BACKGROUND AND OBJECTIVES: Pseudo-labyrinthine symptom without any other accompanying neurologic symptoms or signs occur with cerebellar infarction. The prognosis and management of cerebellar infarction differ from those of vertigo associated with unilateral vestibulopathy. The objective of study was to analyze the clinical symptoms of cerebellar infarction mimicking unilateral vestibulopathy according to the infarction territory. MATERIALS AND METHOD: Among 273 patients who showed pseudo-labyrinthine symptoms or signs, 28 patients were diagnosed cerebellar infarction on MRI between January 2003 and October 2006. Out of the 28 patients, 9 patients accompanying with focal neurologic symptoms or signs in early stage were excluded, and a retrospective analysis of total 19 patients was done through chart reviews. Using diffusion-weighted imaging, we divided 19 patients into two groups, AICA and PICA territory infarction. Clinincal features, outcome of audiologic and vestibular function test were compared between the groups. RESULTS: Among the 19 subjects, 10 were males and 9 were females, the mean age was 63.1+/-.0. On MRI, 5 (26.3%) subjects showed infarction in unilateral AICA territory, 14(73.7%) in unilateral PICA territory. In the patients with AICA territory infarction, audiological tests confirmed unilateral sensorineuronal hearing loss in all 5 subjects. On V-ENG, 4/5 (80%) demonstrated horizontal or mixed horizontal torsional spontaneous nystagmus, and 4/5 (80%) had a canal paresis to caloric stimulation. In several days of hospital stay, 3/5 (60%) showed new neurologic signs, facial numbness. In the patients with PICA infarction, there was no hearing change. On V-ENG, 12/14(85.7%) demonstrated horizontal or mixed horizontal torsional spontaneous nystagmus, and 7/14 (50%) had a canal paresis to caloric stimulation. In several days of hospital stay, 10/14 (71.4%) accompanied with cerebellar ataxia. CONCLUSION: Cerebellar infarction simulating unilateral vestibulopathy is more common than previously thought. Early recognition of the cerebellar infarction showing pseudo-vestibular symptom may allow specific management. Also taking into account that clinical features differ by infarction territory will assist in determining the patient's status of the disease.
Cerebellar Ataxia ; Cerebellum ; Female ; Hearing ; Hearing Loss ; Humans ; Hypesthesia ; Infarction* ; Length of Stay ; Magnetic Resonance Imaging ; Male ; Neurologic Manifestations ; Paresis ; Pica ; Prognosis ; Retrospective Studies ; Vertigo ; Vestibular Function Tests

OBJECTIVES: The prognostic significance of vertigo in patients with idiopathic sudden sensorineural hearing loss (SSNHL) remains a matter of debate because vertigo is associated with many different vestibular disorders. The purpose of this study is to determine the role of benign paroxysmal positional vertigo (BPPV) as a prognostic factor in patients with SSNHL. METHODS: We conducted a retrospective study of 298 patients with SSNHL. Hearing outcomes were evaluated by assessments of pre-treatment hearing and hearing gain. Comparative multivariate analyses between prognostic factors and hearing outcome were conducted. RESULTS: Thirty-eight (12.7%) SSNHL patients were found to also have BPPV. BPPV showed significant negative prognostic factors in hearing outcome on multivariate analysis (odds ratio, 0.15). In comparison to average pure tone audiometry (PTA), patients diagnosed with SSNHL with BPPV exhibited poorer hearing in pre- and post-treatment PTA compared to SSNHL without BPPV. Old age (>60 years), pre-treatment hearing, and canal paresis were significant outcome predictors. CONCLUSION: BPPV in SSNHL patients, representing definitive vestibular damage, was closely related to poor prognosis.
Audiometry ; Hearing ; Hearing Loss, Sensorineural ; Hearing Loss, Sudden ; Humans ; Multivariate Analysis ; Paresis ; Prognosis ; Retrospective Studies ; Vertigo

No abstract available.

