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Lee DH, Kim TH, Jang M, Kim CH. The Light Cupula Phenomenon: A Scoping Review. Brain Sci 2023; 14:15. [PMID: 38248229 PMCID: PMC10813105 DOI: 10.3390/brainsci14010015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/07/2023] [Accepted: 12/16/2023] [Indexed: 01/23/2024] Open
Abstract
Direction-changing positional nystagmus (DCPN), which refers to the change in the direction of nystagmus with different head positions, is a well-known characteristic of horizontal semicircular canal BPPV. The supine head roll test is commonly used to diagnose horizontal canal BPPV. However, persistent geotropic DCPN observed during this test cannot be explained by the conventional explanations of canalolithiasis or cupulolithiasis. To account for this unique nystagmus, the concept of a "light cupula" has been recently introduced. In this review, we provide an overview of the historical background, clinical features and diagnostic methods, proposed mechanisms, and treatment strategies associated with the light cupula phenomenon based on the available literature to date.
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Affiliation(s)
| | | | | | - Chang-Hee Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute of Medical Science, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul 05030, Republic of Korea; (D.-H.L.); (T.H.K.); (M.J.)
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Peng H, Wang L, Song H, Gao B, Yang Y, Lyu F. Clinical Characteristics of persistent geotropic horizontal direction-changing positional nystagmus: Experience in 189 participants. J Vestib Res 2023; 33:203-211. [PMID: 36776085 DOI: 10.3233/ves-220086] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
BACKGROUND The etiology and mechanism of persistent geotropic horizontal direction-changing positional nystagmus (DCPN) are still unclear. Whether this pattern of nystagmus is a subtype of benign paroxysmal positional vertigo (BPPV) remains controversial. OBJECTIVE The goal of this study was to observe the clinical characteristics of persistent geotropic horizontal DCPN involving the lateral semicircular canal. METHODS The analysis was performed to participants with episodic positional vertigo in our clinic from 2014 to 2021. Participants were included via positional test. We observed and summarized the distribution data, vertigo history, follow-up tests, and recurrence situations of 189 persistent geotropic horizontal DCPN participants. RESULTS The mean age at the first time showing of persistent geotropic horizontal DCPN was 56±14.7 and more women than men were affected by persistent geotropic horizontal DCPN (female-to-male ratio 2.4 : 1). Overall, 58.7% (57/94) of participants who came for the first-week follow-up test were asymptomatic. Thirty-three participants experienced recurrence (female-to-male ratio: 4.5 : 1). Fifty-three (28.0%) participants experienced the conversion of the patterns of DCPN in the history, the follow-up tests and the recurrence compared to the first showing of persistent geotropic horizontal DCPN. 24(12.1%) participants still experienced persistent geotropic horizontal DCPN attack in the follow-up tests and the recurrences without benign paroxysmal positional vertigo history. CONCLUSION Persistent geotropic horizontal DCPN affected more women than men. The persistent geotropic horizontal DCPN that with conversion to transient geotropic horizontal DCPN or to persistent apogeotropic horizontal DCPN might be a subtype of BPPV or in a stage of BPPV process. However, the persistent geotropic horizontal DCPN without conversion might be an independent disease that is not related to BPPV.
