Research in Vestibular Science

Original Articles

Saccadic oscillations as a possible indicator of dizziness due to choline esterase inhibitors: an observational study with video-oculography: Ileok Jung, Moon-Ho Park, Ji-Soo Kim; Res Vestib Sci. 2024;23(3):101-105. Published online September 15, 2024; DOI: https://doi.org/10.21790/rvs.2024.015

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Abstract PDF Supplementary Material: Introduction: Cholinesterase inhibitors (ChEIs) are widely used to treat mild to moderate Alzheimer disease and vascular dementia. Even though dizziness due to medication of ChEIs has been ascribed to adverse effects on the cardiovascular or central nervous system, the mechanisms remain unclear and objective indicators are not available.
Methods
We recorded the eye movements using video-oculography in three patients who developed dizziness and unsteadiness after initiation or increment of ChEI, donepezil (Aricept).
Results
The patients showed frequent saccadic oscillations that improved after discontinuation of ChEI.
Conclusions
Frequent saccadic oscillations may be an indicator of dizziness in patients taking ChEIs.

Prevalence and preferred medication for vestibular migraine in Menière’s disease: a multicenter retrospective cohort study in Korea: Dong-Han Lee, Hong Ju Park, Kyu-Sung Kim, Hyun Ji Kim, Jae-Yong Byun, Min-Beom Kim, Minbum Kim, Myung-Whan Suh, Jae-Hyun Seo, Jong Dae Lee, Eun-Ju Jeon, Myung Hoon Yoo, Seok Min Hong, Sung-Kwang Hong, Hyo-Jeong Lee, Jung Woo Lee, Se-Joon Oh, Hyun Ah Kim, Hyung Lee, Eek-Sung Lee, Eun-Jin Kwon, Seong-Hae Jeong, Jeong-Yoon Choi, Chang-Hee Kim; Res Vestib Sci. 2024;23(2):37-45. Published online June 14, 2024; DOI: https://doi.org/10.21790/rvs.2024.005

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Abstract PDF Supplementary Material: Objectives
The aim of this study is to categorize headaches associated with definite Menière’s disease (MD) according to diagnostic criteria, to determine their prevalence, and to investigate the preferred medication across participating centers.
Methods
Patients diagnosed with definite MD at 17 university hospitals in otolaryngology or neurology departments in Korea between January 1, 2021 to December 31, 2021 were retrospectively included. Data on the presence of accompanying vestibular migraine (VM), migraine or non-migraine headaches, and clinical information were collected. A survey was conducted to assess preferences for treatment drugs for vertigo and headache control in MD patients with headache.
Results
A total of 435 definite MD patients were included, with a mean age of 57.0±14.9 years. Among them, 135 (31.0%) had accompanying headaches, of whom 48 (11.0% of all definite MD patients) could be diagnosed with VM. The prevalence of comorbid VM (definite and probable) was significantly higher in females (41 of 288, 14.2%) than in males (7 of 147, 4.8%) (p<0.05). There was no significant difference in the prevalence of comorbid VM between unilateral and bilateral MD patients (10.8% and 13.6%, respectively) (p > 0.05). Benzodiazepines, antihistamines, and antiemetics were mainly preferred for acute vertigo control, while nonsteroidal anti-inflammatory drugs, acetaminophen, and triptans were preferred for acute headache control, and topiramate, propranolol, and calcium channel blockers were mainly preferred for headache prevention.
Conclusions
VM is not uncommon in patients with definite MD in Korea. Further research is needed to understand the differences in headache prevalence and preferred medications across different centers.

