Research in Vestibular Science

Therapeutic Efficacy and Prognostic Factors of Canalith Repositioning Maneuver in the Patients with Benign Paroxysmal Positional Vertigo: Shi Nae Park, Kyoung Ho Park, Ji Hong Kim, Jong Hoon Kim, Bong Jin Choi, Ji Hyeon Shin, Min Ah Han, Sang Won Yeo; J Korean Bal Soc. 2007;6(1):9-15.

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Abstract PDF: Background and Objectives: The purpose of this study were to evaluate the therapeutic efficacy of canalith repositioning maneuver (CRP) according to accompanying mastoid percussion and to investigate the prognostic factors that may affect successful repositioning maneuver and the recurrence of benign paroxysmal positional vertigo. Materials and Method: A total of 70 patients with canalith type BPPV visiting the dizziness clinic of Kangnam St. Mary's Hospital were included in this study. Variables identified for statistical analysis were patient's age, sex,maneuver method, number of involved canal, number of CRP and dizziness handicap inventory. Result: Overall success rate of CRP was 90%. The mean number of maneuver was 1.6 and the recurrence rate was 25.7% during the follow up period. Success rate of CRP (94.9%) was higher than maneuver without mastoid percussion (83.9%) though it was not statistically significant. Successful CRP group showed the significant less number of maneuvers at initial treatment session and less number of involved canal than failed CRP group at the time of one week-follow up visit. Patients with recurrence of BPPV had the more number of CRP during the period of previous BPPV. Conclusion: Therapeutic efficacy of CRP with mastoid percussion was higher than CRP without mastoid percussion though it was not statistically significant. Suggesting prognostic factors for effective CRP and recurrence were number of CRP and number of involved canal.

Role of Vestibular Evoked Myogenic Potentials to Elevate the Sensitivity of Objective Tests in Early Meniere’s Disease: Ik Joon Choi, Sung Kwang Hong, Ji Soo Kim, Ja Won Koo; J Korean Bal Soc. 2007;6(1):16-20.

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Abstract PDF: Background and Objectives: Diagnosis of Meniere’s disease (MD) is based on detailed medical history and audiometry in addition to electrocochleography (ECoG). However, the sensitivity of ECoG is rather low and the diagnosis seems to be rather obscure if the patient is evaluated after resolution of acute symptom, especially in early stage of disease without substantial hearing loss. In such cases, if a patient complains recurrent episodes within short term period, any objective result would be beneficial to initiate medical treatment such as diuretics. Since the saccule is the main target organ in MD, authors suppose vestibular evoked myogenic potential (VEMP) test combined with ECoG may elevate the diagnostic sensitivity in MD. Aim of study is to evaluate the possibility of this suggestion. Materials and Method: Thirty-four patients of unilateral MD who have hearing loss less than 40 dB and onset of first attack within 1 year were included in this study. They underwent VEMP, caloric test and ECoG. Abnormal rates of each test and results of combination were analyzed according to the group of MD. Results: Patients with abnormal results in VEMP, ECoG and calorict tests were 29%, 15% and 35%, respectively. Patients showed abnormal results either in VEMP or ECoG were 41% in all MD and 72% in definite group. Conclusions: To get higher objective evidence of cochleovestibu

The Effects of Test Positions and Acoustic Stimulations on the Vestibular Evoked Myogenic Potentials: Jin Dong Kim, Eui Kyung Goh, Young Ok Lee, Soo Keun Kong, Kyu Sup Cho, Kyong Myong Chon; J Korean Bal Soc. 2007;6(1):21-28.

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Abstract PDF: Background and Objectives: Vestibular evoked myogenic potentials (VEMP) have become a good diagnostic tool to evaluate the integrity of the vestibulocollic reflex. To investigate the standard recording of VEMP response in normal hearing subjects, the authors studied the effects of test positions and different acoustic stimulations on the VEMP. Subjects and Method: We performed VEMP on both ears of thirty normal hearing volunteers. Three acoustic stimulations (clicks and 500 Hz and 1,000 Hz short tone bursts) and four test positions were presented alternately to evoke VEMP. The latencies of peak p13 and n23, p13n23 interpeak latency (IPL) and amplitude were measured by EMG equipment and compared by statistical program. We also made up questions for the compliance of the test positions. Results: The effects of test positions p13 latency had no significant difference on all test positions except between test position 2 and 4, n23 latency and p13n23 IPL had shortest waveform on test position 2, p13n23 amplitude had the largest waveform in test position 4. Acoustic stimulations on all test positions were influenced that clicks had shorter waveform about 2-3 ms than STBs on p13 latency and n23 latency, STBs had larger waveform than clicks on p13n23 amplitude. And the compliance of the test positions exhibited highest comfort in test position 1. Conclusion: Test position 1 had higher VEMP response rates and compliance, 500 Hz STB had a largest p13n23 amplitude. Therefore we recommend that the ideal conditions were position 1 and 500 Hz STB for acoustic stimulations to evoke VEMP.

