Research in Vestibular Science

Original Articles

Clinical Significance of Spontaneous Nystagmus Frequency in Vestibular Neuronitis: Sang Hyun Park, Min Young Lee, Jae Yun Jung; Res Vestib Sci. 2016;15(2):55-59. Published online June 15, 2016

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Abstract PDF: OBJECTIVE: Spontaneous nystagmus is typical sign in vestibular neuronitis. However, the clinical significance of spontaneous nystagmus frequency remains unclear. The aim of this study is to analyze the spontaneous nystagmus frequency in patients with vestibular neuronitis.
METHODS
Twenty-five patients with vestibular neuronitis were included. Patients were divided good (≥20%) and poor (<20%) group according to change of spontanous nystagmus frequency. Frequency and velocity of spontaneous nystagmus were analyzed by using video-nystagmography. Caloric test and slow harmonic acceleration test were also performed.
RESULTS
There was a positive linear correlation between frequency and velocity in initial and follow test (R²=0.51, 0.43, p<0.01, p<0.01). Also, there was a strong positive linear correlation betweeng change of frequency and change of velocity (R²=0.64, p<0.01). The phase lead of slow harmonic acceleration test of good group was smaller compared with poor group, and this was statistically significant in 0.04 Hz.
CONCLUSION
We suggested that frequency of spontaneous nystagmus may be a useful clinical factor in vestibular neuronitis.

Correlation between Rotating Chair Test and Dizziness Handicap Inventory in Patients with Acute Unilateral Vestibular Neuritis: Hyeong Joo Lee, Jin Yong Kim, Dong Gu Hur, Seong Ki Ahn; Res Vestib Sci. 2016;15(2):51-54. Published online June 15, 2016

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Abstract PDF: OBJECTIVE: Vestibular neuritis (VN) is one of the most common causes of acute spontaneous vertigo. However, such dizziness symptoms in patients with VN vary among patients, and various methods are used to evaluate subjective vestibular symptoms following attack of VN. Studies on correlation between subjective vestibular symptom changes and result of rotation chair test after vestibular rehabilitation therapy (VRT) have not been reported. Therefore, we compared change of dizziness handicap inventory (DHI) and results of rotation chair test in patients with VN between attack and 3 month later following VRT.
METHODS
Forty-seven patients were included in this study. In patients with VN, DHI and rotation chair test were performed at the time of VN attack and recovery time of 3 months after VN attack.
RESULTS
In general, the DHI score and the percentage of directional preponderance (DP) in a rotation chair test performed on patients with VN have all decreased. However, the changes in these results were not statistically significant. DP% difference and DHI score were compared to each other among patients with VN and showed no relational significance to each other (r=0.326).
CONCLUSION
The degree of improvement in a rotation chair test done on patients with VN did not reflect the severity of improvement for symptom like dizziness.

Assessment of Vestibular Functional Recovery Using Video Head Impulse Test in Vestibular Neuritis: Jun Hyun Kim, Tae Kyeong Lee, Sang Woo Lee, Nari Choi, Seungcheol Lee, Ki Bum Sung; Res Vestib Sci. 2015;14(4):132-138.

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Abstract PDF: Objective: The video head impulse test (vHIT) is useful for evaluation of high frequency vestibulo-ocular reflex. There are a few reports regarding the recovery of head impulse test in vestibular neuritis (VN) but the factors for the recovery were not studied. The study aimed to identify the recovery patterns of vHIT in VN and the factors influencing the recovery.
Methods
Among 31 patients with acute VN, 18 patients with identified recovery pattern were selected. We conducted serial checks of subjective vertigo and spontaneous nystagmus until discharged (1?8 days), and scheduled vHITs. We found three patterns in serial vHITs during follow-ups and analyzed the relationship of initial vestibular function tests, serial check-ups of subjective vertigo, bedside neuro-otologic tests, and vHITs.
Results
Five patients showed normal vHIT gain in acute stage (non-damaged pattern) and 8 patients’ gains were recovered after 30 days after symptom onset (early recovered pattern). Poor recovery pattern was found in 5 patients (poorly recovered pattern). There were relationship between vHIT recovery patterns and the severity of vestibular dysfunctions. Duration of spontaneous nystagmus (until grade 1), degree of subjective visual vertical tilt, ocular vestibular myogenic potential abnormalities, and abnormality of rotatory chair test were all related to poorly recovered vHIT patterns. All poor recovery patients had residual symptom at 30 days after symptom onset.
Conclusion
The vHIT may give clinicians useful hints in predicting prognosis in VN, and the recovery of vHIT would be delayed if the damage were more extensive.

Reviews

Clinical Applications of Vestibular Evoked Myogenic Potentials: Jeong Yoon Choi; Res Vestib Sci. 2015;14(2):37-41.

