Research in Vestibular Science

Pathophysiology of Nystagmus in Benign Paroxysmal Positional Vertigo: Tae Kyeong Lee, Ki Bum Sung; Res Vestib Sci. 2013;12(1):1-15.

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Abstract: Benign paroxysmal positional vertigo (BPPV) is easily diagnosed when the specific pattern of nystagmus is demonstrated by adequate provoking maneuver. Therefore, recognizing the pattern of nystagmus is important to determine the affected ear and whether the otoconia is free-floating in the canal or attached to the cupula. However, the latency and the duration of nystamus can be various depending on the type of otoconia and even the direction of nystagmus is atypical in some cases. In addition, not all the positionally-induced nystamus are ascribed to benign semicircular canal pathology. Atypical pattern and refractory for the canalith repositioning maneuver can raise the possibility for the central positional vertigo or nystagmus. Physicians are often perplexed if the pattern of nystagmus by positioning maneuver is not the expected one. For those account, physicians should be well equipped with the knowledge of the pathophysiology of nystamus in BPPV. The pathophysiology and the various patterns of nystagmus in BPPV are discussed in this review.

Role of Endolymphatic Sac Decompression in Intractable Meniere’s Disease: Shin Hye Kim, Jihye Rhee, Yoonjong Ryu, Byung Yoon Choi, Ja Won Koo; Res Vestib Sci. 2013;12(1):16-21.

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Abstract: Background and Objectives: The role of endolymphatic sac decompression (ELSD) for the treatment of intractable Meniere disease (MD) has been debated. However, considering few treatment options for medically intractable MD with serviceable hearing or intractable bilateral MD, ELSD has shown reasonable treatment results without ablating inner ear function. The aims of this study are to review the role of ELSD in the treatment of MD and clinical course and long-term outcome after ELSD. Materials and Methods: The ELSD was performed in 7 patients among 603 definite Meniere disease patients between May 2003 and December 2010. Patient’s medical history and clinical courses after surgery were obtained by medical record review and telephone interview. Results: Mean duration of follow up until receiving ELSD was 575 days since initial visit. Six patients showed complete control or substantial control of vertigo, but one patient suffered from sustained vertigo attacks even after ELSD, the vertigo was controlled after intratympanic gentamicin injection (ITGI) at 20 months after ELSD. Another patient had recurrence of vertigo after 30 months, which was successfully controlled by ITGI. The preoperatively mean monthly vertigo was 4.8 and it was significantly decreased to 1.5 after postoperatively 1 year, 0 after postoperatively 2 years (p<0.001). Hearing was preserved in 6 patients during the follow-up period. Conclusion: Most patients who were uncontrolled vertigo with 3 to 6 months medication showed significantly reduced vertigo and hearing preservation after ELSD. The ELSD seems to be a beneficial treatment option for intractable MD.

Cochleovestibular Otosclerosis Without Conductive Hearing Loss: Woo Sung Na, Sang Hyun Park, Chung Ku Rhee, Jae Yun Jung; Res Vestib Sci. 2013;12(1):22-26.

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Abstract: Otosclerosis typically starts around stapes footplate presenting conductive hearing loss initially. However, otosclerosis may involve cochlea and vestibule causing sensorineural hearing loss and dizziness. We report a case of cochleovestibular otosclerosis without conductive hearing loss featuring Meniere’s disease.

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.

Isolated Body Lateropulsion as a Presenting Symptom of Lateral Medullary Infarction: Jae Hwan Choi, Min Gyu Park, Kyung Pil Park, Kwang Dong Choi; Res Vestib Sci. 2013;12(1):31-34.

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Abstract: Body lateropulsion is a common manifestation of lateral medullary infarction (LMI), and usually associated with vertigo, limb ataxia, sensory disturbance, and Horner’s syndrome. However, isolated body lateropulsion as a presenting symptom of LMI is rare, and the responsible lesion for lateropulsion remains uncertain. We report a 71-year-old woman who showed isolated body lateropulsion as a presenting symptom of LMI. Ipsilateral body lateropulsion in our patient may be ascribed to the involvement of the ascending dorsal spinocerebellar tract rather than the descending lateral vestibulospinal tract, which runs more ventromedially.

Benign Paroxysmal Positional Vertigo After Cochlear Implantation: Jong Won Park, Min Ju Park, Ye Won Lee, Sung Il Nam; Res Vestib Sci. 2013;12(1):35-38.

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Abstract: Cochlear implantation (CI) has enabled hearing rehabilitation of patients with severe hearing impairment for more than 20 years now. There have been reported that one possible complication of CI is the impairment of balance function with resulting vertigo symptoms. CI still implies trauma on the labyrinthine structures to allow the electrode system to be inserted into the cochlear turns. Benign paroxysmal positional vertigo is an uncommon development after CI. We experienced an 80-year-old woman who had immediate onset of vertigo after CI, which diagnosed in postoperative one day after CI. In postoperative videonystagmography, no spontaneous nystagmus was observed, but in right Dix-Hallpike, torsional nystagmus, where the top of the eye rotates towards the right ear in beating fashion. Vertigo improved after modified Epley maneuver. However there was one recurrence after 12 days later. The case is described along with a review of the literature.

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