Expression of Glutamate Receptors in the Medial Vestibular Nuclei following Acute Hypotension: Jae Hee Lee, Myoung Ae Choi, Dong Ok Choi, Bo Kyoung Kim, Seok Min Hong, Byung Rim Park; J Korean Bal Soc. 2007;6(1):29-35.

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Abstract PDF: Acute hypotension induced excitation of electrical activities and expression of c-Fos protein and pERK in the vestibular nuclei. In this study, to investigate the excitatory signaling pathway in the vestibular nuclei following acute hypotension, expression of NR2A and NR2B subunits of glutamate NMDA receptor and GluR1 subunit of glutamate AMPA receptor was determined by RT-PCR and Western blotting in the medial vestibular nucleus 30 min after acute hypotension in rats. Acute hypotension increased expression of NR2A, NR2B, and pGluR1 in the medial vestibular nuclei. These results suggest that both of NMDA and AMPA glutamate receptors take part in transmission of excitatory afferent signals following acute hypotension.

Clinical Analysis of the Canal Paresis in Patients with Benign Paroxysmal Positional Vertigo: Beom Gyu Kim, Jong Sun Lee, Jin Hyoung Chun, Jai Hyuk Chang, Il Woo Kim, Dong Joon Choi, Il Seok Park, Yong Bok Kim; J Korean Bal Soc. 2007;6(1):36-40.

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Abstract PDF: Background and Objectives: Canal paresis in patients with BPPV has been variously reported to present in 13% to 57%. Should disorders affecting the peripheral vestibular system, such as vestibular neuronitis, head trauma precede or coexist the onset of BPPV, then particle repositioning maneuver (PRM) may be less effective or ineffective and need further vestibular rehabilitation after the particle repositioning maneuver. The purpose of this study is to investigate the clinical feature and importance of vestibular rehabilitation in patients with BPPV associated with canal paresis. Materials and Methods: A retrospective review was made of 212 patients who visited and diagnosed as BPPV at Hallym university medical center from March 2004 to September 2006. We evaluated the coexistence of canal paresis, methods of treatment and outcome of 128 patients who performed bithermal caloric test. Results: The vestibular assessment by bithermal caloric test showed the canal paresis in 28 patients. In 21 patients, the canal paresis was ipsilateral, in 2 patients, it was contralateral to the BPPV, and in 5 patients, canal paresis was bilateral. Among 28 patients with canal paresis, 12 patients demonstrated as primary BPPV, 16 patients as secondary BPPV. 28 patients with canal paresis were performed PRM. Vestibular rehabilitation was performed in 18 patients who had ongoing symptoms such as nonspecific continuous dizziness after PRM. Among 18 patients, 14 patients were improved, 4 patients were treatment resistant. Conclusion: This study shows the importance of detailed vestibular testing such as bithermal caloric test in BPPV patients. Patients with evidence of concomitant vestibular pathology would be expected to require further vestibular rehabilitation.

Lateralizing Value of Romberg Test and Modified Romberg Test in Acute Unilateral Vestibular Neuritis: Won Hee Chung, Jeong Ho Park, Tae Kyeong Lee, Ki Bum Sung; J Korean Bal Soc. 2007;6(1):41-49.

