Research in Vestibular Science

Arnold-Chiari Type 1 Malformation Mimicking Benign Paroxysmal Positional Vertigo: Young Chul Kim, Chae Dong Yim, Hyun Jin Lee, Dong Gu Hur, Seong Ki Ahn; Res Vestib Sci. 2019;18(3):87-90. Published online September 15, 2019; DOI: https://doi.org/10.21790/rvs.2019.18.3.87

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Abstract PDF: Arnold-Chiari malformation type 1 is a congenital disease characterized by herniation of the cerebellar tonsils through the foramen magnum. Most common clinical symptom is pain, including occipital headache and neck pain, upper limb pain exacerbated by physical activity or valsalva maneuvers. Various otoneurological manifestations also occur in patients with the disease, which has usually associated with dizziness, vomiting, dysphagia, poor hand coordination, unsteady gait, numbness. Patients with Arnold-Chiari malformation may develop vertigo after spending some time with their head inclined on their trunk. Positional and down-beating nystagmus are common forms of nystagmus in them. We experienced a 12-year-old female who presented complaining of vertigo related to changes in head position which was initially misdiagnosed as a benign paroxysmal positional vertigo.

A Case of Sensorineural Hearing Loss and Vertigo during Epidural Nerve Block: Byeong Min Lee, Jin hong Noh, Seong Ki Ahn, Hyun Woo Park; Res Vestib Sci. 2018;17(4):170-174. Published online December 21, 2018; DOI: https://doi.org/10.21790/rvs.2018.17.4.170

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Abstract PDF: Epidural anesthesia has significantly advanced in neuraxial anesthesia and analgesia. It is used for surgical anaesthesia and treatment of chronic pain. Hearing loss during or after epidural anesthesia is rare, and it is known to occur by the change of the intracranial pressure. Cerebrospinal fluid is connected with perilymph in the cochlear and vestibule that is important to hearing and balance. If the intracranial pressure is abruptly transferred to the inner ear, perilymph can be leak, that called perilymphatic fistula, dizziness, and hearing loss can occur suddenly. We report a 65-year-old woman who presented with acute onset dizziness and hearing loss during the epidural nerve block for back pain, wherein we speculated a possibility of perilymphatic fistula as the mechanism of hearing loss and dizziness. The mechanism of dizziness and hearing loss was suspected with perilymphatic fistula.

A case of sensorineural hearing loss and vertigo during epidural nerve block: Byeong min Lee, Jin hong Noh, Seong ki Ahn, Hyun woo Park; Received October 11, 2018 Accepted December 4, 2018 Published online December 4, 2018; [Accepted]

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Abstract: Epidural anesthesia has significantly advanced in neuraxial anesthesia and analgesia. It is used for surgical anaesthesia and treatment of chronic pain. Hearing loss during or after epidural anesthesia is rare, and it is known to occur by the change of the intracranial pressure. Cerebrospinal fluid is connected with perilymph in the cochlear and vestibule that is important to hearing and balance. If the intracranial pressure is abruptly transferred to the inner ear, perilymph can be leak, that called perilymphatic fistula, dizziness and hearing loss can occur suddenly. We report a 65-year-old women who presented with acute onset dizziness and hearing loss during the epidural nerve block for back pain, wherein we speculated a possibility of perilymphatic fistula as the mechanism of hearing loss and dizziness. The mechanism of dizziness and hearing loss was suspected with perilymphatic fistula.

Incidence of Progression into Ménière Disease from Idiopathic Sudden Sensorineural Hearing Loss: Midterm Follow-up Study: Byeong Min Lee, Jin Hyun Seo, Hyun Woo Park, Hyun Jin Lee, Dong Gu Hur, Seong Ki Ahn; Res Vestib Sci. 2018;17(3):95-101. Published online September 18, 2018; DOI: https://doi.org/10.21790/rvs.2018.17.3.95

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Abstract PDF: Objectives
Ménière disease is a clinical syndrome characterized by the four major symptoms of episodic vertigo, sensorineural hearing loss, tinnitus, and aural fullness. Sensorineural hearing loss, especially low frequency, is the characteristic type of audiogram in Ménière's disease. However, it is difficult to distinguish idiopathic sudden sensorineural hearing loss (ISSNHL) with vertigo from the first attack of Ménière disease. The purpose of this study was to investigate the incidence of progression into Ménière Disease from low frequency ISSNHL.
Methods
Two hundred eighty-three patients were included in this study. We classified the patients with ISSNHL according to the hearing loss in audiogram and analyzed how many of them actually progressed to Ménière disease based on diagnosis criteria.
Results
Among the 240 patients, 37.1% (89 patients) were confirmed low frequency ISSNHL and 14.6% (13 patients) of them were diagnosed with Meniere disease.
Conclusions
This study showed that the progression from low frequency ISSNHL to Ménière disease was higher than other frequency ISSNHL, as in other studies.

