Research in Vestibular Science

Original Articles

Re-fixation Saccade at Video-Head Impulse Test in Patients with Sudden Sensorineural Hearing Loss: Dong Hyuk Jang, Sun Seong Kang, Hyun Joon Shim, Yong-Hwi An; Res Vestib Sci. 2023;22(2):46-51. Published online June 15, 2023; DOI: https://doi.org/10.21790/rvs.2023.22.2.46

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Abstract PDF: Objectives
This study was performed to evaluate characteristics and their prognostic value of video-head impulse test (vHIT) in sudden sensorineural hearing loss (SSNHL) with vertigo.
Methods
Of the 612 patients with a diagnosis of SSNHL from 2010 to 2018, 110 patients (18.0%) with vertigo and 39 patients (6.4%) with vHIT results were recruited. The patients were evaluated for their pure-tone hearing average (at initial, 1-month, and 6-month visit), the presence of re-fixation saccade and gains at vHIT, the canal paresis (CP) at ccaloric test.
Results
Patients with saccade (+) showed higher pure-tone averages than those with saccade (‒) on initial and follow-up audiograms. The improvement in pure-tone averages was less in the saccade (+) group than in the saccade (‒) group. There was no significant difference of hearing recovery between SSNHL patients with normal gain and those with decreased gain. There was no difference of hearing improvement between CP (+) and CP (‒) groups according to the presence of re-fixation saccade.
Conclusions
Concurrent re-fixation saccade at vHIT is a negative prognostic factor of hearing function in SSNHL. Re-fixation saccade in SSNHL may suggest widespread damages to both the cochlea and the vestibule, leading to the poor prognosis.

Difference of Cervical Vestibular Evoked Myogenic Potentials between Bone-Conduction and Air-Conduction in Patients with Nonspecific Dizziness: Yong-Hwi An, Jung Ho Choi, Seung Yeon Jeon, Hyun Joon Shim; Res Vestib Sci. 2022;21(4):93-98. Published online December 15, 2022; DOI: https://doi.org/10.21790/rvs.2022.21.4.93

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Abstract PDF: Objectives
This study was performed to evaluate the difference of the cervical vestibular evoked myogenic potentials (cVEMP) stimulated by bone-conduction (BC) and air-conduction (AC) in patients with nonspecific dizziness.
Methods
Twenty-eight dizzy patients (56 ears) and 15 subjects (30 ears) as normal control was enrolled. Responses of BC- and AC-cVEMP were recorded sequentially in both groups. cVEMP parameters including latencies, inter-latencies intervals, amplitudes, and interaural amplitude asymmetry were analyzed and compared.
Results
Among the patients with nonspecific dizziness, AC-cVEMP responses were clearly detected in all 56 ears while BC-cVEMP responses were detected in 32 ears (57.1%). Amplitudes of BC-cVEMP were significantly smaller than those of AC-cVEMP in all patients with BC-cVEMP response. There was no difference in latencies, inter-latencies intervals, and interaural amplitude asymmetry ratios between BC- and AC-cVEMP. There was no significant difference in BCand AC-cVEMP between the dizzy and control groups.
Conclusions
BC-cVEMP is not clinically useful in comparison to AC-cVEMP for the evaluation of nonspecific dizziness. An effective stimulation tool for BC is necessary to provoke more reliable responses of BC-cVEMP.

Which Is More Important for the Prognosis of Sudden Sensorineural Hearing Loss with Vertigo, Canal Paresis or Benign Paroxysmal Positional Vertigo?: Yong-Hwi An, Hyun Joon Shim; Res Vestib Sci. 2021;20(3):101-107. Published online September 15, 2021; DOI: https://doi.org/10.21790/rvs.2021.20.3.101

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Abstract PDF

Objectives
This study was performed to determine characteristics and the prognostic values in idiopathic sudden sensorineural hearing loss (SSNHL) with comorbid ipsilateral canal paresis (CP) and/or benign paroxysmal positional vertigo (BPPV).
Methods
Of the 338 patients with a diagnosis of idiopathic SSNHL, 29 patients (8.6%) with CP and 24 patients (7.1%) with BPPV were recruited and compared to 23 patients with SSNHL and vertigo but without CP or BPPV. The patients were evaluated for their initial hearing threshold, type of canal involved, response to repositioning maneuvers, and hearing outcome for 6 months.
Results
Patients with CP (+) BPPV (‒) showed lower pure-tone averages than those with CP (‒) BPPV (+) on initial and follow-up audiograms. The improvement in pure-tone averages was less in the CP (+) BPPV (‒) group than in the CP (‒) BPPV (+) group. The improvement in speech discrimination scores was less in the CP (+) BPPV (‒) group than in the CP (‒) BPPV (‒) group. BPPV most commonly involved the posterior canal (15 of 24, 62.5%), followed by the horizontal canal (13 of 24, 54.2%). Three of 24 patients (12.5%) had recurrences of BPPV.
Conclusions
CP is a more serious sign for hearing recovery than BPPV, although both CP and BPPV are negative prognostic indicators of auditory function in SSNHL. Concurrent CP and/or BPPV in SSNHL suggest combined damage to the vestibule and may indicate severe and widespread labyrinthine damage, leading to a poor prognosis.

