Research in Vestibular Science

Volume 5 (1); June 2006

Original Articles

Possibility of Epithelial Sodium Channelopathy as a Pathogenesis of Meniere's Disease: Shi Nae Park, Byung Hoon Lee, Kyung Ho Park, Myoung Hwa Hong, Heung Youp Lee, Ki Hong Chang, Sang Won Yeo; J Korean Bal Soc. 2006;5(1):9-14.

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Abstract PDF: Background
and Objectives: Meniere's disease is a paroxysmal disorder with vertigo and hearing loss. Its episodic nature of vertigo attacks and responsiveness to diuretics is similar to several neurologic disorders with channelopathy. We performed this study to identify the possibility sodium channelopathy in the patients with Meniere's disease. Materials and Method: Thirty patients with definite Meniere's disease and 25 normal controls were included in this study. Clinical features of the patients with Meniere's disease were collected using dizziness chart. Whole blood was taken from all the patients with Meniere's disease and normal controls and used for DNA testing. α-ENaC gene was screened for mutations using direct DNA sequencing.
Results
Patients with Meniere's disease in this study showed the various clinical features of onset age, number of attacks and hearing levels. Many of them showed the caloric response reduction and abnormal electrocochleogram. Genetic analysis did not identify any mutations or differences in α-ENaC gene in normal controls and the patients with Meniere's disease.
Conclusion
Na channelopathy due to α-ENaC gene mutation might not be a pathogenesis of Meniere's disease. Further studies with other subunits of ENaC and other ion channel genes are needed to explore the possibility of channelopathy as a pathogenesis of Meniere's disease. Key Words : Meniere's disease, Channelopathy.

Change of Otoacoustic Emissions in Early Stage of Meniere's Disease: Jeong Hyug Ahn, Eui Kyung Goh, Se Joon Oh, Soo Keun Kong, Il Woo Lee, Kyong Myong Chon; J Korean Bal Soc. 2006;5(1):15-20.

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Abstract PDF: Background
and Objectives: To determine the clinical application of otoacoustic emissions (OAE) in screening of cochlear function, author studied changes of OAE in Meniere's disease patients. Materials and Methods: The author has measured several parameters of OAE with 34 meniere's patients and 15 normal persons. Pass rate, response amplitude, reproducibility were recorded at TEOAE. Amplitude of DP-gram were measured at 2 F2 frequencies - 1000, 2000 Hz. The input/output functions of DPOAE were recorded at 2 F2 frequencies - 1001, 2002 Hz (respectively DP-1000, DP-2000). Input/output function were determined based on 2 parameters -maximal level and Detection threshold of DPOAE.
Results
1) TEOAE: Significant lower rate of positive finding was recorded at involved ears (55.8%, 19/34) than normal ears (100%, 30/30). 2) DP-gram: At frequency was 2000 Hz, amplitude of involved ears (n=28, 6.3±8.5dB/SPL) was significant smaller than normal ears (n=30, 6.3±8.5 dB/SPL). 3) DP-input/output function: At maximum DP level of DP-2000, response of involved ears (n=11, 51.6±7.9 dB/SPL) was significant larger than normal ears (n=22, 48.5±7.0 dB/SPL).
Conclusion
Parameters of OAE, such as pass rate of TEOAE, amplitude of DP-gram at 2000 Hz, and maximum DP level of DP-2000 was considered to good indicators for monitoring cochlear function of Meniere's disease. Furthermore, evaluation by changes in the TEOAE & DPOAE combined parameters, appeared to be very useful for detection of subtle change in cochlear function of Meniere's disease. Key Words : Otoacoustic emissions, Meniere's disease

Morphologic Change of the Vestibular Organ in the Na+-K+-2Cl- Cotransporter Deficiency Mouse: Ju Hyoung Lee, Jae Young Choi, Sang Ho Jung, Won Sang Lee; J Korean Bal Soc. 2006;5(1):21-28.

