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Bone-Anchored Hearing Aid Effects on Vestibular Function: A Preliminary Report. Audiol Res 2024; 14:386-400. [PMID: 38666904 PMCID: PMC11047723 DOI: 10.3390/audiolres14020033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/31/2024] [Accepted: 04/18/2024] [Indexed: 04/29/2024] Open
Abstract
OBJECTIVE Cochlear receptors are sensitive to vibratory stimuli. Based on this sensibility, bone-anchored hearing aids have been introduced to correct unilateral or bilateral conductive or mixed hearing loss and unilateral deafness. The vestibular system is also sensitive to the vibratory stimulus and this type of response is used in clinics to test its functionality. Being aware of this double separated sensibility, we wondered whether bone vibration, which activates the acoustic receptors of patients with bone conduction aids, can also influence the functionality of the vestibular system. METHODS To this end, we recruited 12 patients with a bone-anchored hearing aid and evaluated their vestibular function with and without an activated vibratory acoustic device. RESULTS Our results show that the vibratory stimulus delivered by the bone conduction aid also reaches and stimulates the vestibular receptors; this stimulation is evidenced by the appearance or modification of some nystagmus findings during bedside vestibular testing. Despite this, none of these patients complained of dizziness or vertigo during prosthesis use. Nystagmus that appeared or changed during acoustic vibratory stimulation through the prosthesis was almost all predominantly horizontal, unidirectional with respect to gaze or body position, inhibited by fixation, and most often consistent with vestibular function tests indicating peripheral vestibular damage. CONCLUSIONS The findings of sound-evoked nystagmus seem to indicate peripheral rather than central vestibular activation. The occurrence of some predominantly horizontal and high-frequency induced nystagmus seems to attribute the response mainly to the utricle and lateral semicircular canal.
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A Clinical Infrared Video-Oculoscopy Suppression Head Impulse (IR-cSHIMP) Test. Audiol Res 2024; 14:151-165. [PMID: 38391770 PMCID: PMC10886088 DOI: 10.3390/audiolres14010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 01/21/2024] [Accepted: 01/26/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND We propose a Suppression Head IMPulse (SHIMP) test method that provides for equipment only through the use of InfraRed Video-OculoScopy (IR-VOS) and allows horizontal and vertical semicircular canal function evaluation in bedside mode. We therefore named the test InfraRed clinical SHIMP (IR-cSHIMP). METHODS To check IR-cSHIMP diagnostic efficiency, we studied 22 normal subjects, 18 patients with unilateral, and 6 with bilateral deficient vestibulopathy. Each subject first underwent a vestibular examination and, only later, an IRc-SHIMP test. RESULTS When the IR-cSHIMP test was performed in the horizontal plane, all normal subjects showed anti-compensatory saccades. When the vertical semicircular canal function was evaluated, the same result was obtained in all normal subjects except three, which were considered false positives. In patients with vestibular deficits, the test performed in the horizontal and vertical planes were always pathological, with 100% agreement between clinical and instrumental tests. CONCLUSIONS Our bedside method proved to be fast, simple, and effective in discriminating between healthy and pathological subjects. It required only the same skill as the better-known cHIT. For these reasons, we believe that the IR-cSHIMP should be part of daily clinical practice as a useful tool in the selection of patients to undergo more sophisticated investigations.
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Magnetic field, nystagmus and serendipity. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2023; 43:360-361. [PMID: 37519140 PMCID: PMC10551731 DOI: 10.14639/0392-100x-n2485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 04/21/2023] [Indexed: 08/01/2023]
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The first two-year follow-up in a patient with isolated sensory neuronopathy due to biallelic expansion in RFC1 gene. Acta Neurol Belg 2022:10.1007/s13760-022-02116-7. [PMID: 36214978 DOI: 10.1007/s13760-022-02116-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/03/2022] [Indexed: 11/30/2022]
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Symptom improvement after transtympanic tube placement in Ménière's disease: preliminary observations. ACTA OTORHINOLARYNGOLOGICA ITALICA 2021; 41:467-473. [PMID: 34734583 PMCID: PMC8569656 DOI: 10.14639/0392-100x-n1705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 06/18/2021] [Indexed: 11/23/2022]
Abstract
Objective The treatment of choice for Ménière disease (MD) aims at preventing severity and frequency of vertigo attacks. The purpose of this study was to evaluate the effectiveness of ventilation tube (VT) placement on vertigo control in patients affected by MD with no response to standard medical therapy. Methods 76 consecutive outpatients diagnosed with definite MD who failed medical therapy received VT insertion at the Department of Otolaryngology Head and Neck Surgery, "Ospedale del Mare", Naples, Italy, with a 3-year follow up. Results Over the long term, VT placement was effective in controlling vertigo in 61.8% of patients. In the control group treated with standard preventive care (SPC) alone, all patients continued to experience recurrent vertigo during the entire study. Comparison of survival curves by using the log-rank test shows that significant differences in survival exist between subjects treated with VT placement and the control sample (p = 0.001). Conclusions Our long-term follow-up confirms that VT placement is an effective and safe management option in intractable definite MD, especially in the elderly or in those refusing more invasive treatments.