Correlation between Rotating Chair Test and Dizziness Handicap Inventory in Patients with Acute Unilateral Vestibular Neuritis: Hyeong Joo Lee, Jin Yong Kim, Dong Gu Hur, Seong Ki Ahn; Res Vestib Sci. 2016;15(2):51-54. Published online June 15, 2016

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Abstract PDF: OBJECTIVE: Vestibular neuritis (VN) is one of the most common causes of acute spontaneous vertigo. However, such dizziness symptoms in patients with VN vary among patients, and various methods are used to evaluate subjective vestibular symptoms following attack of VN. Studies on correlation between subjective vestibular symptom changes and result of rotation chair test after vestibular rehabilitation therapy (VRT) have not been reported. Therefore, we compared change of dizziness handicap inventory (DHI) and results of rotation chair test in patients with VN between attack and 3 month later following VRT.
METHODS
Forty-seven patients were included in this study. In patients with VN, DHI and rotation chair test were performed at the time of VN attack and recovery time of 3 months after VN attack.
RESULTS
In general, the DHI score and the percentage of directional preponderance (DP) in a rotation chair test performed on patients with VN have all decreased. However, the changes in these results were not statistically significant. DP% difference and DHI score were compared to each other among patients with VN and showed no relational significance to each other (r=0.326).
CONCLUSION
The degree of improvement in a rotation chair test done on patients with VN did not reflect the severity of improvement for symptom like dizziness.

Vestibular Rehabilitation for Patient with Bilateral Peripheral Vestibular Deficit: Hyun Woo Park, Seong Ki Ahn; Res Vestib Sci. 2016;15(1):1-4.

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Abstract PDF: Bilateral vestibular deficit affects far fewer patients than unilateral deficit, and thus has been understudied. When bilateral vestibular organs are injured, loss of input of vestibulo-ocular and vestibulo-spinal reflex that normally stabilize the eyes and body, affected patients suffer blurred vision during head movement, postural instability, and disequilibrium. Vestibular rehabilitation therapy is an exercise-based treatment program designed to promote vestibular adaptation and substitution. The rationale for the exercises, which originated from the observation that patients who were active recovered faster, was based on the supposition that the head movements that provoke the patient’s dizziness play an important role in hastening the recovery process. Here the author reviews the clinical manifestation and treatment of bilateral vestibular deficit that include vestibular rehabilitation therapy and vestibular device that studied today.

Bilateral Benign Paroxysmal Positional Vertigo Occurred during Dancing Rehearsal: Dong Gu Hur, Joon Seok Ko, Jin Yong Kim, Seong Ki Ahn; Res Vestib Sci. 2015;14(3):93-96.

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Abstract PDF: Benign paroxysmal positional vertigo (BPPV) is the most common cause of recurrent vestibular vertigo. The etiology of BPPV is unidentified in 50%?70% of patients. However in secondary BPPV, the etiologies are well known a head injury as an example. And it has been reported that even minor head trauma can evoke BPPV. The authors experienced a case of bilateral BPPV occurred during a dancing rehearsal in a school thereby we report the case with a review of the related literatures.

Long-Term Follow-Up of Patients with Benign Paroxysmal Positional Vertigo: Jin Yong Kim, Joon Seok Ko, Ho Joong Lee, Dong Gu Hur, Seong Ki Ahn; Res Vestib Sci. 2015;14(3):83-86.

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Abstract PDF: Objective: Benign paroxysmal positional vertigo (BPPV) is one of most common peripheral vestibular disorders. The aim of this study was to identify recurrence in the long-term follow-up of patients with BPPV after successful canalith repositioning maneuvers, and to determine which factors contribute to recurrence.
Methods
The authors reviewed the medical records of 202 consecutive patients with BPPV during the period January 2002 to December 2004 and investigated 112 patients with BPPV treated over the same period. Finally, 71 patients were enrolled in this study. The estimated risk of recurrence used a Kaplan-Meier analysis. For long-term follow-up, patients were contacted by telephone for further information by one experienced doctor.
Results
A total of 71 patients with idiopathic BPPV fulfilled the inclusion criteria. Forty-two patients had posterior semicircular canal-BPPV and 29 patients lateral semicircular canal-BPPV. Recurrence rates in the posterior semicircular canal-and lateral semicircular canal-BPPV were 24% (18/42) and 41% (12/29), respectively (p＞0.05). Recurrence following successful treatment during a longterm follow-up period was 23 out of 30 patients within 1 year, 5 patients between 1 and 3 years, 1 patient at between 3 and 5 years, 1 patient after 5 years, respectively.
Conclusion
The authors found no significant difference between the posterior semicircular canal and lateral semicircular canal-BPPV regarding recurrence. Recurrence mostly occurred within the first 3 years (93%) following successful canalith repositioning procedure.

