Research in Vestibular Science

Case Report

Nystagmus in Intracranial Vertebral Artery Dissection Caused by Golf Swing: Jin Woo Choi, Yeonsil Moon, Jung Eun Shin, Chang-Hee Kim; Res Vestib Sci. 2021;20(1):28-32. Published online March 11, 2021; DOI: https://doi.org/10.21790/rvs.2021.20.1.28

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Abstract PDF Supplementary Material: Vertebral artery dissection (VAD) during a golf swing is extremely rare. Golfrelated VAD has been reported to occur more commonly at extracranial segments on the right side. In the present study, we report a 57-year-old, right-handed, female amateur golfer with golf-related VAD which developed at the intracranial segment (V4) of the left vertebral artery. The patient complained of sudden vertigo with nausea and vomiting, and aggravation of the left tinnitus. Video oculography showed very weakly left- and upbeating spontaneous nystagmus. The intensity of nystagmus was increased by positioning such as bowing, lying down or right head-rolling. The patient was treated with oral aspirin, and complete recanalization of the left vertebral artery was observed in a follow-up imaging study.

Original Article

Positional Audiometry in Patients with Light Cupula: A Preliminary Study: Jiyeon Lee, Dong-Han Lee, Jung Eun Shin, Chang-Hee Kim; Res Vestib Sci. 2020;19(3):89-94. Published online September 15, 2020; DOI: https://doi.org/10.21790/rvs.2020.19.3.89

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Objectives
Light cupula is characterized by persistent geotropic direction-changing positional nystagmus in a supine head-roll test. The purpose of this study is to investigate if hearing level is influenced by the change of head position in light cupula under the assumption that relative density difference similarly occurs between the tectorial membrane and endolymph.
Methods
Twelve patients with unilateral light cupula who underwent positional audiometry were included in this study. Pure tone thresholds were compared among three head positions.
Results
Hearing threshold in pure tone audiometry (PTA) of the affected ear was not different from that of the healthy ear. PTA thresholds of the affected side were not significantly different in three head positions; upright seating, cochlear apex-up, and cochlear apex-down positions.
Conclusions
Although positional change of nystagmus direction is the most significant clinical feature of light cupula, positional change of hearing level was not observed in those patients. The lack of positional influence on hearing may be explained as follows: (1) the heavier endolymph phenomenon occurs only in the vestibular end organ without involving the cochlea; (2) the light cupula phenomenon is more likely to occur due to light debris mechanism rather than heavier endolymph or lighter cupula mechanism; and (3) the effects of light cupula could be modified by outer hair cells, which work for tuning in the cochlea, even though light tectorial membrane or heavy endolymph occurs.

Citations

Citations to this article as recorded by

Light cupula phenomenon: a systematic review
Nilüfer Bal, Melike Altun, Elif Kuru, Meliha Basoz Behmen, Ozge Gedik Toker
The Egyptian Journal of Otolaryngology.2022;[Epub] CrossRef

Case Reports

Acute Peripheral Vestibular Syndrome in Relapsing Polychondritis: Haemin Noh, Dong-Han Lee, Jung Eun Shin, Chang-Hee Kim; Res Vestib Sci. 2020;19(3):104-109. Published online September 15, 2020; DOI: https://doi.org/10.21790/rvs.2020.19.3.104

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Abstract PDF Supplementary Material: Relapsing polychondritis is a rare multisystemic autoimmune disorder of unknown etiology and characterized by recurrent episodes of inflammation affecting the cartilaginous tissues. Otologic manifestation such as auricular chondritis is one of the most frequent presenting symptoms in relapsing polychondritis, and inner ear symptoms, such as hearing loss, tinnitus, and vertigo, may develop in 7% to 42% of the patients. In this study, we present a 42-year-old male patient with relapsing polychondritis, who experienced two separate episodes of acute vestibular syndrome at the interval of 6 years. At the first vertigo attack, the patient showed left-beating spontaneous nystagmus with sudden hearing loss on the right side, and a bithermal caloric test revealed canal paresis on the right side. At the second vertigo attack, he showed right-beating spontaneous nystagmus, and a bithermal caloric test, compared to that during the first vertigo attack, revealed additional decrease in caloric response on the left side.

