Research in Vestibular Science

Original Articles

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; Res Vestib Sci. 2023;22(2):34-45. Published online June 15, 2023; DOI: https://doi.org/10.21790/rvs.2023.22.2.34

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Abstract PDF: Objectives
The objective of this study was to analyze vestibulocochlear function results in patients identified with isolated semicircular canal (SCC) hypofunction using the video head impulse test (vHIT).
Methods
A retrospective review was conducted on the clinical records of 123 patients diagnosed with isolated SCC hypofunction based on vHIT results. Among these patients, 72 had isolated posterior SCC (PSCC) hypofunction, 25 had isolated lateral SCC (LSCC) hypofunction, and 26 had isolated anterior SCC (ASCC) hypofunction. Descriptive analyses were performed on various vestibulocochlear tests including pure tone audiometry, sinusoidal harmonic acceleration (SHA), spontaneous nystagmus (SN), head-shaking nystagmus (HSN), caloric testing, and cervical vestibular evoked myogenic potential, with results analyzed separately for each SCC hypofunction group.
Results
The study found that 66.0% of the evaluated patients exhibited abnormal results in at least one vestibulocochlear function test. PSCC hypofunction patients showed a significantly higher incidence of hearing loss compared to ASCC and LSCC hypofunction patients. LSCC hypofunction patients exhibited higher rates of corrective saccade, phase asymmetry of SHA, and SN abnormalities compared to other SCC hypofunction patients. Additionally, the rates of corrective saccade and phase asymmetry of SHA were also higher in LSCC hypofunction patients. ASCC hypofunction patients demonstrated significantly higher rates of normal corrective saccade, phase lead of SHA, and SN.
Conclusions
The analysis of this study suggests that even in cases where vHIT indicates isolated SCC hypofunction, additional vestibulocochlear function tests should be conducted to identify any associated vestibulocochlear dysfunctions. This highlights the importance of comprehensive evaluation to accurately diagnose and manage patients with SCC hypofunction.

Development of An Algorithm for Slippage-Induced Motion Artifacts Reduction in Video-Nystagmography: Yerin Lee, Young Joon Seo, Sejung Yang; Res Vestib Sci. 2022;21(4):104-110. Published online December 15, 2022; DOI: https://doi.org/10.21790/rvs.2022.21.4.104

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Abstract PDF: Objectives
The slippage of the video-nystagmography devices causes motion artifacts in the trajectory of the pupil and thus results in distortion in the nystagmus waveform. In this study, the moving average was proposed to reduce slippage-induced motion artifacts from the real-world data obtained in the field.
Methods
The dataset consists of an infrared video of positional tests performed on eight patients with a lateral semicircular canal benign paroxysmal positional vertigo. The trajectories of the pupil were obtained from the video with binarization, morphological operation, and elliptical fitting algorithm. The acquired data was observed and the section where the slippage occurred was labeled by an otolaryngologist. The moving average with windows of various lengths was calculated and subtracted from the original signal and evaluated to find the most adequate parameter to reduce the motion artifact.
Results
The period of nystagmus in the given data was found to be ranged from 0.01 to 4 seconds. The slippages that appeared in the data can be categorized into fast and slow slippages. The length, distance, and speed of trajectories in the slippage ranges were also measured to find the characteristics of the motion artifact in video-nystagmography data. The shape of the nystagmus waveform was preserved, and the motion artifacts were reduced in both types of slippages when the length of the window in moving average was set to 1 second.
Conclusions
The algorithm developed in this study is expected to minimize errors caused by slippage when developing a diagnostic algorithm that can assist clinicians.

