Recovery Phase Spontaneous Nystagmus, Its Existence and Clinical Implication

BACKGROUND AND OBJECTIVES: Determination of the lesion side based on the direction of the nystagmus could result in confusions to the clinicians due to mismatch between the vestibular function tests and also between vestibular and audiologic features. To minimize these mistakes, we elucidated the clinical manifestation and vestibular function test results in cases with recovery spontaneous nystagmus (rSN). SUBJECTS AND METHODS: Patients who visited ENT clinic of tertiary referral hospital for acute onset continuous vertigo from January 2008 to December 2011 were enrolled. In these patients, we assessed onset time of vertigo, time point of paralytic spontaneous nystagmus (SN) and time point of rSN. At each time point of SN, vestibular function tests and hearing function tests were performed. RESULTS: We confirmed the rSN among patients with unilateral vestibulopathy and demonstrated that high gain of the rotatory chair test (slow harmonic acceleration) and/or mismatch of the SN direction and contralateral caloric weakness could indicate the recovery state of patients and nystagmus observed in this stage is recovery phase nystagmus. CONCLUSIONS: In acute vestibulopathy patients, recovery phase nystagmus was observed and on this stage of disease vestibular function tests shows several features that could predict recovery state.

Factors Affecting Bronchial Hyperresponsiveness in Rhinitis Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Many studies have revealed a close relationship between allergic rhinitis (AR) and asthma. This study was designed to evaluate clinical parameters affecting bronchial hyperresponsiveness (BHR) in patients with rhinitis symptoms. SUBJECTS AND METHOD: One hundred thirty-seven patients who visited the outpatient clinic due to rhinitis symptoms were evaluated retrospectively. All patients undertook an allergic skin test, the methacholine bronchial provocation test and were tested for clinical parameters such as allergic symptoms, IgE levels, and sinonasal outcome test-20 were evaluated. RESULTS: Patients with AR had a higher proportion of BHR than the non-allergic group (28.0% vs. 4.5%, p=0.001) did, and children had higher prevalence of BHR than adults (p<0.005) did. There was no significant difference according to the type of allergen. Sinusitis or nasal polyp did not influence BHR and there were no significant differences according to the Allergic Rhinitis and Its Impact on Asthma classification. The mean serum eosinophil count was significantly higher in BHR group. CONCLUSION: Patients with AR had more BHR, and age and serum eosinophil counts were related to BHR. Hence, the additional evaluation of lower airway might be required in high risk patients of BHR, such as pediatric AR patients and patients with elevated eosinophil counts.

A Case of Septal Abscess Extending to the Nasal Dorsum / 대한이비인후과학회지

Nasal septal abscess is an uncommon entity and causes nasal obstruction, saddle nose deformity and septal perforation. It is defined as a collection of pus between the cartilage or bony septum and its normally applied mucoperichondrium or mucoperiostium. Previously reported cases are confined in the nasal septal space and case of nasal septal abscess extending to nasal dorsum has not yet been reported in the literature. We recently experienced an extremely rare case of nasal septal abscess which extended to the nasal dorsum and caused abscess on the nasal dorsum. Therefore, we present this case with a brief review of literature.

Predictive Value of Rectified Vestibular Evoked Myogenic Potential in Determining Lesion Side in Unilateral Vestibulopathy Patients / 대한평형의학회지

BACKGROUND AND OBJECTIVES: Rectified vestibular evoked myogenic potential (rVEMP) is a relatively new method that simultaneously measures the muscle contraction power during VEMP recording and corrects the difference of contraction power afterwards. Several studies showed rVEMP is more reliable than non-rectified VEMP (nVEMP). However, those studies evaluated usefulness of rVEMP in patients with normal vestibular function. Thus, we evaluate the effect of rectification to predict lesion side in unilateral vestibulopathy patients. MATERIALS AND METHODS: One-hundred nine acute unilateral vestibulopathy patients whom VEMP were performed in were included retrospectively. We regarded hearing loss side as lesion side in sudden hearing loss (n=33), meniere's disease (n=29) and in vestibular neuritis (n=45), the side of positive head thrust test with canal paresis >30% was regarded as a lesion side. We excluded bilateral vestibulopathy. The inter-aural amplitude difference (IAD) ratio was calculated by the nVEMP and rVEMP. RESULTS: Mismatch rate between nVEMP and rVEMP was 36.61%, match rate was 49.54%, opposition rate was 13.76%. rVEMP predicted lesion side on 15 patients of mismatch group correctly, while nVEMP predicted lesion side on 25 patients of mismatch group. There was no significant difference in IAD ratio between nVEMP and rVEMP in patients who showed lesion side weakness on both nVEMP and rVEMP. But, the younger the patient was, the more chance of mismatch was significantly (p=0.03). CONCLUSION: There was no more corrective role in determining lesion side by rectification in unilateral vestibulopathy. Thus rVEMP might not be helpful for predicting lesion side in unilateral vestibulopathy.