The clinical significance of arterial stiffness in the differential diagnosis of vertigo: Bang-Hoon Cho, Jae-Myung Kim, Young-In Kim, Seung-Han Lee; Res Vestib Sci. 2024;23(1):16-23. Published online March 15, 2024; DOI: https://doi.org/10.21790/rvs.2024.003

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Abstract PDF Supplementary Material: Objectives
Pulse wave velocity (PWV) is a known indicator of arterial stiffness reflecting vascular damage. However, there are few reports of the relationship between PWV and dizziness/vertigo of a vascular origin. We investigated whether the PWV value could be useful as an ancillary measurement for identifying the etiology of dizziness/vertigo.
Methods
We enrolled dizzy patients from March 2016 to December 2018. The patients with posterior circulation stroke presenting with dizziness/vertigo were categorized as having central vertigo. The patients with vertigo due to benign paroxysmal positional vertigo, Ménière disease, or acute unilateral vestibulopathy were categorized as having peripheral vertigo. The PWV value, ankle-brachial index (ABI), and traditional vascular risk factors were collected.
Results
We consecutively enrolled a total of 93 participants. The PWV values were higher in the central vertigo group (p<0.001), but ABI did not differ between the groups. Among the vascular risk factors, the number of patients with diabetes mellitus, dyslipidemia, and male patients was significantly higher in the central vertigo group. The brachial-ankle PWV (baPWV) values were higher in the central vertigo group, even after adjusting for confounding factors (p<0.01). The receiver operating characteristic curve showed that the sensitivity was 74% and specificity was 81% when the mean baPWV value was 14.78 m/sec.
Conclusions
Increased baPWV values were observed in patients with dizziness/vertigo due to stroke. Measurement of the baPWV value could be an ancillary test for evaluating the cause of dizziness/vertigo, even though more convincing evidence is still required.

Efficacy of the Fixation Index of Bithermal Caloric Test for Differentiating Brain Lesions in Vestibular Disoder: Young Jae Lee, Wonyong Baek, Sung-Il Cho, Gi-Sung Nam; Res Vestib Sci. 2023;22(4):106-111. Published online December 15, 2023; DOI: https://doi.org/10.21790/rvs.2023.22.4.106

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Abstract PDF: Objectives
This study was performed to investigate the efficacy of the fixation index (FI) of the bithermal caloric test for differentiating brain lesions in vestibular disorder.
Methods
We reviewed the medical records of 286 consecutive dizzy patients who underwent brain magnetic resonance imaging (MRI) and the bithermal caloric test at department of otorhinolarnygology. Central vestibulopathy (CVP) was defined as when corresponding lesion was identified on brain MRI, otherwise peripheral vestibulopathy (PVP) was defined. The FI was defined as the mean slow phase velocity (SPV) with fixation divided by the mean SPV without fixation, and failure was indicated when the FI exceeded 70%.
Results
The CVP confirmed by brain MRI and PVP were 16.8% and 83.2%, respectively. The most common CVPs were cerebellopontine angle tumor (n=19, 39.6%) and chronic cerebellar infarction (n=18, 37.5%). There were 23 cases of CVP (47.9%) and 47 cases of PVP (19.7%) with abnormal number of FI in at least two of the four caloric irrigations. The FI score of right cool (RC), left cool (LC), and right warm (RW) were also increased significantly in patients with CVP (p=0.031 at RCFI, p=0.014 at LCFI, p=0.047 at RWFI, and p=0.057 at LWFI; Mann-Whitney U-test).
Conclusions
If two or more abnormal FIs are detected during bithermal caloric testing, there is a high likelihood of CVP. Consequently, additional brain MRI may be necessary for further evaluation.

Reviews

Canal Conversion and Reentry of Otolith in Benign Paroxysmal Positional Vertigo: Jong Sei Kim, Minbum Kim; Res Vestib Sci. 2023;22(3):59-67. Published online September 15, 2023; DOI: https://doi.org/10.21790/rvs.2023.22.3.59

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Abstract PDF: During the treatment process for benign paroxysmal positional vertigo (BPPV) using the canalith repositioning procedure, the otolith can inadvertently enter the semicircular canal instead of the utricle. Canal conversion refers to the situation where the otolith enters a different semicircular canal, while reentry occurs when the otolith returns to the same semicircular canal. The occurrence of a canal conversion can complicate the accurate diagnosis and treatment of BPPV, potentially leading to misdiagnosis and unsuccessful results in the canalith repositioning procedure. In this review, we aim to summarize the incidence, clinical features, and associated risk factors of canal conversion and reentries.

