단일온도안진 검사에서의 어지러움증의 감각과 안진 Parameters의 연령별 비교

신상승,차창일,진영완,변재용,이동엽,홍남표 대한이비인후과학회 1998 대한이비인후과학회지 두경부외과학 Vol.41 No.5

동시 자극 온도 안진 검사의 유용성

정운교,문성균,고윤우,이해성,이주형,윤혜진 대한이비인후과학회 1998 대한이비인후과학회지 두경부외과학 Vol.41 No.9

온도안진검사에서 시고정지수의 정량적 분석과 임상적 적용

원중연,권세영,김지희,이효정,김형종,구자원,홍성광 대한평형의학회 2012 Research in Vestibular Science Vol.11 No.4

Background and Objectives: There is no general consensus as to the normal limit or recommended procedure for visual fixation index (VFI) during caloric test because fixation suppression (FS) could be influenced by different variables. In this study, we present our mathematical modeling according to different variables to establish a clinical implication of VFI in patients with vertigo. Materials and Methods: Data were analyzed from a retrospective record of patients who underwent caloric testing. Three subgroups were classified (normal caloric response, unilateral vestibular hypofunction and central vertigo). VFI distribution and mathematical modeling to estimate an associated probability were performed from each group. A receiver operation characteristics (ROC) curve was plotted to determine its diagnostic value. Results: Four hundred eighteen, 67 and 14patients met our inclusion criteria for normal caloric response, unilateral vestibular hypofunction and cerebellar infarction respectively. VFIs on warm irrigation showed more consistent distribution than cold irrigation in normal caloric response group. In contrast, there was significant inconsistency of VFIs between each side in unilateral vestibular hypofunction group (p>0.05). FS ability was inversely propositional with increase in age on all caloric (p<0.05). The area under the ROC curve of VFIs on warm caloric irrigation was 0.821and that on cold irrigation was 0.785 for detecting central vertigo. Conclusion:Calibrated normal limit for VFI according to age is needed to ensure its clinical implication. Diagnostic value of VFI and its reliability on warm stimulation was superior to that of cold, which indicates VFI on warm stimulation seems to be a more reliable parameter. Background and Objectives: There is no general consensus as to the normal limit or recommended procedure for visual fixation index (VFI) during caloric test because fixation suppression (FS) could be influenced by different variables. In this study, we present our mathematical modeling according to different variables to establish a clinical implication of VFI in patients with vertigo. Materials and Methods: Data were analyzed from a retrospective record of patients who underwent caloric testing. Three subgroups were classified (normal caloric response, unilateral vestibular hypofunction and central vertigo). VFI distribution and mathematical modeling to estimate an associated probability were performed from each group. A receiver operation characteristics (ROC) curve was plotted to determine its diagnostic value. Results: Four hundred eighteen, 67 and 14patients met our inclusion criteria for normal caloric response, unilateral vestibular hypofunction and cerebellar infarction respectively. VFIs on warm irrigation showed more consistent distribution than cold irrigation in normal caloric response group. In contrast, there was significant inconsistency of VFIs between each side in unilateral vestibular hypofunction group (p>0.05). FS ability was inversely propositional with increase in age on all caloric (p<0.05). The area under the ROC curve of VFIs on warm caloric irrigation was 0.821and that on cold irrigation was 0.785 for detecting central vertigo. Conclusion:Calibrated normal limit for VFI according to age is needed to ensure its clinical implication. Diagnostic value of VFI and its reliability on warm stimulation was superior to that of cold, which indicates VFI on warm stimulation seems to be a more reliable parameter.

Reliability of Air Caloric Response in Healthy Volunteers and Patients With Chronic Otitis Media

홍성광,김지수,최진웅,구자원 대한평형의학회 2012 Research in Vestibular Science Vol.11 No.1

Background and Objectives: To investigate reliability of the air caloric test compared to the water caloric test and to determine whether anatomical alterations due to chronic otitis media (COM) influence air caloric response. Materials and Methods: Fifty-six subjects without vestibulopathy (24 healthy individuals as control group and 32 patients with unilateral COM as experimental group) were included. The bithermal water and air caloric test were sequentially conducted in control group. The bithermal air caloric tests, high-resolution temporal bone computed tomography and endoscopic photography of the ear drum were obtained from experimental group. Results: Although maximal slow phase velocities and time to reach peak velocity using water irrigation were significantly higher and shorter, respectively, than those by air irrigation in normal subjects, caloric parameters on air caloric test agreed well with those of water caloric testing. However, inverted nystagmus occurred in 16 ears of 16 subjects, which was predominantly presented during warm air stimulation in the com patient group. The large tympanic membrane perforation and asymmetrical mastoid pneumatization were significant parameters affecting caloric response. The presented prediction model for cold-induced mspvs corresponded with observed values according to mastoid pneumatization. Conclusion: Although the air caloric stimuli resulted in a reliable response in healthy subjects, air caloric results among com patients affected by anatomical alteration as well as irrigation temperature. Presented mathematical model for cold induced mspv could serve as a good reference in measuring true vestibular function in com patients.

