Research in Vestibular Science

Convergence-Retraction Nystagmus: Analysis with 3-dimensional Oculography: Ji Soo Kim, Kwang Dong Choi, Sun Young Oh; J Korean Bal Soc. 2005;4(1):5-12.

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Abstract PDF: Background
and Objectives : Convergence-retraction oscillations are rhythmic or arrhythmic jerks of dysjunctive eye movements associated with backward displacement of the eyeballs during the convergence phase. Oscillations in convergence-retraction oscillations have been proposed to be consisted of opposed adducting saccades immediately followed by slow abducting glissades without latency. However, dynamic characteristics of convergence oscillations accompanying retraction have not been studied, and pathomechanism of these eye movements remains to be elucidated. This study was to get insights on the pathomechanisms of convergence-retraction oscillations by using 3-dimensional recording of eye movements. In particular, we intended to clarify whether the nystagmus originates from instability of vergence eye movement or of saccades. Materials and Method : Seven consecutive patients with convergence-retraction oscillations were recruited. All the patients received full neurological and neuro-ophthalmological evaluation by the senior author. Some of the patients underwent 3-dimensional recordings of convergence-retraction oscillations with video-oculography or magnetic search coil technique.
Results
: Wave forms of convergence-retraction oscillations were varied. The onset of convergent eye movements was either synchronous or asynchronous between both eyes. The initial directions of eye movement was same (conjugate) or opposite (disjunctive). In some, vergence eye movements occurred only in one eye (unilateral). Convergence phase of one eye was commonly consisted of multiple steps while the other eye attained final position with a single step. The following divergent eye movements commonly overshoot the orbital midposition and were followed by correcting convergent eye movements. The velocity-amplitude relationship of convergent eye movements, which was analyzed in typical pairs of vergence oscillations, did not differ between both eyes. Divergent eye movements are slower than convergent eye movements. The both convergent and divergent eye movements were slower than the microsaccades of similar amplitudes.
Conclusion
: Quantitative analyses of convergence-retraction oscillations revealed various patterns of wave forms. The amplitude-velocity relationships of the disjunctive eye movements suggest that the slowed saccades may be due to co-contraction of the agonist and antagonist, or due to enhanced vergence eye movements by the accompanying saccades.

Immunologic Screening Test and Type II Collagen Autoimmunity in Meniere's Disease: Ja Won Koo, Min Hyun Park, Seung Ha Oh, Tai June Yoo, Sun O Chang, Chong Sun Kim; J Korean Bal Soc. 2005;4(1):13-16.

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Abstract PDF: Background
and Objectives :Altered immunity against one’s own tissue, especially inner ear, is in part responsible for the development of Meniere’s disease (MD). Since immunologic screening test results are usually nonspecific, even if tested for those patients suspicious of autoimmune inner ear disease, they do not seem to provide valuable information. The aim of this study is to evaluate the validity of immunologic screening laboratory tests for MD patients with type II collagen (CII) autoimmunity and to discuss the diagnostic role in this localized immunologic disease. Materials and Method : Thirty-six patients of MD in which immunologic screening laboratory test result was available were included in this study and their clinical features were described according to the criteria of AAO-HNS(1995). They were divided into two groups, CII(+) (N=8) or CII(-) (N=28) according to the presence of anti-CII antibody determined by ELISA method as described earlier. Rheumatoid factor (RF), Fluorescent antinuclear antibody (FANA), immunoglobulin G, M and A, and complement 3 and 4 were included for immunologic screening test. Individual test and clinical features were compared between groups.
Results
: Any single test did not show significant correlation between groups. But RF, total IgG and the proportion of patients more than at least one marker are higher in CII(+) group with borderline significance.
Conclusion
: Higher positive rate of immunologic screening test may support the immunologic involvement in CII(+) group. However the role of this screening test seems to be limited in a localized disease like MD compared systemic immunologic disorder, such as rheumatoid arthritis.

The Analysis of Post Traumatic Benign Paroxysmal Positional Vertigo: Chang Hyun Cho, Dong Kyu Kim, Gyu Cheol Han, Eun Jeong Lee, Joo Hyun Woo, Ju Hyoung Lee; J Korean Bal Soc. 2005;4(1):17-25.

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Abstract PDF: Background
and Objectives :Benign paroxysmal positional vertigo (BPPV) has a lot of causes. Except idiopathic BPPV, the most common cause of BPPV was trauma. The aim of this study was to study its character, diagnosis, prognosis and treatment. Materials and Method : We retrospectively collected the 14 patients by reviewing charts, analyzing vestibular function tests.
Results
: Post traumatic BPPV had characters different from idiopathic BPPV in patient' sex ratio and age distribution. The mean age of patients was 40 years old, men were 11 women were 3. In the mechanisms of trauma, traffic accidents were 11, assault was 1, and fall down were 2. In types, posterior semicircular canal were 10, horizontal semicircular canal were 4. In origins, cupulolithiasis were 8, canalolithiasis were 6. Treatment and prognosis were similar to those of idiopathic BPPV.
Conclusion
: But origin, diagnostic criteria, treatment and prognosis are identical with idiopathic BPPV. Therefore, in evaluating post traumatic BPPV patients, we need correct diagnosis and treatment together by history taking, physical examination and vestibular function tests. And by this, we can treat idiopathic BPPV accurately, reduce expense and time for patients to return daily life.

