Feasibility of Virtual Reality-Based Auditory Localization Training With Binaurally Recorded Auditory Stimuli for Patients With Single-Sided Deafness

Objectives@#. To train participants to localize sound using virtual reality (VR) technology, appropriate auditory stimuli that contain accurate spatial cues are essential. The generic head-related transfer function that grounds the programmed spatial audio in VR does not reflect individual variation in monaural spatial cues, which is critical for auditory spatial perception in patients with single-sided deafness (SSD). As binaural difference cues are unavailable, auditory spatial perception is a typical problem in the SSD population and warrants intervention. This study assessed the applicability of binaurally recorded auditory stimuli in VR-based training for sound localization in SSD patients. @*Methods@#. Sixteen subjects with SSD and 38 normal-hearing (NH) controls underwent VR-based training for sound localization and were assessed 3 weeks after completing training. The VR program incorporated prerecorded auditory stimuli created individually in the SSD group and over an anthropometric model in the NH group. @*Results@#. Sound localization performance revealed significant improvements in both groups after training, with retained benefits lasting for an additional 3 weeks. Subjective improvements in spatial hearing were confirmed in the SSD group. @*Conclusion@#. By examining individuals with SSD and NH, VR-based training for sound localization that used binaurally recorded stimuli, measured individually, was found to be effective and beneficial. Furthermore, VR-based training does not require sophisticated instruments or setups. These results suggest that this technique represents a new therapeutic treatment for impaired sound localization.

Foreign Body Complications in Ears due to Mishandled Hearing Aid Fitting and Proposed Clinical Guidelines to Address the Complications

Background@#South Korea has one of the world’s fastest aging populations and is witnessing increased age-related hearing impairment cases as well as an increase in the number of hearing aid users. The aim of this study was to analyze complications caused by hearing aid mold materials. In addition, we hope to raise awareness of the harm and danger that inexperienced hearing aid providers can cause to patients. @*Methods@#We retrospectively reviewed the medical records of 11 patients who were diagnosed with hearing aid mold material as a foreign body in the ear at a tertiary center between 2016 and 2020. The following data were analyzed: symptoms, endoscopic findings, audiometry, temporal bone CT images, treatment methods, and complications after removal. The currently available literature was also reviewed to develop clinical guidelines, to identify the systematic weaknesses in the South Korean hearing aid market, and to identify policies that warrant better quality control. @*Results@#Among the 11 cases, 9 were restricted to the external auditory canal, all of which were successfully removed under endoscopy with minor complications. Two cases with middle ear involvement resulted in infection and thus required surgical removal with mastoidectomy. The average age of these patients was 76.4, and all patients received their molding procedure at private hearing aid shops without an otolaryngologist’s examination. @*Conclusion@#Thorough patient history-taking and otologic examination must be performed to identify patients at higher risk of complications. Such patients should be referred to an otolaryngologist. If a patient exhibits alarming symptoms, early referral is critical since prompt surgery can minimize complications. A CT scan is highly recommended to determine an optimal approach for foreign body removal. Systematic and regulatory changes in hearing aid dispensers, such as requiring apprenticeship, raising the required level of education, and legally mandating referrals, can help reduce these complications.

Hearing Results After Type I Tympanoplasty With Versus Without Mastoidectomy / 대한이비인후과학회지

