Characteristics of Nystagmus during Attack of Vestibular Migraine / 대한평형의학회지

OBJECTIVES: The purpose of this study is to investigate characteristics of nystagmus during attacks of vestibular migraine (VM), and to find a distinct clinical feature compared to other migraine and peripheral vestibular disorders. METHODS: This study is a retrospective chart review of 82 patients satisfied with VM criteria, which is formulated by the new Bárány Society. Spontaneous and positional nystagmus provoked by various head positions were examined with video-nystagmography in all patients. Bithermal caloric test and cervical vestibular evoked myogenic potential test (cVEMP) were also performed. The direction and peak slow-phase velocity (SPV) of nystagmus, unilateral caloric weakness and interaural difference of cVEMP were analyzed. Control groups were lesion side in acute VN for nystagmus results and healthy side in the patients with benign paroxysmal positional vertigo of posterior semicircular canal for caloric and cVEMP results. Chi-square test and Mann-Whitney U-test were used for statistical analysis. RESULTS: During the acute attack, nystagmus was seen in 71.9% (59 of 82) of patients. Horizontal nystagmus was the predominant type. Peak SPV in VM patients was much slower than in the control group (2.37±1.73 °/sec vs. 17.05±12.69 °/sec, p<0.0001). There was no significant difference on the result of both caloric and cVEMP test, compared to those of control groups. CONCLUSION: Nystagmus with horizontal directions and low SPV was dominant form in the attack of VM. Close observation of nystagmus can be helpful to make a correct diagnosis and to understand the pathomechanism of vertigo in VM.

Posttraumatic Peripheral Vertigo / 대한평형의학회지

Posttraumatic vertigo can be defined as the vertiginous disorder occurred after head and neck trauma without other pre-existing vestibular disorder. Central, peripheral, and combined deficits might cause this condition. Especially, various peripheral vestibulopathies are possible causes of posttraumatic vertigo; benign paroxysmal positional vertigo, temporal bone fracture, perilymphatic fistula, labyrinthine concussion, posttraumatic hydrops, and cervical vertigo. Since the differential diagnosis of the posttraumatic vertigo is often difficult, it is essential to acquire knowledge of their pathophysiology and clinical features. In this review, peripheral vestibulopathy as the possible causes of posttraumatic vertigo were described according to the current literature.

Identification of Vestibular Organ Originated Information on Spatial Memory in Mice / 대한평형의학회지

OBJECTIVES: We aimed to study the role of vestibular input on spatial memory performance in mice that had undergone bilateral surgical labyrinthectomy, semicircular canal (SCC) occlusion and 4G hypergravity exposure. METHODS: Twelve to 16 weeks old ICR mice (n=30) were used for the experiment. The experimental group divided into 3 groups. One group had undergone bilateral chemical labyrinthectomy, and the other group had performed SCC occlusion surgery, and the last group was exposed to 4G hypergravity for 2 weeks. The movement of mice was recorded using camera in Y maze which had 3 radial arms (35 cm long, 7 cm high, 10 cm wide). We counted the number of visiting arms and analyzed the information of arm selection using program we developed before and after procedure. RESULTS: The bilateral labyrinthectomy group which semicircular canal and otolithic function was impaired showed low behavioral performance and spacial memory. The semicircular canal occlusion with CO₂ laser group which only semicircular canal function was impaired showed no difference in performance activity and spatial memory. However the hypergravity exposure group in which only otolithic function impaired showed spatial memory function was affected but the behavioral performance was spared. The impairment of spatial memory recovered after a few days after exposure in hypergravity group. CONCLUSIONS: This spatial memory function was affected by bilateral vestibular loss. Space-related information processing seems to be determined by otolithic organ information rather than semicircular canals. Due to otolithic function impairment, spatial learning was impaired after exposure to gravity changes in animals and this impaired performance was compensated after normal gravity exposure.

