Maximum diameter versus volumetric assessment for the response evaluation of vestibular schwannomas receiving stereotactic radiotherapy

PURPOSE: To explore the feasibility of maximum diameter as a response assessment method for vestibular schwannomas (VS) after stereotactic radiosurgery or fractionated stereotactic radiotherapy (RT), we analyzed the concordance of RT responses between maximum diameters and volumetric measurements. MATERIALS AND METHODS: Forty-two patients receiving curative stereotactic radiosurgery or fractionated stereotactic RT for VS were analyzed retrospectively. Twelve patients were excluded: 4 did not receive follow-up magnetic resonance imaging (MRI) scans and 8 had initial MRI scans with a slice thickness >3 mm. The maximum diameter, tumor volume (TV), and enhanced tumor volume (ETV) were measured in each MRI study. The percent change after RT was evaluated according to the measurement methods and their concordances were calculated with the Pearson correlation. The response classifications were determined by the assessment modalities, and their agreement was analyzed with Cohen kappa statistics. RESULTS: Median follow-up was 31.0 months (range, 3.5 to 86.5 months), and 90 follow-up MRI studies were analyzed. The percent change of maximum diameter correlated strongly with TV and ETV (r(p) = 0.85, 0.63, p = 0.000, respectively). Concordance of responses between the Response Evaluation Criteria in Solid Tumors (RECIST) using the maximum diameters and either TV or ETV were moderate (kappa = 0.58; 95% confidence interval, 0.32-0.85) or fair (kappa = 0.32; 95% confidence interval, 0.05-0.59), respectively. CONCLUSION: The percent changes in maximum diameter and the responses in RECIST were significantly concordant with those in the volumetric measurements. Therefore, the maximum diameters can be used for the response evaluation of VS following stereotactic RT.

Efficacy of Percutaneous Ethanol Injection for Benign Neck Cyst / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Advantages of percutaneous ethanol injection (PEI) were represented by insignificant mortality, minimal damage to normal parenchyma, relatively low cost and easy availability. The objective of the present study was to evaluate the efficacy of ethanol ablation as a minimally invasive management of cystic lesions in the neck or arising from the neck. SUBJECTS AND METHOD: Between August 2010 and December 2015, 28 patients with cystic lesions in the neck were diagnosed and treated with percutaneous ethanol injection. We evaluated the outcome of treatment using the alteration of volume reduction and the improvement of symptomatic and cosmetic complaints and complications. RESULTS: The initial mean tumor volume was 21 mL (range, 1.6-36.9 mL), as shown by ultrasonography. The mean number of the treatment sessions was 3.5 (range, 1-9 sessions). At the last follow-up, the mean volume of the treated neck cyst decreased significantly from 21 mL to 2.7 mL (p<0.001). The average volume reduction rate was 82.4% with the success rate of procedure of 82%. The mean symptoms and cosmetics visual analog scale improved from 5.4 to 2.4 and from 4.8 to 1.5 (p<0.001). No significant complications were observed during follow-ups. CONCLUSION: PEI is simple, easy, safe, and effective without surgical scars and hospitalization for neck cyst patients and favorable outcomes can be achieved without significant complications. It can be used as a substitute for surgery in the treatment of benign neck cyst lesions.

An Experience of Patient Involvement in the Pre-Transfusion Checking Process: A Single Center Study / 대한수혈학회지

BACKGROUND: Correct transfusion of blood product to the right patient requires multiple processes. Errors occurring in the pre-transfusion checking step can result in a serious incident. The role of patients in the safe blood transfusion practice has been investigated. METHODS: We have adopted patient involvement in bedside checking using patient's signature since 2010. We conducted a retrospective review of transfusion medical records during January 2013. The signatures of doctors, nurses, and patients were audited and the reasons for omitting patient's signature were examined. RESULTS: The practice of patient's signature was performed after the problems of procedures were improved. A total of 4697 blood products for 576 patients were issued. The first transfused products were 426 units of RBC (74.0%), 56 units of platelet (9.7%), and 34 units of fresh frozen plasma (5.9%). Completion of patient's signature was observed in 336 patients (63.5%). The reason for omitting patient's signature was operation (104, 18.1%), unclear consciousness or sedation (75, 13.0%), and neonate or infancy (7, 1.2%). CONCLUSION: Patient involvement in the pre-transfusion checking process by writing down the patient's own signature could be achievable. In case of no patient's signature as with an operation, sedation, and neonate or infancy, specific attention is required to ensure a safe transfusion practice.