Background and Objectives@#The purpose of the mastoidectomy and tympanoplasty is to improve the hearing by removing the middle ear lesion and reconstructing the hearing mechanism. The purpose of this study is to verify whether several factors, including the presence of mastoidectomy can affect the hearing outcome of tympanoplasty patients.Subjects and Method From 1989 to 2018, 1260 patients with chronic otitis media who had been followed up for more than 6 months after type 1 tympanoplasty were selected. The each patient group was divided into 2 groups based on the last audiometry; Group A (post operative air-bone gap [ABG] ≤10 dB HL) and Group B (post operative ABG >10 dB HL). We analyzed the various factors including patency of E-tube or mastoid aeration for each group to figure out which factors affect the post operative hearing outcome. @*Results@#In conclusion, even with mastoidectomy, the final hearing after surgery was worse than that of the group who underwent tympanoplasty only (final ABG; tympanoplasty only vs. tympanoplasty with mastoidectomy; 6.59±9.09 vs. 9.71±8.94). In both with and without mastoidectomy group, the size of the perforation and external ear canal diameter before surgery did not affect the final hearing outcome. On the otherhand, in the group with mastoidectomy, mastoid pneumatization and E-tube patency affected the postoperative prognosis, but not in the case without mastoidectomy. @*Conclusion@#In this study, the factors affecting postoperative hearing success were analyzed. The results can be used to predict the postoperative hearing prognosis and to help select surgical treatment.

Surgical Outcomes of Revision Operation for Non-Cholesteatomatous Chronic Otitis Media / 대한이비인후과학회지

Background and Objectives@#The aim of this study was to investigate the surgical outcomes of revision operation due to recurrence of non-cholesteatomatous chronic otitis media (COM) surgery cases.Subjects and Method From 1989 to 2018, 5197 cases of COM surgery were performed at Kangdong and Hallym University Sacred Heart Hospital. Among them, clinical data of 297 subjects who had undergone revision tympanoplasty and/or mastoidectomy for recurrent noncholesteatomatous COM were retrospectively collected from computerized database of middle ear surgery (Korean Otological Society program 2005). Each case was categorized by surgical approaches into canal wall down mastoidectomy (CWDM), canal wall up mastoidectomy (CWUM), or tympanoplasty only groups. @*Results@#Tympanoplasty only was performed in 170 cases, CWDM in 74 cases, and CMUM in 53 cases. Postoperative perforation occurred in 9.4% of total cases, and less frequently in CMDM compared with tympanoplasty only (p=0.023), and CMUM (p=0.049), respectively, whereas no differences between tympanoplasty only and CMUM (p=0.930) were found. Postoperative infection rate was 1.0% and did not show any differences among the groups. Postoperative successful hearing was obtained in 66.7% of total cases, and the success rate of tympanoplasty only was better than that of CMDM (p=0.001), and CMUM (p=0.011). And, that of CMUM was better than that of CMDM (p=0.011). @*Conclusion@#The results showed that postoperative perforation occurred less frequently in CMDM than in tympanoplasty only and in CWUM; successful hearing was achieved more frequently in tympanoplasty alone than in the other surgical approaches in recurrent non-cholesteatomatous COM.

Surgical Outcome of Revision Operation for Recurrent Aural Cholesteatoma / 대한이비인후과학회지

Background and Objectives@#To investigate surgical outcomes of revision operation for recurrent cholesteatoma.Subjects and Method From 1989 to 2018, 5245 cases of middle ear surgeries were performed at Kangdong and Hallym University Sacred Heart Hospital. A total of 138 clinical records of the subjects who underwent revision cholesteatoma surgery, and whose follow-up durations were more than 3 months, were reviewed. Hearing outcomes were analyzed in accordance with the 2005 Korean otology society guideline. Postoperative perforation was defined to be present if perforation exists after three months of surgery. Postoperative infection or recurrence was defined if patients were treated with intravenous antibiotics or underwent reoperation. @*Results@#Among 138 cases, surgical approaches used were canal wall up mastoidectomy in 38 (28%), canal wall down mastoidectomy in 89 (64%), and exploratory tympanotomy in 11 (8%). Air conduction and air bone gap showed statistically significant differences before and after the surgery. The number of patients who met at least 1 criteria was 70, accounting for 51%. Patients were classified into four groups according to the Postoperative ABG grade, where 43% of patients were included in “Excellent” or “Good” results group. When the results were compared according to the surgical method, canal wall up group showed significantly higher hearing success rate compared to CWDM group. Patients without postoperative perforation, infection or recurrence were considered successful and there were 122 such cases, accounting for 88%. @*Conclusion@#CWDM more frequently underwent revision than CWUM and ET, and showed worse hearing results than other groups. These analyses can be used for preoperative counseling.

