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Background@#and Purpose Ischemia of the inner ear may damage the otoconia. However, no study has explored any changes in the configuration of otoconia after transient ischemia of the labyrinth. @*Methods@#Nineteen 7-week-old Sprague-Dawley rats were randomly assigned to either the sham (n=5) or the experimental group (n=14). The rats in the experimental group were subjected to global ischemia for 20 minutes using a four-vessel occlusion model, and were sacrificed seven days after the procedure. The rats in the sham group were sacrificed without any procedure. The otolithic organs (utricle and saccule) were dissected out for scanning electron microscope. @*Results@#The otolithic organs in the sham group showed their normal gross configuration with a dense clumping of otoconia with a normal hexagonal morphology and a smooth surface. The otolithic organs in the experimental group also maintained a grossly normal configuration, but each otoconia showed irregular surfaces with numerous cracks or furrows, especially in the periphery of the otoconial bed. @*Conclusions@#The current study showed that otoconial degeneration may occur even after transient ischemia of the labyrinth. This finding supports an association between cerebral ischemia and benign paroxysmal positional vertigo.
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Purpose@#This study aimed to evaluate the association of redundant nerve roots of the cauda equina (RNRCEs) with the degree and duration of symptoms in patients with lumbar spinal canal stenosis. @*Materials and Methods@#Between January 2017 and December 2018, 224 patients demonstrating central canal stenosis on lumbar spine MRI were included. Various imaging findings associated with spinal canal stenosis were investigated, as were the presence, level, type, and length of RNRCEs, and the presence of nerve root swelling. Clinically, the degree of symptoms and symptom changes after treatment were investigated. Multinomial logistic regression was used for statistical analysis. @*Results@#RNRCEs were present in 142 patients (63.4%). Most RNRCEs were observed above the level of stenosis (47.3%). RNRCE was associated with the number of stenoses and symptom duration (p < 0.05). The presence, level, type, and length of RNRCE and nerve root swelling significantly affected the severity of symptoms (p < 0.05). The type of treatment influenced symptom changes (p < 0.05). @*Conclusion@#The recognition and assessment of RNRCEs on spinal MRI are clinically important because the presence, level, type, and length of a RNRCE may be associated with the degree of symptoms and help predict the clinical outcome according to treatment methods.
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Background@#Milk consumption is associated with bone mineral density (BMD), but reports are limited in terms of participant age, sex, and number of study subjects. We investigated the association between milk consumption and BMD in South Korean adults (≥20 years). @*Methods@#We analyzed men and women aged ≥20 years who participated in the Korean National Health and Nutrition Examination Survey, 2008–2011. We used linear regression to calculate the mean BMD and 95% confidence interval (CI) based on the frequency of milk consumption. Multivariate logistic regression analysis was used to estimate the odds ratios (ORs) and 95% CI for T-scores ≤-2.5 (osteoporosis) in both men aged ≥50 years and postmenopausal women. @*Results@#In total 8,539 subjects were studied. Drinking milk more than once a day was associated with higher BMD in the total femur and femoral neck in men aged <50 years and lumbar spine in men aged ≥50 years, compared to less than once a week. It was also associated with lower ORs for osteoporosis of the femoral neck and lumbar spine in men aged ≥50 years (OR, 0.35; 95% CI, 0.125–0.979 and OR, 0.34; 95% CI, 0.143–0.804, respectively). In postmenopausal women who consumed milk 2–6 times weekly, higher BMD and lower OR for osteoporosis were observed in the total femur (OR, 0.23; 95% CI, 0.055–0.958). @*Conclusion@#This study suggests that frequent milk consumption could potentially reduce osteoporosis incidence in South Korean adults. Further prospective study is necessary to elucidate the effect of milk consumption on BMD.
