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A Case of Atypical Benign Paroxismal Positional Vertigo.

Beom Gyu KIM ; Jai Hyuk CHANG ; Il Seok PARK ; Yong Bok KIM

Journal of the Korean Balance Society.2004;3(2):428-430.

Paroxysmal positional nystagmus is a common finding in patients with vertigo and can occur in typical and atypical forms. Atypical forms of paroxismal positional nystagmus are thought to represent conditions which are in fact not "benign". This patient was diagnosed as right posterior semicircular canal BPPV at first. After modified Epley maneuver, the type of nystagmus was changed to atypical forms. After left cupulolith reposition maneuver (CRmM), the nystagmus and dizziness were disappeared finally.
Dizziness ; Humans ; Nystagmus, Physiologic ; Semicircular Canals ; Vertigo*

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A Case of Bilateral Otosyphilis in the Patient with HIV Infection.

Jae Jun SONG ; Hyun Su JUN ; Sung Won CHAE ; Soon Jae HWANG

Journal of the Korean Balance Society.2004;3(2):424-427.

Syphilis was a common cause of progressive or sudden sensorineural hearing loss. After introduction of penicillin, the incidence of syphilis decreased in general population. However, with the prevalence of HIV infection, it's incidence is increasing. Many studies have substantiated the aggressive and rapidly progressive behavior of neurosyphilis, including otosyphilis, in the presence of HIV infection . We report a case of 38-year-old man HIV infected patient with bilateral sensorineural hearing loss and bilateral total vestibular loss caused by otosyphilis which was resistant to treatment.
Adult ; Hearing Loss, Sensorineural ; HIV Infections* ; HIV* ; Humans ; Incidence ; Neurosyphilis ; Penicillins ; Prevalence ; Syphilis

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Ocular Flutter Associated with a Thalamic Lesion.

Man Wook SEO

Journal of the Korean Balance Society.2004;3(2):417-423.

Ocular flutter is a rare, horizontal eye movement disorder characterized by rapid saccadic oscillations. Previous reports have presented a relationship between ocular flutter syndrome and many conditions/diseases. However, it is surprising that there have been few reported cases in which there has been a clear anatomically localized lesion linked to ocular flutter. So the pathophysiological basis for ocular flutter syndrome is not understood yet. We have recently experienced a case of ocular flutter syndrome where the ocular flutter was associated with dysmetria, dysdiadochokinesia, kinetic predominant tremor, and ataxia. The prodromal symptoms, self-limited illness course and cerebrospinal fluid (CSF) pleocytosis of our case suggest an infectious aetiology for this syndrome. Although most of the sequelae of infectious diseases represent more diffuse involvement of the nervous system, the predominant cerebellar symptoms and signs associated with ocular flutter imply that the single responsible lesion of the present case might have been related to the cerebellum-associated neural circuits. Brain single photon emission computed tomography (SPECT) in the present case showed perfusion decrease in the left thalamus. The present case suggests that the cerebellar output circuit (dorsal vermis-fastigial nucleus-vestibular nucleus-thalamus-cortex) might be related to the occurrence of ocular flutter. The description of this case may improve the understanding of the pathological mechanisms of ocular flutter syndrome.
Ataxia ; Brain ; Cerebellar Ataxia ; Cerebrospinal Fluid ; Communicable Diseases ; Leukocytosis ; Nervous System ; Ocular Motility Disorders ; Perfusion ; Prodromal Symptoms ; Thalamus ; Tomography, Emission-Computed, Single-Photon ; Tremor

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Possible Mechanism of Seesaw Nystagmus in Internuclear Ophthalmoplegia.

Ji Soo KIM ; Kwang Dong CHOI ; Ja Won KOO ; Kyungmi OH ; Jae Hong CHANG ; Kun Woo PARK ; Dae Hie LEE ; Gyu Cheol HAN

Journal of the Korean Balance Society.2004;3(2):413-416.

The authors report jerky seesaw nystagmus, extorsional downbeating in the ipsilesional eye and intorsional upbeating in the contralesional eye, in a patient with internuclear ophthalmoplegia (INO) from focal pontine lesion. This pattern of nystagmus may occur by disrupting pathways from contralateral posterior and anterior semicircular canals by a lesion in the medial longitudinal fasciculus. Depending on the pathways involved, various patterns of dissociated torsional-vertical nystagmus may accompany INO.
Humans ; Ocular Motility Disorders* ; Semicircular Canals

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The Correlation between the Change in the Degree of the Canal Paresis in Bithermal Caloric Test and the Degree of Hearing Loss after Chemical Labyrinthectomy in Patients with Meniere's Disease.

Chang Woo KIM ; San Ho JUNG ; Won Sang LEE

Journal of the Korean Balance Society.2004;3(2):404-409.

