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Diagnostic Criteria for M?nier?’s Disease
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Jose A Lopez-Escamez, John Careyb, Won Ho Chung, Joel A Goebeld, Mans Magnusson, Marco Mandala, David E Newman-Tokerg, Michael Strupp, Mamoru Suzuki, Franco Trabalzini, Alexandre Bisdorff
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Res Vestib Sci. 2015;14(3):67-74.
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- This paper presents diagnostic criteria for M?nier?’s disease jointly formulated
by the Classification Committee of the B?r?ny Society, The Japan Society for
Equilibrium Research, the European Academy of Otology and Neurotology, the
Equilibrium Committee of the American Academy of Otolaryngology-Head and
Neck Surgery, and the Korean Balance Society. The classification includes two
categories: definite M?ni?re's disease and probable Meni?re's disease. The
diagnosis of definite M?ni?re's disease is based on clinical criteria and requires
the observation of an episodic vertigo syndrome associated with low- to medium-
frequency sensorineural hearing loss and fluctuating aural symptoms
(hearing, tinnitus and/or fullness) in the affected ear. Duration of vertigo episodes
is limited to a period between 20 minutes and 12 hours. Probable M?nier?'s
disease is a broader concept defined by episodic vestibular symptoms (vertigo
or dizziness) associated with fluctuating aural symptoms occurring in a period
from 20 minutes to 24 hours.
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Two Cases of Barotraumatic Perilymph Fistula Mimicking Atypical Benign Paroxysmal Positional Vertigo with Sudden Hearing Loss
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Jung Joo Lee, Gwanghui Ryu, Il Joon Moon, Won Ho Chung
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Res Vestib Sci. 2015;14(1):26-31.
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- Barotraumatic perilymph fistula is difficult to diagnose and needs diagnosis of
suspicion. Symptoms like hearing loss, tinnitus, ear fullness and positional
dizziness can develop following barotrauma such as valsalva, nose blowing,
straining and diving, etc. We reported 2 cases of perilymph fistula following
barotrauma. The patients developed hearing loss, tinnitus and ear fullness
followed by sudden onset of positional dizziness mimicking benign paroxysmal
positional vertigo (BPPV). On positional tests, the direction of nystagmus has
changed over time. In addition, the characteristics of nystagmus on positional test
were not similar to typical BPPV, which showed longer duration of nystagmus,
no reversibility and no fatigability. We concluded that barotraumatic perilymph
fistula could present as hearing loss with positional dizziness mimicking sudden
hearing loss with BPPV. The differential diagnostic points were history of
barotrauma, time sequence of development of hearing loss and positional
dizziness, and atypical positional nystagmus unlike BPPV.
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Residual Vestibulo-Ocular Reflex Result in Better Functional Outcomes in Bilateral Vestibulopathy
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Ji Eun Choi, Gwanghui Ryu, Young Sang Cho, Won Ho Chung
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Res Vestib Sci. 2014;13(4):89-95.
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- 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.
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Multicenter Study on the Clinician’s Diagnostic and Therapeutic Approaches for Benign Paroxysmal Positional Vertigo in Korea
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Eun Ju Jeon, Won Ho Chung, Jeong Hwan Choi, Eui Cheol Nam, Hong Ju Park, Jong Dae Lee, Won Sang Lee, Kyu Sung Kim, Eui Kyung Goh, Ja Won Koo, Min Bum Kim, Min Beom Kim, Se Hyung Kim, Young Jin Kim, Chang Hee Kim, Sung Il Nam, Seog Kyun Mun, Ga Young Park, Sang Yoo Park, Shi Nae Park, Chang Hoon Bae, Sung Hyun Boo, Myung Whan Suh, Jae Hyun Seo, Eun Jin Son, Jae Jun Song, Jae Jin Song, Joong Wook Shin, Dae Bo Shim, Seong Ki Ahn, Hye Youn Youm, Shin Young Yoo, Dong Hee Lee, Seung Hwan Lee, Chang Ho Lee, Hyun Seok Lee, Hwan Ho Lee, Hyo Jeong Lee, Yun Hoon Choung, Seung Hyo Choi, Jee Sun Choi, Seok Min Hong, Sung Kwang Hong
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Res Vestib Sci. 2013;12(3):79-92.