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Objectives@#Adolescent suicide is a serious national issue in Korea. Recently, life satisfaction has been recognized as a major factor related to this issue. The main purpose of this study was to identify the domains of life satisfaction that affect suicidal behavior in adolescence. @*Methods@#Data were collected from eight middle schools in Incheon, Korea. A total of 1297 students answered questions regarding their demographic characteristics, happiness, self-related life satisfaction domains (appearance, leisure time, physical health, and mental health), depressive symptoms, and suicidal behavior. @*Results@#In the Spearman correlation analysis, female sex, perceived socioeconomic status (SES), happiness, and all four self-related satisfaction scores showed significant correlations with depression and suicidality. Multivariate regression analysis suggested that suicidality was significantly affected by perceived SES, satisfaction with appearance, mental health satisfaction, and depression. Finally, depression was identified as a partial mediator of the association between mental health satisfaction and suicidality, and a complete mediator of the association between female sex and suicidality. @*Conclusion@#Perceived SES, satisfaction with appearance, and mental health satisfaction significantly affected students’ suicidality, with or without the effect of depression. Health authorities, educators, and family members must be aware of this to identify adolescents at suicide risk earlier.
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Background@#We investigated the incidence and risk of retinal vein occlusion (RVO) in endstage renal disease (ESRD) patients on dialysis in Korea. @*Methods@#In this nationwide cohort study, we used Korean National Health Insurance Service data between 2004 and 2013 for analysis. ESRD patients who started dialysis from 2004 to 2013 and an equal number of controls were selected through propensity score matching. RVO incidence in both cohorts were calculated for 2004–2013 using washout data from 2003. The multivariable Cox proportional hazards model was used to assess the risk of RVO in dialysis cohort. The Kaplan-Meier method was used to generate the cumulative RVO incidence curve.Whether the dialysis modality affects the development of RVO was also evaluated. @*Results@#In this study, 74,551 ESRD patients on dialysis and the same number of controls were included. The incidence of RVO was significantly higher in the dialysis cohort than in the control cohort (dialysis = 7.3/1,000 person-years [PY]; control = 1.9/1,000 PY; P < 0.001). The cumulative-incidence of RVO was also significantly higher in the dialysis cohort than in the control cohort (P < 0.001; log-rank test). However, there was no significant difference in the incidence of RVO between the two dialysis methods (P = 0.550; log-rank test). @*Conclusion@#This study provided epidemiological evidence that receiving dialysis for ESRD could increase the risk of developing RVO. We also found a rapid increase in the incidence of RVO with a longer dialysis period. These results strengthen the relationship between retinal vascular disease and renal function.
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Background@#and PurposeTo determine the diagnostic value of straight head hanging (SHH) in benign paroxysmal positional vertigo involving the posterior semicircular canal (PC-BPPV). @*Methods@#We retrospectively included 62 patients (age=56.2±15.0 years, 47 female) with unilateral PC-BPPV who underwent both the Dix-Hallpike maneuver and SHH before receiving canalith repositioning therapy (CRT) between September 2017 and July 2020 at the Dizziness Center of Seoul National University Bundang Hospital in South Korea (16 patients, 25.8%) or the Neurology Outpatient Clinic of Aerospace Central Hospital in China (46 patients, 74.2%). SHH was performed before (n=29, group A) or after (n=33, group B) the Dix-Hallpike maneuver. @*Results@#Torsional upbeat nystagmus typical of PC-BPPV was induced during SHH in 52 (83.9%) patients, and the incidence of this type of positional nystagmus did not differ between the groups A and B (79.3% vs. 87.9%, p=0.569). The maximum slow-phase velocity of the induced upbeat nystagmus was higher during SHH than during the Dix-Hallpike maneuver toward the lesion side [range=2.0–60.0°/s (median=18.5°/s) vs. range=2.7–40.0°/s (median=13.4°/s), p<0.001]. Reversal of the positional nystagmus was observed upon resuming the sitting position after SHH in 47 (75.8%) patients and after the Dix-Hallpike maneuver in 54 (87.7%) patients, with no significant difference between the groups (p=0.082). @*Conclusions@#SHH is effective for diagnosing PC-BPPV. Given its simplicity, SHH may be performed before the Dix-Hallpike maneuver, and CRT may be attempted thereafter when the typical positional nystagmus for unilateral PC-BPPV is induced during SHH.
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This review reports on recent advances in understanding nystagmus and other involuntary eye movements. Advances in quantitative evaluations of eye movements using oculography, computational model simulations, genetics, and imaging technologies have markedly improved our understanding of the pathophysiology of involuntary eye movements, as well as their diagnosis and management. Patient-initiated capture of eye movements, especially when paroxysmal, and the online transfer of these data to clinicians would further enhance the ability to diagnose involuntary eye movements.