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Efficacy of Epley's canalith repositioning procedure according to the number of repetitions in the same session: comparison of three protocols. Acta Otolaryngol 2021; 141:599-602. [PMID: 34028319 DOI: 10.1080/00016489.2021.1912387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
BACKGROUND The canalith repositioning manoeuvre (CRM) described by Epley remains a grade A recommended treatment for Benign Paroxysmal Positional Vertigo (BPPV) of the posterior semicircular canal (PSC). However, significant variability in the efficacy of Epley CRM has been reported. AIMS To compare the treatment efficacy of different combinations of the Epley CRM and Dix-Hallpike retest. MATERIAL AND METHODS Patients with PSC BPPV were divided into one of the following three treatment groups. Manoeuvre group (M): patients underwent a single Epley CRM without subsequent Dix-Hallpike retesting. Manoeuvre-Control group (MC): patients underwent up to three Epley CRM followed by Dix-Hallpike retesting until nystagmus resolution. Manoeuvre-Control-Manoeuvre group (MCM): A similar procedure to that used in the MC group except that, after the negative Dix-Hallpike retest, there was an additional CRM. RESULTS A more favourable tendency for recovery was observed in the MCM group. There was a positive odds ratio of 1.1 between groups M and MC at the first control, 2.7 between groups M and MCM, and 2.5 between groups MC and MCM. CONCLUSIONS AND SIGNIFICANCE Close repetition of a single Epley CRM after the first effective one would allow a positional retest to be combined with a reduction in the risk of persistent/recurrent BPPV.
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Pseudo-spontaneous nystagmus increases Bow and Lean Test accuracy. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2021; 41:270-276. [PMID: 34264921 PMCID: PMC8283397 DOI: 10.14639/0392-100x-n1136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/28/2020] [Indexed: 06/13/2023]
Abstract
OBJECT The aim of this study was to evaluate the effectiveness of the Bow and Lean Test (BLT) based on nystagmus intensity and direction evaluation (NID-BLT) in the diagnosis of benign paroxysmal positional vertigo of the lateral semicircular canal (LSC-BPPV). We hypothesised that the presence of a pseudo-spontaneous nystagmus increases the diagnostic accuracy of the test. METHODS The BLT was performed in 32 subjects affected by LSC-BPPV. RESULTS BLT was positive in 27 cases with a sensitivity of 84.3% and an accuracy of 70.4%. In other words, it was possible to carry out a BPPV root canal diagnosis (LSC) with BLT in 27 patients, of whom 19 also received a diagnosis of side and form. Pseudo-spontaneous nystagmus was detected in 15 patients, all of whom were BLT positive. In these patients, a clear diagnosis of form and side was also obtained in 14 cases (accuracy 93.3%). In the 12 patients without pseudo-spontaneous nystagmus and BLT positive, a diagnosis of side and form was reached in 5 cases (accuracy 41.6%). The comparison between percentages (Chi square test) showed a significant difference (p = 0.038). CONCLUSIONS The presence of a pseudo-spontaneous nystagmus, as an expression of more mobile debris within the canal or a more deflectable cupula, increases the accuracy of the BLT.