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Abstract PDF: Background
and Objectives: The Na+-K+-2Cl- cotransporter-1 (NKCC1) is a member of the cation-coupled chloride transporter that participates in salt transport and cell volume regulation in diverse tissues. NKCC1 deficient mice exhibit deafness, and have structural alterations in the cochlea. In addition to hearing loss, NKCC1-deficient mice show a shaker-waltzer behavior, which suggests a vestibular system defect. This study investigated the morphology of the vestibular system of NKCC1-deficient mice. In addition, this study evaluated whether NKCC1 mRNA and its protein are expressed in human vestibular end organs. Materials and Method: NKCC1-deficient and wild type mice aged 4~5 weeks were sacrificed. Their heads were cut in the midsagittal plane, fixed and decalcified. For light microscopy, 5 m sections were cut, and stained with hematoxylin and eosin. Human vestibular end organs were harvested during acoustic tumor surgery via translabyrinthine approach. Some of these end organs were used for the total mRNA extraction and the remainder was used for immunostaining. RT-PCR was performed for NKCC1.
Results
The scala media of the cochlear of the NKCC1-deficient mice were collapsed but the bony labyrinth of the cochlea appeared unaffected. However, the semicircular canals (SCCs) were much smaller than those in the wild type. Furthermore, the SCCs were completely missing in some NKCC1-deficient mice. NKCC1 mRNA was expressed in both human macula and crista ampullaris and its protein was expressed mainly in the transitional and dark cell area of the human crista ampullaris.
Conclusion
NKCC1 may be essential for maintaining the vestibular morphology and its function in mice and NKCC1 is well expressed in human vestibular end organs. Key Words : Ion transport, Vestibule, Knockout mouse

A Promotive Effect of Low Level Laser on Hair Cell Viability in Postnatal Organotypic Culture of Rat Utricles: Yong Won Chung, Jin Chul Ahn, Eun Seok Lim, Young Saeng Kim, Min Young Lee, Jae Yun Jung, Chung Ku Rhee; J Korean Bal Soc. 2006;5(1):29-34.

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Abstract PDF: Background
and Objectives: To culture and maintain mammalian hair cells is still a big challenge. In this study, long-term organotypic culture of rat utricular maculae was established to study vestibular hair cell. The effects of low level laser on hair cell viability in postnatal organotypic culture of rat utricles were investigated. Materials and Method: Uticular explants were prepared from postnatal 2 to 7 rats and cultured. To improve hair cell survival, the utricles were irradiated daily with low level laser. Whole-mount utricles were stained with FM1-43 which is known to be an efficient marker to identify live hair cells in cultured tissues. Such cells visualized directly through tissue culture dish with cover glass bottom by Confocal laser scanning microscope at specific time points.
Results
The explanted utricular hair cells were cultured for up to 31 days in in vitro culture system. In low level laser irradiation group, utricular hair cells were more survived at 24 DIV and 31 DIV.
Conclusion
These results suggest that low level laser promotes hair cell viability in utricular explants. Key Words : Organotypic culture, Low level laser, FM 1-43, Utricle

A Promotive Effect of Low Level Laser on Hair Cell Viability in Postnatal Organotypic Culture of Rat Utricles: Sun Young Oh, Kwang Dong Choi, Jae Moon Kim, Jei Kim, Seong Ho Park, Ji Soo Kim; J Korean Bal Soc. 2006;5(1):35-43.

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Abstract PDF: Background
and Objectives: To culture and maintain mammalian hair cells is still a big challenge. In this study, long-term organotypic culture of rat utricular maculae was established to study vestibular hair cell. The effects of low level laser on hair cell viability in postnatal organotypic culture of rat utricles were investigated. Materials and Method: Uticular explants were prepared from postnatal 2 to 7 rats and cultured. To improve hair cell survival, the utricles were irradiated daily with low level laser. Whole-mount utricles were stained with FM1-43 which is known to be an efficient marker to identify live hair cells in cultured tissues. Such cells visualized directly through tissue culture dish with cover glass bottom by Confocal laser scanning microscope at specific time points.
Results
The explanted utricular hair cells were cultured for up to 31 days in in vitro culture system. In low level laser irradiation group, utricular hair cells were more survived at 24 DIV and 31 DIV.
Conclusion
These results suggest that low level laser promotes hair cell viability in utricular explants. Key Words : Organotypic culture, Low level laser, FM 1-43, Utricle

Sleep and Vestibular Neuritis: Hyun Ah Kim, Hyung Lee; J Korean Bal Soc. 2006;5(1):44-48.