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Background@#Milk consumption is associated with bone mineral density (BMD), but reports are limited in terms of participant age, sex, and number of study subjects. We investigated the association between milk consumption and BMD in South Korean adults (≥20 years). @*Methods@#We analyzed men and women aged ≥20 years who participated in the Korean National Health and Nutrition Examination Survey, 2008–2011. We used linear regression to calculate the mean BMD and 95% confidence interval (CI) based on the frequency of milk consumption. Multivariate logistic regression analysis was used to estimate the odds ratios (ORs) and 95% CI for T-scores ≤-2.5 (osteoporosis) in both men aged ≥50 years and postmenopausal women. @*Results@#In total 8,539 subjects were studied. Drinking milk more than once a day was associated with higher BMD in the total femur and femoral neck in men aged <50 years and lumbar spine in men aged ≥50 years, compared to less than once a week. It was also associated with lower ORs for osteoporosis of the femoral neck and lumbar spine in men aged ≥50 years (OR, 0.35; 95% CI, 0.125–0.979 and OR, 0.34; 95% CI, 0.143–0.804, respectively). In postmenopausal women who consumed milk 2–6 times weekly, higher BMD and lower OR for osteoporosis were observed in the total femur (OR, 0.23; 95% CI, 0.055–0.958). @*Conclusion@#This study suggests that frequent milk consumption could potentially reduce osteoporosis incidence in South Korean adults. Further prospective study is necessary to elucidate the effect of milk consumption on BMD.
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Objectives@#Adolescent suicide is a serious national issue in Korea. Recently, life satisfaction has been recognized as a major factor related to this issue. The main purpose of this study was to identify the domains of life satisfaction that affect suicidal behavior in adolescence. @*Methods@#Data were collected from eight middle schools in Incheon, Korea. A total of 1297 students answered questions regarding their demographic characteristics, happiness, self-related life satisfaction domains (appearance, leisure time, physical health, and mental health), depressive symptoms, and suicidal behavior. @*Results@#In the Spearman correlation analysis, female sex, perceived socioeconomic status (SES), happiness, and all four self-related satisfaction scores showed significant correlations with depression and suicidality. Multivariate regression analysis suggested that suicidality was significantly affected by perceived SES, satisfaction with appearance, mental health satisfaction, and depression. Finally, depression was identified as a partial mediator of the association between mental health satisfaction and suicidality, and a complete mediator of the association between female sex and suicidality. @*Conclusion@#Perceived SES, satisfaction with appearance, and mental health satisfaction significantly affected students’ suicidality, with or without the effect of depression. Health authorities, educators, and family members must be aware of this to identify adolescents at suicide risk earlier.
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Background@#We investigated the incidence and risk of retinal vein occlusion (RVO) in endstage renal disease (ESRD) patients on dialysis in Korea. @*Methods@#In this nationwide cohort study, we used Korean National Health Insurance Service data between 2004 and 2013 for analysis. ESRD patients who started dialysis from 2004 to 2013 and an equal number of controls were selected through propensity score matching. RVO incidence in both cohorts were calculated for 2004–2013 using washout data from 2003. The multivariable Cox proportional hazards model was used to assess the risk of RVO in dialysis cohort. The Kaplan-Meier method was used to generate the cumulative RVO incidence curve.Whether the dialysis modality affects the development of RVO was also evaluated. @*Results@#In this study, 74,551 ESRD patients on dialysis and the same number of controls were included. The incidence of RVO was significantly higher in the dialysis cohort than in the control cohort (dialysis = 7.3/1,000 person-years [PY]; control = 1.9/1,000 PY; P < 0.001). The cumulative-incidence of RVO was also significantly higher in the dialysis cohort than in the control cohort (P < 0.001; log-rank test). However, there was no significant difference in the incidence of RVO between the two dialysis methods (P = 0.550; log-rank test). @*Conclusion@#This study provided epidemiological evidence that receiving dialysis for ESRD could increase the risk of developing RVO. We also found a rapid increase in the incidence of RVO with a longer dialysis period. These results strengthen the relationship between retinal vascular disease and renal function.
