Research in Vestibular Science

Original Articles

Clinical Outcomes of Endolymphatic Sac Decompression Surgery in Menière’s Disease: Hee Won Seo, Young Sang Cho, Won-Ho Chung; Res Vestib Sci. 2023;22(4):97-105. Published online December 15, 2023; DOI: https://doi.org/10.21790/rvs.2023.22.4.97

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Abstract PDF: Objectives
Endolymphatic sac decompression surgery (ESDS) is one of the surgical methods for intractable Menière’s disease (MD), and it is known as a relatively safe treatment that does not cause hearing loss. However, the effectiveness and the degree of vertigo control rate of ESDS are still controversial. In this study, we aimed to evaluate the clinical outcomes of ESDS in intractable MD.
Methods
We retrospectively reviewed 33 patients who underwent ESDS for intractable MD from January 2002 to March 2022. Clinical characteristics of patients, pure tone threshold, medical treatment method, and number of vertigo attacks before and after surgery were assessed. The improvement of hearing and vertigo was evaluated according to the 1995 American Academy of Otolaryngology-Head and Neck Surgery criteria.
Results
Of the 33 patients, the average follow-up period was 21.2 months, with immediate follow-up within 2 months (28 patients), short term between 2 and 6 months (27 patients), and long term at 12 months or later (29 patients). In the immediate hearing threshold, both air conduction and bone conduction showed slight deterioration, but there was no significant change in the long-term hearing threshold. At long-term follow-up, 12 patients (41.4%) were able to live without medication, and 18 patients (62.1%) showed improvement in their vertigo symptoms. In addition, patients who showed improvement in hearing also showed improvement in vertigo at the same time.
Conclusions
ESDS in intractable MD is a relatively safe and effective treatment method for reducing vertigo attack without worsening hearing threshold.

Comparison of Predictive Parameters between the Video Head Impulse Test and Caloric Test: Chun Han, Seung Won Paik, Hui Joon Yang, Sang Yoo Park, Ji Hyeon Lee, Young Joon Seo; Res Vestib Sci. 2020;19(2):55-61. Published online June 15, 2020; DOI: https://doi.org/10.21790/rvs.2020.19.2.55

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Objectives
The aim of this paper was to determine if a correlation exists between video head impulse test (vHIT) and electronystagmography with caloric test (ENG). More specifically, comparison of covert and overt value from vHIT test with cold and warm stimulation value from ENG test.
Methods
Retrospective study of our single institue from the period of January 2015 to January 2017 enrolled 91 patients. Patients were divided into 3 groups by their diagnosis of either vestibular neuritis (VN), Meniere disease, or sudden sensorineural loss with vertigo accordingly. Each of the patients’ both ENG and vHIT data were recorded and parameters were evaluated.
Results
VN group was the only group to show a significant correlation between canal paresis (CP) with covert and overt saccades. Further analysis was done in the VN group and result showed covert saccade showing a larger area under the receiver operation characteristic curve value (0.77) compared to overt saccades (0.70), implying that covert saccade is a more accurate parameter for the prediction of the CP value. Furthermore, a positive correlation was seen between the gain value and the cold caloric stimulation value as well as between warm caloric stimulation value.
Conclusions
The value of our study lies in the fact that we have attempted to find a correlation between different parameters of 2 different vestibular tests. We concluded that the evaluation of overt nystagmus by the bedside head thrust test is inappropriate for predicting CP, and a vHIT is required to accurately evaluate vestibular function.

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A Comparative Analysis of the Vestibulocochlear Function in Patients with Isolated Semicircular Canal Hypofunction Using a Video Head Impulse Test
Yu Jung Park, Min Young Lee, Ji Eun Choi, Jae Yun Jung, Jung Hwa Bahng
Research in Vestibular Science.2023; 22(2): 34. CrossRef

Incidence of Progression into Ménière Disease from Idiopathic Sudden Sensorineural Hearing Loss: Midterm Follow-up Study: Byeong Min Lee, Jin Hyun Seo, Hyun Woo Park, Hyun Jin Lee, Dong Gu Hur, Seong Ki Ahn; Res Vestib Sci. 2018;17(3):95-101. Published online September 18, 2018; DOI: https://doi.org/10.21790/rvs.2018.17.3.95