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Abstract
- Background and Objectives: It is necessary to establish the most efficient diagnostic and therapeutic method for benign paroxysmal positional vertigo (BPPV), which is appropriate for Korean healthcare system. We aimed to evaluate current state of Korean clinician’s diagnostic and therapeutic approaches for BPPV. Materials and Methods: A 16-item survey was emailed to the members of dizziness department of Otology Research Interest Group in the Korean Otologic Society (n=68). 43 were returned and analyzed. Results: All respondents (100%) used Dix-Hallpike test as a diagnostic tool for vertical canal-BPPV. Supine roll test was used for diagnosing lateral canal BPPV in nearly all the respondents (97.7%). Epley maneuver was chosen as otolith repositioning maneuver (ORM) for posterior canal BPPV in all respondents and barbecue rotation (BBQ) was used for treating lateral canal BPPV with geotropic nystagmus in 95.3% of respondents. Extreme variation was noted for therapeutic approach of lateral canal BPPV with ageotropic nystagmus BBQ, with 4 kinds of ORM and adjunctive measures to liberate otolith from cupula, while BBQ was again the most commonly used ORM (76.7%). Conclusion: The development of practical and efficient ORM for lateral canal BPPV with ageotropic nystagmus is necessary.
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Spontaneous Recovery of Vestibulo-Ocular Reflex Gain after Bilateral Complete Vestibular Loss Following Head Injury
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Ga Young Park, Eun Wook Chung, Jong Sei Kim, Won Ho Chung
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Res Vestib Sci. 2012;11(4):146-153.
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Abstract
- Dizziness is a frequent complication of head injury and objective evidence of vestibular dysfunction in the dizzy patient following head injury has been reported in literatures. However, there is no report about bilateral spontaneous recovery of caloric response after complete loss of bilateral vestibular function following head injury. A 27-year-old male patient who presented with continuous dizziness and disequilibrium following head injury was diagnosed as diffuse axonal injury after brain magnetic resonance image and bilateral complete loss of vestibular function after caloric and rotary chair test. He showed gradual improvement of dizziness, vestibulo-ocular reflex gain and left caloric response at 2 months after vestibular exercise. After another 4 months, his caloric function was fully recovered, and dizziness disappeared at 16 months after the onset of dizziness. We present this case with reviews of previous literatures about dizziness following head injury and diffuse axonal injury.
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New Proposal of Functional Status of Vestibular System Based on Vestibular Function Tests Findings in Dizzy Patients with Normal Caloric Response
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Hye Youn Youm, Yang Sun Cho, Sung Hwa Hong, Won Ho Chung
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Res Vestib Sci. 2011;10(4):121-128.
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- Background and Objectives: Vestibular function tests are very useful in diagnosing dizzy patients. Among them, bithermal caloric test is most commonly used test for localizing their permanent vestibular loss. However, it causes much discomfort to the patients with non-physiologic stimuli. In addition, it doesn't represent the present functional status of vestibular system. Therefore, normal caloric result does not accurately correspond to normal vestibular function in dizzy patients. Currently, rotation chair test and dynamic posturography have been introduced adjunctly to assess vestibular function accompanied by bithermal caloric test. It has not been elucidated for their specific role in diverse settings of vestibular disorders. So we planned this study to evaluate clinical usefulness of rotation chair test, videonystagmography and computerized dynamic posturogr-phy in dizzy patients with normal caloric response. Materials and Methods: We reviewed clinical records of 46 patients who met their inclusion criteria. They were categorized into five subgroups according to abnormal vestibular function test findings. Results: In each subgroup, we hypothesized its clinical relevance, possible mechanism of dizz-iness and presumed diagnosis. Five categories are as below; visual dependency, imbalance of vestibular tones, chronic peripheral vestibulopathy, abnormality in the vestibulospinal tract and abnormality of oculomotor system. Conclusion: We suggest new classification of abnormal vestibular functional status in dizzy patients with normal caloric results. These are comparable according their clinical features and thought to be helpful in managing and counseling each patient.
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A Case of Neurovascular Cross-compression of the Eighth Cranial Nerve Representing Longstanding Uncompensated Vestibular Hypofunction
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Jae Kwon Lee, Ho Suk Chu, Moon Hee Ko, Won Ho Chung
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Res Vestib Sci. 2009;8(2):137-141.
