A Case of Pseudo-Vestibular Neuritis with Contralesional Canal Paresis due to Spontaneous Bilateral Vertebral Artery Dissection / 대한이비인후과학회지

Pseudo-vestibular neuritis is a central pathology of acute vestibular syndrome, characterized by unidirectional nystagmus mimicking acute peripheral vestibulophaty. We report a 39-year-old female patient who developed cerebellar infarction with isolated vertigo, spontaneous nystagmus, a positive head thrust test, and unilateral canal paresis in the contralesional side. The patient had no vascular risk factors. A diffusion-weighted image of the brain showed infarction of medial branch of posterior inferior and superior cerebellar artery on the left side. A magnetic resonance angiography of neck disclosed a wide range of diffused severe stenosis and narrowing of right and left vertebral arteries, respectively. This case suggests the possibility of vestibular ischemia masking the central pathology in isolated vertigo.

Risk Factors for Treatment Failure in Benign Paroxysmal Positional Vertigo / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Particular repositioning maneuver (PRM) have been recommended as a treatment of benign paroxysmal positional vertigo (BPPV). Some patients require multiple treatments for remission, although most of the patients are treated at the first trial of single maneuver. The purpose of this study was to evaluate risk factors for the treatment failure in patients with posterior canal BPPV (p-BPPV) and horizontal canal BPPV (h-BPPV). SUBJECTS AND METHOD: Retrospective review was performed for the 287 patients diagnosed as BPPV visiting the dizziness clinic between February 2011 and August 2012. The diagnostic criteria for BPPV were met by following the guidelines provided by the American Academy of Otolaryngology-Head and Neck Surgery. Patients were classified into two groups: Group 1 (treatment success) that requires only 1 PRM and Group 2 (treatment failure) that requires more than 2 PRMs. We analyzed the relationship between treatment failure and the clinical characteristics, and studied the etiology of BPPV. RESULTS: The study included 183 patients with p-BPPV, 54 patients with h-BPPV (geotropic type), and 50 patients with h-BPPV (apogeotropic type). The type of BPPV and average numbers of PRM required for remission were significantly related with treatment failure by statistical analysis (p<0.05, respectively). Statistically significant correlation was demonstrated between the history of ipsilateral inner ear viral infection (acute vestibular neuritis, sudden sensorineural hearing loss) and treatment failure (p<0.05). CONCLUSION: Multiple PRMs may be required in patients with h-BPPV (apogeotropic type) or with secondary BPPV caused by ipsilateral inner ear viral disease. Clinically, this information may be used to provide helpful information for clinicians performing PRM to treat BPPV.

Cochlear Implantation in a Patient with Advanced Otosclerosis / 대한이비인후과학회지

The incidence of otosclerosis, especially the retrofenestral advanced type, is relatively low in Koreans compared to that of the Western population. A case is reported in which cochlear implantation was performed in a patient with advanced otosclerosis presenting with mixed profound hearing loss on one side and pure sensorineural hearing loss on the other side. Intraoperative or postoperative complications of cochlear implantation commonly encountered in patients with otosclerosis did not occur in our patient and successful auditory outcome could be achieved. The results are reported with the review of literature, and clinical considerations regarding cochlear implantation in otosclerosis are discussed.

Sudden Sensorineural Hearing Loss Occurring after Blunt Head Trauma

Sudden sensorineural hearing loss (SNHL) due to blunt head trauma is a rare condition. Possible causes of SNHL by head trauma include cellular injury, perilymphatic fistula, labyrinthine concussion due to microfracture in inner ear and blunt trauma with simultaneous acute labyrithitis. We report here on two unusual cases in which cochleovestibular functions were totally damaged in patients with sudden SNHL due to blunt head trauma. Both cases presented with vertigo, tinnitus and a sudden onset of hearing impairment in the unilateral ear after blunt trauma. Audiograms revealed a profound to severe unilateral SNHL. Caloric testing revealed a decreased caloric response of 100% in the ipsilateral side compared to the contralateral side. Vestibular evoked myogenic potential testing revealed no response in the ipsilateral ear. Neither patient recovered hearing despite oral and/or intratympanic steroid therapy.

Sudden Sensorineural Hearing Loss Occurring after Blunt Head Trauma

Sudden sensorineural hearing loss (SNHL) due to blunt head trauma is a rare condition. Possible causes of SNHL by head trauma include cellular injury, perilymphatic fistula, labyrinthine concussion due to microfracture in inner ear and blunt trauma with simultaneous acute labyrithitis. We report here on two unusual cases in which cochleovestibular functions were totally damaged in patients with sudden SNHL due to blunt head trauma. Both cases presented with vertigo, tinnitus and a sudden onset of hearing impairment in the unilateral ear after blunt trauma. Audiograms revealed a profound to severe unilateral SNHL. Caloric testing revealed a decreased caloric response of 100% in the ipsilateral side compared to the contralateral side. Vestibular evoked myogenic potential testing revealed no response in the ipsilateral ear. Neither patient recovered hearing despite oral and/or intratympanic steroid therapy.