Research in Vestibular Science

Original Articles

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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Abstract 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.

A Comparative Analysis of the Vestibulocochlear Function in Patients with Isolated Semicircular Canal Hypofunction Using a Video Head Impulse Test: Yu Jung Park, Min Young Lee, Ji Eun Choi, Jae Yun Jung, Jung Hwa Bahng; Res Vestib Sci. 2023;22(2):34-45. Published online June 15, 2023; DOI: https://doi.org/10.21790/rvs.2023.22.2.34

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Abstract PDF: Objectives
The objective of this study was to analyze vestibulocochlear function results in patients identified with isolated semicircular canal (SCC) hypofunction using the video head impulse test (vHIT).
Methods
A retrospective review was conducted on the clinical records of 123 patients diagnosed with isolated SCC hypofunction based on vHIT results. Among these patients, 72 had isolated posterior SCC (PSCC) hypofunction, 25 had isolated lateral SCC (LSCC) hypofunction, and 26 had isolated anterior SCC (ASCC) hypofunction. Descriptive analyses were performed on various vestibulocochlear tests including pure tone audiometry, sinusoidal harmonic acceleration (SHA), spontaneous nystagmus (SN), head-shaking nystagmus (HSN), caloric testing, and cervical vestibular evoked myogenic potential, with results analyzed separately for each SCC hypofunction group.
Results
The study found that 66.0% of the evaluated patients exhibited abnormal results in at least one vestibulocochlear function test. PSCC hypofunction patients showed a significantly higher incidence of hearing loss compared to ASCC and LSCC hypofunction patients. LSCC hypofunction patients exhibited higher rates of corrective saccade, phase asymmetry of SHA, and SN abnormalities compared to other SCC hypofunction patients. Additionally, the rates of corrective saccade and phase asymmetry of SHA were also higher in LSCC hypofunction patients. ASCC hypofunction patients demonstrated significantly higher rates of normal corrective saccade, phase lead of SHA, and SN.
Conclusions
The analysis of this study suggests that even in cases where vHIT indicates isolated SCC hypofunction, additional vestibulocochlear function tests should be conducted to identify any associated vestibulocochlear dysfunctions. This highlights the importance of comprehensive evaluation to accurately diagnose and manage patients with SCC hypofunction.

Retraction

Retraction of “Factors Associated with Patient Satisfaction in Customized Vestibular Exercise: A Pilot Study”: Hye Soo Ryu, Min Young Lee, Jae Yun Jung, Ji Eun Choi; Res Vestib Sci. 2020;19(4):149-149. Published online December 15, 2020; DOI: https://doi.org/10.21790/rvs.2020.19.4.149; Retracts: Res Vestib Sci 2019;18(3):71

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Original Articles

Can Cupulolithiasis Affect the Time Constant or Gain of the Velocity Step Test?: Min Tae Kim, Ji Eun Choi, Min Young Lee, Jae Yun Jung; Res Vestib Sci. 2019;18(4):98-102. Published online December 15, 2019; DOI: https://doi.org/10.21790/rvs.2019.18.4.98

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Abstract PDF

Objectives
The nystagmus evoked by an angular velocity step is influenced by the cupula dynamics and the status of velocity storage mechanisms. This study questioned whether the cupulolithiasis of horizontal canal benign paroxysmal positional vertigo (HC-BPPV) affects the time constant or gain of the velocity step test.
Methods
We performed a retrospective study of 30 patients who diagnosed with HC-BPPV and performed rotary chair test at Dankook University Hospital from June 2010 to May 2017. All patients had normal vestibular function on the sinusoidal harmonic acceleration test. According to the direction of nystagmus on the head roll test, we further divided the patients into “geotrophic” (canalolithiasis) and “apogeotrophic” (cupulolithiasis) groups. We compared the time constant (Tc), gain, and directional preponderance (DP) between the 2 groups. We also compared the time constant and gain between lesion side of BPPV and normal side in each group.
Results
In the supine head roll, geotrophic nystagmus observed in 14 patients and apogeotrophic nystagmus observed in 16 patients. When parameters of the velocity step test compared according to lesion side of BPPV (per-rotary of lesion side, postrotary of lesion side, per-rotary of normal side, and postrotary of normal side), there were no significant differences in Tc, gain, and DP between the 2 groups. There were also no significant differences in Tc and gain between lesion side and normal side in each group.
Conclusions
We assumed that cupulolithiasis of HC-BPPV could affect the cupular deflection evoked by an angular velocity step, but there were no significant differences in Tc and gain between patients with cupulolithiasis and canalolithiasis.

