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Multicenter Study on the Clinician’s Diagnostic and Therapeutic Approaches for Benign Paroxysmal Positional Vertigo in Korea
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Eun Ju Jeon, Won Ho Chung, Jeong Hwan Choi, Eui Cheol Nam, Hong Ju Park, Jong Dae Lee, Won Sang Lee, Kyu Sung Kim, Eui Kyung Goh, Ja Won Koo, Min Bum Kim, Min Beom Kim, Se Hyung Kim, Young Jin Kim, Chang Hee Kim, Sung Il Nam, Seog Kyun Mun, Ga Young Park, Sang Yoo Park, Shi Nae Park, Chang Hoon Bae, Sung Hyun Boo, Myung Whan Suh, Jae Hyun Seo, Eun Jin Son, Jae Jun Song, Jae Jin Song, Joong Wook Shin, Dae Bo Shim, Seong Ki Ahn, Hye Youn Youm, Shin Young Yoo, Dong Hee Lee, Seung Hwan Lee, Chang Ho Lee, Hyun Seok Lee, Hwan Ho Lee, Hyo Jeong Lee, Yun Hoon Choung, Seung Hyo Choi, Jee Sun Choi, Seok Min Hong, Sung Kwang Hong
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Res Vestib Sci. 2013;12(3):79-92.
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- Background and Objectives: It is necessary to establish the most efficient diagnostic and therapeutic method for benign paroxysmal positional vertigo (BPPV), which is appropriate for Korean healthcare system. We aimed to evaluate current state of Korean clinician’s diagnostic and therapeutic approaches for BPPV. Materials and Methods: A 16-item survey was emailed to the members of dizziness department of Otology Research Interest Group in the Korean Otologic Society (n=68). 43 were returned and analyzed. Results: All respondents (100%) used Dix-Hallpike test as a diagnostic tool for vertical canal-BPPV. Supine roll test was used for diagnosing lateral canal BPPV in nearly all the respondents (97.7%). Epley maneuver was chosen as otolith repositioning maneuver (ORM) for posterior canal BPPV in all respondents and barbecue rotation (BBQ) was used for treating lateral canal BPPV with geotropic nystagmus in 95.3% of respondents. Extreme variation was noted for therapeutic approach of lateral canal BPPV with ageotropic nystagmus BBQ, with 4 kinds of ORM and adjunctive measures to liberate otolith from cupula, while BBQ was again the most commonly used ORM (76.7%). Conclusion: The development of practical and efficient ORM for lateral canal BPPV with ageotropic nystagmus is necessary.
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Recent Research of Radiologic Diagnosis in Meniere’s Disease
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Won Sang Lee, Young Joon Seo
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Res Vestib Sci. 2010;9(4):121-127.
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Abstract
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- 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.
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A Case of Otosclerosis with Meniere’s Symptom
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Dong Woo Hyun, Se Ra Park, Sung Huhn Kim, Won Sang Lee
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Res Vestib Sci. 2009;8(2):174-177.
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- It has been postulated that otosclerosis may produce vertigo by several mechanisms. An association between otosclerosis and Meniere’s disease has been proposed on both a clinical and histopathologic basis but the causal relationship is controversial. We report a case of bilateral otosclerosis in a man manifesting vertiginous symptoms. Fifty one year-old man was examined for rotational vertigo and poor hearing in his both ear for ten years. The audiogram revealed left sided hearing loss of a conductive type and right sided sensorineural hearing loss, and caloric asymmetry. Meniere’s disease was suspected, but temporal bone CT showed low attenuated lesion around bilateral cochlear and semicircular canal. A diagnosis of otosclerosis was made. He was recommended sodium fluoride therapy. Severe endolymphatic hydrops manifesting itself as Meniere’s disease can be the result of otosclerosis, so vertiginous and concurrent hearing symptoms should not be overlooked.
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Multicenter study on the treatment pattern of Ménière’s disease in Korea
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Sung Kwang Hong, Eui Kyung Koh, Kyu Sung Kim, Kyoung Ho Park, Hong Ju Park, Seong Ki Ahn, Joong Ho Ahn, Won Sang Lee, Gi Jung Im, Jae Yun Jung, Won Ho Chung, Gyu Cheol Han, Sung Won Chae, Ja Won Koo
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J Korean Bal Soc. 2008;7(2):174-181.
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- Background and Objectives: It is hard to determine the efficacy of several treatment options of Ménière’s disease since dynamic course of the disease and diverse rate of recurrence. Few modalities are regarded as ‘effective’ in the viewpoint of evidence based medicine. Study was conducted to know the current status of treatment options for Ménière’s disease.
Materials and Methods: A multicenter survey was conducted using questionnaires to collect information on current status of treatment patterns in Ménière’s disease. The questionnaire answered by neurotologic surgeons working at 12 institutes in Korea was analyzed.
