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Bell's Palsy associated with Acute Vestibulopathy.

Ja Won KOO ; Jae Jin SONG ; Dong Yeop CHANG ; Ji Soo KIM

Journal of the Korean Balance Society.2005;4(2):259-263.

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

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Implementation of a Critical Pathway to the Dizzy Patients in the Emergency Center.

Shi Nae PARK ; Young Min KIM ; Joong Seok KIM ; Min Sik KIM ; Won Jae LEE ; Kwang Soo LEE ; Chung Soo KIM ; Hong Jin PARK ; Sang Won YEO

Journal of the Korean Balance Society.2005;4(2):250-256.

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

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Expression of Caveolin-1 in the Differentiated Vestibular Cell Line (UB/UE-1) after Gentamicin Toxicity.

Byung Han CHO ; Kyu Sung KIM ; Min Wook KIM ; Min Sun KIM ; Byung Rim PARK

Journal of the Korean Balance Society.2005;4(2):243-249.

BACKGROUND AND OBJECTIVES: The caveolin is known as a mediator of cell death or survival of injured cell and inhibitor of various signaling pathways. We examined expression of caveolin-1 involved by protein kinase A(PKA) signaling pathway in the differentiated mouse vestibular cell line(UB/UE-1) after gentamicin toxicity. MATERIALS AND METHOD: We observed caveolae in the vestibular hair cell of healthy guinea pig through electron microscope. UB/UE-1 cells were cultured at 95% CO2, 5% O2, 33DegreeC for 2days and at 95% CO2, 5% O2, 39DegreeC for 24 hours for differentiation. Cells were treated with 1 mM of gentamicin, 0.02 mM H89 (PKA inhibitor), and then incubated for 24 hours. Caveolin-1 expression was examined by western blot and PKA activity by PepTag? assay. RESULTS: Caveolae were observed in the vestibular hair cell of healthy guinea pig by electron microscope. Caveolin-1 was expressed spontaneously in differentiated UB/UE-1 cells and increased after gentamicin treatment. PKA is overactivated by gentamicin treatment. The gentamicin induced caveolin-1 expression and PKA overactivation was inhibited by H89. CONCLUSION: Our results indicate that gentamicin induced caveolin-1 expression is mediated by PKA signaling pathway. We conclude that the caveolae/caveolin through a PKA signaling pathway is the important mechanism of gentamicin induced ototoxicity.
Animals ; Blotting, Western ; Caveolae ; Caveolin 1* ; Cell Death ; Cell Line* ; Gentamicins* ; Guinea Pigs ; Hair Cells, Vestibular ; Mice ; Protein Kinases

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Jongkees' Formula Reevaluated: Mathematical Significance of CP and Negative SCV Value.

Sung Wan BYUN

Journal of the Korean Balance Society.2005;4(2):238-242.

BACKGROUND AND OBJECTIVES: In caloric test, the CP (canal paresis) value was derived from Jongkees formula. The input parameters of the formula were initially nystagmus duration (seconds), which were replaced later with more stable parameters : slow component velocity (SCV, deg/sec). The nystagmus duration cannot be negative value, but SCV can be, especially in acute vestibular loss with excessive spontaneous nystagmus (SN) which is not overcome by caloric nystagmus. This study aims to investigate the occurrence of negative SCV, to check proper processing of negative SCV values in nystagmography software, and to consider the mathematical significance of CP and negative SCV values. MATERIALS AND METHOD: Tests with negative SCV values were examined in 690 alternate binaural bithermal caloric tests (open loop system). RESULTS: Nine percents (62 of 690 tests) showed negative SCV values. The reported CP was erroneously calculated from debased zero SCV values instead of negative SCV values. The underestimated CP (mean 52.1%, SD 21.8%) can be corrected (mean 80.9%, SD 21.8%) by recalculations with negative SCV values. CONCLUSION: To produce correct CP values in caloric tests, negative values should be properly processed about the SCV value of caloric nystagmus with opposite direction of physiologic response. The mathematical significance of CP was horizontal coordinate of intersection point of the warm line (LW-RW) and cold line (LC-RC) in butterfly pattern calorigram. Detailed description is presented in figures.
Butterflies ; Caloric Tests ; Nystagmus, Physiologic

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Factors Affecting Treatment of Benign Paroxysmal Positional Vertigo.

Yoon Kyoung SO ; Won Ho CHUNG ; Sung Hyun BOO ; Young Jun CHUNG ; Hyun Seok LEE ; Woo Young LEE ; Ki Nam PARK

Journal of the Korean Balance Society.2005;4(2):230-237.

