자발 하향안진 및 보행장애를 동반한 아놀드-키아리 기형

김민범,Youn Jin Cho 대한평형의학회 2023 Research in Vestibular Science Vol.22 No.4

Arnold Chiari malformation is a disease which is characterized by herniation of a portion of the cerebellum through the foramen magnum. Symptoms vary depending on the extent of the affected area, including posterior neck pain, upper limb pain, paralysis, paresthesia, weakness, dizziness, and ataxia. Among the patients presenting with dizziness, nystagmus is frequently observed, which is primarily characterized by down-beating nystagmus. We experienced a 42- years-old female patient presented with vertigo and gait disturbance, who were diagnosed with type 1 Arnold-Chiari malformation and treated by surgical decompression.

The Light Cupula: An Emerging New Concept for Positional Vertigo

김민범,홍석민,최혜랑,최성준,Ngoc Chien Pham,신정은,김창희 대한청각학회 2018 Journal of Audiology & Otology Vol.22 No.1

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 characteristicdirection-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 inLSCC canalolithiasis is transient with a latency of a few seconds, the diagnosis can be challengingif geotropic DCPN is persistent without latency. The concept of “light cupula” hasbeen introduced to explain persistent geotropic DCPN, although the mechanism behind itrequires further elucidation. In this review, we describe the characteristics of the nystagmicpattern in light cupula and discuss the current evidence for possible mechanisms explainingthe phenomenon.

상반고리관 양성 돌발성 두위현훈의 임상양상

김민범 대한평형의학회 2013 Research in Vestibular Science Vol.12 No.2

The aim of this study is to investigate the characteristics of anterior semicircular canal benign paroxysmal positional vertigo (BPPV). Materials and Methods: This is a retrospective chart review of 1,150patients who were diagnosed with BPPV at an ENT special hospital. We investigated a number of canalith repositioning procedure (CRP), canal switch and a history of recurrence or head trauma. Results: Anterior semicircular canal BPPV was observed in 41 (3.5%) patients. The average number of CRPs in patients with anterior semicircular canal BPPV was 2.19, which was higher than 1.60in those with posterior semicircular canal BPPV (p<0.0001). Canal conversion from anterior to posterior semicircular canal was found in 5 (12.1%) patients during treatment. The average number of CRPs in conversion cases was 4,which was higher than 1.94 in non‐conversion cases (p=0.001). Conclusion:More CRPs were necessary for the treatment of anterior semicircular canal BPPV than posterior semicircular canal BPPV. Canal switch could be considered as a factor to prevent a successful treatment.

Effects of Intratympanic Injection of Isosorbide on the Vestibular Function of Animal Models of Endolymphatic Hydrops

김민범,윤소연,홍한솔,홍현준 대한이비인후과학회 2021 Clinical and Experimental Otorhinolaryngology Vol.14 No.4

Objectives. The aims of this study were to investigate the effects of intratympanic injections of isosorbide on vestibular function in animal models of endolymphatic hydrops and to find a new treatment option for the acute onset of vertigo in Ménière disease (MD). Methods. Seventy male guinea pigs received intratympanic injection of isosorbide (IT-ISB). The animals were divided into three study groups: control, a chronic hydrops model, and an acute hydrops model. Intracochlear drug concentrations were measured using high-performance liquid chromatography. Vestibular function was analyzed using an animal rotator test with bidirectional sinusoidal harmonic acceleration before and after IT-ISB administration. Histological changes were also investigated. Results. ISB successfully permeated the perilymph through the round window membrane (RWM) at all three concentrations (25%, 50%, and 100%). In the chronic hydrops model, while IT-ISB histologically induced a reduction of endolymphatic hydrops, vestibular function was unchanged. In the acute hydrops model, no endolymphatic hydrops was histologically observed, and vestibular symmetry was also preserved after IT-ISB. Conclusion. ISB passed through the RWM into the perilymphatic space even at lower concentrations. IT-ISB histologically reduced hydrops in the chronic model and preserved symmetrical vestibular function in the acute model. IT-ISB could be a treatment candidate for acute attacks of vertigo in MD.

양측 Dix-Hallpike 검사에서 안진이 관찰되지 않은 상반고리관의 양성발작성두위현훈 1예

김민범,김현수,김희남 대한평형의학회 2011 Research in Vestibular Science Vol.10 No.3

Benign paroxysmal positional vertigo (BPPV) of anterior semicircular canal (ASC) is the rarest variant of BPPV, which is thought to be due to the anatomically superior position of ASC during most activities. This type of BPPV is currently diagnosed by detecting positional down-beating nystagmus in the Dix-Hallpike test. A 62-year-old female presented with positional vertigo, especially when sitting up. No nystagmus was induced by both Dix-Hallpike tests, however, positional down-beating nystagmus was observed with the left torsional component when sitting up from both Dix-Hallpike positions and supine position. After the reverse Epley maneuver, up-beating nystagmus was newly observed in the left Dix-Hallpike test, which was compatible with BPPV of the left posterior semicircular canal. This patient was thought to suffer from canalithiasis of the left ASC.