Citations

Citations to this article as recorded by

Influence of Otoliths on the Vestibulo-Ocular Reflex in Horizontal Canal Benign Paroxysmal Positional Vertigo
Hee Soo Yoon, Jae Yeong Jeong, Jae Ho Chung, Ha Young Byun, Chul Won Park, Seung Hwan Lee
Research in Vestibular Science.2020; 19(2): 49. CrossRef

Factors Associated with Patient Satisfaction in Customized Vestibular Exercise: A Pilot Study: Hye Soo Ryu, Min Young Lee, Jae Yun Jung, Ji Eun Choi; Res Vestib Sci. 2019;18(3):71-77. Published online September 15, 2019; DOI: https://doi.org/10.21790/rvs.2019.18.3.71; Retraction in: Res Vestib Sci 2020;19(4):149

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Factors associated with patient satisfaction in customized vestibular exercise : pilot study: Hye Soo Ryu, Min Young Lee, Jae Yun Jung, Ji Eun Choi; Received June 20, 2019 Accepted August 26, 2019 Published online August 26, 2019; [Accepted]

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Abstract: Numerous studies have been reported on the effect of customized vestibular exercise (VE), but little study has been reported on the satisfaction of customized VE. Therefore, this study aims to investigate the factors that affect the satisfaction of customized VE. A telephone survey was conducted on 37 patients who underwent customized vestibular exercise from January to November 2018. The questionnaire consisted of a total of 10 items, including subjective symptom, compliance and satisfaction of exercise, preferred methods of exercise, and appropriate costs. Based on the questionnaire of satisfaction, the clinical features, improvement of symptom, compliance, preferred methods of exercise were compared between satisfactory and unsatisfactory groups. Of the 20 patients who responded to the telephone survey (response rate 57%), 10 patients were included in the satisfactory group and the remaining ten were included in the unsatisfactory group. There were not significant differences between two groups in age, sex, severity of subjective symptom before customized VE, preferred methods of exercise. subjective dizziness after customized VE was significantly decreased in the satisfactory group, but there was no significant difference in the unsatisfactory group. The satisfaction of customized VE was significantly lower in patients with chronic uncompensated vestibulopathy, postural instability, less improvement of dizziness, or poor compliance. The satisfaction of the customized vestibular movement is thought to be closely related to the treatment effect and compliance. Thus, in addition to prescribing appropriate customized exercise, it is necessary to educate the patients and to provide a variety of ways to improve compliance.

Original Articles

Clinical Significance of Spontaneous Nystagmus Frequency in Vestibular Neuronitis: Sang Hyun Park, Min Young Lee, Jae Yun Jung; Res Vestib Sci. 2016;15(2):55-59. Published online June 15, 2016

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Abstract PDF: OBJECTIVE: Spontaneous nystagmus is typical sign in vestibular neuronitis. However, the clinical significance of spontaneous nystagmus frequency remains unclear. The aim of this study is to analyze the spontaneous nystagmus frequency in patients with vestibular neuronitis.
METHODS
Twenty-five patients with vestibular neuronitis were included. Patients were divided good (≥20%) and poor (<20%) group according to change of spontanous nystagmus frequency. Frequency and velocity of spontaneous nystagmus were analyzed by using video-nystagmography. Caloric test and slow harmonic acceleration test were also performed.
RESULTS
There was a positive linear correlation between frequency and velocity in initial and follow test (R²=0.51, 0.43, p<0.01, p<0.01). Also, there was a strong positive linear correlation betweeng change of frequency and change of velocity (R²=0.64, p<0.01). The phase lead of slow harmonic acceleration test of good group was smaller compared with poor group, and this was statistically significant in 0.04 Hz.
CONCLUSION
We suggested that frequency of spontaneous nystagmus may be a useful clinical factor in vestibular neuronitis.

Analysis of Clinical Features in Patients Showing Bilateral Vestibulopathy with Vestibular Function Test: Dong Hyun Kim, Jeong Hyun Lee, Bong Jik Kim, Chung Ku Rhee, Jae Yun Jung; Res Vestib Sci. 2014;13(2):47-52.