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- The neurovascular cross-compression (NVCC) of the eighth cranial nerve (CN) is a clinical entity with symptoms of recurrent vertigo or tinnitus. Although the diagnostic criteria have been defined, the precise clinical presentation and pathomechanism have not been clarified. The treatment response to the carbamazepine; drug of choice for first line medical treatment, has been considered as one of the diagnostic criteria. Herein, we present a case of chronic uncompensated unilateral vestibular hypofunction who responded dramatically to carbamazepine medication. A 55 year-old male admitted to the hospital with symptoms of recurrent oscillopsia and headache for more than 7 years. His symptoms were aggravated by positional changes. Vestibular function tests showed spontaneous nystagmus, canal paresis on caloric test and vestibular dysfunction on dynamic posturography, which represented unilateral uncompensated vestibular hypofunction. Although his symptom was not relived by vestibular rehabilitation, he was treated with carbamazepine. A long standing uncompensated unilateral vestibular hypofunction without any auditory symptoms could be one of the clinical presentations in NVCC of the eighth CN.
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Clinical Features and Treatment Pattern of Migrainous Vertigo in Korea: A Nationwide Prospective Multicenter Study
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Seong Ki Ahn, Kyusik Kang, Ja Won Koo, Kyu Sung Kim, Beom Gyu Kim, Byung Kun Kim, Ji Soo Kim, Kyoung Ho Park, Shi Nae Park, Eun Ho Park, Hong Ju Park, Jae Yong Byun, Myung Whan Suh, Ki Bum Sung, Sun Young Oh, Chung Ku Rhee, Tae Kyeong Lee, Seong Hae Jeong, Won Ho Chung, Chang Il Cha, Sung Won Chae, Eui Kyung Goh
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Res Vestib Sci. 2009;8(2):122-131.
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- Background and Objectives It is being increasing recognized that the morbidities of migraine and balance disorders are interrelated. In fact, migrainous vertigo (MV) is one of frequent causes of recurrent vertigo in patients presenting to specialized dizziness clinics. Nevertheless, not many studies have reported clinical manifestations and treatment. Therefore, the aim of study was designed to assess clinical features and treatment patterns by a nationwide multicenter study. Materials and Methods Patients between 9 and 74 years of age who visited 17 Korean tertiary referral centers and 1 clinic from February to March 2009 were investigated using two forms of questionnaires. Results Overall, 318 patients with MV were enrolled. MV was responsible for ~8.45% of visits to the specialized dizziness clinics. One hundred seventy-five of these patients had definite MV and were included in assessing the clinical features. Vertigo characteristics of patients with definite MV were various. Vertigo was regularly as-sociated with headache in 87% of the patients. The duration of vertigo ranged from seconds to days. For the treatment patterns, an acute and prophylactic therapies were carried in most clinics. There were no differences in either acute or prophylactic therapies between department of neurology and otorhinolaryngology. Conclusions The results of this study suggest that MV the clinical features of MV also varies in Korea. In addition, most clinics provide similar patterns of practice in treatment for MV. The syndrome of MV deserves further research activity as it is relatively common and clinically relevant.
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Multicenter study on the treatment pattern of Ménière’s disease in Korea
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Sung Kwang Hong, Eui Kyung Koh, Kyu Sung Kim, Kyoung Ho Park, Hong Ju Park, Seong Ki Ahn, Joong Ho Ahn, Won Sang Lee, Gi Jung Im, Jae Yun Jung, Won Ho Chung, Gyu Cheol Han, Sung Won Chae, Ja Won Koo
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J Korean Bal Soc. 2008;7(2):174-181.
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- Background and Objectives: It is hard to determine the efficacy of several treatment options of Ménière’s disease since dynamic course of the disease and diverse rate of recurrence. Few modalities are regarded as ‘effective’ in the viewpoint of evidence based medicine. Study was conducted to know the current status of treatment options for Ménière’s disease.
Materials and Methods: A multicenter survey was conducted using questionnaires to collect information on current status of treatment patterns in Ménière’s disease. The questionnaire answered by neurotologic surgeons working at 12 institutes in Korea was analyzed.