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Upright BPPV Protocol: Feasibility of a New Diagnostic Paradigm for Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo Compared to Standard Diagnostic Maneuvers. Front Neurol 2020; 11:578305. [PMID: 33329319 PMCID: PMC7711159 DOI: 10.3389/fneur.2020.578305] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/23/2020] [Indexed: 11/13/2022] Open
Abstract
Background: The diagnosis of benign paroxysmal positional vertigo (BPPV) involving the lateral semicircular canal (LSC) is traditionally entrusted to the supine head roll test, also known as supine head yaw test (SHYT), which usually allows identification of the pathologic side and BPPV form (geotropic vs. apogeotropic). Nevertheless, SHYT may not always allow easy detection of the affected canal, resulting in similar responses on both sides and intense autonomic symptoms in patients with recent onset of vertigo. The newly introduced upright head roll test (UHRT) represents a diagnostic maneuver for LSC-BPPV, supplementing the already-known head pitch test (HPT) in the sitting position. The combination of these two tests should enable clinicians to determine the precise location of debris within LSC, avoiding disturbing symptoms related to supine positionings. Therefore, we proposed the upright BPPV protocol (UBP), a test battery exclusively performed in the upright position, including the evaluation of pseudo-spontaneous nystagmus (PSN), HPT and UHRT. The purpose of this multicenter study is to determine the feasibility of UBP in the diagnosis of LSC-BPPV. Methods: We retrospectively reviewed the clinical data of 134 consecutive patients diagnosed with LSC-BPPV. All of them received both UBP and the complete diagnostic protocol (CDP), including the evaluation of PSN and data resulting from HPT, UHRT, seated-supine positioning test (SSPT), and SHYT. Results: A correct diagnosis for LSC-BPPV was achieved in 95.5% of cases using exclusively the UBP, with a highly significant concordance with the CDP (p < 0.000, Cohen's kappa = 0.94), regardless of the time elapsed from symptom onset to diagnosis. The concordance between UBP and CDP was not impaired even when cases in which HPT and/or UHRT provided incomplete results were included (p < 0.000). Correct diagnosis using the supine diagnostic protocol (SDP, including SSPT + SHYT) or the sole SHYT was achieved in 85.1% of cases, with similar statistical concordance (p < 0.000) and weaker strength of relationship (Cohen's kappa = 0.80). Conclusion: UBP allows correct diagnosis in LSC-BPPV from the sitting position in most cases, sparing the patient supine positionings and related symptoms. UBP could also allow clinicians to proceed directly with repositioning maneuvers from the upright position.
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Congruous Torsional Down Beating Nystagmus in the Third Position of the Semont's Maneuver in Patients Treated for Canalithiasis of Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo: Its Significance and Prognostic Value. Front Neurol 2020; 11:949. [PMID: 33071926 PMCID: PMC7533572 DOI: 10.3389/fneur.2020.00949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/22/2020] [Indexed: 11/29/2022] Open
Abstract
Due to its mechanical pathogenesis, benign paroxysmal positional vertigo treatment is mainly physical: when posterior semicircular canal is involved, Semont's maneuver is reported as one of the most effective liberating procedures. In the case of a canalolithiasis, the efficacy of the maneuver is corroborated by the appearance of some nystagmus findings during its performance. Liberating nystagmus, that can occur in the second position of Semont's maneuver and whose direction is congruous with the excitation of the affected posterior semicircular canal has proven to be a favorable prognostic sign. On the other hand, in clinical experience, we've frequently verified the appearance of another nystagmus during the execution of the maneuver: upon reaching the third position, when replacing the patient seated, a torsional down beating nystagmus, with the torsional component “congruous” with the stimulation of the vertical semicircular canals of the affected side, can often be appreciated. Such a sign can occur with or without having had the previous liberating nystagmus in the second position and is almost always associated with an intense vertigo and/or body pulsion. In this study, we describe the incidence and characteristics of the congruous torsional down beating nystagmus that can arise by assuming the third position of Semont's maneuver in a cohort of patients treated for posterior semicircular canal benign paroxysmal positional vertigo due to canalolithiasis. In the best of our knowledge, such a sign has never been described and explained before. On the basis of the pathophysiology and of the possible canal receptors stimulation during the different phases of Semont's maneuver, we formulated different hypothesis on how such a nystagmus can be generated. We observed that such a sign, when elicited, has a very good prognostic meaning for healing purposes, even better than that of liberating nystagmus. Therefore, congruous torsional down beating nystagmus should always be checked when performing Semont's maneuver because it could help in predicting success of physical treatment and in managing patients.
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Double-Blind Randomized Trial on the Efficacy of the Forced Prolonged Position for Treatment of Lateral Canal Benign Paroxysmal Positional Vertigo. Laryngoscope 2020; 131:E1296-E1300. [PMID: 32822510 DOI: 10.1002/lary.28981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/03/2020] [Accepted: 07/08/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVES/HYPOTHESIS The need for class I and II studies on the efficacy of liberatory maneuvers in the treatment of lateral canal benign paroxysmal positional vertigo (LC-BPPV) motivated the present double-blind randomized trial on the short-term efficacy of the forced prolonged position (FPP). STUDY DESIGN Double-blind, randomized controlled trial. METHODS Two hundred twenty-one patients with unilateral LC-BPPV met the inclusion criteria for a multicentric study. Patients were randomly assigned to treatment by FPP (116 subjects) or sham treatment (105 subjects). Subjects were followed up at 24 hours with the supine roll test by blinded examiners. RESULTS Among the sample, 67.4% and 32.6% of the patients showed respectively geotropic and apogeotropic variant of LC-BPPV. At the 24-hour follow-up, the effectiveness of FFP compared to the sham maneuver was, respectively, 57.8% versus 12.4% (P < .0001) in the total sample, 76.9% versus 11.3% (P < .0001) in the geotropic variant group, and 60.5% versus 17.6% (P = .0003) in the apogeotropic variant group, including resolution or transformation to geotropic variant. CONCLUSIONS FPP proved highly effective compared to the sham maneuver. The present class 2 study of the efficacy of the FPP changes the level of recommendation of the method for treating LC-BPPV into a strong one. LEVEL OF EVIDENCE 2 Laryngoscope, 131:E1296-E1300, 2021.