Influences of Hashimoto's Thyroiditis as Prognostic Factor of Papillary Thyroid Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: As a prognostic factor, the association of Hashimoto's thyroiditis (HT) with papillary thyroid carcinoma (PTC) is still controversial. The aim of this study is to compare clinicopathologic parameters between PTC alone and PTC with HT patients. SUBJECTS AND METHOD: We reviewed the medical record retrospectively. 205 patients underwent thyroid surgery from January 2006 to December 2008. Among the 205 patients, 120 patients were included in this study. We compared various clinicopathologic parameters such as gender, tumor size, multifocality, lymphovascular invasion, extrathyroidal extension, central lymph node metastasis, and lateral lymph node metastasis between PTC alone and PTC with HT patients. RESULTS: 18.3% of PTC patients were associated with HT. There were no significant differences in clinocopatholgic parameters such as gender, tumor size, multifocality, lymphovascular invasion, extrathyroidal extension, central lymph node metastasis or lateral lymph node metastasis. Tumor recurrences were found in 6 out of 98 cases of PTC alone and in 3 out of 22 cases of PTC with HT. There was no significance between two groups (p=0.363). CONCLUSION: Results indicate that HT may not be associated with clinicopathologic factors in PTC.

The Clinical Effectiveness of the Minimally Invasive Transcanal Myringotomy for the Removal of Early Stage Congenital Cholesteatoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Because of the wide application of the endoscopic diagnostic system and increased amount of attention for early stage congenital cholesteatoma (CC) recently, the detection of CC in stages I and II has increased. In this study, we investigated the effectiveness of minimally invasive transcanal myringotomy (MITM), and compared its results with those of postauricular approach (PAA) in early stage CC consisting of stage I and II of Potsic's classification. SUBJECTS AND METHOD: We retrospectively studied 70 patients who were diagnosed with CC after surgery performed by an otologist from June 2006 to June 2013. Thirty-two patients were in early stage CC consisting stage I and II. Of the 32 patients, MITM was performed on 20 and PAA was performed on 12. We analyzed the characteristics of disease, operation time, hospitalization period, recurrence and complications according to the stage and each operation. RESULTS: There were no significant differences between the stages and types of the disease between the MITM and the PAA group (p>0.05). The operation time and hospitalization period for the MITM group were significantly shorter than for the PAA group (p<0.001). There was no recurrence in the two groups during the average follow-up period of 33 months follow-up. Tympanic membrane perforation occurred in one patient in the MITM group. One patient presenting an external aural epidermal cyst in the PAA group was treated with surgical removal. CONCLUSION: The MITM is an efficacious and feasible method to remove early stage CC.

Dexamethasone Induces Apoptosis of Nasal Polyp-Derived Tissue Cultures Through JNK and p38 MAPK Activation

OBJECTIVES: Glucocorticoids, such as dexamethasone (DEX), increase apoptosis in a variety of white cells in nasal polyps and apoptosis is an important factor in the resolution of inflammation. However, the mechanism of glucocorticoids induced apoptosis in nasal polyp remains unclear. In this study the authors evaluated which pathways were engaged in apoptosis induced by DEX in an ex vivo model of nasal polyps. METHODS: Nasal polyp tissues were cultured using an air-liquid interface method. Cultures were maintained in the absence or presence of DEX (10 or 100 microM) for 24 hours. To investigate the involvement of the apoptotic signaling pathways in nasal polyp, such as caspase cascades, Fas-FasL signaling pathway, mitochondrial pathway and p38 mitogen-activated protein kinase (MAPK)/JNK pathway, the authors performed reverse transcription-polymerase chain reaction and Western blotting. RESULTS: The expression ratios of FasL, activated form of caspase-8, caspase-9, and caspase-3 were significantly higher in DEX-treated polyps (P<0.01). In the Bcl-2 family expression, the anti-apoptotic molecules, Bcl-2 and Bcl-XL decreased, but pro-apoptotic molecules, Bax increased, and Bid and Bad were activated. In the conventional MAPKs, JNK, and the phospho-p38 MAPK were significantly higher, but phospho-extracellular signal-regulated kinase (ERK)1/2 was significantly lower in DEX-treated polyps (P<0.01). CONCLUSION: DEX induces apoptosis of nasal polyp via caspase cascades, Fas-FasL signaling pathway, mitochondrial pathway and p38 MAPK/JNK pathway.

