Research in Vestibular Science

Original Articles

Comparison of vestibular evoked myogenic potentials between low and high tone idiopathic sudden sensorineural hearing loss: Sang-Wook Park, Sang Yun Lee, Somi Ryu, Jung Woo Lee, Chae Dong Yim, Dong Gu Hur, Seong-Ki Ahn; Res Vestib Sci. 2024;23(1):11-15. Published online March 15, 2024; DOI: https://doi.org/10.21790/rvs.2024.001

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Abstract PDF: Objectives
Vestibular evoked myogenic potentials (VEMP) have been reported to be useful in evaluating not only vestibular function but also the prognosis of idiopathic sudden sensorineural hearing loss (ISSNHL) patients. Even though low frequency, high frequency, and all frequency-involved ISSNHL groups tend to show varied clinical characteristics, there is a lack of data using VEMP results to analyze these subgroups. We investigated if the VEMP test is a valuable tool to predict recovery from hearing loss in association with different frequencies.
Methods
A total of 26 ISSNHL patients were divided into three different groups impaired with low tone (ascending type), high tone (descending type), and all tones (flat type) based on the initial audiograms. Each group included five, 10, and 11 patents, respectively, and their VEMP results were compared between the three subgroups.
Results
Abnormal VEMP results were found in five of the total 26 ISSNHL patients (19.2%). Two (40.0%), one (10.0%), and two (18.1%) patients of low tone, high tone, and all tone hearing loss groups, respectively, showed abnormal VEMP results. However, there was no statistically significant difference between the three groups.
Conclusions
Even though VEMP is known as a valuable tool for predicting the prognosis of ISSNHL patients, it does not seem to reflect frequency-sensitive aspects of ISSNHL.

Study on Platelet Indices in Benign Paroxysmal Positional Vertigo: Byeong Min Lee, Chae Dong Yim, Dong Gu Hur, Seong-Ki Ahn; Res Vestib Sci. 2021;20(4):141-146. Published online December 15, 2021; DOI: https://doi.org/10.21790/rvs.2021.20.4.141

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Abstract PDF: Objectives
Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of dizziness. Even though the etiology of BPPV has been widely studied, the exact mechanism remains still unclear. One of the possible factors explaining the pathophysiology of BPPV is ischemia of vestibule. In the present study, we have focused on the platelet indices including mean platelet volume (MPV), platelet distribution width (PDW), and platelet crit (PCT) to assess a risk of vestibule ischemia causing BPPV.
Methods
From January 2021 to March 2021, a retrospective review was performed on 39 patients diagnosed with BPPV through vestibular nystagmography. For each platelet indices, a comparative analysis was conducted between the patient group and control group.
Results
There were no significant differences when the platelet, MPV, PDW, and PCT values were compared between the study and control group. Rather, the control group showed higher PDW value than the study group.
Conclusions
Ischemia of vestibule is one of the well-known causes of BPPV, but the current study showed that BPPV cannot be explained by the vestibule ischemia itself. Further studies are needed to identify the potential of ischemia regarding BPPV by approaching with other methods with a large study group.

양성돌발성두위현훈에서 혈소판 지표의 역할에 대한 연구.: Byeong Min Lee, Chae Dong Yim, Dong Gu Hur, Seong-Ki Ahn; Received October 29, 2021 Accepted November 22, 2021 Published online November 22, 2021; [Accepted]

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Abstract: Objective: Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of dizziness. Even though the etiology of BPPV has been widely studied, the exact mechanism remains still unclear. One of the possible factors explaining the pathophysiology of BPPV is ischemia of vestibule. In the present study, we have focused on the platelet (PLT) indices including mean platelet volume (MPV), platelet distribution width (PDW), and platelet crit (PCT) to assess a risk of vestibule ischemia causing BPPV.
Methods
From January 2021 to March 2021, a retrospective review was performed on 39 patients diagnosed with BPPV through vestibular nystagmography. For each PLT indices, a comparative analysis was conducted between the patient group and control group.
Results
In BPPV patients, there were no significant differences when the PLT, MPV, PDW and PCT values were compared between the study and control group. Rather, the control group showed higher PDW value than the study group.
Conclusion
Ischemia of vestibule is one of the well-known causes of BPPV, but the current study showed that BPPV cannot be explained by the vestibule ischemia itself. Further studies are needed to identify the potential of ischemia regarding BPPV by approaching with other methods with a large study group.