Hearing Outcome of Patients with Acute Noise-Induced Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although poor hearing outcomes have been associated with acute noise-induced hearing loss (ANIHL), only limited studies exist on this issue. This study evaluated the prognosis of ANIHL in comparison to idiopathic sudden sensorineural hearing loss (ISSNHL) and investigated the types of noise causing these disorders. SUBJECTS AND METHOD: Patients with sudden sensorineural hearing loss due to noise exposure were included in the ANIHL group if the threshold shift was more than 30 dB in three or more consecutive frequencies within the study period (from January 2010 to December 2016). The ANIHL group included 19 patients. As a matched-control group, treated patients with ISSNHL (n=95) were selected as a way of controlling the known prognostic factors that were evenly distributed between groups. Selected prognostic variables used for matching included age, sex, the degree of initial hearing loss, the number of days before the start of treatment, and treatment method. RESULTS: The overall hearing recovery rate of ANIHL was 11% and that of the control group was 80% (p<0.001). Noise exposure in military service (37%) and leisure activities (37%) was the most prominent cause of ANIHL. CONCLUSION: The hearing outcome of ANIHL was worse than that of ISSNHL. It is thus necessary to establish national guidelines for environmental noise regulations and to raise awareness of hazardous noise exposure.

Change of Tympanogram after Chronic Otitis Media Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Pre-operative eustachian tube function (ETF) is an important factor for the postoperative success after tympanoplasty, though much debates have been reported. In this study, we investigated the tympanogram changes after tympanoplasty, indirectly checking up ETF, to find out the relationship between tympanogram changes and associated factors of tympanoplasty. SUBJECTS AND METHOD: Included in this study were 238 cases of tympanoplasty (canal wall up mastoidectomy with tympanoplasty type I or tympanoplasty type I only) performed by one surgeon for chronic otitis media from January, 2012 to June, 2017. In all cases, tympanometric tests were undertaken at one month, three month, six month, and one year post-operatively, and pure tone audiometry tests were taken at 1 year, post operatively. RESULTS: The average hearing level and air-bone gap were 41.8±19.7 dB, and 17.1±9.3 dB, pre-operatively, and 29.9±21.1 dB, and 6.9±8.5 dB, 1 year post-operatively, respectively. Most of the cases showed improvement in hearing. The results of tympanometry showed that hearing improvement was greater for the A type than for the B or C type (p<0.001). The smaller the size of the tympanic membrane was, the higher, the type A tympanogram appeared to be (p=0.008). CONCLUSION: The estimation of pre-operative ETF using post-operative tympanogram changes can give insight to the degree and process of recovery of the normal middle ear after tympanoplasty.

Change of Tympanogram after Chronic Otitis Media Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#Pre-operative eustachian tube function (ETF) is an important factor for the postoperative success after tympanoplasty, though much debates have been reported. In this study, we investigated the tympanogram changes after tympanoplasty, indirectly checking up ETF, to find out the relationship between tympanogram changes and associated factors of tympanoplasty.SUBJECTS AND METHOD: Included in this study were 238 cases of tympanoplasty (canal wall up mastoidectomy with tympanoplasty type I or tympanoplasty type I only) performed by one surgeon for chronic otitis media from January, 2012 to June, 2017. In all cases, tympanometric tests were undertaken at one month, three month, six month, and one year post-operatively, and pure tone audiometry tests were taken at 1 year, post operatively.@*RESULTS@#The average hearing level and air-bone gap were 41.8±19.7 dB, and 17.1±9.3 dB, pre-operatively, and 29.9±21.1 dB, and 6.9±8.5 dB, 1 year post-operatively, respectively. Most of the cases showed improvement in hearing. The results of tympanometry showed that hearing improvement was greater for the A type than for the B or C type (p<0.001). The smaller the size of the tympanic membrane was, the higher, the type A tympanogram appeared to be (p=0.008).@*CONCLUSION@#The estimation of pre-operative ETF using post-operative tympanogram changes can give insight to the degree and process of recovery of the normal middle ear after tympanoplasty.