Positional Vertigo Showing Direction-Changing Positional Nystagmus after Chronic Otitis Media Surgery: Is It Benign Paroxysmal Positional Vertigo?: Seongjun Choi, Jung Eun Shin, Chang-Hee Kim; Res Vestib Sci. 2018;17(1):23-27. Published online March 15, 2018; DOI: https://doi.org/10.21790/rvs.2018.17.1.23

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Abstract PDF Supplementary Material

This case report describes a patient who developed positional vertigo after surgery for chronic otitis media on the right side. Canal wall up mastoidectomy was performed, and the stapes was moderately mobilized during removal of the inflammatory granulation tissues that were attached to it. Immediately after the surgery, positional vertigo developed. The patient showed weakly left-beating spontaneous nystagmus in a seated position. Examination of positional nystagmus revealed geotropic direction-changing positional nystagmus with a prolonged duration and weak intensity in a supine head-roll test, which may be caused by a change in inner ear fluids due to a disruption of inner ear membrane around the oval window or penetration of toxic materials into the labyrinth during surgery.

Citations

Citations to this article as recorded by

Light cupula phenomenon: a systematic review
Nilüfer Bal, Melike Altun, Elif Kuru, Meliha Basoz Behmen, Ozge Gedik Toker
The Egyptian Journal of Otolaryngology.2022;[Epub] CrossRef
Direction-Changing Positional Nystagmus in Acute Otitis Media Complicated by Serous Labyrinthitis: New Insights into Positional Nystagmus
Jin Woo Choi, Kyujin Han, Hyunjoo Nahm, Jung Eun Shin, Chang-Hee Kim
Otology & Neurotology.2019; 40(4): e393. CrossRef
Dialysis disequilibrium syndrome revisited: Feeling “Disequilibrated” due to inner ear dyshomeostasis?
Chang-Hee Kim, Jung Eun Shin, Jung Hwan Park
Medical Hypotheses.2019; 129: 109262. CrossRef

Positional vertigo showing direction-changing positional nystagmus after chronic otitis media surgery: Is it benign paroxysmal positional vertigo?: Seoungjun Choi, Jung Eun Shin; Received January 8, 2018 Accepted February 28, 2018 Published online February 28, 2018; [Accepted]

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Abstract: This case report describes a patient who developed positional vertigo after surgery for chronic otitis media on the right side. Canal wall up mastoidectomy was performed, and the stapes was moderately mobilized during removal of the inflammatory granulation tissues that were attached to it. Immediately after the surgery, positional vertigo developed. The patient showed weakly left-beating spontaneous nystagmus in a seated position. Examination of positional nystagmus revealed geotropic direction-changing positional nystagmus with a prolonged duration and weak intensity in a supine head-roll test, which may be caused by a change in inner ear fluids due to a disruption of inner ear membrane around the oval window or penetration of toxic materials into the labyrinth during surgery.

Case Report

A Case of Herpes Zoster Oticus without Facial Nerve Palsy Associated with Vertigo and Hearing Loss: Jee Min Choi, Jung Eun Shin, Chang Hee Kim; Res Vestib Sci. 2012;11(4):138-141.

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Abstract: Herpes zoster oticus (HZO) is characterized by facial nerve palsy, otalgia and auricular vesicles on the affected side and accepted to be caused by the reactivation of varicella zoster virus (VZV) in the geniculate ganglion. Vestibulocochlear deficits are known to be frequently accompanied by HZO. Unusual clinical manifestations such as only vertigo without facial nerve palsy or hearing loss has been reported. We report a case of 27-year-old man presented with vertigo, sensorineural hearing loss and vesicular eruptions on the left auricle without facial nerve palsy. Serologic test revealed that the patient was positive for immunoglobulin G (IgG) and IgM antibodies against VZV.

Original Articles

Clinical Characteristics of 7 Patients with Lateral Semicircular Canal Dysplasia: Chang Hee Kim, Jung Eun Shin, Yeo Jin Lee, Hong Ju Park; Res Vestib Sci. 2012;11(2):64-68.