Laboratory Management Status of Vestibular Function Test in Korea / 대한평형의학회지

OBJECTIVES: This study was conducted to assess the current management status of the vestibular function test laboratories in Korea. METHODS: Questionnaire about the management status of the vestibular function test laboratories was sent by email to the entire members of the Korean Balance Society. The contents of questionnaire included situation of employees who perform the tests, the types of vestibular function tests and equipment, frequency of the test and types of dizziness related questionnaires. RESULTS: Forty-nine hospitals and clinics responded. All the 49 respondents answered that they have videonystagmography. Spontaneous nystagmus analysis by videonystagmogrphy was the most frequently tests for patients with dizziness. Questionnaires for dizziness were used by 27 respondents (55.1%) for initial evaluation of the dizziness patients. The Korean version of dizziness handicap inventory was the most frequently used dizziness related questionnaire. CONCLUSIONS: We analyzed the current management status of vestibular function test laboratories to comprehend the present condition of the vestibular function test. We think that these results will help to provide a standard for laboratory operations and prepare for the education, focusing on high-demand tests.

Hyper-response of Cervical Vestibular Evoked Myogenic Potential in Patients with Meniere Disease: A Preliminary Study / 대한평형의학회지

OBJECTIVES: The purpose of this study is to investigate the hyper-responsiveness of cervical vestibular-evoked myogenic potential (cVEMP) in patients with Meniere disease (MD), and to compare the result of cVEMP between probable and definite MD group. METHODS: A total of 110 patients satisfied with probable MD and definite MD criteria, which is recently formulated by the Classification Committee of the Bárány Society, were included. An interpeak amplitude and interaural amplitude difference (IAD) ratio of both ears was measured. The abnormal response of ipsi-lesional cVEMP was categorized into 2 groups; hyper-response and hypo-response. Chi-square test and Mann-Whitney U-test were used for statistical analysis. RESULTS: In the probable MD and definite MD group, the mean IAD was 25.24%±17.79% and 53.82%±34.98%, respectively (p < 0.01). The abnormal response of cVEMP at the affected ear was more frequent in the definite MD group, compared to the probable MD group (32/40 vs. 13/36, p < 0.01). However, hyper-response was more frequently observed in the patients with probable MD, compared to the patients with definite MD (13/36 vs. 3/40, p < 0.01). CONCLUSION: Hyper-response of cVEMP was more frequently observed in the early probable MD patients. It might be an early sign of MD, related with the saccular hydrops, which can help the early detection and treatment.

Experiemental Model for Ménière's Disease Using Surgical Ablation of Endolymphatic Sac / 대한평형의학회지

Endolymphatic hydrops is a representing pathologic finding of Ménière's disease. For the induction of endolymphatic hydrops in an animal model, surgical ablation of endolymphatic sac has been used. Although traditional model with the blockage of endolymphatic sac induced severe hydrops, it has several limitations for the study of pathophysiology of Ménière's disease. Recently, modified experimental models have been introduced, in which additional procedure was performed to induce the acute aggravation of hydrops after the surgical ablation. These new models could be helpful to elucidate the mechanism and develop a new treatment of Ménière's disease. In this review, we introduce the characteristics of animal models using surgical ablation of endolymphatic sac from the classical model to novel modified models.

Acute Vestibular Neuritis and Ramsay-Hunt Syndrome / 대한평형의학회지

Acute vestibular neuritis is the disorder characterized by acute, spontaneous vertigo with the unilateral vestibular loss. Reactivation of herpes simplex virus is considered as its cause. Its management consists of symptomatic therapy in the acute phase and following rehabilitation exercise to improve central compensation. The differential diagnosis should include central vestibular disorders mimicking peripheral vertigo. Ramsay-Hunt syndrome, which defined as a herpes zoster oticus with facial paresis, is also a disorder frequently accompanied with vestibular deficit. Combination therapy of acyclovir and corticosteroid is recommended for the treatment. In this review, diagnosis and management of the two disorders are described.

Vestibulo-Ocular Reflex Recordings of Small Rodents using a Novel Marker Array / 대한평형의학회지

OBJECTIVE: Recording the nystagmus of small experimental rodents is an integral technique in vestibular research. Theoretically, the size and the shape of markers strongly affect the analysis of 3 dimensional nystagmus. METHODS: The nystagmus of 6 healthy ICR mice were recorded and their gain values were compared using 200 µm, 300 µm, 400 µm, and 600 µm isosceles triangle markers at the peak velocity of 60°/sec and 100°/sec with the rotational stimulations of 0.1 Hz, 0.2 Hz, and 0.5 Hz. RESULTS: The gain values of 3 different sizes of the markers showed no significant differences in horizontal- vertical-torsional component. However, it was unable to record the nystagmus with 200 µm markers since the markers were too small to be placed and stayed on the center of the pupils. CONCLUSION: Technicians can decide the size of the markers from 200 to 600 µm to record the nystagmus of mice, depending on the technicians' skills.

