Research in Vestibular Science

Case Reports

A Case of Delayed Audiovestibulopathy after Posterior Circulation Ischemic Stroke: Hyun Su Lee, Eun Kyung Jeon, Dong Hwan Kwon, Tae Hoon Kong; Res Vestib Sci. 2023;22(3):77-82. Published online September 15, 2023; DOI: https://doi.org/10.21790/rvs.2023.22.3.77

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Abstract PDF: Distinguishing central and peripheral causes of dizziness is vital. A case is presented where a 42-year-old man with a history of posterior circulation ischemic stroke developed acute unilateral vestibulopathy with hearing loss. Clinical examination revealed signs of vestibular dysfunction on the left side. Audiometry confirmed deafness on the left, but imaging ruled out new central issues. The patient was diagnosed with audiovestibulopathy and treated with steroids, antiviral agents, intratympanic injections, and hyperbaric oxygen therapy. Hearing loss persisted, but dizziness improved with vestibular rehabilitation. Poststroke patients should be closely monitored for peripheral complications. Further research should explore the benefits of antiplatelet therapy in vascular-related conditions, even without clear central lesions.

Two Cases of Pediatric Pneumolabyrinth with Traumatic Tympanic Membrane Perforation after Penetrating Injury: Yeon Seok You, Ji Hoon Koh, Byeong Jin Kim, Eun Jung Lee; Res Vestib Sci. 2019;18(3):83-86. Published online September 15, 2019; DOI: https://doi.org/10.21790/rvs.2019.18.3.83

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Abstract PDF: Pneumolabyrinth is an uncommon condition in which air is present in the vestibule or cochlear. It is rarely found, even in otic capsule violating fractures or in transverse fracture of the temporal bone. So far, there is no consensus on management of pneumolabyrinth. We describe 2 new cases of pneumolabyrinth by penetrating injury with traumatic tympanic membrane perforation. They presented whirling vertigo with moderate conductive hearing loss. Temporal bone computed tomography clearly demonstrated the presence of air in the vestibule and cochlear.

A Case of Labyrinthitis Ossificans Presenting as an Intractable Benign Paroxysmal Positional Vertigo: Dong Hyun Kim, Jae Moon Sung, Hwi Kyeong Jung, Chang Woo Kim; Res Vestib Sci. 2017;16(3):92-96. Published online September 15, 2017; DOI: https://doi.org/10.21790/rvs.2017.16.3.92

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Abstract PDF: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder. It is easily cured with canal repositioning maneuvers, but some patients are resistant to the repositioning maneuver and require surgical intervention. Labyrinthitis ossificans is the pathologic condition that fibrous tissue and new bone occupy the membranous labyrinthine space. It occurs as a sequela of inner ear inflammation resulting from diverse causes, mostly bacterial meningitis and otitis media. We describe here a 42-year-old female patient with refractory posterior semicircular canal (PSCC) BPPV and adhesive otitis media in same ear. Otoscopic examination revealed adhesive tympanic membrane without middle ear space and temporal bone computed tomography showed complete ossification of the labyrinth at the same side. We performed a canal wall down mastoidectomy and PSCC occlusion. The patient had complete resolution of paroxysmal vertigo and positional nystagmus, postoperatively.

Bacterial Meningitis Initially Presenting as Labyrinthitis: Bon Min Koo, Sung Il Nam, Soon Hyung Park; Res Vestib Sci. 2017;16(2):69-72. Published online June 15, 2017; DOI: https://doi.org/10.21790/rvs.2017.16.2.69

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Abstract PDF: Labyrinthitis causes damage to inner ear structure, and in turn hearing loss and vertigo. Labyrinthitis is classified as otogenic labyrinthitis and meningogenic labyrinthitis. Otogenic labyrinthitis can be diagnosed early through otoscopic examination. However, when there are no characteristic neurologic symptoms in patients with meningogenic labyrinthitis, clinicians can overlook the underlying meningitis and this may lead to the peripheral vertigo. We encountered an unusual case of meningogenic labyrinthitis that is misdiagnosed as peripheral dizziness.