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Abstract PDF: Background and Objectives: Dysplasia of lateral semicircular canal (LSCC) is the most common inner ear malformation, because LSCC is the last single structure to be formed during inner ear embryogenesis. There have been several case reports about the LSCC anomaly which showed clinical spectrum ranging from no symptom to severe sensorineural hearing loss. The authors investigated the clinical characteristics of 7 patients with LSCC dysplasia. Materials and Methods: The medical records of 7 patients who were diagnosed as LSCC dysplasia from temporal bone computed tomography were retrospectively reviewed. We analysed the findings of history taking, pure tone audiometry, speech audiometry, and caloric tests. Results: The LSCC dysplasia was observed in all of 7 patients in which 5 showed unilaterally confined LSCC dysplasia, 1 showed bilaterally confined LSCC dysplasia, and 1 exhibited bilateral LSCC dysplasia combined with bilateral posterior semicircular canal dysplasia. From 7 patients, hearing loss was chief complaint only in 2 patients. Pure tone audiometry revealed sensorineural hearing loss in one patient, and conductive hearing loss in the other patient. Two patients complained of whirling type vertigo, and 3 complained of nonspecific dizziness. Conclusion: The patients with LSCC dysplasia may show variable symptoms such as sensorineural hearing loss, conductive hearing loss, vertigo and nonspecific dizziness.

Effects of Changes of Plateau and Rise/Fall Times on Ocular Vestibular Evoked Myogenic Potentials: Yeo Jin Lee, Soo Hee Han, Eun Jung Ha, Yong Soo Jung, Hi Boong Kwak, Mun Su Park, Jung Eun Shin, Hong Ju Park; J Korean Bal Soc. 2008;7(2):193-196.

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Abstract PDF: Background and Objectives: The ocular vestibular evoked myogenic potential (OVEMP) is a recently discovered test of labyrinthine function, analogous to the cervical VEMP. Recent works have demonstrated the existence of OVEMPs, which likely reflect otolith-ocular reflex. The purpose of this study was to identify the optimal plateau and rise/fall times of short tone bursts to detect OVEMPs in healthy subjects. Materials and Methods: Thirteen healthy subjects (26 ears) were included in this study. Surface electromyographic activity was recorded from active electrodes placed inferior to each eye. Stimulation with 500 Hz short tone bursts was used. We used a variety of plateau and rise/fall times. Three different plateau times (1, 2, and 3 ms) and rise/fall times (0.5, 1, and 2 ms) were used. The incidence, amplitudes and latencies were compared. Results: VEMP responses were clearly observed in all 26 ears at the plateau time of 2 ms and two rise/fall times (0.5 and 1 ms). The amplitudes in the individual ears tested were lower at the rise/fall time of 2 ms than at the other conditions. The amplitudes were lower at the plateau time of 3 ms compared to the other conditions. When the rise/fall time was prolonged from 0.5 to 2 ms, the n1 and p1 latencies were prolonged in parallel. However, there was no such change in latencies according to the plateau times. Conclusions: Our findings show that the ideal stimulation pattern for evoking OVEMP is at the rise/fall times of 0.5 or 1 ms and the plateau time of 2 ms. The waveform morphology of the VEMP responses observed with this stimulation pattern was simultaneously the most constant and marked. Key words: Evoked potentials, Ocular VEMP, Vestibulo-ocular reflex, Otolith

Follow-up Changes of Eye Movements by Caloric Stimulation in Patients With Vestibular Neuritis: Mun Su Park, Ga Hyun Park, Yong Soo Jeong, Yeo Jin Lee, Jung Eun Shin, Hong Ju Park; J Korean Bal Soc. 2008;7(1):33-37.