BACKGROUND AND OBJECTIVES: Benign paroxysmal positional vertigo (BPPV) is one of the most common clinical entities encountered in a dizziness clinic. Treatment of this disease, canalith repositioning procedures, have been reported to be successful in 44-90%. Treatment requires only one treatment visit in most patients. However, there are significant numbers of patients who require multiple treatment visits for relief. The goal of this study is to identify variables that may be associated with these difficult to treat cases. METHODS: Retrospective review was performed for the patients diagnosed as BPPV at Samsung medical center. Variables for statistical analysis included age, sex, involved canal, presence of bilateral disease, involvement of unilateral multiple canals, presence of recent head trauma, presence of chronic otitis media, history of middle ear surgery, history of otologic surgery, unilateral vestibular loss, accompanying sudden SNHL, underlying disease such as hypertension or diabetes, change of involved canal during treatment course and number of treatment visits. Statistical analysis using Pearson chi-square test was performed. RESULTS: Three hundred thirty-one patients with BPPV who received treatment were identified from 2001 to 2005. 85.2% required one treatment visit, 12.4% required a second treatment visit, and 98.2% were successfully treated after three treatment visits. Variables such as bilateral disease, anterior canal BPPV, post-traumatic BPPV, duration of symptom before treatment and change of involved canal during treatment were significantly related with number of treatments. CONCLUSION: Patients with anterior semicircular canal BPPV or bilateral BPPV or with recent head trauma or longer duration of symptom are more likely to require multiple visits for canalith repositioning.
Craniocerebral Trauma ; Dizziness ; Ear, Middle ; Humans ; Hypertension ; Otitis Media ; Retrospective Studies ; Semicircular Canals ; Vertigo*

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Disequilibrium without Vertigo.

Tae Kyeong LEE ; Ki Bum SUNG

Journal of the Korean Balance Society.2008;7(2):253-259.

No abstract available.
Vertigo

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Recurrent positional vertigo.

Seung Han LEE

Journal of the Korean Balance Society.2008;7(2):244-252.

No abstract available.
Vertigo

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Recurrent Spontaneous Vertigo.

Kyu Sung KIM

Journal of the Korean Balance Society.2008;7(2):239-243.

No abstract available.
Vertigo

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Acute spontaneous vertigo.

Sung Won CHAE

Journal of the Korean Balance Society.2008;7(2):231-238.

No abstract available.
Vertigo

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Regional Distribution of 5-HT 1A, 1B, and 1D Receptors in Rat Vestibular Nuclei (Vn) and Inner Ear.

Seong Ki AHN ; Carey D BALABAN

Journal of the Korean Balance Society.2008;7(2):228-228.

Migraine and anxiety disorders are frequently co-morbid with balance disorders. Potential mechanisms for migrainous vertigo include sites of action of 5-HT (serotonin) 1B and 1D receptor agonists such as rizatriptan, which attenuate motion sickness in migraineurs. Selective serotonin reuptake inhibitors (SSRIs) are also known to be efficacious in the treatment of vertigo. Relative distribution of the 5-HT receptor subtypes and their functional roles in the vestibular nuclei and inner ear is still unknown. Using 5-HT1A, 1B, AND 1D receptors-specific antibody, we have demonstrated a differential distribution of these receptor subtypes within the rat vestibular nuclei and inner ear. For 5-HT receptor subtypes expression in the vestibular and auditory periphery, most ganglion cells in the vestibular ganglion showed immunoreactivity for 5-HT1A, 5-HT1B and 5-HT1D receptors. In addition, 5-HT1B and 1D receptors immunopositive reactivities were associated with endothelial cells of small blood vessels in the vestibular ganglion and nerve, endothelial cells in both the spiral ligament deep to the spiral prominence and stria vascularis and endothelial cells on blood vessels along the margins of the spiral ganglion. For 5-HT receptor subtypes expression in the vestibular nuclei (VN), the 5-HT1A, 1B and 1D receptors were expressed differentially in the VN. Fine varicose axons in the periventricular plexus showed intense 5-HT1A receptor expression in the medial VN (MVN) and extended into the superior VN (SVN). By contrast, 5-HT1B receptors were not expressed the ventricular plexus axons. Rather, 5-HT1B and 1D receptors immunopositive cell bodies and neuronal processes were dense in rostral MVN, dorsal SVN, lateral VN (LVN) and ventral aspect of nucleus prepositus hypoglossi (NPH). In the present study, inner ear and vestibular nuclei showed distinct distributions of 5- HT1A, 1B and 1D receptors expressions that are parallel to their distribution in peripheral and central nociceptive pathways. These differentially distributed 5-HT receptor subtypes are potential targets to explain the efficacy of SSRIs and triptans in treating migraine and migrainous vertigo.
Animals ; Anxiety Disorders ; Axons ; Blood Vessels ; Ear, Inner ; Endothelial Cells ; Ganglion Cysts ; Migraine Disorders ; Motion Sickness ; Neurons ; Rats ; Receptor, Serotonin, 5-HT1A ; Receptor, Serotonin, 5-HT1B ; Receptor, Serotonin, 5-HT1D ; Serotonin ; Serotonin Uptake Inhibitors ; Spiral Ganglion ; Spiral Ligament of Cochlea ; Stria Vascularis ; Triazoles ; Tryptamines ; Vertigo ; Vestibular Nuclei

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