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7 "Prognosis"
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Original Articles
Canal Dysfunction Detected by Video Head Impulse Test in Patients with Vestibular Migraine and Its Relationship with Symptomatic Improvement
Ji Won Choi, Won Sub Lim, Sung Seok Ryu, Yeonjoo Choi, Sang Hun Lee, Seung Cheol Ha, Hong Ju Park
Res Vestib Sci. 2022;21(2):46-52.   Published online June 15, 2022
DOI: https://doi.org/10.21790/rvs.2022.21.2.46
  • 2,509 View
  • 53 Download
AbstractAbstract PDF
Objectives
Video head impulse test (vHIT) can evaluate function of the vestibuloocular reflex for high frequency range of head rotation. We aimed to characterize the abnormal patterns of canal dysfunction by vHIT in vestibular migraine (VM) and evaluate the relationship between the presence of canal dysfunction and symptomatic improvement.
Methods
Eighty-seven patients with VM were included. Abnormality of vHIT at the initial examination was determined by the vHIT gain and the degrees of the corrective saccades at each canal and each side. The relationship between the abnormal patterns and the symptomatic improvement (no need for preventive medication) after modification of life styles and preventive medications for 1, 3, and 6 months was evaluated.
Results
Abnormal vHIT of the lateral canal was 13.8% when determined by the gain criteria and 31.0% when based on both gain and corrective saccade, regardless of the side. Abnormal vHIT of the superior and posterior canals were 18.4% and 27.6%, regardless of the side. Abnormal vHIT at any canal and side was observed in 47%. Patients showed symptomatic improvement in 29.9%, 71.3%, and 88.5% after modification of life styles and preventive medications for 1, 3, and 6 months. Abnormal vHIT results of canals were significantly related to the poor response to preventive mediations.
Conclusions
Prolonged preventive medication was required for symptomatic improvement in VM patients when vHIT results of any canals were abnormal, suggesting that peripheral vestibular abnormality is closely related to the pathophysiology of vestibular migraine.
Which Is More Important for the Prognosis of Sudden Sensorineural Hearing Loss with Vertigo, Canal Paresis or Benign Paroxysmal Positional Vertigo?
Yong-Hwi An, Hyun Joon Shim
Res Vestib Sci. 2021;20(3):101-107.   Published online September 15, 2021
DOI: https://doi.org/10.21790/rvs.2021.20.3.101
  • 3,336 View
  • 55 Download
  • 1 Crossref
AbstractAbstract PDF
Objectives
This study was performed to determine characteristics and the prognostic values in idiopathic sudden sensorineural hearing loss (SSNHL) with comorbid ipsilateral canal paresis (CP) and/or benign paroxysmal positional vertigo (BPPV).
Methods
Of the 338 patients with a diagnosis of idiopathic SSNHL, 29 patients (8.6%) with CP and 24 patients (7.1%) with BPPV were recruited and compared to 23 patients with SSNHL and vertigo but without CP or BPPV. The patients were evaluated for their initial hearing threshold, type of canal involved, response to repositioning maneuvers, and hearing outcome for 6 months.
Results
Patients with CP (+) BPPV (‒) showed lower pure-tone averages than those with CP (‒) BPPV (+) on initial and follow-up audiograms. The improvement in pure-tone averages was less in the CP (+) BPPV (‒) group than in the CP (‒) BPPV (+) group. The improvement in speech discrimination scores was less in the CP (+) BPPV (‒) group than in the CP (‒) BPPV (‒) group. BPPV most commonly involved the posterior canal (15 of 24, 62.5%), followed by the horizontal canal (13 of 24, 54.2%). Three of 24 patients (12.5%) had recurrences of BPPV.
Conclusions
CP is a more serious sign for hearing recovery than BPPV, although both CP and BPPV are negative prognostic indicators of auditory function in SSNHL. Concurrent CP and/or BPPV in SSNHL suggest combined damage to the vestibule and may indicate severe and widespread labyrinthine damage, leading to a poor prognosis.