A Clinical Significance of AAO-HNS guidelines for Meniere's Disease: Jun Ho Lee, Yun Hoon Choung, Keehyun Park, Min Jung Cho, Jinseok Lee, Yong Ro Yoon, Yun Tae Kim; J Korean Bal Soc. 2005;4(1):26-32.

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Abstract PDF: 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.

The History of Meniere's Disease: Until the Discovery of Endolymphatic Hydrops (1862-1938): Kyu Sung Kim; J Korean Bal Soc. 2005;4(1):35-41.

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Abstract PDF: Author divided the history of Meniere's disease into a three part based on two important historical affairs, the novel concept of Prosper Meniere which reported in 1861, and the discovery of temporal bone histopathology of endolymphatic hydrops by Hallpike and Yamakawa in 1938. This article traces the period since Prosper Meniere's report until discovery of endolymphatic hydrops.

A Case of Contralateral Benign Paroxysmal Positional Vertigo after Mastoidectomy: Sung Lyong Hong, Ji Soo Kim, Ja Won Koo; J Korean Bal Soc. 2005;4(1):45-48.

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Abstract PDF: hors suggest plausible mechanisms of the contralateral side BPPV after mastoid surgery as follows. Surgical position during mastoid surgery (contralateral ear down) and postoperative bulky mastoid compressive dressing usually kept the patient’s head to the contralateral side can be precipitating factors for migration of detached particles into the semicircular canal of dependent position. Anyway, appropriate differential diagnosis and management plans should be prompted using bed side vestibular evaluation, since serious irreversible inner ear complications are more frequent cause of postoperative vertigo than BPPV.

Jerky Seesaw Nystagmus in Isolated Internuclear Ophthalmoplegia: Kyungmi Oh, Jae Hong Chang, Kun Woo Park, Dae Hie Lee, Kwang Dong Choi, Ji Soo Kim; J Korean Bal Soc. 2005;4(1):49-52.

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Abstract PDF: The authors report jerky seesaw nystagmus, extorsional downbeating in the right eye and intorsional upbeating in the left eye, in a patient with right internuclear ophthalmoplegia (INO). This pattern of nystagmus may occur by disrupting pathways from contralateral posterior and anterior semicircular canals by a lesion in the medial longitudinal fasciculus. Depending on damage to the pathways from contralateral vertical canals, various patterns of dissociated torsional-vertical nystagmus may accompany INO.

Acute Vestibular Neuritis in Children: You Ree Shin, Yun Hoon Choung, Yoon Tae Kim; J Korean Bal Soc. 2005;4(1):53-57.

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Abstract PDF: 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.

Monostotic Fibrous Dysplasia of the Temporal Bone with Unilateral Vestibular Weakness and Sensorineuronal Hearing Loss: Jae Ho Ban, Chi Yeul Park, Jong Kyu Lee, No Hee Lee; J Korean Bal Soc. 2005;4(1):58-62.

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Abstract PDF: Fibrous dysplasia is an uncommon benign disorder of unknown etiology. The disease was first described by McCune and Albright in separate publications in 1937. The term, fibrous dysplasia was suggested by Lichtenstein in 1938. The disease has since been found to have 3 different variants: monostotic, polyostotic, and McCune-Albright syndrome. It is a slowly progressive bony disorder where normal bone is replaced by abnormal fibrosseous tissue. Involvement of fibrous dysplasia of the temporal bone is usually unilateral. The squama becomes thickened and the pneumatic system is obliterated. Because fibrous dysplasia shows a predilection for the facial and cranial bone, where it causes deformity and dysfunction. In this paper, we report a case of fibrous dysplasia of the temporal bone. We discuss the characterisitic features of this specific location of the disease, the differential diagnosis, and the treatment policy. We also address the issue of vertigo.

Overview and History Taking of Dizziness: TaeKyeong Lee, M.D.; J Korean Bal Soc. 2005;4(1):67-73.

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Bedside Examination of Dizzy Patients: Ji Soo Kim, M.D., Ph; J Korean Bal Soc. 2005;4(1):74-78.

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Audiologic Test in Patients with Dizziness: Jae Young Choi, M.D.; J Korean Bal Soc. 2005;4(1):79-80.

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Radiological Evaluation of Vestibular Dysfunction: Hyung-Jin Kim, M.D.; J Korean Bal Soc. 2005;4(1):81-85.

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Electro-oculography: Hyung Lee, M.D.; J Korean Bal Soc. 2005;4(1):89-96.

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Rotational Test: Heung-Youp Lee, M.D.; J Korean Bal Soc. 2005;4(1):97-106.

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