A Case of Early Developed Labyrinthine Fistula after Canal Wall Down Mastoidectomy: Sung Yong Choi, Yee Hyuk Kim; Res Vestib Sci. 2016;15(3):89-93. Published online September 15, 2016; DOI: https://doi.org/10.21790/rvs.2016.15.3.89

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1 Crossref

Abstract PDF

Labyrinthine fistula refers to a condition caused by an abnormal connection between the inner ear and surrounding structures. Most cases of that occur as a result of a complication brought about by cholesteatoma. It may also be generated by long repeated infections of a mastoid cavity that has been exposed to the outside after canal wall down mastoidectomy (CWDM). The infection is usually repeated for several years or decades after surgery. Therefore, labyrinthine fistula after CWDM is known as a late complication. In this case, labyrinthine fistula occurred in two months after surgery due to postoperative infection. Although cholesteatoma was removed after CWDM and the horizontal semicircular canal (HSCC) was not damaged during the operation, this labyrinthine fistula was thought to develop very early after surgery. Two months after surgery, the patient complained of dizziness, we identified the opened bony labyrinth and damaged endosteum of the HSCC in the patient.

Citations

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A Case of Labyrinthitis Ossificans Presenting as an Intractable Benign Paroxysmal Positional Vertigo
Dong Hyun Kim, Jae Moon Sung, Hwi Kyeong Jung, Chang Woo Kim
Research in Vestibular Science.2017; 16(3): 92. CrossRef

Original Articles

Role of the Cerebral Cortex on Vestibular Compensation Following Unilateral Labyrinthectomy in Rats: Hyun Kwang Ryoo, Seung Bum Yang, Min Sun Kim, Byung Rim Park; Res Vestib Sci. 2015;14(3):75-82.

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Abstract PDF: Objective: The cerebral cortex can modulate vestibular functions through direct control of neuronal activities in the vestibular nuclei. The purpose of this study was to investigate the effect of unilateral cortical lesion or cortical stimulation on static vestibular symptoms and vestibular nuclear activities at the acute stage of vestibular compensation following unilateral labyrinthectomy (UL) in rats.
Methods
The photothrombic ischemic injury using rose bengal was induced in the primary motor cortex or primary sensory cortex, and electrical stimulation was applied to the primary motor cortex, primary sensory cortex, or sencondary sensory cortex, respectively, in unilateral labyrinthectomized rats. Static vestibular symptoms including ocular movement and postural deficits, and expression of c-Fos protein in the medial vestibular nucleus (MVN) were measured.
Results
Lesion of the motor cortex produced a marked postural deficit with paralytic weakness in the hindlimb contralateral to UL. Number of spontaneous nystagmus in animals receiving cortical lesion was significantly increased 2, 6, and 12 hours after UL compared with animals being UL only. Lesion of the primary motor cortex or stimulation of the S2 sensory cortex decreased expression of c-Fos protein in MVN following UL compared with UL only group. Electrical stimulation of S2 sensory areas caused significant reduction of static vestibular symptoms and decreased expression of c-Fos protein in MVN 24 hours following UL.
Conclusion
The present results suggest that cerebral cortex involves in recovery of static vestibular symptoms during vestibular compensation following UL.

Cervical Vestibular Evoked Myogenic Potential and Ocular Vestibular Evoked Myogenic Potential in Patients With Vestibular Neuritis and Acute Viral Labyrinthitis: Il Ha Moon, Chan Goo Lee, Moo Kyun Park, Jong Dae Lee; Res Vestib Sci. 2012;11(3):92-96.