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Background@#and PurposeTo determine the diagnostic value of straight head hanging (SHH) in benign paroxysmal positional vertigo involving the posterior semicircular canal (PC-BPPV). @*Methods@#We retrospectively included 62 patients (age=56.2±15.0 years, 47 female) with unilateral PC-BPPV who underwent both the Dix-Hallpike maneuver and SHH before receiving canalith repositioning therapy (CRT) between September 2017 and July 2020 at the Dizziness Center of Seoul National University Bundang Hospital in South Korea (16 patients, 25.8%) or the Neurology Outpatient Clinic of Aerospace Central Hospital in China (46 patients, 74.2%). SHH was performed before (n=29, group A) or after (n=33, group B) the Dix-Hallpike maneuver. @*Results@#Torsional upbeat nystagmus typical of PC-BPPV was induced during SHH in 52 (83.9%) patients, and the incidence of this type of positional nystagmus did not differ between the groups A and B (79.3% vs. 87.9%, p=0.569). The maximum slow-phase velocity of the induced upbeat nystagmus was higher during SHH than during the Dix-Hallpike maneuver toward the lesion side [range=2.0–60.0°/s (median=18.5°/s) vs. range=2.7–40.0°/s (median=13.4°/s), p<0.001]. Reversal of the positional nystagmus was observed upon resuming the sitting position after SHH in 47 (75.8%) patients and after the Dix-Hallpike maneuver in 54 (87.7%) patients, with no significant difference between the groups (p=0.082). @*Conclusions@#SHH is effective for diagnosing PC-BPPV. Given its simplicity, SHH may be performed before the Dix-Hallpike maneuver, and CRT may be attempted thereafter when the typical positional nystagmus for unilateral PC-BPPV is induced during SHH.
ABSTRACT
This review reports on recent advances in understanding nystagmus and other involuntary eye movements. Advances in quantitative evaluations of eye movements using oculography, computational model simulations, genetics, and imaging technologies have markedly improved our understanding of the pathophysiology of involuntary eye movements, as well as their diagnosis and management. Patient-initiated capture of eye movements, especially when paroxysmal, and the online transfer of these data to clinicians would further enhance the ability to diagnose involuntary eye movements.
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This article provides an update on tinnitus for audiologists and other clinicians who provide tinnitus-specific services. Tinnitus can be attributable to hearing loss, somatosensory system dysfunction, or auditory cortex dysfunction, with hearing loss being the most common cause and serious underlying pathologies being rare. Hearing loss does not always lead to tinnitus, and patients with tinnitus do not always suffer from hearing loss. The first scenario is explained by a so-called inhibitory gating mechanism, whereas the second assumes that all tinnitus sufferers have some degree of hearing impairment, which might not be detected in standard audiological examinations. The treatments should aim at symptomatic relief and management of associated distress. Current treatment options include pharmacotherapy, education, counseling, cognitive behavioral therapy, and sound therapy.
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Objectives@#The purpose of this study was to investigate the risk factors related to periodontal health in middle school and high school adolescents. @*Methods@#This study was conducted using data from the Sixth Korean National Health and Nutrition Examination Survey (KNHANES, 2013-2015). Among the 22,948 participants in the Sixth KNHANES, 1,222 participants (aged 12-18 years) who completed the systemic and oral health examinations and questionnaires were included in this study. Independent variables related to demographic socioeconomic status and oral health-related behaviors were the following: age, gender, household income, frequency of daily toothbrushing, smoking, alcohol drinking, annual dental visit, and periodontal treatment. The dependent variables were the prevalence of gingival bleeding or calculus and the number of sextants with gingival bleeding or calculus. @*Results@#Among the total participants, 34.1% were diagnosed with prevalence of gingival bleeding or calculus, and periodontal health was found to be at its worst at 17 years of age (41.6% of participants). Moreover, household income, alcohol drinking, annual dental visits, and frequency of daily toothbrushing were related to prevalence and the number of sextants with gingival bleeding or calculus. The adjusted odds ratio (aOR) for prevalence of gingival bleeding or calculus by alcohol consumption, toothbrushing less than twice per day, and number of DMFT were 5.00 (95% CI: 2.24-11.18), 2.21 (95% CI: 1.21-4.04), and 1.09 (95% CI: 1.02-1.17), respectively. @*Conclusions@#To prevent periodontal disease among adolescents, it is necessary to improve oral health-related behavior and its associated factors and continuous oral health education.
