[Four Cases of Other Iatrogenic Immunodeficiency-associated Lymphoproliferative Disorders in the Head and Neck Region].

Other iatrogenic immunodeficiency-associated lymphoproliferative disorders (OIIA-LPD) comprise lymphoid proliferations or lymphomas that arise in patients treated with immunosuppressive drugs for autoimmune diseases, especially rheumatoid arthritis (RA) treated with methotrexate (MTX). MTX has been increasingly administered to patients with RA, resulting in methotrexate-associated lymphoproliferative disorder (MTX-LPD) in patients. We report herein on four cases of patients with RA, who diagnosed with head and neck region. In two cases (one case MTX and another case tacrolimus) drug therapy was discontinued, when the patients were diagnosed as having OIIA-LPD in only a few local findings. These patients have followed good clinical courses for 24 months. In the other two cases, consultations were performed for cervical lymphadenopathy by the Division of Rheumatology. In one case drug therapy was discontinued and a good clinical course was followed. In case of the other patient, however, who had undergone tacrolimus therapy after MTX therapy was discontinued, she relapsed and died. In the case of patients with an autoimmune disease such as RA who are taking MTX, tacrolimus, or anti TNF-α therapy, when cervical lymphadenopathy and extranodal disease are detected, OIIA-LPD should be suspected. We should cooperate with a hematologist-oncologist, a rheumatologist, and pathologist in such a case.

[A Case of Juvenile-Onset Laryngeal Papillomatosis Requiring Emergency Airway Management].

Juvenile-onset laryngeal papillomatosis has a serious tendency for rapid growth and repeated recurrence. Thus, patience and prudence are required for the successful management of this pathology. We report herein on 2-year and 4-month-old boy with juvenile-onset laryngeal papillomatosis, which caused remarkable airway constriction that required urgent airway management. He was delivered vaginally by a mother with condyloma acuminatum. Hoarseness appeared at 1 year of age, and retractive breathing was observed at 1 year and 6 months of age. He finally presented with severe wheezing and was admitted to the emergency room of our hospital with a laryngeal tumor strongly resembling a papilloma. Emergency endotracheal intubation was possible by means of a fine endotracheal tube with an internal diameter of 2.5 mm. His supraglottic space was filled with the tumor; thus, making the visibility of the vocal folds difficult. The tumor was surgically removed using a microdebrider under general anesthesia. The histopathological diagnosis was benign papilloma and HPV11 virus was detected. The rapidly growing papilloma showed a strong tendency for recurrence, and four additional surgical procedures had to be performed within 6 months after the first operation. This patient will therefore require cautious medical care in the future.

Effects of high-dose betahistine on intractable dizziness in patients with uncompensated unilateral vestibulopathy.

OBJECTIVE: In the present study, we examined the effects of high-dose betahistine on dizziness handicap inventory (DHI) scores in patients with unilateral vestibulopathy. METHODS: An uncontrolled, open-label, multicenter clinical trial was conducted. Fifteen patients with unilateral vestibulopathy, such as vestibular neuritis, who complained of intractable dizziness for more than three months were enrolled. Initially, all patients were orally administered betahistine at a dose of 36 mg/day for four weeks, which is the standard dose and dosing period for the treatment of dizziness in Japan. The patients were then administered betahistine at a double dose of 72 mg/day for four weeks. Six patients who became aware of the benefits of high-dose betahistine were further administered betahistine at 72 mg/day for an additional 12 weeks (a total of 16 weeks). Perceived disability due to dizziness was assessed by DHI scores. RESULTS: In all 15 patients, short-term administration with high-dose (72 mg/day) betahistine for four weeks, but not low-dose betahistine (36 mg/day) for four weeks significantly decreased DHI scores. In particular, in six responding patients with self-reported benefits after short-term administration with high-dose betahistine, long-term administration with high-dose betahistine for 16 weeks further significantly decreased DHI scores. However, DHI scores of the remaining nine non-responding patients were not changed after short-term administration with high-dose betahistine for four weeks. CONCLUSION: Short-term administration with the standard dose and dosing period of betahistine did not improve DHI scores in the enrolled patients, indicating that they were not compensated for unilateral vestibulopathy with intractable dizziness. The present findings suggest that long-term administration with high-dose betahistine facilitates vestibular compensation to improve intractable dizziness in some, but not all patients with uncompensated unilateral vestibulopathy.

