BACKGROUND AND OBJECTIVES: The purpose of this study was to investigate the characteristics of gentamicin-induced vestibulotoxicity of otolith organs and preventive effect of low power laser to vestibulotoxicity by assessing the result of earth vertical and the off vertical axis rotation tests. MATERIALS AND METHODS: Twenty guinea pigs were grouped into two groups, laser and no laser group. Vestibulotoxicity was induced by intratympanic injection of gentamicin. Prevention of the vestibulotoxicity was studied by irradiation of low power laser. Off vertical axis rotation tilted 30 degree relative to the earth vertical axis was applied to evaluate the otolithic function. Results and CONCLUSION: Gentamicin induced vestibulotoxicity was confirmed by gain decreasing in slow harmonic acceleration test and modulation decreasing in the off vertical axis rotation test. Prevention effect of low power laser to gentamicin induced vestibulotoxicity was confirmed by modulation maintaining in the off vertical axis rotation test and gain maintaining in the earth vertical axis rotation.
Acceleration ; Animals ; Axis, Cervical Vertebra ; Gentamicins ; Guinea Pigs* ; Guinea* ; Low-Level Light Therapy* ; Otolithic Membrane

BACKGROUND & OBJECTIVES: Recently many reports suggest the horizontal canal benign paroxysmal positional vertigo (h-BPPV) is not rare. However there have been few reports on physical therapy for horizontal canal cupulolithiasis, while horizontal canal canalithiasis has a relatively well defined and effective therapy. To evaluate the efficacy of different methods of treating horizontal canal cupulolithiasis, we conducted prospective study. METHODS: We enrolled 104 consecutive patients who were diagnosed with h-BPPV. During that period, patients with posterior canal BPPV numbered 112. Patients with h-BPPV were diagnosed when lateral head rotation in the supine position resulted in geotropic or apogeotropic bilateral horizontal nystagmus. In patients presenting with apogeotropic variant (n=40), following maneuvers was performed sequentially. First of all, we performed head shaking and applied vibrator to the mastoid bone to detach otolith from cupula. If they failed to detach otolith from cupula, we performed barbecue rotation and forced prolonged position (FPP). The treatment outcome was considered as responsive when, immediately after each physical therapy, nystagmus shifted from apogeotropic to geotropic or no nystagmus was elicited by provocation test and symptoms of positional vertigo abated. RESULTS: There were 27 women and 13 men from ages 30 to 80 (mean 55) years. The average duration of symptoms before intervention was 0 to 12 (mean 0.6) days. In 4 cases, symptoms resolved spontaneously after provocation test. Of the 36 patients treated with headshaking, 6 were responsive. Of the 30 patients treated with vibrator after failure of head shaking, only 1 were responsive. In the barbecue rotation, none obtained relief after barbecue rotation. Of the 9 patients treated with FPP after failure of the barbecue rotation, 4 were symptom free after FPP. Twenty five patients, including 5 non-responders with FPP, underwent no more rehabilitation maneuver. In most of cases (n=24), horizontal canal cupulolithiasis resolved spontaneously within a week. CONCLUSIONS: The direct effectiveness of physical therapy for horizontal canal cupulolithiasis is largely unsatisfactory. However, in many cases, horizontal canal cupulolithiasis resolved spontaneously in a few days.
Female ; Head ; Humans ; Male ; Mastoid ; Nystagmus, Pathologic ; Otolithic Membrane ; Prospective Studies ; Rehabilitation ; Supine Position ; Treatment Outcome ; Vertigo

BACKGROUND AND OBJECTIVES: Otitis media with effusion (OME) is one of the most common diseases in children and may be frequently related with dizziness. However, the association between OME and dizziness seems to be not clear and remains controversy. The purpose of this study was to determine the incidence of dizziness in children with long lasting OME, and to investigate the difference in vestibular functions between children with long lasting OME and the control group. MATERIALS AND METHOD: Thirty one children who had long-lasting OME over than 6 months (study group) and 28 normal hearing children without OME who were scheduled for adenotonsillectomy (control group), were given questionnaires and vestibular function tests (VFT) including electronystagmography (ENG) and rotation chair test (RCT). Statistical analysis was performed with chi-square test. RESULTS: Dizziness was found in 7 (22.6%) of 31 children in the study group and 2 (7.1%) of 28 children in the control group (p>0.05). The difference of abnormal findings in VFT between the study group and the control was not significant except visual vestibulo-ocular reflex (VVOR) in RCT. Most of the correlations in the study group, bilateral vs. unilateral OME, OME with dizziness vs. OME without dizziness, and preoperative vs. postoperative, were not significant. CONCLUSION: We did not find any evidences of significant difference of the incidence of dizziness and findings of VFT between children with long lasting OME and children without OME. However, there was a significant abnormal response in VVOR in RCT in children with long-lasting OME, suggesting the children with OME may be more dependent on the nonvestibular system including visual compensation to maintain balance.
Child* ; Compensation and Redress ; Dizziness ; Electronystagmography ; Hearing ; Humans ; Incidence ; Otitis Media with Effusion* ; Otitis Media* ; Otitis* ; Surveys and Questionnaires ; Reflex, Vestibulo-Ocular ; Vestibular Function Tests