TransformaThe Relationship between Vestibulocochlear Symptoms and Types of the Anterior Inferior Cerebellar Artery (AICA) Pathway in Cerebellopontine Angle

김민범,추호석,송민영,이상덕,김희남 대한이비인후과학회 부산,울산,경남 지부회 2012 임상이비인후과 Vol.23 No.1

Aims of this study are 1) to evaluate radiological characteristics of the anterior inferior cerebellar artery (AICA) using three-dimensional Fourier Transformation Constructive Interference in Steady State (3D-FT CISS) MR imaging, and 2) to investigate the relationship between types of AICA and auditory or vestibular symptom. Materials and Methods:This is a retrospective study. Forty-five adult patients, who presented with auditory symptom and/ or vestibular symptom of unknown etiology at an ENT hospital from April 2010 to August 2011, were studied. Using 3D-FT CISS images, AICA course was identified in all the patients (90 ears). The relationship was investigated between types of the AICA loop and vestibulocochlear symptom. Results:According to Chavda’s classification, 55 type I loops, 24 type II loops and11 type III loops of the AICA were observed. Only type III loops show a statistically significant association with ipsilateral hearing loss and tinnitus (p=0.0001). According to Shelton’s classification, 14 class A courses, 52 class B, 18 class C and 6 class D were observed. However, any sigificant relationship was not found between cochleovestublar symptoms and AICA types of class A through D. Conclusion:A significant relationship was found between AICA loop and auditory symptom, when it extends more than 50% of the length of IAC. In these patients, neurovascular compression of vestibulocochlear nerve could be considered as a possible cause of hearing deterioration and tinnitus.

Hearing Outcomes According to the Types of Mastoidectomy: A Comparison between Canal Wall Up and Canal Wall Down Mastoidectomy

김민범,최지선,이재권,박주연,추호석,조양선,홍성화,장원호 대한이비인후과학회 2010 Clinical and Experimental Otorhinolaryngology Vol.3 No.4

Objectives. The aim of this study was to compare the hearing outcomes between canal wall up mastoidectmy (CWUM)and canal wall down mastoidectmy (CWDM). Methods. One hundred seventy one chronic suppurative otitis media (CSOM) patients were enrolled in this retrospective study. The patients who underwent the second staged ossiculoplasty at least 6 months after mastoidectomy and who had an intact, well aerated tympanic cavity as well as intact mobile stapes at the time of operation were selected from the medical record. Based on the type of mastoid surgery, the patients were categorized into two groups: the CWUM (n=38) and CWDM groups (n=133). The hearing results of the CWUM and CWDM groups were compared using the pre- and post-operative air-bone gap (ABG) at 3 months after ossiculoplasty. Results. The preoperative ABG in both groups (CWUM and CWDM) were 28.4±15.6 dB and 31.8±14.5 dB, respectively (P=0.18). Both groups didn’t show any significant difference (10.9 dB vs. 13.5 dB, respectively) (P=0.21) for the postoperative ABG closure. The proportion of patients with an ABG less than 20 dB was 58.6% of the CWDM patients and 68.4% of the CWUM patients (P=0.25). Conclusion. The type of mastoid surgery (CWUM and CWDM) did not affect the hearing results of CSOM patients. When choosing the type of mastoidectomy procedure for CSOM surgery, the hearing outcomes are basically the same for both types of procedure.