Perilymphatic fistula with characteristic findings of the inner ear by contrast-enhanced magnetic resonance imaging: a case report.

A perilymphatic fistula (PLF) presents with abnormal traffic in the otic capsule, causing cochlear and vestibular symptoms. However, the mechanisms underlying symptom recurrence remain controversial. Herein, we report the case of a 27-year-old female who complained of hearing disturbance in her right ear and recurrent vertigo after sudden onset of hearing loss with vertigo. The caloric test revealed unilateral weakness in the right ear, and the video head impulse test (vHIT) showed decreased vestibulo-ocular reflex (VOR) gain. Contrast-enhanced magnetic resonance imaging (MRI) using hybrid of reversed image of positive endolymph signal and negative image of perilymph signal (HYDROPS) indicated a collapsed endolymphatic space. As the vestibular symptoms did not improve, an exploratory tympanotomy was performed on the right ear. Although perilymph leakage was not noted in the oval or round windows, both windows were sealed with connective tissue. The patient's vestibular symptoms rapidly improved after surgery, and postoperative contrast-enhanced MRI showed improvement in the collapsed endolymphatic space. Although the caloric test revealed unilateral weakness, the VOR gain on the vHIT improved to normal on the right side. Thus, these findings indicated that recurrent symptoms caused by PLF are associated with a collapsed endolymphatic space. We speculate that the collapsed endolymphatic space was due to a ruptured Reissner's membrane. We hypothesized that sealing the fistula would promote normalization of perilymph pressure. The ruptured Reissner's membrane may have been gradually repaired as vestibular symptoms improved. This case adds to the existing literature on the occurrence of the "double-membrane break syndrome". Collapse of the endolymph due to a ruptured Reissner's membrane may be the cause of PLF symptoms.

Endolymphatic hydrops presumption tests for patients with vestibular migraine.

BACKGROUND: The aetiology of vestibular migraine (VM) has not yet been defined; endolymphatic hydrops (EH) has been suggested as a candidate. OBJECTIVES: This study aimed to clarify the relationship between VM and EH using neuro-otological tests, including the EH presumption test. MATERIALS AND METHODS: Fourteen patients with VM underwent caloric testing, video head impulse test (vHIT), cervical and ocular vestibular evoked myogenic potential (cVEMP and oVEMP), and EH presumption tests such as the Futaki's test and furosemide loading VEMP. RESULTS: Caloric testing was abnormal in two of the 14 cases (14.3%), and vHIT was abnormal in one of 12 cases (8.3%). Abnormal asymmetry ratios (ARs) of cVEMP and oVEMP were observed in two of 14 cases (14.3%) and six of 13 cases (46.2%), respectively. Futaki's test results were positive in five of 14 cases (35.7%). Furosemide loading VEMP was positive in seven of 14 cases (50.0%). Nine patients (64.3%) were positive for at least one EH presumption test. CONCLUSIONS AND SIGNIFICANCE: EH is not a rare finding in VM; however, the ratio is less than that in Meniere's disease.

Diagnostic and therapeutic strategies for vestibular neuritis of the Japan society for equilibrium research.

OBJECTIVE: To provide diagnostic and therapeutic strategies for vestibular neuritis in accordance with the Japanese Clinical Practice Guidelines for Vestibular Neuritis 2021. METHODS: The Committee for Clinical Practice Guidelines for Vestibular Neuritis was entrusted with a review of the relevant scientific literature on the above topic. Clinical Questions (CQs) concerning the treatment of vestibular neuritis were produced, and a search of the literature was conducted to identify studies related to the CQs. The recommendations were based on the literature review and the expert opinion of a subcommittee. RESULTS: We proposed the diagnostic criteria for vestibular neuritis, as well as answers to CQs, recommendations, and evidence levels for the treatment of vestibular neuritis. CONCLUSION: The diagnostic criteria for vestibular neuritis were based on clinical history and examination findings after completing the differential diagnosis process. The treatment of vestibular neuritis was divided into acute, subacute, and chronic stages. The Japanese Clinical Practice Guidelines for Vestibular Neuritis 2021 should be used as a reference in the diagnosis and treatment of vestibular neuritis.

A 14-year nationwide epidemiological analysis of delayed endolymphatic hydrops in Japan.