Hearing Outcome of Patients with Acute Noise-Induced Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#Although poor hearing outcomes have been associated with acute noise-induced hearing loss (ANIHL), only limited studies exist on this issue. This study evaluated the prognosis of ANIHL in comparison to idiopathic sudden sensorineural hearing loss (ISSNHL) and investigated the types of noise causing these disorders.SUBJECTS AND METHOD: Patients with sudden sensorineural hearing loss due to noise exposure were included in the ANIHL group if the threshold shift was more than 30 dB in three or more consecutive frequencies within the study period (from January 2010 to December 2016). The ANIHL group included 19 patients. As a matched-control group, treated patients with ISSNHL (n=95) were selected as a way of controlling the known prognostic factors that were evenly distributed between groups. Selected prognostic variables used for matching included age, sex, the degree of initial hearing loss, the number of days before the start of treatment, and treatment method.@*RESULTS@#The overall hearing recovery rate of ANIHL was 11% and that of the control group was 80% (p<0.001). Noise exposure in military service (37%) and leisure activities (37%) was the most prominent cause of ANIHL.@*CONCLUSION@#The hearing outcome of ANIHL was worse than that of ISSNHL. It is thus necessary to establish national guidelines for environmental noise regulations and to raise awareness of hazardous noise exposure.

Usefulness of a Novel Staging System for Congenital Cholesteatoma of the Middle Ear / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#Although there are number of studies on the risk factors of recidivism in the congenital middle ear cholesteatoma, few have focused on the staging system. In this study, we aimed to investigate the postoperative recurrence rate in surgical cases of congenital middle ear cholesteatoma, and compare the results of using the Potsic staging system with those of a novel Kim staging system. Additionally, we also studied to see if the Kim staging system could suggest an appropriate surgical approach for each stage.SUBJECTS AND METHOD: Surgical cases of the disease from January, 1989 to August, 2017 performed at Kangdong Sacred Heart or Hallym University Sacred Heart Hospital were included and those data were retrospectively reviewed. All the cases were pre-operatively assigned to the stages using both Potsic and Kim staging system, retrospectively. The post-operative recurrence rate was analyzed for each subject according to the findings of one year after surgery using both staging systems. Additionally, surgical approach performed in these cases, such as mastoidectomy and/or ossiculoplasty were analyzed and compared among the stage groups of Kim staging system.@*RESULTS@#The Potsic staging system showed that recurrence was significantly lower in the stage I than in the other stages, and the Kim staging system showed that recurrence was significantly higher in the revision R stage than in the primary A, P, and M stages. The Kim staging system showed that mastoidectomy was performed more frequently in the M stage, and ossiculoplasty was performed less frequently in the A stage than in the other stages.@*CONCLUSION@#Although Potsic and Kim staging systems were both useful for predicting prognosis, the Kim staging system can additionally provide a clue for an appropriate surgical approach for each stage.

Feasibility of Eye Tracking Assisted Vestibular Rehabilitation Strategy Using Immersive Virtual Reality

OBJECTIVES: Even though vestibular rehabilitation therapy (VRT) using head-mounted display (HMD) has been highlighted recently as a popular virtual reality platform, we should consider that HMD itself do not provide interactive environment for VRT. This study aimed to test the feasibility of interactive components using eye tracking assisted strategy through neurophysiologic evidence. METHODS: HMD implemented with an infrared-based eye tracker was used to generate a virtual environment for VRT. Eighteen healthy subjects participated in our experiment, wherein they performed a saccadic eye exercise (SEE) under two conditions of feedback-on (F-on, visualization of eye position) and feedback-off (F-off, non-visualization of eye position). Eye position was continuously monitored in real time on those two conditions, but this information was not provided to the participants. Electroencephalogram recordings were used to estimate neural dynamics and attention during SEE, in which only valid trials (correct responses) were included in electroencephalogram analysis. RESULTS: SEE accuracy was higher in the F-on than F-off condition (P=0.039). The power spectral density of beta band was higher in the F-on condition on the frontal (P=0.047), central (P=0.042), and occipital areas (P=0.045). Beta–event-related desynchronization was significantly more pronounced in the F-on (–0.19 on frontal and –0.22 on central clusters) than in the F-off condition (0.23 on frontal and 0.05 on central) on preparatory phase (P=0.005 for frontal and P=0.024 for central). In addition, more abundant functional connectivity was revealed under the F-on condition. CONCLUSION: Considering substantial gain may come from goal directed attention and activation of brain-network while performing VRT, our preclinical study from SEE suggests that eye tracking algorithms may work efficiently in vestibular rehabilitation using HMD.

