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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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Benign Paroxysmal Positional Vertigo of Childhood
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Seong Jun Choi, Dong Hyun Kim, You Ree Shin, Hun Yi Park, Tae Yun Kim, Yun Hoon Choung
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J Korean Bal Soc. 2006;5(2):269-273.
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Abstract
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- Background
and Objectives: Episodic vertigo and/or dizziness in children are not frequent symptoms. Causes of benign episodic vertigo in pediatric age include bengin paroxysmal vertigo of childhood(BPV) and bengin paroxysmal positional vertigo(BPPV). While BPPV has been frequently observed in adult, less frequently observed in children. The aim is to review the clinical manifestations in children with BPPV.
Materials and Method: 154 children with dizziness or vertigo, who visited the Dizziness Clinic in the Department of Otolaryngology, Ajou University Hospital, Suwon, Korea between January 2001 and November 2006 were selected for this study. From all the patients, a comprehensive history was obtained, followed by clinical examination of the ears, nose, and throat and a complete audiologic and neurotologic examination including electronystagmography. All patients were treated with an appropriate canalith repositioning maneuver(CRP), depending on the type of BPPV.
Results
Seven (4.5%) of 154 children with dizziness or vertigo showed typical BPPV. The mean age was 11.8 years old (9-15 years). The horizontal and anterior semicircular canals were involved in 6 (85.8%) whereas the multiple semicircular canals were involved in 1 (14.2%) patients. Vertigo symptom subsided immediately in 6 (85.7%) patients after one or two trials of CRP, but 1(28.6%) patient showed recurred vertigo, that was treated with retrial of CRP.
Conclusion
The incidence of BPPV in children were much lower than that of adult BPPV, but it was higher than we expected before. We recommend that clinical tests such as Dix-Hallpike maneuver and head rolling test should be performed on all children with dizziness to establish the diagnosis of BPPV.
Key Words : Positional vertigo, Child
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Bilateral Multiple Benign Paroxysmal Positional Vertigo Combined with Vestibular Neuritis
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Seong Jun Choi, You Lee Shin, Yun Tae Kim, Nam Soo Han, Yun Hoon Choung
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J Korean Bal Soc. 2006;5(1):81-85.
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Abstract
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- Although classical benign paroxysmal positional vertigo (BPPV) has generally been resolvable by routine manual repositioning maneuvers, nevertheless resistant cases and variant remain a significant problem. Recently, we experienced a case of posterior semicircular canal BPPV combined with changes to various types of BPPV during manual reposition maneuver and vestibular neuritis. We examined her brain MRI due to low response of routine manual reposition maneuvers and frequently recurrence of BPPV. In brain MRI, we found 1.3cm sized mass in hypoglossal canal. It seemed to be neuroma on hypoglossal nerve. A refractory BPPV poses problems of pathophysiogenetic interpretation, differential diagnosis with a CNS lesion and therapeutic strategy. We thought that refractory BPPV should be treated with more frequently examination and manual repositional maneuver and distinguished from CNS lesion.
Key Words : Canalolithiasis, Cupulolithiasis, Vestibular neuritis
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The New Method to Determine the Causing Site of Horizontal Canal Benign Paroxysmal Positional Vertigo: “Bowing and Leaning Nystagmus”
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You Ree Shin, Hison Khang, Jung Sub Park, Seong Jun Choi, Keehyun Park, Yun Hoon Choung
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J Korean Bal Soc. 2006;5(1):55-60.
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Abstract
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- Background
and Objectives: One of problems for the management of horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV) is the difficulty of determining the affected ear using Ewald’s second law. The purpose of this study is to develop the new “Bow and Lean Test (BLT)” to determine easily the affected ear of HSC-BPPV and evaluate its efficiency.
Materials and Method: We compared the efficiency between the classical method and BLT in 26 patients with HSC-BPPV. The classical method is based on Ewald's second law comparing the intensity of nystagmus or symptoms in head roll test. BLT is based on the direction of both “bowing nystagmus” and “leaning nystagmus” at head’s bowing and leaning state on sitting position. The affected ear is the same direction of bowing nystagmus in canalolithiasis and the same direction of leaning nystagmus in cupulolithiasis.
Results
In 26 patents (15 canalolithiasis, 11 cupulolithiasis), 3 (11.5%) patients did not show a prominent affected ear in the classical method, and 7 (26.9%) patients showed the different affected ear between two methods. All 10patients were successfully treated with just one trial of barbecue rotation based on the affected ear in BLT. Three patients did not show any bowing or leaning nystagmus. The side with canal paresis in all 4 patients, who showed significant canal paresis in bithermal caloric tests, was equal to the affected ear based on BLT.