BACKGROUND: Delayed endolymphatic hydrops (DEH) is an inner ear disease that causes recurrent vertigo in the ipsilateral ear or fluctuating hearing in the contralateral ear due to endolymphatic hydrops secondary to preceding deafness. There are few reports of large, multicentre studies investigating the clinical-epidemiological characteristics of DEH. OBJECTIVE: This study aimed to clarify the characteristics of DEH in Japan. METHODS: Clinical data on 662 patients with DEH were analysed by nationwide, multicentre surveys conducted by the Peripheral Vestibular Disorders Research Group of Japan. RESULTS: The proportion of ipsilateral DEH (IDEH) was slightly higher than that of contralateral DEH (CDEH) at 55.4%. The time delay between onset of precedent deafness and onset of DEH was significantly longer for CDEH than for IDEH. The most common cause of precedent deafness was a disease of unknown cause with onset in early childhood (33.1%). Epidemiological characteristics were not significantly different between CDEH with and without vertigo. CONCLUSION: DEH appearing to be caused by viral labyrinthitis has a high rate of onset within 40 years of precedent deafness. Clinical and epidemiological characteristics of IDEH, CDEH with vertigo, and CDEH without vertigo were very similar. SIGNIFICANCE: The clinical-epidemiological characteristics of DEH in Japan were clarified.

The effect of systemic administration of salicylate on the auditory cortex of guinea pigs.

OBJECTIVE: To investigate the effect of systemic administration of salicylate as a tinnitus inducing drug in the auditory cortex of guinea pigs. METHODS: Extracellular recording of spikes of the primary auditory cortex and dorsocaudal areas in healthy male albino Hartley guinea pigs was continuously performed (pre- and post-salicylate). RESULTS: We recorded 160 single units in the primary auditory cortex from five guinea pigs and 156 single units in the dorsocaudal area from another five guinea pigs. The threshold was significantly elevated after the administration of salicylate in both the primary auditory cortex and dorsocaudal areas. The Q10dB value was significantly increased in the primary auditory cortex, whereas it has significantly decreased in the dorsocaudal area. Spontaneous firing activity was significantly decreased in the primary auditory cortex, whereas it has significantly increased in the dorsocaudal area. CONCLUSION: Salicylate induces significant changes in single units of both stimulated and spontaneous activity in the auditory cortex of guinea pigs. The spontaneous activity changed differently depending on its cortical areas, which may be due to the neural elements that generate tinnitus.

Temporal Adjusters Can Reduce Pain During the Video Head Impulse Test for Patients With Mongoloid Facial Features, Without Increasing the Slippage-Induced Artifacts.

BACKGROUND: The aim of this study was to determine whether the extent and intensity of pain caused by wearing goggles during the video head impulse test (vHIT) could be reduced by adjusting the direction in which the band pulls the goggles, without increasing the number of artifacts recorded during vHIT. METHODS: vHIT tests were performed in 65 healthy adult subjects, and the Visual Analog Scale (VAS) and Numerical Rating Scale (NRS) were used to evaluate pain intensity. Temporal adjusters were used to adjust the direction in which the band pulls the goggles, without decreasing the tightness of the temple straps. Artifacts were compared by calculating the instantaneous gains at 40 ms, 60 ms, and 80 ms of head movement. RESULTS: Maximum VAS and NRS of pain were significantly reduced from 22.0 ± 2.3 to 13.0 ± 1.7 and from 3.0 ± 0.2 to 2.0 ± 0.2 (both P < .0001). The VAS score without adjusters was significantly correlated with the improvement of the VAS score with temporal adjusters (P < .0001, r = 0.61). The higher the VAS score without adjusters, the greater the improvement in the VAS score with temporal adjusters. The instantaneous gains were close to 1.0 under both conditions. CONCLUSION: The pain induced by the goggle was significantly mitigated with temporal adjusters in the bilateral temple strap. Using temporal adjusters is a useful and easy solution to reduce discomfort during vHIT, while maintaining the tightness of the strap to decrease the slippageinduced artifacts.

Test Batteries and the Diagnostic Algorithm for Chronic Vestibular Syndromes.