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Abstract: Background and Objectives: Vestibular neuritis predominantly affects the superior branch of the vestibular nerve, resulting in vertigo. Acute viral labyrinthitis occurs when an infection affects both vestibulo-cochlear nerve and labyrinth, resulting in hearing changes as well as vertigo. The purpose of study is to identify there is a difference of cervical vestibular evoked myogenic potentials (cVEMP) and ocular VEMP (oVEMP) in patients with vestibular neuritis and acute viral labyrinthitis. Materials and Methods: cVEMP and oVEMP tests using 500-Hz tone-burst stimuli were performed on patients with vestibular neuritis and acute viral labyrinthitis. Pure tone audiometry, caloric test and subjective visual vertical (SVV) were performed in all patients. We compared the VEMP results, SVV, caloric test in patients with vestibular neuritis and acute viral labyrinthitis. Results: Abnormal cVEMP responses were detected in 2 (20%) patients with vestibular neuritis and 5 (100%) patients with labyrinthitis. Abnormal oVEMP responses were detected in 9 patients (90%) with vestibular neuritis and 5 (100%) patients with labyrinthitis. oVEMP abnormalities is correlated with caloric test and subjective visual vertical in patients with vestibular neuritis and labyrinthits. Conclusion: Our results shows that the response of cVEMP and oVEMP between patients with vestibular neuritis and acute viral labyrinthitis is different. We can infer that oVEMP response to air-conducted sound is different vestibular origin compared to cVEMP and may originate from utricle.

Role of the Peripheral Vestibular End Organ in the Expression of c-Fos Protein in the Medial Vestibular Nucleus Following Occlusion of the Anterior Inferior Cerebellar Artery: Nari Kim, Jae Hee Lee, Myoung Ae Choi, Byung Geon Park, Min Sun Kim, Byung Rim Park; Res Vestib Sci. 2012;11(2):51-58.

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Abstract PDF: Background and Objectives: The present study investigated the role of the peripheral vestibular end organ in vestibular symptoms and temporal changes in expression of c-Fos protein in the vestibular nuclei following anterior inferior cerebellar artery (AICA) occlusion using rats with unilateral or bilateral labyrinthectomy. Materials and Methods: Expression of c-Fos protein in the vestibular nuclei was measured 2, 12, 24, and 48 hours after AICA occlusion. Results: Unilateral AICA occlusion significantly induced expression of c-Fos protein bilaterally in the medial, inferior, superior, and lateral vestibular nuclei. Following AICA occlusion, the medial vestibular nucleus (MVN) showed the highest expression of c-Fos protein among the 4 vestibular nuclei. The expression of c-Fos protein was asymmetric between the bilateral MVN, showing higher expression in the MVN contralateral to the side of AICA occlusion compared to the ipsilateral MVN. The degree of asymmetry in c-Fos protein expression between the bilateral MVN peaked 12 hours after AICA occlusion. The expression of c-Fos protein gradually decreased 24 hours after AICA occlusion and returned to control levels 48 hours after AICA occlusion. Unilateral labyrinthectomy significantly decreased expression of c-Fos protein in the MVN ipsilateral to the side of labyrinthectomy following AICA occlusion. Moreover, bilateral labyrinthectomy significantly decreased expression of c-Fos protein in the bilateral MVN flowing AICA occlusion. Conclusion: These results suggest that afferent signals from the peripheral vestibular end organ are crucial to the expression of c-Fos protein in the MVN following AICA occlusion and that expression of c-Fos protein is sustained for 24 hours after AICA occlusion.

Quantification of Vestibulospinal Reflex Under the Stress Condition on Both Soleus Muscles: Mi Joo Kim, Seo Jin Jang, Eun Ji Lee, Ah Ram Yu, Jong Hyun Hwang, Gyu Cheol Han, Ju Kang Lee; Res Vestib Sci. 2012;11(1):14-22.