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Abstract PDF: Objectives
Ménière disease is a clinical syndrome characterized by the four major symptoms of episodic vertigo, sensorineural hearing loss, tinnitus, and aural fullness. Sensorineural hearing loss, especially low frequency, is the characteristic type of audiogram in Ménière's disease. However, it is difficult to distinguish idiopathic sudden sensorineural hearing loss (ISSNHL) with vertigo from the first attack of Ménière disease. The purpose of this study was to investigate the incidence of progression into Ménière Disease from low frequency ISSNHL.
Methods
Two hundred eighty-three patients were included in this study. We classified the patients with ISSNHL according to the hearing loss in audiogram and analyzed how many of them actually progressed to Ménière disease based on diagnosis criteria.
Results
Among the 240 patients, 37.1% (89 patients) were confirmed low frequency ISSNHL and 14.6% (13 patients) of them were diagnosed with Meniere disease.
Conclusions
This study showed that the progression from low frequency ISSNHL to Ménière disease was higher than other frequency ISSNHL, as in other studies.

Prognosis of Sudden Low Frequency Hearing Loss during Long-term Follow-up: Ji Hyung Kim, Sang Hyun Kwak, Seong Hoon Bae, Sung Hunh Kim, Gi-Sung Nam; Res Vestib Sci. 2018;17(3):102-108. Published online September 18, 2018; DOI: https://doi.org/10.21790/rvs.2018.17.3.102

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Abstract PDF

Objectives
The prognosis of sudden low frequency hearing loss (SLFHL) is relatively good, but recurrences of hearing loss and possible progression to Meniere’s disease is still a clinically important concern. This study was conducted to confirm the rate at which SLFHL proceeds to Meniere’s disease.
Methods
We retrospectively analyzed the medical records of 160 SLFHL patients who were followed up for more than 6 months from September 2005 to August 2013. Progression, initial hearing level, recovery and recurrence of hearing loss were reviewed.
Results
106 patients (66.25%) had complete hearing recovery, 32 (20%) had recurrent hearing loss. Of the 32 recurrent group, 15 (9.38%) had progressed to Meniere’s disease after average of 1.7±1.4 years. The mean age of nonrecurrent group was higher than recurrent group (55.3±14.6 and 48.0±13.4, respectively, p=0.011). The threshold of 250Hz was significantly higher in the nonrecurrent group compared with recurrent group (p=0.047).
Conclusions
In patients with SLFHL, recurrence at relatively young age should be considered with the possibility of progression to Meniere’s disease.

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Findings of Intravenous Gadolinium Inner Ear Magnetic Resonance Imaging in Patients With Acute Low-Tone Sensorineural Hearing Loss
Hee Won Seo, Yikyung Kim, Hyung-Jin Kim, Won-Ho Chung, Young Sang Cho
Clinical and Experimental Otorhinolaryngology.2023; 16(4): 334. CrossRef

Hyper-response of Cervical Vestibular Evoked Myogenic Potential in Patients with Meniere Disease: A Preliminary Study: Soyeon Yoon, Mi Joo Kim, Minbum Kim; Res Vestib Sci. 2018;17(2):44-48. Published online June 15, 2018; DOI: https://doi.org/10.21790/rvs.2018.17.2.44

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Abstract PDF

Objectives
The purpose of this study is to investigate the hyper-responsiveness of cervical vestibular-evoked myogenic potential (cVEMP) in patients with Meniere disease (MD), and to compare the result of cVEMP between probable and definite MD group.
Methods
A total of 110 patients satisfied with probable MD and definite MD criteria, which is recently formulated by the Classification Committee of the Bárány Society, were included. An interpeak amplitude and interaural amplitude difference (IAD) ratio of both ears was measured. The abnormal response of ipsi-lesional cVEMP was categorized into 2 groups; hyper-response and hypo-response. Chi-square test and Mann-Whitney U-test were used for statistical analysis.
Results
In the probable MD and definite MD group, the mean IAD was 25.24%±17.79% and 53.82%±34.98%, respectively (p＜0.01). The abnormal response of cVEMP at the affected ear was more frequent in the definite MD group, compared to the probable MD group (32/40 vs. 13/36, p＜0.01). However, hyper-response was more frequently observed in the patients with probable MD, compared to the patients with definite MD (13/36 vs. 3/40, p＜0.01).
Conclusion
Hyper-response of cVEMP was more frequently observed in the early probable MD patients. It might be an early sign of MD, related with the saccular hydrops, which can help the early detection and treatment.