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Background@#and Purpose: Nonketotic hyperglycemia often causes transient visual field defects, but only scattered anecdotes are available in the literature. @*Methods@#We report a patient with homonymous superior quadrantanopsia due to nonketotic hyperglycemia and provide a systematic literature review of the clinical features of 40 previously reported patients (41 in total, including our case) with homonymous visual field defects in association with nonketotic hyperglycemia. @*Results@#The typical visual field defect was congruous (84.6%), homonymous hemianopsia (87.8%) with macular splitting (61.5%) or sparing (38.5%). It was transient and repetitive in 54.5% of the patients, but it developed as a persistent form in the remainder. Positive visual symptoms such as hallucinations and phosphenes developed in 73.2% of patients. Brain MRI revealed corresponding abnormalities in most patients (84.8%), characterized by a low-intensity white-matter signal or a high-intensity gray-matter signal on T2-weighted or fluid-attenuated inversion recovery images with diffusion restriction or gadolinium enhancement. Most (97.0%) patients recovered completely, with 48.5% treated by glycemic control alone and the remainder also receiving antiepileptic agents. @*Conclusions@#Nonketotic hyperglycemia should be considered a possible cause of transient visual field defects, especially when it is associated with repetitive positive visual symptoms and typical MRI findings in hyperglycemic patients.
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Background@#and Purpose: The findings of ophthalmic examinations have not been systematically investigated in visual snow syndrome. This study reviewed the abnormal neuroophthalmologic findings in a patient cohort with symptoms of visual snow syndrome. @*Methods@#We retrospectively reviewed 28 patients who were referred for symptoms of visual snow to a tertiary referral hospital from November 2016 to October 2019. We defined the findings of best corrected visual acuity (BCVA), visual field testing, pupillary light reflex, contrast sensitivity, full-field and multifocal electroretinography, and optical coherence tomography. @*Results@#Twenty patients (71%) were finally diagnosed as visual snow syndrome. Their additional visual symptoms included illusionary palinopsia (61%), enhanced entoptic phenomenon (65%), disturbance of night vision (44%), and photophobia (65%). A history of migraine was identified in ten patients (50%). The mean BCVA was less than 0.1 logarithm of the minimum angle of resolution, and electrophysiology showed normal retinal function in all patients. Contrast sensitivity was decreased in two of the seven patients tested. Medical treatment was applied to five patients which all turned out to be ineffective. Among the eight patients who were excluded, one was diagnosed with rod-cone dystrophy and another with idiopathic intracranial hypertension. @*Conclusions@#Neuro-ophthalmologic findings are mostly normal in patients with visual snow syndrome. Retinal or neurological diseases must be excluded as possible causes of visual snow.
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Background@#and Purpose: Orbital and cranial form of idiopathic inflammatory pseudotumors (IIPs) are rare disorders with heterogeneous clinical presentations. Corticosteroids have been the first-line treatment for IIPs, but they are not always effective. @*Methods@#We reviewed the medical records of three patients with orbital or cranial form of IIP who were treated with tacrolimus as an adjuvant treatment. @*Results@#The three patients showed favorable outcomes with the addition of tacrolimus, which is a calcineurin inhibitor that inhibits T-cell activation and T-cell-dependent B-cell activation. @*Conclusions@#Tacrolimus may be a safe and effective immunosuppressant for refractory or relapsing form of orbital or cranial IIPs.