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Affiliation(s)
- Hao Peng
- Department of Otolaryngology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, China
| | - Liyi Wang
- Department of Otolaryngology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, China
| | - Haitao Song
- Department of Otolaryngology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, China
| | - Bo Gao
- Department of Otolaryngology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, China
| | - Yi Yang
- Department of Otolaryngology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, China
| | - Fan Lyu
- Department of Otolaryngology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, China
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Bal N, Altun M, Kuru E, Basoz Behmen M, Gedik Toker O. Light cupula phenomenon: a systematic review. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2022. [DOI: 10.1186/s43163-022-00336-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AbstractGeotropic direction-changing positional nystagmus (DCPN) is transient in lateral semicircular canal (LSSK) canalolithiasis; it usually cuts off within a minute and fatigues. However, a “light cupula” mechanism has been described for patients with positional vertigo who exhibit a persistent geotropic DCPN without delay or fatigue. When the cupula becomes lighter than the surrounding endolymph, deflection may occur in the cupula under the influence of gravity. The person experiences dizziness and persistent positional nystagmus can be observed while remaining in that position.In this review, studies investigating the “light cupula phenomenon,” which is a newly defined phenomenon in the literature, were compiled. A systematic literature search was conducted on the light cupula phenomenon in PubMed and Google Scholar databases to illuminate the clinical side of this new phenomenon and reveal its distinctive features. Turkish and English articles published between 2010 and 2021 were scanned; the thesis, reviews, and books were excluded from the study. Forty-eight articles were included in the study.Mechanisms underlying light cupula has been explained as the “heavier endolymph hypothesis” with increased endolymph specific gravity due to an acute attack such as labyrinth hemorrhage, insufficient inner ear perfusion, or inflammation in the inner ear; “lighter cupula hypothesis” based on alcohol acting on the cupula earlier and making it lighter than the endolymph; “light particle hypothesis” due to the buoyancy of light debris, which are degenerative, swollen, and inflammatory cells in the endolymph adhering to the cupula and the “altered endolymph/perilymph density ratio hypothesis” that the difference in density between perilymph and endolymph causes light cupula. The pathophysiology of the light cupula phenomenon is still unclear, but it can be thought that all the different hypotheses may be effective in this phenomenon. Therefore, nystagmus characteristics and clinical course should be considered in patients for a more effective diagnosis and treatment process. In addition, the results of the studies show that light cupula may not be an uncommon disease and that some patients with geotropic DCPN can often be misdiagnosed as canalolithiasis LSCC-BPPV.
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Lee J, Park JY, Shin JE, Kim CH. Direction-changing spontaneous nystagmus in patients with dizziness. Eur Arch Otorhinolaryngol 2022; 280:2725-2733. [PMID: 36454383 DOI: 10.1007/s00405-022-07761-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 11/21/2022] [Indexed: 12/04/2022]
Abstract
PURPOSE The present study aimed to investigate the clinical features of patients with direction-changing spontaneous nystagmus (DCSN) and gain insight into its underlying mechanisms. METHODS Medical records and vestibular function test results collected in our dizziness clinic between February 2013 and February 2020 were retrospectively reviewed. Spontaneous nystagmus was recorded while sitting upright using videonystagmography for 2 min to confirm the spontaneous changes in nystagmus direction. Causative disease diagnoses were based on the patients' clinical history, audiometry results, vestibular function tests, and imaging studies. RESULTS Of 4786 patients, DCSN was observed in 41 (0.86%). Causative disease diagnoses included vestibular neuritis (n = 9), lateral semicircular canal cupulopathy (n = 9), cerebellopontine angle tumor (n = 8), vestibular paroxysmia (n = 2), vestibular migraine (n = 2), vestibular nucleus infarction (n = 1), sudden sensorineural hearing loss with vertigo (n = 2), Meniere's disease (n = 2), Ramsay Hunt syndrome (n = 1), labyrinthine fistula due to middle ear cholesteatoma (n = 1), lateral semicircular canal dysplasia (n = 1), post tympanomastoidectomy dizziness (n = 1), and head trauma (n = 2). CONCLUSIONS Although the periodicity of DCSN could not be determined because of insufficiently long observation times, it was observed in various central and peripheral vestibulopathies. Careful examination of spontaneous nystagmus over a sufficient period may ensure the detection of DCSN when evaluating dizziness.