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Abstract PDF: Cervical and ocular vestibular evoked myogenic potential (VEMP) may be one of the important clinical tools for evaluation of vestibular function. Cervical VEMP evaluates saccule and reflects the functional status of inferior vestibular nerve combining with vertical head impulse test. Ocular VEMP assesses utricle function and provides superior vestibular nerve function in addition to horizontal head impulse test and caloric test. Currently, the clinical implications of VEMP have been expanded to estimate disease severity and location, differentiate diverse vestibular disorders, and predict the prognosis. In present review, we discuss the findings of VEMP according to the lesion location from peripheral vestibular dysfunction to central vestibulopathy and disease characteristics from monophasic transient disorders to chronic progressive disorders.

Clinical Application of the Head Impulse Test in Vestibular Disorders: Seung Han Lee; Res Vestib Sci. 2015;14(1):1-8.

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Abstract PDF: The head impulse test (HIT) is an established way to test the angular vestibulo-ocular reflex (aVOR) at the bedside. When the aVOR is normal, the eyes rotate opposite to the head movement through the angle required to keep images stable on the fovea. If the aVOR is impaired, the eyes move less than required and, at the end of the head rotation, the eyes are not directed at the intended target and the visual image is displaced from the fovea. A promptly-generated corrective saccade brings the image of the target back on the fovea. The identification of this corrective saccade is the signature feature of vestibular hypofunction and has greatly increased the utility of the bedside examination for identifying an aVOR deficit. However, sometimes it is not easy to detect corrective saccades without quantitative HIT devices. Exact execution and interpretation of the HIT are warranted to reduce the diagnostic errors, because the HIT has become an important part of the differential diagnosis of both acute and chronic vestibular disturbances.

Original Articles

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

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

Comparison of Audiovestibular Dysfunction in Patients of Acute Unilateral Peripheral Vestibulopathy with and without Vascular Risk Factors: Jun Hyun Kim, Tae Kyeong Lee, Ki Bum Sung; Res Vestib Sci. 2014;13(4):96-101.

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Abstract PDF: Background
and Objectives: Etiology of acute unilateral peripheral vestibulopathy (AUPV) includes virus, ischemia, and autoimmune. As anatomical distribution is similar between vasculature and innervation, AUPV with vascular risk factors could be ischemic origin. We investigated the pattern of audiovestibular dysfunction to explore the influence of risk factors on AUPV. Materials and
Methods
We collected records of 162 AUPV patients from 2011 to 2013 who were admitted within 7 days from vertigo onset and diagnosed as AUPV by caloric test and neuro-otologic examination. Vascular risk factors are stroke history, hypertension, diabetes, body mass index ＞25, age ＞60, and vertebrobasilar stenosis. Bedside examination includes spontaneous nystagmus grade, head impulse test, head shaking test. Results of rotatory chair test (n=125), caloric test (n=162), cervical (n=33) and ocular (n=23) vestibular evoked myogenic potential (VEMP), subjective visual vertical (SVV) (n=91), and pure tone audiometry (PTA) (n=62) are collected. Results: Abnormalities of PTA are found more in patients with vascular risk factor than without any risk factor. Specifically, hypertension (p=0.008) and old age (p=0.025) are associated with PTA abnormality (p=0.006). Tilt angle of vertical is larger in risk factor group (p=0.019). The number of vascular risk factor correlates with abnormalities of PTA (p=0.025) and tilt angle of SVV. Results of bedside examination, rotatory chair test, caloric test, cervical and ocular VEMP are not associated with vascular risk factors. Conclusion: AUPV patients with vascular risk factors have more extensive involvement of audiovestibular function. Ischemic etiology may contribute to pathogenesis of extensive AUPV.

Case Report

Acute Vestibular Neuritis Associated with Herpes Zoster Ophthalmicus: Yoon Chang Oh, Jong Kyung Lee, Jae Myung Kim, Seung Han Lee; Res Vestib Sci. 2014;13(3):81-84.

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Abstract PDF: Vestibular neuritis, one of common causes of acute spontaneous vertigo, is characterized by a sudden onset of vertigo with horizontal-torsional spontaneous nystagmus and unsteadiness with a falling tendency. Herpes zoster is a common infection caused by varicella-zoster virus (VZV), and herpes zoster ophthalmicus (HZO) occurs when this virus is reactivated in the ophthalmic branch of the trigeminal nerve. VZV can cause vestibular neuritis with cochlear dysfunction as a form of herpes zoster oticus, also known as Ramsay-Hunt syndrome. However, to our knowledge, isolated vestibular neuritis associated with HZO has been rarely reported, because of distance between the trigeminal nerve and the vestibulocochlear nerve. We present an unusual case of vestibular neuritis complicated by the HZO.