Vestibular schwannoma (VS) is a rare benign tumor arising from the vestibular portion of the 8th cranial nerve. Patients with VS complain of diverse symptoms, such as asymmetrical hearing loss, tinnitus, vertigo, and unsteadiness. The most common symptom of VS is unilateral and gradual loss of hearing, which may also be associated with tinnitus. We experienced an unusual case of 62-year-old woman, who presented with acute vertigo without any typical otologic symptoms of hearing loss and tinnitus. Because of the unusual symptom, the patient was initially diagnosed with vestibular neuronitis. However, atypical nystagmus was presented after head shaking test. Internal auditory canal MRI scanning confirmed the diagnosis of VS. We removed the patient's VS by middle cranial fossa approach. We present this case with a review of relevant peer-reviewed medical articles and literature.
Cranial Fossa, Middle ; Cranial Nerves ; Diagnosis ; Female ; Head ; Hearing ; Hearing Loss ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Neuroma, Acoustic* ; Tinnitus ; Vertigo* ; Vestibular Neuronitis

Hemangioblastoma is solid or cystic benign vascular tumor that may arise anywhere in the body. It is rarely presented tumor accounting for only 1% to 2.5% of all intracranial neoplasms. Usually, hemangioblastoma is located in the cerebellum and posterior cranial fossa and it occurs in a variety of symptoms depending on where the tumor is located. The initial symptoms in 80% to 90% of hemangioblastoma patients are headache and vomiting due to elevated intracranial pressure, and also dizziness and balance problems are initially presented in about half of the patients. We experienced 2 cases of hemangioblastoma who presented with isolated vertigo. All of them initially showed unidirectional spontaneous nystagmus during head impulse test. Finally, hemangioblastoma of the cerebellum has been diagnosed on magnetic resonance imaging scan. In one case, the tumor was successfully removed by retrosigmoid approach and the other case was treated conservatively due to pregnancy.
Brain Neoplasms ; Cerebellum ; Cranial Fossa, Posterior ; Dizziness ; Head Impulse Test ; Headache ; Hemangioblastoma ; Humans ; Intracranial Hypertension ; Magnetic Resonance Imaging ; Pregnancy ; Vertigo ; Vomiting

PURPOSE: Numerous methods have been utilized to repair nasal septal perforation with varying degrees of success; however, no consensus has been reached on nasoseptal perforation repair. Here, the authors describe a surgical method based on human dermal allograft (Surederm(TM), Hans Biomed Corp. Korea) for the repair of nasal septal perforations. MATERIALS AND METHODS: Eleven patients with a nasal septal perforation were included in this study. The causes of these septal perforations included previous nasal surgery, trauma, foreign body (button battery), and idiopathy. There were several sites of perforation: 9 in the central area, 1 in the posterior-central area, and 1 in the anterior area. An interpositional graft incorporating Surederm(TM) was positioned between bilateral mucoperichondrial flaps using an intranasal approach. A silastic sheet was then left in the nasal septum bilaterally until complete healing had occurred through new nasal mucosa, which took a mean duration of 6 weeks. RESULTS: Outcomes in ten of the eleven patients were successful, with complete septal perforation closure. The remaining perforation, which was caused by a button battery, closed incompletely; however, its initial size of 2cm was reduced to 5mm. CONCLUSION: The described technique has a high success rate and can be performed under local anesthesia without external scarring. In the absence of donor site morbidity, this technique can also be utilized to repair posterior or multiple septal perforations without difficulty.
Adolescent ; Adult ; Aged ; Child ; Dermis/*transplantation ; Female ; Humans ; Male ; Middle Aged ; Nasal Septum/pathology/*surgery ; Nose Diseases/*surgery ; Skin Transplantation/methods ; Transplantation, Homologous ; Treatment Outcome