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Superior Semicircular Canal Dehiscence Syndrome Manifested as Menière’s Disease: A Case Report
Byeong Jin Kim, Yun Na Yang, Chan Mi Lee, Eun Jung Lee
Research in Vestibular Science.2021; 20(3): 108. CrossRef
Characteristics of Nystagmus during Attack of Vestibular Migraine
Soyeon Yoon, Mi Joo Kim, Minbum Kim
Research in Vestibular Science.2019; 18(2): 38. CrossRef

Case Report

A Case of Recurrent Vertigo in Vestibular Schwannoma Treated with Chemical Labyrinthectomy: Seung Jae Lee, Eun Sang Lee, Bo Gyung Kim, Jong Dae Lee; Res Vestib Sci. 2017;16(4):147-150. Published online December 15, 2017; DOI: https://doi.org/10.21790/rvs.2017.16.4.147

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Abstract PDF

Vestibular schwannoma (VS) can have various symptoms and almost half of the patients have balance problems. Some patients with VS can suffer from recurrent vertigo mimicking Meniere’s disease. We present the case of a 61-year-old male patient who was suffering from recurrent vertigo due to VS while symptoms improved by chemical labyrinthectomy with gentamicin. We consider that chemical labyrinthectomy can be an option in the treatment of patients with recurrent vertigo for VS.

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Diagnosis and Management of Vestibular Schwannoma: Focus on Dizziness
Sung Il Nam
Research in Vestibular Science.2021; 20(4): 119. CrossRef

Reviews

Recent Research Trend for Ménièreʼs Disease: Sung-Il Nam; Res Vestib Sci. 2017;16(2):39-46. Published online June 15, 2017; DOI: https://doi.org/10.21790/rvs.2017.16.2.39

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Abstract PDF: Ménièreʼs disease is a poorly understood disorder of the inner ear characterized by intermittent episodic vertigo, fluctuating hearing loss, ear fullness and tinnitus. In this paper, we present a review of the histopathology, cytochemistry, gene, blood-labyrinthine barrier and imaging of Ménièreʼs disease. Histopathology is significant for neuroepithelial damage with hair cell loss, basement membrane thickening, perivascular damage and microvascular damage. Cytochemical alterations are significant for altered AQP4 and AQP6 expression in the supporting cell, and altered cochlin and mitochondrial protein expression. Since the discovery of aquaporin water channels (AQP1, AQP2, AQP3, AQP4, AQP5, AQP6, AQP7 and AQP9), it has become clear that these channels play a crucial role in inner ear fluid homeostasis. Several gene studies related to Ménièreʼs disease have been published, but there is no clear evidence that Ménièreʼs disease is associated with a special gene. Currently, imaging techniques to determine the extent and presence of endolymphatic hydrops are being studied, and further studies are needed to correlate the visualization of the endolymphatic hydrops with clinical symptoms.

Experiemental Model for Ménière’s Disease Using Surgical Ablation of Endolymphatic Sac: Minbum Kim, Mi Joo Kim; Res Vestib Sci. 2016;15(4):95-100. Published online December 12, 2016; DOI: https://doi.org/10.21790/rvs.2016.15.4.95

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Abstract PDF: Endolymphatic hydrops is a representing pathologic finding of Ménière's disease. For the induction of endolymphatic hydrops in an animal model, surgical ablation of endolymphatic sac has been used. Although traditional model with the blockage of endolymphatic sac induced severe hydrops, it has several limitations for the study of pathophysiology of Ménière's disease. Recently, modified experimental models have been introduced, in which additional procedure was performed to induce the acute aggravation of hydrops after the surgical ablation. These new models could be helpful to elucidate the mechanism and develop a new treatment of Ménière's disease. In this review, we introduce the characteristics of animal models using surgical ablation of endolymphatic sac from the classical model to novel modified models.

