Research in Vestibular Science

Volume 16 (3); September 2017

Review

Treatment of Neurogenic Orthostatic Hypotension: Jung-Ick Byun, Sang Beom Kim; Res Vestib Sci. 2017;16(3):73-79. Published online September 15, 2017; DOI: https://doi.org/10.21790/rvs.2017.16.3.73

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Orthostatic hypotension (OH) is a common feature of sympathetic autonomic dysfunction and can lead to lightheadedness, weakness, dizziness, and syncope. It is defined as decrease in systolic blood pressure of at least 20 mm Hg or diastolic blood pressure of at least 10 mm Hg within 3 minutes of standing. OH is associated with an increased incidence of cerebrovascular disease, myocardial infarction, and mortality. Non-pharmacological treatments may alleviate OH-related symptoms; however, are not sufficient when used alone. Pharmacological treatment is essential in managing OH. In this review, we aimed to discuss non-pharmacological and pharmacological treatment options for OH.

Citations

Citations to this article as recorded by

Classification of Chronic Dizziness in Elderly People and Relation with Falls
Dong-Suk Yang, Da-Young Lee, Sun-Young Oh, Ji-Yun Park
Research in Vestibular Science.2018; 17(1): 13. CrossRef

Original Articles

Dizzy and Psychological Scales in Benign Paroxysmal Positional Vertigo: Suspicious Patients without Characteristic Nystagmus: Seok Min Hong, Sung Kyun Kim, Heejin Kim, Seok Jin Hong, Yong Bok Kim, Il-Seok Park, Dawoon Oh; Res Vestib Sci. 2017;16(3):80-84. Published online September 15, 2017; DOI: https://doi.org/10.21790/rvs.2017.16.3.80

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Abstract PDF: Objectives
Patients, who have had a history of benign paroxysmal positional vertigo (BPPV)-like symptoms, but no characteristic nystagmus, were often present. They are diagnosed as having a resolved state from BPPV or normal, and tend to be overlooked. We investigated the dizzy and psychological scales in BPPV-suspicious patients. Methods: Thirty-nine patients, which they had vertigo of a short duration at the specific head position, and clinically suspicious BPPV, but no nystagmus in positional tests, were enrolled. We compared dizzy and psychological scales of suspicious BPPV patients with 138 BPPV patients, using dizziness handicap inventory (DHI), the beck depression inventory (BDI), and the Spielberger state-trait anxiety inventory. Additionally, among the BPPV-suspicious group, patients with a BPPV history were compared with those with no previous BPPV. Results: No differences in the all scales were found between the two groups. However, DHI scores of patients with a previous BPPV attack were significantly higher than those of patients with no BPPV-like symptoms; in particular, there was a significant difference in emotional scores. Conclusion: Although the patients had no characteristic nystagmus, if they have a BPPV-like history and symptoms, emotional support and periodic follow up are needed. In particular, careful observation should be performed in patients with previous BPPV attack.

Intratympanic Steroid Treatment versus Intratympanic Steroid and Diuretics Combination Treatment in Patients with Acute Low Frequency Sensorineural Hearing Loss with Vertigo: Hyeon Sik Oh, Hyun Joon Shim, Yong-Hwi An; Res Vestib Sci. 2017;16(3):85-91. Published online September 15, 2017; DOI: https://doi.org/10.21790/rvs.2017.16.3.85

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Abstract PDF: Objectives
Intratympanic dexamethasone (ITD) is a standard treatment for patients with sudden sensorineural hearing loss. The aim of this study was to evaluate the effectiveness of ITD vs. combination of ITD and diuretics for acute low frequency sensorineural hearing loss (LFHL) with vertigo. Methods: A total 31 patients with LFHL that had developed within previous 2 weeks were enrolled and categorized into two groups: treated with ITD four times on 4 consecutive days (ITD group; 17 patients) and treated with ITD in the same way and diuretics orally for 2 weeks (combination group; 14 patients). After 6 months, we analyzed treatment outcomes using subjective improvement and audiometric change. Results: Hearing thresholds at low frequencies ≤500 Hz were significantly improved in both ITD only and combination group (p＜0.05). The cure rate of combination group was not significantly higher than that of ITD only group (57.1% vs. 52.9%, p＞0.05). For subjective symptoms, there were no significant differences of improvement rate in both groups (combination 64.3% vs. ITD only 64.7%, p＞0.05). In pure tone audiometry, the improvement rate of combination group was not significantly different from that of ITD only group (71.4% vs. 76.5%, p＞0.05). There was a significant correlation between the complete recovery rate and duration of symptoms. Conclusion: ITD alone is an effective treatment modality for acute LFHL with vertigo within 2 weeks of development. Combined ITD and diuretics have no additive effect for the recovery of hearing in patients with LFHL.

Case Reports

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.

A Case of Partial Oculomotor Nerve Palsy Caused by Vascular Compression in Idiopathic Intracranial Hypertension: Seol-Won Lee, Seung-Bae Hwang, Byoung Soo Shin, Man Wook Seo, Sun-Young Oh; Res Vestib Sci. 2017;16(3):97-100. Published online September 15, 2017; DOI: https://doi.org/10.21790/rvs.2017.16.3.97

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Abstract PDF: Pupil-involving oculomotor nerve palsy (ONP) is frequently associated with compressive lesion such as intracranial aneurysm originating from the posterior communicating arteries. Vascular variant of posterior intracranial circulation is regarded as an uncommon cause and association between these vascular variants and intracranial hypertension has not been reported. We present an 18-year-old girl with pupil-involving ONP combined with idiopathic intracranial hypertension who revealed compression of oculomotor nerve by a vascular variant of superior cerebellar artery (SCA). This is a rare case of an ONP attributed to compressive effect from an aberrant SCA affected by intracranial hypertension.

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