BACKGROUND AND OBJECTIVE: Vestibular evoked myogenic potentials (VEMP) has been promoted as a means of assessing the integrity of saccular function. Even though sacculospinal reflex may not be influenced by abnormality of cochlear pathway, saccule is closely related with cochlea in its embryological development and also in geographic location. So authors hypothesized the presence of functional alterations of saccule in patients with sudden sensorineural hearing loss who do not complain of vertigo, since saccular dysfunction may not induce subjective vestibular symptoms or signs. Authors tested saccular function in those patients using VEMP and analyzed the parameters according to other clinical indicators. MATERIALS AND METHOD: From July to September 2005, 22 patients who diagnosed with unilateral sudden sensorineural hearing loss without vertigo were enrolled. The patients who had vertigo as initial symptom or showed spontaneous nystagmus were excluded. All patients received conventional audiometry, tone-burst VEMP test, and caloric test. We analyzed P13 and N23 latency, interpeak amplitude and asymmetric ratio of amplitude. The patients divided to complete hearing recovery, partial recovery, and no response group according to treatment outcome. The correlation between parameters and treatment result was analyzed. RESULTS: In 2 out of 22 patients (9.1%), VEMP waves were not detected. There was no latency delay in affected ear. But the interpeak amplitude of the affected ear was significantly smaller than that of healthy side (paired t test, p=0.02). Patients who did not respond to treatment showed smaller interpeak amplitude than those who showed complete recovery. CONCLUSION: Most patients of idiopathic sudden sensorineural hearing loss without vertigo seem to show normal VEMP waves. But some parameters regarding amplitude had abnormal findings in affected ear. Further studies with larger sample size seem to be necessary to elucidate such outcomes.
Audiometry ; Caloric Tests ; Cochlea ; Ear ; Evoked Potentials ; Hearing ; Hearing Loss, Sensorineural* ; Humans ; Reflex ; Saccule and Utricle ; Sample Size ; Treatment Outcome ; Vertigo* ; Vestibular Evoked Myogenic Potentials ; Vestibular Function Tests

BACKGROUND AND OBJECTIVES: Aims of the study were to determine if the somatosensory input influences on vertical perception by comparing the results with the head or body tilted (15Degree to the right and to the left, and to examine the influence of tactile sensation in the perception of verticality in head lateral positions. MATERIALS AND METHOD: We tested 34 normal subjects in their ability to set a straight line to the perceived gravitational vertical. Measurements were taken in static conditions, sitting upright, head tilted (15Degree, body tilted (15Degree, and head lateral positions (90Degree on the right/left sides with or without physical support under the head. RESULTS: The normal range of the subjective visual vertical (SVV) was 0.65Degree/-.23Degreein upright position. The normal ranges of SVV in head-tilts 15Degreeto the left/right sides were -0.47Degree/-.76Degreeand 1.88Degree/-.94Degree which were significantly different from those in upright position (E-effect). But the normal ranges of SVV in body-tilts 15Degreeto the left/right were not different from those in upright position. And the normal ranges of SVV in head lateral positions maintained actively and passively were not different each other, but significantly larger than that in upright position (A-effect). CONCLUSION: Our results support that neck somatosensory input plays a part in the perception of verticality. In contrast, tactile sensation of the head had no effect on the settings of a visual line to visual vertical in head lateral positions.
Head ; Neck ; Otolithic Membrane ; Reference Values ; Sensation

BACKGROUND AND OBJECTIVES: Central role of the vestibular system on control of blood pressure and interrelationships between the vestibular nucleus and solitary nucleus during acute hypotension were investigated in bilateral labyrinthectomized (BLX) or sinoaortic denervated (SAD) rats. Changes of electrical activity in the medial vestibular nucleus (MVN), solitary tract nucleus (STN), and rostral ventrolateral medullary nucleus (RVLM) were investigated in rats in while acute hypotension was induced by sodium nitroprusside (SNP). RESULTS: Evoked potential in MVN neuron caused by electrical stimulation of the peripheral vestibular system was composed of 3 waves with latencies of 0.48+/-.10 ms, 1.04+/-.09 ms and 1.98+/-.19 ms. Electrical stimulation to MVN or RVLM increased blood pressure. MVN at the induction of acute hypotension showed excitation in 61% of type I neurons and inhibition in 68% of type II neurons. In STN, acute hypotension produced excitation in 62.1% of neurons recorded in intact labyrinthine animals, inhibition in 72.3% of neurons recorded in BL animals, and excitation in 60% of recorded neurons in SAD animals. In RVLM, acute hypotension produced excitation in 66.7% of neurons recorded in intact labyrinthine animals and inhibition in 64.9% of neurons recorded in BL animals. In spatial distribution of STN neurons responded to acute hypotension, excitatory responses were mainly recorded in rostral and ventral portion, and inhibitory responses were mainly recorded in caudal and lateral portion. In RVLM, excitatory responses were mainly recorded in rostral and dorsomedial portion, and inhibitory responses were mainly recorded in caudal and ventrolateral portion. CONCLUSION: These results suggest that afferent signals from the peripheral vestibular receptors are transmitted to STN through the vestibular nuclei and assist to the baroreceptors for controlling blood pressure following acute hypotension.
Animals ; Blood Pressure* ; Electric Stimulation ; Evoked Potentials ; Hypotension* ; Neurons ; Nitroprusside ; Pressoreceptors ; Rats* ; Solitary Nucleus ; Vestibular Nuclei