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Kutlubaev M. Clinical and pathogenetic aspects of positional nystagmus. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:123-127. [DOI: 10.17116/jnevro2021121121123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Lagos AE, Ramos PH, Aracena-Carmona K, Novoa I. Conversion from geotropic to apogeotropic direction changing positional nystagmus resulting in heavy cupula positional vertigo: case report. Braz J Otorhinolaryngol 2020; 87:629-633. [PMID: 33334708 PMCID: PMC9422597 DOI: 10.1016/j.bjorl.2020.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 10/29/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
- Antonia Elisa Lagos
- Pontificia Universidad Católica de Chile, Otolaryngology Department, Santiago, Chile.
| | - Phoebe Helena Ramos
- Pontificia Universidad Católica de Chile, Otolaryngology Department, Santiago, Chile
| | - Karina Aracena-Carmona
- Pontificia Universidad Católica de Chile, Otolaryngology Department, Otolaryngology Laboratory Technologist, Santiago, Chile; Pontificia Universidad Católica de Chile, Faculty of Medicine, Health Sciences Department, Speech Therapy Career, Santiago, Chile
| | - Iván Novoa
- Pontificia Universidad Católica de Chile, Faculty of Medicine, Health Sciences Department, Speech Therapy Career, Santiago, Chile
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Zhang SL, Tian E, Xu WC, Zhu YT, Kong WJ. Light Cupula: To Be Or Not to Be? Curr Med Sci 2020; 40:455-462. [PMID: 32681250 DOI: 10.1007/s11596-020-2199-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/09/2020] [Indexed: 01/09/2023]
Abstract
Benign paroxysmal positional vertigo (BPPV) represents the most common form of positional vertigo. It is caused by dislodged otoconia that freely float in the semicircular canals (canalolithiasis) or attach to the cupula (cupulolithiasis). A cupulolithiasis-type (or a heavy cupula-type) of BPPV implicating the lateral semicircular canal (LSCC) exhibits persistent ageotropic direction-changing positional nystagmus (DCPN) in a head-roll test. However, in some cases, unlike any type of BPPV, persistent geotropic DCPN cannot be explained by any mechanisms of BPPV, and don't fit the current classifications. Recently, the notion of light cupula has been introduced to refer to the persistent geotropic DCPN. In this study, we looked at the clinical features of light cuplula and discussed the possible mechanisms and therapeutic strategies of the condition. The notion of light cupula is a helpful addition to the theory of peripheral positional vertigo and nystagmus.
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Affiliation(s)
- Su-Lin Zhang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China. .,Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - E Tian
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Wen-Chao Xu
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yu-Ting Zhu
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Wei-Jia Kong
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China. .,Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China. .,Key Laboratory of Neurological Disorders of Education Ministry, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Kim CH, Choi HR, Choi S, Lee YS, Shin JE. Patterns of nystagmus conversion in sudden sensorineural hearing loss with vertigo. Medicine (Baltimore) 2018; 97:e12982. [PMID: 30412127 PMCID: PMC6221715 DOI: 10.1097/md.0000000000012982] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The patients with sudden sensorineural hearing loss (SSNHL) may complain of vertigo. Although there have been many reports on SSNHL with vertigo (SSNHL_V), changes in the pattern of nystagmus have not been studied as yet. This study is a retrospective study and aims to investigate the characteristic changes in type of nystagmus and clinical features in patients with SSNHL_V who experienced a change in their nystagmus pattern during follow-up. Among 50 patients with SSNHL_V between January 2012 and December 2015, we identified 15 patients with SSNHL_V whose pattern of nystagmus changed. Initial nystagmus was classified into 5 subgroups: paretic type, irritative type, persistent geotropic direction-changing positional nystagmus (PG-DCPN), persistent apogeotropic direction-changing positional nystagmus (PA-DCPN), and posterior semicircular canal benign paroxysmal positional vertigo. The most common pattern of initial nystagmus was PG-DCPN (n = 7). The change of initial nystagmus pattern occurred on day 2 to 75 from symptom onset, and 2 (of 15) patients showed further conversion. The most common pattern of final nystagmus was PA-DCPN (n = 9). Hearing improvement after treatment was not significantly different (P = .59) between SSNHL_V patients with nystagmus change (25 ± 17 dB, n = 15) and those without nystagmus change (28 ± 18 dB, n = 35). In conclusion, clinician's attention is required in evaluating the vertigo symptom in patients with SSNHL_V because the initial patterns of nystagmus can be converted to another type of nystagmus. The presence of nystagmus change during follow-up may not be a prognosticator for hearing recovery in patients with SSNHL_V.