Original Article

The Periodic Fluctuation of Intra-Annual Distribution of Benign Paroxysmal Positional Vertigo and Meteorological Parameters: Chae Dong Yim, Ki Ju Cho, Hyun Jin Lee, Dong Gu Hur, Rock-Bum Kim, Seong-Ki Ahn; Res Vestib Sci. 2020;19(3):99-103. Published online September 15, 2020; DOI: https://doi.org/10.21790/rvs.2020.19.3.99

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Abstract PDF: Objectives
The influence of specific meteorological conditions, such as solar radiation quantity, duration of sunshine, and their covariation on the incidence of benign paroxysmal positional vertigo (BPPV) has been rarely investigated. Aiming at better predictions of the monthly variation of BPPV, we investigated variations in the monthly incidence of BPPV patients and meteorological parameters.
Methods
A total of 2,111 patients who had been diagnosed with BPPV at one institution were analyzed retrospectively. Monthly counts of BPPV patients were analyzed for incidence distributions throughout the 5 years. The relationship between intra-annual distribution of BPPV and meteorological parameters was compared by the time series analysis.
Results
The lowest monthly incidence of BPPV patients was found in September and the highest monthly incidence was found in December. Statistically, as a result of the time series analysis, a periodic fluctuation of both quantity of solar radiation (p=0.004) and percentage of sunshine duration (p=0.002) was identified, but a periodic fluctuation of both number of BPPV patients (p=0.316) and sunshine duration (p=0.057) was not identified.
Conclusions
Unlike previous studies, the results of time series analysis did not confirm that there is a periodic fluctuation in the incidence of BPPV patients. The incidence of BPPV may be more affected by other factors than by meteorological parameters.

Case Report

Arnold-Chiari Type 1 Malformation Mimicking Benign Paroxysmal Positional Vertigo: Young Chul Kim, Chae Dong Yim, Hyun Jin Lee, Dong Gu Hur, Seong Ki Ahn; Res Vestib Sci. 2019;18(3):87-90. Published online September 15, 2019; DOI: https://doi.org/10.21790/rvs.2019.18.3.87

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Abstract PDF: Arnold-Chiari malformation type 1 is a congenital disease characterized by herniation of the cerebellar tonsils through the foramen magnum. Most common clinical symptom is pain, including occipital headache and neck pain, upper limb pain exacerbated by physical activity or valsalva maneuvers. Various otoneurological manifestations also occur in patients with the disease, which has usually associated with dizziness, vomiting, dysphagia, poor hand coordination, unsteady gait, numbness. Patients with Arnold-Chiari malformation may develop vertigo after spending some time with their head inclined on their trunk. Positional and down-beating nystagmus are common forms of nystagmus in them. We experienced a 12-year-old female who presented complaining of vertigo related to changes in head position which was initially misdiagnosed as a benign paroxysmal positional vertigo.

Original Articles

Incidence of Progression into Ménière Disease from Idiopathic Sudden Sensorineural Hearing Loss: Midterm Follow-up Study: Byeong Min Lee, Jin Hyun Seo, Hyun Woo Park, Hyun Jin Lee, Dong Gu Hur, Seong Ki Ahn; Res Vestib Sci. 2018;17(3):95-101. Published online September 18, 2018; DOI: https://doi.org/10.21790/rvs.2018.17.3.95