동시 및 순차적 양측 인공와우 이식술의 시간 및 비용 비교

김민범,김환,최재영 대한이비인후과학회 2013 대한이비인후과학회지 두경부외과학 Vol.56 No.10

Background and Objectives Purpose of this study is to compare the cost-effectiveness between sequential (SeqBCI) and simultaneous bilateral cochlear implantations (SimBCI). Subjects and Method This is a retrospective study of 15 patients who underwent bilateral cochlear implantations at a tertiary care facility. Nine patients with SimBCI and six with SeqBCI were included. Operation time, anesthesia time, expenses for preoperative evaluation, hospitalization time, hospital expenses and postoperative expenses were investigated. Results The 1st, 2nd and cumulative operation time for the SeqBCI group were 181, 120 and 301 minutes, respectively, on the average. The 1st, 2nd and cumulative anesthesia time were 212, 162 and 373 minutes, respectively. The 1st, 2nd and cumulative expenses for preoperative evaluation were 1074754, 280118 and 1354872 won, respectively. The 1st, 2nd and total hospitalization time were 6.2, 4.2 and 10.4 days, respectively. The 1st, 2nd and cumulative hospital expenses were 24082713, 24158366 and 48176734 won, respectively. The 1st, 2nd and cumulative postoperative expenses were 447830, 551778 and 999608 won, respectively. For the SimBCI group, the operation time, anesthesia time, expenses for evaluation, hospitalization time, hospital expenses and postoperative expenses were 246, 280 minutes, 1396793 won, 6.2 days, 46073011 and 816121 won, respectively. On the whole, anesthesia time, hospitalization time and postoperative expenses of the SimBCI group were less than those of the SeqBCI group (p=0.01, 0.02 and 0.02, respectively). The postoperative expenses of SeqBCI were the highest during the first 4 months whereas those of SimBCI were less during the same period (p=0.03). Conclusion Cumulative anesthesia time, hospitalization time and postoperative cost of SimBCI were less than those of SeqBCI. Our results may be useful for counseling the timing of second CI.

급성 중추성 현훈

김민범,반재호 대한이비인후과학회 2014 대한이비인후과학회지 두경부외과학 Vol.57 No.8

Acute vertigo is a common symptom at the otolaryngology clinics or the Emergency Department. Also, many otolaryngologists see these patients first or they are referred from the Emergency Department. Although the stroke incidence in all dizzy patients is relatively low, the misdiagnosis of central vertigo may lead to serious morbidity and even mortality. Nevertheless, it is difficult to diagnose in vertigo patients whether the origin is central or not, especially at the initial visit. The purpose of this clinical review was to investigate clinical findings of acute central vertigo and to suggest the recent advance of differential diagnosis in these patients from peripheral vestibulopathy. We also suggest an appropriate practice for the radiologic investigation in these patients. Korean J Otorhinolaryngol-Head Neck Surg 2014;57(8):504-10

The Efficiency of Simultaneous Binaural Ocular Vestibular Evoked Myogenic Potentials: A Comparative Study with Monaural Acoustic Stimulation in Healthy Subjects

김민범,반재호 대한이비인후과학회 2012 Clinical and Experimental Otorhinolaryngology Vol.5 No.4

Objectives. To evaluate the test-retest reliability and convenience of simultaneous binaural acoustic-evoked ocular vestibular evoked myogenic potentials (oVEMP). Methods. Thirteen healthy subjects with no history of ear diseases participated in this study. All subjects underwent oVEMP test with both separated monaural acoustic stimulation and simultaneous binaural acoustic stimulation. For evaluating test-retest reliability, three repetitive sessions were performed in each ear for calculating the intraclass correlation coefficient (ICC) for both monaural and binaural tests. We analyzed data from the biphasic n1-p1 complex, such as latency of peak, inter-peak amplitude, and asymmetric ratio of amplitude in both ears. Finally, we checked the total time required to complete each test for evaluating test convenience. Results. No significant difference was observed in amplitude and asymmetric ratio in comparison between monaural and binaural oVEMP. However, latency was slightly delayed in binaural oVEMP. In test-retest reliability analysis, binaural oVEMP showed excellent ICC values ranging from 0.68 to 0.98 in latency, asymmetric ratio, and inter-peak amplitude. Additionally, the test time was shorter in binaural than monaural oVEMP. Conclusion. oVEMP elicited from binaural acoustic stimulation yields similar satisfactory results as monaural stimulation. Further, excellent test-retest reliability and shorter test time were achieved in binaural than in monaural oVEMP. Objectives. To evaluate the test-retest reliability and convenience of simultaneous binaural acoustic-evoked ocular vestibular evoked myogenic potentials (oVEMP). Methods. Thirteen healthy subjects with no history of ear diseases participated in this study. All subjects underwent oVEMP test with both separated monaural acoustic stimulation and simultaneous binaural acoustic stimulation. For evaluating test-retest reliability, three repetitive sessions were performed in each ear for calculating the intraclass correlation coefficient (ICC) for both monaural and binaural tests. We analyzed data from the biphasic n1-p1 complex, such as latency of peak, inter-peak amplitude, and asymmetric ratio of amplitude in both ears. Finally, we checked the total time required to complete each test for evaluating test convenience. Results. No significant difference was observed in amplitude and asymmetric ratio in comparison between monaural and binaural oVEMP. However, latency was slightly delayed in binaural oVEMP. In test-retest reliability analysis, binaural oVEMP showed excellent ICC values ranging from 0.68 to 0.98 in latency, asymmetric ratio, and inter-peak amplitude. Additionally, the test time was shorter in binaural than monaural oVEMP. Conclusion. oVEMP elicited from binaural acoustic stimulation yields similar satisfactory results as monaural stimulation. Further, excellent test-retest reliability and shorter test time were achieved in binaural than in monaural oVEMP.