Psychogenic Dizziness : The psychiatric diagnosis and vestibular function tests

BACKGROUND AND OBJECTIVES: Psychogenic dizziness has not been studied extensively in Korea while it is seen frequently. We investigated the prevalence of psychiatric diagnosis and the results of vestibular function testings in patients with the diagnosis of psychogenic dizziness at a Korean tertiary university hospital. MATERIALS AND METHODS: The study was conducted on 38 patients with the diagnosis of psychogenic dizziness. They all received vestibular function testings (ENG, rotating chair test and posturography). Patients with central or vestibular organic disease were excluded from this study. RESULTS: Somatoform disorder was the most common psychiatric disorder causing psychogenic vertigo(47.4%) in this study. Anxiety disorder(21.1%) and depression(21.1%) were the next common causes. The vestibular function testings were abnormal in 19 patients(50.0%). The electronystagmography in 11, rotating chair test in 6, and posturography in 14 patients were abnormal. CONCLUSIONS: Somatoform disorder was the most common psychiatric disorder and vestibular function tests were abnormal in 50% of psychogenic dizziness patients. It implies that the patients with psychogenic dizziness have functional abnormalities in vestibular system.

Histologic difference of the nasal mucosa of both nasal cavities in patients with nasal septal deviation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Patients with nasal septal deviation usually manifest compensatory hypertrophy of the mucosa of unilateral nasal cavity. However, the histologic difference of the bilateral septal mucosa of both nasal cavities in patients with nasal septal deviation has not been extensively studied. Thus we tried to investigate histologic difference of both the septal mucosa of both sides in patients with nasal septal deviation. MATERIALS AND MEHTODS: Nasal mucosae taken from 15 patients with nasal septal deviation were studied. About 0.5 x 0.5 cm sized piece of septal mucosae were obtained from the corresponding site of both nasal cavities at 2 cm from the nostril and 2 cm inferior to the nasal dorsum. After staining by hematoxylin-eosin, the histologic differences of the bilateral nasal mucosa were examined under a light microscope. RESULTS: Surface epithelia of both nasal cavities showed squamous metaplasia or epithelial exfoliation. Inflammatory cell infiltration was more severe in the concave side compared with the convex side. The number of nasal gland were significantly higher in the convex side than in the concave side. CONCLUSIONS: The result of this study indicated that the concave and convex nasal mucosae in patients with nasal septal deviation have different histologic features in terms of inflammatory cell infiltration, and number of nasal glands.

Evaluation of Vestibulo-spinal Reflex Using Modified Romberg Test / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The Romberg test is a simple, inexpensive modality to test the vestibulo-spinal reflex. However, it is not a quantitative measure and has low sensitivity and specificity. We investigated the effectiveness of the modified Romberg test in evaluating equilibrium ability in dizzy patients by comparing it with the computerized dynamic posturography. MATERIALS AND METHODS: The study was conducted on 63 patients with various degrees of dizziness. Computerized dynamic posturography(CDP) was performed and equilibrium ability was measured with the modified Romberg test. Modifications were made in two ways : heel-to-toe standing(test 1) and standing on sponge(test 2). RESULTS: Correlation coefficients between the modified Romberg test and the vestibular dysfunction score of CDP were 0.62 and 0.52, respectively, and they were statistically significant(P<0.01). The Receiver Operating Characteristics(ROC) curve showed that the area index of tests 1 and 2 were 0.86 and 0.78, respectively. CONCLUSIONS: The modified Romberg tests showed fairly good correlation with the vestibular dysfunction score of CDP. Further modifications are required to use the modified Romberg test as an accurate diagnostic tool in the evaluation of dizzy patients.

Changes of Vestibulo-Ocular Reflex and Its Relation with Auditory functions in Chronic Renal Failure Patients Receiving Hemodialysis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sensorineural hearing loss and vestibular dysfunction are frequently found in patients receiving hemodialysis with chronic renal failure (CRF). However, the responsible etiologic factors, prevalence, relationship between auditory and vestibular dysfunction still remains unclear. The purpose of this study is to assess vestibular dysfunction and to investigate the relation between changes in vestibulo-ocul ar reflex (VOR) and auditory dysfunction in CRF patients receiving hemodialysis. MATERIALS AND METHODS: Thirty-five patients (70 ears) receiving hemodialysis with chronic renal failure were selected. Pure tone audiometry, monothermal caloric test, and velocity step rotation test were performed to assess the audio-vestibular function of the patients. Thirty normal controls were selected for comparison of vestibular function tests. RESULTS: Twenty-four (34%) out of 70 ears had pure tone average (PTA) of 25dBHL or more. The average peak velocity of caloric test and the value of slow cumulative eye position (SCEP) of velocity step test in the patient group were 18.7+/-10.5 d/sec and 376.9+/-170.0 degree, respectively. These values were significantly different from those of normal controls whose average peak velocity of caloric test and SCEP values of velocity step test were 25.3+/-6.0d/sec and 586.3+/- 207.3 degree, respectively(p<0.05). The results of caloric test and velocity step test in the patients with PTA of 25dBHI, or more were 10.2+/- 6.0 d/sec and 224.5+/-143.0 degree, respectively, while those of the patients with PTA of less than 25dBHL were 22.7+/-9.7 d/sec and 437.9+/-140.5 degree, respectively. These two groups showed a statistically significant difference(p<0.05). CONCLUSION: The patients under hemodialysis with CRF exhibited reduced vestibular function compared to normal control group.