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Re-fixation Saccade at Video-Head Impulse Test in Patients with Sudden Sensorineural Hearing Loss
Dong Hyuk Jang, Sun Seong Kang, Hyun Joon Shim, Yong-Hwi An
Research in Vestibular Science.2023; 22(2): 46. CrossRef

어지럼증을 동반한 돌발성 감각신경성 난청의 예후에 대해 반고리관 마비와 양성돌발두위현훈 중 어느 것이 더 중요한가?: Yong-Hwi An, Hyun Joon Shim; Received May 31, 2021 Accepted July 26, 2021 Published online July 26, 2021; [Accepted]

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Abstract: Objectives
To determine characteristics and the prognostic values in idiopathic sudden sensorineural hearing loss (SSNHL) with comorbid ipsilateral canal paresis (CP) and/or benign paroxysmal positional vertigo (BPPV).
Methods
Of the 338 patients with a diagnosis of idiopathic SSNHL, 29 patients (8.6%) with CP and 24 patients (7.1%) with BPPV were recruited and compared to 23 patients with SSNHL and vertigo but without CP or BPPV. The patients were evaluated for their initial hearing threshold, type of canal involved, response to repositioning maneuvers, and hearing outcome for 6 months.
Results
Patients with CP (+) BPPV (-) showed lower pure-tone averages than those with CP (-) BPPV (+) on initial and follow-up audiograms. The improvement in pure-tone averages was less in the CP (+) BPPV (-) group than in the CP (-) BPPV (+) group. The improvement in speech discrimination scores was less in the CP (+) BPPV (-) group than in the CP (-) BPPV (-) group. BPPV most commonly involved the posterior canal (15/24, 62.5%), followed by the horizontal canal (13/24, 54.2%). Three (12.5%) of 24 patients had recurrences of BPPV.
Conclusion
CP is more serious sign for hearing recovery than BPPV, although both CP and BPPV are negative prognostic indicators of auditory function in SSNHL. Concurrent CP and/or BPPV in SSNHL suggest combined damage to the vestibule and may indicate severe and widespread labyrinthine damage, leading to the poor prognosis.

Original Articles

Does 125-Hz Pure-Tone Thresholds Have Prognostic Value in Patients with Sudden Sensorineural Hearing Loss and Vertigo?: Yong-Hwi An, Hyun Joon Shim; Res Vestib Sci. 2020;19(1):6-11. Published online March 15, 2020; DOI: https://doi.org/10.21790/rvs.2020.19.1.6

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Abstract PDF: Objectives
To analyze 125-Hz pure-tone thresholds in dizzy patients with sudden sensorineural hearing loss (SSNHL) and to investigate the relationship between 125-Hz thresholds and the prognosis of SSNHL with vertigo.
Methods
Hearing and vestibular function tests including 125-Hz pure-tone were performed in 132 patients with SSNHL and 65 subjects with normal hearing. Audiometric follow-up was performed at 6 months after initial visit. Intergroup and intragroup comparison of 125 Hz was made between SSNHL and control groups.
Results
Twenty-four patients (18.2%) had normal thresholds at 125 Hz in SSNHL group, whereas all subjects showed normal at 125 Hz in control group. None with average hearing threshold at 250 and 500 Hz≥30 dB had normal threshold at 125 Hz. There was no significant relationship between 125-Hz threshold and results of vestibular function test. There was no correlation between 125-Hz threshold and hearing recovery in SSNHL group.
Conclusions
There might be no need to assess 125-Hz pure-tone threshold in patients with SSNHL, because it is enough to evaluate thresholds of 250 and 500 Hz for low frequency.