Results: Low salt diet was always instructed to their patients, but 8 out of 12 responders (67%) did not emphasis on the amount of dietary salt. Duration of pharmacotherapy was ranged from 3 to 12 months. Intratympanic steroid injection was performed in 8 institutes (67%). Every institute agreed on the role of intratympanic gentamicin application. Treatment options for intractable patients were asked. Endolymphatic sac surgery, intratympanic steroid, Meniette device and intratympanic aminoglycoside injection were answered in patients who hope to preserve residual hearing. On the contrary, in patients without serviceable hearing, intratympanic jnjection of aminoglycosides (9/12, 75%) dominated as the next treatment option.
Conclusions: Most institutes provide similar patterns of practice in medical treatment. The application of intratympanic aminoglycoside is also agreed in intractable patients without serviceable hearing. However, thoughts about the role and detailed methods of the surgical and adjunctive treatment options were not agreed, especially in intractable patients with good hearing. Further clinical studies and discussions would be necessary to provide consensus for the best treatment of Ménière’s disease in Korea.
Key words : Ménière’s disease, Pharmacotherapy, Surgery, Aminoglycosides
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Visualization of endolymphatic hydrops using Magnetic Resonance Imaging after intratympanic Gd-DTPA administration in patients with Meniere’s disease
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Young Joon Seo, Dae Bo Shim, Jinna Kim, Won Sang Lee
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J Korean Bal Soc. 2008;7(2):167-173.
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- 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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Clinical Significance of Vestibular Evoked Myogenic Potentials in Patients With Benign Paroxysmal Positional Vertigo
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Won Sun Yang, Dae Bo Shim, Won Sang Lee
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J Korean Bal Soc. 2008;7(1):38-42.
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- Objectives: To investigate the vestibular evoked myogenic potentials (VEMP) results in benign paroxysmal positional vertigo (BPPV) patients and to verify its clinical applications in BPPV.
Subjects and Methods: Forty-one patients with diagnosis of BPPV and 92 healthy volunteers who underwent VEMP testing. Patients were treated by canalith repositioning maneuvers according to the affected canal, and testing of VEMP was performed at diagnosis and after treatment.
Results: VEMP results of BPPV patients showed prolonged p13 and n23 latencies compared with those of the control group, and we could not find any significant difference in VEMP latencies between patients with posterior and horizontal canal type of BPPV. The number of times that the maneuver was repeated did not correlate with the degree of latency prolongation, but in the “no response” group, the number of times was considerably greater than those in the “response” group.
Conclusions: We found that VEMP latencies are increased in BPPV patients, which may signify neuronal degenerative changes in the macula of the saccule. When an extensive neuronal damage was suspected by VEMP results such as “no response” in VEMP, the disease progress showed a chronic and resistive course. Therefore, we propose that VEMP could be a useful method to determine a clinical prognosis of patients with BPPV.
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Morphologic Change of the Vestibular Organ in the Na+-K+-2Cl- Cotransporter Deficiency Mouse
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Ju Hyoung Lee, Jae Young Choi, Sang Ho Jung, Won Sang Lee
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J Korean Bal Soc. 2006;5(1):21-28.
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Abstract
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- 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
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The Correlation between the Change in the Degree of the Canal Paresis in Bithermal Caloric Test and the Degree of Hearing Loss after Chemical Labyrinthectomy in Patients with Meniere's Disease
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Chang Woo Kim, San Ho Jung, Won Sang Lee
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J Korean Bal Soc. 2004;3(2):404-409.
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- Background
and Objectives : The chemical labyrinthectomy with aminoglycoside is a good method for vertigo control in Meniere's disease. It is relatively non-invasive and easy procedure, but hearing loss is a awful complication. We aimed to evaluate the relationship between the change in the degree of canal paresis in bithermal caloric test and the degree of hearing change.
Materials and Methods : Sixty-five patients of Meniere's disease who underwent chemical labyrinthectomy with streptomycin between October 1997 and December 2001 were included in this study. The minimum follow-up period for the patients was 24 months. Medical records were analyzed retrospectively. Criteria had been prescribed in 1995 by the American Academy of Otolaryngology-Head and Neck Surgery were used. Forty patients were tested a caloric response before and after the chemical labyrinthectomy. We analyzed the vertigo control rate, the change of the canal paresis and the change of hearing level.
Results
: Vertigo was controlled in 90.8% of the 65 patients. Twelve patients of total 65 patients were decreased hearing level more than 10 ㏈ after this procedure. Even though the severity of canal paresis increased, the hearing ability of most patients was unaffected. Some patients who had only slight canal paresis happened to suffer from
hearing loss.
Conclusion
: There was no correlation between the change in the degree of canal paresis in the bithermal caloric test and the degree of the hearing change.
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Real-Time Measurement of 3-Dimensional Eye Movements by Videooculography
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Mee Hyun Song, Soo Chan Kim, Ki Chang Nam, Deok Won Kim, Yoo Sup Shin, Won Sang Lee
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J Korean Bal Soc. 2004;3(1):161-169.
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- Background
and Objectives：In order to analyze and understand the oculomotor system completely, it is essential
to measure horizontal, vertical, and torsional eye movements. We developed a new system of 3-dimensional
videooculography that can accurately estimate the pupil center and measure torsional eye movement in real time while
minimizing the errors caused by upper eyelid droop, eyelashes, corneal reflection, and eye blinking.