A Case of Image-Guided Posterior Tympanotomy in Chronic Otitis Media / 대한이비인후과학회지

Posterior tympanotomy is a procedure performed to access the posterior mesotympanum through a mastoid exposure while preserving the posterior external auditory canal wall. It is dangereous to drill the the site of procedure, as it is surrounded by incuidal fossa superiorly, facial nerve posteriomedially, and chorda tympani nerve anterolaterally, and forms a very narrow pathway. There is always a risk of surgical trauma involving important surgical structures, especially facial nerve and chorda tympani nerve. The development of image-guided surgery (IGS) has significantly improved the performance of many surgical procedures by aiding the identification of surgical landmarks, improving surgical outcomes, rendering the procedure safer and more efficient, especially for beginner otologic surgery, in revision operations, in cases of massive bleeding and tumor of complex anatomy. To see how IGS could help otologic surgeons to identify fine, important structures during posterior tympanotomy, we report a case of posterior tympanotomy in chronic otitis media, which was done using the image-guided surgical technique.

A Case of Solitary Neurofibroma Arising from the Arytenoid Treated by Transoral Laser Surgery / 대한이비인후과학회지

Neurofibroma arising solitarily in the larynx is uncommon. With the branch of the superior laryngeal nerve involved, the aryepiglottic fold is the most common site in endolaryngeal neurofibromas. The recurrence rate for the disease is high unless en bloc excision, the treatment of choice, is taken. We present a case of neurofibroma in a 58-year-old female who complained of throat discomfort and dysphagia. The mass was removed by transoral laser surgery and no recurrence was found after 18 months.

A Case of Image-Guided Surgery in Congenital Aural Atresia / 대한이비인후과학회지

The repair of congenital aural atresia remains one of the most challenging otologic procedures because of the scarcity of surgical landmarks, the complexity and the variety of the temporal bone anatomy, and the limited space for reconstruction. The risks of facial nerve injury and profound sensorineural hearing loss following atresia surgery are common concerns. Furthermore, the rarity of the disease makes it difficult to improve surgical learning. Image-guided surgery may aid otologic surgeons in repairing atresia as it allows identifying the exact position of surgical instruments in relation to the specific anatomy. To our knowledge, there have been no published reports on image-guided atresia surgery in Korea. Herein, we report a case of congenital aural atresia, which was repaired using image-guided surgical technique.

Detection of BRAF(V600E) Mutation using Peptide Nucleic Acid-Mediated PCR Clamping Method in Fine Needle Aspiration Cytology / 대한내분비외과학회지

PURPOSE: The aim of this study was to evaluate the diagnostic value of a peptide nucleic acid (PNA)-mediated PCR clamping method for the detection of BRAFV600E mutations in fine needle aspiration cytology (FNAC). METHODS: One hundred sixty four patients underwent FNAC to evaluate BRAFV600E mutations between April 2011 and November 2011. Among them, forty-two patients were diagnosed with papillary thyroid carcinoma in a permanent pathologic specimen. A PNA-mediated PCR clamping method and a Dual-Priming Oligonucleotide (DPO)-based Real-time PCR method were used to detect the BRAFV600E mutation. We compared the result of mutation between the two methods. RESULTS: A BRAF mutation was found in 31 samples created by the PNA-mediated PCR clamping method, and in 28 samples in the DPO-based Real-time PCR method. The rate of BRAF mutation was 73.8% in association with the PNA-mediated PCR clamping method, and 66.7% in association with the DPO-based Real-time PCR method. There was no statistical differences between the two methods (P>0.05). CONCLUSION: The PNA-mediated PCR clamping method may be an alternative to the DPO-based Real-Time PCR method for detection of BRAF mutations in thyroid nodules.