Therapeutic Effect of Combination Treatment of Antihistamine and Montelukast in Allergic Rhinitis

BACKGROUND: Montelukast is a type 1 cysteinyl-leukotrienes receptor antagonist that has been widely used in allergic disease. However, the effect of combination of leukotriene receptor antagonist and antihistamine is controversial. The aim of this study was to compare the effect of combination treatment of montelukast and antihistamine, fexofenadine, over antihistamine alone in patients with allergic rhinitis (AR). SUBJECTS AND METHODS: Retrospective chart review of 60 patients with AR was undertaken. Patients were classified into combination group (montelukast and fexofenadine, n=28) and antihistamine only group (fexofenadine, n=32) according to treatment modalities. Questionnaire survey was performed and allergic symptoms (VAS scale, 5pointscale), and SNOT (sinonasal outcome test)-20 score were obtained before and after the treatment. RESULTS: Mean follow-up duration was 6.7+/-4.6weeks. There was no significant difference in demographic data between two groups. Allergic symptoms and SNOT-20 score(nasal, QOL domain) were improved significantly in both groups after the treatment (all p 0.05, respectively). CONCLUSION: A combination treatment of montelukast and fexofenadine showed more efficacies in nasal obstruction than single fexofenadine treatment in patients with AR. Therefore, montelukast could be used effectively with antihistamine in patients with AR complaining nasal congestion.

Gender Difference of Clinical Characteristics in Meniere's Disease / 대한평형의학회지

BACKGROUND AND OBJECTIVES: Meniere's disease (MD) is a clinical cluster of common symptoms by various causes rather than a single disease entity. Many causes such as autoimmune, allergy, vascular insufficiency have been thought to be related with Meniere's disease. We assumed that different pathologic mechanisms have contribution in each gender. With this premise, we compared clinical characteristics between male and female patients to determine if there is any difference indicating heterogeneous underlying pathology. MATERIALS AND METHODS: We reviewed medical records of 61 patients (43 female, 18 male) who were diagnosed as unilateral definite MD and underwent vestibular function test and audiologic evaluation (more than two times of pure tone audiometry during the follow-up period) from October 2005 to December 2011. RESULTS: The average duration of dizziness in females was longer than in males. In the worst ipsilateral pure tone audiometry, low frequency thresholds were lower in females than in males. Female had lesser hearing difference at all frequencies between the sides and showed more hearing fluctuation than male. There was no significant difference between male and female in the vestibular function test. CONCLUSION: These results are insufficient to suggest that the pathogenesis of MD differs between the genders. However, some differences between the genders prompt a need for future studies involving more patients.

Apogeotropic Positional Nystagmus in Pontine Infarction / 대한평형의학회지

It is thought that horizontal canal benign paroxysmal positional vertigo (BPPV) is the most common cause of apogeotropic direction-changing positional nystagmus (DCPN). But there are many reports about cerebellar or brainstem lesions as the cause of apogeotropic DCPN. We also report a 72-year-old male patient who showed apogeotropic DCPN, but was proven to have a pontine infarction. The patients complained of disequilibrium which has lasted for 3-4 years and aggravated recently. The symptom was present only when he stood up, and was absent as soon as he sat down. He was not able to successfully perform the Romberg test and tandem gait on physical examination. Vestibular function test revealed apogeotropic DCPN without spontaneous nystagmus. Rotation chair test and caloric test results were all within normal limit. On the brain magnetic resonance imaging, newly detected infarction in the left basal ganglia, pons and right parietal lobe was found. Although horizontal canal BPPV is the most common cause of apogeotropic DCPN, we should be aware that there can be patients with central origin DCPN. In this report, we present the detailed history of this patient and tried to point out the clues to suspect central lesion in patients with apogeotropic DCPN.

A Case of Sinusitis due to Bisphosphonate Related Osteonecrosis of Jaw / 대한이비인후과학회지

Bisphosphonates are used effectively for many medical conditions, such as multiple myeloma, Paget's disease, osteoporosis, etc. However, recent case series and retrospective studies have established a relationship between necrotic bone lesions localized to the jaw and the use of chronic bisphosphonate therapy. This condition has been named bisphosphonate related osteonecrosis of the jaw (BRONJ). Although some cases with BRONJ affect the paranasal sinus, they have been rarely reported in otorhinolaryngology. Hence, we report a case of BRONJ with sinus involvement and a review of the relevant literature.

Conservative Management of Horizontal Canal Benign Paroxysmal Positional Vertigo Resistant to Treatment / 대한평형의학회지

Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo. Although it is easily cured by repositioning maneuvers for the majority of patients, it can be resistant to treatment in rare cases. Surgery can be considered for such patients with intractable BPPV. But surgery may be followed by some side effects such as hearing loss and persistent disequilibrium. We report a 77-year-old-female patients who had positional vertigo for 5 years in despite of repositioning maneuver at several hospitals. We performed repeated repositioning maneuvers twice a day for 1 month. Her symptom and nystagmus finally subsided after 2 months. Repeated aggressive repositioning maneuver may be an alternative for surgery for patients with intractable BPPV.