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Abstract PDF: Objectives
Ménière disease is a clinical syndrome characterized by the four major symptoms of episodic vertigo, sensorineural hearing loss, tinnitus, and aural fullness. Sensorineural hearing loss, especially low frequency, is the characteristic type of audiogram in Ménière's disease. However, it is difficult to distinguish idiopathic sudden sensorineural hearing loss (ISSNHL) with vertigo from the first attack of Ménière disease. The purpose of this study was to investigate the incidence of progression into Ménière Disease from low frequency ISSNHL.
Methods
Two hundred eighty-three patients were included in this study. We classified the patients with ISSNHL according to the hearing loss in audiogram and analyzed how many of them actually progressed to Ménière disease based on diagnosis criteria.
Results
Among the 240 patients, 37.1% (89 patients) were confirmed low frequency ISSNHL and 14.6% (13 patients) of them were diagnosed with Meniere disease.
Conclusions
This study showed that the progression from low frequency ISSNHL to Ménière disease was higher than other frequency ISSNHL, as in other studies.

Long-Term Results of CyberKnife Radiosurgery for Vestibular Schwannoma: Ho Joong Lee, Chae Dong Yim, Hyun Woo Park, Dong Gu Hur, Ho Jin Jeong, Seong-Ki Ahn; Res Vestib Sci. 2017;16(1):23-28. Published online March 15, 2017; DOI: https://doi.org/10.21790/rvs.2017.16.1.23

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Abstract PDF: Objective: Since the 2000s, CyberKnife radiosurgery (CKRS) is either a primary or an adjunct management approach used to treat patients with vestibular schwannoma (VS). The goals of CKRS are prevention of tumor growth, preservation of cranial nerve function and prevention of new neurologic deficiencies. The aim of this study was to assess the efficacy and safety of CKRS, in terms of tumor control, hearing preservation, and complications.
Methods
Forty patients with VS underwent CKRS as a treatment modality for from January 2010 to February 2016. The long term results of 32 patients were evaluated who received CKRS as primary treatment. 8 patients presented with previously performed surgical resection. Information related to clinical history, Brain MRI and outcomes of patients with VS collected retrospectively by reviewing patient’s chart and telephone survey.
Results
The mean tumor volume was 3.3 cm³ and the mean follow-up was 41 months. The most recent follow-up showed that tumor size decreased in 17 patients (42.5%), displayed no change in 19 patients (47.5%), and increased in 4 patients (10%). Progression-free survival rates after CKRS at 1, 3, and 5 years were 95%, 90%, and 90%. After CKRS, 13 patients experienced hearing degradation. The overall rate of preservation of serviceable hearing at the long-term follow-up was 60%. Vertigo, ataxia, and headache were improved after CKRS compared with pretreated status. But, facial weakness, trigeminal nerve neuropathy, and tinnitus were worsen.
Conclusion
CKRS provide an excellent tumor control rate and a comparable hearing preservation rate in VS patients. Also CKRS is associated with low rate of cranial neuropathy, other complications.

Correlation between Rotating Chair Test and Dizziness Handicap Inventory in Patients with Acute Unilateral Vestibular Neuritis: Hyeong Joo Lee, Jin Yong Kim, Dong Gu Hur, Seong Ki Ahn; Res Vestib Sci. 2016;15(2):51-54. Published online June 15, 2016

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Abstract PDF: OBJECTIVE: Vestibular neuritis (VN) is one of the most common causes of acute spontaneous vertigo. However, such dizziness symptoms in patients with VN vary among patients, and various methods are used to evaluate subjective vestibular symptoms following attack of VN. Studies on correlation between subjective vestibular symptom changes and result of rotation chair test after vestibular rehabilitation therapy (VRT) have not been reported. Therefore, we compared change of dizziness handicap inventory (DHI) and results of rotation chair test in patients with VN between attack and 3 month later following VRT.
METHODS
Forty-seven patients were included in this study. In patients with VN, DHI and rotation chair test were performed at the time of VN attack and recovery time of 3 months after VN attack.
RESULTS
In general, the DHI score and the percentage of directional preponderance (DP) in a rotation chair test performed on patients with VN have all decreased. However, the changes in these results were not statistically significant. DP% difference and DHI score were compared to each other among patients with VN and showed no relational significance to each other (r=0.326).
CONCLUSION
The degree of improvement in a rotation chair test done on patients with VN did not reflect the severity of improvement for symptom like dizziness.

