Research in Vestibular Science

Case Reports

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; Res Vestib Sci. 2017;16(3):92-96. Published online September 15, 2017; DOI: https://doi.org/10.21790/rvs.2017.16.3.92

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Abstract PDF: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder. It is easily cured with canal repositioning maneuvers, but some patients are resistant to the repositioning maneuver and require surgical intervention. Labyrinthitis ossificans is the pathologic condition that fibrous tissue and new bone occupy the membranous labyrinthine space. It occurs as a sequela of inner ear inflammation resulting from diverse causes, mostly bacterial meningitis and otitis media. We describe here a 42-year-old female patient with refractory posterior semicircular canal (PSCC) BPPV and adhesive otitis media in same ear. Otoscopic examination revealed adhesive tympanic membrane without middle ear space and temporal bone computed tomography showed complete ossification of the labyrinth at the same side. We performed a canal wall down mastoidectomy and PSCC occlusion. The patient had complete resolution of paroxysmal vertigo and positional nystagmus, postoperatively.

Bacterial Meningitis Initially Presenting as Labyrinthitis: Bon Min Koo, Sung Il Nam, Soon Hyung Park; Res Vestib Sci. 2017;16(2):69-72. Published online June 15, 2017; DOI: https://doi.org/10.21790/rvs.2017.16.2.69

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Abstract PDF: Labyrinthitis causes damage to inner ear structure, and in turn hearing loss and vertigo. Labyrinthitis is classified as otogenic labyrinthitis and meningogenic labyrinthitis. Otogenic labyrinthitis can be diagnosed early through otoscopic examination. However, when there are no characteristic neurologic symptoms in patients with meningogenic labyrinthitis, clinicians can overlook the underlying meningitis and this may lead to the peripheral vertigo. We encountered an unusual case of meningogenic labyrinthitis that is misdiagnosed as peripheral dizziness.

Original Article

Cervical Vestibular Evoked Myogenic Potential and Ocular Vestibular Evoked Myogenic Potential in Patients With Vestibular Neuritis and Acute Viral Labyrinthitis: Il Ha Moon, Chan Goo Lee, Moo Kyun Park, Jong Dae Lee; Res Vestib Sci. 2012;11(3):92-96.

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Abstract: Background and Objectives: Vestibular neuritis predominantly affects the superior branch of the vestibular nerve, resulting in vertigo. Acute viral labyrinthitis occurs when an infection affects both vestibulo-cochlear nerve and labyrinth, resulting in hearing changes as well as vertigo. The purpose of study is to identify there is a difference of cervical vestibular evoked myogenic potentials (cVEMP) and ocular VEMP (oVEMP) in patients with vestibular neuritis and acute viral labyrinthitis. Materials and Methods: cVEMP and oVEMP tests using 500-Hz tone-burst stimuli were performed on patients with vestibular neuritis and acute viral labyrinthitis. Pure tone audiometry, caloric test and subjective visual vertical (SVV) were performed in all patients. We compared the VEMP results, SVV, caloric test in patients with vestibular neuritis and acute viral labyrinthitis. Results: Abnormal cVEMP responses were detected in 2 (20%) patients with vestibular neuritis and 5 (100%) patients with labyrinthitis. Abnormal oVEMP responses were detected in 9 patients (90%) with vestibular neuritis and 5 (100%) patients with labyrinthitis. oVEMP abnormalities is correlated with caloric test and subjective visual vertical in patients with vestibular neuritis and labyrinthits. Conclusion: Our results shows that the response of cVEMP and oVEMP between patients with vestibular neuritis and acute viral labyrinthitis is different. We can infer that oVEMP response to air-conducted sound is different vestibular origin compared to cVEMP and may originate from utricle.

Case Reports

A Case of Acute Serous Labyrinthitis Complicated by Chronic Otitis Media Showing Atypical Nystagmus Pattern: Hyun Woo Park, Seong Ki Ahn, Dong Gu Hur; Res Vestib Sci. 2011;10(1):42-45.

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Abstract PDF: Serous or suppurative labyrinthitis is one of the intratemporal complications of acute or chronic otitis media. Labyrinthitis can occur by meningogenic or hematogenous infection. Major symptoms of labyrinthitis are vertigo and hearing loss. The disease progresses in two phases; serous labyrinthitis, so called toxic labyrinthitis, and suppurative labyrinthitis. If labyrinthitis treated at serous phase, hearing could be saved. But, if the disease progressed to suppurative phase, hearing loss is difficult to recover. Therefore it is very important to distinguish these two phases of labyrinthitis when treating the patient. In general, the direction of nystagmus during labyrinthitis is helpful sign to distinguish these two phases. We report here on an unusual case of acute serous labyrinthitis complicated with chronic otitis media showing atypical pattern with a review of the related literatures.

A Case of Vestibular Schwannoma Mimicking Acute Labyrinthitis: Dong Yeol Han, Won Ik Jang, Jong Dae Lee; Res Vestib Sci. 2009;8(2):164-167.

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Abstract PDF: Acute labyrinthitis is clinically characterized by cochlear symptom like sudden hearing loss, tinnitus and aural fullness and vestibular symptom like vertigo and spontaneous nystagmus. Several disease entities may mimic labyrinthitis when the disease does not manifest its own characteristic findings. We present the case of a 43-year-old female patient who was suffering from the acute vertigo and sudden hearing loss in her right ear. The speech discrimination score in right side was 24% and brain magnetic resonance imagine revealed a mass in internal auditory canal and minimally extending cerebellopontine angle. Removal of mass was performed via translabyrinthine approach and rapid vestibular compensation was accomplished after surgery.

Delayed Postoperative Vertigo After Tympanomastoidectomy Due to Simultaneous Serous Labyrinthitis and BPPV: Yun Ho Kim, Jae Yun Jung, Chung Ku Rhee, Myung Whan Suh; J Korean Bal Soc. 2008;7(1):89-95.

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Abstract PDF: Postoperative vertigo after tympanomastoidectomy can be attributed to several causes such as inner ear damage due to excessive ossicle handling, labyrinthitis, BPPV resulting from vibration of drilling, iatrogenic lateral semicircular canal damage, and perilymphtic fistula. Differential diagnosis is critical for the proper management and prognosis of accompanied sensorineural hearing loss, but it may be difficult in some cases. Especially it is quite difficult to distinguish between the serous and suppurative labyrinthitis. In this article we present a case with simultaneous serous labyrinthitis and BPPV. The patient developed whirling vertigo and hearing loss on the 5th day after tympanomastoidectomy. After conservative treatment with steroid and antibiotics, his hearing recovered to preoperative level. We retrospectively reviewed the pitfalls to make a correct diagnosis in this patient and the serial change in nystagmus during the treatment period. The usefullness of the rotation chair test to predict the prognosis of sensorineural hearing loss in labyrinthitis was also discussed.

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