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Abstract PDF: Background and Objectives: Caloric test and rotatory chair test have been adopted in diagnosing bilateral vestibulopathy. However, most of patients who were confirmed by the diagnostic testing not complained typical symptoms of bilateral vestibulopathy such as ossilopsia and ataxia. Patients who do not have typical symptoms of bilateral vestibulopathy, were often diagnosed with bilateral vestibulopathy by caloric test and slow harmonic acceleration test (SHA). The aim of this study is to assess the clinical features between groups classified according to the caloric test and SHA test, and possibly to investigate the representative test in the diagnosis of bilateral vestibulopathy. Materials and Methods: Seventy-five patients were divided into three groups: (A) patients diagnosed with the caloric test only, (B) patients diagnosed with SHA test only, (C) patients satisfying the diagnostic criteria of both tests. Clinical characteristics, the results of physical examination, hearing test and vestibular function test (VFT) were compared among three groups. Results: There was no difference in clinical characteristics and results of physical examination among three groups. Regarding VFT results, only in step velocity test, The proportion of patients who showed low gain value on both sides were higher in group C than that of group A and B. No difference was observed in the other VFT results among three groups. Conclusion: We could not predict the clinical features of bilateral vestibulopathy by the results of VFT, and could not find preferable test in diagnosing bilateral vestibulopathy.

Predictive Value of Rectified Vestibular Evoked Myogenic Potential in Determining Lesion Side in Unilateral Vestibulopathy Patients: Hye Ran Son, Bong Jik Kim, Chung Ku Rhee, Jae Yun Jung; Res Vestib Sci. 2013;12(4):121-126.

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Abstract: Background and Objectives: Rectified vestibular evoked myogenic potential (rVEMP) is a relatively new method that simultaneously measures the muscle contraction power during VEMP recording and corrects the difference of contraction power afterwards. Several studies showed rVEMP is more reliable than non-rectified VEMP (nVEMP). However, those studies evaluated usefulness of rVEMP in patients with normal vestibular function. Thus, we evaluate the effect of rectification to predict lesion side in unilateral vestibulopathy patients. Materials and Methods: One-hundred nine acute unilateral vestibulopathy patients whom VEMP were performed in were included retrospectively. We regarded hearing loss side as lesion side in sudden hearing loss (n=33), meniere’s disease (n=29) and in vestibular neuritis (n=45), the side of positive head thrust test with canal paresis >30% was regarded as a lesion side. We excluded bilateral vestibulopathy. The inter-aural amplitude difference (IAD) ratio was calculated by the nVEMP and rVEMP. Results: Mismatch rate between nVEMP and rVEMP was 36.61%, match rate was 49.54%, opposition rate was 13.76%. rVEMP predicted lesion side on 15 patients of mismatch group correctly, while nVEMP predicted lesion side on 25 patients of mismatch group. There was no significant difference in IAD ratio between nVEMP and rVEMP in patients who showed lesion side weakness on both nVEMP and rVEMP. But, the younger the patient was, the more chance of mismatch was significantly (p=0.03). Conclusion: There was no more corrective role in determining lesion side by rectification in unilateral vestibulopathy. Thus rVEMP might not be helpful for predicting lesion side in unilateral vestibulopathy.

Case Reports

Cochleovestibular Otosclerosis Without Conductive Hearing Loss: Woo Sung Na, Sang Hyun Park, Chung Ku Rhee, Jae Yun Jung; Res Vestib Sci. 2013;12(1):22-26.

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Abstract: Otosclerosis typically starts around stapes footplate presenting conductive hearing loss initially. However, otosclerosis may involve cochlea and vestibule causing sensorineural hearing loss and dizziness. We report a case of cochleovestibular otosclerosis without conductive hearing loss featuring Meniere’s disease.

Apogeotropic Positional Nystagmus in Pontine Infarction: Hye Ran Son, Jae Yun Jung, Myung Whan Suh; Res Vestib Sci. 2012;11(3):105-109.

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Abstract: It is thought that horizontal canal benign paroxysmal positional vertigo (BPPV) is the most common cause of apogeotropic direction-changing positional nystagmus (DCPN). But there are many reports about cerebellar or brainstem lesions as the cause of apogeotropic DCPN. We also report a 72-year-old male patient who showed apogeotropic DCPN, but was proven to have a pontine infarction. The patients complained of disequilibrium which has lasted for 3-4 years and aggravated recently. The symptom was present only when he stood up, and was absent as soon as he sat down. He was not able to successfully perform the Romberg test and tandem gait on physical examination. Vestibular function test revealed apogeotropic DCPN without spontaneous nystagmus. Rotation chair test and caloric test results were all within normal limit. On the brain magnetic resonance imaging, newly detected infarction in the left basal ganglia, pons and right parietal lobe was found. Although horizontal canal BPPV is the most common cause of apogeotropic DCPN, we should be aware that there can be patients with central origin DCPN. In this report, we present the detailed history of this patient and tried to point out the clues to suspect central lesion in patients with apogeotropic DCPN.