Comparison of Treatment Outcomes between Intratympanic Steroid Injection and Oral Diuretics in Patients with Acute Low Frequency Sensorineural Hearing Loss with Vertigo: Yong-Hwi An, Hyun Joon Shim; Res Vestib Sci. 2019;18(4):111-117. Published online December 15, 2019; DOI: https://doi.org/10.21790/rvs.2019.18.4.111

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Abstract PDF: Objectives
Sudden sensorineural hearing loss and Meniere disease can be managed with intratympanic steroid injection (ITSI) as a primary treatment. The aim of this study was to compare the effectiveness of ITSI versus oral diuretics for acute low frequency sensorineural hearing loss (LFHL) with vertigo.
Methods
A total 76 patients with LFHL that had developed within previous 2 weeks were enrolled and categorized into 2 groups: treated with ITSI four times on 4 consecutive days (ITSI group; 42 patients) and treated with diuretics orally for 2 weeks (diuretics group; 34 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 ITSI and diuretics group (p＜0.05). The cure rate of ITSI group was not significantly higher than that of diuretics group (54.8% vs. 52.9%, p＞0.05). For subjective symptoms, there were no significant differences of improvement rate in both groups (ITSI 64.3% vs. diuretics 61.8%, p＞0.05). In pure tone audiometry, the improvement rate of ITSI group was not significantly different from that of diuretics group (78.6% vs. 70.6%, p＞0.05). There was a significant correlation between the cure rate and duration of symptoms.
Conclusions
Both ITSI and diuretics are effective treatment modalities for acute LFHL with vertigo within 2 weeks of development. There is no difference of treatment outcomes between ITSI and diuretics in patients with acute LFHL and vertigo.

Significance of 125 Hz Pure-Tone Thresholds for Dizzy Patients with Low Frequency Sensorineural Hearing Loss: Yong-Hwi An, Hyun Joon Shim; Res Vestib Sci. 2017;16(4):108-112. Published online December 15, 2017; DOI: https://doi.org/10.21790/rvs.2017.16.4.108

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Abstract PDF: Objectives
To measure 125 Hz pure-tone thresholds in patients with low frequency sensorineural hearing loss (LFHL) and vertigo and to evaluate the necessity of 125 Hz thresholds for assessment of LFHL with vertigo. Methods: Pure tone audiometry including 125 Hz was performed in 25 dizzy patients with LFHL ≤500 Hz and 25 age-matched subjects with normal hearing. Patients with sudden sensorineural hearing loss and vertigo were excluded. Comparison of 125 Hz between LFHL and control groups, and comparison of 125 Hz and other frequencies in LFHL group was made. Results: Mean pure-tone thresholds at 125 Hz in LFHL group (41.7±7.5 dB) was higher than that in normal controls (12.8±6.4 dB). Three (12%) patients had normal thresholds at 125 Hz in LFHL group, whereas all subjects showed normal at 125 Hz in control group. None with average hearing thresholds at 250 and 500 Hz ≥35 dB had normal threshold at 125 Hz. There was a significant correlation between 125 Hz and other low frequencies in LFHL group (250 Hz; r=0.79, 500 Hz; r=0.66). Conclusions: Not every patient of LFHL with vertigo has abnormal hearing threshold at 125 Hz, although all subjects with normal hearing is within normal limits at 125 Hz. Measurement of 125 Hz pure-tone threshold is highly recommended when a mild LFHL exists.

Significance of 125 Hz Pure-Tone Thresholds for Dizzy Patients with Low Frequency Sensorineural Hearing Loss: Yong-Hwi An, Hyun Joon Shim; Received December 3, 2017 Accepted December 8, 2017 Published online December 8, 2017; [Accepted]

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Abstract: Objectives
To measure 125 Hz pure-tone thresholds in patients with low frequency sensorineural hearing loss (LFHL) and vertigo and to evaluate the necessity of 125 Hz thresholds for assessment of LFHL with vertigo.
Methods
Pure tone audiometry including 125 Hz was performed in 25 dizzy patients with LFHL ≤ 500 Hz and 25 age-matched subjects with normal hearing. Patients with sudden sensorineural hearing loss and vertigo were excluded. Comparison of 125 Hz between LFHL and control groups, and comparison of 125 Hz and other frequencies in LFHL group was made.
Results
Mean pure-tone thresholds at 125 Hz in LFHL group (41.7 ± 7.5 dB) was higher than that in normal controls (12.8 ± 6.4 dB). Three (12%) patients had normal thresholds at 125 Hz in LFHL group, whereas all subjects showed normal at 125 Hz in control group. None with average hearing thresholds at 250 and 500 Hz ≥ 35 dB had normal threshold at 125 Hz. There was a significant correlation between 125 Hz and other low frequencies in LFHL group (250 Hz; r=0.79, 500 Hz; r=0.66).
Conclusion
Not every patient of LFHL with vertigo has abnormal hearing threshold at 125 Hz, although all subjects with normal hearing is within normal limits at 125 Hz. Measurement of 125 Hz pure-tone threshold is highly recommended when a mild LFHL exists.

Original Article

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.

Intra-tympanic Steroid Treatment vs Intra-tympanic 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; Received May 31, 2017 Accepted August 23, 2017 Published online August 23, 2017; [Accepted]

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Abstract: Objectives
Intra-tympanic 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: 1) treated with ITD four times on 4 consecutive days (ITD group; 17 patients) and 2) 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.
Conclusions
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.

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