BACKGROUND AND OBJECTIVES:The chemical labyrinthectomy with aminoglycoside is a good method for vertigo control in Meniere's disease. It is relatively non-invasive and easy procedure, but hearing loss is a awful complication. We aimed to evaluate the relationship between the change in the degree of canal paresis in bithermal caloric test and the degree of hearing change. MATERIALS AND METHODS:Sixty-five patients of Meniere's disease who underwent chemical labyrinthectomy with streptomycin between October 1997 and December 2001 were included in this study. The minimum follow-up period for the patients was 24 months. Medical records were analyzed retrospectively. Criteria had been prescribed in 1995 by the American Academy of Otolaryngology-Head and Neck Surgery were used. Forty patients were tested a caloric response before and after the chemical labyrinthectomy. We analyzed the vertigo control rate, the change of the canal paresis and the change of hearing level. RESULTS:Vertigo was controlled in 90.8% of the 65 patients. Twelve patients of total 65 patients were decreased hearing level more than 10 dB after this procedure. Even though the severity of canal paresis increased, the hearing ability of most patients was unaffected. Some patients who had only slight canal paresis happened to suffer from hearing loss. CONCLUSION:There was no correlation between the change in the degree of canal paresis in the bithermal caloric test and the degree of the hearing change.
Caloric Tests* ; Ear, Inner ; Follow-Up Studies ; Hearing Loss* ; Hearing* ; Humans ; Medical Records ; Meniere Disease* ; Neck ; Paresis* ; Retrospective Studies ; Streptomycin ; Vertigo

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The Design of Subjective Visual Vertical and Horizontal Measurement Method in Normal Peoples.

Gyu Cheol HAN ; Jong Su HA ; Sun Young KIM ; Joo Hyoung LEE ; Chang Hyun CHO ; Dong Young KIM ; Seon Tae KIM

Journal of the Korean Balance Society.2004;3(2):395-403.

BACKGROUND AND OBJECTIVES:Subjective visual vertical and horizontal presented as test that evaluate otolithic organ. However, was not discussed about condition that is factor influencing in examination or position at examination. Therefore, we wished to evaluate effect of subjective visual vertical and horizontal in each test condition and find repletion item. MATERIALS AND METHOD:Measured subjective visual vertical and horizontal dividing by gender and three age group to 45 normal persons. Do so that there may be axis of rotation of 0.3x0 cm size candlepin on center of screen and lower part of screen to 18 inch LCD monitor at subjective visual vertical. Do so that may be center of screen and left middle at subjective visual horizontal and gave change length and axis of rotation of candlepin. Measured subjective visual vertical and horizontal each 3 times in standing, sitting, supine position in darkroom. RESULTS:There are no statistical differences in each positions and distinction of gender and axis of rotation. But there are statistical differences in age groups. CONCLUSION:Difference in age groups means that examination method or control of number of test, preliminary education of patients, assistance need rather than is caused change or abnormality of otolithic organ. Therefore, is thought to be representative test that evaluate function of otolithic organ as clinical test.
Axis, Cervical Vertebra ; Humans ; Otolithic Membrane ; Patient Education as Topic ; Reflex, Vestibulo-Ocular ; Supine Position

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The Optimization of Galvanic Vestibular Stimulation according to Evoked Nystagmus.

Gyu Cheol HAN ; Dong Kyu KIM ; Ju Hyoung LEE ; Chang Hyoun CHO ; Dong Young KIM ; Heung Eok CHA

Journal of the Korean Balance Society.2004;3(2):386-394.

BACKGROUND AND OBJECTIVES:The aim of this study were to observe the nystagmus of normal general populations on galvanic vestibular stimulation, to set a new korean standard for galvanic vestibular stimulation. MATERIALS AND METHOD:We recruited 10 healthy adults and they were stimulated by 1,2,3 mA monaural monopolar, monaural bipolar, binaural monopolar, binaural bipolar galvanic vestibular stimulation through carbon-rubber electrode and Ag-AgCl electrode. We evaluated galvanic stimulating nystagmus and after galvanic stimulating nystagmus on sitting position through Frenzel goggle and video-nystagmography. RESULTS:We detect stimulating and after-stimulating nystagmus on 1,2,3 mA monaural monopolar, monaural bipolar, binaural monopolar, binaural bipolar galvanic vestibular stimulation. The nystagmus on galvanic vestibular stimulation was directed to the negative electrode side and after-galvanic stimulating nystagmus was directed to opposite side. The greater current, the more occurrence of nystagmus was found. We detect nystagmus mostly on monaural bipolar vestibular stimulation through carbon-rubber electrode. We thought most effective Galvanic vestibular stimulation was 2 mA monaural bipolar vestibular stimulation through carbon-rubber electrode in consideration of increased pain and discomfort on 3 mA monaural bipolar vestibular stimulation in spite of high occurrence of nystagmus. CONCLUSION:Galvanic vestibular stimulation evoked different nystagmus according to stimulation, stimulated site. We thought 2 mA monaural bipolar vestibular stimulation through carbon-rubber electrode was most effective, stable galvanic stimulation. Specifity and sensitivity of 2 mA monaural bipolar vestibular stimulation were 100%, 100% respectively. Galvanic vestibular stimulation is useful to evaluate vestibular function.
Adult ; Electric Stimulation ; Electrodes ; Humans

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Chicken Embryo as a Model of Inner Ear Study.