Is the Auditory Brainstem Response Diagnostic for Vestibular Paroxysmia? / 대한평형의학회지

OBJECTIVES: Vestibular paroxysmia (VP) of the eighth cranial nerve is characterized by recurrent auditory and vestibular disturbances when a proximal part of the eighth cranial nerve is continuously pressed by a vessel. A detailed history and several ancillary diagnostic tools, such as tinnitogram, caloric test, auditory brainstem response (ABR) and magnetic resonance imaging, are used for diagnosis of VP. Among them, although Møller criteria using ABR is a simple method, the previous study is insufficient. Therefore, this study aimed to evaluate ABR's diagnostic value of VP. METHODS: ABR records of the 14 patients (patient group) who were diagnosed with VP and 45 patients (as control) who were diagnosed with only tinnitus were reviewed retrospectively. We analyzed the differences in Møller criteria between 2 groups. RESULTS: Mean age of the patient group was 52.9 years old and the control group was 55.4 years old. As compared with the control group, there were no significant differences of Møller 3 criteria contents (peak II wave amplitude < 33% [35.7% vs. 15.5%, p=0.133], interpeak latency I–III ≥2.3 msec [42.8% vs. 35.5%, p=0.622]), Contralateral interpeak latency III–V ≥2.2 msec (0% vs. 4.4%, p=1.000) in patient group. CONCLUSION: There was no significant difference of ABR parameters according to the Møller criteria between patient and control groups.

Physical Activity, Sedentary Habits, Sleep, and Obesity are Associated with Asthma, Allergic Rhinitis, and Atopic Dermatitis in Korean Adolescents

PURPOSE: Since pathophysiologic evidence has been raised to suggest that obesity could facilitate an allergic reaction, obesity has been known as an independent risk factor for allergic disease such as asthma. However, the relationship between sedentary behavior and lifestyle which could lead to obesity, and those allergic diseases remains unclear. MATERIALS AND METHODS: We analyzed the relations between physical activity, including sitting time for study, sitting time for leisure and sleep time, and obesity, asthma, allergic rhinitis, and atopic dermatitis using the Korea Youth Risk Behavior Web-based Survey, which was conducted in 2013. Total 53769 adolescent participants (12 through 18 years old) were analyzed using simple and multiple logistic regression analyses with complex sampling. RESULTS: Longer sitting time for study and short sitting time for leisure were associated with allergic rhinitis. High physical activity and short sleep time were associated with asthma, allergic rhinitis, and atopic dermatitis. Underweight was negatively associated with atopic dermatitis, whereas overweight was positively correlated with allergic rhinitis and atopic dermatitis. CONCLUSION: High physical activity, and short sleep time were associated with asthma, allergic rhinitis, and atopic dermatitis.

