnant vestibular function. This study compared one patient group complaining of chronic vertigo with another normal group with no symptom. We tried to confirm the efficacy as a tool for the evaluation of the vestibular function in the old who had less knowledge of diasease itself, by searching the occurrence rate of head-shake nystagmus by age. Materials and Methods : Of dizzy patients under Vertigo Index III, 19 patients with normal ENG and 20 patients showing only the decrease of the gain on the rotatory test were selected, and head-shake nystagmus was evaluated. Normal control (n=12) were all the heathy patients without any history of the otologic illness after consideration of their age. Eye movement was recorded with ENG testing and Frenzel glasses for 1minute in the dark room after vigorous head shaking at a frequency of 2Hz. Presence or absence of the head-shake nystagmus was judged by two otolaryngologist.
Results
: Only 41% (16/39) of the dizzy patients showed headshake nystagmus. On the other hand, 8% (1/12) of normal control group revealed headshake nystagmus(p < 0.03). 50% (10/20) of the patient group showing the decrease of the gain, and 31% (6/19) of the another group with normal vestibular function revealed headshake nystagmus. When the detection rate of the nystagmus is compared according to the testing methods, it is 33% (17/51) by ENG testing, 12% (6/51) by Franzel glass test. Incidence rate of the headshake nystagmus by age is 25% (5/20) in the dizzy patient group under 50 years old, 58% (11/19) in the group over 50 years old(p < 0.03).
Conclusion
: Head-shake nystagmus showed some difference according to the vestibular compensatory periods, but Its sensitivity was 41% and it is thought to be used convenient just in the old. However, attention should be paid to observe the nystagmus in case of using the Frenzel glasses.

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