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Diagnosis of benign paroxysmal positional vertigo in Emergency Department: Our experience. Audiol Res 2020; 10:232. [PMID: 32774823 PMCID: PMC7378380 DOI: 10.4081/audiores.2020.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 04/16/2020] [Indexed: 11/23/2022] Open
Abstract
The Benign Paroxysmal Positional Vertigo (BPPV) represents the first cause of peripheral vertigo in populations and it is determined by a displacement of otoconial fragments within the semicircular canals. Following the patient’s head movements, these fragments, moving by inertia, incorrectly stimulate the canals generating vertigo. The BPPV is diagnosable by observing the nystagmus that is generated in the patient following the Dix-Hallpike maneuver used for BPPV diagnosis of vertical semi-circular canal, and, following the supine head yaw test used for lateral semi-circular canal. Correctly identifying the origin of this specific peripheral vertigo, would mean to obtain a faster diagnosis and an immediate resolution of the problem for the patient. In this context, this study aims to identify precise training activities, aimed at the application of specific diagnostic maneuverers for algorithm decisions in support of medical personnel. The evaluations reported in this study refer to the data collected in the Emergency Department of the Cardarelli Hospital of Naples. The results obtained, over a six-month observation period, highlighted the advantages of the proposed procedures in terms of costs, time and number of BPPV diagnoses.
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Alcohol binge-drinking damage on the vestibulo-oculomotor reflex. Eur Arch Otorhinolaryngol 2020; 278:41-48. [PMID: 32449024 DOI: 10.1007/s00405-020-06052-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/12/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Binge drinking is associated with several adverse effects in multiple organs. This study aimed at evaluating the effects of a binge-like-drinking on the vestibulo-oculomotor reflex (VOR) using the video Head Impulse Test (vHIT) and the functional Head Impulse Test (fHIT). METHODS Eleven healthy men (age range 32-35 years) with moderate drinking habits and no history of vestibular dysfunction were enrolled. A preliminary assessment of breath alcohol concentration (BrAC) to check for zero alcohol value and a pre-intake evaluation of VOR using the vHIT and the fHIT were carried on. Then, the subjects were asked to take drinks with different alcohol content (8-40% ethanol by volume) according to their choice, consuming at least 5 standard drinks. Volunteers stopped drinking after 3 h. After a further 30 min, post-intake BrAC measurements and VOR analysis were repeated. RESULTS After alcohol intake, vHIT recorded an overall significant reduction of VOR gain (0.82 ± 0.07 on both sides) although the outcomes were below the normal range only in the four subjects with the highest blood alcohol levels. The post-intake fHIT outcomes were substandard in 9 participants, with a significant deterioration in performance (% of exact answers = 84.54 ± 11.05% on the left, 83.18 ± 14.53 on the right). CONCLUSIONS Binge drinking severely affects VOR; fHIT seems more sensitive than vHIT in the assessment of VOR function for complex vestibular lesions, such as those determined by ethanol, suggesting that fHIT could support vHIT in vestibular dysfunction assessment.
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Horizontal semicircular canal jam: Two new cases and possible mechanisms. Laryngoscope Investig Otolaryngol 2020; 5:163-167. [PMID: 32128444 PMCID: PMC7042637 DOI: 10.1002/lio2.352] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/15/2019] [Accepted: 12/24/2019] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Benign paroxysmal positional vertigo (BPPV) of the horizontal semicircular canal (hSCC) can present with otoconia blocking its lumen (canalith jam), with signs and symptoms that make it difficult to distinguish from central nervous system pathology. OBJECTIVE Here we report two cases of canalith jam affecting the hSCC and offer a theoretical mechanism based on known vestibular neurophysiology. METHODS We use video-oculography to document the canalith jam and show the moment the otoconia loosen. RESULTS Canalith jam is a rare form of BPPV remedied with repositioning maneuvers. CONCLUSION Clinicians should consider canalith jam as a mechanism for BPPV when the nystagmus is (a) Direction fixed with fixation removed and during positional testing; (b) Velocity dependent on supine head position; (c) Converts to geotropic directional changing nystagmus.