심도 돌발성 난청 환자의 예후 인자

고석화,강희정,변하영,정재호,이승환,박철원 대한이비인후과학회 부산,울산,경남 지부회 2019 임상이비인후과 Vol.30 No.1

Background and Objectives:Profound sudden sensorineural hearing loss (SSNHL) is particularly known to have poor prognosis. However, there were few studies on the prognosis of profound idiopathic SSNH. The aim of the study is to investigate the possible prognostic factor in profound SSNHL using various clinical parameters. Materials and Methods:A retrospective study was performed with 65 patients who treated with profound SSNHL from January 2011 to December 2017. High dose steroid and intratympanic steroid therapy was uniformly applied and then, hearing recovery was determined by the AAO and HNS classification. Prognostic factors, including clinical characteristic, audiological outcomes and vestibula function tests were assessed by uni and multi-variable analysis. Results:In 65 patients with profound SSNHL, class A hearing recovery was achieved in just 9 (13.8%) patients, while 44 (67.7%) patients showed no hearing improvement. In a subgroup analysis, patients with vertigo showed lower hearing gain than those without vertigo (p=0.032). In addition, canal paresis on caloric test was negatively correlated with hearing gain (r=-0.279). Univariate analysis showed that no hearing improvement group were frequently accompanied with vertigo and higher initial hearing threshold. According to the multivariate analysis, initial hearing threshold was only factor that related to the poor hearing recovery. Conclusions:In profound SSNHL, caloric loss was correlated with poor hearing gain and initial hearing level was associated with the hearing recovery.

두부 외상으로 발생한 양측성 전정기능소실 환자에서 전정안반사의 이득 감소가 회복된 1예

박가영,정은욱,김종세,정원호 대한평형의학회 2012 Research in Vestibular Science Vol.11 No.4

Dizziness is a frequent complication of head injury and objective evidence of vestibular dysfunction in the dizzy patient following head injury has been reported in literatures. However, there is no report about bilateral spontaneous recovery of caloric response after complete loss of bilateral vestibular function following head injury. A 27-year-old male patient who presented with continuous dizziness and disequilibrium following head injury was diagnosed as diffuse axonal injury after brain magnetic resonance image and bilateral complete loss of vestibular function after caloric and rotary chair test. He showed gradual improvement of dizziness, vestibulo-ocular reflex gain and left caloric response at 2 months after vestibular exercise. After another 4 months, his caloric function was fully recovered,and dizziness disappeared at 16 months after the onset of dizziness. We present this case with reviews of previous literatures about dizziness following head injury and diffuse axonal injury.

내이도내 전정신경종의 임상적 특징 및 수술적 방법에 따른 결과 비교

김종양,정종우,이광선 대한이비인후과학회 2007 대한이비인후과학회지 두경부외과학 Vol.50 No.3

Background and Objectives:Modern imaging and surgical techniques have made intrameatal vestibular schwanoma (IMVS) surgery safe and have allowed for good outcomes with respect to facial nerve function and hearing outcome. This study aimed to analyze clinical features and to compare the results of the middle fossa approach (MFA) and translabyrinthine approach (TLA) used during IMVS surgery. Subjects and Method:We reviewed retrospectively 10 patients who were operated for IMVS from November 1995 to May 2005. This study analyzed chief complaint, size of tumor, audiological studies, caloric test, imaging study, and treatment modality. Results:The main symptom for IMVS patients is vertigo. But, in our study, patients having only vertigo was rare;disturbance in PTA and unilateral weakness in the Caloric test. In terms of mean operation time, it took 7.5 hours in MFA and 4 hours in TLA. Postoperative hearing loss and facial nerve palsy occurred in early MFA operation cases. With respect to facial nerve function, the MF approach group had a higher rate of development of facial neuropathy than did the TL approach group. Conclusion:We think patients with vertigo and tinnitus will progress to hearing loss. We should suspect IMVS if patients com-plain of vertigo and tinnitus. But, further evaluation should be needed. If postoperative hearing preservation is not important, the To use the MFA method, otolaryngologic surgeons need more direct and indirect experiences, considering the low incidence of acoustic schwannoma surgery and that the MFA method requires longer mean operation time than TLA. (Korean J Otolaryngol 2007 ;50 :203-8)

