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ENT AND Vertigo [keywords]
- Sudden unilateral hearing loss as first sign of cerebral sinus venous thrombosis? A 3-year retrospective analysis. [Journal Article]
- Otol Neurotol 2013 Jun; 34(4):657-61.
Recently, several studies and case reports have dealt with the topic of cerebral sinus venous thrombosis (CSVT) and focused on sudden hearing loss as an early and rare symptom, to diminish the delay in diagnosing this serious disease.We conducted a retrospective analysis over 3 years and investigated MRIs of all inpatients who were treated for sudden sensorineural hearing loss. The aim of the study was to evaluate whether sudden hearing loss could be an early indicator, or the first sign, of CSVT.In total, 554 patients were included. Only 2 patients with CSVT could be identified. In both, sudden unilateral sensorineural hearing loss was not the only symptom. They also reported headache, and 1 patient also reported tinnitus and vertigo.In our opinion, sudden unilateral sensorineural hearing loss alone is not a reliable indicator of CSVT. In combination with headache or visual impairment, this rare vascular disease should be taken into account.
- Dehiscence of the superior semicircular canal: a review of the literature on its possible pathogenic explanations. [JOURNAL ARTICLE]
- Eur Arch Otorhinolaryngol 2013 Apr 18.
The dehiscence of superior semicircular canal is a well-known affection which is able to explain some cases of hearing loss, tinnitus and/or vertigo unexpectedly presenting in adults without previous otologic affections. Although a diagnostic algorithm has been assessed and a surgical therapy has been indicated, the review of the literature shows that a completely satisfactory explanation for the reason why symptoms of a supposed congenital condition only occur in adulthood is still lacking. A pathogenic hypothesis based on the slow metabolism of the bony labyrinth, which could in time result in a prevalence of bone re-absorption on new bone formation leading to a dehiscence, despite some controversial findings could represent a the most reliable explanation for the question.
- Benign paroxysmal positional vertigo secondary to vestibular neuritis. [JOURNAL ARTICLE]
- Eur Arch Otorhinolaryngol 2013 Apr 11.
The aim of this study was to present the demographic, pathogenetic and clinical features of benign paroxysmal positional vertigo (BPPV) secondary to vestibular neuritis (VN). The medical records of 22 patients, who presented with BPPV within 12 weeks after the onset of VN, were reviewed. Data of a complete otolaryngological, audiological, neurotologic and imaging evaluation were available for all patients. Two hundred and eighty-four patients with idiopathic BPPV were used as a control group. The patients with BPPV secondary to VN presented the following features, in which they differed from the patients with idiopathic BPPV: (1) a lower mean age; (2) involvement of the posterior semicircular canal; (3) presence of canal weakness; (4) more therapeutic sessions needed for cure and a higher rate of recurrence. It may be, thus, concluded that BPPV associated with VN differs from idiopathic BPPV in regard to several epidemiological and clinical features, it responds less effectively to treatment and may follow a protracted course, having a tendency for recurrence.
- Apogeotropic Variant of Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo: Is There a Correlation Between Clinical Findings, Underlying Pathophysiologic Mechanisms and the Effectiveness of Repositioning Maneuvers? [JOURNAL ARTICLE]
- Otol Neurotol 2013 Mar 18.
OBJECTIVE:The apogeotropic variant of horizontal semicircular canal (h-SCC) benign paroxysmal positional vertigo (BPPV) is attributed to canalithiasis of the anterior arm or cupulolithiasis. This study is an attempt to distinguish the most effective maneuvers for each case, by investigating any correlation, between the clinical findings or the treatment options and the possible location of the displaced debris.
DATA SOURCES:A review of the literature (1990-2012) was conducted via the PubMed database with the search terms "apogeotropic nystagmus and benign paroxysmal positional vertigo."
STUDY SELECTION:Articles on central nervous system lesions were excluded.
DATA EXTRACTION:The studies included in the analysis provided detailed diagnostic and therapeutic protocols, supported by the resolution of the signs and symptoms through repositioning maneuvers.
DATA SYNTHESIS:Descriptive statistics were used to summarize the findings. Intergroup and intragroup comparisons were performed through Pearson's χ or Fischer's exact test.
CONCLUSION:Protocols vary considerably among studies. Nystagmus from seated to supine position is the best studied secondary clinical sign and possibly a clinical indication of cupulolithiasis. In patients with symmetrical responses in the head yaw test, no significant differences can be detected in the occurrence of secondary signs of lateralization compared to patients with asymmetrical responses. The Gufoni maneuver seems to be effective in all pathophysiologic types of apogeotropic h-SCC BPPV. The Barbeque and Vannucchi-Asprella maneuvers mainly target at lithiasis of the anterior ampullary arm. The results of this analysis may imply that different clinical subgroups of h-SCC BPPV may regard to different pathophysiologic and therapeutical mechanisms.