Original Article

Gender Difference of Clinical Characteristics in Meniere’s Disease: Se Young An, Hye Ran Son, Myung Whan Suh, Chung Ku Rhee, Jae Yun Jung; Res Vestib Sci. 2012;11(3):88-91.

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Abstract: Background and Objectives: Meniere’s disease (MD) is a clinical cluster of common symptoms by various causes rather than a single disease entity. Many causes such as autoimmune, allergy, vascular insufficiency have been thought to be related with Meniere’s disease. We assumed that different pathologic mechanisms have contribution in each gender. With this premise, we compared clinical characteristics between male and female patients to determine if there is any difference indicating heterogeneous underlying pathology. Materials and Methods: We reviewed medical records of 61 patients (43 female, 18 male) who were diagnosed as unilateral definite MD and underwent vestibular function test and audiologic evaluation (more than two times of pure tone audiometry during the follow-up period) from October 2005 to December 2011. Results: The average duration of dizziness in females was longer than in males. In the worst ipsilateral pure tone audiometry, low frequency thresholds were lower in females than in males. Female had lesser hearing difference at all frequencies between the sides and showed more hearing fluctuation than male. There was no significant difference between male and female in the vestibular function test. Conclusion: These results are insufficient to suggest that the pathogenesis of MD differs between the genders. However, some differences between the genders prompt a need for future studies involving more patients.

Case Reports

A Case of Bilateral Benign Paroxysmal Positional Vertigo in Bilateral Mondini Malformation With Right Enlarged Vestibular Aqueduct Syndrome: Min Young Lee, Sung Do Jung, Myung Whan Suh, Jae Yun Jung; Res Vestib Sci. 2012;11(2):77-80.

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Abstract PDF: Enlarged vestibular aqueduct syndrome (EVAS) is well known congenital bony ear anomaly. It’s audiologic symptoms and radiological findings are reported in many literatures. However vestibular symptoms of EVAS are rarely reported. A patient with right EVAS developed sudden spinning vertigo on casual observation. He is diagnosed as bilateral benign paroxysmal positional vertigo and recovered by canal repositioning maneuver. We present this case with reviews of previous literatures.

Conservative Management of Horizontal Canal Benign Paroxysmal Positional Vertigo Resistant to Treatment: Hye Ran Son, Chung Ku Rhee, Myung Whan Suh, Jae Yun Jung; Res Vestib Sci. 2011;10(4):141-144.

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Abstract PDF: Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo. Although it is easily cured by repositioning maneuvers for the majority of patients, it can be resistant to treatment in rare cases. Surgery can be considered for such patients with intractable BPPV. But surgery may be followed by some side effects such as hearing loss and persistent disequilibrium. We report a 77-year-old-female patients who had positional vertigo for 5 years in despite of repositioning maneuver at several hospitals. We performed repeated repositioning maneuvers twice a day for 1 month. Her symptom and nystagmus finally subsided after 2 months. Repeated aggressive repositioning maneuver may be an alternative for surgery for patients with intractable BPPV.

Original Article

Clinical Comparison Between Ocular and Cervical Vestibular Evoked Myogenic Potentials: Il Kwon Cho, Myung Whan Suh, Tae Hyun Moon, Chung Ku Rhee, Jae Yun Jung; Res Vestib Sci. 2011;10(2):68-73.

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Abstract PDF: Background and Objectives: The goal of this study was to compare the outcome between cervical vestibular-evoked myogenic potential (cVEMP) and ocular VEMP (oVEMP) in the patients with definite vestibular dysfunction. Also, the subjective discomfort level was compared between cVEMP, classic oVEMP and head positioned oVEMP (a new method designed by the authors). Materials and Methods: Eighteen patients with dizziness associated with unilateral vestibular hypofunction were included in this study. Vestibular neuritis, Ramsay-hunt syndrome and sudden sensorineural hearing loss with vertigo were included in unilateral vestibular hypofunction disease. cVEMP, classic oVEMP, and head positioned oVEMP were assessed and compared. To compare the subjective discomfort during the tests, visual analogue scale on discomfort was checked. Results: There was a discrepancy between the cVEMP and classic oVEMP in 31.3% of the cases. The classic oVEMP were associated with more discomfort than the cVEMP. But, there was no difference between the classic and head positioned oVEMP. Conclusion: Since a substantial discrepancy was identified between the cVEMP and oVEMP, the pathways involved in cVEMP and oVEMP are likely different even with the same air conduction tone stimuli. The head positioned oVEMP may be an alternative to the classic oVEMP which has similar results and subjective discomfort levels.

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