Original Articles

Results of High-Frequency and High-Acceleration Rotary Chair Test in Patients with Acute Unilateral Vestibular Neuritis: Hwan Seo Lee, Jun Woo Park, Chang Wook Lee, Chan Il Song, Myung Hoon Yoo, Hong Ju Park; Res Vestib Sci. 2014;13(2):41-46.

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Abstract PDF: r neuritis. Materials and Methods: Twenty-four patients who were diagnosed as acute vestibular neuritis and underwent rotational chair and caloric tests during March 2012 to March 2013 were included. Slow harmonic acceleration (SHA) test was performed at 0.01, 0.04, 0.16, 0.64, 1.28, and 2.00 Hz. Step velocity tests at the peak velocity of 100o/sec (low-acceleration) and 240o/sec (high-acceleration) were performed. Gains and phases in SHA test and gains and time constants (Tc) in step velocity test were analyzed. Results: In SHA test, decreased gain and phase lead was observed mostly in low frequencies. Gains (phases) at 0.01, 0.04, 0.16, 0.64, 1.28, and 2.00 Hz were 0.2±0.1 (62.2±15.4), 0.3±0.2 (24.5±13.0), 0.4±0.2 (7.2±18.8), 0.5±0.1 (7.2±11.3), 0.7±0.2 (11.0±7.5), and 0.8±0.3 (4.4±14.4), respectively. In step velocity (SV) test, gains stimulating the lesion side were significantly lower than those stimulating the intact side in both low- and high-acceleration SV test (p＜0.05) and per-rotatory gain stimulating the lesion side in high-acceleration SV test was significantly lower than that in low-acceleration SV test. Tc stimulating the lesion side were significantly shorter than those stimulating the intact side in low- acceleration SV test (p＜0.05) but not in high-acceleration SV test. Per- and post-rotatory Tc in high-acceleration SV test stimulating the intact side was significantly lower than those in low-acceleration SV test (p＜0.05). Conclusion: At high-frequency SHA test, gain was pretty normal and phase lead was observed in some patients. High-acceleration SV test showed shortened Tc regardless of the sides, suggesting that high-acceleration SV test can reveal the impaired velocity storage system in patients with vestibular neuritis more frequently than low-acceleration SV test.

Effects of Meteorological Factors on the Onset of Vestibular Neuritis: Eun Ju Jeon, Dong Hyun Kim; Res Vestib Sci. 2012;11(4):116-122.

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Abstract PDF: Background and Objectives: The objective of this study was to evaluate the effect of meteorological factors on the onset of vestibular neuritis. Materials and Methods: Meteorological data from 2004 to 2009 were obtained from the web-based ‘Monthly Weather Reports of the Meteorological Administration’ database. Patients with vestibular neuritis who visited Incheon St. Mary’s Hospital during this same period and presented the precise day on which the symptoms appeared were included in this study involving a retrospective chart review. Twelve meteorological factors were analyzed between the days when vestibular neuritis onset was observed and the days when vestibular neuritis did not occur. Time lags (D-₁-D-₇) which mean 1-7 days before the onset were included to assess a possible delayed meteorological effect in relation to the onset of vestibular neuritis. Seasonal incidence of vestibular neuritis and a relationship with seasonal patterns of weather parameters were evaluated. Results: Mean values for the meteorological parameters of the days when vestibular neuritis occurred were not significantly different from the days on which vestibular neuritis onset was not observed. At time lag of 3-5 days, mean and maximal wind velocities were significantly higher for the days when vestibular neuritis occurred than the days without vestibular neuritis onset. The incidence of vestibular neuritis was highest in spring, when the wind velocity was higher compared to other seasons. Conclusion: Wind speed and the spring season showed significant relationships with vestibular neuritis occurrence.

Clinical Comparison Between Ocular and Cervical Vestibular Evoked Myogenic Potentials: Il Kwon Cho, Myung Whan Suh, Tae Hyun Moon, Chung Ku Rhee, Jae Yun Jung; Res Vestib Sci. 2011;10(2):68-73.

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Abstract PDF: Background and Objectives: The goal of this study was to compare the outcome between cervical vestibular-evoked myogenic potential (cVEMP) and ocular VEMP (oVEMP) in the patients with definite vestibular dysfunction. Also, the subjective discomfort level was compared between cVEMP, classic oVEMP and head positioned oVEMP (a new method designed by the authors). Materials and Methods: Eighteen patients with dizziness associated with unilateral vestibular hypofunction were included in this study. Vestibular neuritis, Ramsay-hunt syndrome and sudden sensorineural hearing loss with vertigo were included in unilateral vestibular hypofunction disease. cVEMP, classic oVEMP, and head positioned oVEMP were assessed and compared. To compare the subjective discomfort during the tests, visual analogue scale on discomfort was checked. Results: There was a discrepancy between the cVEMP and classic oVEMP in 31.3% of the cases. The classic oVEMP were associated with more discomfort than the cVEMP. But, there was no difference between the classic and head positioned oVEMP. Conclusion: Since a substantial discrepancy was identified between the cVEMP and oVEMP, the pathways involved in cVEMP and oVEMP are likely different even with the same air conduction tone stimuli. The head positioned oVEMP may be an alternative to the classic oVEMP which has similar results and subjective discomfort levels.