전정신경염에서 소음자극에 의한 반대측 유발이음향방사의 억제

우훈영,손정협,유영삼,최정환 대한평형의학회 2011 Research in Vestibular Science Vol.10 No.1

The etiology of vestibular neuritis is unknown. Many investigators have suggested that this condition spares the inferior vestibular nerve system. However, others have reported that the lesion sometimes affects the inferior vestibular nerve system based on vestibular evoked myogenic potential. The function of the inferior vestibular nerve was studied in acute vestibular neuritis by monitoring medial olivocochlear bundle (MOCB) function. Under normal conditions, contralateral acoustic stimulation has inhibitory effects on ipsilateral otoacoustic emissions through the MOCB. Materials and Methods: Twenty patients that presented with dizziness and spontaneous nystagmus, and were confirmed to have acute vestibular neuritis by rotatory chair and caloric testing were enrolled in this study. We evaluated the evoked otoacoustic emissions with and without contralateral acoustic stimulation in both ears in all patients. The percent loss of normal inhibitory action on otoacoustic emissions was determined in the normal and affected ears. Results: All patients showed inhibitory effects in response to contralateral acoustic stimulation on evoked otoacoustic emissions in normal ears. Fifteen patients (75%) had an absence of contralateral suppression of otoacoustic emissions on the affected side. Conclusion: The findings of this study suggest the presence of dysfunction of the MOCB in patients with acute vestibular neuritis.

메니에르병에서 진동유발안진의 의의

정우진,최광동,김지수,구자원 대한이비인후과학회 2006 대한이비인후과학회지 두경부외과학 Vol.49 No.2

Background and Objectives:Clinical presentation of Meniere’s disease is dynamic. Nystagmus changes phase to phase, which is attributed to central compensation and recovery process in the peripheral vestibular system. Vibration-induced nystagmus (VIN) has been shown to reflect side difference of peripheral vestibular excitability. Aim of this study was to analyze the characteristics of VIN between attacks in Menieres disease. Subjects and Method:48 patients with unilateral Meniere’s disease (definite criteria) were included. Auditory and vestibular function tests including caloric test, post-head shaking nystagmus (pHSN) and VIN were evaluated during symptom free period. Vibratory stimuli (100 Hz) was applied to both mastoids and forehead, and direction of horizontal nystagmus was recorded using video eye movement recording system or video nystagmography system, which was then compared with pHSN and caloric test results. Results:Thirty-one patients (65%) showed VIN in at least one area. VIN to ipsilesional side was noted in 13 cases, and to contralesional side in 18. In patients with canal paresis (CP) over 30% (N=27), 10 beat to ipsilesional side, 6 to contralesional side, and 11 showed no VIN. In patients with CP of less than 30% (N=21), 3 beat to ipsilesional side, 12 to contralesional side, and 6 showed no VIN (p<0.05). Thirty-six patients (75%) showed pHSN, and 28 patients of them (78%) showed contralesional nystagmus. Conclusion:Presence of ipsilesional VIN was significantly higher in Meniere’s disease group with low CP, which suggests that the capacity of functional recovery by vestibular end organ may be higher in early Meniere’s disease. (Korean J Otolaryngol 2006;49:153-6)

전정병증에서 뇌병변 감별을 위한 시고정 지수의 유용성 평가

Young Jae Lee,Wonyong Baek,Sung-Il Cho,Gi-Sung Nam 대한평형의학회 2023 Research in Vestibular Science Vol.22 No.4

Objectives: This study was performed to investigate the efficacy of the fixation index (FI) of the bithermal caloric test for differentiating brain lesions in vestibular disorder. Methods: We reviewed the medical records of 286 consecutive dizzy patients who underwent brain magnetic resonance imaging (MRI) and the bithermal caloric test at department of otorhinolarnygology. Central vestibulopathy (CVP) was defined as when corresponding lesion was identified on brain MRI, otherwise peripheral vestibulopathy (PVP) was defined. The FI was defined as the mean slow phase velocity (SPV) with fixation divided by the mean SPV without fixation, and failure was indicated when the FI exceeded 70%. Results: The CVP confirmed by brain MRI and PVP were 16.8% and 83.2%, respectively. The most common CVPs were cerebellopontine angle tumor (n=19, 39.6%) and chronic cerebellar infarction (n=18, 37.5%). There were 23 cases of CVP (47.9%) and 47 cases of PVP (19.7%) with abnormal number of FI in at least two of the four caloric irrigations. The FI score of right cool (RC), left cool (LC), and right warm (RW) were also increased significantly in patients with CVP (p=0.031 at RCFI, p=0.014 at LCFI, p=0.047 at RWFI, and p=0.057 at LWFI; Mann-Whitney U-test). Conclusions: If two or more abnormal FIs are detected during bithermal caloric testing, there is a high likelihood of CVP. Consequently, additional brain MRI may be necessary for further evaluation.