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  • Re-fixation Saccade at Video-Head Impulse Test in Patients with Sudden Sensorineural Hearing Loss
    Dong Hyuk Jang, Sun Seong Kang, Hyun Joon Shim, Yong-Hwi An
    Research in Vestibular Science.2023; 22(2): 46.     CrossRef
Clinical Characteristics of Sudden Sensorineural Hearing Loss Accompanying Benign Paroxysmal Positional Vertigo
Sung Min Park, Bin Kwon, Sung Won Li, Seok Min Hong, Sung Kyun Kim
Res Vestib Sci. 2020;19(2):71-78.   Published online June 15, 2020
DOI: https://doi.org/10.21790/rvs.2020.19.2.71
  • 5,282 View
  • 120 Download
  • 1 Crossref
AbstractAbstract PDF
Objectives
Idiopathic unilateral sudden sensorineural hearing loss (SSNHL) with simultaneous benign paroxysmal vertigo (BPPV) is known to be associated with poor hearing recovery. We aimed to investigate clinical findings in patients with SSNHL with BPPV and analyze prognostic factors including presence of BPPV related to hearing outcome.
Methods
We retrospectively reviewed the electronic medical data of 14 patients with concurrent SSNHL and BPPV (combined group). We selected 52 patients without BPPV as a control group who have matched initial threshold of pure tone audiometry and age of each patient in the combined group. We evaluated clinical characteristics of all participants and compared hearing outcomes between the 2 groups. A multivariate logistic regression analysis was performed to investigate the factors related to hearing recovery.
Results
Initial mean pure tone audiometry (PTA) threshold of combined group was 90.36±26.2 dB. Posterior canal was most commonly involved (n=7, 50%), and 8 (57%) patients showed abnormal video head impulse test results. There was no significant difference between hearing recovery rates of combined and control group (p=0.237) and mean pure tone audiometry threshold changes were not significantly different between the 2 groups (p=0.942). Old age (≥60 years), high initial PTA threshold (>90 dB), and obesity (body mass index ≥ 25 kg/m2) were poor prognostic predictors.
Conclusions
There was no difference between hearing outcomes of combined group and profound SSNHL only group. BPPV was not a significant prognostic factor of SSNHL patients.

Citations

Citations to this article as recorded by  
  • Which Is More Important for the Prognosis of Sudden Sensorineural Hearing Loss with Vertigo, Canal Paresis or Benign Paroxysmal Positional Vertigo?
    Yong-Hwi An, Hyun Joon Shim
    Research in Vestibular Science.2021; 20(3): 101.     CrossRef
Vestibular Function and Prognosis of Sudden Sensorineural Hearing Loss with Vertigo
Se A Lee, Hyo Jun Kim, Bo Gyung Kim, Jong Dae Lee
Res Vestib Sci. 2018;17(3):90-94.   Published online September 18, 2018
DOI: https://doi.org/10.21790/rvs.2018.17.3.90
  • 6,263 View
  • 157 Download
AbstractAbstract PDF
Objectives
Vertigo combined with sudden sensorineural hearing loss (SSNHL) is known as a poor prognostic factor. We investigated clinical findings and vestibular function tests in patients of SSNHL with vertigo to find the prognostic factors.
Methods
We retrospectively evaluated data on the patients diagnosed with SSNHL with vertigo at Bucheon Soonchunhyang University Hospital from March 2009 to February 2018. We reviewed medical records and the results of vestibular function tests and audiometry.
Results
Of the 68 patients, 30 (44.1%) showed profound hearing loss and 53 (77.9%) showed poor recovery. Age and the degree of initial hearing loss showed negative prognostic factor in hearing recovery. Abnormal results of cervical vestibular evoked myogenic potentials (cVEMP) also showed significantly differences between good and poor recovery groups.
Conclusions
In this study, most of the patients of SSNHL with vertigo showed poor recovery. Age, degree of initial hearing loss, and the abnormal result of the cVEMP have a negative effect on the prognosis of hearing recovery.
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
  • 7,850 View
  • 529 Download
  • 1 Crossref
AbstractAbstract 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.

