OBJECTIVE: To analyze the occurrence and probable etiological factors of benign paroxysmal positional vertigo (BPPV). METHOD: one hundred and twenty four BPPV cases were inquired histories, classified into different groups and analyzed relevant diseases. All patients were taken Caloric tests before Canal repositioning procedure, and compared the differences of unilateral weakness (UW) and semicircular canal involved between BPPV patients with and without relevant diseases. RESULT: There were 97 (78.2%) patients with relevant diseases while 27 (21.8%) without. Ninety-two (74.2%) patients with abnormal UW. To compare the normal and abnormal UW, posterior canal and lateral canal with abnormal UW values, unilateral or bilateral of abnormal UW values, consistency of abnormal UW side and BPPV side between BPPV patients with and without relevant diseases, there were no significant differences (Chi-square values were 0.000, 0.000, 0.306, 0.027, P>0.05). CONCLUSION BPPV patients with relevant diseases are common, which mainly occurs in middle-aged or aged people and female. Otolith ecclesiis and dysfunction of semicircular canal may have the same etiological factors. Caloric tests may do help to analyze the BPPV etiological factors.
Adolescent ; Adult ; Aged ; Benign Paroxysmal Positional Vertigo ; Caloric Tests ; Female ; Humans ; Male ; Middle Aged ; Vertigo ; diagnosis ; etiology ; pathology ; Young Adult

OBJECTIVE: To show the value of rotating chair test (ROT) as an adjunct to the conventional electronystagmography (ENG) examination including caloric test for the diagnosis of vestibular lesions. BACKGROUND: Since caloric stimulatim is regarded as a very low frequency (0. 003Hz) test, it is desirable to test the function of horizontal semicircula canals by stimulating with faster frequencies. Baloh et al. (1984a) described that lesions ofdifferentiated by ROT. Leigh and Zee(1991) told that ROT can give more accurate and reproducible results than do caloric tests. METHOD: 30 patients who suffered from vertigo with either peripheral or central pathology were given computerized ENG and ROT. We discuss the representative examples of our initial experience with ROT. RESULTS: 1.In eight patients with known peripheral pathology, low-frequency phase deficits, asymmetry toward the lesim side and VOR suppression by gazefixation were seen during ROT. With bilateral peripheral vetibular disease, the ROT could identify remaining vestibular function at higher frequencies. 2. Seven patients with lesions of central vestibular structure showed abnormalities of saccades and pursuit during ENG and failure of VOR suppression by gaze fixation during ROT. 3. Out of 15 patients whose lesions could not be localized distinctly after caloric test, four patients were suggested to have central pathology. CONCLUSION: ROT can be a useful method to study the vestibular abnonnahties and an adjunct to the conventional ENG test.
Caloric Tests ; Diagnosis ; Electronystagmography ; Humans ; Pathology ; Saccades ; Vertigo* ; Vestibular Function Tests

BACKGROUNDAnatomic and electrophysiological studies have revealed that the neurons located in the media vestibular nuclei (MVN) receive most of the sensory vestibular input coming from the ipsilateral labyrinth and the responses of MVN neurons to caloric stimulation directly reflect changes in primary vestibular afferent activity. The aim of this study was to clarify the intrinsic characteristics of serotonin (5-hydroxytryptamine, 5-HT) release in the MVN during the period of vertigo induced by caloric stimulation.

METHODSWe used an in vivo microdialysis technique to examine the effects of caloric stimulation on the serotoninergic system in MVN. Twenty four guinea pigs were randomly divided into the groups of irrigation of the ear canal with hot water (n = 6), ice water (n = 6) and 37 degrees C water (n = 4), and the groups of irrigation of the auricle with hot water (n = 4) and ice water (n = 4), according to different caloric vestibular stimulation. We examined the animal's caloric nystagmus with a two-channel electronystagmographic recorder (ENG), and meanwhile examine serotonin (5-hydroxytryptamine, 5-HT) level in the MVN with microdialysis technique after caloric stimulation.

RESULTSIn the caloric test the hot water (44 degrees C) irrigation of the right external auditory canal induced horizontal nystagmus towards the right side lasting about 60 seconds and the ice water irrigation of the right external auditory canal induced it towards the left side lasting for about 90 seconds. No nystagmus was induced by 37 degrees C water irrigation of the external ear canal. Therefore, it was used as a negative control stimulation to the middle ear. The MVN 5-HT levels significantly increased in the first 5-minute collecting interval and increased to 254% and 189% of the control group in the second collecting interval in response to caloric vestibular stimulation with ice water and hot water respectively. The serotonin release was not distinctly changed by the irrigation of the auricle with ice water or hot water.