Materials and Method：For accurate estimation of the center and diameter of the pupil, the edges of the pupil
were searched by using a sector-form window and circle fitting was performed using the least square regression.
Torsional eye movement was measured using polar cross-correlation technique with modification to lessen the errors
produced by the change in pupil size. Calibrations were performed and to verify the proposed system, the linearity
between the measured and actual eye movements was measured. Also, the results of the proposed system were
compared with those of another commercialized system.
Results
： The linearity between the measured and actual eye movements showed errors of less than 1%. The spatial
resolutions of the system for horizontal, vertical, and torsional eye movements were 0.3, 0.4, and 0.2, respectively
whereas the temporal resolution was 30 frames/sec. In comparison to the commercialized system, our system showed
less artifact by eye blinking when measuring vertical eye movement.
Conclusion
：We proposed an algorithm and a system for measuring horizontal, vertical, and torsional eye
movements which minimized the influence of partial eyelid closure, eyelashes, corneal reflections, and change in pupil
size.
Key Words：Eye movement Vestibulo ocular reflex, Measurement.
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The study of galvanic vestibular stimulation in patients of total unilateral vestibular loss
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Hyun Jik Kim, Chang Woo Kim, Won Sang Lee
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J Korean Bal Soc. 2003;2(2):211-217.
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- Objectives
The aim of this study was to observe the nystagmus of totally unilateral vestibular function loss on galvanic vestibular stimulation and the diagnostic value of galvanic vestibular stimulation. Additionally we wanted to evaluate which portions may be stimulated by galvanic vestibular stimulation.
Materials and Methods: We evaluated the three parameters of galvanic stimulation in fourteen patients with totally unilateral vestibular function loss, 1)spontaneous nystagmus, 2)galvanic stimulating nystagmus, 3)Post galvanic stimulating nystagmus through 3-dimensional video-oculography technique.
Results
When negative electrode was attached to the intact side, The nystagmus on galvanic vestibular stimulation was directed to the negative electrode side in all patients and post galvanic stimulating nystagmus was directed to the opposite side but on functional loss side, we couldn't detect any nystagmus on galvanic vestibular stimulation and in 10 patients, post galvanic stimulating nystagmus was observed and directed to the intact side.
Conclusions
Galvanic vestibular stimulation is very useful for evaluating the vestibular function and for diagnosing the vestibular disease.
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Results of otolith reposition therapy in posterior semicircular canal BPPV
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Sung Hun Kim, Ju Hyoung Lee, Mi Ran Bae, Chang Woo Kim, Soo Young Lee, Won Sang Lee
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J Korean Bal Soc. 2003;2(1):107-112.
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- Background
and objectives: Benign paroxysmal positional vertigo (BPPV) has been well controlled with otolith reposition therapy. Posterior canal is known as the most common site of BPPV. The purpose of this study was to study the therapeutic result of reposition therapy in posterior canal BPPV, to investigate the unusual cases such as recurred cases and type changed cases during the reposition maneuver, and to figure out the therapeutic strategy.
Materials and methods: One hundred and ten patients diagnosed posterior canal BPPV were included in this study. Epley maneuver was performed once a day until nystagmus disappeared. We analyzed the number of treatment, changing type, recurrence and the relationship between recurrence and age or sex of patients.
Result
All cases except 2 were recovered by Epley maneuver. In 11 cases, the type of disease was changed, and the treatment of these cases were changed according to new type and origin. Overall recurrence rate was 15%, and they were completely treated with reposition therapy. There was no correlation between recurrence and age, sex of patients.
Conclusion
All most cases were cured with Epley maneuver. The type of the disease was possibly changeable. Recurrence rate was relative high, and close follow up was required.
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Galvanic Nystagmus in Normal Person
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Woon Kyo Chung, Ju Hyoung Lee, Soo Chan Kim, Ki Chang Nam, Deok Won Kim, Won Sang Lee
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J Korean Bal Soc. 2002;1(1):108-112.
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- Background
and objectives: Vestibulo-ocular reflex and vestibulo-spinal reflex are induced by transmatoid galvanic stimulation of vestibular system. Nystagmus and body sway are result of each reflex. Recently, videooculograph possible to record a minute ocular movement was commonly used, vestibulo-ocular reflex induced by galvanic simualtion is easily documented. The purposes of this study are to evaluate the galvanic nystagmus in nomal persons in order to better understand the physiology of the vestibular system.
Materials and methods: Eye movement of 20 neurootologic normal subjects by both side transmstoid galvanic stimulation (40cases) were analyzing by videonystagmography.
Result
The direction of nystagmus in fast phase was to the negative electrode. Galvanic nystagmus was occured all normal subjects when stimulus intensity was more than 2mA. There was positive correlation between slow phase velocity(SPV) and electric current but negative correlation was noted between asymmery of SPV and electric current.
Conclusion
It is suggested that the galvanic nystagmus test could be a new diagnostic tool for evaluation of vestibular status.
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