Research in Vestibular Science

Review Article

Virtual reality simulators for temporal bone dissection: overcoming limitations of previous models: Temuulen Batsaikhan, Young Joon Seo; Res Vestib Sci. 2024;23(1):1-10. Published online March 15, 2024; DOI: https://doi.org/10.21790/rvs.2024.002

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Abstract PDF: Temporal bone dissection is a critical skill for otolaryngology trainees: however, it is challenging to master due to the complex anatomy and limited exposure to cadaveric specimens. The aim of this review was to develop and evaluate a novel virtual reality (VR) simulator for temporal bone dissection, addressing the limitations of previous simulators reported in the literature. A comprehensive literature search was conducted in the PubMed, Embase, and Cochrane Library databases from inception to September 2022. The search was limited to studies that evaluated the effectiveness of VR simulators for temporal bone dissection. The quality of the included studies was assessed using the Cochrane Risk of Bias Tool. The results showed that VR simulators can significantly improve temporal bone dissection skills, including anatomical knowledge, instrument handling, and surgical performance. Compared to traditional training methods, VR simulation was associated with faster learning curves, better retention of skills, and greater confidence among trainees. However, some limitations of current VR models were identified, including the lack of haptic feedback, limited realism, and short duration of practice. VR simulators are a valuable adjunct to traditional methods for temporal bone dissection training. The recently developed VR simulator addressed the limitations of previous simulators and demonstrated its potential to enhance the training of clinicians in temporal bone dissection. Future directions for research include further validation of the simulator and exploration of its potential for use in clinical settings.

Case Report

A Rare Case of Isolated Infarcts of the Pons with Sudden Vertigo: Clinical Features and Imaging Findings: Dong Hwan Kwon, Eun kyung Jeon, Young Joon Seo; Res Vestib Sci. 2023;22(3):89-94. Published online September 15, 2023; DOI: https://doi.org/10.21790/rvs.2023.22.3.89

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Abstract PDF: Isolated infarcts of the pons (IIP) are a rare subtype of ischemic stroke, accounting for less than 1% of all strokes. It refers to a specific type of ischemic stroke that occurs within the pons region of the brain. IIP can be associated with vertebrobasilar insufficiency in certain cases. This case report describes a 64-year-old female patient who presented with acute vertigo and spontaneous nystagmus to the lesion side, ultimately diagnosed with IIP in the posterior right side of pons. Tegmental pontine infarcts typically manifest as oblique small (lacunar) infarctions that are localized in the mediolateral tegmental area of the middle to upper pons. The patient’s symptoms resolved spontaneously, but a 2-mm infarct was confirmed by brain diffusion magnetic resonance imaging. This case highlights the distinctive symptoms associated with IIP and emphasizes the importance of careful neurological examination and advanced neuroimaging techniques for accurate diagnosis.

Original Articles

Quantifying the Prevalence of Acute Vestibular Neuritis through Big Data Analysis: Chul Young Yoon, Seulgi Hong, Ji-Yun Park, Young Joon Seo; Res Vestib Sci. 2023;22(3):68-76. Published online September 15, 2023; DOI: https://doi.org/10.21790/rvs.2023.22.3.68

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Abstract PDF Supplementary Material: Objectives
Big data analytics in healthcare research have gained momentum, offering unprecedented opportunities to investigate complex medical conditions like acute vestibular neuritis (AVN). However, an inappropriate definition can introduce bias and inaccuracies into prevalence estimation, making the results unreliable and hindering cross-study comparisons. The Health Insurance data in South Korea will be used to create a robust operational definition for AVN.
Methods
The study utilized the National Patients Sample dataset from the Health Insurance Review and Assessment Service (HIRA) of the Republic of Korea. The operational definition of AVN was defined using the HIRA data, which includes specific codes for diagnosis, testing, and medications. The revised categorization scheme for AVN was presented as case 1 through case 5, with criteria for each category.
Results
The optimal conditions are deemed to be those that encompass the outcomes of both case 5 and case 1-1, encompassing all conditions. The study also provided prevalence estimates for subgroups based on demographic factors (age, sex), and found a consistent pattern throughout all years, sex, and age.
Conclusions
The study analyzed the prevalence of AVN in case 1 and case 5, which were similar to the reference prevalence of 3.5 per 100,000 people reported in other countries. The study’s results are encouraging for several reasons, including the validity of the operational definitions used, and the agreement between the study’s prevalence estimates and the reference prevalence. The operational definition in statistics, in the context of big data, serves as a precise and standardized criterion.

