Research in Vestibular Science

Original Article

Efficacy of the Fixation Index of Bithermal Caloric Test for Differentiating Brain Lesions in Vestibular Disoder: Young Jae Lee, Wonyong Baek, Sung-Il Cho, Gi-Sung Nam; Res Vestib Sci. 2023;22(4):106-111. Published online December 15, 2023; DOI: https://doi.org/10.21790/rvs.2023.22.4.106

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Abstract PDF: Objectives
This study was performed to investigate the efficacy of the fixation index (FI) of the bithermal caloric test for differentiating brain lesions in vestibular disorder.
Methods
We reviewed the medical records of 286 consecutive dizzy patients who underwent brain magnetic resonance imaging (MRI) and the bithermal caloric test at department of otorhinolarnygology. Central vestibulopathy (CVP) was defined as when corresponding lesion was identified on brain MRI, otherwise peripheral vestibulopathy (PVP) was defined. The FI was defined as the mean slow phase velocity (SPV) with fixation divided by the mean SPV without fixation, and failure was indicated when the FI exceeded 70%.
Results
The CVP confirmed by brain MRI and PVP were 16.8% and 83.2%, respectively. The most common CVPs were cerebellopontine angle tumor (n=19, 39.6%) and chronic cerebellar infarction (n=18, 37.5%). There were 23 cases of CVP (47.9%) and 47 cases of PVP (19.7%) with abnormal number of FI in at least two of the four caloric irrigations. The FI score of right cool (RC), left cool (LC), and right warm (RW) were also increased significantly in patients with CVP (p=0.031 at RCFI, p=0.014 at LCFI, p=0.047 at RWFI, and p=0.057 at LWFI; Mann-Whitney U-test).
Conclusions
If two or more abnormal FIs are detected during bithermal caloric testing, there is a high likelihood of CVP. Consequently, additional brain MRI may be necessary for further evaluation.

Case Reports

Acute Vestibular Syndrome Preceded by Otologic Symptoms in Sarcoidosis: Hyeon-Joong Park, Jae-Myung Kim, Han-Sol Choi, Taebum Lee, Seung-Han Lee; Res Vestib Sci. 2021;20(2):69-73. Published online June 14, 2021; DOI: https://doi.org/10.21790/rvs.2021.20.2.69

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Abstract PDF Supplementary Material: Sarcoidosis is a rare, multisystem granulomatous disease. Neurological complications occur in about 5% of patients and vestibulocochlear involvement is even rarer. A 27-year-old woman presented with acute spontaneous vertigo for 5 days. She was diagnosed with pulmonary sarcoidosis 4 months ago, but specific treatments have not yet started. She had preceding otologic symptoms including bilateral tinnitus and ear fullness in the right for 3 months without hearing loss. Initial bedside examinations revealed spontaneous right-beating nystagmus and abnormal catch-up saccades in the left during head impulse tests (HIT). After 2 weeks, video-oculography documented the direction of spontaneous nystagmus was changed into left-beating. Caloric test showed canal paresis in the left, and video HIT showed subtle covert saccades. After starting oral prednisolone, her symptoms improved rapidly. In our case, acute vestibular syndrome and otologic symptoms might be associated with sarcoidosis when considering clinical course and treatment response. Sarcoidosis may be considered as a cause in cases with audiovestibulopathy of unknown etiology.

Atypical Presentation of Acute Vestibular Syndrome with Ramsay Hunt Syndrome: Bong-Hui Kang, Yong-Woo Lee, Jae-Il Kim; Res Vestib Sci. 2020;19(1):16-21. Published online March 15, 2020; DOI: https://doi.org/10.21790/rvs.2020.19.1.16

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Abstract PDF: Ramsay Hunt syndrome is an acquired paralysis of the face specifically caused by a varicella-zoster virus infection in the facial nerve. Other cranial nerves including vestibulo-cochlear disturbance can be affected. Herein we reported a case of Ramsay Hunt syndrome with atypical vestibular syndrome. Although central vestibular signs including direction changing post head-shaking nystagmus or normal head impulse test are generally meaningful, clinicians need to be careful to interpret them because some findings can be observed not only in cases of central disorders but also in peripheral disorders. Clinical findings such as distinct ear pain and close observation of vesicles are important to diagnose Ramsay Hunt syndrome.

A Case of Bilateral Semicircular Canal Dysplasia with Normal Cochlear Found in Bilateral Vestibulopathy: Seokhwan Lee, Sung-Won Choi; Res Vestib Sci. 2019;18(4):122-127. Published online December 15, 2019; DOI: https://doi.org/10.21790/rvs.2019.18.4.122

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Abstract PDF: A 25-year-old woman presented with atypical dizziness with oscillopsia. The neuro-otological evaluations showed bilateral vestibulopathy with mild sensorineural hearing loss. Computed tomography and magnetic resonance imaging demonstrated bilateral isolated lateral canal dysplasia (LSCD) with normal cochlea. LSCD is relatively common inner ear malformation, but it is rarely found in bilateral vestibulopathy. In case of patients with bilateral vestibulopathy who cannot find the cause, should be considered conducting radiological examinations in mind of the inner ear anomalies.

Review

Clinical Application and Update of Video Head Impulse Test: Jung Yup Lee, Jin Su Park, Min-Beom Kim; Res Vestib Sci. 2018;17(3):79-89. Published online September 18, 2018; DOI: https://doi.org/10.21790/rvs.2018.17.3.79

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8 Crossref

Abstract PDF

Recently with the introduction of video head impulse test (vHIT), it can be easily performed quantitative and objective measurement of vestibulo-ocular reflex (VOR). vHIT has been used as a clinical vestibular function test that can individually evaluate the function of each semicircular canal. Loss of VOR gain and corrective catch-up saccades that occur during the vHIT usually indicate peripheral vestibular hypofunction, whereas in acute vestibular syndrome, normal vHIT should prompt a search for a central lesion. In this study, we will examine the principle of vHIT and its interpretation, and explain its clinical application in peripheral and central vestibulopathy. In addition, we will compare the caloric test and the differences, and review the most recently introduced suppression head impulse paradigm test.

Citations

Citations to this article as recorded by

Application of the Barany Society's Presbyvestibulopathy Criteria in Older Adults With Chronic Dizziness
Joon‐Pyo Hong, Min‐Beom Kim
Otolaryngology–Head and Neck Surgery.2024; 170(2): 515. CrossRef
Vestibular mapping in Ramsay-Hunt syndrome and idiopathic sudden sensorineural hearing loss
Joon-Pyo Hong, Jung-Yup Lee, Min-Beom Kim
European Archives of Oto-Rhino-Laryngology.2023; 280(12): 5251. CrossRef
Re-fixation Saccade at Video-Head Impulse Test in Patients with Sudden Sensorineural Hearing Loss
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Research in Vestibular Science.2023; 22(2): 46. CrossRef
A Comparative Analysis of the Vestibulocochlear Function in Patients with Isolated Semicircular Canal Hypofunction Using a Video Head Impulse Test
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Research in Vestibular Science.2023; 22(2): 34. CrossRef
A Comparative Study Using Vestibular Mapping in Sudden Sensorineural Hearing Loss With and Without Vertigo
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Journal of the Korean Neurological Association.2023; 41(4): 293. CrossRef
Vestibular mapping assessment in idiopathic sudden sensorineural hearing loss
Hee Won Seo, Jae Ho Chung, Hayoung Byun, Seung Hwan Lee
Ear & Hearing.2022; 43(1): 242. CrossRef
Group Vestibular Rehabilitation Program: A Cost-Effective Outpatient Management Option for Dizzy Patients
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