Pulmonary Artery Angiosarcoma Confused with Acute Pulmonary Thromboembolism: Focusing on Clinical and Echocardiographic Features in the Differentiation of Two Categories

Although pulmonary artery angiosarcoma is rare, it can be misdiagnosed as pulmonary embolism because of its similar clinical and diagnostic features. The diagnosis is often delayed and the misdiagnosis brings unnecessary treatment. Because we made a wrong diagnosis of pulmonary artery angiosarcoma as an acute pulmonary embolism, we did thrombolytic therapy which could be dangerous to the patient. In this case report, we focused on the clinical and echocardiographic features of pulmonary artery angiosarcoma which can be used in differentiating the diagnosis from pulmonary embolism.

Validation of Waist-to-Height Ratio for Predicting Metabolic Syndrome in Patients with Prediabetes

BACKGROUND: Metabolic syndrome is associated with type 2 diabetes and cardiovascular disease in patients with prediabetes. The aim of this study was to investigate and compare WHtR (Waist-to-Height Ratio) as a predictor of metabolic syndrome with other anthropometric indices as in Body Mass Index (BMI), Waist Circumference (WC) and Waist to Hip Ratio (WHR) in prediabetes. METHODS: A total of 816 subjects with prediabetes were recruited from a community based Cohort Study. Receiver operating characteristic (ROC) curve was performed to find the optimal cutoff value of WHtR. Area under the curve (AUC) was calculated for each anthropometric index and correlation coefficient between WHtR and various dermographic and clinical factors was calculated. RESULTS: WHtR had a significant correlation with metabolic parameters except for fasting glucose and increased with increasing number of risk factors for metabolic syndrome. AUC of WHtR was significantly higher than that of other anthropometric indices. The optimal cutoff value of WHtR was 0.53 for metabolic syndrome in prediabetes. CONCLUSION: WHtR may be the simple and effective anthropometric index for predicting metabolic syndrome in prediabetic patients.

Intracardiac Echocardiography to Guide Biopsy for Two Cases of Intracardiac Masses

Pathologic diagnosis of a cardiac mass is vital in determining the proper treatment modality. Open heart surgery or transesophageal echocardiography guided biopsy can be feasible methods to confirm the pathology. However, the former is highly invasive and both methods require general anesthesia. The introduction of intracardiac echocardiography (ICE) can provide good anatomic information of heart and does not require general anesthesia. In this report, we present two cases of cardiac tumors which were confirmed by percutaneous biopsy under the guidance of an ICE. The patients underwent cardiac biopsy without any complications.

A Comparison of Different Techniques of Two-Dimensional Speckle-Tracking Strain Measurements of Right Ventricular Systolic Function in Patients with Acute Pulmonary Embolism

BACKGROUND: Speckle-tracking echocardiography has been applied to measure right ventricular (RV) systolic function in various diseases. However, variations in strain measurement by different vendors have limited the application of these techniques for assessment of RV function. We sought to compare two methods for the assessment of RV systolic function in patients with acute pulmonary embolism (PE). METHODS: From August 2007 to May 2011, all consecutive PE patients were prospectively included in this cohort study. Global longitudinal strains of RV measured with EchoPAC PC software (GLSRV-EchoPAC; GE Medical Systems) and velocity vector imaging (GLSRV-VVI; Siemens Medical Systems) were recorded on the same set of echocardiographic images. RESULTS: We analyzed a total of 50 patients (12 males, 68 +/- 14 years) with acute PE in this study. GLSRV-EchoPAC and GLSRV-VVI were correlated (r = 0.793, p < 0.001) and they showed significant correlations with conventional echocardiographic parameters of RV systolic function and Log B-type natriuretic peptide (BNP) level. However, GLSRV-VVI only showed significant correlations with cardiac biomarkers as serum creatinine kinase-MB (r = 0.367, p = 0.010) and tropoinin-I concentrations (r = 0.294, p = 0.040). CONCLUSION: GLSRV-VVI and GLSRV-EchoPAC showed significant correlations with conventional echocardiographic parameters of RV systolic function and LogBNP value in patients with PE.