CONCLUSIONSNeither somato-sensory stimulation of the middle ear nor nonspecific cold or hot stress affects the serotonin release. The rise of 5-HT in MVN may be involved in the mechanism of vertigo induced by caloric stimulation.

Animals ; Caloric Tests ; Guinea Pigs ; Microdialysis ; Serotonin ; secretion ; Vertigo ; etiology ; Vestibular Nuclei ; pathology

PURPOSE: Vertigo and dizziness are not common complaints in childhood, but are present more often than formerly thought. A detailed interview and otoneurological examination are important for reaching a specific diagnosis and treatment. The purpose of our study was to obtain our own etiological, clinical and diagnostic statistics, and to review the major related pathologies. METHODS: We investigated eighty-five children who visited Dankook University Hospital with a chief complaint of vertigo. Presenting symptoms, the result of diagnostic tests, and etiologic diagnoses were evaluated. RESULTS: Benign paroxysmal vertigo in childhood was the most common etiology of childhood vertigo accounting for about 38.8%, and migrainous vertigo and post-traumatic vertigo were present in 17.6% and 12.9% respectively. In vestibular function testings, electronystagmography and rotating chair test were abnormal in 11.2% and 21.2%, and the score of sensory organization test in posturography was lower than 50 in 44.4%. Other clinical diagnostic tests were informative for elucidation of individual etiologies. CONCLUSION: Benign paroxysmal vertigo in childhood and migrainous vertigo were the most common etiologies in childhood vertigo, with the former more common in under 12 years and the latter more common in over 12 years. Vestibular function tests were not so informative in diagnostic approach of childhood vertigo.
Child ; Diagnosis ; Diagnostic Tests, Routine ; Dizziness ; Electronystagmography ; Humans ; Pathology ; Vertigo* ; Vestibular Function Tests

There are a number of reports on the pathologies of vestibular disorders. However, these studies included only a few examples, which were not quantitative but merely anecdotal or descriptive. However, a single tissue section may be relevant to a specific disease in multiple ways. The histopathological characteristics of common peripheral vestibulopathies, including benign paroxysmal positional vertigo, Ménière's syndrome, labyrinthitis, vestibular neuritis, and ototoxicity, have been described. A recent study validated a new quantitative method for determining vestibular otopathology. Detailed quantitative analyses of vestibular pathology are required to obtain a deeper understanding of the vestibular system. Such studies will likely reveal the pathophysiological causes of specific diseases by elucidating the correlations between structural and functional features. Therefore, histopathological studies of vestibular disorders should be performed.
Benign Paroxysmal Positional Vertigo ; Ear, Inner ; Labyrinthitis ; Methods ; Pathology ; Temporal Bone ; Vestibular Neuronitis

Hearing loss caused by cochlear damage is the main symptom of sudden deafness (SD). Some patients also suffer from vestibular symptoms. In recent years, more attention has been paid to the vestibular dysfunction in patients with SD. The lesions could involve the whole inner ear in SD patients with and without vertigo. Comprehensive evaluation of vestibular function may help us understand the extent of lesions in sudden deafness and analyze the pathogenesis of disease. A less involvement of inner ear lesion may indicate a better hearing recovery.
Cochlea ; injuries ; Hearing Loss, Sudden ; diagnosis ; pathology ; Hearing Tests ; Humans ; Vertigo ; Vestibule, Labyrinth ; physiopathology

OBJECTIVE: To evaluate the clinical utility of MR imaging of the temporal bone in patients with facial and audiovestibular dysfunction with particular emphasis on the importance of contrast enhancement. MATERIALS AND METHODS: We retrospectively reviewed the MR images of 179 patients [72 men, 107 women; average age, 44 (range, 1-77) years] who presented with peripheral facial palsy (n=15), audiometrically proven sensorineural hearing loss (n=104), vertigo (n=109), or tinnitus (n=92). Positive MR imaging findings possibly responsible for the patients' clinical manifestations were categorized according to the anatomic sites and presumed etiologies of the lesions. We also assessed the utility of contrast-enhanced MR imaging by analyzing its contribution to the demonstration of lesions which would otherwise not have been apparent. All MR images were interpreted by two neuroradiologists, who reached their conclusions by consensus. RESULTS: MR images demonstrated positive findings, thought to account for the presenting symptoms, in 78 (44%) of 179 patients, including 15 (100%) of 15 with peripheral facial palsy, 43 (41%) of 104 with sensorineural hearing loss, 40 (37%) of 109 with vertigo, and 39 (42%) of 92 with tinnitus. Thirty (38%) of those 78 patients had lesions that could be confidently recognized only at contrastenhanced MR imaging. CONCLUSION: Even though its use led to positive findings in less than half of these patients, MR imaging of the temporal bone is a useful diagnostic procedure in the evaluation of those with facial and audiovestibular dysfunction. Because it was only at contrast-enhanced MR imaging that a significant number of patients showed positive imaging findings which explained their clinical manifestations, the use of contrast material is highly recommended.
Adult ; Contrast Media ; Facial Paralysis/*pathology ; Female ; Hearing Loss, Sensorineural/*pathology ; Human ; *Magnetic Resonance Imaging ; Male ; Temporal Bone/*pathology ; Tinnitus/*pathology ; Vertigo/*pathology

