Gait and Falls in Benign Paroxysmal Positional Vertigo: A Systematic Review and Meta-analysis

BACKGROUND AND PURPOSE

Benign paroxysmal positional vertigo (BPPV) is one of the most common vestibular disorders, and is treated effectively with particle repositioning maneuvers (PRM). The aim of this study was to assess the influence of BPPV and treatment effects of PRM on gait, falls, and fear of falling.

METHODS

Three databases and the reference lists of included articles were systematically searched for studies comparing gait and/or falls between (1) people with BPPV (pwBPPV) and controls and (2) pre- and posttreatment with PRM. The Joanna Briggs Institute critical appraisal tools were used to assess risk of bias.

RESULTS

Twenty of the 25 included studies were suitable for meta-analysis. Quality assessment resulted in 2 studies with high risk of bias, 13 with moderate risk, and 10 with low risk. PwBPPV walked slower and demonstrated more sway during tandem walking compared with controls. PwBPPV also walked slower during head rotations. After PRM, gait velocity during level walking increased significantly, and gait became safer according to gait assessment scales. Impairments during tandem walking and walking with head rotations did not improve. The number of fallers was significantly higher for pwBPPV than for controls. After treatment, the number of falls, number of pwBPPV who fell, and fear of falling decreased.

DISCUSSION AND CONCLUSIONS

BPPV increases the odds of falls and negatively impacts spatiotemporal parameters of gait. PRM improves falls, fear of falling, and gait during level walking. Additional rehabilitation might be necessary to improve gait while walking with head movements or tandem walking.Video Abstract available for more insights from the authors (see the Supplemental Digital Content Video, available at: http://links.lww.com/JNPT/A421 ).

Real-life assessment of chronic rhinosinusitis patients using mobile technology: The mySinusitisCoach project by EUFOREA

BACKGROUND

Chronic rhinosinusitis (CRS) is a chronic inflammatory disease associated with a substantial personal and socioeconomic burden. Monitoring of patient-reported outcomes by mobile technology offers the possibility to better understand real-life burden of CRS.

METHODS

This study reports on the cross-sectional evaluation of data of 626 users of mySinusitisCoach (mSC), a mobile application for CRS patients. Patient characteristics of mSC users were analysed as well as the level of disease control based on VAS global rhinosinusitis symptom score and adapted EPOS criteria.

RESULTS

The mSC cohort represents a heterogeneous group of CRS patients with a diverse pattern of major symptoms. Approximately half of patients reported nasal polyps. 47.3% of all CRS patients were uncontrolled based on evaluation of VAS global rhinosinusitis symptom score compared to 40.9% based on adapted EPOS criteria. The impact of CRS on sleep quality and daily life activities was significantly higher in uncontrolled versus well-controlled patients. Half of patients had a history of FESS (functional endoscopic sinus surgery) and reported lower symptom severity compared to patients without a history of FESS, except for patients with a history of more than 3 procedures. Patients with a history of FESS reported higher VAS levels for impaired smell.

CONCLUSION

Real-life data confirm the high disease burden in uncontrolled CRS patients, clearly impacting quality of life. Sinus surgery improves patient-reported outcomes, but not in patients with a history of more than 3 procedures. Mobile technology opens a new era of real-life monitoring, supporting the evolution of care towards precision medicine.

Facial trauma

Facial trauma. Patients with facial trauma must be assessed in a systematic way so as to avoid missing any injury. Severe and disfiguring facial injuries can be distracting. However, clinicians must first focus on the basics of trauma care, following the Advanced Trauma Life Support (ATLS) system of care. Maxillofacial trauma occurs in a significant number of severely injured patients. Life- and sight-threatening injuries must be excluded during the primary and secondary surveys. Special attention must be paid to sight-threatening injuries in stabilized patients through early referral to an appropriate specialist or the early initiation of emergency care treatment. The gold standard for the radiographic evaluation of facial injuries is computed tomography (CT) imaging. Nasal fractures are the most frequent isolated facial fractures. Isolated nasal fractures are principally diagnosed through history and clinical examination. Closed reduction is the most frequently performed treatment for isolated nasal fractures, with a fractured nasal septum as a predictor of failure. Ear, nose and throat surgeons, maxillofacial surgeons and ophthalmologists must all develop an adequate treatment plan for patients with complex maxillofacial trauma.