Analysis of Predisposing Factors for Hearing Loss in Adults

We aimed to estimate the effects of various risk factors on hearing level in Korean adults, using data from the Korea National Health and Nutrition Examination Survey. We examined data from 13,369 participants collected between 2009 and 2011. Average hearing thresholds at low (0.5, 1, and 2 kHz) and high frequencies (3, 4, and 6 kHz), were investigated in accordance with various known risk factors via multiple regression analysis featuring complex sampling. We additionally evaluated data from 4,810 participants who completed a questionnaire concerned with different types of noise exposure. Low body mass index, absence of hyperlipidemia, history of diabetes mellitus, low incomes, low educational status, and smoking were associated with elevated low frequency hearing thresholds. In addition, male sex, low body mass index, absence of hyperlipidemia, low income, low educational status, smoking, and heavy alcohol consumption were associated with elevated high frequency hearing thresholds. Participants with a history of earphone use in noisy circumstances demonstrated hearing thresholds which were 1.024 dB (95% CI: 0.176 to 1.871; P = 0.018) higher, at low-frequencies, compared to participants without a history of earphone use. Our study suggests that low BMI, absence of hyperlipidemia, low household income, and low educational status are related with hearing loss in Korean adults. Male sex, smoking, and heavy alcohol use are related with high frequency hearing loss. A history of earphone use in noisy circumstances is also related with hearing loss.

Vestibular Rehabilitation for Patients with Unilateral Peripheral Vestibular Deficit / 대한평형의학회지

Unilateral peripheral vestibular deficit can occur from a different etiology including viral infection, trauma, ear surgery or idiopathic. Patients with sudden unilateral vestibular deficit usually complain of whirling vertigo, postural imbalance and ipsilesional lateropulsion, which gradually recover over a few weeks by vestibular compensation mechanism. Vestibular rehabilitation therapy has been accepted as helpful exercise based training program with strong evidence for acceleration of vestibular compensation in unilateral vestibular deficit. Here the authors described the current issue regarding vestibular rehabilitation in unilateral vestibular hypofunction from the informative literature review.

Effects of Tinnitus Duration and Concomitant Hearing Loss on the Cognitive-Behavioral Treatment Outcomes / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Several reports indicated that tinnitus treatment was influenced by several factors including age of patients, concomitant hearing loss, onset and duration of tinnitus, etc. The purpose of this study was to investigate the effects of the duration of tinnitus and the degree of hearing loss on the treatment outcomes. SUBJECTS AND METHOD: Seventy-two subjects with tinnitus were divided into several groups according to the duration of tinnitus and the degree of hearing loss. All subjects were treated by cognitive-behavioral treatment program in tinnitus clinic. Treatment effects were studied by Tinnitus Handicap Inventory (THI) and Visual Analogue Scale (VAS), which were used to measure the loudness, awareness, and annoyance of tinnitus. RESULTS: THI and VAS scores were decreased significantly after the treatment. Tinnitus of 12 months or shorter duration showed greater improvement than those cases of longer than 12 months. The lower degree of hearing loss also showed greater improvement when compared with the greater degree of hearing loss. CONCLUSION: Tinnitus of shorter duration and milder hearing loss showed better prognosis: the results of this study may help in treatment counseling for tinnitus patients.

Neurovascular Compression Syndrome of the Eighth Cranial Nerve: Clinical Features and Medical Treatment / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Neurovascular compression syndrome of the eighth cranial nerve is characterized by recurrent auditory and vestibular symptoms. A detailed history and laboratory findings are important in the differential diagnosis of other diseases, such as Meniere's disease, vestibular neuritis, or vestibular migraine. This study reviewed its clinical features and the efficacy of medical treatment. SUBJECTS AND METHOD: The medical records of seven patients with a diagnosis of neurovascular compression syndrome of the eighth cranial nerve were reviewed retrospectively. RESULTS: Their ages at the time of disease onset ranged from 30 to 67 years. Six of the patients had unilateral typewriter tinnitus, like Morse code, and five had vertigo. The duration of these symptoms was up to 20 seconds. Three of the five patients with vertigo had canal paresis. All patients responded completely to carbamazepine or oxcarbazepine. CONCLUSION: Medical treatment was very successful for treating the symptoms of neurovascular compression syndrome of the eighth cranial nerve. The characteristics of the audiovestibular symptom and laboratory results are important for differentiating other diseases.