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Abstract PDF: Background and objectives: Romberg test has been regarded as simple and efficient bedside modality to evaluate the vestibulospinal reflex in patients with balance disorders. we compared the direction of fall and that of yaw head rotation during Romberg test to evaluate its lateralizing value in acute unilateral vestibular neuritis. Materials and methods: Forty three patients (n=43) with acute unilateral vestibular neuritis were included. We did Romberg test in three different head positions: with a head looking straight ahead (Romberg test1), turned to the right by about 90 degrees (Romberg test2) and turned to the left by about 90 degrees (Romberg test3) in yaw. Affected side of the vestibular neuritis was decided by the direction of nystagmus and the side of canal paresis. We compared the falling direction in each Romberg test, direction of nystagmus and canal paresis. Results: During Romberg test, 19 out of 43 fell to the lesion side (44%) and during modified Romberg test, 18 out of 43 fell to the lesion side (42%). On modified Romberg test, fallings to the side of affected labyrinth showed 14/18(78%) in the Romberg test 2 and 15/18 (83%) in the Romberg test 3. The direction of falling in each maneuvers correlated statistically to the side of the affected labyrinth (p<0.05). Direction of nystagmus and the side of the canal paresis also showed correlation to the direction of falling in modified Romberg test. Conclusion: Romberg and Modified Romberg tests are helpful to decide the affected side in vestibular neuritis to some extents.

Benign Paroxysmal Positional Vertigo in Bilateral Vestibular Loss: Jeong Hun Jang, Sung Kwang Hong, Ji Soo Kim, Ja Won Koo; J Korean Bal Soc. 2007;6(1):53-56.

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Abstract PDF: Usual presentations of bilateral vestibular loss are ataxia and oscillopsia. However, fluctuating dizziness is also observed in bilateral vestibulopathy patient. Fluctuating vestibular function in bilateral vestibular loss patients may suggest asymmetric progression of functional loss after compensation is partially accomplished. Because labyrinthine lesion causing vestibular loss is a predisposing factor of benign paroxysmal positional vertigo (BPPV), secondary BPPV can also be developed in bilateral vestibular loss patients. However, BPPV has been hardly noticed in bilateral vestibulopathy patients as a cause of fluctuating dizziness. Authors experienced two cases of BPPV developed in bilateral vestibular loss, one of which showed complete dead labyrinth on ice water caloric test and no significant vestibule-ocular reflex on rotation test. These cases show recurrent BPPV can be the cause of recurrent vertigo in bilateral vestibular loss patients.

Dandy-Walker Syndrome Confused with Peripheral Vestibular Neuronitis: Heung Eog Cha, Joo Hyun Jung, Jin Ho Yoon, Ju Hyoung Lee; J Korean Bal Soc. 2007;6(1):57-59.

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Abstract PDF: Dandy-Walker syndrome is congenital malformation characterized by cystic enlargement of the fourth ventricle and agenesis or hypogenesis of the cerebellar vermis. The major clinical symptoms of the disease are hydrocephalus, weakening of physical strenth and athletic abilities, macrocephaly, cerebellar disorders like ataxia, nystagmus and irritability, vomiting from IICP. The syndrome usually occurs in early infancy and is barely diagnosed in adult. A fifty six aged female patient whose chief complaints were dizziness with right nystagmus and right hearing disturbance visited our outpatient clinic and showed ninety three/fifty six dB in right pure tone audiometry. So we prescribed PO medication on the assumption that she had right sudden sensoryneural hearing loss with vertigo, however left nystagmus was seen in her physical examination after discharge. We present this case that she was diagnosed as Dandy-Walker syndrome in brain MRI after all.

Inner Ear Regeneration: Juichi Ito; J Korean Bal Soc. 2007;6(1):65-65.

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Impulsive Testing of Semicircular Canal Function: GM Halmagyi; J Korean Bal Soc. 2007;6(1):69-69.

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Vestibular Evoked Myogenic Potentials: a Test of Otolith Function: GM Halmagyi; J Korean Bal Soc. 2007;6(1):70-70.

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Diagnostic Approach to a Patient with Dizziness: Won-Ho Chung, M.D., Kyu Whan Chung, M.D.; J Korean Bal Soc. 2007;6(1):73-79.

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Diagnosis and Treatment of Acute Vertigo: Byung Kun Kim, M.D.; J Korean Bal Soc. 2007;6(1):80-83.

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Recurrent Vertigo: Diagnosis and Treatment: HongJu Park, M.D.; J Korean Bal Soc. 2007;6(1):84-92.

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Diagnosis and Treatment of Chronic Dizziness: Jae Il Kim, M.D.; J Korean Bal Soc. 2007;6(1):93-99.

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