Impairment of Vestibular Function in Patients with Vestibular Schwannoma According to the Presence of Dizziness: Youngjeong Lee, Se A Lee, Eek-Sung Lee, Tae-Kyeong Lee, Jong Dae Lee; Res Vestib Sci. 2022;21(3):75-79. Published online September 15, 2022; DOI: https://doi.org/10.21790/rvs.2022.21.3.75

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Abstract PDF: Objectives
Vestibular schwannoma (VS) is a benign Schwann cell-derived slow growing tumor originating from the vestibular nerve. Here, we aimed to investigate the correlation between the presence of the dizziness symptoms and several vestibular function test results.
Methods
We analyzed 32 patients who diagnosed with VS from 2010 to 2021 in our hospital. Caloric test, cervical vestibular-evoked myogenic potential (cVEMP) test, and video head impulse test (vHIT) were analyzed.
Results
Age, sex, pure tone audiometry, and tumor size did not show any statistical significance according to the presence or absence of dizziness. There was also no association between the presence of dizziness symptom or dizziness type and the results of the caloric test, vHIT, and cVEMP test, respectively. However, patients with dizziness had a higher rate of tumors confined to the inner auditory canal than those without dizziness.
Conclusions
In this study, the rate of complaints of dizziness was higer in patients with intracanalicular VS. The diagnostic role of vestibulsr function tests in VS is limited. The dissociation of the results of caloric test, vHIT, and cVEMP test suggest that these test are complementary.

The Clinical Efficacy of Vestibular Function Tests in Patients with Acute Unilateral Vestibulopathy: Bong-Hui Kang, Jae-Il Kim; Res Vestib Sci. 2018;17(2):49-54. Published online June 15, 2018; DOI: https://doi.org/10.21790/rvs.2018.17.2.49

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Abstract PDF: Objectives
Aim of this study is to investigate the clinical efficacy of the vestibular function tests (VFTs) and the predictability of lesion side of vestibular asymmetry parameters in acute unilateral peripheral vestibulopathy.
Methods
Medical records and results of VFTs (caloric, rotatory chair, and head impulse tests) of 57 patients with acute unilateral vestibulopathy were reviewed retrospectively. The VFTs were examined within 7 days after the clinical onset.
Results
For the caloric test, 74% showed significant canal paresis and the predictability of lesion side was 88%. For the sinusoidal harmonic acceleration test, 91% had low gain in at least 1 Hz, phase lead showed 70%, 89% showed phase asymmetry and the predictability of lesion side was 90%. For velocity step test, 67% had abnormal Tc asymmetry and the predictability of lesion side was 95%. In bedside head impulse test (HIT), abnormal catch up saccades were observed in 89% and the predictability of lesion side was 100%. For the video HIT, cover or overt catch-up saccades were observed in 95% and the predictability of lesion side was 100%. One hundred percent (100%) had low gain on the video HIT, but the lesion sides were uncertain because of bilateral involvements or artifacts.
Conclusions
The most important things in the diagnosis of acute unilateral vestibulopathy are typical clinical symptoms and spontaneous nystagmus. A combination of rotatory, caloric, and HITs will result in a more complete examination of the vestibular system. Among them, HIT is recommended as the best tool in acute unilateral vestibulopathy.

Case Report

Extremely Long Latency Benign Paroxysmal Positional Vertigo: Emil Riis Abrahamsen, Dan Dupont Hougaard; Res Vestib Sci. 2017;16(2):64-68. Published online June 15, 2017; DOI: https://doi.org/10.21790/rvs.2017.16.2.64

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1 Crossref

Abstract PDF

Case history of a 67-year-old man diagnosed with posterior benign paroxysmal positional vertigo (BPPV) with extremely long latencies after holding the Dix-Hallpike position for five minutes. Additional vestibular assessment indicated partial unilateral hypofunction. The patient had a history compatible with classic BPPV. This patient, however, did not have any positional nystagmus after doing standard positional testing. With extremely prolonged Dix-Hallpike testing (five minutes), the patient experienced nausea and vertigo. Concomitantly classic peripheral nystagmus was observed. After a total of seventeen treatments in a reposition chair a total relief of symptoms was obtained. The extremely long latencies observed in this patient were ascribed to otoconial adherence and/or otoconial size. This type of BPPV has not previously been described.