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Abstract PDF: Background and Objectives: A significant recovery of resting activity in the vestibular nuclei ipsilateral to the unilateral labyrinthectomy has been reported by the time symptoms such as spontaneous nystagmus and roll head tilt have largely disappeared. However, the dynamic vestibular response after unilateral vestibular loss to passively imposed vestibular stimuli does not recover. Materials and Methods: We investigated changes of the caloric responses in 32 patients with vestibular neuritis during in- and out-patient visits separated by 2 months in an attempt to identify changes brought about by peripheral and/or central compensation processes. Results: The slow-phase eye velocities stimulated by warm caloric stimulation at acute and follow-up stage were 6.6±6.6°/s, 9.5±9.9°/s in the lesioned side; 28.4±19.1°/s, 24.5±11.6°/s in the intact side. The slow-phase eye velocities stimulated by cold caloric stimulation at acute and follow-up stage were 5.9±7.7°/s, 10.3±8.2°/s in the lesioned side; 19.8±10.3°/s, 18.8±9.9°/s in the intact side. Conclusion: Our findings show that the recovery of caloric responses comes mostly from the recovery of the eye responses to the caloric stimulation in the lesioned side and the eye responses to the caloric stimulation in the intact side does not change over time after vestibular neuritis.

Vibration-Induced Nystagmus in Patients with Vestibular Disorders: Yeo Jin Lee, Hong Ju Park, Jung Eun Shin, Jae Yoon Ahn, Ga Hyun Park, Yong Soo Jung, Hi Boong Kwak, Jin Seok Yoo; J Korean Bal Soc. 2007;6(2):192-195.

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Abstract PDF: Background and Objectives: It has been reported that vibration applied either on the mastoid or the sternocleidomastoid (SCM) muscles induces nystagmus in patients after unilateral vestibular neuritis. The aims of the study were to characterize the vibration-induced nystagmus (VIN) in patients with various vestibular disorders and to compare the results of VIN to unilateral weakness in caloric test. Materials and Methods: Fifthy-four patients with Meniere’s disease, 58 patients with unilateral vestibular neuritis, 170 patients with migraine-associated dizziness, and 78 patients with chronic recurrent vestibulopathy were included. We recorded eye movements during unilateral 100-Hz vibration on the mastoids and SCM muscles. The bithermal caloric test was also performed. Abnormal criteria of VIN were slow-phase slow-phase velocity (SPV) at 4 all different conditions ≥ 2°/s with the same directions or mean of SPV at vibration on both mastoids or both SCM muscles ≥ 5°/s with the same directions. Results: In Meniere’s disease, 28 of 57 (49.1%) of patients show pathologic VIN, 21 of 57 (36.8%) show pathologic canal paresis. 14 of 57 (24.6%) show abnormalities in both tests, and 35 of 57 (61.4%) show any abnormalities in either test. In unilateral vestibular neuritis, 43 of 58 (77.6%) showed pathologic VIN, 58 of 58 (100%) show canal paresis. In migraine-associated dizziness, 48 of 170 (28.2%) showed pathologic VIN, 58 of 170 (18.8%) show canal paresis. 15 of 170 (8.8%) showed abnormalities in both tests, and 65 of 170 (38.2%) show any abnormalities in either test. In chronic recurrent vestibulopathy, 23 of 78 (29.5%) of patients show pathologic VIN and 17 of 78 (21.8%) show pathologic canal paresis. Seven of 78 (9.0%) showed abnormalities in both tests, and 33 of 78 (42.3%) show any abnormalities in either test. Conclusion: VIN test can increase the sensitivity in detecting vestibular imbalance in vestibular disorders when combined with caloric test.

Changes of Vibration-Induced Nystagmus by Age in Normal Subjects: Yong Soo Jung, Hong Ju Park, Jung Eun Shin, Jae Yoon Ahn, Ga Hyun Park, Hi Boong Kwak, Yeo Jin Lee, Jin Seok Yoo; J Korean Bal Soc. 2007;6(2):186-191.

