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Volume 22 (4); December 2023
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Original Articles
Clinical Outcomes of Endolymphatic Sac Decompression Surgery in Menière’s Disease
Hee Won Seo, Young Sang Cho, Won-Ho Chung
Res Vestib Sci. 2023;22(4):97-105.   Published online December 15, 2023
DOI: https://doi.org/10.21790/rvs.2023.22.4.97
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AbstractAbstract PDF
Objectives
Endolymphatic sac decompression surgery (ESDS) is one of the surgical methods for intractable Menière’s disease (MD), and it is known as a relatively safe treatment that does not cause hearing loss. However, the effectiveness and the degree of vertigo control rate of ESDS are still controversial. In this study, we aimed to evaluate the clinical outcomes of ESDS in intractable MD.
Methods
We retrospectively reviewed 33 patients who underwent ESDS for intractable MD from January 2002 to March 2022. Clinical characteristics of patients, pure tone threshold, medical treatment method, and number of vertigo attacks before and after surgery were assessed. The improvement of hearing and vertigo was evaluated according to the 1995 American Academy of Otolaryngology-Head and Neck Surgery criteria.
Results
Of the 33 patients, the average follow-up period was 21.2 months, with immediate follow-up within 2 months (28 patients), short term between 2 and 6 months (27 patients), and long term at 12 months or later (29 patients). In the immediate hearing threshold, both air conduction and bone conduction showed slight deterioration, but there was no significant change in the long-term hearing threshold. At long-term follow-up, 12 patients (41.4%) were able to live without medication, and 18 patients (62.1%) showed improvement in their vertigo symptoms. In addition, patients who showed improvement in hearing also showed improvement in vertigo at the same time.
Conclusions
ESDS in intractable MD is a relatively safe and effective treatment method for reducing vertigo attack without worsening hearing threshold.
Efficacy of the Fixation Index of Bithermal Caloric Test for Differentiating Brain Lesions in Vestibular Disoder
Young Jae Lee, Wonyong Baek, Sung-Il Cho, Gi-Sung Nam
Res Vestib Sci. 2023;22(4):106-111.   Published online December 15, 2023
DOI: https://doi.org/10.21790/rvs.2023.22.4.106
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AbstractAbstract PDF
Objectives
This study was performed to investigate the efficacy of the fixation index (FI) of the bithermal caloric test for differentiating brain lesions in vestibular disorder.
Methods
We reviewed the medical records of 286 consecutive dizzy patients who underwent brain magnetic resonance imaging (MRI) and the bithermal caloric test at department of otorhinolarnygology. Central vestibulopathy (CVP) was defined as when corresponding lesion was identified on brain MRI, otherwise peripheral vestibulopathy (PVP) was defined. The FI was defined as the mean slow phase velocity (SPV) with fixation divided by the mean SPV without fixation, and failure was indicated when the FI exceeded 70%.
Results
The CVP confirmed by brain MRI and PVP were 16.8% and 83.2%, respectively. The most common CVPs were cerebellopontine angle tumor (n=19, 39.6%) and chronic cerebellar infarction (n=18, 37.5%). There were 23 cases of CVP (47.9%) and 47 cases of PVP (19.7%) with abnormal number of FI in at least two of the four caloric irrigations. The FI score of right cool (RC), left cool (LC), and right warm (RW) were also increased significantly in patients with CVP (p=0.031 at RCFI, p=0.014 at LCFI, p=0.047 at RWFI, and p=0.057 at LWFI; Mann-Whitney U-test).
Conclusions
If two or more abnormal FIs are detected during bithermal caloric testing, there is a high likelihood of CVP. Consequently, additional brain MRI may be necessary for further evaluation.
Unilateral Vestibulopathy Mimicking Inner Ear Ischemia Modeling Using Photothrombosis and Behavioral Assessment Using EthoVision
Min Seok Song, Min Young Lee, Ji Eun Choi, So-Young Chang, Jae-Hun Lee, John Patrick Cuenca, Nathaniel T. Carpena, Jae Yun Jung
Res Vestib Sci. 2023;22(4):112-119.   Published online December 15, 2023
DOI: https://doi.org/10.21790/rvs.2023.22.4.112
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AbstractAbstract PDF
Objectives
Inner ear ischemic animal models using photochemical reactions have been devised in various ways. Localized vascular ischemia occurs with 532-nm laser irradiation after systemic rose bengal injection, a known photothrombotic mechanism. The aim of this study is to evaluate a photothrombosis-induced vestibulopathy mimicking behavioral changes in the inner ear ischemia model.
