Research in Vestibular Science

Original Article

Auto-Pattern Recognition for Diagnosis in Benign Paroxysmal Positional Vertigo Using Principal Component Analysis: A Preliminary Study: O-Hyeon Gwon, Tae Hoon Kong, Jaehong Key, Sejung Yang, Young Joon Seo; Res Vestib Sci. 2022;21(1):6-18. Published online March 15, 2022; DOI: https://doi.org/10.21790/rvs.2022.21.1.6

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Objectives
The aim of this study was to develop a filtering algorithm for raw nystagmus images and a diagnostic assistive algorithm using a principal component analysis (PCA) to distinguish the different types of benign paroxysmal positional vertigo (BPPV).
Methods
Fifteen video clips of clinical data with typical nystagmus patterns of BPPV (13 cases) and with normal nystamgmus (two cases) were preprocessed when applied the thresholding, morphology operation, residual noise filtering, and center point extraction stages. We analyzed multiple data clusters in a single frame via a PCA; in addition, we statistically analyzed the horizontal and vertical components of the main vector among the multiple data clusters in the canalolithiasis of the lateral semicircular canal (LSCC) and the posterior semicircular canal (PSCC).
Results
We obtained a clear imaginary pupil and data on the fast phases and slow phases after preprocessing the images. For a normal patient, a round shape of clustered dots was observed. Patients with LSCC showed an elongated horizontal shape, whereas patients with PSCC showed an oval shape at the (x, y) coordinates. The scalar values (mm) of the horizontal component of the main vector when performing a PCA between the LSCC- and PSCC-BPPV were substantially different (102.08±20.11 vs. 32.36±12.52 mm, respectively; p=0.0012). Additionally, the salar ratio of horizontal to vertical components in LSCC and PSCC exhibited a significant difference (16.11±10.74 mm vs. 2.61±1.07 mm, respectively; p=0.0023).
Conclusions
The data of a white simulated imaginary pupil without any background noise can be a separate monitoring option, which can aid clinicians in determining the types of BPPV exhibited. Therefore, this analysis algorithm will provide assistive information for diagnosis of BPPV to clinicians.

Citations

Citations to this article as recorded by

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

Case Reports

Dissociated Vertical-Torsional Nystagmus in Vestibular Nucleus Lesion: Hyun-Sung Kim, Eun Hye Oh, Jae-Hwan Choi; Res Vestib Sci. 2022;21(1):19-23. Published online March 15, 2022; DOI: https://doi.org/10.21790/rvs.2022.21.1.19

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Abstract PDF: Dissociated vertical-torsional nystagmus is a unique form of nystagmus characterized by conjugate torsional but disparate vertical components. It has been mainly reported in internuclear ophthalmoplegia or medial medullary lesion involving the medial longitudinal fasciculus (MLF). The patterns of the nystagmus may be explained by a disruption of vestibulo-ocular reflex pathways from vertical semicircular canal or utriculo-ocular reflex within the MLF, but it is debatable. We described a dissociated upbeat-torsional nystagmus in a patient with vestibular nucleus infarction without involvement of MLF.

Isolated Floccular Infarction with Impairment of High-Frequency Vestibulo-Ocular Reflex: A Case Report: Eun Hye Oh, Hyun-Sung Kim, Jae-Hwan Choi; Res Vestib Sci. 2021;20(4):147-150. Published online December 15, 2021; DOI: https://doi.org/10.21790/rvs.2021.20.4.147

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Abstract PDF: The flocculus plays a crucial role in control of eye movements. Based on animal experiment, it is suggested that the flocculus is important for governing vestibuleocular reflexes. In humans, an isolated floccular lesion is extremely rare. We report oculomotor abnormalities in a patient with unilateral infarction of the flocculus, and compare our results with those of previously reported patients with floccular lesion.

