BACKGROUND AND OBJECTIVES: The aim of this study is to investigate the characteristics of anterior semicircular canal benign paroxysmal positional vertigo (BPPV). MATERIALS AND METHODS: This is a retrospective chart review of 1,150 patients who were diagnosed with BPPV at an ENT special hospital. We investigated a number of canalith repositioning procedure (CRP), canal switch and a history of recurrence or head trauma. RESULTS: Anterior semicircular canal BPPV was observed in 41 (3.5%) patients. The average number of CRPs in patients with anterior semicircular canal BPPV was 2.19, which was higher than 1.60 in those with posterior semicircular canal BPPV (p<0.0001). Canal conversion from anterior to posterior semicircular canal was found in 5 (12.1%) patients during treatment. The average number of CRPs in conversion cases was 4, which was higher than 1.94 in non-conversion cases (p=0.001). CONCLUSION: More CRPs were necessary for the treatment of anterior semicircular canal BPPV than posterior semicircular canal BPPV. Canal switch could be considered as a factor to prevent a successful treatment.
Head ; Hospitals, Special ; Humans ; Recurrence ; Retrospective Studies ; Semicircular Canals ; Vertigo

Benign paroxysmal positional vertigo (BPPV) of anterior semicircular canal (ASC) is the rarest variant of BPPV, which is thought to be due to the anatomically superior position of ASC during most activities. This type of BPPV is currently diagnosed by detecting positional down-beating nystagmus in the Dix-Hallpike test. A 62-year-old female presented with positional vertigo, especially when sitting up. No nystagmus was induced by both Dix-Hallpike tests, however, positional down-beating nystagmus was observed with the left torsional component when sitting up from both Dix-Hallpike positions and supine position. After the reverse Epley maneuver, up-beating nystagmus was newly observed in the left Dix-Hallpike test, which was compatible with BPPV of the left posterior semicircular canal. This patient was thought to suffer from canalithiasis of the left ASC.
Female ; Humans ; Middle Aged ; Semicircular Canals ; Supine Position ; Vertigo

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.
Acyclovir ; Compensation and Redress ; Diagnosis ; Diagnosis, Differential ; Facial Paralysis ; Herpes Zoster Oticus ; Rehabilitation ; Simplexvirus ; Vertigo ; Vestibular Neuronitis

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.
Edema ; Endolymphatic Hydrops ; Endolymphatic Sac ; Meniere Disease ; Models, Animal ; Models, Theoretical

For differential diagnosis between vestibular neuritis and lateral medullary infarction with similar clinical features, bedside examination of nystagmus is important. We report a 45-year-old male who presented with acute vertigo for two days. He showed spontaneous right-beating nystagmus. However, left-beating nystagmus was evoked during bilateral horizontal gaze and by horizontal head oscillation. Brain MRI revealed an acute infarction in the left lateral medulla.
Brain ; Diagnosis, Differential ; Head ; Humans ; Infarction ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Vertigo ; Vestibular Neuronitis

OBJECTIVES: The aims of this study were to investigate the feasibility of isosorbide delivery into perilymph through the round window membrane (RWM), and to compare the intracochlear isosorbide concentration in perilymph after oral administration (PO) versus that after round window perfusion (RWP). METHODS: Sixteen male guinea pigs (32 ears) were used. Isosorbide, an osmotic diuretic, was administered via RWP or PO. First, to investigate the optimal perfusion time, perilymph sampling of scala tympani from the RWM was performed after RWP for 15, 30, or 60 minutes. Second, to compare the drug concentration after RWP versus that after PO, perilymph was aspirated at 3 and 6 hours after administration. Intracochlear concentration of isosorbide was analyzed by high-performance liquid chromatography coupled to refractive index detection. RESULTS: Isosorbide passed through the RWM into perilymph after RWP. After RWP for 15, 30, and 60 minutes, mean isosorbide concentrations in perilymph were 116.27+/-44.65, 245.48+/-112.84, and 279.78+/-186.32 mM, respectively. The intracochlear concentration after RWP for 30 minutes was higher than that after RWP for 15 minutes (P=0.043). At 3 and 6 hours after PO, isosorbide concentrations in perilymph were 28.88+/-4.69 and 12.67+/-2.28 mM, respectively. In contrast, the corresponding concentrations after RWP were 117.91+/-17.70 and 75.03+/-14.82 mM at 3 and 6 hours, respectively. Isosorbide concentrations in perilymph following RWP were significantly higher than those following PO at both 3 and 6 hours (P=0.025 and P=0.034, respectively). CONCLUSION: Isosorbide can rapidly pass through the RWM after RWP in guinea pigs, and 30 minutes of perfusion is considered to be appropriate. In addition, over a 6-hour period, RWP can deliver higher concentrations of isosorbide into perilymph than those achieved with PO.
Administration, Oral* ; Animals ; Chromatography, Liquid ; Diuretics, Osmotic ; Guinea Pigs* ; Humans ; Isosorbide* ; Male ; Membranes ; Meniere Disease ; Perfusion* ; Perilymph* ; Refractometry ; Scala Tympani