Light Cupula: Recent Updates: Dong-Han Lee, Chang-Hee Kim; Res Vestib Sci. 2023;22(2):23-33. Published online June 15, 2023; DOI: https://doi.org/10.21790/rvs.2023.22.2.23

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Abstract PDF: Benign paroxysmal positional vertigo (BPPV) is the most common cause of positional vertigo and nystagmus. Direction-changing positional nystagmus (DCPN), which refers to the change in the direction of nystagmus with different head positions, is a well-known characteristic of horizontal semicircular canal BPPV. The supine head roll test is commonly used to diagnose horizontal canal BPPV. However, persistent geotropic DCPN observed during this test cannot be explained by conventional mechanisms of canalolithiasis or cupulolithiasis. The concept of a “light cupula” has been proposed to account for this unique nystagmus. In this review, we summarize the historical background, clinical features and diagnostic methods, presumed mechanisms, and treatment approaches of the light cupula phenomenon based on the available literatures up to date.

Original Articles

Dizziness in Patients with Vestibular Epilepsy: Wankiun Lee, Jae-Moon Kim; Res Vestib Sci. 2023;22(1):7-13. Published online March 13, 2023; DOI: https://doi.org/10.21790/rvs.2023.22.1.7

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Abstract PDF: Objectives
Vestibular epilepsy refers to epilepsy in which vertigo is the sole or main symptom of a seizure. However, epilepsy is rarely considered as a differential diagnosis in patients complaining of dizziness. Here, we reviewed ten cases of vestibular epilepsy and analyzed the dizziness complained by the patient.
Methods
In this study, the medical records of dizziness patients with epileptic discharges observed on electroencephalogram were retrospectively analyzed. Patients who had other obvious causes of dizziness, lacked a description of dizziness, or were not taking antiseizure medications were excluded. We finally recruited 10 patients, and investigated their dizziness characteristic, brain imaging tests, electroencephalograms, and blood test findings.
Results
Patients with vestibular epilepsy usually felt dizzy abruptly while not moving, and often complained of dizziness in the form of spinning around or becoming dazed. Dizziness was short, usually between a few seconds and a few minutes, and the frequency of occurrence was variable, so there was no consistent trend. There were no abnormal findings in blood tests. In brain imaging test, most patients did not show significant abnormalities. The electroencephalographic abnormalities of the patients were mainly observed in the temporal lobe, and the dizziness they complained of improved when they started taking antiseizure medications.
Conclusions
If a patient with dizziness complains of dizziness that occurs suddenly and lasts for a short time, early electroencephalogram should be considered to prevent the diagnosis of epilepsy from being overlooked or delayed.

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.

Case Reports

A Case of Pontine Infarction with Facial Palsy and Vertigo Confused with Ramsay Hunt Syndrome: Jae Seon Park, Sang Hyun Kim, Jung-Yup Lee, Min-Beom Kim; Res Vestib Sci. 2022;21(2):57-62. Published online June 15, 2022; DOI: https://doi.org/10.21790/rvs.2022.21.2.57

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Abstract PDF: Facial palsy can be caused by central and peripheral causes, and it can also be caused by brain tumors or infarction. A 59-year-old male, who lost his right hearing 13 years ago due to Ramsay Hunt syndrome, visited our hospital with facial palsy and dizziness. Initial brain diffusion-weighted magnetic resonance imaging (MRI) showed no abnormal findings, and recurrent Ramsay Hunt syndrome or a neoplastic lesion in the internal auditory canal was suspected. After hospitalization, the patient was administered high-dose steroids, and the videonystagmography showed direction-changing gaze-induced nystagmus, so a brain MRI reexamination was scheduled. While waiting for MRI, the patient complained of neurological symptoms such as diplopia, and right lower pontine infarction was diagnosed on MRI. The patient was transferred to the neurologic department and was discharged on the 10th day after conservative treatment. During the 1-year follow-up, pontine infarction did not recur, and neurological symptoms such as facial palsy gradually improved.