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Approach to residual dizziness after successfully treated benign paroxysmal positional vertigo: effect of a polyphenol compound supplementation. Clin Pharmacol 2019; 11:117-125. [PMID: 31534374 PMCID: PMC6681902 DOI: 10.2147/cpaa.s210763] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 06/25/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose To assess if a polyphenol compound supplementation (Vertigoval®) could improve residual dizziness earlier after benign paroxysmal positional vertigo (BPPV) and relieve patients from this disabling symptomatology. Methods In this prospective, multicentric study, 127 patients were randomized in the treatment group (TG), who received a 60-day supplementation, while 131 patients were randomized in the control group (CG), who did not receive any medication. The dizziness handicap inventory (DHI) score, static posturography, and the visual analog scale (VAS) for both dizziness (D-VAS) and nausea/vomit (N/V-VAS) were used as measures of outcome at baseline and after 30 and 60 days. Patients were asked about efficacy and tolerance to the treatment. Side effects were examined. Results A statistically significant greater decrease was established in the TG for DHI, D-VAS, and N/V-VAS compared to the CG. On the other hand, static posturography did not show statistical differences between the two groups, though a better clinical improvement after 60-day supplementation was shown in the TG in comparison to the CG. We counted mild side effects in only 2 patients. Most patients reported an excellent or good efficacy and tolerance to the treatment. Conclusion Residual dizziness is a frequent condition of unknown origin that manifests as persistent disabling imbalance after successful repositioning maneuvers for BPPV. The decreasing postural control can affect the quality of life, contributing to falling and psychological problems. The supplementation with the polyphenol compound used in our study is safe, manageable, and appeared to be able to reduce subjective symptoms and improve instability earlier, decreasing the risk of potential complications.
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Does cervical range of motion affect the outcomes of canalith repositioning procedures for posterior canal benign positional paroxysmal vertigo? Am J Otolaryngol 2019; 40:494-498. [PMID: 30967256 DOI: 10.1016/j.amjoto.2019.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 03/27/2019] [Accepted: 04/02/2019] [Indexed: 01/01/2023]
Abstract
PURPOSE Canalith repositioning procedure (CRP) for posterior canal benign positional paroxysmal vertigo (BPPV), also known as Epley maneuver, is a common procedure for the treatment of BPPV. This maneuver entails flexion, extension and rotation of the patient's neck. This study aims to investigate the impact of cervical range of motion (C-ROM) on CRP efficacy. MATERIALS AND METHODS The study included 47 patients with posterior canal BPPV treated by CRP. The procedure was considered successful if vertigo and nystagmus disappeared at the post-treatment evaluation. If CRP resulted ineffective, it was repeated up to three times per session. C-ROM was measured at BPPV diagnosis before treatment. Patients were followed up for 30 days. RESULTS The first CRP was successful in 29 patients (61.7%), while it was ineffective in 18 patients (38.3%) requiring multiple repositioning maneuvers. Patients who needed two or more CRP showed lower C-ROM in extension (p = .003) and flexion (p = .042), and earlier recurrences (p = .006). Univariate regression analysis showed that lower cervical extension was significantly associated with the failure of the first CRP (OR: 0.899, 95% CI 0.831-0.973, p = .008). CONCLUSIONS Our data suggest that a reduced C-ROM can require multiple CRPs to successfully treat BPPV and increase the risk of early recurrences.
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Assessment of the effect of mesoglycan in the treatment of audiovestibular disorders of vascular origin. Int J Immunopathol Pharmacol 2018; 32:2058738418773833. [PMID: 29734824 PMCID: PMC5946343 DOI: 10.1177/2058738418773833] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
It is a well-known fact that inner ear diseases are often caused by microcirculatory disorders, and the recent literature is oriented towards investigations into the relationship between the cardiovascular system and cochleovestibular illness with related classical symptoms: tinnitus, hearing loss, and vertigo or instability. These symptoms, and particularly the vertigo, may be the alarm signal of microcirculatory disorders of the labyrinth or vertebrobasilar circulation so as to represent a possible symptom of posterior circulation stroke. The treatment aimed at correcting the haemodynamic and metabolic imbalance, generated by the cochleovestibular microcirculatory disorders, with drugs that act on the vessel wall being very useful, both alone and in combination with other treatment protocols. This is a multicenter retrospective observational study conducted in 40 neurootological laboratories with 873 patients with cardiovascular risk factors suffering from tinnitus, instability or peripheral vertigo alone or in combination with one another treated for the first time with mesoglycan. The data collected showed that the treatment with mesoglycan, irrespective of the type of vascular risk factor, is not only well tolerated but also significantly and objectively improves the cochleovestibular symptoms and the quality of life of patients suffering from tinnitus, peripheral vertigo and instability.