Objective: To develop a diagnostic algorithm for chronic vestibular syndromes by determining significant items that differ among diagnoses. Methods: Two hundred thirty-one patients with chronic vestibular syndromes lasting for >3 months were included. Full vestibular tests and questionnaire surveys were performed: bithermal caloric test, cervical and ocular vestibular-evoked myogenic potential assessment, video head impulse test (vHIT), posturography, rotatory chair test, dizziness handicap inventory, hospital anxiety and depression scale (HADS), and Niigata persistent postural-perceptual dizziness (PPPD) questionnaire (NPQ). Differences in each item of the vestibular tests/questionnaires/demographic data were tested among the diagnoses. A receiver operating characteristic (ROC) curve was created for the significant items. The value that provided the best combination of sensitivity/specificity on the ROC curve was adopted as a threshold for diagnosing the targeted disease. Multiple diagnostic algorithms were proposed, and their diagnostic accuracy was calculated. Results: There were 92 patients with PPPD, 44 with chronic dizziness due to anxiety (CDA), 31 with unilateral vestibular hypofunction (UVH), 37 with undifferentiated dizziness (UD), and 27 with other conditions. The top four diagnoses accounted for 88% of all chronic vestibular syndromes. Five significant items that differed among the four diseases were identified. The visual stimulation and total NPQ scores were significantly higher in the patients with PPPD than in those with UVH and UD. The percentage of canal paresis (CP %) was significantly higher in the patients with UVH than in those with PPPD, CDA, and UD. The patients with CDA were significantly younger and had higher anxiety scores on the HADS (HADS-A) than those with UVH and UD. Moreover, catch-up saccades (CUSs) in the vHIT were more frequently seen in the patients with UVH than in those with PPPD. The most useful algorithm that tested the total and visual stimulation NPQ scores for PPPD followed by the CP%/CUSs for UVH and HADS-A score/age for CDA showed an overall diagnostic accuracy of 72.8%. Conclusions: Among the full vestibular tests and questionnaires, the items useful for differentiating chronic vestibular syndromes were identified. We proposed a diagnostic algorithm for chronic vestibular syndromes composed of these items, which could be useful in clinical settings.

Effects of using cane and vestibular rehabilitation on the walking function in elderly patients with dizziness.

OBJECTIVE: Adults over the age of 65 years with balance disorders are at about twice the risk of falls, compared with those without balance disorders. Falls contribute to about 74% of the proximal femoral fractures commonly seen in the elderly. Since balance disorders are more prevalent in older adults than in younger adults, it is important to deal with balance disorders in older adults to prevent falls and the resulting deterioration in their ADL (activity of daily living). In this study, we investigated the effects of vestibular rehabilitation (VR) and cane use on improving gait and balance in patients aged over 65 years with balance disorder. METHODS: Patients aged over 65 years presenting to the Department of Otolaryngology at St. Marianna University School of Medicine between July 1 and November 1, 2018, with symptoms of dizziness for ≥ 3 months and a Japanese translation of the Dizziness Handicap Inventory score of ≥ 26 were included in the study. We quantitatively analyzed their gait before and after VR, and with and without the use of a cane. RESULTS: A total of 21 patients participated in the study (14 women; mean age 73.9 ± 6.9 years). Before VR, using a cane made no difference to step length or walking speed. After VR, using a cane increased step length from 50.5 cm (95% confidence interval [CI], 47.4-53.7 cm) to 52.0 cm (95% CI, 48.9-55.1 cm) (p = 0.039). There was no change in walking speed. A comparison of walking assessment results while using a cane before and after VR showed that step length increased from 49.9 cm (95% CI, 46.6-53.2 cm) to 52.0 cm (95% CI, 48.9-55.1 cm) (p = 0.005), and walking speed increased from 90.5 cm/s (95% CI, 82.7-98.4 cm/s) to 96.1 cm/s (95% CI, 88.3-103.9 cm/s) (p = 0.005). CONCLUSIONS: Walking speed and step length with the use of a cane significantly improved following VR. VR and cane use may act synergistically to improve walking.

[Study of cerebellar infarction with isolated vertigo].

Isolated vertigo is generally attributed to labyrinthine disease, but may also signal otherwise asymptomatic cerebellar infarction. Of 309 subjects admitted between April 2004 and March 2009 for the single symptom of acute vertigo initially thought to be labyrinthine, four were found to have cerebellar infarction of the posterior inferior cerebellar artery area (PICA). All were over 60 years old and had risk factors including hypertension, diabetes mellitus, arrhythmia, and/or hyperlipidemia. Two had trunk ataxia, with magnetic resonance imaging (MRI) showing infarction within a few days. The other two could walk without apparent trunk ataxia, however, it took 4 to 7 days to find the infarction, mainly through neurological, neurootological, and MRI findings. Neurologically, astasia, dysbasia or trunk ataxia were important signs. Neurootologically, nystagmus and electronystagmographic testing involving eye tracking, saccade, and optokinetic patttens were useful.