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Kim CH, Hong SM. Is the modified cupulolith repositioning maneuver effective for treatment of persistent geotropic direction-changing positional nystagmus? Eur Arch Otorhinolaryngol 2018; 275:1731-1736. [PMID: 29804128 DOI: 10.1007/s00405-018-5006-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 05/18/2018] [Indexed: 10/16/2022]
Abstract
OBJECTIVE Clinicians sometimes see patients with relatively persistent geotropic direction-changing positional nystagmus (DCPN) as a variant of lateral semicircular canal-benign paroxysmal positional vertigo (LSCC-BPPV). Recently, the concept of a "light cupula" in the lateral semicircular canal, exhibiting persistent geotropic DCPN, has been introduced. However, the underlying pathogenesis of light cupula is not known. We investigated the efficacy of a modified cupulopathy repositioning maneuver (mCuRM), designed to reduce light debris attached to the cupula in patients with persistent geotropic DCPN. STUDY DESIGN Retrospective cohort study. METHODS Participants included 65 patients with a persistent geotropic DCPN: 35 underwent treatment (mCuRM group), and 30 were followed-up but received no treatment (No CuRM group). We compared the therapeutic and survival rate of persistent geotropic DCPN between two groups. RESULTS On Day 1, the persistent geotropic DCPN did not resolve in either group. On the first and second follow-up days, persistent geotropic DCPN was observed in 28 (80%) and 21 (60%) of patients, respectively, in the mCuRM group, and in 28 (93.3%) and 24 (80%) patients, respectively, in the no mCuRM group. The differences between groups were not statistically significant. Furthermore, no between-group differences were found in the time from diagnosis to resolution of nystagmus, or the time from symptom onset to resolution of nystagmus. Kaplan-Meier analysis of the time course of persistent geotropic DCPN resolution from the day of diagnosis and day of symptom onset revealed no significant differences between the groups. CONCLUSION Our findings indicate that mCuRM had no therapeutic benefit for a persistent geotropic DCPN and suggest that the pathophysiology of persistent geotropic DCPN is less likely to be a light debris attached to the cupula.
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Affiliation(s)
- Chang-Hee Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea
| | - Seok Min Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, #7 Keunjaebong-gil, Hwaseong, Gyeonggi-do, 18450, South Korea.
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Kim MB, Hong SM, Choi H, Choi S, Pham NC, Shin JE, Kim CH. The Light Cupula: An Emerging New Concept for Positional Vertigo. J Audiol Otol 2017; 22:1-5. [PMID: 29061034 PMCID: PMC5784369 DOI: 10.7874/jao.2017.00234] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 09/12/2017] [Accepted: 09/14/2017] [Indexed: 11/22/2022] Open
Abstract
Benign paroxysmal positional vertigo (BPPV) is the most common type of positional vertigo. A canalolithiasis-type of BPPV involving the lateral semicircular canal (LSCC) shows a characteristic direction-changing positional nystagmus (DCPN) which beats towards the lower ear (geotropic) on turning the head to either side in a supine position. Because geotropic DCPN in LSCC canalolithiasis is transient with a latency of a few seconds, the diagnosis can be challenging if geotropic DCPN is persistent without latency. The concept of “light cupula” has been introduced to explain persistent geotropic DCPN, although the mechanism behind it requires further elucidation. In this review, we describe the characteristics of the nystagmic pattern in light cupula and discuss the current evidence for possible mechanisms explaining the phenomenon.