Clinical Characteristics and Course of Recurrent Vestibulopathy Following Diuretics Medication: Joon Seok Ko, Ho Yeop Kim, Dong Gu Hur, Seong Ki Ahn; Res Vestib Sci. 2014;13(1):7-11.

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Abstract: et, and the characteristics of vertigo. Results: Median follow-up was 29 months (range, 27−37 months). Patients had a mean age at onset of 48.2 years and a mean duration of 2.75 years. An obvious female predilection was found, and unilateral caloric paresis (≥25%) was seen in 23.3%. Of the 30 patients, symptoms resolved in 80% but were unchanged in 20%. No patient with RV developed a central nervous system disease or benign paroxysmal positional vertigo during follow-up. Conclusion: The present study shows that in the majority of cases, vertigo resolved following diuretics medication. In cases of the patients with severe or disabling recurrent vestibulopathy, the diuretics medication may be effective in reducing the frequency of vertigo attacks.

Clinical Characteristics and Natural Course of Benign Paroxysmal Vertigo of Childhood: A Long-Term Follow-Up Study: Eun Jae Lee, Seong Ki Ahn, Dong Gu Hur, Joon Seok Ko; Res Vestib Sci. 2013;12(3):93-98.

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Abstract: Background and Objectives: It is suggested that some patients with benign paroxysmal vertigo of childhood (BPVC) go on to develop migraine. However, neither the natural course nor the clinical features of BPVC have been determined, and therefore, the aim of this study was to investigate the clinical characteristics and the natural course of BPVC. Materials and Methods: During the period January 2002 to December 2009, we reviewed the clinical records of 58 patients diagnosed with BPVC. All patients were approached by telephone and using a questionnaire. The clinical characteristics of vertigo, such as sex and age distribution, duration and frequency of vertigo, associated symptoms, development of migraine, and neurologic abnormalities, were analyzed. Results: Mean follow- up duration was 73.2 months (range, 31-119 months). Patients had a mean age at onset of 11.8 years and a mean duration of 6.1 years. An obvious female predilection was found, and 40% of BPVC developed to migraine had a family history of migraine. Of the 32 patients, symptoms resolved in 68.7% but were unchanged in five patients (15.6%). BPVC developed to migraine in five patients (15.6%). Conclusion: This study suggests that vertigo spontaneously resolves in the majority of cases. However, the incidence of development to migraine in the BPVC patients is higher than that in general population.

Multicenter Study on the Clinician’s Diagnostic and Therapeutic Approaches for Benign Paroxysmal Positional Vertigo in Korea: Eun Ju Jeon, Won Ho Chung, Jeong Hwan Choi, Eui Cheol Nam, Hong Ju Park, Jong Dae Lee, Won Sang Lee, Kyu Sung Kim, Eui Kyung Goh, Ja Won Koo, Min Bum Kim, Min Beom Kim, Se Hyung Kim, Young Jin Kim, Chang Hee Kim, Sung Il Nam, Seog Kyun Mun, Ga Young Park, Sang Yoo Park, Shi Nae Park, Chang Hoon Bae, Sung Hyun Boo, Myung Whan Suh, Jae Hyun Seo, Eun Jin Son, Jae Jun Song, Jae Jin Song, Joong Wook Shin, Dae Bo Shim, Seong Ki Ahn, Hye Youn Youm, Shin Young Yoo, Dong Hee Lee, Seung Hwan Lee, Chang Ho Lee, Hyun Seok Lee, Hwan Ho Lee, Hyo Jeong Lee, Yun Hoon Choung, Seung Hyo Choi, Jee Sun Choi, Seok Min Hong, Sung Kwang Hong; Res Vestib Sci. 2013;12(3):79-92.