Epidemiology of ENT emergencies

OBJECTIVE

To give an overview of ear, nose, and throat (ENT) pathologies encountered in the emergency room (ER).

METHODS

Retrospective analysis of 1296 files of patients visiting the ER between January 2008 and December 2012. Diagnosis, treatment, hospitalisation, referral, and demographic parameters were evaluated.

RESULTS

Epistaxis is the most frequent ENT condition seen in the ER. One third of epistaxis patients are on anticoagulant therapy. The second most frequent conditions observed were infections of the pharynx and tonsils. Nasal fractures and vertigo were also frequently observed.

CONCLUSION

Epistaxis and its treatment were the most frequent ENT diagnosis and therapy seen in the ER. Infections are the main cause of hospitalisation. Referral to other disciplines and revisits seldom occurred.

Comparing the microdebrider and standard instruments in endoscopic sinus surgery: a double-blind randomised study

Comparing the microdebrider and standard instruments in endoscopic sinus surgery: a double-blind randomised study.

OBJECTIVE

It is frequently stated that microdebriders provide better mucosal preservation in endoscopic sinus surgery (ESS), and therefore better and faster healing, when compared to the standard Blakesley instruments. However, evidence from comparative prospective studies is lacking. In this study, we compared the results of microdebriders with traditional surgical instruments for ESS.

METHODS

A prospective, randomised, comparative, double-blind study in 50 patients undergoing bilateral ESS. Each patient was operated on with both instruments: one side of the nose with the microdebrider only, and the other side with standard instruments. The outcome of surgery was measured by using a symptom score and an endoscopic score at five time points during the first six postoperative months.

RESULTS

Both instruments resulted in symptom improvement and in endoscopically visible healing over time, but no significant difference was found between the two techniques. In endoscopic evaluation, only the total score at 3 weeks after surgery was significantly better in the microdebrider group. No significant difference was found at any other time point. Synechia formation, patency of middle meatal antrostomy, and open access to the ethmoid were the same in both groups.

CONCLUSION

In this study of endoscopic sinus surgery the use of the microdebrider does not offer major advantages compared to the standard instruments.

Septal suturing following nasal septoplasty, a valid alternative for nasal packing?

Septal suturing following nasal septoplasty, a valid alternative for nasal packing? After septal surgery most surgeons still routinely perform nasal packing since this is generally recommended. The aims of packing are numerous: haemostasis, prevention of haematoma, increase septal flap apposition, closure of dead space and prevention of displacement of the replaced cartilage. However, nasal packing is not an innocuous procedure and may lead to cardiovascular changes, continued bleeding, nasal injury, hypoxia, foreign body reaction or infection. The major disadvantage of nasal packing is patient discomfort--usually necessitating hospital stay--and the need to administer antibiotics. Therefore alternatives were sought. Sessions, Lee and Vukovic conceived and reported in the eighties forms of continuous septal suturing, but are not widely used. A similar technique of septal suturing after nasal septoplasty without nasal packing was used in 226 consecutive surgical procedures and reviewed retrospectively. Complications like postoperative episodes of bleeding, infections, septal haematomas, septal perforations or synechia were not noted. On one patient a recurrence of the septal deviation occurred. Patients reported almost no discomfort. Moreover, the septal surgery procedure could be carried out on a day-surgery basis. Readmission of a patient was never necessary. Based on these observations the septal suturing technique is a valid alternative to intranasal packing following septal surgery.

Reference values of magnesium and potassium in mononuclear cells and erythrocytes of children

Reference values for magnesium and potassium contents of mononuclear cells and erythrocytes were estimated in cord blood and in children from infancy through adolescence. No differences were detected between results for boys and girls. The mononuclear magnesium content was independent of age and was within the adult range of values. No significant correlation was shown between magnesium in serum and in mononuclear cells. Mononuclear potassium also showed no age-related differences. The correlation between magnesium and potassium contents in mononuclear cells was significant: however, the correlation was lower when the magnesium and potassium contents were expressed in terms of protein potent: micromoles or millimoles per gram of protein, respectively. The concentration of magnesium in erythrocytes was significantly lower in cord blood and during the first month of life, compared with that at older ages, and showed no significant correlation with serum magnesium. The concentration of erythrocyte potassium was independent of age and showed a low but significant correlation with erythrocyte magnesium content.