Citations

Citations to this article as recorded by

Upbeat and Direction-Changing Torsional Nystagmus While Straight Head Hanging: A New Sign of Benign Paroxysmal Positional Vertigo Involving Bilateral Posterior Semicircular Canals
Hyun-Jae Kim, Sang Jin Park, Ji-Soo Kim
Journal of Clinical Neurology.2024; 20(1): 100. CrossRef

Original Article

Vestibular Dysfunctions in Vestibular Migraine Evaluated by Rotatory Chair Test: Ji Yun Park, Byeong Cheo Oh, Tae Kyeong Lee, Ki Bum Sung; Res Vestib Sci. 2015;14(4):123-131.

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Abstract PDF: Objective: There have been several efforts to elucidate the pathophysiology of the vestibular migraine (VM). But, there is no consistent result. This study was to identify the possible pathophysiology of VM by comparing vestibulo-ocular reflex (VOR) parameters between VM, and the tension type headache (TTH) patients. In addition, we compared VOR parameters between ictal and interictal period in the VM group.
Methods
Seventy eight patients were included: 44 having VM and 34 TTH. Three parameters (gain, asymmetry, and phase) of the horizontal VOR rotating at 60 degrees were measured. In 10 VM patients VOR parameters were obtained twice sequentially first in the ictal and second in the interictal period.
Results
Although the average of the VOR gain in VM group was lower than that of TTH group but there was no statistical significance. An asymmetry of the VOR was significantly higher in VM group. There were various changes in other VOR parameters between ictal and interictal periods with no consistent trends.
Conclusion
We could deduce that VM patients might have subclinical vestibular dysfunction from the reduced gain and increased asymmetry of the VOR in the interictal period. Dynamic changes of the VOR in the ictal period could be responsible for dizziness in VM patients, which are caused by the pathological alteration of the physiologic plasticity of the VOR.

Review

The Principle and Methodology of Vestibular Evoked Myogenic Potential: Min Young Lee, Myung Whan Suh; Res Vestib Sci. 2015;14(1):9-14.

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Abstract PDF: Vestibular evoked myogenic potential (VEMP) has developed as a broadly applied vestibular function test in clinics from its introduction in 1992. In the past, there was only one well known VEMP protocol, which is cervical VEMP, however recently ocular VEMP is also popular. Therefore, clarifying the VEMP recording protocol (cervical VEMP or ocular VEMP) before discussing the VEMP
result
has become essential. There is considerable difference regarding this VEMP test from other vestibular function tests. VEMP is thought to be assessing the functions of the otolith organs (utricle and saccule) which are evoked by acoustic stimulus. Cervical VEMP is valuable since this is the only available test method which could speculate the function of the saccule and inferior vestibular nerve. Still, there’s less clearly understood part regarding the central pathway of VEMP. However, many clinicians and researchers participating in vestibular research speculate that this functional test will have a more dominant role in the near future. Here we describe the basic principles and methodological considerations regarding VEMP recording.

Original Article

Eye Movement Abnormalities and Neuroimaging Findings of Disequilibrium of Unknown Origin: Jae Yong Go, Jung Im Seok, Dong Kuck Lee; Res Vestib Sci. 2014;13(4):108-113.