Treatment Outcome in Differentiated Thyroid Cancer in Children and Adolescents / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Differentiated thyroid cancer (DTC) in children and adolescents is an advanced type of disease that has frequent recurrence and metastasis. But DTC in children and adolescents has a more favorable outcome than those in adults. We report the clinical features and treatment outcomes in children and adolescents who have undergone surgeries. SUBJECTS AND METHOD: We studied 16 patients younger than 21 years old who were diagnosed as DTC from August 1995 to January 2011. We retrospectively reviewed for the following factors: clinical features, tumor size, multifocality, pathologic type, regional or distant metastasis, recurrence, complications, extent of surgery, postoperative I-131 therapy with medical records, imaging studies, and pathologic reports. RESULTS: The mean follow-up periods were 87 months. As an initial operation, a total thyroidectomy alone was performed on 4 patients, central compartment neck dissection on 7 patients, a modified radical neck dissection on 5 patients. On the pathologic reports, observed were 14 papillary thyroid cancer patients, 2 follicular thyroid cancer patients. Extrathyroidal extension was observed in 10 patients. Cervical lymph node involvement was noted in 11 patients. Two patients exhibited local lymph node recurrences, and one patient distant metastasis in the lung. After an additional operation and radioactive iodine therapy, they are alive at the present time, without recurrence. CONCLUSION: Even with the limited number of cases in our study, we found that pediatric DTC has common extrathyroidal extension and lymph node metastasis. Careful surgical approach may protect postoperative complications. Regular follow up can detect recurrence earlier and could ensure disease free survival in pediatric DTC.

Rat Mastoid Bullae Obliteration with Hydroxyapatite: Histopathologic Results with Various Size of Hydroxyapatite / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Mastoid obliteration is the technique developed to reduce cavity problems after canal wall down mastoidectomy. Different materials have been explored for the technique, and of the variety of materials that have been used for mastoid obliteration, hydroxyapatite has gained particular attention. Hydroxyapatite can be made into a specific particle size, which affects the postoperative result. The aim of this study is to evaluate the histopathologic findings of mastoids obliterated with various particle sizes of hydroxyapatite in the temporal bullae of rat. Materials and Method: Rat bullaes were obliterated with hydroxyapatite and diversified into different particle sizes. In group 1, the mastoids were obliterated with Mimix(R) powder and in groups 2, 3, 4 with Bongros(R). The particle sizes were 0.3-0.6 mm, 0.6-1.0 mm and 1.0-3.0 mm each. After 3 months, the mastoids were examined under the microscope. RESULTS: In group 1, a new bone was formed in a consecutive fashion from the mastoid wall toward the center of the mastoid; there was no inflammation, with the new bone formation constituting 15%. In group 2, 3, 4, the proportion of new bone formation was higher than in the group 1, and constituted 40%, 55% and 60%, respectively. Inflammation was more severe when the particle size became larger. CONCLUSION: New bone formation was faster if larger hydroxyapatite particles were used; however, inflammation also increased. The powder form of hydroxyapatite was slow in new bone formation, but there was little inflammation. We therefore think that the hydroxyapatite is a very safe material.

A Case of the Carotid Rupture in Procedure of Tracheostomy / 대한이비인후과학회지

In order to avoid complications of tracheostomy, it is important to treat the tendency to bleed preoperatively and to control it meticulously during the operation as well. Also, careful dissection of trachea and tracheal fenestration technique is helpful for a safe tracheostomy. Recently, the authors experienced a rare case of a ruptured common carotid artery that took place during the dissection of peritracheal soft tissues caused by a lack of operative carefulness. It was controled by suture of the common carotid artery under direct vision of the vessel with the help of CS department. The authors report it with a review of literature.

Histologic Serial Changes of Obliterating Materials in the Rat Temporal Dorsal Bullae / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Mastoid obliteration surgery is a modern trend for otitis media either with or without cholesteatoma. The aim of our study is to evaluate histologic changes and effectiveness over time resulting from different obliterating materials and the existence of mucosa in the temporal dorsal bullae in rats. MATERIALS AND METHOD: Rats were divided into two groups. One group had the mucosa removed and was treated with trichloroacetic acid (TCA). The other group with mucosa remaining was untreated. The temporal dorsal bullae of the two groups of rats were obliterated with Mimix(R) (hydroxyapatite cement), Regenafil(R) (demineralized bone matrix), cartilage chip, and bone chip. Three months and again six months after the implantation, 5 animals in each group were examined. A histological study was performed to evaluate inflammation, new bone formation, and mucocele formation within the bullae. RESULTS: The group that had Mimix(R) implanted had a high inflammatory reaction, low implanted material resorption and cyst formation. The group with Regenafil(R) implanted had high cyst formation and more cyst formation with the passage of time. The group with bone chip implanted had high new bone formation, but also high cyst formation. The group that had cartilage chip implanted had high new bone formation, low implanted material resorption and low cyst formation. CONCLUSION: Cartilage chip is the only material that should be used in the air cell with mucosa remaining. Demineralized bone matrix and bone chip should not be used in the air cell with mucosa remaining. Hydroxyapatite cement should not be used due to severe inflammation.