Results: Low salt diet was always instructed to their patients, but 8 out of 12 responders (67%) did not emphasis on the amount of dietary salt. Duration of pharmacotherapy was ranged from 3 to 12 months. Intratympanic steroid injection was performed in 8 institutes (67%). Every institute agreed on the role of intratympanic gentamicin application. Treatment options for intractable patients were asked. Endolymphatic sac surgery, intratympanic steroid, Meniette device and intratympanic aminoglycoside injection were answered in patients who hope to preserve residual hearing. On the contrary, in patients without serviceable hearing, intratympanic jnjection of aminoglycosides (9/12, 75%) dominated as the next treatment option.
Conclusions: Most institutes provide similar patterns of practice in medical treatment. The application of intratympanic aminoglycoside is also agreed in intractable patients without serviceable hearing. However, thoughts about the role and detailed methods of the surgical and adjunctive treatment options were not agreed, especially in intractable patients with good hearing. Further clinical studies and discussions would be necessary to provide consensus for the best treatment of Ménière’s disease in Korea.
Key words : Ménière’s disease, Pharmacotherapy, Surgery, Aminoglycosides
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A Case of Herpes Zoster Oticus Involving Vestibular Nerve without Facial Nerve Palsy
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Sung Hyun Boo, Kwon Hyo Bok, Nam Gyu Ryu, Won Ho Chung
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J Korean Bal Soc. 2006;5(2):311-316.
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- Herpes zoster oticus (Ramsay Hunt syndrome) is characterized by facial nerve paralysis associated with vesticular eruptions and cochleovestibular symptoms. Many evidences have supported that it is caused by the reactivation of latent varicella-zoster virus in the geniculate ganglion. Recently we experienced a case 49-year-old man presented severe vertigo and a vesicular eruptions of auricle and external ear canal. It is an unusual variant of herpes zoster oticus that involves only vestibular nerve without facial nerve palsy and hearing loss. We believe this case results from reactivation of latent varicella zoster virus in the vestibular ganglion and report with a review of literatures.
Key Words: Herpes zoster oticus, Vestibular nerve, Vertigo, Dizziness
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Clinical Characteristics of Dizziness in Children
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Joon Ho Kim, Kwon Hyo Bok, Won Ho Chung
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J Korean Bal Soc. 2006;5(2):242-247.
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Abstract
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- Background
and Objectives: The children who are complaining of dizziness are difficult to manage. Because the incidence is quite low and the diagnostic spectrum is different from the adult. The purpose of this study is to analyze the clinical characteristics and vestibular function test in dizzy children, leading to provide a proper diagnostic approach.
Materials and Method: A total of 57 children with dizziness who underwent vestibular function test were included in this study. Theses patients were retrospectively reviewed based on clinical charts. The average age of the patients was 11.1 years (range: 4-15). Caloric and rotation chair tests were performed in 57 and 31 patients respectively. Imaging study such as computed tomography and magnetic resonance imaging was performed in selective cases.
Results
Recurrent vertigo (49.1%) is the most common symptoms in dizzy children. Most common diagnostic entity in dizzy children is benign positional vertigo (BPV) (31.6%). Compared to adults, BPPV is relatively uncommon. Uncertain diagnosis is also common in dizzy children. Caloric test suggested that 19.3% of dizzy patients showed unilateral weakness. However, among normal caloric responders who underwent rotation chair test simultaneously, 11 out of 23 (47.8%) showed abnormal VOR gain and oculomotor abnormality.
Conclusion
Most common diagnosis of dizzy children is BPV, although many patients were remained uncertain. Abnormality of oculomotor test and VOR is relatively common, that suggests abnormal visual vestibular interaction is related with dizzy symptoms in children. The evaluation of vertigo in children should include a complete history and vestibular function test related with visual vestibular interaction.
Key Words : Vertigo, dizziness, Child, Caloric test, Vestibulo-ocular reflex
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Factors Affecting Treatment of Benign Paroxysmal Positional Vertigo
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Yoon Kyoung So, Won Ho Chung, Sung Hyun Boo, Young Jun Chung, Hyun Seok Lee, Woo Young Lee, Ki Nam Park
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J Korean Bal Soc. 2005;4(2):230-237.