Citations

Citations to this article as recorded by  
  • 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
Residual Vestibulo-Ocular Reflex Result in Better Functional Outcomes in Bilateral Vestibulopathy
Ji Eun Choi, Gwanghui Ryu, Young Sang Cho, Won Ho Chung
Res Vestib Sci. 2014;13(4):89-95.
  • 2,118 View
  • 35 Download
AbstractAbstract PDF
Background
and Objectives: The patients with bilateral vestibulopathy (BV) suffer from unsteadiness and oscillopsia, and despite of appropriate rehabilitation, permanent disability is inevitable. However, the level of functional outcomes could be influenced by whether there is residual vestibulo-ocular reflex (VOR) or not. Under the hypothesis that residual VOR function could result in better performances, we tried to compare in functional outcomes between complete and incomplete BV. Materials and Methods: Fifty patients who have been diagnosed with BV in our institution were retrospectively reviewed retrospectively between 2008 and 2012. We classified them into complete BV group (n=19) and incomplete BV (n=31) group according to the presence of residual VOR. Among them, 31 patients responded to telephone survey (6 in complete group and 25 in incomplete group). The survey includes 5 categories such as the subjective dizziness restriction on daily life, oscillopsia, unsteadiness and depression. Each score ranged from 0 to 4 and patients were asked twice in different time period.
Results
There was no difference in etiology between complete and incomplete group. Incomplete group showed significant improvement in dizziness, restriction on daily life, oscillopsia and unsteadiness compared to complete group. Among 5 catergories, dizziness score was significantly improved in incomplete group (each mean improved sore±standard deviation; dizziness 1.84±0.83, oscillopsia 0.44±0.64, unsteadiness 1±1.09, depression 0.24±0.86 restriction on daily life 1.16±0.97). Conclusion: The presence of residual VOR function had better functional outcomes in bilateral vestibulopathy.
Therapeutic Efficacy and Prognostic Factors of Canalith Repositioning Maneuver in the Patients with Benign Paroxysmal Positional Vertigo
Shi Nae Park, Kyoung Ho Park, Ji Hong Kim, Jong Hoon Kim, Bong Jin Choi, Ji Hyeon Shin, Min Ah Han, Sang Won Yeo
J Korean Bal Soc. 2007;6(1):9-15.
  • 1,696 View
  • 15 Download
AbstractAbstract PDF
Background and Objectives: The purpose of this study were to evaluate the therapeutic efficacy of canalith repositioning maneuver (CRP) according to accompanying mastoid percussion and to investigate the prognostic factors that may affect successful repositioning maneuver and the recurrence of benign paroxysmal positional vertigo. Materials and Method: A total of 70 patients with canalith type BPPV visiting the dizziness clinic of Kangnam St. Mary's Hospital were included in this study. Variables identified for statistical analysis were patient's age, sex,maneuver method, number of involved canal, number of CRP and dizziness handicap inventory. Result: Overall success rate of CRP was 90%. The mean number of maneuver was 1.6 and the recurrence rate was 25.7% during the follow up period. Success rate of CRP (94.9%) was higher than maneuver without mastoid percussion (83.9%) though it was not statistically significant. Successful CRP group showed the significant less number of maneuvers at initial treatment session and less number of involved canal than failed CRP group at the time of one week-follow up visit. Patients with recurrence of BPPV had the more number of CRP during the period of previous BPPV. Conclusion: Therapeutic efficacy of CRP with mastoid percussion was higher than CRP without mastoid percussion though it was not statistically significant. Suggesting prognostic factors for effective CRP and recurrence were number of CRP and number of involved canal.

Res Vestib Sci : Research in Vestibular Science