Research in Vestibular Science

Volume 17 (1); March 2018

Reviews

Interaction of Autonomic and Vestibular System: Eek-Sung Lee, Tae-Kyeong Lee; Res Vestib Sci. 2018;17(1):1-7. Published online March 15, 2018; DOI: https://doi.org/10.21790/rvs.2018.17.1.1

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The relationship between the vestibular system and the autonomic nervous system has been well studied in the context of the maintenance of homeostasis to the changing internal and external milieus. The perturbations of the autonomic indexes to the vestibular stimuli have been demonstrated in animal studies. In addition, the fluctuation of the blood pressure and the heart rate with other autonomic symptoms such as nausea, vomiting, and pallor are common manifestations in the wide range of vestibular disorders. At the same time, the disorders of the autonomic nervous system can cause dizziness and vertigo in some group of patients. In the anatomical point of view, the relationship between autonomic and vestibular systems is evident. The afferent signals from each system converge to the nucleus of solitary tract to be integrated in medullary reticular formation and the each pathway from the vestibular and autonomic nervous system is interconnected from medulla to cerebral cortex. In this paper, the reported evidence demonstrating the relationship between autonomic derangement and vestibular disorders is reviewed and the further clinical implications are discussed.

Citations

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AGE FEATURES OF THE VESTIBULAR ANALYZER
S.N. Vadzyuk, R.M. Shmata, T.A. Lebedeva, L.B. Lozina
Fiziolohichnyĭ zhurnal.2023; 69(4): 103. CrossRef

Evaluation of Adrenergic Function: Tilt-Table and Valsalva Test: Hyung Lee, Hyun Ah Kim; Res Vestib Sci. 2018;17(1):8-12. Published online March 15, 2018; DOI: https://doi.org/10.21790/rvs.2018.17.1.8

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Abstract PDF

Orthostatic dizziness is a common dizziness syndrome characterized by nonvertiginous lightheadedness when patients rise to stand from a sitting or supine position. Orthostatic dizziness is commonly believed to derive from orthostatic hypotension (OH) or postural tachycardia syndrome (POTS). Tilt-table test and Valsalva maneuver are standardized methods for evaluating of adrenergic autonomic function and essential for diagnosis of OH and POTS. We described the guidelines and interpretations of the tilt-table test and Valsalva maneuver.

Citations

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Interpretation of Autonomic Function Test
Kee Hong Park, Eun Hee Sohn
Journal of the Korean Neurological Association.2021; 39(2): 61. CrossRef

Original Articles

Classification of Chronic Dizziness in Elderly People and Relation with Falls: Dong-Suk Yang, Da-Young Lee, Sun-Young Oh, Ji-Yun Park; Res Vestib Sci. 2018;17(1):13-17. Published online March 15, 2018; DOI: https://doi.org/10.21790/rvs.2018.17.1.13

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Abstract PDF: Objectives
Fall is a major cause of morbidity and mortality among older adults. Falls result from many various causes, and dizziness is important risk for falls, especially in the elderly. Research on the relationship between chronic dizziness and falls in elderly people has been rarely performed and these were no studies that analyzed the risk of falls according to subtypes of chronic dizziness.
Methods
We conducted a prospective study of the association between subtypes of chronic dizziness and falls in the elderly between 65 to 75 years. We divided dizzy patients into 5 groups according to the results of symptom, vestibular and autonomic function test. Falls and new events (acute dizziness or other medical conditions) were checked monthly by telephone or out patient department follow-up for 6 months.
Results
Thirty-four patients were enrolled and all completed follow-up for 6 months. Nine patients classified as the falling groups and 34 patients as nonfalling group. Whereas the frequencies of orthostatic hypotension (n=6, 67%) and vestibular dysfunction (n=1, 11%) were higher in fall group, psychogenic dizziness (n=12, 35%), and vestibular migraine (n=3, 9%) were more frequent in nonfall group.
Conclusions
The presence of dizziness in the elderly is a strong predictor of fall, especially orthostatic hypotension is an important predictor of fall. In order to lower the risk of falls in the elderly, an approach based on the cause of dizziness is needed.

Clinical Significance of Spontaneous Nystagmus in Horizontal Semicircular Canal Benign Paroxysmal Positional Vertigo: Jun Lee, Sehun Chang, Ho Yun Lee; Res Vestib Sci. 2018;17(1):18-22. Published online March 15, 2018; DOI: https://doi.org/10.21790/rvs.2018.17.1.18