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Abstract PDF: Background
and Objectives: Although disequilibrium is common type of dizziness in older people, it is sometimes difficult to identify a specific cause for this problem. The diffuse brain pathology including subcortical ischemia and atrophy can be a cause for patients with disequilibrium of unknown cause. Aim of this study is to identify the eye movements and neuroimaging features in patients with disequilibrium. Materials and Methods: We performed a prospective investigation in patients with disequilibrium of unknown cause. We collected information on demographic characteristics and clinical features of disequilibrium. The impact of dizziness on everyday life was assessed by 25-item dizziness handicap inventory (DHI). Vestibular function test (VFT) includes smooth pursuit, saccade, optokinetic nystagmus, and rotatory chair test. Subcortical white matter lesions and brain atrophy were graded from brain magnetic resonance image (MRI).
Results
This study included 14 patients (12 female and 2 male), aged between 64 and 84 years, mean age 74.01±6.02 years. The score of DHI was 39.4±11.8 (20?58). Eye movements were abnormal in 13 patients and normal in only one patient. The degree of subcortical ischemia was mild in 7, moderate in 4, and severe in 3 patients. Ventricular brain ratio was 0.23±0.03. However, there was no significant relationship between MRI findings and the degree of oculomotor alterations (result of VFT). Conclusion: Patients with disequilibrium of unknown cause are usually elderly women. Alterations in oculomotor movements and diffuse brain pathology including white matter lesions and atrophy were observed in patients with disequilibrium of unknown cause.

Case Report

A Case of Selective Inferior Vestibular Neuritis Showing Normal Caloric Test: Eun Goo Kang, Kyu Rin Hwang, Jong Dae Lee, Ki Bum Sung; Res Vestib Sci. 2009;8(1):45-48.

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Abstract PDF: Vestibular neuritis is commonly diagnosed by demonstrating of peripheral vestibular failure as a unilateral loss of the caloric response. It is a sudden, spontaneous, unilateral loss of vestibular function without simultaneous hearing loss or brainstem signs. In most patients with vestibular neuritis, the process is thought to involve the superior vestibular nerve. Very rarely, vestibular neuritis involves only the inferior vestibular nerve. We experienced a 56-year-old male with inferior vestibular neuritis. The patient had vertigo and spontaneous nystagmus, but a normal caloric test. Brain magnetic resonance imaging was normal, while vestibular evoked myogenic potentials had absent amplitudes on the lesion side. The patient was thought to suffer from pure inferior nerve vestibular neuritis. Key Words: Vestibular neuronitis; Vestibular function tests

Original Articles

Follow-up Examination of Vibration-Induced Nystagmus in Patients with Unilateral Vestibular Neuritis: Hong Ju Park, Jung Eun Shin, Jae Yoon Ahn, Ga Hyun Park, Yong Soo Jung, Hi Boong Kwak, Yeo Jin Lee, Jin Seok Yoo; J Korean Bal Soc. 2007;6(2):172-175.

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Abstract PDF: Background and Objectives: The aim of this study was to verify if vibration-induced nystagmus in patients with vestibular neuritis changed over time and to compare the results of vibration-induced nystagmus (VIN) test to those of caloric test. Materials and Method: We compared VIN results with those of caloric testing in 23 patients (M:F = 11:12, 15~67 years old) with unilateral vestibular neuritis seen at onset and in follow-up for around 2 months. The eye movement recordings were made and the maximum slow-phase eye velocities (SPV) were calculated during vibration. If spontaneous nystagmus was present, it was subtracted from the slow-phase eye velocities of VIN. Results: In acute stage, VIN of which SPV was directed towards the lesioned side was observed in 21 (91%). In follow-up, VIN of which SPV was directed towards the lesioned side was observed in 19 (83%). There was a significant decrease of the SPV of VIN over time. Significant correlations were observed in between canal paresis & SPV of VIN in both acute and follow-up stages. Conclusion: Our findings show that VIN test can predict the severity of vestibular asymmetry not only in acute stage but also in follow-up stage. Our results suggest that vibration-induced nystagmus might represent the peripheral vestibular asymmetry in patients with vestibular neuritis.

The Effect of Balance Exercise Using Exercise Ball on Balance Function of Elderly: Suk Joon Lee, Jai Hwan Hyun, Yong Soo Lee, Hyun Ju Lee, Hyun Jung Lee, Jae Yun Jung, Chung Ku Rhee; J Korean Bal Soc. 2007;6(2):132-137.