Case Reports

Auditory Neuropathy Accompanying Unilateral Vestibulopathy: Hye Young Kim, Jae Yun Jung, Chung Ku Rhee, Myung Whan Suh; Res Vestib Sci. 2009;8(1):60-65.

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Abstract PDF: Auditory neuropathy is a term used to describe abnormal auditory brain stem response (ABR) in the presence of preserved cochlear outer hair cell functions which can be measured by otoacoustic emissions (OAE). We report a case of auditory neuropathy accompanying unilateral vestibular hypofunction and benign paroxysmal positional vertigo. The patient was a 50-year-old man who had experienced hearing loss and tinnitus which started two weeks ago. He had taken several medicines for the last few months due to his lung cancer and tuberculosis. ABR and OAE were checked and the results were compatible with auditory neuropathy. To evaluate his vestibular function, video nystagmography, rotatory chair and oculomotor test were checked. The results were compatible with left unilateral vestibular loss and left lateral canal cupulolithiasis. But the patient experienced nearly no vertigo during his daily life. As presented in this case, most of the auditory neuropathy patients do not complain of vertigo. This is probably due to long term central compensation or maybe due to the decreased nerve conduction of the vertiginous sensation. Vestibular evaluation may be crucial in order to detect masked vestibular dysfunction and to protect these patients from imbalance accidents. Key Words: Auditory neuropathy; Vestibular Neuronitis; Evoked Potentials, Auditory, Brain Stem; Otoacoustic Emissions

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

Assessment of Subjective Symptoms Using Dizziness Handicap Inventory in Patients with Vestibular Neuritis: Jin Yong Kim, Dong Gu Hur, Sea Yuong Jeon, Jin Pyeong Kim; Res Vestib Sci. 2009;8(1):27-31.

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Abstract PDF: Background and Objectives Vestibular neuritis (VN) is one of critical life events that can affect physical, emotional, and function aspects of quality of life. Most patients recover well from VN within 6 months following the onset of the disease. However, they can still interfere with their daily lives in some patient with VN. Dizziness Handicap Inventory (DHI) was developed to assess the self-perceived handicapping effects imposed by vestibular system diseases. The aim of study was to evaluate subjective symptoms among the pre-VN, at the time of onset of VN, and post-VN using DHI questionnaire, respectively. Materials and Methods Twenty patients with VN were asked to complete the DHI by mailed survey. Each of the DHI was scored. We also evaluated the relationship between the DHI scores and degree of the canal paresis on the caloric test. Results Almost every patients had substantially improved its subjective symptoms in 6 months after VN. There was no correlation between the canal paresis in the lesion ear and DHI scores at the time of VN. Conclusion The results of this study suggest that most patients recovery well from VN without any handicap, but the emotional support in combination with physical and/or functional rehabilitation should be required to provide early resumption of normal activity. Key Words: Vertigo; Vestibular Neuronitis; Questionnaires

Autoantibodies and Complements in Acute Peripheral Vestibulopathy: Mi Joo Kim, Joo Hyun Jung, Chang Hyun Cho, Jung Ho Lee; Res Vestib Sci. 2009;8(1):23-26.

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Abstract PDF: Background and Objectives The etiology and pathophysiology of acute peripheral vestibulopathy are largely unknown. The purpose of this study is to evaluate the manifestation of the autoantibodies and complements in patients with acute peripheral vestibulopathy. Materials and Methods We checked anti-ds-DNA, rheumatoid factor, anti phospholipid IgG and IgM, anti nuclear antibody (ANA), C3, C4 in 72 patients who were diagnosed as acute peripheral vestibulopathy on physical examination and the caloric test. The results of the patients with unilateral acute peripheral vestibulopathy were compared to those of the patients with bilateral acute peripheral vestibulopathy. Results Twelve patients (16.6%) in anti-ds-DNA, 4 patients (5.5%) in C3, 10 patients (13.8%) in C4, 2 patients (2.7%) in anti-phospholipid IgG and 13 patients (18%) in antinuclear antibody (ANA) showed abnormal findings among patients with acute peripheral vestibulpahty. There was no difference in the manifestation of the autoantibodies and complements between the patients with unilateral and bilateral acute peripheral vestibulopathy. Conclusion The autoimmune diseases may be one of etiologic factors in acute peripheral vestibulopathy. Key Words: Autoantibodies; Vestibular Neuronitis; Complement System Proteins

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