Research in Vestibular Science

Original Article

Quantifying the Prevalence of Acute Vestibular Neuritis through Big Data Analysis: Chul Young Yoon, Seulgi Hong, Ji-Yun Park, Young Joon Seo; Res Vestib Sci. 2023;22(3):68-76. Published online September 15, 2023; DOI: https://doi.org/10.21790/rvs.2023.22.3.68

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Abstract PDF Supplementary Material: Objectives
Big data analytics in healthcare research have gained momentum, offering unprecedented opportunities to investigate complex medical conditions like acute vestibular neuritis (AVN). However, an inappropriate definition can introduce bias and inaccuracies into prevalence estimation, making the results unreliable and hindering cross-study comparisons. The Health Insurance data in South Korea will be used to create a robust operational definition for AVN.
Methods
The study utilized the National Patients Sample dataset from the Health Insurance Review and Assessment Service (HIRA) of the Republic of Korea. The operational definition of AVN was defined using the HIRA data, which includes specific codes for diagnosis, testing, and medications. The revised categorization scheme for AVN was presented as case 1 through case 5, with criteria for each category.
Results
The optimal conditions are deemed to be those that encompass the outcomes of both case 5 and case 1-1, encompassing all conditions. The study also provided prevalence estimates for subgroups based on demographic factors (age, sex), and found a consistent pattern throughout all years, sex, and age.
Conclusions
The study analyzed the prevalence of AVN in case 1 and case 5, which were similar to the reference prevalence of 3.5 per 100,000 people reported in other countries. The study’s results are encouraging for several reasons, including the validity of the operational definitions used, and the agreement between the study’s prevalence estimates and the reference prevalence. The operational definition in statistics, in the context of big data, serves as a precise and standardized criterion.

Case Reports

Vestibular Neuritis after COVID-19 Vaccination: So-Hyun Kim, Se Hwan Hwang; Res Vestib Sci. 2022;21(3):89-92. Published online September 15, 2022; DOI: https://doi.org/10.21790/rvs.2022.21.3.89

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Abstract PDF: Coronavirus disease 2019 (COVID-19) spread rapidly and was declared a pandemic. In this situation, vaccination for COVID-19 is important and has been prompted in many countries. However, a number of adverse events have been reported for the Pfizer, Moderna, and AstraZeneca vaccines. Otolaryngologic adverse events after COVID-19 vaccination were reported, including several cases of sudden sensorineural hearing loss. Vestibular neuritis (VN) is an acute vestibular syndrome that causes acute and spontaneous vertigo due to unilateral vestibular deafferentiation, leading to nausea or vomiting and unsteadiness that can last from days to weeks. Neurotropism for the cochleovestibular nerve, immunoglobulin G mediated immune off-target reaction, and reactivation of latent viruses are hypothesized to be etiologies. Herein, the case of a 49-year-old female who developed VN after COVID-19 vaccination is presented. Although the association between VN and COVID-19 vaccination remains unclear, clinicians should be aware that VN may occur as an adverse event of COVID-19 vaccination.

Paraneoplastic Cerebellar Degeneration Presented as Acute Vertigo: Sung-Hee Kim; Res Vestib Sci. 2022;21(1):24-27. Published online March 15, 2022; DOI: https://doi.org/10.21790/rvs.2022.21.1.24

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Abstract PDF: Paraneoplastic cerebellar degeneration is a rare neurological manifestation of nonmetastatic malignancy. Its usual manifestation is subacute to chronic dizziness, gait ataxia, and dysarthria. There have been only a few cases of paraneoplastic cerebellar degeneration with acute presentation. This study describes a patient with paraneoplastic cerebellar degeneration, who presented acute vestibular syndrome and then episodically developed horizontal gaze-evoked nystagmus and gait ataxia.