BACKGROUND AND OBJECTIVES: Purpose of this study is to compare the cost-effectiveness between sequential (SeqBCI) and simultaneous bilateral cochlear implantations (SimBCI). SUBJECTS AND METHOD: This is a retrospective study of 15 patients who underwent bilateral cochlear implantations at a tertiary care facility. Nine patients with SimBCI and six with SeqBCI were included. Operation time, anesthesia time, expenses for preoperative evaluation, hospitalization time, hospital expenses and postoperative expenses were investigated. RESULTS: The 1st, 2nd and cumulative operation time for the SeqBCI group were 181, 120 and 301 minutes, respectively, on the average. The 1st, 2nd and cumulative anesthesia time were 212, 162 and 373 minutes, respectively. The 1st, 2nd and cumulative expenses for preoperative evaluation were 1074754, 280118 and 1354872 won, respectively. The 1st, 2nd and total hospitalization time were 6.2, 4.2 and 10.4 days, respectively. The 1st, 2nd and cumulative hospital expenses were 24082713, 24158366 and 48176734 won, respectively. The 1st, 2nd and cumulative postoperative expenses were 447830, 551778 and 999608 won, respectively. For the SimBCI group, the operation time, anesthesia time, expenses for evaluation, hospitalization time, hospital expenses and postoperative expenses were 246, 280 minutes, 1396793 won, 6.2 days, 46073011 and 816121 won, respectively. On the whole, anesthesia time, hospitalization time and postoperative expenses of the SimBCI group were less than those of the SeqBCI group (p=0.01, 0.02 and 0.02, respectively). The postoperative expenses of SeqBCI were the highest during the first 4 months whereas those of SimBCI were less during the same period (p=0.03). CONCLUSION: Cumulative anesthesia time, hospitalization time and postoperative cost of SimBCI were less than those of SeqBCI. Our results may be useful for counseling the timing of second CI.
Anesthesia ; Cochlear Implantation ; Cochlear Implants* ; Counseling ; Hospitalization ; Humans ; Retrospective Studies ; Tertiary Healthcare

Bilateral vestibulopathy (BV) is a clinical entity with impaired function of bilateral peripheral vestibular system, which is characterized by movement-induced postural vertigo, oscillopsia and unsteadiness of gait. The possible causes are reported including aminoglycosides, Meniere's disease and meningitis, however, cause of BV remains unclear in up to half. The diagnosis is confirmed by a combination of the vestibulo-ocular reflex tests such as a bilateral head-impulse test, the rotatory chair test and the caloric test. The treatment consists of prophylaxis of progressive vestibular loss, recovery of impaired vestibular function and promotion of central compensation or substitution with rehabilitation therapy.
Aminoglycosides ; Caloric Tests ; Compensation and Redress ; Gait ; Meniere Disease ; Meningitis ; Reflex, Vestibulo-Ocular ; Vertigo

BACKGROUND AND OBJECTIVES: Although video head impulse test (V-HIT) has emerged as a popular test for vestibular function, there have been no reports about the influence of benzodiazepine on the test. The aim of this study is to investigate the influence of diazepam on the V-HIT in patients with acute vestibular neuritis. SUBJECTS AND METHOD: We retrospectively analyzed charts and medical records of 10 patients diagnosed with acute vestibular neuritis. The patients repeated V-HIT before and after intravenous (IV) injection of diazepam. Gain and presence of catch-up saccade (CUS) were compared. RESULTS: Gain in the affected ear was decreased compared to that in the unaffected ear. After the injection of IV diazepam, the presence of CUS was not changed significantly. Gain of CUS in V-HIT was also unchanged both in the affected and unaffected ear after the injection of IV diazepam. CONCLUSION: The influence of IV diazepam on the gain and presence of CUS in V-HIT were insignificant, indicating that it could be considered as a useful test to evaluate vestibular function in patients treated with diazepam.
Benzodiazepines ; Diazepam* ; Ear ; Head Impulse Test* ; Head* ; Humans ; Medical Records ; Retrospective Studies ; Saccades ; Vestibular Function Tests ; Vestibular Neuronitis*

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.
Classification ; Ear ; Edema ; Humans ; Meniere Disease