Research in Vestibular Science

Dural Arteriovenous Fistula Presenting as Acute Unilateral Vestibulopathy: Won Jeong Son, Jieun Roh, Eun Hye Oh, Jae-Hwan Choi; Res Vestib Sci. 2023;22(4):127-131. Published online December 15, 2023; DOI: https://doi.org/10.21790/rvs.2023.22.4.127

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Abstract PDF: Intracranial dural arteriovenous fistula (dAVF) is characterized by an abnormal connection between branches of arteries and veins in the dura mater. Clinical manifestations of dAVF vary depending on their location, feeder arterial supply, amount of shunting, and most importantly, their venous drainage pattern. Acute vertigo has been rarely reported as an initial presentation of dAVF due to venous congestion in the brainstem. We report a patient who presented with acute right vestibulopathy without any brainstem signs in dAVF involving the transversesigmoid sinus. The patient showed abnormal caloric response but normal head impulse in the affected ear. Without any treatment, the patient’s symptoms gradually improved with a normalization of right canal paresis. Follow-up cerebral angiography also revealed a spontaneous regression of the shunt flow and reduction of venous drainage at the right transverse-sigmoid sinus. Based on the results of vestibular function tests and cerebral angiography, acute vertigo in our patient may be ascribed to impaired reabsorption of endolymph by focal venous congestion.

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 Early Developed Labyrinthine Fistula after Canal Wall Down Mastoidectomy: Sung Yong Choi, Yee Hyuk Kim; Res Vestib Sci. 2016;15(3):89-93. Published online September 15, 2016; DOI: https://doi.org/10.21790/rvs.2016.15.3.89

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Abstract PDF

Labyrinthine fistula refers to a condition caused by an abnormal connection between the inner ear and surrounding structures. Most cases of that occur as a result of a complication brought about by cholesteatoma. It may also be generated by long repeated infections of a mastoid cavity that has been exposed to the outside after canal wall down mastoidectomy (CWDM). The infection is usually repeated for several years or decades after surgery. Therefore, labyrinthine fistula after CWDM is known as a late complication. In this case, labyrinthine fistula occurred in two months after surgery due to postoperative infection. Although cholesteatoma was removed after CWDM and the horizontal semicircular canal (HSCC) was not damaged during the operation, this labyrinthine fistula was thought to develop very early after surgery. Two months after surgery, the patient complained of dizziness, we identified the opened bony labyrinth and damaged endosteum of the HSCC in the patient.

Citations

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A Case of Labyrinthitis Ossificans Presenting as an Intractable Benign Paroxysmal Positional Vertigo
Dong Hyun Kim, Jae Moon Sung, Hwi Kyeong Jung, Chang Woo Kim
Research in Vestibular Science.2017; 16(3): 92. CrossRef

Delayed Positional Vertigo after Stapes Surgery: Jin Woo Park, Joon Hee Lee, Mee Hyun Song, Dae Bo Shim; Res Vestib Sci. 2015;14(4):147-151.

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Abstract PDF: Postoperative vertigo can occur after stapes surgery in approximately 5% of the patients, which more commonly presents immediately after surgery rather than in the delayed period. Isolated delayed vertigo after stapes surgery is commonly related to perilymphatic fistula. Herein we report a 36-year-old female patient who developed positional vertigo 18 days after stapes surgery demonstrating severe geotropic horizontal positional nystagmus on both sides during supine roll test. This patient was eventually diagnosed as the horizontal semicircular canal benign paroxysmal positional vertigo (BPPV) on the left side. This is a rare case of delayed vertigo following stapes surgery caused by BPPV rather than perilymphatic fistula.

Two Cases of Barotraumatic Perilymph Fistula Mimicking Atypical Benign Paroxysmal Positional Vertigo with Sudden Hearing Loss: Jung Joo Lee, Gwanghui Ryu, Il Joon Moon, Won Ho Chung; Res Vestib Sci. 2015;14(1):26-31.