Development of An Algorithm for Slippage-Induced Motion Artifacts Reduction in Video-Nystagmography: Yerin Lee, Young Joon Seo, Sejung Yang; Res Vestib Sci. 2022;21(4):104-110. Published online December 15, 2022; DOI: https://doi.org/10.21790/rvs.2022.21.4.104

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Abstract PDF: Objectives
The slippage of the video-nystagmography devices causes motion artifacts in the trajectory of the pupil and thus results in distortion in the nystagmus waveform. In this study, the moving average was proposed to reduce slippage-induced motion artifacts from the real-world data obtained in the field.
Methods
The dataset consists of an infrared video of positional tests performed on eight patients with a lateral semicircular canal benign paroxysmal positional vertigo. The trajectories of the pupil were obtained from the video with binarization, morphological operation, and elliptical fitting algorithm. The acquired data was observed and the section where the slippage occurred was labeled by an otolaryngologist. The moving average with windows of various lengths was calculated and subtracted from the original signal and evaluated to find the most adequate parameter to reduce the motion artifact.
Results
The period of nystagmus in the given data was found to be ranged from 0.01 to 4 seconds. The slippages that appeared in the data can be categorized into fast and slow slippages. The length, distance, and speed of trajectories in the slippage ranges were also measured to find the characteristics of the motion artifact in video-nystagmography data. The shape of the nystagmus waveform was preserved, and the motion artifacts were reduced in both types of slippages when the length of the window in moving average was set to 1 second.
Conclusions
The algorithm developed in this study is expected to minimize errors caused by slippage when developing a diagnostic algorithm that can assist clinicians.

Auto-Pattern Recognition for Diagnosis in Benign Paroxysmal Positional Vertigo Using Principal Component Analysis: A Preliminary Study: O-Hyeon Gwon, Tae Hoon Kong, Jaehong Key, Sejung Yang, Young Joon Seo; Res Vestib Sci. 2022;21(1):6-18. Published online March 15, 2022; DOI: https://doi.org/10.21790/rvs.2022.21.1.6

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Abstract PDF

Objectives
The aim of this study was to develop a filtering algorithm for raw nystagmus images and a diagnostic assistive algorithm using a principal component analysis (PCA) to distinguish the different types of benign paroxysmal positional vertigo (BPPV).
Methods
Fifteen video clips of clinical data with typical nystagmus patterns of BPPV (13 cases) and with normal nystamgmus (two cases) were preprocessed when applied the thresholding, morphology operation, residual noise filtering, and center point extraction stages. We analyzed multiple data clusters in a single frame via a PCA; in addition, we statistically analyzed the horizontal and vertical components of the main vector among the multiple data clusters in the canalolithiasis of the lateral semicircular canal (LSCC) and the posterior semicircular canal (PSCC).
Results
We obtained a clear imaginary pupil and data on the fast phases and slow phases after preprocessing the images. For a normal patient, a round shape of clustered dots was observed. Patients with LSCC showed an elongated horizontal shape, whereas patients with PSCC showed an oval shape at the (x, y) coordinates. The scalar values (mm) of the horizontal component of the main vector when performing a PCA between the LSCC- and PSCC-BPPV were substantially different (102.08±20.11 vs. 32.36±12.52 mm, respectively; p=0.0012). Additionally, the salar ratio of horizontal to vertical components in LSCC and PSCC exhibited a significant difference (16.11±10.74 mm vs. 2.61±1.07 mm, respectively; p=0.0023).
Conclusions
The data of a white simulated imaginary pupil without any background noise can be a separate monitoring option, which can aid clinicians in determining the types of BPPV exhibited. Therefore, this analysis algorithm will provide assistive information for diagnosis of BPPV to clinicians.

Citations

Citations to this article as recorded by

Development of An Algorithm for Slippage-Induced Motion Artifacts Reduction in Video-Nystagmography
Yerin Lee, Young Joon Seo, Sejung Yang
Research in Vestibular Science.2022; 21(4): 104. CrossRef

Comparison of Predictive Parameters between the Video Head Impulse Test and Caloric Test: Chun Han, Seung Won Paik, Hui Joon Yang, Sang Yoo Park, Ji Hyeon Lee, Young Joon Seo; Res Vestib Sci. 2020;19(2):55-61. Published online June 15, 2020; DOI: https://doi.org/10.21790/rvs.2020.19.2.55