Case Report

Bilateral Benign Paroxysmal Positional Vertigo Occurred during Dancing Rehearsal: Dong Gu Hur, Joon Seok Ko, Jin Yong Kim, Seong Ki Ahn; Res Vestib Sci. 2015;14(3):93-96.

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Abstract PDF: Benign paroxysmal positional vertigo (BPPV) is the most common cause of recurrent vestibular vertigo. The etiology of BPPV is unidentified in 50%?70% of patients. However in secondary BPPV, the etiologies are well known a head injury as an example. And it has been reported that even minor head trauma can evoke BPPV. The authors experienced a case of bilateral BPPV occurred during a dancing rehearsal in a school thereby we report the case with a review of the related literatures.

Original Articles

Long-Term Follow-Up of Patients with Benign Paroxysmal Positional Vertigo: Jin Yong Kim, Joon Seok Ko, Ho Joong Lee, Dong Gu Hur, Seong Ki Ahn; Res Vestib Sci. 2015;14(3):83-86.

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Abstract PDF: Objective: Benign paroxysmal positional vertigo (BPPV) is one of most common peripheral vestibular disorders. The aim of this study was to identify recurrence in the long-term follow-up of patients with BPPV after successful canalith repositioning maneuvers, and to determine which factors contribute to recurrence.
Methods
The authors reviewed the medical records of 202 consecutive patients with BPPV during the period January 2002 to December 2004 and investigated 112 patients with BPPV treated over the same period. Finally, 71 patients were enrolled in this study. The estimated risk of recurrence used a Kaplan-Meier analysis. For long-term follow-up, patients were contacted by telephone for further information by one experienced doctor.
Results
A total of 71 patients with idiopathic BPPV fulfilled the inclusion criteria. Forty-two patients had posterior semicircular canal-BPPV and 29 patients lateral semicircular canal-BPPV. Recurrence rates in the posterior semicircular canal-and lateral semicircular canal-BPPV were 24% (18/42) and 41% (12/29), respectively (p＞0.05). Recurrence following successful treatment during a longterm follow-up period was 23 out of 30 patients within 1 year, 5 patients between 1 and 3 years, 1 patient at between 3 and 5 years, 1 patient after 5 years, respectively.
Conclusion
The authors found no significant difference between the posterior semicircular canal and lateral semicircular canal-BPPV regarding recurrence. Recurrence mostly occurred within the first 3 years (93%) following successful canalith repositioning procedure.

Clinical Characteristics and Course of Recurrent Vestibulopathy Following Diuretics Medication: Joon Seok Ko, Ho Yeop Kim, Dong Gu Hur, Seong Ki Ahn; Res Vestib Sci. 2014;13(1):7-11.

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Abstract: et, and the characteristics of vertigo. Results: Median follow-up was 29 months (range, 27−37 months). Patients had a mean age at onset of 48.2 years and a mean duration of 2.75 years. An obvious female predilection was found, and unilateral caloric paresis (≥25%) was seen in 23.3%. Of the 30 patients, symptoms resolved in 80% but were unchanged in 20%. No patient with RV developed a central nervous system disease or benign paroxysmal positional vertigo during follow-up. Conclusion: The present study shows that in the majority of cases, vertigo resolved following diuretics medication. In cases of the patients with severe or disabling recurrent vestibulopathy, the diuretics medication may be effective in reducing the frequency of vertigo attacks.

Clinical Characteristics and Natural Course of Benign Paroxysmal Vertigo of Childhood: A Long-Term Follow-Up Study: Eun Jae Lee, Seong Ki Ahn, Dong Gu Hur, Joon Seok Ko; Res Vestib Sci. 2013;12(3):93-98.