Conclusion
“Bow and Lean Test” (also called “Choung’s test”) is a new method which can easily determine the affected ear of HC-BPPV.
Key Words : Vertigo, Benign paroxysmal positional vertigo, Horizontal semicircular canal, iagnosis, Nystagmus
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Analysis of the Vestibular Function in Children with Otitis Media with Effusion
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in Jung Cho, Keehyun Park, You Ree Shin, Yun Hoon Choung
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J Korean Bal Soc. 2005;4(2):212-218.
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Abstract
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- Otitis media with effusion (OME) is one of the most common diseases in children and may be frequently related with dizziness. Background and Objectives: However, the association between OME and dizziness seems to be not clear and remains controversy. The purpose of this study was to determine the incidence of dizziness in children with long lasting OME, and to investigate the difference in vestibular functions between children with long lasting OME and the control group.
Materials and Method: Thirty one children who had long-lasting OME over than 6 months (study group) and 28 normal hearing children without OME who were scheduled for adenotonsillectomy (control group), were given questionnaires and vestibular function tests (VFT) including electronystagmography (ENG) and rotation chair test(RCT). Statistical analysis was performed with chi-square test.
Results
Dizziness was found in 7 (22.6%) of 31 children in the study group and 2 (7.1%) of 28 children in the control group (p>0.05). The difference of abnormal findings in VFT between the study group and the control was not significant except visual vestibulo-ocular reflex (VVOR) in RCT. Most of the correlations in the study group, bilateral vs. unilateral OME, OME with dizziness vs. OME without dizziness, and preoperative vs. postoperative, were not significant.
Conclusion
We did not find any evidences of significant difference of the incidence of dizziness and findings of VFT between children with long lasting OME and children without OME. However, there was a significant abnormal response in VVOR in RCT in children with long-lasting OME, suggesting the children with OME may be more dependent on the nonvestibular system including visual compensation to maintain balance.
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Acute Vestibular Neuritis in Children
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You Ree Shin, Yun Hoon Choung, Yoon Tae Kim
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J Korean Bal Soc. 2005;4(1):53-57.
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Abstract
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- The acute vestibular neuritis is rarely seen in children and it is hard to find the related reports. In this paper, we report three cases of acute vestibular neuritis less than 15 years old that we experienced during last 10 years. The three cases are 14 and 11-year old boys and a 12-year-old-girl. They complained vertigo without hearing loss. Only one of three cases had previous common cold history and they showed all negative reactions in virus blood tests. After medical treatment and early rehabilitation, vertigo was completely controlled within 3 weeks and there was no recurrent symptoms so far. This recovery in children seems to be faster and more complete than in adults.
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A Clinical Significance of AAO-HNS guidelines for Meniere's Disease
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Jun Ho Lee, Yun Hoon Choung, Keehyun Park, Min Jung Cho, Jinseok Lee, Yong Ro Yoon, Yun Tae Kim
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J Korean Bal Soc. 2005;4(1):26-32.
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Abstract
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- Background
and Objectives :The guidelines for Meniere's disease recommended from the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) in 1995, provided a basis for reporting results of the treatment used in Meniere's disease. However, these guidelines are sometimes not all inclusive and appropriate for management and reporting for some patients clinically considered having Meniere's disease. The objectives of this study is to review and analyze the symptoms, vertiginous episodes, audiometry, vestibular function test and results of the treatment in Meniere's disease and to evaluate the significance of AAO-HNS guidelines.
Materials and Method : This study consisted of the patients with Meniere symptoms who visited the Dizziness Clinic of Ajou University Hospital between 1994 and 2001 were included in this study. The characteristics of dizziness (duration, frequency, and episodes), pure tone audiometry, vestibular function tests, and treatment results were carefully analyzed according to AAO-HNS guidelines.
Results
: Of 550 patients with Meniere symptoms, 198 patients were in the criteria for Meniere's disease. They were classified to 75 (37.9%) of the “definite”, 120 (60.6%) of the “possible”, and only 3 (1.5%) of the “probable”. In the “definite” group, the pure tone average (PTA) was 54.3 dB and canal paresis (CP) was showed in 33 patients (44%) with a mean CP of 53.6%, and the peak and descending types of the pure tone audiogram were dominant (62%). In the “possible” group, the PTA was 19.4dB and CP was found in 30 patients (25%) with mean CP of 50.1%.