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Abstract PDF: Background and Objectives: Vestibular rehabilitation is an important therapy to treat dizziness in elderly. The aim of this study is to evaluate the effect of balance and resistance exercises in improving balance function in elderly. Methods: Sixty elderlies between the age of 65 to 80 years old were divided into two groups; the control group and exercise group. The exercise group carried out balance and resistance exercises using an exercise ball for 60 minutes each time, 3 times/week for 16 weeks. The elderlies in both groups went through sensory organization test (SOT) and motor control test (MCT) of Equi test pre-series of exercise and post-series of exercise. Results: Conditions 4 and 6 of SOT in control group and conditions 3, 4, 5, and 6 of exercise group showed significantly higher scores in post-exercise compared to those of pre-exercise status. In condition 4, the score was significantly higher in exercise group compared to that of control group. In sensory analysis, the visual and vestibule analyses ratio of post-exercise were significantly higher compared to those of pre-exercise status. The visual analysis ratio of exercise group was significantly higher compared to that of control group. In MCT, the latency of medium forward of exercise group was significantly decreased compared to that of control group in post-exercise status. Conclusion: The results of this study showed that the balance and resistance exercises using an exercise ball was effective in improving various scores and ratio of SOT and sensory analyses in the elderly. This kind of exercises appears to improve balance function in the elderly. The balance and resistance exercises using exercise ball may be effective exercises to improve balance function of chronic dizziness including presbyastasis.

Otolith Function Tests in Patient with Meniere’s Disease: Hong Ju Park, Jung Eun Shin, Jae Yoon Ahn, Ga Hyun Park, Yong Soo Jung, Hi Boong Kwak, Yeo Jin Lee, Jin Seok Yoo; J Korean Bal Soc. 2007;6(2):127-131.

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Abstract PDF: Background and Objectives: The aims of this study were to measure otolith function using subjective visual vertical (SVV) test and vestibular evoked myogenic potential (VEMP) test in patients with unilateral Meniere’s disease, and to see the relationship of the otolithic impairment with caloric and audiologic results. Materials and Methods: Twenty two patients with unilateral Meniere’s disease who received treatment and also had been tested for pure tone, caloric, SVV and VEMP tests were enrolled. All the tests were done simultaneously. Results: Five of 22 (23%) patients showed abnormal tilt to the lesion side in SVV test, and 13 of 22 (59%) patients showed abnormal VEMP results on the affected side. There was no correlation between SVV tilts and unilateral weakness (UW) in caloric tests or pure-tone average. There was also no difference of UW in patients with or without VEMP abnormalities. Two patients showed abnormal finding in both SVV & VEMP tests. One patient showed UW (47%) and SVV tilt (3.08°) to the lesion side, and the other showed normal UW and SVV tilt (3.22°) to the lesion side. Conclusion: Our results demonstrate that the otolith system was implicated in 16 out of 22 (73%) patients with Meniere’s disease. However, there was no correlation between the abnormal results of the three tests and these findings suggest that impairment of the otolithic function is depending on the extent and/or the localization of Meniere’s disease, suggesting vestibular rehabilitation for the specific lesion might be helpful.

Case Report

Benign Paroxysmal Positional Vertigo in Bilateral Vestibular Loss: Jeong Hun Jang, Sung Kwang Hong, Ji Soo Kim, Ja Won Koo; J Korean Bal Soc. 2007;6(1):53-56.

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Abstract PDF: Usual presentations of bilateral vestibular loss are ataxia and oscillopsia. However, fluctuating dizziness is also observed in bilateral vestibulopathy patient. Fluctuating vestibular function in bilateral vestibular loss patients may suggest asymmetric progression of functional loss after compensation is partially accomplished. Because labyrinthine lesion causing vestibular loss is a predisposing factor of benign paroxysmal positional vertigo (BPPV), secondary BPPV can also be developed in bilateral vestibular loss patients. However, BPPV has been hardly noticed in bilateral vestibulopathy patients as a cause of fluctuating dizziness. Authors experienced two cases of BPPV developed in bilateral vestibular loss, one of which showed complete dead labyrinth on ice water caloric test and no significant vestibule-ocular reflex on rotation test. These cases show recurrent BPPV can be the cause of recurrent vertigo in bilateral vestibular loss patients.