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Abstract PDF: Background and Objectives: It has been reported that vibration applied either on the mastoid or on the sternocleidomastoid (SCM) muscles induces nystagmus in normal subjects. The aims of the study were to characterize the direction and velocity of slow-phase eye movement which is induced by vibration in normal subjects and to propose the mechanism of vibration-induced nystagmus (VIN) in normal subjects. Materials and Method: We recorded eye movements during unilateral 100-Hz vibration on the mastoid bone and SCM muscles in 56 normal subjects. The subjects were divided into 4 groups in ages (20s, 30s, 40s, 50~60s). The directions of VIN, the degree of maximal slow-phase eye velocities were analyzed according to age. Positive value means slow-phase velocity (SPV) to the right side. Results: In 20s, vibration on right/left mastoids induced SPV of 1.2±2.0°/sec, 0±2.1°/sec and on right/left SCM muscles, 1.1±1.9°/sec, -1.2±2.5°/sec. In 30s, vibration on right/left mastoids induced SPV of 3.3±3.8°/sec, -0.3± 1.4°/sec and on right/left SCM muscles, 2.8±4.2°/sec, -1.0±1.5°/sec. In 40s, vibration on right/left mastoids induced SPV of 0±1.7°/sec, -0.2±1.2°/sec and on right/left SCM muscles, 0±1.8°/sec, 0±1.0°/sec. In 50~60s, vibration on the right/left mastoids induced SPV of -1.3±1.3°/sec, 1.2±1.3°/sec and on right/left SCM muscles, -0.6±0.9°/sec, 0.9 ±1.5°/sec. The directional preponderance of the slow-phase eye movement to the vibrated side was statistically significant in 20s and 30s, however, the preponderance of the slow-phase eye movement changed into the non-vibrated side in 50~60s. Conclusion: The proprioceptive input, changing major rotator from the inferior oblique muscle to the sternocleidomastoid muscles might explain the change of the directional preponderance of the slow-phase eye movements in normal subjects according to ages. Although this directional preponderance is not consistent in all age groups, it is still important in discriminating normal responses from abnormal responses which can be induced by vibration.

Follow-up Examination of Vibration-Induced Nystagmus in Patients with Unilateral Vestibular Neuritis: Hong Ju Park, Jung Eun Shin, Jae Yoon Ahn, Ga Hyun Park, Yong Soo Jung, Hi Boong Kwak, Yeo Jin Lee, Jin Seok Yoo; J Korean Bal Soc. 2007;6(2):172-175.

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Abstract PDF: Background and Objectives: The aim of this study was to verify if vibration-induced nystagmus in patients with vestibular neuritis changed over time and to compare the results of vibration-induced nystagmus (VIN) test to those of caloric test. Materials and Method: We compared VIN results with those of caloric testing in 23 patients (M:F = 11:12, 15~67 years old) with unilateral vestibular neuritis seen at onset and in follow-up for around 2 months. The eye movement recordings were made and the maximum slow-phase eye velocities (SPV) were calculated during vibration. If spontaneous nystagmus was present, it was subtracted from the slow-phase eye velocities of VIN. Results: In acute stage, VIN of which SPV was directed towards the lesioned side was observed in 21 (91%). In follow-up, VIN of which SPV was directed towards the lesioned side was observed in 19 (83%). There was a significant decrease of the SPV of VIN over time. Significant correlations were observed in between canal paresis & SPV of VIN in both acute and follow-up stages. Conclusion: Our findings show that VIN test can predict the severity of vestibular asymmetry not only in acute stage but also in follow-up stage. Our results suggest that vibration-induced nystagmus might represent the peripheral vestibular asymmetry in patients with vestibular neuritis.

Comparison of Air Caloric Test and Vibration-Induced Nystagmus Test in Patients with Unilateral Chronic Otitis Media without Vertigo: Jae Yoon Ahn, Hong Ju Park, Jung Eun Shin, Ga Hyun Park, Yong Soo Jung, Hi Boong Kwak, Yeo Jin Lee, Jin Seok Yoo; J Korean Bal Soc. 2007;6(2):167-171.

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Abstract PDF: Background and Objectives: The aims of the study were to characterize the vibration-induced nystagmus (VIN) and air caloric test in patients with unilateral chronic otitis media, and to clarify the clinical availability of VIN by comparing the results of VIN test with those of air caloric test. Materials and Methods: Nineteen patients with unilateral chronic otitis media who had had no vestibular symptoms in past history were investigated. Pure tone audiometry (PTA), air caloric, VIN and subjective visual vertical (SVV) tests were done and the results were analyzed to estimate the utility for investigating vestibular imbalance. Results: If we consider a patient with abnormal results from two or more tests as a patient with latent vestibular imbalance, because they had no previous vestibular symptoms, 3 patients was considered to have latent asymmetric vestibular function. False positive rate were 32% in air caloric test, 5% in VIN test and 0% in SVV test. Conclusion: Our findings show that vestibular imbalance in patients with chronic otitis media should be determined through various tests and vibration-induced nystagmus test can be more useful than air caloric test in estimating the vestibular imbalance.