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Abstract: Background and Objectives: It is necessary to establish the most efficient diagnostic and therapeutic method for benign paroxysmal positional vertigo (BPPV), which is appropriate for Korean healthcare system. We aimed to evaluate current state of Korean clinician’s diagnostic and therapeutic approaches for BPPV. Materials and Methods: A 16-item survey was emailed to the members of dizziness department of Otology Research Interest Group in the Korean Otologic Society (n=68). 43 were returned and analyzed. Results: All respondents (100%) used Dix-Hallpike test as a diagnostic tool for vertical canal-BPPV. Supine roll test was used for diagnosing lateral canal BPPV in nearly all the respondents (97.7%). Epley maneuver was chosen as otolith repositioning maneuver (ORM) for posterior canal BPPV in all respondents and barbecue rotation (BBQ) was used for treating lateral canal BPPV with geotropic nystagmus in 95.3% of respondents. Extreme variation was noted for therapeutic approach of lateral canal BPPV with ageotropic nystagmus BBQ, with 4 kinds of ORM and adjunctive measures to liberate otolith from cupula, while BBQ was again the most commonly used ORM (76.7%). Conclusion: The development of practical and efficient ORM for lateral canal BPPV with ageotropic nystagmus is necessary.

A Case of Bilateral Vestibular Hypofunction Following Oseltamivir Medication: Ho Yeop Kim, Seong Ki Ahn, Dong Gu Hur; Res Vestib Sci. 2013;12(1):27-30.

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Abstract: The threat of pandemic influenza has focused attention and resources on virus surveillance, prevention, and containment. The World Health Organization has strongly recommended the use of the antiviral drug, Oseltamivir (TamifluⓇ), to treat and prevent pandemic influenza infection. In recent years, there have been case reports of vestibulocochlear events during or after oseltamivir treatment, other countries. Oseltamivir is generally well-tolerated and its most frequent adverse effects include nausea and vomiting, diarrhea, and abdominal pain. Up to now, bilateral vestibular hypofunction after oseltamivir medication has not been reported. Herein, we report a very rare case of a 36-year-old female with bilateral vestibular hypofunction following oseltamivir medication.

Contrivance of Management for Intractable Vertigo: Dong Gu Hur, Eun Jae Lee, Hung Soo Kang, Seong Ki Ahn; Res Vestib Sci. 2012;11:69-70.

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Immunohistochemical Study on β1- and β2-Adrenergic Receptors in Rat Vestibular Nuclei: Seong Ki Ahn, Roza Khalmuratova, Dong Gu Hur, Ho Yeop Kim, Hyun Woo Park, Yeon Hee Joo, Hung Soo Kang; Res Vestib Sci. 2012;11(2):59-63.

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Abstract PDF: Background and Objectives: The aim of this study was to examine the localizations of β1- and β2-adrenergic receptors (ARs) in rat vestibular nuclei by immunohistochemical staining procedure. Materials and Methods: Twelve male Sprague- Dawley rats were used in this study. Primary antibodies for the β1- and β2-ARs were used. The sections were treated with a biotinylated goat anti-rabbit antibody. The sections were then incubated in avidin-biotin-peroxidase reagent and processed with immunoperoxidase using 3.3’-diaminobenzidine tetrahydrochloride. Results: β1-AR and β2-AR immunopositive neurons were found to be distributed throughout the four major vestibular nuclei. Both receptors were primarily detected in neuronal somata and their proximal dendrites. β1-AR and β2-AR were moderately expressed in the superior vestibular nucleus, lateral vestibular nucleus, medial vestibular nucleus, and spinal vestibular nucleus. Conclusion: The present study demonstrates, for the first time, that β1-AR and β2-AR receptors are localized in rat vestibular nuclei. Furthermore, this study may provide additional speculation into the role of ARs during vestibular signal processing. Further studies are needed to clarify the roles played by β1-ARs and β2-ARs through physiologic and functional studies.

Two Cases of Central Origin Vertigo Mimicking Acute Vestibular Neuritis: Hung Soo Kang, Seong Ki Ahn, Dong Gu Hur, Seong Yong Ahn; Res Vestib Sci. 2011;10(2):77-81.

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Abstract PDF: Vestibular neuritis (VN) is characterized by the acute onset of vertigo, nausea and vomiting, in the absence of hearing loss or tinnitus. Cerebellar and brain stem infarction represents approximately 2.3% of acute strokes overall. Those can result from occlusion of the superior cerebellar artery, anterior inferior cerebellar artery, or the posterior inferior cerebellar artery. Central vertigo such as cerebellar or brain stem infarction may present with nonspecific symptoms similar to those of VN. Patients with isolated vertigo due to cerebral infarction may pose a significant diagnostic challenge to the neurotologists. It is know n for being frequently misdiagnosed, often with consequent disability. We report 2 cases of cerebral infarction mimicking VN initially with a review of the related literatures.

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