Research in Vestibular Science

Review

Canal Conversion and Reentry of Otolith in Benign Paroxysmal Positional Vertigo: Jong Sei Kim, Minbum Kim; Res Vestib Sci. 2023;22(3):59-67. Published online September 15, 2023; DOI: https://doi.org/10.21790/rvs.2023.22.3.59

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Abstract PDF: During the treatment process for benign paroxysmal positional vertigo (BPPV) using the canalith repositioning procedure, the otolith can inadvertently enter the semicircular canal instead of the utricle. Canal conversion refers to the situation where the otolith enters a different semicircular canal, while reentry occurs when the otolith returns to the same semicircular canal. The occurrence of a canal conversion can complicate the accurate diagnosis and treatment of BPPV, potentially leading to misdiagnosis and unsuccessful results in the canalith repositioning procedure. In this review, we aim to summarize the incidence, clinical features, and associated risk factors of canal conversion and reentries.

Original Article

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; Res Vestib Sci. 2020;19(2):49-54. Published online June 15, 2020; DOI: https://doi.org/10.21790/rvs.2020.19.2.49

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Abstract PDF: Objectives
The aim of the study was to evaluate the possible alteration of the vestibulo-ocular reflex (VOR) in patients with horizontal canal benign paroxysmal positional vertigo (h-BPPV) using the video head impulse test (vHIT).
Methods
This was a prospective case-control study of BPPV patients. We includeed 133 patients with h-BPPV who underwent the vHIT prior to the positioning test. The control group consisted of 76 normal subjects who also underwent the vHIT. The vHIT parameters of gain and asymmetry were assessed, and clinical parameters such as treatment duration, number of canalith reposition maneuvers executed and recurrence rates were evaluated. The VOR and clinical parameters were compared between the h-BPPV and control group. The VOR parameters of h-BPPV canalolithiasis were also compared with those of cupulolithiasis.
Results
The mean age of the patients was 56.5 years and the male to female ratio was 1:2.02. Of the patients, 75 were diagnosed as having the canalolithiasis type of h-BPPV, while the other 58 had the cupulolithiasis type. The mean vHIT gains of the ipsi-lesional horizontal canal plane were 1.13 and 1.15 in the h-BPPV and control group, respectively (p=0.564). However, the asymmetry of the VOR was significantly higher in the h-BPPV than the control group (p=0.013), while the gains and asymmetries of the vHIT in the canalolith and cupulolith types were not significantly different (p=0.454, p=0.826).
Conclusions
The asymmetry of VOR is significantly elevated in the cupulolith type of hBPPV.

Case Report

A Case of Tumarkin Otolithic Crisis Treated with Intratympanic Gentamicin Injection: Soo Hyun Joo, Hong-Ju Kim, Hyun-Ji Kim, Kyu-Sung Kim; Res Vestib Sci. 2020;19(1):22-28. Published online March 15, 2020; DOI: https://doi.org/10.21790/rvs.2020.19.1.22

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Abstract PDF: Tumarkin otolithic crisis is an abrupt attack of falling without loss of consciousness because of peripheral vestibular disorders. It occurs without warning in patients with late stage or end-stage of Meniere’s disease. It is an otologic emergency due to the risk of fall down injury, and has been treated with labyrinthectomy, vestibular neurectomy, and intratympanic gentamicin injection. Many reports have reported the efficacy of intratympanic injection of gentamicin (ITIG) as chemical ablation. We report a 58-year-old man with Tumarkin otolothic crisis from Meniere’s disease who presented with sudden drop attack while driving a taxi. He has suffered from recurrent rotatory vertigo accompanied by fluctuating hearing loss and tinnitus in the right ear for years. Despite medical treatment over the next 2 months, he experienced three more sudden drop attacks. He got chemical ablation with ITIG and remains without sudden drop attack until fourteen months later. Tumarkin otolithic crisis is a life-threatening otologic emergency. What we have experienced in this case is that for the safety and quality of life of the patient who suffers from Tumarkin otolithic crisis, aggressive vestibular function ablation with high dose ITIG is necessary.

Review

Vestibular Responses to Gravity Alterations: Nguyen Nguyen, Gyutae Kim, Kyu-Sung Kim; Res Vestib Sci. 2020;19(1):1-5. Published online March 15, 2020; DOI: https://doi.org/10.21790/rvs.2020.19.1.1

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Abstract PDF: Due to the adaptation to environments on Earth, various health-related issues are raised when exposed to different circumstances in space. Of environmental factors in space, gravity alteration has been considered as one of critical environmental changes. The primary inner organ to detect the gravity change is the vestibular system, especially otolith organs, and some limited researches have conducted to understand its mechanical and physiological properties. However, the related consequences were not consistent in despite of well description in systemic effects ranged from the peripheral vestibular system to the central nervous system. Here, we revisited the neuronal and behavioral effects of the gravity alteration on the relevant organs through this review. By representing previous studies for the gravity effects on the peripheral and central vestibular system, this review would provide the concrete understanding of the vestibular responses to the gravity alteration. Also, the physiological responses are expected to provide the useful resources to understand the systemic vestibular responses under the gravity alteration.

Case Report

Vestibular Paroxysmia Mimicking Benign Parxysmal Positional Vertigo: Hyuk Ki Cho, Ye Won Lee, Soon Hyung Park, Sung Il Nam; Res Vestib Sci. 2016;15(4):141-146. Published online December 12, 2016; DOI: https://doi.org/10.21790/rvs.2016.15.4.141

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Abstract PDF: Vestibular paroxysmia is the name given to the syndrome caused by vascular compression of the vestibulocochlear nerve. The main symptoms of vestibular paroxysmia are recurrent, spontaneous, brief attacks of spinning, non-spinning vertigo or positional vertigo that generally last less than one minute, with or without ear symptoms (tinnitus and hypoacusis). Prior to attributing a patient’s symptoms to vestibular paroxysmia, however, clinicians must exclude common conditions like benign paroxysmal positional vertigo, Menière’s disease, vestibular neuritis and vestibular migraine. This is usually possible with a thorough history and bedside vestibular/ocular motor examination. Herein, we describe a patient with vestibular paroxysmia that mimicked resolved BPPV with a literature review.

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