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Abstract PDF: Barotraumatic perilymph fistula is difficult to diagnose and needs diagnosis of suspicion. Symptoms like hearing loss, tinnitus, ear fullness and positional dizziness can develop following barotrauma such as valsalva, nose blowing, straining and diving, etc. We reported 2 cases of perilymph fistula following barotrauma. The patients developed hearing loss, tinnitus and ear fullness followed by sudden onset of positional dizziness mimicking benign paroxysmal positional vertigo (BPPV). On positional tests, the direction of nystagmus has changed over time. In addition, the characteristics of nystagmus on positional test were not similar to typical BPPV, which showed longer duration of nystagmus, no reversibility and no fatigability. We concluded that barotraumatic perilymph fistula could present as hearing loss with positional dizziness mimicking sudden hearing loss with BPPV. The differential diagnostic points were history of barotrauma, time sequence of development of hearing loss and positional dizziness, and atypical positional nystagmus unlike BPPV.

Superior Semicircular Canal Dehiscence Syndrome Presenting with Sudden Deafness and Vertigo after Trauma: Seong Il Kang, Sunjoo Lee, Ji Soo Kim, Ja Won Koo; Res Vestib Sci. 2013;12(4):132-135.

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Abstract: Superior semicircular canal dehiscence syndrome (SCDS) is characterized by cochleovestibular hyper-responsiveness symptoms including sound- and pressure- evoked vertigo and oscillopsia, autophony, hyperacusis and ear fullness. The typical audiometric feature of SCDS is known as conductive hearing loss at low frequency. A 43-year-old man presented with unilateral sudden deafness after several events of heading during soccer game. High-resolution temporal bone computed tomography revealed a dehiscence of superior canal encased by superior petrous sinus. We reviewed audio-vestibular findings in this patient and speculated potential pathogenic mechanisms of sudden deafness in SCDS with literature review.

MRI Findings of a Cholesteatomatous Labyrinthine Fistula Showing Abnormal Inner Ear Enhancement: Yun Ah Park, Do Yang Park, Tae Sub Chung, Hyun Seok Choi, Eun Jin Son; Res Vestib Sci. 2010;9(4):144-148.

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Abstract PDF: A 59-year-old male patient presented with sudden onset of vertigo and hearing loss. Labyrinthitis due to lateral semicircular canal fistula caused by cholesteamatous otitis media was suspected from temporal bone computed tomography (CT) and clinical symptoms. The patient was treated with canal wall down mastoidectomy with removal of the cholesteatoma and lateral semicircular canal occlusion. Preoperative gadolinium-enhanced magnetic resonance imaging (MRI) images of the inner ear revealed increased signal in the cochlea as well as vestibule. Correlation of the MRI findings and the inner ear involvement in labyrinthine fistula is discussed.

A Case of Multiple Perilymph Fistula Induced by Tympanostomy Tube Insertion: Seung Won Chung, Mi Joo Kim, Gyu Cheol Han; Res Vestib Sci. 2010;9(1):32-37.

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Abstract PDF: This controversial diagnosis centers around the phenomenon of perilymph leaking from the inner ear into the middle ear cleft through the oval window, round window or other fissures in the bony labyrinth that may be abnormally patent. A perilymph fistula may develop after stapedectomy surgery, penetrating middle ear trauma, head trauma, barotrauma, or possibly spontaneously. Uncertainty regarding the clinical criteria for the diagnosis and the inability to document the presence of a microfistula at surgery contribute to the problematic nature of this diagnosis. However, this condition should be seriously considered in the patient with vertigo after head trauma, barotrauma injury, or previous middle ear surgery. It is particularly likely in patients with penetrating middle ear trauma with vertigo. Most authors agree that perilymph fistulas generally heal spontaneously, therefore a few days of bed rest is appropriate in acute cases. Cases suspected after penetrating trauma should be explored early if symptoms persist. Here, authors report a case of multiple perilymph fistula possibly caused by tympanostomy tube insertion in a 48-year-old man with a review of the literature.

A Case of Carotid Cavernous Fistula Presenting with “Delayed Red-Eyed Shunts”: Ki Bum Sung, Won Hee Chung, Jeong Ho Park, Dae Ho Kim; J Korean Bal Soc. 2006;5(2):307-310.