Methods
Seven-week-old male Spraque-Dawley rats were used. Animals were divided into three groups: control group (n=6), sham laser group (n=9), and laser group (n=9). To induce the photothrombosis, animals were injected with rose bengal into the femoral vein and then were irradiated with a 532-nm laser (175 mW for 900 seconds) via transtympanic membrane. To investigate the vestibulopathy after photothrombosis, the behavior tests (tail lift reflex test, air righting reflex test, rotarod test) were performed on the 1st, 3rd, and 7th days after surgery. Additionally, an open field test was conducted and analyzed using EthoVision XT (Noldus).
Results
The laser group exhibited significant behavioral change to mimic vestibulopathy in all assessments. Inducing photothrombosis with rose bengal caused severe gait instability, which precluded rotarod testing. In the tail lift reflex test, the laser group displayed vestibular dysfunction with a lower angle formation compared to the control rats. During the open field test, the laser group exhibited reduced mobility, a condition that persisted in the laser groups for 7 days.
Conclusions
Noninvasive laser irradiation using rose bengal and a 532-nm laser induces photothrombosis in the inner ear of animals, leading to the development of vestibulopathy mimicking imbalanced behavior.
Case Reports
A Case of Ramsay Hunt Syndrome Showing Central Findings due to Brainstem Involvement
Min Hyuk Lee, Min-Beom Kim
Res Vestib Sci. 2023;22(4):120-126.   Published online December 15, 2023
DOI: https://doi.org/10.21790/rvs.2023.22.4.120
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AbstractAbstract PDF
Ramsay Hunt syndrome occurs when the varicella zoster virus reactivates. Classic findings include the triad of facial paralysis, otic pain and herpetic lesions due to the pathogenesis associated with anterograde axonal reactivation of the varicella zoster virus in the geniculate ganglion. In addition to the classic triad, rare features such as a central type of vestibular function test may be observed due to the retrograde spread of the varicella zoster virus from the geniculate ganglion into the brain stem, including involvement of the vestibular nucleus. We present a case of Ramsay Hunt syndrome in a 57-year-old male patients, manifesting not only the typical triad of symptoms but also the unique features associated with brain stem involvement. This presented as direction-changing gaze-evoked nystagmus and a decrease in gain on both sides on video head impulse test. And brain magnetic resonance imaging showed a lesion in the vestibular nucleus of the brain stem.
Dural Arteriovenous Fistula Presenting as Acute Unilateral Vestibulopathy
Won Jeong Son, Jieun Roh, Eun Hye Oh, Jae-Hwan Choi
Res Vestib Sci. 2023;22(4):127-131.   Published online December 15, 2023
DOI: https://doi.org/10.21790/rvs.2023.22.4.127
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AbstractAbstract PDF
Intracranial dural arteriovenous fistula (dAVF) is characterized by an abnormal connection between branches of arteries and veins in the dura mater. Clinical manifestations of dAVF vary depending on their location, feeder arterial supply, amount of shunting, and most importantly, their venous drainage pattern. Acute vertigo has been rarely reported as an initial presentation of dAVF due to venous congestion in the brainstem. We report a patient who presented with acute right vestibulopathy without any brainstem signs in dAVF involving the transversesigmoid sinus. The patient showed abnormal caloric response but normal head impulse in the affected ear. Without any treatment, the patient’s symptoms gradually improved with a normalization of right canal paresis. Follow-up cerebral angiography also revealed a spontaneous regression of the shunt flow and reduction of venous drainage at the right transverse-sigmoid sinus. Based on the results of vestibular function tests and cerebral angiography, acute vertigo in our patient may be ascribed to impaired reabsorption of endolymph by focal venous congestion.
Arnold-Chiari Malformation Presented with Spontaneous Down-Beating Nystagmus and Gait Disturbance
Minbum Kim, Youn Jin Cho
Res Vestib Sci. 2023;22(4):132-136.   Published online December 15, 2023
DOI: https://doi.org/10.21790/rvs.2023.22.4.132
  • 1,525 View
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AbstractAbstract PDFSupplementary Material
Arnold Chiari malformation is a disease which is characterized by herniation of a portion of the cerebellum through the foramen magnum. Symptoms vary depending on the extent of the affected area, including posterior neck pain, upper limb pain, paralysis, paresthesia, weakness, dizziness, and ataxia. Among the patients presenting with dizziness, nystagmus is frequently observed, which is primarily characterized by down-beating nystagmus. We experienced a 42- years-old female patient presented with vertigo and gait disturbance, who were diagnosed with type 1 Arnold-Chiari malformation and treated by surgical decompression.
Corrigendum
Correction: A Case of Patient with Bilateral Cochleovestibular Function Loss due to Infratentorial Superficial Siderosis
Gyuman Lee, Youngmin Mun, Dae Bo Shim
Res Vestib Sci. 2023;22(4):137.   Published online December 15, 2023
DOI: https://doi.org/10.21790/rvs.2023.22.4.137
Corrects: Res Vestib Sci 2023;22(3):83
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Res Vestib Sci : Research in Vestibular Science