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Nystagmus intensity and direction in bow and lean test: an aid to diagnosis of lateral semicircular canal benign paroxysmal positional vertigo. ACTA OTORHINOLARYNGOLOGICA ITALICA 2018; 36:520-526. [PMID: 28177336 PMCID: PMC5317134 DOI: 10.14639/0392-100x-795] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 05/07/2016] [Indexed: 11/23/2022]
Abstract
The objective was to evaluate nystagmus intensity and direction (NID) during bow and lean test (BLT) in subjects suffering from idiopathic lateral semicircular canal benign paroxysmal positional vertigo (LSC-BPPV), in order to differentiate between the geotropic and the apogeotropic form and to determine the affected ear before using classic diagnostic procedures. The BLT was performed in 32 subjects affected by LSC-BPPV. "Nystagmus intensity" evaluation allows distinguishing the geotropic variant from the apogeotropic one, while the "nystagmus direction" allows identification of the side. In particular, a more intense nystagmus in the bow position compared to the lean position indicates an ampullipetal flow caused by the presence of free-floating particles in the non-ampullary arm, and is suggestive of geotropic form. In this case, if the nystagmus in the bow position is left beating, the free-floating particles necessarily occupy the left LSC non-ampullary arm, while a right-beating nystagmus indicates the right LSC involvement. In contrast, a more intense nystagmus in the lean position compared to the bow position indicates an ampullifugal flow due to the presence of particles adherent to the cupula (cupulolithiasis) or free-floating in the ampullary arm (canalolithiasis), suggesting an apogeotropic form. In this situation, if the nystagmus in the lean position is left beating, the particles are in the left LSC ampullar arm or are coated on the left LSC cupula; vice versa, a right-beating nystagmus in the lean position is suggestive of the involvement of the right LSC. As a general rule, in both forms the direction of the more intense nystagmus points to the affected side. "NID-BLT" was effective in identifying the form and the side in 22/28 subjects (79% of the study population). The proper execution and interpretation of the "NID-BLT" helps to establish the form (geotropic versus apogeotropic) and side (right versus left) in most cases of LSC-BPPV. Unlike Choung's test, which requires knowing a priori if the form is geotropic or apogeotropic, our test enables fast and accurate diagnosis, or at least provides indispensable elements if the diagnosis of the affected side is doubtful, with the patient remaining in the sitting position.
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Prevalence of macular abnormalities assessed by optical coherence tomography in patients with Usher syndrome. Ophthalmic Genet 2017; 39:17-21. [DOI: 10.1080/13816810.2017.1329445] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Speech discrimination is impaired in parkinsonian patients: Expanding the audiologic findings of Parkinson's disease. Parkinsonism Relat Disord 2015; 22 Suppl 1:S138-43. [PMID: 26421391 DOI: 10.1016/j.parkreldis.2015.09.040] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 09/13/2015] [Accepted: 09/19/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Hearing impairment (HI) has been previously demonstrated in patients with Parkinson's disease (PD). Pure Tone Audiometry (PTA) gives no information about patients' ability to hear and understand speech. To find out hearing ability and speech discrimination of PD patients, we expanded audiological evaluation by means of speech audiometry (SA). PATIENTS AND METHODS We screened a series of consecutive PD patients. Severity of motor symptoms and staging were measured by the UPDRS-III and the H&Y scales. Audiometric evaluation consisted of a standardized audiological examination, PTA and SA. Healthy age- and sex-matched subjects were selected as controls. RESULTS 45 PD patients and 45 healthy controls were enrolled. PTA confirmed our previous finding of high-frequency HI in PD patients. The mean values for the Speech Recognition Threshold were higher in PD patients as compared with controls. PD patients were more likely to have impaired speech discrimination profiles and higher disease stages. Neither the patients nor the controls showed a significant speech-tone dissociation and rollover phenomenon. CONCLUSION Our results confirmed sensorineural HI in PD patients. Moreover, SA showed impaired speech discrimination abilities in PD patients as compared with control group thus expanding the audiologic findings of PD.