Original Articles

Temporal Relationship between Nystagmus and Perception during Bithermal Alternate Caloric Test: Sooyoung Kim, Eun-Jin Kwon, Hyunjin Jo, Seong-Hae Jeong; Res Vestib Sci. 2021;20(4):134-140. Published online December 15, 2021; DOI: https://doi.org/10.21790/rvs.2021.20.4.134

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Abstract PDF: Objectives
During caloric irritation, the spinning/rotating sensation is predominant. However, there is no report on the temporal relationship between caloric nystagmus and perception.
Methods
Consecutive 57 participants underwent bithermal caloric test in the dizziness clinic of Chungnam National University Hospital from February 2018 to September 2018. For vestibular perception, we asked the subject to report feelings of rotation and/or linear sensation during each warm and cold water irrigation period. Besides routine caloric parameters, the duration of nystagmus and vestibular sensation were analyzed.
Results
In most participants, the caloric nystagmus preceded the vestibular sensation (79.6% in right warm, 83.3% in left warm, 88.5% in right cool, and 84.6% in left cool stimuli). The precedence of perception was observed in 5 normal persons and 15 patients with vestibular migraine (n=4), unilateral vestibulopathy (n=3), and Menière’s disease (n=2), multiple systemic atrophy (n=2), cerebellar ataxia (n=2), vertebrobasilar insufficiency (n=1), and post-earthquake dizziness (n=1). The mean latency between nystagmus and perception was 11.7 seconds. And the duration of nystagmus was longer than that of perception in all conditions. Non-spinning sensations during the caloric test were also observed in some participants (26.8% in right warm, 30.3% in left warm, 29.1% in right cool, and 24.1% in left cool stimuli).
Conclusions
During the bithemal alternate caloric test, various vestibular perception and temporal relationship between perception and nystagmus suggest the bithermal caloric stimulation does not reflect only the signal originating from the horizontal canal pathway. A further validation study is needed.

Influence of Otoliths on the Vestibulo-Ocular Reflex in Horizontal Canal Benign Paroxysmal Positional Vertigo: Hee Soo Yoon, Jae Yeong Jeong, Jae Ho Chung, Ha Young Byun, Chul Won Park, Seung Hwan Lee; Res Vestib Sci. 2020;19(2):49-54. Published online June 15, 2020; DOI: https://doi.org/10.21790/rvs.2020.19.2.49

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Abstract PDF: Objectives
The aim of the study was to evaluate the possible alteration of the vestibulo-ocular reflex (VOR) in patients with horizontal canal benign paroxysmal positional vertigo (h-BPPV) using the video head impulse test (vHIT).
Methods
This was a prospective case-control study of BPPV patients. We includeed 133 patients with h-BPPV who underwent the vHIT prior to the positioning test. The control group consisted of 76 normal subjects who also underwent the vHIT. The vHIT parameters of gain and asymmetry were assessed, and clinical parameters such as treatment duration, number of canalith reposition maneuvers executed and recurrence rates were evaluated. The VOR and clinical parameters were compared between the h-BPPV and control group. The VOR parameters of h-BPPV canalolithiasis were also compared with those of cupulolithiasis.
Results
The mean age of the patients was 56.5 years and the male to female ratio was 1:2.02. Of the patients, 75 were diagnosed as having the canalolithiasis type of h-BPPV, while the other 58 had the cupulolithiasis type. The mean vHIT gains of the ipsi-lesional horizontal canal plane were 1.13 and 1.15 in the h-BPPV and control group, respectively (p=0.564). However, the asymmetry of the VOR was significantly higher in the h-BPPV than the control group (p=0.013), while the gains and asymmetries of the vHIT in the canalolith and cupulolith types were not significantly different (p=0.454, p=0.826).
Conclusions
The asymmetry of VOR is significantly elevated in the cupulolith type of hBPPV.

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

Analysis of Age-Dependent Normative Values of Suppression Video-Head-Impulse Test in Healthy Korean Subjects: Do Yoon Jeong, Yoon Sik Park, Sung Il Cho; Res Vestib Sci. 2019;18(1):8-13. Published online March 15, 2019; DOI: https://doi.org/10.21790/rvs.2019.18.1.8

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Abstract PDF

Objectives
Suppression head impulse paradigm (SHIMP) in video head impulse test is now newly used to test vestibular function. The aim of this study was to analyze normative values of SHIMP for healthy Korean subjects in each decade of life.
Methods
SHIMP and HIMP responses were measured with the video head impulse test in 70 healthy subjects. Vestibulo-ocular reflex gain and anticompensatory saccade were analyzed and compared at each decade of life.
Results
All subjects produced anticompensatory saccades in SHIMP. Gain values did not vary significantly with age. Gain values in SHIMP were lower than gain values in HIMP. The gain values of rightward impulse were higher than the gain values of leftward impulse.
Conclusions
Gain values and anticompensatory saccades in SHIMP were consistently equal in each decade of life. Normative values of SHIMP seems largely unaffected by aging.