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Abstract PDF: Objectives
We aimed to assess the clinical significance of spontaneous nystagmus (SN) in horizontal semicircular canal benign paroxysmal positional vertigo (HC-BPPV).
Methods
Twenty-four patients who were diagnosed with HC-BPPV in Eulji University Hospital from January 2015 to December 2016 were recruited. Various bed-side examinations including SN in both sitting and supine position, head roll test, and bithermal caloric test were evaluated. The number of canalith repositioning maneuvers were counted in all patients.
Results
SN was observed in 18.2% of geotropic HC-BPPV and 38.5% of apogeotropic HC-BPPV, respectively. There was no significant difference between presence of SN and the direction of initial nystagmus (p=0.386, 2-tailed Fisher exact test). The mean number of otolith repositioning maneuvers in patients with SN was 3.29±1.799 and this was significantly higher than in patients without SN (1.76±0.831) (p=0.009). Although the mean number of repositioning maneuver in patients in apogeotropic HC-BPPV and SN (3.80±1.924) tended to be higher than those who were diagnosed with apogeotropic HC-BPPV without SN (1.88±1.991) (p=0.035), the post hoc analysis with Bonferroni correction revealed that it was not significant because it was higher than the adjusted p-value (p=0.017). The initial direction of nystagmus was changed into the opposite direction in 29.17% of patient. However, this change was not different according to presence of SN (p=0.374, 2-tailed Fisher exact test).
Conclusions
The presence of SN in HC-BPPV may be associated with lower treatment response. In particular, cautions are needed in patients with apogeotropic HC-BPPV.

Case Reports

Positional Vertigo Showing Direction-Changing Positional Nystagmus after Chronic Otitis Media Surgery: Is It Benign Paroxysmal Positional Vertigo?: Seongjun Choi, Jung Eun Shin, Chang-Hee Kim; Res Vestib Sci. 2018;17(1):23-27. Published online March 15, 2018; DOI: https://doi.org/10.21790/rvs.2018.17.1.23

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Abstract PDF Supplementary Material

This case report describes a patient who developed positional vertigo after surgery for chronic otitis media on the right side. Canal wall up mastoidectomy was performed, and the stapes was moderately mobilized during removal of the inflammatory granulation tissues that were attached to it. Immediately after the surgery, positional vertigo developed. The patient showed weakly left-beating spontaneous nystagmus in a seated position. Examination of positional nystagmus revealed geotropic direction-changing positional nystagmus with a prolonged duration and weak intensity in a supine head-roll test, which may be caused by a change in inner ear fluids due to a disruption of inner ear membrane around the oval window or penetration of toxic materials into the labyrinth during surgery.

Citations

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Light cupula phenomenon: a systematic review
Nilüfer Bal, Melike Altun, Elif Kuru, Meliha Basoz Behmen, Ozge Gedik Toker
The Egyptian Journal of Otolaryngology.2022;[Epub] CrossRef
Direction-Changing Positional Nystagmus in Acute Otitis Media Complicated by Serous Labyrinthitis: New Insights into Positional Nystagmus
Jin Woo Choi, Kyujin Han, Hyunjoo Nahm, Jung Eun Shin, Chang-Hee Kim
Otology & Neurotology.2019; 40(4): e393. CrossRef
Dialysis disequilibrium syndrome revisited: Feeling “Disequilibrated” due to inner ear dyshomeostasis?
Chang-Hee Kim, Jung Eun Shin, Jung Hwan Park
Medical Hypotheses.2019; 129: 109262. CrossRef

Autoimmune Inner Ear Disease Mimicking Bilateral Ménièreʼs Disease: A Case Report: Hong-Ju Kim, Yoon-Gi Choi, Hyun Ji Kim, Kyu-Sung Kim; Res Vestib Sci. 2018;17(1):28-34. Published online March 15, 2018; DOI: https://doi.org/10.21790/rvs.2018.17.1.28

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Abstract PDF

Autoimmune inner ear disease (AIED) is a rare disease, accounting for <1% of all cases of hearing impairment or dizziness. It is characterized by sensorineural hearing loss (SNHL) or vestibular dysfunction that results from an immunemediated process. Clinical features of AIED is SNHL that progresses over weeks to month with fluctuating hearing symptoms. Because there are no diagnostic laboratory and clinical feature, response to immunosuppressive therapy were important for diagnosis of AIED. Many diseases such as sudden SNHL and Meniere disease may also mimic AIED, a broad differential must be maintained in patients suspected of having AIED. We report a case of a 46-year-old female who presented with sudden hearing loss and vertigo. We could diagnose her as AIED with systemic lupus erythematous. The symptoms were improved treated with steroids.

Citations

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Sensorineural Hearing Loss of Suspected Autoimmune Etiology: Two Cases of Cogan’s Syndrome
Jungmin Ahn, Brian Kim, Kyoung Rai Cho, Young-Soo Chang
Korean Journal of Otorhinolaryngology-Head and Nec.2021; 64(12): 943. CrossRef
A Case of Autoimmune Sensorineural Hearing Loss Responding to Cytotoxic Agent
Yong Woo Lee, Jin Lee, Min-Beom Kim, Sun O Chang
Korean Journal of Otorhinolaryngology-Head and Nec.2019; 62(8): 470. CrossRef

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