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Abstract
ABSTRACT:Background:The cervico-oculo-acoustic syndrome comprises Klippel-Feil anomaly, sensorineural deafness and Duane's retraction syndrome. Polygenic, autosomal dominant, and X-linked inheritance have been hypothesized. The disorder has rarely been reported in males.Case Report:A 42-year-old male, born of consanguineous parents, presented with Duane's syndrome, mixed hearing loss, C2-C3 fusion, neck stiffness, and right facial palsy. A variety of cardiac, neurological and urogenital anomalies occurred in his relatives. The electro-oculographic studies showed impaired abduction and adduction of the right eye and impaired abduction of the left eye. Vergence, vertical eye movements and peripheral vestibular responses were normal. Somatosensory evoked potentials showed absence of the N13 peak and brainstem auditory evoked potentials bilateral delay of the I-III interpeak latencies.Conclusions:Consanguinity of the patient's parents, not previously reported, suggests autosomal recessive inheritance, but autosomal dominant inheritance is indicated by the family history. The pattern of the oculomotor deficit is consistent with bilateral dysplasia of the abducens nuclei with preserved internuclear neurons in the right abducens nucleus. Neurophysiological investigations revealed lower brainstem and cervical cord involvement.
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EHMTI-0055. Abnormal thalamic function in patients with vestibular migraine. J Headache Pain 2014. [PMCID: PMC4181882 DOI: 10.1186/1129-2377-15-s1-e32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
OBJECTIVE To investigate the functional response of neural pathways associated with vestibular stimulation in patients with vestibular migraine (VM). METHODS Twelve patients with VM underwent whole-brain blood oxygen level-dependent (BOLD) fMRI during ear irrigation with cold water. The functional response of neural pathways to this stimulation in patients with VM was compared with age- and sex-matched patients with migraine without aura and healthy controls. Secondary analyses explored associations between BOLD signal change and clinical features of migraine in patients. RESULTS We observed a robust cortical and subcortical pattern of BOLD signal change in response to ear irrigation across all participants. Patients with VM showed a significantly increased thalamic activation in comparison with both patients with migraine without aura and healthy controls. The magnitude of thalamic activation was positively correlated with the frequency of migraine attacks in patients with VM. CONCLUSIONS We provide novel evidence for abnormal thalamic functional response to vestibular stimulation in patients with VM. These functional abnormalities in central vestibular processing may contribute to VM pathophysiology.
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Anti-GAD antibody ocular flutter: expanding the spectrum of autoimmune ocular motor disorders. J Neurol 2013; 260:2675-7. [PMID: 24057150 DOI: 10.1007/s00415-013-7110-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 09/10/2013] [Accepted: 09/10/2013] [Indexed: 11/30/2022]
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Double-blind randomized trial on the efficacy of the Gufoni maneuver for treatment of lateral canal BPPV. Laryngoscope 2013; 123:1782-6. [PMID: 23382081 DOI: 10.1002/lary.23918] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2012] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS The need for class I and II studies on the efficacy of liberatory maneuvers in the treatment of lateral canal benign paroxysmal positional vertigo (LC-BPPV) motivated the present double-blind randomized trial on the short-term efficacy of the Gufoni liberatory maneuver (GLM). STUDY DESIGN Double-blind randomized controlled trial. METHODS Seventy-two patients with unilateral LC-BPPV were recruited for a multicentric study. Patients were randomly assigned to treatment by GLM (n = 37) or sham treatment (n = 35). Subjects were followed up twice (at 1 hour and 24 hours) with the supine roll test by blinded examiners. RESULTS At 1- and 24-hour follow-up, 75.7% and 83.8% of patients, respectively, undergoing GLM had recovered from vertigo, compared to around 10% of patients undergoing the sham maneuver (P < 0.0001). CONCLUSION To the best of our knowledge, this is the first class I study on the efficacy of the GLM in the treatment of LC-BPPV in both geotropic and apogeotropic forms. GLM proved highly effective compared to the sham maneuver (P < 0.0001). The present class I study of the efficacy of the GLM changes the level of recommendation of the method for treating LC-BPPV from level U to level B for the geotropic variant and from level B to level A for the apogeotropic variant of LC-BPPV.