Case Report

A Case of Patient with Meniere’s Disease Who Presented Periodic Alternating Nystagmus: Jin Woo Park, Ja Won Gu, Mee Hyun Song, Dae Bo Shim; Res Vestib Sci. 2016;15(3):80-83. Published online September 15, 2016; DOI: https://doi.org/10.21790/rvs.2016.15.3.80

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Abstract PDF: Periodic alternating nystagmus (PAN) is a spontaneous horizontal jerky nystagmus that reverses its direction periodically with a quiescent interval. PAN has been reported in acquired and congenital forms. The main lesion site of the acquired form of PAN has been attributed to the caudal brainstem or cerebellum. Herein we report a 63-year-old male patient with Meniere’s disease, who presented PAN during a vertigo attack. The patient demonstrated no abnormality on neurologic evaluation and brain imaging, which is different feature compared to the central or congenital form of PAN. It should be kept in mind that peripheral vestibular disorders such as Meniere’s disease can produce PAN.

Review

A History for Experimental Animal Models of Endolymphatic Hydrops: Hyun Ji Kim, Kyu-Sung Kim; Res Vestib Sci. 2016;15(3):65-69. Published online September 15, 2016; DOI: https://doi.org/10.21790/rvs.2016.15.3.65

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Abstract PDF: It is known that endolymphatic hydrops is a pathophysiologic mechanism of Meniere’s disease, while the detailed role is not fully clarified. Study for endolymphatic hydrops mainly represents a pathologic histologic finding found only in the post-mortem examination of temporal bone, so endolymphatic hydrops animal models have played important role in terms of understanding how hydrops affects the function of the inner ear. Numerous challenges with diverse animals and techniques have been tried to reveal the possible pathophysiology of endolymphatic hydrops and develop an effective treatment. This review shows historical background and technical advances in experimental animal model for endolymphatic hydrops and Meniere’s disease.

Original Article

Multicenter Randomized Study on the Efficacy of Isosorbide in Patients with Mèniére's Disease: Hyun Woo Park, Won Ho Chung, Sung Huhn Kim, Kyu Sung Kim, Jong Woo Chung, Sung Won Chae, Ja Won Koo, Bo Gyung Kim, Eui Kyung Goh, Gyu Cheol Han; Res Vestib Sci. 2016;15(2):44-50. Published online June 15, 2016

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Abstract PDF: Objective: Mèniére's disease is one of the most common causes of episodic vestibular syndrome that shows symptom complexes of recurrent vertigo, hearing loss, tinnitus and ear fullness. Isosorbide (Isobide) is a osmotic diuretics which has been used for Meniere's disease to reduce the endolymphatic pressure. The purpose of this study was to evaluate the efficacy of isosorbide in the treatment of Mèniére's disease by comparing the combined therapy of isosorbide and betahistine (Meniace) to betahistine only.
Methods
Among 220 patients enrolled with Mèniére's disease from 9 centers, 187 patients completed this clinical study. Patients were randomly subjected either to betahistine alone therapy at dose of 6 mg three times a day (n=97) or to combined therapy with isosorbide (dose of 30 mL three times a day) and betahistine (n=90) for 12 weeks. Two groups were compared at 4 and 12 weeks after treatment on frequency of vertigo, hearing level (pure tone audiometry, speech audiometry), electocochleography (ECoG), tinnitus (Tinnitus Handicap Inventory, THI) and quality of life (Korean functional level scale, Korean dizziness handicap inventory).
Results
During first 4 weeks after treatment, the frequency of vertigo was not reduced in either betahistine alone therapy group or combined therapy group. However, between 8 and 12 weeks, the frequency of vertigo was significantly reduced in either group, and in the combined group frequency of vertigo was more significantly reduced than in the betahistine alone therapy group (p=0.041). The hearing level, ECoG, tinnitus and quality of life was not significantly different between two groups.
Conclusion
Isosorbide and betahistine combined therapy were more effective for vertigo control than betahistine alone therapy. Isosorbide is an effective diuretic in vertigo control in definite Mèniére's disease.