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Abstract PDF: Background
and Objectives: While it is known that sleep have influence on emergence of rapid eye movements(REMs), namely saccades including fast component of nystagmus, whether spontaneous nystagmus due to vestibular imbalance presents during sleep is still unclear. The purpose of our study was to investigate whether tonic vestibular imbalance appeared as spontaneous nystagmus during the wakeful state could present during REM sleep. Materials and Method: Overnight polysomnography (PSG) was performed in 7 patients with spontaneous nystagmus due to vestibular neuritis (VN) and 7 control patients without dizziness or any nystagmus. The numbers of horizontal saccades were counted, during 3 minutes samples of the alert state before and after the PSG and the first and last REM sleep.
Results
All patients with VN showed significantly more saccades (fast phases of spontaneous nystagmus) towards the side contralateral to their vestibular lesion in the awake state before and after the PSG compared with control group. By contrast, during REM sleep the patients with VN showed no preponderance in saccade direction (p<0.05). Some brief nystagmoid jerks showed during REM sleep in both patients and controls equally and also had no preponderance in direction.
Conclusion
The tonic vestibular imbalance at peripheral level observed during alert state does not appear at the brainstem level during REM sleep. It is suggested that a de-afferentation of the peripheral vestibular input to the REM sleep generating areas may explain an absence of nystagmus during REM sleep in patients with VN. Key Words : Vestibular imbalance, Nystagmus, REM sleep

Otolith Function Tests in Patient with Vestibular Neuritis: Hong Ju Park, Jung Eun Shin, Dae Bo Shim, Hyang Ae Shin, Sang Kyun Lim, Jae Yoon Ahn, Yong Soo Jung, Jin Suk Yu; J Korean Bal Soc. 2006;5(1):49-54.

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Abstract PDF: Background
and Objectives: Vestibular evoked myogenic potentials (VEMP) test provides a useful method for assessment of saccule function and the functional integrity of the inferior vestibular nerve, and subjective visual vertical (SVV) abnormalities are presumably related to a lesion of the utricle. The aim(s) of this study were to measure otolith function using SVV and VEMP tests, and to define the influence of the otolithic organs in patients suffering from vestibular neuritis. Materials and Method: From September 2005 to January 2006, twelve patients who received treatment in hospital and also had been tested for caloric test, subjective visual vertical (SVV) and vestibular evoked myogenic potential (VEMP) tests with unilateral vestibular neuritis were enrolled. All the tests were done within 8 days after the onset of their symptoms, simultaneously. The SVV was measured in 34 normal subjects as well as in patients.
Results
Eight of 12 patients showed abnormal tilt to the lesion side in SVV test, and five of 8 patients showed no VEMP on the affected side. There was no correlation between SVV tilts and unilateral weakness (UW) in caloric tests. Two patients with abnormal UW (54, 82%) showed normal finding in SVV & VEMP tests. One patient with abnormal UW (83%) and SVV tilts (18.04˚) to the lesion side was normal in VEMP test. Two patients with abnormal UW (28, 37%) and no response in VEMP test were normal in SVV test.
Conclusion
Our results demonstrate that the incidence of abnormal results were 62.5, 66.7% in VEMP and SVV tests in acute stage of vestibular neuritis, respectively. There was no correlation between the abnormal results of the tests and these findings suggest that impairment of the otolithic function is depending on the extent and/or the localization of vestibular neuritis. Key Words : Vestibular neuritis, Otolith, Vestibular function tests, Subjective visual vertical, Vestibular evoked myogenic potentials

The New Method to Determine the Causing Site of Horizontal Canal Benign Paroxysmal Positional Vertigo: “Bowing and Leaning Nystagmus”: You Ree Shin, Hison Khang, Jung Sub Park, Seong Jun Choi, Keehyun Park, Yun Hoon Choung; J Korean Bal Soc. 2006;5(1):55-60.

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Abstract PDF: 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

Case Reports

Horizontal Canal Benign Paroxysmal Positional Vertigo in Caloric Dead Labyrinth: Jae Jin Song, Yong Hwi Ahn, Ji Soo Kim, Ja Won Koo; J Korean Bal Soc. 2006;5(1):63-69.