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Abstract PDF: Therefore, by establishing method that enables to track and observe quantified VSR, the reliability of experiment is attempted to be increased. Materials and Methods:On five SD Rats to measure electromyogram (EMG), electrodes, in the form of stranded cables composed of seven wires, are chronically implanted on both sides of the soleus muscles. Pre and post operative condition of sitting still, standing, and ladder step walking was compared before, and six and twenty four hours after a unilateral labyrinthectomy with quantified muscle activity in maximal voluntary activity. Simultaneously by using multi modality electric potential plus package, the muscle activity between the two legs was tracked and compared. Results: In the sitting still position, the left/right soleus muscle activities were 25.7/26.0 μV before a unilateral labyrinthectomy which was changed after the surgery with the value of 23.1/8.1 μV and 23.4/14.3 μV when six and twenty four hours passed respectively. In the standing position, 92.8/124.0 μV of preoperative value was changed to 89.6/37.3 μV six hours after the unilateral labyrinthectomy, and it was 97.0/54.7 μV 24 hours after. The preoperative value in ladder step walking test was 56.2/86.0 μV, and postoperative ones were 54.9/21.2 μV and 55.7/38.0 μV after six and twenty four hours respectively. Conclusion: VSR assessment method by using quantitative EMG well reflects the process of vestibular compensation, and to maintain the tension of extensor muscles, ladder step walking test is shown to be useful.

Case Report

A Case of Acute Serous Labyrinthitis Complicated by Chronic Otitis Media Showing Atypical Nystagmus Pattern: Hyun Woo Park, Seong Ki Ahn, Dong Gu Hur; Res Vestib Sci. 2011;10(1):42-45.

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Abstract PDF: Serous or suppurative labyrinthitis is one of the intratemporal complications of acute or chronic otitis media. Labyrinthitis can occur by meningogenic or hematogenous infection. Major symptoms of labyrinthitis are vertigo and hearing loss. The disease progresses in two phases; serous labyrinthitis, so called toxic labyrinthitis, and suppurative labyrinthitis. If labyrinthitis treated at serous phase, hearing could be saved. But, if the disease progressed to suppurative phase, hearing loss is difficult to recover. Therefore it is very important to distinguish these two phases of labyrinthitis when treating the patient. In general, the direction of nystagmus during labyrinthitis is helpful sign to distinguish these two phases. We report here on an unusual case of acute serous labyrinthitis complicated with chronic otitis media showing atypical pattern with a review of the related literatures.

Original Article

Measuring the Behavioral Parameters of Mouse Following Unilateral Labyrinthectomy in Round Free Field Using an Infrared Lamp and a Simple Webcam Camera: Mi Joo Kim, Hyun Jung Hwang, Seung Won Chung, Gyu Cheol Han; Res Vestib Sci. 2011;10(1):12-18.

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Abstract PDF: Background and Objectives: In this research, movements of mouse after labyrinthectomy were analyzed to determine the degree of vestibular dysfunction and compensation. Materials and Methods: By using an infrared lamp, mouse movements were recorded for 100 seconds in a dark room. The experimental area was manufactured as a circular space with a diameter of 60 cm. The movements of five mice labyrinthectomized on right side were observed and recorded at 3 hours, 9 hours and 120 hours after the operation, and also the ten mice of control group. Results: The differences between the total moving distances and the rotating angle from the origin that set the center of round field between groups were analyzed with pictures of 1 frame per second. It is concluded that all 4 groups show significant differences between its mean rotation angle and total moving distances statistically. At 9 hours after right labyrinthectomy, mice tended to turn clockwise; but at 120 hours, there was no significant difference between clockwise and counter-clockwise rotation. Conclusion: Measuring the movement of mouse in round free field can be the proper method to determine the degree of vestibular dysfunction and vestibular compensation. This test was time-saving and cost-effective method.

Case Reports

MRI Findings of a Cholesteatomatous Labyrinthine Fistula Showing Abnormal Inner Ear Enhancement: Yun Ah Park, Do Yang Park, Tae Sub Chung, Hyun Seok Choi, Eun Jin Son; Res Vestib Sci. 2010;9(4):144-148.

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Abstract PDF: A 59-year-old male patient presented with sudden onset of vertigo and hearing loss. Labyrinthitis due to lateral semicircular canal fistula caused by cholesteamatous otitis media was suspected from temporal bone computed tomography (CT) and clinical symptoms. The patient was treated with canal wall down mastoidectomy with removal of the cholesteatoma and lateral semicircular canal occlusion. Preoperative gadolinium-enhanced magnetic resonance imaging (MRI) images of the inner ear revealed increased signal in the cochlea as well as vestibule. Correlation of the MRI findings and the inner ear involvement in labyrinthine fistula is discussed.