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Abstract PDF

Objectives
The aim of this paper was to determine if a correlation exists between video head impulse test (vHIT) and electronystagmography with caloric test (ENG). More specifically, comparison of covert and overt value from vHIT test with cold and warm stimulation value from ENG test.
Methods
Retrospective study of our single institue from the period of January 2015 to January 2017 enrolled 91 patients. Patients were divided into 3 groups by their diagnosis of either vestibular neuritis (VN), Meniere disease, or sudden sensorineural loss with vertigo accordingly. Each of the patients’ both ENG and vHIT data were recorded and parameters were evaluated.
Results
VN group was the only group to show a significant correlation between canal paresis (CP) with covert and overt saccades. Further analysis was done in the VN group and result showed covert saccade showing a larger area under the receiver operation characteristic curve value (0.77) compared to overt saccades (0.70), implying that covert saccade is a more accurate parameter for the prediction of the CP value. Furthermore, a positive correlation was seen between the gain value and the cold caloric stimulation value as well as between warm caloric stimulation value.
Conclusions
The value of our study lies in the fact that we have attempted to find a correlation between different parameters of 2 different vestibular tests. We concluded that the evaluation of overt nystagmus by the bedside head thrust test is inappropriate for predicting CP, and a vHIT is required to accurately evaluate vestibular function.

Citations

Citations to this article as recorded by

A Comparative Analysis of the Vestibulocochlear Function in Patients with Isolated Semicircular Canal Hypofunction Using a Video Head Impulse Test
Yu Jung Park, Min Young Lee, Ji Eun Choi, Jae Yun Jung, Jung Hwa Bahng
Research in Vestibular Science.2023; 22(2): 34. CrossRef

Review

Recent Research of Radiologic Diagnosis in Meniere’s Disease: Won Sang Lee, Young Joon Seo; Res Vestib Sci. 2010;9(4):121-127.

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Abstract PDF: 동물 실험에서, 정맥 및 고실을 통한 Gd 결합체의 주입은 내이의 외림프액 공간의 조영 증강을 확인할 수 있었다. 와우축은 첨단를 통하지 않고 고실계와 전정계 사이에 외림프액을 소통하는 중요한 부위임이 밝혀졌으며, 이를 이용하여 Gd 결합체를 이용한 영상 기술은 더욱 발전할 것이다. 사람에서도 내림프수종을 시각화하는 데 성공하였으며, 고실을 통한 Gd 결합체 주입 후 다양한 MR 기술을 통하여 신호 대잡음 비가 높은 고 해상도의 영상을 얻을 수 있게 되었다.28 아직도 와우의 세부적인 구조를 시각화하는 데는 한계가 있지만, 저자는 내림프수종을 시각화하는 것은 메니에르병을 진단하는 데 필수적이고, 내림프액 공간의 영상과 증상간의 관계에 대한 앞으로의 연구가 내이의 질병들의 병인들을 밝히는 데 큰 역할을 할 것이라고 생각된다.

Original Article

Visualization of endolymphatic hydrops using Magnetic Resonance Imaging after intratympanic Gd-DTPA administration in patients with Meniere’s disease: Young Joon Seo, Dae Bo Shim, Jinna Kim, Won Sang Lee; J Korean Bal Soc. 2008;7(2):167-173.

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Abstract PDF: Background and Objectives: Endolymphatic hydrops are known as major causes of Meniere’s disease. MRI (Magnetic resonance imaging) with contrast tried recently makes it possible to visualize perilymphatic and endolymphatic space without invasive procedures. There are no tryouts in the interior of our country. We attempted MRI after injection of gadolinium-diethylen –triamine pentaacetic acid (Gd-DTPA) in normal adults and patients with Meniere’s disease to make sure 3D-FLAIR (fluid-attenuated inversion recovery) MRI parameters and to visualize endolymphatic spaces. Materials and Methods: Five normal adults and Five patients with Meniere’s disease were included in this study. Twenty-four hours after Gd-DTPA intratympanic injection, we performed 3D-FLAIR and 3D-IR imaging at 3T. MRI region of interest signal intensity was used to determine the diffusion of Gd-DTPA into the perilymphatic fluid spaces over time. Results: Five of five in normal group, using 3D-IR MRI after Gd injection, had enhanced imagings (perilymphatic spaces) of inner ears. Five of five in patients group, using 3D-IR after Gd injection, had enhanced perilymphatic spaces and non-enhanced endolymphatic hydrops. Conclusions: Delayed contrast imaging of the inner ear with 3D-IR MRI after Gd-DTPA intratympanic injection revealed in vivo visualization of endolymphatic hydrops. Key words: Endolymphatic hydrops, 3D-FLAIR MRI, Gd-DTPA, Intratympanic injection

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