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Affiliation(s)
- Min-Beom Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seok Min Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Hyerang Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Seongjun Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Ngoc Chien Pham
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Jung Eun Shin
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Chang-Hee Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
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Ahn SH, Shin JE, Kim CH. Final diagnosis of patients with clinically suspected vestibular neuritis showing normal caloric response. J Clin Neurosci 2017; 41:107-110. [DOI: 10.1016/j.jocn.2017.02.064] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 02/07/2017] [Indexed: 10/19/2022]
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Kim CH, Shin JE, Yang YS, Im D. Sudden sensorineural hearing loss with positional vertigo: Initial findings of positional nystagmus and hearing outcomes. Int J Audiol 2016; 55:541-6. [PMID: 27329283 DOI: 10.1080/14992027.2016.1194532] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To investigate the initial findings of positional nystagmus in patients with sudden sensorineural hearing loss (SSNHL) and positional vertigo, and to compare hearing improvement among patients with different types of positional nystagmus. DESIGN The characteristics of positional nystagmus upon initial examination were analysed, and the initial mean pure-tone audiometry (PTA) threshold was compared with that at three months after treatment. STUDY SAMPLE Forty-four SSNHL patients with concomitant positional vertigo were included. RESULTS Positional nystagmus was classified into five subgroups; persistent geotropic direction-changing positional nystagmus (DCPN) in head-roll test (HRT) and negative Dix-Hallpike test (DHT), persistent apogeotropic DCPN in HRT and negative DHT, positive DHT and negative HRT, persistent geotropic DCPN in HRT and positive DHT, and persistent apogeotropic DCPN in HRT and positive DHT. PTA threshold improvement was significantly greater in SSNHL patients with negative DHT than with positive DHT (p = 0.027). CONCLUSIONS When geotropic DCPN was elicited by HRT, the nystagmus was persistent, which suggests that alteration of specific gravity of the endolymph, rather than the lateral canal canalolithiasis, may be a cause of this characteristic positional nystagmus. Positive DTH may be a prognostic factor for worse hearing recovery among patients with SSNHL and positional vertigo.
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Affiliation(s)
- Chang-Hee Kim
- a Department of Otorhinolaryngology - Head and Neck Surgery , Konkuk University Medical Center, Konkuk University School of Medicine , Seoul , Korea
| | - Jung Eun Shin
- a Department of Otorhinolaryngology - Head and Neck Surgery , Konkuk University Medical Center, Konkuk University School of Medicine , Seoul , Korea
| | - Young Soo Yang
- a Department of Otorhinolaryngology - Head and Neck Surgery , Konkuk University Medical Center, Konkuk University School of Medicine , Seoul , Korea
| | - Donghyuk Im
- a Department of Otorhinolaryngology - Head and Neck Surgery , Konkuk University Medical Center, Konkuk University School of Medicine , Seoul , Korea
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Kim CH, Yang YS, Im D, Shin JE. Nystagmus in patients with unilateral acute otitis media complicated by serous labyrinthitis. Acta Otolaryngol 2016; 136:559-63. [PMID: 26797398 DOI: 10.3109/00016489.2015.1132845] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Conclusion The patients with serous labyrinthitis caused by acute otitis media (AOM) exhibited various patterns of nystagmus in which direction-fixed irritative-type nystagmus was the most common pattern. Differential effects on inner ear function by toxic or inflammatory mediators may be responsible for the various manifestation of nystagmus. Objective This study aimed to investigate nystagmus patterns in patients with serous labyrinthitis, and discuss possible mechanisms. Methods From October 2011 to March 2014, 13 consecutive patients with serous labyrinthitis were included. Eye movements of the patients were serially examined using video-nystagmography, and patterns of nystagmus were investigated. Results The most commonly observed pattern was direction-fixed nystagmus (nine of 13 patients). Of these, eight showed irritative-type, and one showed paretic-type. Direction of nystagmus, although the intensity gradually decreased, was not changed during the course of treatment. One patient showed direction-changing spontaneous nystagmus, which changed into paretic-type direction-fixed nystagmus 1 day after myringotomy. Three patients exhibited persistent direction-changing positional nystagmus in a supine head-roll test. Of them, two showed apogeotropic and one showed geotropic type. In all 13 patients, vertigo and hearing loss were improved after the treatment.
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Affiliation(s)
- Chang-Hee Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Young Soo Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Donghyuk Im
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jung Eun Shin
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
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