Research in Vestibular Science

Volume 23 (4); December 2024

Review Articles

Digital therapeutics and telemedicine for benign paroxysmal positional vertigo and other vestibular disorders: a review: Eun-Hyeok Choi, Hyo-Jung Kim, Ji-Soo Kim; Res Vestib Sci. 2024;23(4):115-123. Published online December 15, 2024; DOI: https://doi.org/10.21790/rvs.2024.018

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Abstract PDF: In the recent wave of digital transformation, digital therapeutics and telemedicine are changing the concepts in the management of benign paroxysmal positional vertigo and other vestibular disorders. These technologies provide accessible and cost-effective solutions amid the ongoing digital revolution in healthcare. This review article covers the recently advanced digital therapeutics for vestibular disorders that include questionnaire- or artificial intelligence-based diagnostic algorithms, telemedicine and self-application of canalith repositioning therapy, wearable devices for monitoring of eye movements during the attacks of dizziness/vertigo, and metaverse for vestibular rehabilitation. Integration of these digital technologies would improve diagnostic accuracy and treatment efficacy, reduce the economic burden associated with vestibular disorders, and promise a revolutionary shift in patient care towards personalized medicine.

Clinical application of virtual reality for vestibular rehabilitation: Sung Kwang Hong; Res Vestib Sci. 2024;23(4):124-131. Published online December 15, 2024; DOI: https://doi.org/10.21790/rvs.2024.019

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Abstract PDF: Virtual reality has emerged as a promising tool in vestibular rehabilitation therapy (VRT), offering immersive and interactive environments that enhance patient engagement and adherence to therapy. Its potential lies in delivering controlled, customizable exercise protocols that simulate real-world challenges in a safe, monitored environment. This allows healthcare providers to tailor exercises based on gaze stabilization, vestibulo-ocular reflex training, and balance training, according to a patient’s specific complaints, symptoms, and progress. While cybersickness is a potential concern with virtual reality interventions, patients with vestibular loss are generally less susceptible to the visual-vestibular mismatch that often causes motion sickness. Studies have shown that side effects, such as nausea or discomfort from cybersickness, are minimal for most patients undergoing virtual reality-based VRT. Despite these promising results, further research is needed to fully validate the effectiveness of virtual reality interventions in VRT. This article will explore the current status and future potential of virtual reality in VRT, including considerations for its clinical application and areas for future research.

Exploring the nexus: unilateral vestibulopathy and visuospatial cognitive impairments: Sun-Young Oh, Thanh Tin Nguyen, Marianne Dieterich; Res Vestib Sci. 2024;23(4):132-146. Published online December 15, 2024; DOI: https://doi.org/10.21790/rvs.2024.014

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Abstract PDF: The interplay between vestibular disorders and visuospatial impairments has long captured scholarly attention. While evidence robustly supports visuospatial deficits in bilateral vestibulopathy, findings regarding unilateral vestibulopathy remain equivocal. Recent studies, both animal-based employing vestibular deafferentation models and human-based involving spatial cognitive tasks, hint at potential visuospatial cognitive impairments in individuals with acute and chronic unilateral vestibulopathy. Nevertheless, these results are preliminary and necessitate further rigorous investigation. The posture-first principle is evident in cognitive-motor dual tasks among patients with vestibular disorders. This review synthesizes these emergent insights, aiming to lay a groundwork for future studies that seek to elucidate this complex relationship further.

Original Articles

Various symptoms and signs of vestibular paroxysmia in a tertiary neurotologic clinic: a retrospective comparative study: Tae Uk Cheon, Eun Hye Cha, Yehree Kim, Hong Ju Park; Res Vestib Sci. 2024;23(4):147-155. Published online December 15, 2024; DOI: https://doi.org/10.21790/rvs.2024.021

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Abstract PDF Supplementary Material: Objectives
Vestibular paroxysmia (VP) is characterized by brief episodes of vertigo due to neurovascular cross-compression (NVCC) of the eighth cranial nerve. This study aimed to analyze the clinical features of VP patients in a tertiary neurotologic clinic using the 2008 and 2016 diagnostic criteria and to compare these features.
Methods
A retrospective review was conducted on patients diagnosed with definite or probable VP at the Asan Medical Center from May 2012 to May 2013. Patients underwent comprehensive evaluations including history taking, physical examination, audiometry, vestibular function tests, and magnetic resonance imaging (MRI). The 2008 and 2016 diagnostic criteria for VP were applied, and clinical characteristics were compared.
Results
Nineteen patients were included (14 females and five males; mean age, 57.9±14.5 years). According to the 2008 criteria, 17 patients were diagnosed with definite VP and two with probable VP; however, using the 2016 criteria, nine were definite and two were probable VP. NVCC was observed in 88.9% of patients under the 2016 criteria. MRI revealed NVCC predominantly involving the anterior inferior cerebellar artery. Patients with cerebellopontine angle (CPA) tumors presenting with VP-like symptoms responded to medication.
Conclusions
The 2016 diagnostic criteria for VP allow for a syndromic diagnosis based solely on clinical features. Neurovascular contact is commonly observed in VP patients, and CPA tumor can present VP-like symptoms and respond to carbamazepine. Although MRI is not included in the current criteria, it can be beneficial in diagnosis by identifying neurovascular contact and distinguishing CPA tumors.

Associations between Dizziness Handicap Inventory scores and vestibular function tests: a cross-sectional survey: Eun-Ju Jeon, Chae-Hyun Lim, Eun-Jin Son, Chang-Yeong Jeong, Ji Hyung Lim, Hyun Jin Lee; Res Vestib Sci. 2024;23(4):156-164. Published online December 15, 2024; DOI: https://doi.org/10.21790/rvs.2024.023

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Abstract PDF: Objectives
This study aims to evaluate the relationship between subjective dizziness disability, as assessed by the Dizziness Handicap Inventory (DHI), and objective vestibular function test (VFT) results in patients presenting with dizziness.
Methods
We conducted a retrospective review of 177 patients who completed the DHI, vertigo visual analog scale, and disability scale at their initial visit. Objective VFTs included videonystagmography with caloric testing, cervical vestibular evoked myogenic potential (cVEMP), and the sensory organization test (SOT). Statistical analyses were conducted to assess correlations and differences in DHI scores based on VFT results and clinical characteristics.
Results
The DHI scores indicated a higher perceived dizziness handicap among female patients compared to males (p=0.012). Chronic dizziness was associated with elevated DHI scores in specific items (DHI-2, DHI-12, and DHI-21; p<0.05). Patients with abnormal caloric responses exhibited higher scores in several DHI items and subscales (DHI-4, DHI-12, DHI-14, DHI-17, DHI-19, DHI-23, physical, emotional, and functional; p<0.05). No significant differences were found in cVEMP results. Only one SOT condition (equilibrium score 5) showed a statistically significant but weak association with DHI scores (r=–0.151, p=0.045).
Conclusions
There were limited correlations between objective vestibular test outcomes and subjective dizziness disability. These findings underscore the multidimensional nature of dizziness and the importance of integrating subjective and objective measures for a comprehensive clinical assessment.

Letter to the editor

Isolated ocular tilt reaction in unilateral thalamic infarction: a short case report: Seongjin Jeon, Jae-Chan Ryu, Ji-Yun Park; Res Vestib Sci. 2024;23(4):165-167. Published online December 15, 2024; DOI: https://doi.org/10.21790/rvs.2024.025

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