Gyu Cheol HAN ; Youn Kyu LEE ; Jin Ho YOON ; Kyung Kun MIN ; Ju Hyoung LEE

Journal of the Korean Balance Society.2004;3(2):379-385.

BACKGROUND AND OBJECTIVES:Nowdays, numbers of patient who suffers from inner ear disease are increased and we need to completely understand about inner ear anatomy and embryology. But we have many problems to use human itself as a model, so it is difficult for us to study. Instead of using human as a model, recent days, many doctors use mammalians and birds. In this study, we used chicken embryo as a model whose inner ear was thought to be similar with human's inner ear and we made effort to get inner ear images by light microscope. MATERIALS AND METHOD:We incubated Gallus domesticus in auto-incubator for 12days. In each embryonic day (4th to 12th days), we got the chicken embryo and made paraffin block. Next, with micro-tomb, we made slice section and fixed to slide. Using micro-digital camera system, we took the picture of the inner ear of chicken embryo. RESULTS:We observed the structures of inner ear of chicken embryo from 4th embryonic day to 12th embryonic day. In 4th day and 5th day, we could not get the definite clear image. But from 6th to 12th day, we got the clear images of utricle, saccule, semicircular canals, etc. In several micro-section methods, making oblique coronal section was showed the best images of inner ear. CONCLUSION:This study was the start point of chicken inner ear embryology and anatomy. Hereafter, we should make the deeper study about chicken inner ear with these results and investigate the genetic and extrinsic factors which influence to inner ear disease. So we should solve the fundamental problem of inner ear disease based on this study
Birds ; Chickens* ; Ear, Inner* ; Embryology ; Embryonic Structures* ; Humans ; Labyrinth Diseases ; Paraffin ; Saccule and Utricle ; Semicircular Canals

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Otologic Causes of Drop Attacks in Elderly Patients.

Hyung LEE ; Hyon Ah YI ; Jeong Geung LIM ; Byung Hoon AHN ; Byung Rim PARK

Journal of the Korean Balance Society.2004;3(2):372-378.

BACKGROUND AND OBJECTIVES: Many neurologists are unaware of the drop attack that may occur from an inner ear dysfunction especially in elderly. We performed this study to investigate the clinical features and results of quantitative audiovestibular tests in six elderly patients (> or =65 years of age) who presented with drop attacks attributable to an inner ear pathology. MATERIALS AND METHOD:Group was divided into Meniere's syndrome (4) or non-Meniere peripheral vestibulopathy (2). Standard dizziness questionnaire and quantitative audiovestibular function testing were performed. RESULTS:Episodes were described as a sudden push to the ground in four or a violent illusionary movement of environment leading to a fall in two. All cases gave a history of prior vertiginous episodes and vestibular testing revealed unilateral caloric paresis. Ipsilateral hearing loss was documented in four cases. CONCLUSIONS:Our results suggest that otologic causes should be considered in the differential diagnosis of the drop attack in elderly, even if the symptoms and signs were not consistent with Meniere's syndrome.
Aged* ; Diagnosis, Differential ; Dizziness ; Ear, Inner ; Hearing Loss ; Humans ; Meniere Disease ; Paresis ; Pathology ; Surveys and Questionnaires ; Syncope*

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Characteristics of the Extratympanic Electrocochleography in the Patients with Meniere's Disease.

Shi Nae PARK ; Hyun Jin OH ; Kyung Ho PARK ; Sang Won YEO

Journal of the Korean Balance Society.2004;3(2):367-371.

BACKGROUND AND OBJECTIVES:Electrocochleography is the only proven investigation and diagnostic tool to demonstrate the endolymphatic hydrops at this time. We designed this study to assess the characteristics of transtympanic electrocochleographic findings and to estimate the clinical value of the test results in the patients with Meniere's disease. MATERIALS AND METHOD:Electrocochleographic duration and amplitude were measured in a clinically defined definite Meniere's disease group and the results were compared with those from a normal hearing control group. RESULTS:The summating potential (SP)/action potential (AP) amplitude ratio was significantly different among study groups with 0.40+/-.10 in the bilateral Meniere's group, 0.34+/-.08 in the unilateral Meneire's group and 0.22+/-.08 in the normal group (p<0.01). The elevated SP/AP ratio in the patients with such a relatively long duration of Meniere's disease in this study was mainly due to the decreased AP amplitude rather than the enhanced SP amplitude. CONCLUSION:Measuring electrocochleography and demonstrating the elevated SP/AP ratio could be quite valuable to diagnose the patients with Meniere's disease. The recognition of decreased AP amplitude might be helpful to understand the cochlear pathologic status in the patients with Meniere's disease.
Audiometry, Evoked Response* ; Endolymphatic Hydrops ; Hearing ; Humans ; Meniere Disease*

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