BACKGROUND AND OBJECTIVES: Endolymphatic hydrops are known as major causes of Meniere's disease. MRI (Magnetic resonance imaging) with contrast tried recently makes it possible to visualize perilymphatic and endolymphatic space without invasive procedures. There are no tryouts in the interior of our country. We attempted MRI after injection of gadolinium-diethylen-triamine pentaacetic acid (Gd-DTPA) in normal adults and patients with Meniere's disease to make sure 3D-FLAIR (fluid-attenuated inversion recovery) MRI parameters and to visualize endolymphatic spaces. MATERIALS AND METHODS: Five normal adults and Five patients with Meniere's disease were included in this study. Twenty-four hours after Gd-DTPA intratympanic injection, we performed 3D-FLAIR and 3D-IR imaging at 3T. MRI region of interest signal intensity was used to determine the diffusion of Gd-DTPA into the perilymphatic fluid spaces over time. RESULTS: Five of five in normal group, using 3D-IR MRI after Gd injection, had enhanced imagings (perilymphatic spaces) of inner ears. Five of five in patients group, using 3D-IR after Gd injection, had enhanced perilymphatic spaces and non-enhanced endolymphatic hydrops. CONCLUSIONS: Delayed contrast imaging of the inner ear with 3D-IR MRI after Gd-DTPA intratympanic injection revealed in vivo visualization of endolymphatic hydrops.
Adult ; Diffusion ; Ear, Inner ; Endolymphatic Hydrops ; Gadolinium DTPA ; Humans ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Meniere Disease

No abstract available.
Vertigo

Bell's palsy is acute idiopathic peripheral facial nerve palsy which is diagnosed after all the possible causes are ruled out. Several symptoms and signs of polyneuropathy, such as hypesthesia of cranial nerve IX or V, vagal motor weakness, retroauricular pain, and hearing impairment were frequently accompanied with Bell's palsy. However, association of vertigo has been rarely reported, and moreover, associated vestibulopathy was not characterized in detail in those cases. We report a 35 year-old male patient with Bell's palsy accompanying acute peripheral vestibular loss, which eventually evolved to benign paroxysmal positional vertigo.
Adult ; Bell Palsy* ; Facial Nerve ; Glossopharyngeal Nerve ; Hearing Loss ; Humans ; Hypesthesia ; Male ; Paralysis ; Polyneuropathies ; Vertigo

BACKGROUND AND OBJECTIVES: Dizziness and vertigo are frequent causes of presentation in the emergency center. Nevertheless, the practice guideline for the primary care doctor in the emergency center has not been reported yet. Considering its complex approach for diagnosis, we developed critical pathway for dizzy patients who visited emergency center. We performed this study to show the process of development and the result of implementation of critical pathway. MATERIALS AND METHOD: A critical pathway was developed following the analysis of dizzy patients visiting emergency center by retrospective chart review and in the basis of questionnaire for knowing the needs for critical pathway to the primary care doctor in emergency center. Specialists for caring dizzy patients joined to make the flow sheet and practice guideline for dizzy patients and also made educational materials for doctors in emergency center. The critical pathway was then implemented and its results were analyzed by estimating the practice time and the degree of satisfaction of the patients and doctors. RESULTS: Most of the primary care doctors in emergency center reported the difficulty in diagnostic approach for dizzy patients and the need for critical pathway. More than half of the dizzy patients were diagnosed as peripheral vertigo and the commonest disease was benign paroxysmal positional vertigo. All of the patients with vertigo diagnosed as central origin showed the neurologic deficit. After the implementation of critical pathway, practice time was significantly decreased and many of the dizzy patients and doctors were satisfied. CONCLUSION: Development and implementation of a critical pathway for dizzy patient in emergency center was possible, valuable and effective for the patients and doctors, though the process was not easy and needed interdisciplinary cooperation of involving departments.
Critical Pathways* ; Diagnosis ; Dizziness ; Emergencies* ; Humans ; Neurologic Manifestations ; Primary Health Care ; Surveys and Questionnaires ; Retrospective Studies ; Specialization ; Vertigo