- Experimental designs for a Benign Paroxysmal Positional Vertigo model. [Journal Article]
- Theor Biol Med Model 2013.:21.
The pathology of the Benign Paroxysmal Positional Vertigo (BPPV) is detected by a clinician through maneuvers consisting of a series of consecutive head turns that trigger the symptoms of vertigo in patient. A statistical model based on a new maneuver has been developed in order to calculate the volume of endolymph displaced after the maneuver.A simplification of the Navier-Stokes problem from the fluids theory has been used to construct the model. In addition, the same cubic splines that are commonly used in kinematic control of robots were used to obtain an appropriate description of the different maneuvers. Then experimental designs were computed to obtain an optimal estimate of the model.D-optimal and c-optimal designs of experiments have been calculated. These experiments consist of a series of specific head turns of duration Δt and angle α that should be performed by the clinician on the patient. The experimental designs obtained indicate the duration and angle of the maneuver to be performed as well as the corresponding proportion of replicates. Thus, in the D-optimal design for 100 experiments, the maneuver consisting of a positive 30° pitch from the upright position, followed by a positive 30° roll, both with a duration of one and a half seconds is repeated 47 times. Then the maneuver with 60° /6° pitch/roll during half a second is repeated 16 times and the maneuver 90° /90° pitch/roll during half a second is repeated 37 times. Other designs with significant differences are computed and compared.A biomechanical model was derived to provide a quantitative basis for the detection of BPPV. The robustness study for the D-optimal design, with respect to the choice of the nominal values of the parameters, shows high efficiencies for small variations and provides a guide to the researcher. Furthermore, c-optimal designs give valuable assistance to check how efficient the D-optimal design is for the estimation of each of the parameters. The experimental designs provided in this paper allow the physician to validate the model. The authors of the paper have held consultations with an ENT consultant in order to align the outline more closely to practical scenarios.
- Surgery for Ménière's disease. [Journal Article, Meta-Analysis, Review]
- Cochrane Database Syst Rev 2013.:CD005395.
This is an update of a Cochrane review first published in The Cochrane Library in Issue 1, 2010.Ménière's disease is characterised by three major symptoms: vertigo, deafness, and tinnitus or aural fullness, all of which are discontinuous and variable in intensity. A number of surgical modalities, of varying levels of invasiveness, have been developed to reduce the symptoms of Ménière's disease, but it is not clear whether or not these are effective.To assess the effectiveness of surgical options for the treatment of Ménière's disease. All surgical interventions used in the treatment of Ménière's disease, either to alter the natural history of the disease or to abolish vestibular function, were considered for this review.We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 7 November 2012.Randomised or quasi-randomised controlled studies of a surgical modality versus a placebo therapy in Ménière's disease.Two authors independently assessed trial quality and extracted data. We contacted study authors for further information.The only surgical intervention which has been evaluated in randomised controlled trials and met the inclusion criteria was endolymphatic sac surgery. We identified two randomised trials, involving a total of 59 patients; one comparing endolymphatic sac surgery with ventilation tubes and one with simple mastoidectomy. Neither study reported any beneficial effect of surgery either in comparison to placebo surgery or grommet insertion.The two trials included in this review provide insufficient evidence of the beneficial effect of endolymphatic sac surgery in Ménière's disease.
- Sudden sensorineural hearing loss: an otologic emergency. [Journal Article]
- Indian J Otolaryngol Head Neck Surg 2012 Mar; 64(1):1-4.
The study purpose was to determine the efficacy of steroids, volume expanders and antivirals in the management of idiopathic sudden sensory neural hearing loss and to establish importance of early medical intervention. In this prospective study, thirty-four patients presenting with idiopathic sudden hearing loss of 30 db or more were enrolled in study group between 2005 and 2009. Patient variables as they related to recovery were studied and include patient age, time to onset of therapy, status of contralateral ear, presence of diabetes, severity of hearing loss, pattern of hearing loss in audiogram and presence of associated symptoms, (tinnitus, vertigo). Treatment protocol with intravenous hydrocortisone, intravenous dextran and oral anti-viral agent was followed. Pre-treatment and post-treatment pure tone average was analyzed. With combination therapy the overall improvement in pure tone threshold was seen in 27 patients (79.4%). A statistically significant association was found between the time at which medical intervention was started and hearing improvement. Early intervention in patients presenting before 3 days has given 77.8% complete type 1 recovery Idiopathic sudden sensory neural hearing loss is a medical emergency. It should not be misdiagnosed. Early detection and management with volume expanders, steroids and antivirals will improve the chances of complete recovery.
