Research in Vestibular Science

Original Articles

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

Does 125-Hz Pure-Tone Thresholds Have Prognostic Value in Patients with Sudden Sensorineural Hearing Loss and Vertigo?: Yong-Hwi An, Hyun Joon Shim; Res Vestib Sci. 2020;19(1):6-11. Published online March 15, 2020; DOI: https://doi.org/10.21790/rvs.2020.19.1.6

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Abstract PDF: Objectives
To analyze 125-Hz pure-tone thresholds in dizzy patients with sudden sensorineural hearing loss (SSNHL) and to investigate the relationship between 125-Hz thresholds and the prognosis of SSNHL with vertigo.
Methods
Hearing and vestibular function tests including 125-Hz pure-tone were performed in 132 patients with SSNHL and 65 subjects with normal hearing. Audiometric follow-up was performed at 6 months after initial visit. Intergroup and intragroup comparison of 125 Hz was made between SSNHL and control groups.
Results
Twenty-four patients (18.2%) had normal thresholds at 125 Hz in SSNHL group, whereas all subjects showed normal at 125 Hz in control group. None with average hearing threshold at 250 and 500 Hz≥30 dB had normal threshold at 125 Hz. There was no significant relationship between 125-Hz threshold and results of vestibular function test. There was no correlation between 125-Hz threshold and hearing recovery in SSNHL group.
Conclusions
There might be no need to assess 125-Hz pure-tone threshold in patients with SSNHL, because it is enough to evaluate thresholds of 250 and 500 Hz for low frequency.

Significance of 125 Hz Pure-Tone Thresholds for Dizzy Patients with Low Frequency Sensorineural Hearing Loss: Yong-Hwi An, Hyun Joon Shim; Res Vestib Sci. 2017;16(4):108-112. Published online December 15, 2017; DOI: https://doi.org/10.21790/rvs.2017.16.4.108

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Abstract PDF: Objectives
To measure 125 Hz pure-tone thresholds in patients with low frequency sensorineural hearing loss (LFHL) and vertigo and to evaluate the necessity of 125 Hz thresholds for assessment of LFHL with vertigo. Methods: Pure tone audiometry including 125 Hz was performed in 25 dizzy patients with LFHL ≤500 Hz and 25 age-matched subjects with normal hearing. Patients with sudden sensorineural hearing loss and vertigo were excluded. Comparison of 125 Hz between LFHL and control groups, and comparison of 125 Hz and other frequencies in LFHL group was made. Results: Mean pure-tone thresholds at 125 Hz in LFHL group (41.7±7.5 dB) was higher than that in normal controls (12.8±6.4 dB). Three (12%) patients had normal thresholds at 125 Hz in LFHL group, whereas all subjects showed normal at 125 Hz in control group. None with average hearing thresholds at 250 and 500 Hz ≥35 dB had normal threshold at 125 Hz. There was a significant correlation between 125 Hz and other low frequencies in LFHL group (250 Hz; r=0.79, 500 Hz; r=0.66). Conclusions: Not every patient of LFHL with vertigo has abnormal hearing threshold at 125 Hz, although all subjects with normal hearing is within normal limits at 125 Hz. Measurement of 125 Hz pure-tone threshold is highly recommended when a mild LFHL exists.

Symposium I

Associated Symptoms in Dizziness: Hearing Loss and Tinnitus: Mi Na Park, Myung-Whan Suh; Res Vestib Sci. 2013;12:S16-S23. Published online June 1, 2013

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Abstract PDF: Dizziness is one of the most common complaint leading patients to visit their primary care physicians in older people. Despite its frequency, symptoms of dizziness can be difficult for the physician to categorize. Also many dizzy patients have hearing loss. The evaluation of patients with dizziness depends on not only the history of dizziness, physical findings but also basic laboratory tests such as audiometry, electrocochleogram, Cochlear hydrops analysis masking procedure, auditory brainstem response. Based on these considerations, this article outlines the interpretation of basic audiologic tests which is fundamental in evaluating dizzy patients.

Original Article

Various Causes of Vertigo in Children with Normal Eardrums: Yun Hoon Choung, Sang Jun Ryu, Min Jung Cho, Sung Kyun Moon, Keehyun Park; J Korean Bal Soc. 2003;2(1):121-126.

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Abstract PDF: Background
and Objectives: The differential diagnosis of vertigo in children is extensive. Otitis media and middle ear effusion could be most common causes of vertigo in children, but there are some problems in detecting the other causes for vertigo because they are one of most popular diseases in childhood. The purpose of this study is to review the clinical characteristics and both the audiological and vestibular findings of vertigo in children with normal eardrums, who do not show otitis media or middle ear effusion, and assist in making a differential diagnosis of vertigo. Materials and Method: The sixty eight children (less than 16 years old) with vertigo, who visited the Department of Otolaryngology, Ajou University Hospital, Suwon, Korea between January 1995 and April 2003 were selected for this study. These excluded the patients with abnormal eardrums/tympanograms or those that did not perform questionnaires, audiological, or vestibular evaluations. They were retrospectively analyzed for clinical symptoms, audiograms, vestibular functions, and differential diagnosis.
Results
The most common causes for vertigo in children were benign paroxysmal vertigo of childhood (BPVC) in 21 (30.9%) and migraine in 20 (29.4%). Other less frequent causes included four cases of trauma, three cases of acute vestibular neuritis. two cases each of Meniere's disease, delayed endolymphatic hydrops, benign positional vertigo, and one case only for cerebellopontine angle tumor, seizure, juvenile rheumatoid arthritis, leaving eleven cases (16.2%) as unclassified. Abnormal findings were noted in 14 (20.6%) in pure tone audiogram, 3 (4.4%) in positioning test, 11 (16.2%) in bithermal caloric test, and 47 (69.1%) in rotation chair test.
Conclusions
The vertigo in children with normal eardrums, who did not show otitis media or middle ear effusion, was most commonly caused by BPVC and migraine. These findings have shown to be very different from those with adult vertigo. The evaluation of vertigo in children requires a questionnaire for extensive and complete history taking, audiograms and vestibular function tests. And in selected cases, electroencephalography, hematological evaluation, imaging of the brain or temporal bone should be performed.

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