Review

Clinical Applications of Vestibular Evoked Myogenic Potentials: Jeong Yoon Choi; Res Vestib Sci. 2015;14(2):37-41.

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Abstract PDF: Cervical and ocular vestibular evoked myogenic potential (VEMP) may be one of the important clinical tools for evaluation of vestibular function. Cervical VEMP evaluates saccule and reflects the functional status of inferior vestibular nerve combining with vertical head impulse test. Ocular VEMP assesses utricle function and provides superior vestibular nerve function in addition to horizontal head impulse test and caloric test. Currently, the clinical implications of VEMP have been expanded to estimate disease severity and location, differentiate diverse vestibular disorders, and predict the prognosis. In present review, we discuss the findings of VEMP according to the lesion location from peripheral vestibular dysfunction to central vestibulopathy and disease characteristics from monophasic transient disorders to chronic progressive disorders.

Case Reports

Profound Hearing Loss after Endolymphatic Sac Decompression in Intractable Meniere’s Disease: Pona Park, Kyung Tae Park, Hyun Seok Choi, Ja Won Koo; Res Vestib Sci. 2014;13(3):72-76.

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Abstract: Endolymphatic sac decompression (ESD) is indicated in intractable Meniere’s disease patients with serviceable hearing. A 43-year-old man presented with recurrent vertigo and fluctuating right hearing loss that had been intractable to medical treatment. ESD was performed for the purpose of vertigo control with hearing preservation. Positional vertigo with profound hearing loss developed immediate after surgery and positional vertigo was resolved within days. Following paralytic vestibulopathy with positive sign on head thrust test also resolved after 2 weeks, while sensorineural hearing loss was not recovered to preoperative level during 1 year of follow up. Recurrent vertigo attacks were developed again 1 year after the operation. Hearing preservation was not always guaranteed in ESD. Furthermore, chance of hearing loss should be included in informed consent though the procedure is purposed for hearing preservation.

Cochleovestibular Otosclerosis Without Conductive Hearing Loss: Woo Sung Na, Sang Hyun Park, Chung Ku Rhee, Jae Yun Jung; Res Vestib Sci. 2013;12(1):22-26.

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Abstract: Otosclerosis typically starts around stapes footplate presenting conductive hearing loss initially. However, otosclerosis may involve cochlea and vestibule causing sensorineural hearing loss and dizziness. We report a case of cochleovestibular otosclerosis without conductive hearing loss featuring Meniere’s disease.

Original Article

Role of Endolymphatic Sac Decompression in Intractable Meniere’s Disease: Shin Hye Kim, Jihye Rhee, Yoonjong Ryu, Byung Yoon Choi, Ja Won Koo; Res Vestib Sci. 2013;12(1):16-21.

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Abstract: Background and Objectives: The role of endolymphatic sac decompression (ELSD) for the treatment of intractable Meniere disease (MD) has been debated. However, considering few treatment options for medically intractable MD with serviceable hearing or intractable bilateral MD, ELSD has shown reasonable treatment results without ablating inner ear function. The aims of this study are to review the role of ELSD in the treatment of MD and clinical course and long-term outcome after ELSD. Materials and Methods: The ELSD was performed in 7 patients among 603 definite Meniere disease patients between May 2003 and December 2010. Patient’s medical history and clinical courses after surgery were obtained by medical record review and telephone interview. Results: Mean duration of follow up until receiving ELSD was 575 days since initial visit. Six patients showed complete control or substantial control of vertigo, but one patient suffered from sustained vertigo attacks even after ELSD, the vertigo was controlled after intratympanic gentamicin injection (ITGI) at 20 months after ELSD. Another patient had recurrence of vertigo after 30 months, which was successfully controlled by ITGI. The preoperatively mean monthly vertigo was 4.8 and it was significantly decreased to 1.5 after postoperatively 1 year, 0 after postoperatively 2 years (p<0.001). Hearing was preserved in 6 patients during the follow-up period. Conclusion: Most patients who were uncontrolled vertigo with 3 to 6 months medication showed significantly reduced vertigo and hearing preservation after ELSD. The ELSD seems to be a beneficial treatment option for intractable MD.

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