Otoplasty in Otolaryngology / 대한이비인후과학회지

Otoplasty is known to be a challenging and rewarding area in otolaryngology. Although the physiologic effects of ear deformity are negligible, the aesthetic and psychological impact on the patient can be profound. Protruding, thin auricle of the ear is prone to damage from craniofacial trauma. The degree of damage varies, requiring immediate treatment and management. In order to obtain favorable results from otoplasty, having firm knowledge on the anatomy and embryology of the external ear must be preceded prior to meticulous assessment and assiduous operative planning for deformity of external ear and auricular injury. Anesthetic correction of the ear through diagnosis and subsequent treatment of the affected ear must also be performed. This study summarizes anatomic and embryologic analysis of the external ear and auricular deformities and trauma. In addition, a great number of surgical techniques for the otoplasty is reviewed to provide higher satisfaction for both patients and surgeons.

Association of Blood Pressure and Heart Rate Response to Graded Exercise Test with Left Atrial Volume Index and Pulse Wave Velocity

BACKGROUND: Exaggerated blood pressure (BP) response to exercise can be an independent risk factor for cardiovascular mortality and morbidity. The purpose of this study was to define the factor that effect on early systolic BP response to exercise. METHODS: We examined echocardiographic data, BP, heart rate from graded exercise test and brachial ankle pulse wave velocity (PWV) of 205 patients (137 men and 68 women; mean age 58 +/- 11 years; range, 19 to 83 years). Graded exercise test was conducted in BRUCE protocol. We define delta systolic blood pressure (SBP) as systolic BRUCE stage "n" BP minus baseline BP. RESULTS: Resting BP (127 +/- 16 mm Hg) was elevated to 171 +/- 26 mm Hg after peak graded exercise test. Resting heart rate (80 +/- 15 bpm) was increased to 146 +/- 27 bpm after peak graded exercise test. Stepwise regression test between baseline SBP, delta SBP, maximal SBP and left atrial volume index (LAVI) was done. Supine SBP, delta SBP, maximal SBP was not associated with LAVI (p > 0.5). But increased LAVI was significantly associated with delta SBP1 in woman (R2 = 0.192, p = 0.002). PWV was significantly associated with base line (R2 = 0.311, p < 0.01) and maximal SBP (R2 = 0.051, p < 0.01). However, PWV was not associated with delta SBP. CONCLUSIONS: LAVI and PWV were not associated with early SBP response to exercise. But in women, elevation of early SBP during exercise is associated with LAVI.

Quantification of Vestibulospinal Reflex Under the Stress Condition on Both Soleus Muscles / 대한평형의학회지

BACKGROUND AND OBJECTIVES: Vestibulospinal reflex (VSR), which is measured in static state, tends to be compensated prior to vestibule-ocular reflex. Therefore, by establishing method that enables to track and observe quantified VSR, the reliability of experiment is attempted to be increased. MATERIALS AND METHODS: On five SD Rats to measure electromyogram (EMG), electrodes, in the form of stranded cables composed of seven wires, are chronically implanted on both sides of the soleus muscles. Pre and post operative condition of sitting still, standing, and ladder step walking was compared before, and six and twenty four hours after a unilateral labyrinthectomy with quantified muscle activity in maximal voluntary activity. Simultaneously by using multi modality electric potential plus package, the muscle activity between the two legs was tracked and compared. RESULTS: In the sitting still position, the left/right soleus muscle activities were 25.7/26.0 microV before a unilateral labyrinthectomy which was changed after the surgery with the value of 23.1/8.1 microV and 23.4/14.3 microV when six and twenty four hours passed respectively. In the standing position, 92.8/124.0 microV of preoperative value was changed to 89.6/37.3 microV six hours after the unilateral labyrinthectomy, and it was 97.0/54.7 microV 24 hours after. The preoperative value in ladder step walking test was 56.2/86.0 microV, and postoperative ones were 54.9/21.2 microV and 55.7/38.0 microV after six and twenty four hours respectively. CONCLUSION: VSR assessment method by using quantitative EMG well reflects the process of vestibular compensation, and to maintain the tension of extensor muscles, ladder step walking test is shown to be useful.