Reference values of magnesium and potassium in mononuclear cells and erythrocytes of children

Reference values for magnesium and potassium contents of mononuclear cells and erythrocytes were estimated in cord blood and in children from infancy through adolescence. No differences were detected between results for boys and girls. The mononuclear magnesium content was independent of age and was within the adult range of values. No significant correlation was shown between magnesium in serum and in mononuclear cells. Mononuclear potassium also showed no age-related differences. The correlation between magnesium and potassium contents in mononuclear cells was significant: however, the correlation was lower when the magnesium and potassium contents were expressed in terms of protein potent: micromoles or millimoles per gram of protein, respectively. The concentration of magnesium in erythrocytes was significantly lower in cord blood and during the first month of life, compared with that at older ages, and showed no significant correlation with serum magnesium. The concentration of erythrocyte potassium was independent of age and showed a low but significant correlation with erythrocyte magnesium content.

Combined transcutaneous oxygen, carbon dioxide tensions and end-expired CO2 levels in severely ill newborns

In 12 newborns combined transcutaneous PO2 and PCO2 levels were measured by means of a Sensor Medics Transend Transcutaneous Gas System simultaneously with the end-tidal PCO2 (PetCo2) values using an Angström Eliza CO2 analyzer. Although the individual correlation coefficients differed greatly, the diagnostic sensitivity of PtcO2 and PtcCO2 was satisfactory within specified limits. The PetCO2 did not agree well with the PaCO2 due to physiologic factors related to lung disorders. We conclude that PtcO2 and PtcCO2 values are very useful in monitoring severely ill newborns although arterial blood gas measurements remain necessary, but not as often as when the transcutaneous technique is not used.

Hyperventilation syndrome: measurement of objective symptoms and subjective complaints

In 303 subjects, amongst whom 250 patients suspected of suffering from the hyperventilation syndrome, lung functions were measured, a hyperventilation provocation test was performed and a questionnaire was taken. The subjects were subdivided into categories of nonhyperventilators, and 3 categories of hyperventilators, on the basis of objective measurable lung function parameters and the result of the provocation test. The outcome of the questionnaire in the various categories was evaluated. Some subjective complaints were related to age, sex, PaCO2 and lung function of the subjects. There was no clear correlation between PaCO2 and neurological signs. Hypoventilation after the provocation test occurred in only 5 subjects. No indications were found that hyperventilation might be an early sign of chronic obstructive lung disease.

Hemodynamic effects of isometric exercise and mental arithmetic in hypertension treated with selective and nonselective beta-blockade

Hypertensive patients have an unfavorable pressor response to exogenous epinephrine during nonselective beta-blockade. We studied hemodynamics during epinephrine release induced by handgrip exercise and mental arithmetic to examine the clinical relevance of this phenomenon. Twenty-two hypertensive patients were examined in a double-blind crossover experiment with placebo, propranolol (240 mg daily), placebo-washout, and metoprolol (300 mg daily). Changes induced by stress tests for systolic and diastolic blood pressure, heart rate (HR), and forearm blood flow (FBF) were of the same order on both beta-blockers. Rises in HR and FBF were equally reduced by both drugs. Neither handgrip exercise nor mental arithmetic induced significant differences in reaction during selective and nonselective beta-blockade.

Influence of selective and non-selective beta-adrenoreceptor blockade on the haemodynamic effect of adrenaline during combined antihypertensive drug therapy

1. Haemodynamic effects of adrenaline were studied in 27 hypertensive patients, succesively during treatment with propranol and metoprolol. In 12 patients beta-adrenoreceptor blockade was combined with diuretics and in 15 patients the blockade was combined with vasodilators. 2. During propranolol adrenaline caused a marked pressor effect: there was a considerable rise in systolic as well as in diastolic blood pressure and a marked fall in heart rate. During metoprolol there was only a slight rise in blood pressure and an increase in heart rate. 3. Forearm blood flow was decreased by adrenaline during propranolol and was increased during metoprolol. Calculated vascular resistance showed opposite changes. 4. Results were essentially the same when beta-adrenoreceptor blockade was combined with diuretics or with vasodilators and did not differ from previous results obtained in patients treated by blockade alone. 5. If adrenaline infusion can be considered as a model for acute stress, our results seem to favour a selective beta 1-adrenoreceptor blocking agent over a non-selective one, even when the blocker is combined with a diuretic or a vasodilator.