Unilateral Vestibular Neuritis after Snakebite: Is There a Causal Relationship?: Jae-Myung Kim, Hyeon-Joong Park, Shina Kim, Seung-Han Lee; Res Vestib Sci. 2020;19(4):144-148. Published online December 15, 2020; DOI: https://doi.org/10.21790/rvs.2020.19.4.144

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Abstract PDF: Vast majority of triggering factors preceding vestibular neuritis (VN) are unknown, although many cases are associated with viral infection. A 55-year-old woman was bitten by a viper on her right hand, and she was treated with antivenom at the primary clinic. Three days later, acute persistent vertigo was developed. Neuro-otologic examinations revealed spontaneous left-beating nystagmus and abnormal head impulse test in the right side. Taken together with negative result of brain magnetic resonance imaging, she was diagnosed with a right VN. Various neurological complications such as paralysis, optic neuritis, and stroke can occur after snakebite envenoming. In this case, given the time interval between snakebite and development of dizziness, snakebite envenoming might be a possible predisposing factor of VN as a proinflammatory condition rather than a direct cause of VN. Furthermore, the VN of this case was probably caused by late adverse reactions after antivenom administration. Since about 10% of the snake-bitten patients have complained dizziness, detailed neuro-otologic evaluations may lead to a proper understanding of pathomechanism and a correct diagnosis.

Original Article

Shoe-Type Wearable Sensors Measure Gait Parameters in Vestibular Neuritis: A Preliminary Study: Jun Sang Cha, Dong Young Kim, Hye Soon Lee, Nambeom Kim, Hwan Ho Lee; Res Vestib Sci. 2019;18(2):43-49. Published online June 15, 2019; DOI: https://doi.org/10.21790/rvs.2019.18.2.43

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Abstract PDF

Objectives
Despite patients with dizziness were reported of revealing gait problems, there is still lack of objective quantitative measurement of gait patterns of peripheral vestibular disorders. To demonstrate gait variability in acute unilateral peripheral vestibular deficit, we evaluated the differences in gait patterns between vestibular neuritis (VN) patients and healthy subjects by the use of shoe-type inertial measurement unit (IMU) with sensors mounted.
Methods
Between April 2017 and January 2019, 30 patients diagnosed with unilateral peripheral vestibular deficit presumed to be caused by VN were enrolled in this study. The shoe-type IMU was used to analysis subjects. We assessed gait speed, cadence, stride length, stance phase, normalized stride length, normalized step length, phase coordination index and gait asymmetry of data from shoe-type IMU sensors with the walking protocol. We tested 30 healthy volunteers as control group.
Results
We identified spatiotemporal parameters of human gait. The gait speed of patients with VN was decreased to 3.82±0.8 compared to 4.93±1.08 in control group. In addition, there were differences in normalized stride length, normalized gait speed and related gait parameters, when comparing VN group and control group.
Conclusion
Gait analysis by the use of shoe-type IMU could provide important information regarding vestibular pathophysiology in patients with VN. Gait performance tests can examine gait variability quantitatively. It will be taken into consideration as a vestibular function test for patients with vertigo.

Citations

Citations to this article as recorded by

Comparison of Gait Parameters during Forward Walking under Different Visual Conditions Using Inertial Motion Sensors
Eun Jin Son, Ji Hyung Kim, Hye Eun Noh, Inon Kim, Joo Ae Lim, Seung Hwan Han
Yonsei Medical Journal.2022; 63(1): 82. CrossRef

Case Report

Visuospatial Dysfunction in Patients With the Right Vestibular Neuritis: Seung-Ho Jeon, Ko-Woon Kim, Hyun-June Shin, Byoung-Soo Shin, Man-Wook Seo, Sun-Young Oh; Res Vestib Sci. 2019;18(1):19-23. Published online March 15, 2019; DOI: https://doi.org/10.21790/rvs.2019.18.1.19