Posterior Inferior Cerebellar Artery Stenosis Presenting as Recurrent Orthostatic Dizziness: Seongjin Jeon, Ji-Yun Park, Jong-min Lee, Seulgi Hong; Res Vestib Sci. 2022;21(2):53-56. Published online June 15, 2022; DOI: https://doi.org/10.21790/rvs.2022.21.2.53

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Abstract PDF: We report a unique case of vertebrobasilar transient ischemic attacks manifesting as isolated, recurrent, orthostatic dizziness with posterior inferior cerebellar artery (PICA) stenosis. A 57-year-old male patient without past medical history, presented with brief orthostatic dizziness for 2 weeks. There was no associated nausea, vomiting, diplopia, or weakness. On neuro-otologic examination, the patient did not show spontaneous, positional, or gaze-evoked nystagmus. Vestibular function tests such as caloric test, head impulse test, video-oculography, and tilt table test were normal. Brain diffusion-weighted images showed multiple small high signal intensities in the bilateral cerebellar hemispheres. Brain magnetic resonance angiography revealed hypoplasia of the right vertebral artery without focal intracranial focal stenosis. Four-vessel cerebral angiogram showed severe stenosis at the right PICA artery. Our patient’s clinical scenario appears unique hemodynamic spells without symptoms or signs of posterior circulation ischemia. Physicians should also consider cerebrovascular ischemic when the patient suffers repeated orthostatic dizziness that is not explained clinically.

Reviews

The Association between Dizziness and Anxiety: Update to the Treatment: Seo-Young Choi, Kwang-Dong Choi; Res Vestib Sci. 2022;21(2):40-45. Published online June 15, 2022; DOI: https://doi.org/10.21790/rvs.2022.21.2.40

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Abstract PDF Supplementary Material: Anxiety, depression, or other psychiatric symptoms can be the primary cause of dizziness and the secondary complication of dizziness. Regardless of precedence or consequence, dizziness is closely associated with the psychiatric problem. On this ground, this chapter reviews the association between dizziness and anxiety and the treatment for dizziness with psychiatric symptoms.

Clinical Significance and Update of Postural Orthostatic Tachycardia Syndrome: Jung A Park, Jae Han Park; Res Vestib Sci. 2022;21(1):1-5. Published online March 15, 2022; DOI: https://doi.org/10.21790/rvs.2022.21.1.1

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Abstract PDF: Postural orthostatic tachycardia syndrome (POTS) is a cerebrovascular autonomic dysfunction that is common in young women. POTS can cause dizziness due to orthostatic intolerance. In patients with orthostatic intolerance, it can be diagnosed when the heart rate increases by more than 30 beats per minute within 10 minutes of standing up through the head-up tilt test. However, even a neuro-otologist has difficulty in diagnosing POTS due to the high possibility of misdiagnosis if not paying attention. In this paper, the clinical symptoms, pathophysiology, diagnosis, and treatment of POTS are investigated. In addition, the latest knowledge of POTS is searched to help diagnose and treat POTS.

Original Article

Locus of Control and Dizziness: Mediation Effect of Self-Efficacy: Yemo Jeong, Won Hwa Jin, Eun-Jin Kwon, In-Sun Kwon, Han Young Yu, Seong-Hae Jeong; Res Vestib Sci. 2021;20(4):126-133. Published online December 15, 2021; DOI: https://doi.org/10.21790/rvs.2021.20.4.126

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Abstract PDF: Objectives
An attention to psychological aspects can clarify the understanding and management of patients with unresolved dizziness/vertigo. Thus, we study the locus of control and the mediation effect of self-efficacy for assessing the relationship between locus of control and dizziness/vertigo in a referral-based dizziness clinic.
Methods
We analyzed the dizziness-specific locus of control and self-efficacy using the modified questionnaire in 117 consecutive dizzy patients (34 males; age range, 20–74 years). In addition to the visual analogue scale-dizziness for evaluation of subjective dizziness, the following items were further evaluated; Korean Dizziness Handicap Inventory, Korean Beck Depression Inventory II, and Korean Beck Anxiety Inventory. According to the verification procedure proposed by Hayes, the mediation effect of self-efficacy verifies the relationship between the locus of control and dizziness through analysis.
Results
Except the scale of emotion such as anxiety and depression, sex, age, duration of illness, and diagnosis all did not significantly affect the dependent variables. Vestibular migraine (39.3%), vestibulopathy (15.4%), and dizziness associated with anxiety and depression (14.5%) were the most common diagnoses. On all scales, Cronbach’s α ranged from 0.72 to 0.94. In the direct effect, the internal locus of control had a tendency of aggravation of dizziness/vertigo, but in the indirect effect, the higher the internal locus of control, the higher the self-efficacy, and the higher the self-efficacy, the lower the dizziness.
Conclusions
In our study, we can assume that the locus of control can impart ambivalent effects on dizziness/vertigo. And the modulation of self-efficacy could be another treatment for patients with unresolved dizziness.

