Research in Vestibular Science

Original Articles

Various Nystagmus Patterns and Their Clinical Significance in Benign Paroxysmal Positional Vertigo of Anterior Semicircular Canal: Jin Woo Park, Yong Gook Shin, Ja Won Gu, Mee Hyun Song, Dae Bo Shim; Res Vestib Sci. 2016;15(4):126-131. Published online December 12, 2016; DOI: https://doi.org/10.21790/rvs.2016.15.4.126

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Objective: The purpose of this study was to identify the diverse patterns of nystagmus and analyze their clinical significance in benign paroxysmal positional vertigo (BPPV) of the anterior semicircular canal.
Methods
Fifty-three patients diagnosed with anterior canal BPPV (AC-BPPV) were analyzed retrospectively. Patients were classified according to the presence or absence of the torsional component of the nystagmus and the direction of Dix-Hallpike test which induced the nystagmus. We compared the clinical characteristics and treatment outcomes among the different patient groups.
Results
There were 11 patients with unilateral down beat (DB) nystagmus, 11 patients with bilateral DB nystagmus, 14 patients with ipsilateral torsional down beat (TDB) nystagmus, 7 patients with contralateral TDB nystagmus, and 7 patients with bilateral TDB nystagmus. There were no differences between the unilateral and the bilateral DB groups in terms of the duration of nystagmus or vertigo and the number of treatment sessions. In addition, the ipsilateral TDB group showed no significant clinical difference compared to the contralateral or bilateral TDB group.
Conclusion
Various nystagmus patterns can be seen in AC-BPPV. There was no statistically significant difference in the clinical characteristics according to the different nystagmus patterns. This information may be helpful for clinicians in counseling and managing the patients with AC-BPPV.

Citations

Citations to this article as recorded by

Benign Paroxysmal Positional Vertigo: Diagnostic Criteria and Updated Practice Guideline in Diagnosis
Dae Bo Shim
Research in Vestibular Science.2020; 19(4): 111. CrossRef

The Influence of Sleep Position on Benign Paroxysmal Positional Vertigo: Yong Gook Shin, Jin Woo Park, Ja Won Gu, Mee Hyun Song, Dae Bo Shim; Res Vestib Sci. 2016;15(4):121-125. Published online December 12, 2016; DOI: https://doi.org/10.21790/rvs.2016.15.4.121

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Abstract PDF: Objective: The purpose of this study was to identify the influence of sleep position on benign paroxysmal positional vertigo (BPPV).
Methods
Four hundred sixty patients diagnosed as posterior or horizontal canal BPPV were analyzed retrospectively. All patients were asked about their preferred sleep positions among the following four choices: supine, right or left lateral, or no predominant side via questionnaire at initial visit and after 1month. Patients were classified into two groups: affected side group meaning that the patient preferred to sleep ipsilateral to the affected ear and other position group including all positions other than lying lateral to the affected side after treatment. We analyzed the change in the sleep pattern after treatment and compared the recurrence rate between the two groups.
Results
Our study included 244 patients with posterior canal BPPV (PC-BPPV) and 216 patients with horizontal canal BPPV (HC-BPPV). Statistically significant correlation was demonstrated between sleep position side and the affected side by BPPV. The number of patients who slept on the affected side by BPPV decreased, while the number of patients who slept on the healthy side increased significantly after treatment. There was no statistically significant difference in the recurrence rate between the two groups.
Conclusion
There was significant correlation between the sleep position side and the affected side in PC-BPPV and HC-BPPV. The patient had a tendency to avoid lying lateral to the affected side by BPPV during sleep after treatment, however the change in sleep position did not influence the recurrence rate of BPPV.

Case Reports

A Case of Patient with Meniere’s Disease Who Presented Periodic Alternating Nystagmus: Jin Woo Park, Ja Won Gu, Mee Hyun Song, Dae Bo Shim; Res Vestib Sci. 2016;15(3):80-83. Published online September 15, 2016; DOI: https://doi.org/10.21790/rvs.2016.15.3.80

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Abstract PDF: Periodic alternating nystagmus (PAN) is a spontaneous horizontal jerky nystagmus that reverses its direction periodically with a quiescent interval. PAN has been reported in acquired and congenital forms. The main lesion site of the acquired form of PAN has been attributed to the caudal brainstem or cerebellum. Herein we report a 63-year-old male patient with Meniere’s disease, who presented PAN during a vertigo attack. The patient demonstrated no abnormality on neurologic evaluation and brain imaging, which is different feature compared to the central or congenital form of PAN. It should be kept in mind that peripheral vestibular disorders such as Meniere’s disease can produce PAN.

Delayed Positional Vertigo after Stapes Surgery: Jin Woo Park, Joon Hee Lee, Mee Hyun Song, Dae Bo Shim; Res Vestib Sci. 2015;14(4):147-151.

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Abstract PDF: Postoperative vertigo can occur after stapes surgery in approximately 5% of the patients, which more commonly presents immediately after surgery rather than in the delayed period. Isolated delayed vertigo after stapes surgery is commonly related to perilymphatic fistula. Herein we report a 36-year-old female patient who developed positional vertigo 18 days after stapes surgery demonstrating severe geotropic horizontal positional nystagmus on both sides during supine roll test. This patient was eventually diagnosed as the horizontal semicircular canal benign paroxysmal positional vertigo (BPPV) on the left side. This is a rare case of delayed vertigo following stapes surgery caused by BPPV rather than perilymphatic fistula.

Original Article

Clinical Characteristics of Horizontal Canal Benign Paroxysmal Positional Vertigo with Persistent Geotropic Direction Changing Positional Nystagmus: Kyung Min Ko, Mee Hyun Song, Jin Woo Park, Joon Hee Lee, Yong Gook Shin, Dae Bo Shim; Res Vestib Sci. 2015;14(4):117-122.

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Abstract PDF: Objective: The purpose of this study was to identify the clinical characteristics of horizontal canal benign paroxysmal positional vertigo (h-BPPV) with persistent geotropic direction changing positional nystagmus (DCPN).
Methods
One hundred thirty two patients diagnosed as the geotropic subtype of h-BPPV were analyzed retrospectively. Patients were classified into two groups: persistent h-BPPV (ph-BPPV) group which means h-BPPV showing persistent (＞1 minute) geotropic DCPN and short duration h-BPPV (sh-BPPV) group that means h-BPPV with short duration (≤1 minute) geotropic DCPN. We compared the clinical characteristics and treatment outcomes between the two groups.
Results
The study included 34 patients with ph-BPPV and 98 patients with sh-BPPV. There were no differences between the two groups in age, distribution of sex and the affected side. The ph-BPPV group had higher secondary BPPV preponderance and dizziness handicap index (DHI) score compared to the sh-BPPV group. The ph-BPPV group required higher number of canalith repositioning procedures (CRPs) until resolution and higher multiple/single CRP ratio than the sh-BPPV group. In addition, the ph-BPPV group showed longer duration until the remission of subjective symptoms (vertigo, dizziness) compared to the sh-BPPV group.
Conclusion
ph-BPPV was more frequently associated with secondary causes of BPPV and demonstrated higher DHI score, total number of CRP, and longer remission duration of subjective symptoms compared to sh-BPPV. This information may be helpful for clinicians in counseling and managing the patients with persistent geotropic DCPN h-BPPV.

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