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Abstract PDF

Acute vestibular neuritis (VN) is characterized by acute/subacute vertigo with spontaneous nystagmus and unilateral loss of semicircular canal function. Vestibular system in human is represented in the brain bilaterally with functional asymmetries of the right hemispheric dominance in the right handers. Spatial working memory entails the ability to keep spatial information active in working memory over a short period of time which is also known as the right hemispheric dominance. Three patients (patient 1, 32-year-old female; patient 2, 18-year-old male; patient 3, 63-year-old male) suffered from acute onset of severe vertigo, nausea and vomiting. Patients 1 and 2’s examination revealed VN on the right side showing spontaneous left beating nystagmus and impaired vestibular ocular reflex on the right side in video head-impulse and caloric tests. Patient 3’s finding was fit for VN on the left side. We also evaluated visuospatial memory function with the block design test in these 3 VN patients which discovered lower scores in patients 1 and 2 and the average level in patient 3 compare to those of healthy controls. Follow-up block design test after resolved symptoms showed within normal range in both patients. Our cases suggest that the patients with unilateral peripheral vestibulopathy may have an asymmetrical effect on the higher vestibular cognitive function. The right VN can be associated with transient visuospatial memory dysfunction. These findings add the evidence of significant right hemispheric dominance for vestibular and visuospatial structures in the right-handed subjects, and of predominant dysfunction in the hemisphere ipsilateral to the peripheral lesion side.

Citations

Citations to this article as recorded by

The Differential Effects of Acute Right- vs. Left-Sided Vestibular Deafferentation on Spatial Cognition in Unilateral Labyrinthectomized Mice
Thanh Tin Nguyen, Gi-Sung Nam, Jin-Ju Kang, Gyu Cheol Han, Ji-Soo Kim, Marianne Dieterich, Sun-Young Oh
Frontiers in Neurology.2021;[Epub] CrossRef

Original Article

Cardiovascular Risk Factors in Total or Divisional Vestibular Neuritis: Seunghee Na, Eek-Sung Lee, Ki-Bum Sung, Tae-Kyeong Lee; Res Vestib Sci. 2017;16(4):135-141. Published online December 15, 2017; DOI: https://doi.org/10.21790/rvs.2017.16.4.135

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Abstract PDF: Objectives
In vestibular neuritis (VN), the lesion preferentially affects the superior vestibular nerve because of the anatomic arrangement. It is well known that VN patients have a higher score of metabolic syndrome or a higher incidence of vertebral artery hypoplasia than controls. However, it is unclear whether the frequency of cardiovascular risk factors can affect the selective involvement of the branch of the vestibular nerve. Thus, we investigated the influence of cardiovascular risk factors on the development of total- or divisional VN. Methods: 61 patients with VN were enrolled. Video head impulse tests and caloric tests were performed to determine which vestibular divisionswere affected. The patients were divided into divisional-VN (superior or inferior) and total-VN groups. Statistical analysis of the frequency of cardiovascular risk factors was performed only in superior and total VN groups because the number of inferior VN patients was too small to be statistically analyzed. Results: Nineteen (31.1%) patients were classified as the total-VN group. In the divisional-VN group (42 patients, 65.6%), 40 were superior VN. The frequency of cardiovascular risk factors are not significantly different in superior VN and total-VN groups (All patients 50/61 [82.0%], superior-VN 36/40 [90.0%], total-VN 13/19 [68.4%]). The frequency of having more than one cardiovascular risk factor was slightly higher in the superior VN group, (13 [68.4%] vs. 36 [90.0%], p=0.062) but did not show any significant difference. Conclusions: The number of cardiovascular risk factors did not differ in superior VN patients compared to total VN patients.

Review

Acute Vestibular Neuritis and Ramsay-Hunt Syndrome: Mi Joo Kim, Minbum Kim; Res Vestib Sci. 2016;15(4):112-120. Published online December 12, 2016; DOI: https://doi.org/10.21790/rvs.2016.15.4.112

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Abstract PDF: Acute vestibular neuritis is the disorder characterized by acute, spontaneous vertigo with the unilateral vestibular loss. Reactivation of herpes simplex virus is considered as its cause. Its management consists of symptomatic therapy in the acute phase and following rehabilitation exercise to improve central compensation. The differential diagnosis should include central vestibular disorders mimicking peripheral vertigo. Ramsay-Hunt syndrome, which defined as a herpes zoster oticus with facial paresis, is also a disorder frequently accompanied with vestibular deficit. Combination therapy of acyclovir and corticosteroid is recommended for the treatment. In this review, diagnosis and management of the two disorders are described.

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.

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.

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