Otolith Function Tests in Patient with Meniere’s Disease: Hong Ju Park, Jung Eun Shin, Jae Yoon Ahn, Ga Hyun Park, Yong Soo Jung, Hi Boong Kwak, Yeo Jin Lee, Jin Seok Yoo; J Korean Bal Soc. 2007;6(2):127-131.

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Abstract PDF: Background and Objectives: The aims of this study were to measure otolith function using subjective visual vertical (SVV) test and vestibular evoked myogenic potential (VEMP) test in patients with unilateral Meniere’s disease, and to see the relationship of the otolithic impairment with caloric and audiologic results. Materials and Methods: Twenty two patients with unilateral Meniere’s disease who received treatment and also had been tested for pure tone, caloric, SVV and VEMP tests were enrolled. All the tests were done simultaneously. Results: Five of 22 (23%) patients showed abnormal tilt to the lesion side in SVV test, and 13 of 22 (59%) patients showed abnormal VEMP results on the affected side. There was no correlation between SVV tilts and unilateral weakness (UW) in caloric tests or pure-tone average. There was also no difference of UW in patients with or without VEMP abnormalities. Two patients showed abnormal finding in both SVV & VEMP tests. One patient showed UW (47%) and SVV tilt (3.08°) to the lesion side, and the other showed normal UW and SVV tilt (3.22°) to the lesion side. Conclusion: Our results demonstrate that the otolith system was implicated in 16 out of 22 (73%) patients with Meniere’s disease. However, there was no correlation between the abnormal results of the three tests and these findings suggest that impairment of the otolithic function is depending on the extent and/or the localization of Meniere’s disease, suggesting vestibular rehabilitation for the specific lesion might be helpful.

Otolith Function Tests in Patient with Vestibular Neuritis: Hong Ju Park, Jung Eun Shin, Dae Bo Shim, Hyang Ae Shin, Sang Kyun Lim, Jae Yoon Ahn, Yong Soo Jung, Jin Suk Yu; J Korean Bal Soc. 2006;5(1):49-54.

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Abstract PDF: Background
and Objectives: Vestibular evoked myogenic potentials (VEMP) test provides a useful method for assessment of saccule function and the functional integrity of the inferior vestibular nerve, and subjective visual vertical (SVV) abnormalities are presumably related to a lesion of the utricle. The aim(s) of this study were to measure otolith function using SVV and VEMP tests, and to define the influence of the otolithic organs in patients suffering from vestibular neuritis. Materials and Method: From September 2005 to January 2006, twelve patients who received treatment in hospital and also had been tested for caloric test, subjective visual vertical (SVV) and vestibular evoked myogenic potential (VEMP) tests with unilateral vestibular neuritis were enrolled. All the tests were done within 8 days after the onset of their symptoms, simultaneously. The SVV was measured in 34 normal subjects as well as in patients.
Results
Eight of 12 patients showed abnormal tilt to the lesion side in SVV test, and five of 8 patients showed no VEMP on the affected side. There was no correlation between SVV tilts and unilateral weakness (UW) in caloric tests. Two patients with abnormal UW (54, 82%) showed normal finding in SVV & VEMP tests. One patient with abnormal UW (83%) and SVV tilts (18.04˚) to the lesion side was normal in VEMP test. Two patients with abnormal UW (28, 37%) and no response in VEMP test were normal in SVV test.
Conclusion
Our results demonstrate that the incidence of abnormal results were 62.5, 66.7% in VEMP and SVV tests in acute stage of vestibular neuritis, respectively. There was no correlation between the abnormal results of the tests and these findings suggest that impairment of the otolithic function is depending on the extent and/or the localization of vestibular neuritis. Key Words : Vestibular neuritis, Otolith, Vestibular function tests, Subjective visual vertical, Vestibular evoked myogenic potentials

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