BACKGROUND AND OBJECTIVES: Canal paresis in patients with BPPV has been variously reported to present in 13% to 57%. Should disorders affecting the peripheral vestibular system, such as vestibular neuronitis, head trauma precede or coexist the onset of BPPV, then particle repositioning maneuver (PRM) may be less effective or ineffective and need further vestibular rehabilitation after the particle repositioning maneuver. The purpose of this study is to investigate the clinical feature and importance of vestibular rehabilitation in patients with BPPV associated with canal paresis. MATERIALS AND METHODS: A retrospective review was made of 212 patients who visited and diagnosed as BPPV at Hallym university medical center from March 2004 to September 2006. We evaluated the coexistence of canal paresis, methods of treatment and outcome of 128 patients who performed bithermal caloric test. RESULTS: The vestibular assessment by bithermal caloric test showed the canal paresis in 28 patients. In 21 patients, the canal paresis was ipsilateral, in 2 patients, it was contralateral to the BPPV, and in 5 patients, canal paresis was bilateral. Among 28 patients with canal paresis, 12 patients demonstrated as primary BPPV, 16 patients as secondary BPPV. 28 patients with canal paresis were performed PRM. Vestibular rehabilitation was performed in 18 patients who had ongoing symptoms such as nonspecific continuous dizziness after PRM. Among 18 patients, 14 patients were improved, 4 patients were treatment resistant. CONCLUSION: This study shows the importance of detailed vestibular testing such as bithermal caloric test in BPPV patients. Patients with evidence of concomitant vestibular pathology would be expected to require further vestibular rehabilitation.
Academic Medical Centers ; Caloric Tests ; Craniocerebral Trauma ; Dizziness ; Humans ; Paresis* ; Pathology ; Rehabilitation ; Retrospective Studies ; Vertigo* ; Vestibular Neuronitis

OBJECTIVETo understand the various factors causing vertigo and balance disorders in the elderly.

METHODS118 elderly patients (aged equal or older than 60 years of age) with vertigo or balance disorders were retrospectively analyzed through clinical symptoms, audio-vestibular function tests, X-ray, CT scan or MRI in cervical vertebras, brain and inner ears, ultrasonography, transcranial doppler (TCD) or magnetic resonance angiography (MRA) in blood vessels on head and neck.

RESULTSOf 118 patients, 70 (23%) of them suffered perip heral vestibular disorders while 29 (58%) having cerebral vertigo or dizzness, leaving 19 cases (16%) as unclassified.

CONCLUSIONFor elderly patients, vertigo and balance disorders were commonly caused by many kinds of peripheral and cerebral vestibular pathological disfunctions while the functional weakness of vestibular organs and systems affected by the physiological process of ageing and different concommitant diseases as well as environmental, psychogenic factors should also be considered.

Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Postural Balance ; Retrospective Studies ; Risk Factors ; Vertigo ; etiology ; pathology ; physiopathology

Effort to improve balance ability in the field of rehabilitation has been constantly issued and developed up to now. A variety of subcomponent of postural control including function and cognition should be needed in many body systems and be complicatedly linked to each system. In South Korea, although decreased postural dysfunction due to neurological or musculoskeletal disorders has been well documented, we do not have many experience and knowledge of vestibular rehabilitation for maintain and improve balance function. In the United States, vestibular physical therapy is already acknowledged as clinical subspecialty by American Physical Therapy Association. However, there is no curriculum subject related to vestibular rehabilitation in standard education of physical therapy and no specialist who has clinical experience and knowledge of this realm. Therefore, we reviewed general information and basic knowledge of vestibular rehabilitation such as current state of vestibular disorder in South Korea, pathology, major causes of vestibular dysfunction including peripheral vestibular disorders, vestibular neuritis, benign paroxysmal positional vertigo, and central disorder, evaluation of vestibular dysfunction, and treatment for vestibular dysfunction new approaches. We expect that physical therapist in South Korea recognize clinical significance of vestibular exercise and that clinical concern and research will be begun in near future.
Benign Paroxysmal Positional Vertigo ; Cognition ; Curriculum ; Dizziness ; Education ; Humans ; Korea ; Pathology ; Physical Therapists ; Rehabilitation ; Specialization ; United States ; Vestibular Neuronitis