A Case of Vestibular Schwannoma Mimicking Acute Labyrinthitis: Dong Yeol Han, Won Ik Jang, Jong Dae Lee; Res Vestib Sci. 2009;8(2):164-167.

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Abstract PDF: Acute labyrinthitis is clinically characterized by cochlear symptom like sudden hearing loss, tinnitus and aural fullness and vestibular symptom like vertigo and spontaneous nystagmus. Several disease entities may mimic labyrinthitis when the disease does not manifest its own characteristic findings. We present the case of a 43-year-old female patient who was suffering from the acute vertigo and sudden hearing loss in her right ear. The speech discrimination score in right side was 24% and brain magnetic resonance imagine revealed a mass in internal auditory canal and minimally extending cerebellopontine angle. Removal of mass was performed via translabyrinthine approach and rapid vestibular compensation was accomplished after surgery.

Original Article

Changes in the Gastrointestinal Motility following Unilateral Labyrinthectomy: Jae Hee Lee, Gyoung Wan Lee, Suck Jun Choi, Eun Ho Park; Res Vestib Sci. 2009;8(1):15-22.

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Abstract PDF: Background and Objectives The temporal changes and the role of glutamate receptors in the recovery of vestibulogastrointestinal symptoms following unilateral labyrinthectomy (UL) were investigated in this study. Vestibulogastrointestinal symptoms were evaluated in terms of gastric emptying and intestinal transit. Materials and Methods Expression of the c-Fos protein was observed in the solitary tract nucleus (STN) and rostral ventrolateral medullary nucleus (RVLM). These were measured at 0.5, 2, 6 and 24 h following UL in rats. Results Gastric emptying and intestinal transit were significantly decreased for 6 h post UL and recovered to control levels within 24 h. Pretreatment of UL animals with MK-801 significantly increased the gastric emptying and intestinal transit. Bilateral labyrinthectomy significantly decreased the gastric emptying and intestinal transit compared to the intact labyrinthine animals but significantly increased when compared to UL animals. The expression of c-Fos protein was significantly increased in STN and RVLM compared to the control animals for 6 h post UL and recovered to control levels within 24 h. The expression was significantly decreased in animals that were pretreated with MK-801. Conclusion These results suggest that UL decreases the gastrointestinal motility, which recovers to control levels within 24 h post UL. Glutamate plays an important role in the recovery of vestibulogastrointestinal symptoms following UL. Key Words: Gastric emptying; c-Fos protein; Glutamate; Gastrointestinal Motility; Unilateral labyrinthectomy

Case Report

Delayed Postoperative Vertigo After Tympanomastoidectomy Due to Simultaneous Serous Labyrinthitis and BPPV: Yun Ho Kim, Jae Yun Jung, Chung Ku Rhee, Myung Whan Suh; J Korean Bal Soc. 2008;7(1):89-95.

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Abstract PDF: Postoperative vertigo after tympanomastoidectomy can be attributed to several causes such as inner ear damage due to excessive ossicle handling, labyrinthitis, BPPV resulting from vibration of drilling, iatrogenic lateral semicircular canal damage, and perilymphtic fistula. Differential diagnosis is critical for the proper management and prognosis of accompanied sensorineural hearing loss, but it may be difficult in some cases. Especially it is quite difficult to distinguish between the serous and suppurative labyrinthitis. In this article we present a case with simultaneous serous labyrinthitis and BPPV. The patient developed whirling vertigo and hearing loss on the 5th day after tympanomastoidectomy. After conservative treatment with steroid and antibiotics, his hearing recovered to preoperative level. We retrospectively reviewed the pitfalls to make a correct diagnosis in this patient and the serial change in nystagmus during the treatment period. The usefullness of the rotation chair test to predict the prognosis of sensorineural hearing loss in labyrinthitis was also discussed.

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