Reconstruction of the Posterior Canal Wall with Mastoid Obliteration after Canal Wall Down Mastoidectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There have been heated controversies over the choice of the canal wall down mastoidectomy (CWD) and canal wall up mastoidectomy (CWU), which are operational methods used to eliminate the lesion of cholesteatoma. Combining the advantages of both methods, we reconstructed the posterior canal wall with conchal cartilage plate and obliterated mastoid cavity with bone chips (group I), or hydroxyapatite mixed with bone chips (group II) since 2001. This study was designed to evaluate the surgical outcomes of posterior canal wall reconstruction with mastoid obliteration in the treatment of cholesteatoma. SUBJECTS AND METHOD: From January of 2001 to March of 2007, the posterior canal wall reconstruction with mastoid obliteration was conducted on 66 patients. There were 30 cases of cholesteatoma and 36 cases of old radical cavity. The postoperative observation period ranged from 5 to 74 months, with the average period of 34.7 months. We analyzed the postoperative complications, and hearing results of the 33 ossicular reconstruction cases. RESULTS: There was 1 case of residual cholesteatoma in the middle ear cavity, but no recurrent cholesteatoma. In most cases, reconstructed canal wall was maintained well, but partial canal wall resorption and postauricular dimpling occurred in 5 cases of group I. On the other hand, the epithelization of posterior canal wall was incomplete in 4 cases of group II. After surgery, no patients complained any cavity problems at all. CONCLUSION: The present study suggests that this procedure can prevent cavity problems and reduce the recurrence of cholesteatoma with destructed canal wall.

Histopathologic Study on the Obliteration of the Temporal Dorsal Bullae in Rat Using Hydroxyapatite Cement and Demineralized Bone Matrix / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Mastoid obliteration surgery is a useful technique for otitis media either with or without cholesteatoma. Obliterating materials have to satisfy low antigenecity, less inflammation, little tissue resorption, high regeneration power and good integration into the host tissue. The aim of our study is to evaluate histopathological changes and effectiveness resulting from the different obliterating materials in the temporal dorsal bullae in rats. MATERIALS AND METHOD: We divided the rats into two groups. Group A was untreated, but group B underwent removal of mastoid mucosa with 2% trichloroacetic acid (TCA). Both groups had mastoid obliteration by the implantation of hydroxyapatite cement (Mimix(R)) and demineralized bone matrix (Regenafil(R)). Twelve weeks after the implantation, a histological study was performed to evaluate remaining implanted material, new bone formation and the formation of cysts within the bullae. RESULTS: There was no or minimal inflammation or foreign body reactions in the mastoid obliteration groups with Mimix(R) and Regenafil(R). In the obliterated group that was not treated with 2% TCA, the remaining implanted material with Mimix(R) group was more than in the Regenafil(R) group (p<0.05). The obliterated groups of Mimix(R) and Regenafil(R) were similar with respect to new bone formation. The mucocele formation in the obliterated groups treated with 2% TCA was less than in the obliterated groups not treated with 2% TCA (p<0.05). CONCLUSION: We suggest that Mimix(R) and Regenafil(R) could be valuable resources as graft materials for mastoid obliteration procedures. The research continues for evaluation of long term results of these materials and their potential as graft materials.

Otologic Manifestations in Patients with Systemic Lupus Erythematosus / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Systemic lupus erythematosus (SLE) is considered a prototype of the autoimmune disease because of its multi-organ involvement. Pathologic immune complexes and autoantibodies are the main causes of organ damage. Patients with SLE appear to be at increased risk of inner ear injury. The aim of this study was to evaluate the audiovestibular manifestations in patients with SLE. SUBJECTS AND METHOD: We investigated the audiovestibular manifestations of 22 patients with SLE. Pure tone audiometry and electronystagmography were performed for baseline evaluation. ESR, complement count and dsDNA were evaluated to investigate relationships between audiovestibular manifestations and disease activity of SLE. RESULTS: Ten (45.5%) patients complained of hearing loss. Four of 10 patients were diagnosed as sensorineural hearing loss (SNHL) and 3 patients as sudden SNHL. 9 (40.9%) patients complained of vertigo. Five of 9 patients were diagnosed as peripheral vestibulopathy, 2 as central vestibulopathy and 2 showed nonspecific findings. Audiovestibular symptoms were not related with disease activity of SLE (p>0.05). CONCLUSION: Audiovestibular symptoms are rare but various among patients with SLE. The mechanism of ear damage remains unknown. Thus, additional prospective studies are needed to elucidate its pathogenesis.