Transplantation of autologous oral mucosal epithelial cell sheets inhibits the development of acquired external auditory canal atresia in a rabbit model.

Acquired external auditory canal atresia is characterized by fibrous tissue formation in the ear canal, hearing loss and chronic otorrhea. Although the disease can be treated surgically, the recurrence rate is high. This study explored whether autologous oral mucosal epithelial cell sheets could be used as a novel therapy for ear canal atresia. We succeeded in generating a rabbit model of acquired external auditory canal atresia by dissecting the skin of the ear canal. Endoscopic and histological findings in this model indicated that atresia developed over a 4-week period and was not inhibited by the placement of polyglycolic acid sheets immediately after skin dissection. By contrast, transplantation of autologous oral mucosal epithelial cell sheets, which had been fabricated by culture on temperature-responsive inserts without a feeder layer, prevented the development of atresia during the 4-week period after skin dissection. Transplantation of autologous epithelial cell sheets after surgical treatment of acquired external auditory canal atresia could be a promising new method to reduce the risk of disease recurrence. STATEMENT OF SIGNIFICANCE: Acquired external auditory canal atresia is characterized by fibrous tissue formation in the ear canal, which leads to hearing loss and chronic otorrhea. Although surgical treatments are available, the recurrence rate is high. In this study, we successfully generated a rabbit model of acquired external auditory canal atresia by dissecting the skin of the ear canal. Furthermore, we utilized this new animal model to investigate whether the transplantation of autologous oral mucosal epithelial cell sheets could be used as a novel therapy for ear canal atresia. Our results raise the possibility that the transplantation of autologous epithelial cell sheets after surgical treatment of ear canal atresia could be a promising new method to reduce the risk of disease recurrence.

[Ramsay Hunt syndrome with cranial polyneuropathy involving cranial nerves VII, VIII, IX, and X].

In addition to facial and vestibular nerve paralysis, patients with Ramsay Hunt syndrome may also show glossopharyngeal, vagal, and hypoglossal nerve paralysis. We report a case of Ramsay Hunt syndrome with cranial polyneuropathy including cranial nerves VII, VIII, IX, and X. A 58-year-old rheumatic woman suffering from vertigo, right earache, and sore throat suffered right-side facial palsy, hoarseness, and swallowing difficulty on day 5. Admitted on day 6, she was treated with antiviral medication and steroids. Although vertigo, facial palsy, and hearing loss gradually improved, hoarseness required over three months to recover. Of the 33 patients with Ramsay Hunt syndrome we have seen, 9 (27%) had cranial polyneuropathy, including cranial nerves IX and X in 4 years. Of these, 9% involved total paralysis of nerves IX and X. Physical symptoms of those with polyneuropathy, especially vagal nerve palsy, tended to worsen, making it important to observe other cranial nerve signs, such as for IX and X carefully, in addition to VII and VIII.

[Clinical effect of bipolar radiofrequency thermotherapy on allergic rhinitis].

The clinical effect of bipolar radiofrequency thermotherapy on allergic rhinitis was evaluated. A bipolar radiofrequency system (CelonLab ENT) was used on 16 patients suffering from allergic rhinitis from February 2003 and August 2003. The thermotherapy was conducted under local anesthesia and data was collected by preoperative questionnaire and rhinomanometry and 2 months and 2 years postoperatively. Nearly all the patients reported relieved nasal patency, rhinorrhea, and sneezeing. Statistically significant improvements were observed for all the measured VAS scores: nasal patency, rhinorrhea, and sneezeing. Nasal resistance measured by anterior rhinomanometry also significantly improved. We concluded that CelonLab ENT is effective and safe in treating allergic rhinitis.

Recovery of otolith function in patients with benign paroxysmal positional vertigo evaluated by sinusoidal off-vertical axis rotation.