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Abstract PDF: The presence of functioning semicircular canal is regarded as a prerequisite for the development of benign paroxysmal positional vertigo (BPPV) since BPPV is irritative vestibulopathy. However, authors experienced a case of horizontal semicircular canal BPPV in which bithermal caloric test and ice water test were compatible with complete canal paralysis. Forty eight year-old man visited ER for sudden onset of vertigo and right hearing loss developed 3hours and 4 hours ago, respectively. Vertigo was vaguely complained and was floating in nature, which was aggravated with head position change. Initial audiometry showed 110 dB on pure tone averages. Positional test showed horizontal geotropic direction changing positional nystagmus and it was compatible with canalolithias of right horizontal semicircular canal. The results of initial and follow up bithermal caloric tests and ice water test on supine and prone position were compatible with right side complete canal paralysis. This case implies that caloric dead labyrinth may not represent complete absence of the lateral semicircular canal function and also BPPV can be developed even in a condition with minimal functional remaining. Key Words : Positional vertigo, Caloric test

Isolated Abducens Nerve Palsy Caused by De Novo Pontine Cavernous Angioma: Jeong Ho Park, Won Hee Chung, Sun Ah Park, Ki Bum Sung; J Korean Bal Soc. 2006;5(1):70-73.

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Abstract PDF: Cavernous angiomas are considered to be congenital in origin. Patients under age of 14 years usually does not require imaging because they are likely to have a benign abducens nerve palsy, unless they develop additional signs or symptoms of neurologic disease during observation. Here we report a case of an isolated abducens nerve palsy caused by overt hemorrhage from de novo formation of cavernous angioma in the pons. Cavernous angiomas of the brain stem should be considered as a possible cause of isolated abducens nerve palsy in young adult and MRI, including gradient-echo sequences should be performed. Key Words : Cavernous angioma, Abducens nerve palsy

A Case of Tolosa-Hunt Syndrome with Serial MRI Findings: Jeong Ho Park, Won Hee Chung, Dae Ho Kim, Ki Bum Sung; J Korean Bal Soc. 2006;5(1):74-77.

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Abstract PDF: To diagnosis Tolosa-Hunt syndrome (TSH) used to be difficult because some other diseases like tumors, sarcoids, vasculitises or other inflammatory masses simulate the clinical manifestations, including steroid responsiveness and radiologic findings. According to the international classification of headache disorders 2nd edition, the diagnosis of THS requires demonstration of granuloma by MRI or biopsy. We performed MRI 4 times during 6 months in a patient who seemed to have THS. Initial MRI was normal but the second MRI showed granuloma which decreased gradually in size with steroid treatment. Key Words : Tolosa-Hunt syndrome, Magnetic resonance imaging, Granuloma

A Case of Isolated Unilateral Abducens Nerve Palsy Caused by Clival Metastasis from Rectal Cancer: Won Hee Chung, Jeong Ho Park, Sun Ah Park, Ki Bum Sung; J Korean Bal Soc. 2006;5(1):78-80.

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Abstract PDF: A wide variety of abnormalities, both primary to the nerve itself and secondarily involving the nerve, can cause isolated abducens nerve palsy. Skull base lesions are also regarded as possible causes of isolated abducens nerve palsy but clival metastasis from systemic malignancy has rarely been reported. We report a case of isolated abducens nerve palsy caused by clival metastasis from rectal cancer. Key Words : Abducens nerve palsy, Metastasis, Skull base, Rectal neoplasm

Bilateral Multiple Benign Paroxysmal Positional Vertigo Combined with Vestibular Neuritis: Seong Jun Choi, You Lee Shin, Yun Tae Kim, Nam Soo Han, Yun Hoon Choung; J Korean Bal Soc. 2006;5(1):81-85.

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Abstract PDF: 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

Original Articles

Functional Neuroimaging of the Vestibular System: So Young Moon, M.D.; J Korean Bal Soc. 2006;5(1):91-96.

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Abstract PDF: .

A Sense of Balance: Understanding the Balance -Anxiety-Migraine Linkage: Carey D. Balaban, Ph; J Korean Bal Soc. 2006;5(1):99-107.

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