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Abstract: Background and Objectives: It is suggested that some patients with benign paroxysmal vertigo of childhood (BPVC) go on to develop migraine. However, neither the natural course nor the clinical features of BPVC have been determined, and therefore, the aim of this study was to investigate the clinical characteristics and the natural course of BPVC. Materials and Methods: During the period January 2002 to December 2009, we reviewed the clinical records of 58 patients diagnosed with BPVC. All patients were approached by telephone and using a questionnaire. The clinical characteristics of vertigo, such as sex and age distribution, duration and frequency of vertigo, associated symptoms, development of migraine, and neurologic abnormalities, were analyzed. Results: Mean follow- up duration was 73.2 months (range, 31-119 months). Patients had a mean age at onset of 11.8 years and a mean duration of 6.1 years. An obvious female predilection was found, and 40% of BPVC developed to migraine had a family history of migraine. Of the 32 patients, symptoms resolved in 68.7% but were unchanged in five patients (15.6%). BPVC developed to migraine in five patients (15.6%). Conclusion: This study suggests that vertigo spontaneously resolves in the majority of cases. However, the incidence of development to migraine in the BPVC patients is higher than that in general population.

Case Report

A Case of Bilateral Vestibular Hypofunction Following Oseltamivir Medication: Ho Yeop Kim, Seong Ki Ahn, Dong Gu Hur; Res Vestib Sci. 2013;12(1):27-30.

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Abstract: The threat of pandemic influenza has focused attention and resources on virus surveillance, prevention, and containment. The World Health Organization has strongly recommended the use of the antiviral drug, Oseltamivir (TamifluⓇ), to treat and prevent pandemic influenza infection. In recent years, there have been case reports of vestibulocochlear events during or after oseltamivir treatment, other countries. Oseltamivir is generally well-tolerated and its most frequent adverse effects include nausea and vomiting, diarrhea, and abdominal pain. Up to now, bilateral vestibular hypofunction after oseltamivir medication has not been reported. Herein, we report a very rare case of a 36-year-old female with bilateral vestibular hypofunction following oseltamivir medication.

Contrivance of Management for Intractable Vertigo: Dong Gu Hur, Eun Jae Lee, Hung Soo Kang, Seong Ki Ahn; Res Vestib Sci. 2012;11:69-70.

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PDF

Original Article

Immunohistochemical Study on β1- and β2-Adrenergic Receptors in Rat Vestibular Nuclei: Seong Ki Ahn, Roza Khalmuratova, Dong Gu Hur, Ho Yeop Kim, Hyun Woo Park, Yeon Hee Joo, Hung Soo Kang; Res Vestib Sci. 2012;11(2):59-63.

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Abstract PDF: Background and Objectives: The aim of this study was to examine the localizations of β1- and β2-adrenergic receptors (ARs) in rat vestibular nuclei by immunohistochemical staining procedure. Materials and Methods: Twelve male Sprague- Dawley rats were used in this study. Primary antibodies for the β1- and β2-ARs were used. The sections were treated with a biotinylated goat anti-rabbit antibody. The sections were then incubated in avidin-biotin-peroxidase reagent and processed with immunoperoxidase using 3.3’-diaminobenzidine tetrahydrochloride. Results: β1-AR and β2-AR immunopositive neurons were found to be distributed throughout the four major vestibular nuclei. Both receptors were primarily detected in neuronal somata and their proximal dendrites. β1-AR and β2-AR were moderately expressed in the superior vestibular nucleus, lateral vestibular nucleus, medial vestibular nucleus, and spinal vestibular nucleus. Conclusion: The present study demonstrates, for the first time, that β1-AR and β2-AR receptors are localized in rat vestibular nuclei. Furthermore, this study may provide additional speculation into the role of ARs during vestibular signal processing. Further studies are needed to clarify the roles played by β1-ARs and β2-ARs through physiologic and functional studies.

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