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; : 1. CrossRef

Review

Clinical Application and Update of Video Head Impulse Test: Jung Yup Lee, Jin Su Park, Min-Beom Kim; Res Vestib Sci. 2018;17(3):79-89. Published online September 18, 2018; DOI: https://doi.org/10.21790/rvs.2018.17.3.79

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Abstract PDF

Recently with the introduction of video head impulse test (vHIT), it can be easily performed quantitative and objective measurement of vestibulo-ocular reflex (VOR). vHIT has been used as a clinical vestibular function test that can individually evaluate the function of each semicircular canal. Loss of VOR gain and corrective catch-up saccades that occur during the vHIT usually indicate peripheral vestibular hypofunction, whereas in acute vestibular syndrome, normal vHIT should prompt a search for a central lesion. In this study, we will examine the principle of vHIT and its interpretation, and explain its clinical application in peripheral and central vestibulopathy. In addition, we will compare the caloric test and the differences, and review the most recently introduced suppression head impulse paradigm test.

Citations

Citations to this article as recorded by

Application of the Barany Society's Presbyvestibulopathy Criteria in Older Adults With Chronic Dizziness
Joon‐Pyo Hong, Min‐Beom Kim
Otolaryngology–Head and Neck Surgery.2024; 170(2): 515. CrossRef
Vestibular mapping in Ramsay-Hunt syndrome and idiopathic sudden sensorineural hearing loss
Joon-Pyo Hong, Jung-Yup Lee, Min-Beom Kim
European Archives of Oto-Rhino-Laryngology.2023; 280(12): 5251. CrossRef
Re-fixation Saccade at Video-Head Impulse Test in Patients with Sudden Sensorineural Hearing Loss
Dong Hyuk Jang, Sun Seong Kang, Hyun Joon Shim, Yong-Hwi An
Research in Vestibular Science.2023; 22(2): 46. CrossRef
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
Research in Vestibular Science.2023; 22(2): 34. CrossRef
A Comparative Study Using Vestibular Mapping in Sudden Sensorineural Hearing Loss With and Without Vertigo
Joon‐Pyo Hong, Jung‐Yup Lee, Min‐Beom Kim
Otolaryngology–Head and Neck Surgery.2023; 169(6): 1573. CrossRef
A Study on the Evaluation of Brainstem Dysfunction in Rapid Eye Movement Sleep Behavior Disorder Using Video Nystagmography
Young Hun Kim, Jeongho Park, Seung Ho Choo, Hyunjin Jo, Dae-Won Seo, Byung-Euk Joo, Eun Yeon Joo
Journal of the Korean Neurological Association.2023; 41(4): 293. CrossRef
Vestibular mapping assessment in idiopathic sudden sensorineural hearing loss
Hee Won Seo, Jae Ho Chung, Hayoung Byun, Seung Hwan Lee
Ear & Hearing.2022; 43(1): 242. CrossRef
Group Vestibular Rehabilitation Program: A Cost-Effective Outpatient Management Option for Dizzy Patients
Jae Sang Han, Jung Mee Park, Yeonji Kim, Jae-Hyun Seo, So Young Park, Shi Nae Park
Otology & Neurotology.2022; 43(9): 1065. CrossRef

Case Report

Four Cases of Wernicke’s Encephalopathy with Impaired Horizontal Vestibular Ocular Reflexes: Hyuk-Su Jang, Byoung-Soo Shin, Man-Wook Seo, Sun-Young Oh; Res Vestib Sci. 2017;16(2):57-63. Published online June 15, 2017; DOI: https://doi.org/10.21790/rvs.2017.16.2.57

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Abstract PDF: Wernicke’s encephalopathy (WE) is a neurological disorder induced by a dietary vitamin B1 (thiamine) deficiency which is characterized by encephalopathy, gait ataxia, and variant ocular motor dysfunction. In addition to these classical signs of WE, a loss of the horizontal vestibulo-ocular reflex (VOR) is being reported as the major underdiagnosed symptoms in WE. In this retrospective single center study, we report four cases of WE initially presented with impaired horizontal VOR in addition to the classical clinical presentations, and imaging and neurotological laboratory findings were described.