Review

Diagnosis and Management of Vestibular Schwannoma: Focus on Dizziness: Sung Il Nam; Res Vestib Sci. 2021;20(4):119-125. Published online December 15, 2021; DOI: https://doi.org/10.21790/rvs.2021.20.4.119

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Abstract PDF

Vestibular schwannoma (VS) is commonly encountered in the cerebellopontine angle and benign neoplasms that arise from Schwann cells of the eighth cranial nerve, which can show not only hearing loss but also various vestibular symptoms. Dizziness is the symptom causing significantly negative effect on quality of life in patients with VS. Here, we will review the dizziness in VS.

Citations

Citations to this article as recorded by

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
Research in Vestibular Science.2022; 21(3): 75. CrossRef

Original Article

Correlation between Residual Dizziness and Modified Clinical Test of Sensory Integration and Balance in Patients with Benign Paroxysmal Positional Vertigo: Jung-Yup Lee, In-Buhm Lee, Min-Beom Kim; Res Vestib Sci. 2021;20(3):93-100. Published online September 15, 2021; DOI: https://doi.org/10.21790/rvs.2021.20.3.93

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Abstract PDF

Objectives
This study was performed to investigate the correlation between subjective residual dizziness and objective postural imbalance after successful canalith repositioning procedure (CRP) in benign paroxysmal positional vertigo (BPPV) by using questionnaires and modified Clinical Test of Sensory Integration and Balance (mCTSIB).
Methods
A total of 31 patients with BPPV were included prospectively in the study. All included patients were successfully treated after initial CRP and their symptoms and nystagmus disappeared. Two weeks after CRP, all patients were asked to fill out the questionnaire including both Dizziness Handicap Inventory (DHI) and visual analog scale (VAS). We also conducted mCTSIB 2 weeks after CRP. We divided patients into two groups according to VAS: RD (residual dizziness) group, VAS＞0; non-RD group, VAS=0. We compared age, number of CRP, rates associated with three semicircular canals, DHI score and mCTSIB results between two groups. In addition, we analyzed the correlation between DHI score and mCTSIB results.
Results
There were no significant differences in age, number of CRP, and rates associated with three semicircular canals between the two groups. RD group showed significantly higher DHI score and abnormal mCTSIB results than the non-RD group (p＜0.05). DHI score and the number of abnormal mCTSIB showed a statistically significant correlation.
Conclusions
We demonstrated the correlation between DHI score and mCTSIB after successful CRP for BPPV. It also represents that subjective residual dizziness is correlated with objective postural imbalance even after successful CRP. Therefore, mCTSIB would be a useful test to evaluate both residual dizziness and postural imbalance after CRP in BPPV.

Citations

Citations to this article as recorded by

Immediate Improvement in Subjective Visual Vertical and Disequilibrium Predicts Resolution of Benign Paroxysmal Positional Vertigo Following Single Canalith Repositioning Maneuver
Christine C. Little, Zachary G. Schwam, Marc Campo, James Gurley, Bryan Hujsak, Maura K. Cosetti, Jennifer Kelly
Otology & Neurotology Open.2022; 2(3): e014. CrossRef
Gait and Postural Control Characteristics among Individuals with Benign Paroxysmal Positional Vertigo: A Scoping Review
Haziqah Nasruddin, Maria Justine, Haidzir Manaf
Malaysian Journal of Medicine and Health Sciences.2022; 18(s15): 377. CrossRef

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