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Abstract
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- al vestibular loss, accompanying sudden SNHL, underlying disease such as hypertension or diabetes, change of involved canal during treatment course and number of treatment visits. Statistical analysis using Pearson χ2 test was performed.
Results
Three hundred thirty-one patients with BPPV who received treatment were identified from 2001 to 2005. 85.2% required one treatment visit, 12.4% required a second treatment visit, and 98.2% were successfully treated after three treatment visits. Variables such as bilateral disease, anterior canal BPPV, post-traumatic BPPV, duration of symptom before treatment and change of involved canal during treatment were significantly related with number of treatments.
Conclusion
Patients with anterior semicircular canal BPPV or bilateral BPPV or with recent head trauma or longer duration of symptom are more likely to require multiple visits for canalith repositioning.
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Effects of Medical Treatment on Meniere's disease
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Won Ho Chung, Hyeok Jun Lee, Byung soo Hong, Hyun Jong Lee, Sung Hwa Hong, Yang Sun Cho
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J Korean Bal Soc. 2003;2(1):113-120.
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- Objectives
In Meniere's disease, medical treatment using diuretics has been the mainstream of management. But the effects of medical treatment are very difficult to evaluate because of many variables. Authors tried to investigate the effects of diuretics on Meniere's disease through the change of symptoms.
Materials and Method: From January, 1995 to December, 2000, the twenty patients with definite Meniere's disease who has been followed up over 24 months were retrospectively reviewed. They had no history of previous medication, and were managed with diuretics for the first time. The change of frequency of vertigo, the threshold of pure tone audiometry, type of audiogram were analyzed at each period during 6 month before treatment, during 6 month at 1, 2 and 4 years after treatment.
Results
The ratio of sex was 1:1(male 10, female 10), the average age of diagnosis was 53.9 year old, and the average follow up duration was 39.3 month. By medical treatment, vertigo symptom was significantly controlled in 56.2% at 2 year after treatment. Among 20 patients, 5 patients failed to medical treatment and underwent the sac decompression (N=1) and intratympanic gentamicin injection (N=4). The change of pure tone audiometry was from 34.5 dB before treatment to 38 dB at 24 months and 44.2 dB at 48 months after treatment. The most type of audiometry was flat type and flat type was increased with time.
Conclusion
In Meniere's disease, the medical treatment controlled significantly the vertigo frequency in 50~60%. But the hearing threshold was aggravated with time after treatment despite of medical treatment.
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The clinical characteristics of dizzy patients with normal vestibular function tests
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Won Ho Chung, Eun Guk Bang, Sung Hwa Hong, Chi Kyou Lee, Hyun Seok Lee
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J Korean Bal Soc. 2002;1(2):259-265.
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- 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.
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Outcome of canalith repositioning maneuver in Benign Paroxysmal Positional Vertigo
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Young Jun Chung, Jong Yoon Choi, Won Ho Chung, Sung Hwa Hong
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J Korean Bal Soc. 2002;1(1):118-123.
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Abstract
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- Background
and Objectives : Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of peripheral vestibular disorder and canalith repositioning procedure (CRP) has been popularly used as its treatment. While CRP has been advocated by some as a treatment of choice for BPPV, others have had less uniform results for this disorder. The purpose of this study is to evaluate the effectiveness of the CRP and to define the role of the CRP in BPPV.
Materials and Methods : From January, 1999 to September, 2001, 123 patients diagnosed as BPPV were included in this study. Each patient was undergone by personal history taking and Dix-Hallpike maneuver and supine head turning test for diagnosis. CRP was applied on all the patients and the patients visited OPD 1week later for evaluation.
Results
: The mean age was 51.8 year old in males, and 52.7 year old in females. The most common cause of the disorder was idiopathic and the second common cause was post-traumatic. Posterior semicircular canal was the most common involved site and horizontal, anterior semicircular canal in order. After the initial CRP, successful results were obtained in 90 of the 123 patients (75.6%). Recurrence rate was 31 of the 123 patients and among them, 3patients recurred in different canal.
Conclusion
: Careful observation of the nystagmus is necessary for correct identification of the canal which is involved, and that to perform the appropriate treatment. Although BPPV is known as a self-limited disorder, CRP can help to induce remission of the vertiginous symptoms in short period.
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