The vestibulo-ocular reflex (VOR) was studied via sinusoidal off-vertical axis rotation (OVAR) to evaluate otolith function in patients with benign paroxysmal positional vertigo (BPPV). Subjects were sinusoidally rotated with eyes open in complete darkness at frequencies of 0.4 and 0.8 Hz with a maximum angular velocity of 60 degrees /s in earth vertical axis rotation (EVAR) and OVAR. Ten patients with BPPV patients were investigated. We performed OVAR tests for all patients for the following different points and compared otolith function: (1) The point at which patients had typical nystagmus; we call this state 'Before', that is, before recovery. (2) The point when their nystagmus disappeared; we call this state 'After' that is, after nystagmus disappear. Results showed that VOR gain during OVAR at 0.8 Hz in a 30 degrees nose-up position in BPPV patients was significantly less than the gain during EVAR at the point Before. On the other hand, gain was not significantly different between EVAR and OVAR at the point After. VOR gain itself at 0.8 Hz nose-up OVAR showed a significant increase at the point After compared to Before. This increase of VOR gain might be caused by the recovery of the otolith function in patients with BPPV.

Head-tilting stabilometry in patients with benign paroxysmal positional vertigo.

OBJECTIVE: One of the pathologic conditions underlying benign paroxysmal positional vertigo (BPPV) is degeneration of the otolith organs. In this study, we examined changes in the parameters of stabilometry under an upright condition and head-tilt conditions in patients with BPPV. METHODS: We performed stabilometry on 21 patients with right BPPV, on 21 patients with left BPPV and on 21 controls. First, the subject stood barefoot in an upright position with both feet together on the platform with eyes closed. Next, tilting of the head about 30 degrees to the left was added. Then, tilting about 30 degrees to the right was performed. RESULTS: In right BPPV patients, the total length of velocity vectors in the right or left direction on right or left head-tilt were significantly smaller than those in an upright position. The enveloped area and total length of velocity vectors in the right or left direction were significantly larger than those in controls. In left BPPV patients, there were no parameters that showed any significant difference. CONCLUSIONS: In this study, lesions of right BPPV patients were coincidentally more severe than those in left BPPV patients, and velocity vectors with head-tilts were significantly smaller than in an upright position. Using the total length of the velocity vectors, head-tilting stabilometry has the potential to become a reliable otolith function examination method.

Evaluation of the otolith function using sinusoidal off-vertical axis rotation in patients with benign paroxysmal positional vertigo.

The vestibulo-ocular reflex (VOR) was studied via sinusoidal off-vertical axis rotation (OVAR) to evaluate the otolith function in patients with benign paroxysmal positional vertigo (BPPV). Subjects were sinusoidally rotated with eyes open in complete darkness at frequencies of 0.4 and 0.8 Hz with a maximum angular velocity of 60 degrees s(-1) in earth-vertical axis rotation (EVAR) and OVAR. Twenty-three controls and 24 BPPV patients were investigated. Results showed that VOR gain during OVAR at 0.8 Hz in a 30 degrees nose-up position in BPPV patients was significantly less than the gain during EVAR, whereas the gain was not significantly different between EVAR and OVAR in the controls in each condition. In addition, to examine each type of BPPV, we also investigated whether there were any differences between the patients who suffered from dizziness and those who did not. VOR gain in OVAR of BPPV patients who were suffering from dizziness was significantly less than that of BPPV patients without dizziness. Not only cupulolithiasis or canalolithiasis, but also otolith dysfunction was considered to be the possible origin of BPPV. Because sinusoidal OVAR produced minimal nausea compared to constant velocity OVAR, the stimulation of 0.8 Hz nose-up in sinusoidal OVAR may be used to evaluate otolith function without discomfort for patients.

Investigation into dizziness before and after Epley's maneuver for benign paroxysmal positional vertigo using stabilometry.

OBJECTIVE: To investigate the cause of dizziness after Epley's maneuver using stabilometry. METHODS: Subjects were 35 patients with posterior canal type BPPV. First we performed stabilometry, next Epley's maneuver, then stabilometry was performed again. The enveloped area and the locus length per second of stabilometry were compared. RESULTS: Seventeen patients reported a feeling of dizziness after the treatment, whereas the other 18 patients did not. The patients were divided into two groups: 17 patients with dizziness (WD) and 18 patients without dizziness (WOD) after the treatment. In the WD group, the enveloped area (P=0.0495) and the locus length per second (P=0.0099) before Epley's maneuver were significantly lower than those after Epley's maneuver. In the WOD group, there was no significant difference in the stabilometry parameter between values obtained before and after Epley's maneuver. There were no significant differences found in either parameter between these two groups either before or after applying Epley's maneuver. CONCLUSIONS: Epley's maneuver is a treatment for the posterior semicircular canal. Malfunction of the otolith organ remains. It is considered that the cause of dizziness after Epley's maneuver comes from otolith dysfunction.