Clinical Characteristics and Microbiology of Acute Otitis Media of Children: Multicenter Studies / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Acute otitis media (AOM) is one of the most common forms of bacterial infection in children. The aim of this study was to investigate the clinical characteristics and the common pathogens of AOM children who visited three different centers. SUBJECTS AND METHOD: We have conducted a retrospective study of 133 children under 15 years with the diagnosis of AOM that had been seen between January 2010 and January 2011. We examined of AOM children's symptoms, signs and culture results. RESULTS: The most common symptoms were in the order of crying or irritability, otalgia and fever. Otorrhea was significantly higher under 2 years old and drum injection was over 2 years old. The most common pathogens were Streptococcus pneumoniae (26.6%), followed by Moraxella catarrhalis (19.0%), Haemophilus influenzae (11.4%) and Staphylococcus aureus (11.4%). Among the total pathogens, about 71% of pathogens were resistant to amoxicillin, 78% to macroride, and 55.2% to clindamycin. About 58.3% of H. influenza and M. catarrhalis were positive to beta-lactamase. CONCLUSION: More than half of pathogens were resistant to standard dose amoxicillin. For the appropriate treatment of AOM, decisions were made based on the common symptoms, signs and antibiotic resistances of pathogens.

Multicenter Study on the Clinician's Diagnostic and Therapeutic Approaches for Benign Paroxysmal Positional Vertigo in Korea / 대한평형의학회지

BACKGROUND AND OBJECTIVES: It is necessary to establish the most efficient diagnostic and therapeutic method for benign paroxysmal positional vertigo (BPPV), which is appropriate for Korean healthcare system. We aimed to evaluate current state of Korean clinician's diagnostic and therapeutic approaches for BPPV. MATERIALS AND METHODS: A 16-item survey was emailed to the members of dizziness department of Otology Research Interest Group in the Korean Otologic Society (n=68). 43 were returned and analyzed. RESULTS: All respondents (100%) used Dix-Hallpike test as a diagnostic tool for vertical canal-BPPV. Supine roll test was used for diagnosing lateral canal BPPV in nearly all the respondents (97.7%). Epley maneuver was chosen as otolith repositioning maneuver (ORM) for posterior canal BPPV in all respondents and barbecue rotation (BBQ) was used for treating lateral canal BPPV with geotropic nystagmus in 95.3% of respondents. Extreme variation was noted for therapeutic approach of lateral canal BPPV with ageotropic nystagmus BBQ, with 4 kinds of ORM and adjunctive measures to liberate otolith from cupula, while BBQ was again the most commonly used ORM (76.7%). CONCLUSION: The development of practical and efficient ORM for lateral canal BPPV with ageotropic nystagmus is necessary.

Pseudo-Spontaneous Nystagmus in Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo

OBJECTIVES: Spontaneous nystagmus, which has been considered a typical sign of acute vestibulopathy, has recently been reported in benign paroxysmal positional vertigo involving the lateral semicircular canals (LC-BPPV) without unilateral vestibulopathy (pseudo-spontaneous nystagmus, PSN), but research about its clinical application is still limited. Here we investigate the frequency and characteristics of PSN in LC-BPPV patients, and estimate its prognostic value. METHODS: For 95 patients with LC-BPPV, we examined nystagmus in the sitting position in the clinic with video goggles. Patients were categorized as PSN or non-PSN, according to presence of horizontal nystagmus in the sitting position at diagnosis. The duration of vertiginous symptoms before diagnosis and the duration of treatment were compared between the two groups. The results of video-nystagmography test were reviewed when available. RESULTS: PSN was examined in 16 (16.8%) patients, all of whose symptoms disappeared immediately after successful repositioning therapy. While the duration of symptoms did not differ statistically between groups (P=0.481), the duration of treatment in the PSN group was significantly longer than in the non-PSN group (P<0.001). CONCLUSION: We conclude that the presence of spontaneous nystagmus in the sitting position does not preclude a diagnosis of LC-BPPV without unilateral vestibulopathy. PSN was related to a poor outcome of LC-BPPV in this study.