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Abstract PDF: Presenting symptoms of carotid cavernous fistulas (CCF) may vary according to the draining vessels. Prominent external orbito-ocular signs such as red eye, proptosis, ocular bruit occur, when the shunt drains anteriorly (“red-eyed shunts”), whereas an isolated ocular motor nerve palsy and headache can be the only presenting symptoms when it drains posteriorly (“white-eyed shunts”). Turning the eyes red from white eyed-shunt weeks to months (“delayed red-eyed shunts”) suggest the direction of fistula drainage shifted anteriorly; it has rarely been reported. We report a patient with delayed red-eyed shunts whose red eye resolved after chemical embolization of draining vessels. Key Words : Carotid cavernous sinus fistula, Ocular motor nerve palsy

Specific MRI and MRA findings of Dural Carotid Cavernous Sinus Fistula -A Case Report-: Won Hee Chung, Jong Se Lee, Tae Kyeong Lee, Ki Bum Sung; J Korean Bal Soc. 2006;5(2):296-298.

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Abstract PDF: Dural carotid-cavernous sinus fistula (d-CCF) is a rare cause of ophthalmoplegia, and it may be overlooked when the prominent external orbito-ocular sign is lacking. Conventional angiography is the gold standard in the diagnosis of d-CCF. Recently, the specific MR findings of d-CCF have increasingly been reported. We report a patient with spontaneous d-CCF presenting with an isolated fourth-nerve palsy in whom magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) demonstrated d-CCF. Key Words : Carotid cavernous sinus fistula, Ophthalmoplegia, Angiography, Magnetic resonance imaging, Magnetic resonance angiography

Traumatic Perilymphatic Fistula Presenting with Direction-Changing Positional Nystagmus: Ja Won Koo, Si Whan Kim, Ji Soo Kim, Sung Wha Hong; J Korean Bal Soc. 2004;3(1):173-176.

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Abstract PDF: Diagnosis of perilymphatic fistula (PLF) is considered in the patient presenting hearing loss associated with ataxia after penetrating injury of the tympanic membrane. PLF accompanies mixed type hearing loss and paralytic nystagmus. If audiovestibular symptoms and signs are not definite for those patients, in whom PLF is highly suspicious, they can be induced by affected ear down position. The direction of nystagmus induced by position change was reported either toward or away from the affected ear. But the direction changing nature has not been noted in the previous literature. We report on a case of traumatic PLF presented with direction changing positional nystagmus and discuss the possible mechanism involved in this case. Key Words : Positional nystagmus, Perilymphatic fistula

Analysis of Vertigo in Labyrinthine Fistula Secondary to Cholesteatoma: Gyu Cheol Han, Joo Hyun Woo; J Korean Bal Soc. 2003;2(2):198-201.

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Abstract PDF: Background
and Objectives: Labyrinthine fistula is one of the common complication of the chronic otitis media with cholesteatoma. Disruption of the labyrinthine bone can lead to hearing loss and/or vestibular disturbance. This study aimed to evaluate postoperative vertigo result in patient with labyrinthine fistula and efficacy of vestibular function test for diagnosis. Materials and Method: A retrospective study of the clinical records of 13 patients who were operated for chronic otitis media with cholesteatoma, suspected to have secondary labyrinthine fistula, from January 2001 through June 2003 in Gachon medical school Gil hospital. All patients were evaluated by Fistular test, Vestibular function test, high resolution Temporal bone CT, Pure tone audiometry preoperatively. Vertigo was assessed by Disability Scale.
Results
Canal wall down mastoidectomy were applied in all ears. Labyrinthine fistulas were confirmed in 8 patients during operation. Fistular group had higher rate of peripheral vestibular injury than no-fistular group's in vestibulo-ocular reflex. Fistula cases have high average score (2.9) than non-fistula's (1.6) in Vertigo scale preoperatively. In post-operation, the average score was 0.25 in fistular cases and 0.4 in non-fistula cases. 2 cases presented positive fistular test result (25.0%)
Conclusion
Although Vertigo was more severe in patients who had fistula, in post-operation, symptoms could be relieved a lot. Vestibular function test had efficacy for diagnosis of labyrinthine fistula in preoperative.

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