OBJECTIVES: To evaluate the test-retest reliability and convenience of simultaneous binaural acoustic-evoked ocular vestibular evoked myogenic potentials (oVEMP). METHODS: Thirteen healthy subjects with no history of ear diseases participated in this study. All subjects underwent oVEMP test with both separated monaural acoustic stimulation and simultaneous binaural acoustic stimulation. For evaluating test-retest reliability, three repetitive sessions were performed in each ear for calculating the intraclass correlation coefficient (ICC) for both monaural and binaural tests. We analyzed data from the biphasic n1-p1 complex, such as latency of peak, inter-peak amplitude, and asymmetric ratio of amplitude in both ears. Finally, we checked the total time required to complete each test for evaluating test convenience. RESULTS: No significant difference was observed in amplitude and asymmetric ratio in comparison between monaural and binaural oVEMP. However, latency was slightly delayed in binaural oVEMP. In test-retest reliability analysis, binaural oVEMP showed excellent ICC values ranging from 0.68 to 0.98 in latency, asymmetric ratio, and inter-peak amplitude. Additionally, the test time was shorter in binaural than monaural oVEMP. CONCLUSION: oVEMP elicited from binaural acoustic stimulation yields similar satisfactory results as monaural stimulation. Further, excellent test-retest reliability and shorter test time were achieved in binaural than in monaural oVEMP.
Acoustic Stimulation ; Acoustics ; Ear ; Ear Diseases ; Humans ; Reproducibility of Results ; Saccule and Utricle ; Vestibular Evoked Myogenic Potentials ; Vestibular Function Tests

Fibrous dysplasia is an uncommon benign disorder of unknown etiology. The disease was first described by McCune and Albright in separate publications in 1937. The term, fibrous dysplasia was suggested by Lichtenstein in 1938. The disease has since been found to have 3 different variants: monostotic, polyostotic, and McCune-Albright syndrome. It is a slowly progressive bony disorder where normal bone is replaced by abnormal fibrosseous tissue. Involvement of fibrous dysplasia of the temporal bone is usually unilateral. The squama becomes thickened and the pneumatic system is obliterated. Because fibrous dysplasia shows a predilection for the facial and cranial bone, where it causes deformity and dysfunction. In this paper, we report a case of fibrous dysplasia of the temporal bone. We discuss the characterisitic features of this specific location of the disease, the differential diagnosis, and the treatment policy. We also address the issue of vertigo.
Congenital Abnormalities ; Diagnosis, Differential ; Dizziness ; Fibrous Dysplasia, Monostotic* ; Fibrous Dysplasia, Polyostotic ; Hearing Loss* ; Hearing* ; Temporal Bone* ; Vertigo

BACKGROUND AND OBJECTIVES:Dizziness is a vague symptom of disease. Dizziness of cardiovascular origin is associated with decreased cardiac output and usually presented as light-headed sensation of an impending faint. This study aims to provide the clinician with a logical approach to identifying the cardiovascular causes of dizziness. MATERIALS AND METHOD:From February 2002 to June 2004, we sampled the 30 dizzy patients who complained light-headed sensation of an impending faint with underlying disease of arrhythmia or abnormal blood pressure. The 11 patients with arrhythmia were monitored by 24 hr ambulatory ECG monitoring and all were examined with Schellong test. RESULTS:Among the 11 patients with arrhythmia, 7 patients were diagnosed as cardiovascular origin dizziness by 24hr ambulatory ECG monitoring and 10 patients as orthostatic hypotension by Schellong test. CONCLUSION:The results of this study indicated that 24hr ambulatory ECG monitoring and Schellong test had efficacy for the diagnosis of dizzy patients who complained light-headed sensation of an impending faint with underlying disease of arrhythmia or abnormal blood pressure
Arrhythmias, Cardiac ; Blood Pressure ; Cardiac Output ; Diagnosis* ; Dizziness* ; Electrocardiography* ; Electrocardiography, Ambulatory ; Humans ; Hypotension, Orthostatic ; Logic ; Sensation

This study was conducted to review the clinical features of fungal sinusitis and to evaluate the effectiveness of transnasal endoscopic sinus surgery as a primary surgical method for treating fungal sinusitis. Eighty five patients (86 cases) who were treated for fungal sinusitis with transnasal endoscopic sinus surgery between 1993 and 2004 were retrospectively analyzed by reviewing their profile, which included clinical feature, surgical techniques, operative findings postoperative results and complications. All patients were adults consisting of 30 males and 55 females. All cases were treated successfully by transnasal endoscopic sinus surgery. No recurrence and postoperative complication were observed. However, in 18 cases, fungal debries were observed when sinus irrigation was done at primary follow-up. In these cases, fungal debris disappeared at postoperative 1.7weeks (average) and no recurrence was observed. Transnasal endoscopic sinus surgery is successful method in the treatment of non-invasive fungal sinusitis.
Adult ; Aspergillosis ; Female ; Follow-Up Studies ; Humans ; Male ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Sinusitis*