Conclusion
: Even though AAO-HNS guidelines for Meniere's disease are helpful for communication between doctors, they should be considered to have limitations for the diagnosis and treatment in clinical practices.
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The Comparison of Benign Paroxysmal Vertigo of Childhood and Migraine Related Vertigo in Children
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Yun Hoon Choung, Min Jung Cho, Ho Seok Choi, Seung Joo Lee, Jinseok Lee, Jeong Min Jeon, Sung Su Baik
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J Korean Bal Soc. 2003;2(2):191-197.
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Abstract
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- Background
and Objectives: Benign paroxysmal vertigo of childhood (BPVC) and migraine related vertigo (MRV) are most common causes of vertigo in children. Some authors suggested that BPVC may be an early manifestation of migraine. However there is few articles about relationship between BPVC and MRV. The purpose of this study is to compare the clinical characteristics, audiological and vestibular findings, treatment and prognosis of BPVC and MRV and to provide the helpful information for relationship between BPVC and MRV.
Materials and Method: The twenty four children (less than 16 years old) with BPVC and 23 children with MRV, who visited the Dizziness Clinic in the Department of Otolaryngology, Ajou University Hospital, Suwon, Korea between January 2001 and August 2003 were selected for this study. These excluded the patients with abnormal eardrums/tympanograms or those that did not perform questionnaires, audiological, or vestibular evaluations. They were retrospectively analyzed for clinical symptoms, audiograms, vestibular functions, and treatment results.
Results
BPVC was frequently detected in younger children than MRV. Spinning sensation was frequently associated with BPVC. Aural symptoms, headache, photophobia, phonophobia, and visual symptoms were frequently associated with MRV. Abnormalities in vestibular function tests were 14 (58%) in BPVC and 15 (62%) in MRV. BPVC & MRV had good prognosis. But medication was sometimes more needed in MRV than in BPVC.
Conclusions
BPVC and MRV show some different features in the age of onset, clinical features, treatment and prognosis, but also have some features of MRV. Further studies are needed to find their relationship between them.
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Various Causes of Vertigo in Children with Normal Eardrums
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Yun Hoon Choung, Sang Jun Ryu, Min Jung Cho, Sung Kyun Moon, Keehyun Park
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J Korean Bal Soc. 2003;2(1):121-126.
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Abstract
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- Background
and Objectives: The differential diagnosis of vertigo in children is extensive. Otitis media and middle ear effusion could be most common causes of vertigo in children, but there are some problems in detecting the other causes for vertigo because they are one of most popular diseases in childhood. The purpose of this study is to review the clinical characteristics and both the audiological and vestibular findings of vertigo in children with normal eardrums, who do not show otitis media or middle ear effusion, and assist in making a differential diagnosis of vertigo.
Materials and Method: The sixty eight children (less than 16 years old) with vertigo, who visited the Department of Otolaryngology, Ajou University Hospital, Suwon, Korea between January 1995 and April 2003 were selected for this study. These excluded the patients with abnormal eardrums/tympanograms or those that did not perform questionnaires, audiological, or vestibular evaluations. They were retrospectively analyzed for clinical symptoms, audiograms, vestibular functions, and differential diagnosis.
Results
The most common causes for vertigo in children were benign paroxysmal vertigo of childhood (BPVC) in 21 (30.9%) and migraine in 20 (29.4%). Other less frequent causes included four cases of trauma, three cases of acute vestibular neuritis. two cases each of Meniere's disease, delayed endolymphatic hydrops, benign positional vertigo, and one case only for cerebellopontine angle tumor, seizure, juvenile rheumatoid arthritis, leaving eleven cases (16.2%) as unclassified. Abnormal findings were noted in 14 (20.6%) in pure tone audiogram, 3 (4.4%) in positioning test, 11 (16.2%) in bithermal caloric test, and 47 (69.1%) in rotation chair test.
Conclusions
The vertigo in children with normal eardrums, who did not show otitis media or middle ear effusion, was most commonly caused by BPVC and migraine. These findings have shown to be very different from those with adult vertigo. The evaluation of vertigo in children requires a questionnaire for extensive and complete history taking, audiograms and vestibular function tests. And in selected cases, electroencephalography, hematological evaluation, imaging of the brain or temporal bone should be performed.
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