Original Articles

Vestibulo-Ocular Reflex Recordings of Small Rodents using a Novel Marker Array: Mi Joo Kim, Jiyeon Lee, Eui Jae Hong, Eun Ji Lee, Yu Jin Min, Dong Ju Lee, Nam Beom Kim, Gyu Cheol Han; Res Vestib Sci. 2016;15(1):11-16.

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Abstract PDF: Objective: Recording the nystagmus of small experimental rodents is an integral technique in vestibular research. Theoretically, the size and the shape of markers strongly affect the analysis of 3 dimensional nystagmus.
Methods
The nystagmus of 6 healthy ICR mice were recorded and their gain values were compared using 200 μm, 300 μm, 400 μm, and 600 μm isosceles triangle markers at the peak velocity of 60o/sec and 100o/sec with the rotational stimulations of 0.1 Hz, 0.2 Hz, and 0.5 Hz.
Results
The gain values of 3 different sizes of the markers showed no significant differences in horizontal- vertical-torsional component. However, it was unable to record the nystagmus with 200 μm markers since the markers were too small to be placed and stayed on the center of the pupils.
Conclusion
Technicians can decide the size of the markers from 200 to 600 ?m to record the nystagmus of mice, depending on the technicians’ skills.

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.

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

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

Residual Vestibulo-Ocular Reflex Result in Better Functional Outcomes in Bilateral Vestibulopathy: Ji Eun Choi, Gwanghui Ryu, Young Sang Cho, Won Ho Chung; Res Vestib Sci. 2014;13(4):89-95.

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Abstract PDF: Background
and Objectives: The patients with bilateral vestibulopathy (BV) suffer from unsteadiness and oscillopsia, and despite of appropriate rehabilitation, permanent disability is inevitable. However, the level of functional outcomes could be influenced by whether there is residual vestibulo-ocular reflex (VOR) or not. Under the hypothesis that residual VOR function could result in better performances, we tried to compare in functional outcomes between complete and incomplete BV. Materials and Methods: Fifty patients who have been diagnosed with BV in our institution were retrospectively reviewed retrospectively between 2008 and 2012. We classified them into complete BV group (n=19) and incomplete BV (n=31) group according to the presence of residual VOR. Among them, 31 patients responded to telephone survey (6 in complete group and 25 in incomplete group). The survey includes 5 categories such as the subjective dizziness restriction on daily life, oscillopsia, unsteadiness and depression. Each score ranged from 0 to 4 and patients were asked twice in different time period.
Results
There was no difference in etiology between complete and incomplete group. Incomplete group showed significant improvement in dizziness, restriction on daily life, oscillopsia and unsteadiness compared to complete group. Among 5 catergories, dizziness score was significantly improved in incomplete group (each mean improved sore±standard deviation; dizziness 1.84±0.83, oscillopsia 0.44±0.64, unsteadiness 1±1.09, depression 0.24±0.86 restriction on daily life 1.16±0.97). Conclusion: The presence of residual VOR function had better functional outcomes in bilateral vestibulopathy.

Age and Gender Specific Reference Value of Ocular Torsion by Using Funduscope in Korean: Byoung Youn Ko, Jeong Seok Choi, Kyu Sung Kim, Hoseok Choi; Res Vestib Sci. 2011;10(1):30-33.

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Abstract PDF: Background and Objectives: Ocular torsion may be a result of vestibulopathy. The funduscopy is the most reliable method of measuring an ocular torsion. However, the reference value of ocular torsion in Korean is available at only limited ages. Therefore, we analyzed the angle of ocular torsion more age-specific than previous study. Materials and Methods: We used the fundus photograph of health check-up visitor. And age and sex specific average angle of ocular torsion was measured. Results: The right and left average angle of ocular torsion were 7.7±3.6°, 5.3±3.0°, respectively. In addition, there was no significant difference in age or sex specific angle of ocular torsion. Conclusion: This result might give an aid to evaluating the function of otolithic organ by measurement of ocular torsion.

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