Original Articles

Otolith Function Tests in Patient with Vestibular Neuritis: Hong Ju Park, Jung Eun Shin, Dae Bo Shim, Hyang Ae Shin, Sang Kyun Lim, Jae Yoon Ahn, Yong Soo Jung, Jin Suk Yu; J Korean Bal Soc. 2006;5(1):49-54.

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Abstract PDF: Background
and Objectives: Vestibular evoked myogenic potentials (VEMP) test provides a useful method for assessment of saccule function and the functional integrity of the inferior vestibular nerve, and subjective visual vertical (SVV) abnormalities are presumably related to a lesion of the utricle. The aim(s) of this study were to measure otolith function using SVV and VEMP tests, and to define the influence of the otolithic organs in patients suffering from vestibular neuritis. Materials and Method: From September 2005 to January 2006, twelve patients who received treatment in hospital and also had been tested for caloric test, subjective visual vertical (SVV) and vestibular evoked myogenic potential (VEMP) tests with unilateral vestibular neuritis were enrolled. All the tests were done within 8 days after the onset of their symptoms, simultaneously. The SVV was measured in 34 normal subjects as well as in patients.
Results
Eight of 12 patients showed abnormal tilt to the lesion side in SVV test, and five of 8 patients showed no VEMP on the affected side. There was no correlation between SVV tilts and unilateral weakness (UW) in caloric tests. Two patients with abnormal UW (54, 82%) showed normal finding in SVV & VEMP tests. One patient with abnormal UW (83%) and SVV tilts (18.04˚) to the lesion side was normal in VEMP test. Two patients with abnormal UW (28, 37%) and no response in VEMP test were normal in SVV test.
Conclusion
Our results demonstrate that the incidence of abnormal results were 62.5, 66.7% in VEMP and SVV tests in acute stage of vestibular neuritis, respectively. There was no correlation between the abnormal results of the tests and these findings suggest that impairment of the otolithic function is depending on the extent and/or the localization of vestibular neuritis. Key Words : Vestibular neuritis, Otolith, Vestibular function tests, Subjective visual vertical, Vestibular evoked myogenic potentials

Analysis of the Vestibular Function in Children with Otitis Media with Effusion: in Jung Cho, Keehyun Park, You Ree Shin, Yun Hoon Choung; J Korean Bal Soc. 2005;4(2):212-218.

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Abstract PDF: Otitis media with effusion (OME) is one of the most common diseases in children and may be frequently related with dizziness. Background and Objectives: However, the association between OME and dizziness seems to be not clear and remains controversy. The purpose of this study was to determine the incidence of dizziness in children with long lasting OME, and to investigate the difference in vestibular functions between children with long lasting OME and the control group. Materials and Method: Thirty one children who had long-lasting OME over than 6 months (study group) and 28 normal hearing children without OME who were scheduled for adenotonsillectomy (control group), were given questionnaires and vestibular function tests (VFT) including electronystagmography (ENG) and rotation chair test(RCT). Statistical analysis was performed with chi-square test.
Results
Dizziness was found in 7 (22.6%) of 31 children in the study group and 2 (7.1%) of 28 children in the control group (p>0.05). The difference of abnormal findings in VFT between the study group and the control was not significant except visual vestibulo-ocular reflex (VVOR) in RCT. Most of the correlations in the study group, bilateral vs. unilateral OME, OME with dizziness vs. OME without dizziness, and preoperative vs. postoperative, were not significant.
Conclusion
We did not find any evidences of significant difference of the incidence of dizziness and findings of VFT between children with long lasting OME and children without OME. However, there was a significant abnormal response in VVOR in RCT in children with long-lasting OME, suggesting the children with OME may be more dependent on the nonvestibular system including visual compensation to maintain balance.

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