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Background@#and PurposeWe aimed to determine the patterns and mechanisms of persistent nystagmus (PN) lasting >1 year in lateral medullary infarction (LMI). @*Methods@#We recruited 13 patients with PN due to LMI and another 13 with transient nystagmus (TN) (<1 year) as control. All patients underwent oculography, rotatory chair test, caloric test, bedside head impulse test, dizziness handicap inventory (DHI), and brain MRI. @*Results@#All patients had spontaneous, contralesional, horizontal-torsional nystagmus during the acute phase. Although two patients exhibited consistent contralesional torsional nystagmus, most patients (11/13, 85%) with PN evolved from the initial contralesional to ipsilesional nystagmus. During horizontal gaze, the patterns of ipsilesional PN were diverse; torsional (n=5), torsional-downbeat (n=2), horizontal (n=2), and horizontal nystagmus while looking at the lesion side, and torsional nystagmus while looking at the opposite side (n=2). During rotatory chair test, the gains of the vestibulo-ocular reflex in the PN group were lower than those in the TN group to the lesion side at 0.02 and 0.64 Hz. The caudal and ventrolateral parts of the vestibular nuclei were mostly involved in patients with PN. The DHI score did not differ between the groups. @*Conclusions@#PN patterns frequently change in LMI. Resultant vestibular asymmetry after vestibular afferents or cerebellar inhibitory pathway damage and/or inappropriate vestibular compensation may be responsible for PN in LMI. Impairment of the horizontal or vertical neural integrators may be another cause. The presence of PN does not necessarily indicate more severe dizziness in LMI.
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Background@#and PurposeThis study was designed to determine the prevalence, pattern, lesion location, and etiology of dissociation in the results of the bithermal caloric test and the horizontal video head impulse test (vHIT) in dizzy patients with various etiologies and disease durations. @*Methods@#We analyzed the results of bithermal caloric tests and vHITs performed over 26 months in 893 consecutive patients who underwent both tests within a 10-day period. @*Results@#Dissociation in the results of the two tests was found in 162 (18.1%) patients. Among them, 123 (75.9%) had abnormal caloric tests (unilateral paresis in 118 and bilateral paresis in 5) but normal vHITs. Peripheral lesions were identified in 105 (85.4%) of these patients, with the main underlying diseases being Meniere's disease (62/105, 59%) and vestibular neuritis/labyrinthitis (29/105, 27.6%). In contrast, central pathologies of diverse etiologies were found only in 18 (14.6%) patients. Abnormal vHIT (bilaterally positive in 18, unilaterally positive in 19, and hyperactive in 2) and normal caloric responses were found in 39 patients, with an equal prevalence of central (n=19) and peripheral (n=20) lesions. The peripheral lesions included vestibular neuritis/labyrinthitis in seven patients and Meniere's disease in another seven. The central lesions had diverse etiologies. @*Conclusions@#Dissociation in the results between caloric tests and horizontal vHITs is not uncommon. The present patients with abnormal caloric tests and normal vHITs mostly had peripheral lesions, while central lesions were likely to underlie those with abnormal vHITs and normal caloric tests.
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Purpose@#We investigated the reading speeds of elementary school-aged children with or without intermittent exotropia. @*Methods@#Children between the ages of 7 and 12 years with intermittent exotropia without amblyopia (n = 37) and normal-sighted children (n = 37) were included. Near-stereopsis and fusion were evaluated. Reading speeds were calculated using a Korean reading speed application, twice: once for reading the sentence silently (reading only) and a second time for reading the sentence aloud (reading & speaking). Reading speed was recorded in words per minute (WPM) and letters per minute (LPM) according to the size of the letters. The factors related to reading speed were analyzed, and the reading speeds of the two groups were compared. @*Results@#The rate of fusion at far and near extremes was lower in the intermittent exotropia group than in the control group (p = 0.028). There was a significant correlation between age and reading only speed and reading & speaking speed for both groups (p = 0.006, p = 0.004). Both WPM and LPM reading speeds of the reading only intermittent exotropia group were slower than those of the control group (p = 0.048, p = 0.050); however, the differences between groups became more pronounced after correction for the age distribution (p = 0.029, p = 0.035). LPM reading speed for middle-sized letters was significantly slower in the intermittent exotropia group than in the control group (p = 0.046). There was no statistical difference between the two groups regarding the reading speed or reading & speaking speed. @*Conclusions@#the reading only and reading & speaking speeds increased with the age of the student, regardless of whether the student had intermittent exotropia. The reading only speed was considerably slower in the intermittent exotropia group. Thus, measures should be taken to monitor the reading development of younger school-aged children with intermittent exotropia carefully to allow for early intervention should issues arise.