Cochlear Implantation Via a Scala Vestibuli in Postmeningitic Ossified Cochlea / 대한이비인후과학회지

Obstruction of the fluid spaces of the cochlea was previously thought to contraindicate cochlear implantation due to difficulties of electrodes insertion and questions about potential benefits. However, the concept of implantation of ossified cochlea and its subsequent acceptance have progressed rapidly. A 62-year-old man complained of both hearing loss after meningitis and temporal bone CT scan showed partial obliteration of cochlea bilaterally. We fully inserted 22 active electrodes via scala vestibuli without difficulty. The purpose of this study is to determine the safety and efficacy of scala vestibuli electrode insertion in partially ossified cochlea.

Comparison of the Efficacy of Systemic and Intratympanic Steroid Treatment on Sudden Sensorineural Hearing Loss with Diabetes / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: High dose systemic steroid therapy is currently the mainstay of the treatment for sudden sensorineural hearing loss (SSNHL). However, it makes a glycemic control worse in patients with diabetes. Intratympanic steroid injection (ITSI) can result in reduced systemic steroid toxicity and higher perilymph steroid level selectively. The purpose of this study is to compare the efficacy of ITSI (IT group) with that of systemic steroid (IV group) on SSNHL with diabetes. SUBJECTS AND METHOD: Thirty eight SSNHL patients who were diagnosed with diabetes were divided into the IV group (19 patients) and the IT group (19 patients). In the IV group, prednisolone was administrated intravenously for 7 days followed by tapered doses orally for 7 days. In the IT group, dexamethasone was administrated 4 times within a 2 week-period. Hearing outcome was assessed before and after treatment. RESULTS: In the IV group, 10 patients (58.8%) showed an improvement in the pure tone audiogram (PTA), with a mean improvement of 17.6 dB (p=0.023). In the IT group, 16 patients (84.2%) showed improvement in the PTA, with the mean improvement of 25.1 dB (p=0.000). But there was no significant difference in hearing gain and the recovery rate between the two groups. And it is more difficult to control blood sugar in the IV group rather than in the IT group. CONCLUSION: ITSI treatment is as effective as the systemic steroid treatment for SSNHL patients with diabetes and it can avoid a significant side effect of systemic steroids. So it could be considered as an initial treatment for the SSNHL patient with diabetes.

Clinical Features of the Dizzy Patients with Vertebrobasilar Insufficiency / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Dizziness is the most common symptom of vertebrobasilar insufficiency (VBI), occurring in at least two-thirds of patients. The aim of our study is to document the clinical features and the treatment outcomes in the dizzy patients with VBI. SUBJECTS AND METHOD: A retrospective review of 36 patients suffering dizziness associated with VBI was performed at a tertiary referral center. RESULTS: The most frequent type and duration of dizziness were rotational (52.8%) and minute (55.6%). Sixteen patients (44.4%) reported that their episodes of dizziness occurred several times per a month. Half of the patients had at least one isolated episode of dizziness and in 25% VBI began with an isolated episode of vertigo. Twenty-three patients (63.9%) had risk factors for cerebrovascular diseases. Benign paroxysmal positional vertigo occurred in 27.8%, and 38.9% had a significantly decreased or absent response to caloric stimulation. On the dynamic posturography, visual dysfunction (33.4%) and vestibular dysfunction (19.4%) were observed. Thirty-two patients (88.9%) had abnormal finding on the pure tone audiometry. Nineteen (61.3%) of 31 patients experienced resolution or significant reduction of their episodes of dizziness with treatment. But one patient progressed to acute infarction. CONCLUSION: VBI-associated dizziness cause various clinical manifestations and there should be relevant differential diagnosis for episodic vertigo that last only minutes. We should pay special attention to the VBI in patients with isolated, transient dizziness and the risk factor of the cerebrovascular disease.