Diagnostic Dehydration Testings for Endolymphatic Hydrops / 대한평형의학회지

No abstract available.

Measuring the Behavioral Parameters of Mouse Following Unilateral Labyrinthectomy in Round Free Field Using an Infrared Lamp and a Simple Webcam Camera / 대한평형의학회지

BACKGROUND AND OBJECTIVES: In this research, movements of mouse after labyrinthectomy were analyzed to determine the degree of vestibular dysfunction and compensation. MATERIALS AND METHODS: By using an infrared lamp, mouse movements were recorded for 100 seconds in a dark room. The experimental area was manufactured as a circular space with a diameter of 60 cm. The movements of five mice labyrinthectomized on right side were observed and recorded at 3 hours, 9 hours and 120 hours after the operation, and also the ten mice of control group. RESULTS: The differences between the total moving distances and the rotating angle from the origin that set the center of round field between groups were analyzed with pictures of 1 frame per second. It is concluded that all 4 groups show significant differences between its mean rotation angle and total moving distances statistically. At 9 hours after right labyrinthectomy, mice tended to turn clockwise; but at 120 hours, there was no significant difference between clockwise and counter-clockwise rotation. CONCLUSION: Measuring the movement of mouse in round free field can be the proper method to determine the degree of vestibular dysfunction and vestibular compensation. This test was time-saving and cost-effective method.

C-fos Expression of Vestibular Nucleus in C57BL/6 Mouse Under the 7 Tesla Ultra High Magnetic Field / 대한평형의학회지

BACKGROUND AND OBJECTIVES: A typical side effect of super high magnetic field is dizziness and it is expected that 7 Tesla (T) super high magnetic field will have temporary influence on vestibular nucleus. Prevalence rate of dizziness generally increases with advancing years, so this study discusses whether the influence of 7 T super high magnetic field differs depending on the age. MATERIALS AND METHODS: C57BL/6 mice weighting from 10-40 g were categorized into 4-week-old and 16-week-old groups. They were exposed to 7 T magnetic field and immunohistochemical staining was done to observe expression of c-fos protein in vestibular nucleus of mice. RESULTS: Control group with normal vestibular system did not show c-fos protein. However, mice exposed to 7 T magnetic field showed c-fos expression selectively on medial and lateral parts of vestibular nucleus and there was no significant difference of c-fos expression between both sides (p<0.05). There was statistically significant difference between the different age group: 16-week-old mice group showed higher number of cells expressing c-fos protein than 4-week-old mice group did (p<0.05). CONCLUSION: It is statistically significant that 7 T super high magnetic field is more influential to older age group.

A Case of Multiple Perilymph Fistula Induced by Tympanostomy Tube Insertion / 대한평형의학회지

This controversial diagnosis centers around the phenomenon of perilymph leaking from the inner ear into the middle ear cleft through the oval window, round window or other fissures in the bony labyrinth that may be abnormally patent. A perilymph fistula may develop after stapedectomy surgery, penetrating middle ear trauma, head trauma, barotrauma, or possibly spontaneously. Uncertainty regarding the clinical criteria for the diagnosis and the inability to document the presence of a microfistula at surgery contribute to the problematic nature of this diagnosis. However, this condition should be seriously considered in the patient with vertigo after head trauma, barotrauma injury, or previous middle ear surgery. It is particularly likely in patients with penetrating middle ear trauma with vertigo. Most authors agree that perilymph fistulas generally heal spontaneously, therefore a few days of bed rest is appropriate in acute cases. Cases suspected after penetrating trauma should be explored early if symptoms persist. Here, authors report a case of multiple perilymph fistula possibly caused by tympanostomy tube insertion in a 48-year-old man with a review of the literature.

The Comparison of the Magnetic Resonance Images in the Patient With Definite Meniere's Disease Before and After Endolymphatic Sac Decompression / 대한평형의학회지

Endolymphatic hydrops is believed to be underlying pathophysiology of Meniere's disease. The degree of endolymphatic hydrops observed by MRI (magnetic resonance imaging) in patients with Meniere's disease offers a new method to study the progression of Meniere's disease. There have been multiple attempts to diagnose Meniere's disease with the help of radiologic tests including MRI in Korea. We describe a case report of a patient with Meniere's who showed changes of endolymphatic sac in MRI after endolymphatic sac decompression.