- Is Benign Paroxysmal Vertigo of Childhood a migraine precursor? [JOURNAL ARTICLE]
- Eur J Paediatr Neurol 2013 Feb 21.
INTRODUCTION:Benign Paroxysmal Vertigo of Childhood (BPVC) is a common cause of vertigo in children and it is characterized by recurrent attacks of vertigo without warning resolving spontaneously after minutes to hours. It has been considered the equivalent of migraine in childhood.
METHODS:Twenty-seven patients diagnosed with BPVC were recruited between 1991 and 1997 with a follow up of at least 15 years. The incidence of migraine, inner ear disorders and family medical history is analyzed.
RESULTS:The average age for the onset of the attacks of BPVC was 3 years and 11 months, and for spontaneous resolution, it was around 5 years and 7 months. The average age for follow up was 18 years. Nine patients developed migraine during adulthood. Nineteen of them had a family history of migraine.
CONCLUSION:We have observed that the prevalence of migraine in patients that had been diagnosed with BPVC is higher than in the general population, which leads us to propose BPVC as a precursor of migraine during childhood.
- Outcome of management of otosclerosis by stapedotomy compared to stapedectomy in a jordanian population. [Journal Article]
- Oman Med J 2013 Jan; 28(1):36-8.
To study the success results rates and complications of stapedotomy compared to stapedectomy in the operative management of otosclerosis.This is a retrospective study of 50 patients who were treated surgically for otosclerosis. The medical records of these patients were reviewed for the type of operation performed, complications and the serial pure tune audiometries pre- and postoperatively for at least one year. Patients with conductive hearing loss not due to otosclerosis were excluded from this study. The medical records of equal number of patients (25 patients with stapedotomy and 25 patients with stapedectomy) were analyzed for hearing improvement or loss, postoperative nausea, vomiting, vertigo, nystagmus, perilymph fistula, reparative granuloma, labyrinthitis, tinnitus and perforation of the tympanic membrane. All operations were performed by the senior consultant-otologists of our department. Stapes superstructures were removed by crural scissors and stapes footplate was perforated by microdrill.Out of 25 patients with stapedotomy, 22 (88%) developed complete closure (≤10 dB) of the air-bone gap on pure tune audiometry; in two patients (8%), the air-bone gap improved to less 20 dB, and recurrent conductive hearing loss (due piston slipping) in one patient (4%). On the other hand, in patients with stapedectomy, only 16 patients (64%) developed complete closure of the air-bone gap (≤10 dB) on pure tune audiometry, and in four patients (16%) the air-bone gap improved to less 20 dB, while recurrent conductive hearing loss occured in three patients (12%), one patient developed complete sensorineural hearing loss (4%), there was one case of fluctuating hearing loss due to reparative granuloma (4%), perilymph fistula was reported in one case (4%) and no cases of facial palsy or perforation of the tympanic membrane were recorded.The results of this study clearly show that stapedotomy gives better hearing results and fewer complications than stapedectomy.
- [Impact of physiotherapy on quality of life improvement in patients with central vestibular system dysfunction]. [English Abstract, Journal Article, Research Support, Non-U.S. Gov't]
- Otolaryngol Pol 2013 Jan; 67(1):11-7.
THE AIM of the study was to evaluate the impact of physiotherapy on balance stability and quality of life improvement in patients with central vestibular system dysfunction.The study was conducted on 31 patients (23 females, 8 males) with vertigo/dizziness and unsteadiness diagnosed for central vestibular system impairment based on videonystagraphy examinations, in ENT Department Medical University of Lodz between 2010-2011 years. Patients' history of diseases were collected. The physiotherapeutic programme was individually introduced during four weeks (five time a week). The intervention included balance training and habituation exercises. At baseline and after patients were evaluated therapy with WHO Quality of Life-BREF (WHOQOL-BREF) and Dizzeness Handicap Inventory (DHI) self-assessment scales. Clinical examination with Romberg and stand one leg tests (eyes opened and closed) was performed.After therapy statistically significant differences in total DHI score (p<0.005) and 3 subscales: physical, emotional, functional (p<0.05) and WHOQOL-BREF only physical subscale (p<0.05) compared baseline were found. There were no statistical differences between psychological, social relationships and environment subscales. In clinical evaluation significant reduction of unsteadiness in Romberg test (p<0.05) and in stand one leg tests eyes opened and closed tests (p<0.05) were found.In patients with central vestibular system impairment after physical therapy betterment in clinical examination and some subjective self-assessment scales were observed. Lack of significant improvement in psychological, social relationships and environment domain in WHOQOL-BREF subscale indicated that these patients may need more psychological support or extensions in physiotherapy.