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Hearing impairment in Parkinson's disease: expanding the nonmotor phenotype. Mov Disord 2012; 27:1530-5. [PMID: 23032708 DOI: 10.1002/mds.25149] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 07/03/2012] [Accepted: 07/17/2012] [Indexed: 11/08/2022] Open
Abstract
The objective of this study was to evaluate hearing impairment in patients affected by Parkinson's disease compared with hearing scores observed in normal age- and sex-matched controls. One hundred eighteen consecutive patients with a clinical diagnosis of Parkinson's disease were screened. Severity of motor symptoms and staging were measured with the Unified Parkinson's Disease Rating Scale (section III) and the Hoehn and Yahr scale. Audiometric evaluation consisted of a comprehensive audiologic case history and questionnaire, visual otoscopic examination, acoustic immittance measures (tympanogram and acoustic reflexes), pure tone audiometry, and measurement of brain stem auditory-evoked potentials. Healthy age- and sex-matched subjects were selected as the control group. One hundred six of 118 patients were enrolled. Pure tone audiometry revealed age-dependent high-frequency hearing loss in patients with Parkinson's disease compared with both normative values and values for healthy age- and sex-matched controls (75/106 [71%], χ(2) = 5.959, P = .02; 92/106 [86.8%] vs 60/106 [56.6%], χ(2) = 23.804, P < .001, respectively). Pure tone audiometry scores correlated with Hoehn and Yahr scale scores (P < .05). Brain stem auditory-evoked potentials were normal in all patients. Our patients with Parkinson's disease showed age-dependent peripheral, unilateral, or bilateral hearing impairment. Whether these auditory deficits are intrinsic to Parkinson's disease or secondary to a more complex impaired processing of sensorial inputs occurring over the course of illness remains to be determined. Because α-synuclein is located predominately in the efferent neuronal system within the inner ear, it could affect susceptibility to noise-induced hearing loss or presbycusis. It is feasible that the natural aging process combined with neurodegenerative changes intrinsic to Parkinson's disease might interfere with cochlear transduction mechanisms, thus anticipating presbycusis.
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Double-blind randomized trial on short-term efficacy of the Semont maneuver for the treatment of posterior canal benign paroxysmal positional vertigo. J Neurol 2011; 259:882-5. [DOI: 10.1007/s00415-011-6272-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2011] [Accepted: 09/29/2011] [Indexed: 11/30/2022]
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Vestibular impairment and adaptive postural imbalance in parkinsonian patients with lateral trunk flexion. Mov Disord 2011; 26:1458-63. [PMID: 21465552 DOI: 10.1002/mds.23657] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2010] [Revised: 12/21/2010] [Accepted: 12/28/2010] [Indexed: 01/26/2023] Open
Abstract
Lateral trunk flexion is a very common clinical observation in patients affected by Parkinson's disease. Postural control is known to depend on vestibular, visual, and somatosensory information. The aim of this study was to investigate whether impairment of vestibular function can account for the postural alterations observed in parkinsonian patients with lateral trunk flexion. We evaluated vestibular function in 11 parkinsonian patients with lateral trunk flexion and in 11 age-, sex-, and disease duration-matched patients without lateral trunk flexion. The following vestibular tests were performed: infrared videonystagmography including fast and slow ocular movements, spontaneous-positional and evoked nystagmus search with and without visual fixation, fast positioning maneuvers, the bithermal caloric test, and the vibration test. A peripheral, unilateral vestibular hypofunction was identified in all patients with lateral trunk flexion. The vestibular hypofunction was ipsilateral to the leaning side and contralateral to the most affected parkinsonian side in all patients. In the control group, 7 subjects had no vestibular signs; 4 subjects had unilateral vestibular hypofunction without clinically evident lateral trunk flexion. Two of the latter patients subsequently developed lateral trunk flexion ipsilateral to the vestibular deficit and contralateral to the side most affected by Parkinson's disease. The processing of vestibular information was impaired in parkinsonian patients affected by lateral trunk flexion. The impairment was at least in part responsible for the patients' postural abnormality. We propose that the acronym PISA (Postural Imbalance Syndrome with vestibular Alterations) be used to describe the specific postural change observed in parkinsonian patients affected by a vestibular defect and lateral trunk flexion.
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Bisphosphonates and oral cavity avascular bone necrosis: a review of twelve cases. Anticancer Res 2006; 26:3111-5. [PMID: 16886642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND Intravenous bisphosphonates are the current standard of care for the treatment of hypercalcemia of malignancy and for the prevention of skeletal complications associated with bone metastases. Recently, retrospective case studies have reported an association between long-term bisphosphonate therapy and osteonecrosis of the jaws. PATIENTS AND METHODS The data for twelve patients, referred to either an oral and maxillofacial surgeon or to an oral medicine specialist for the management of clinically apparent chronic oral osteonecrosis of unknown etiology, were reviewed. All had received cancer-related therapy simultaneously with bisphosphonate management. RESULTS The typical presenting symptoms were pain and exposed bone at the site of a previous tooth extraction. In most patients, the lesions initially occurred after dental extraction or other odontostomatological procedures, while five had a spontaneous event. Biopsy of the involved area showed the presence of necrotic lacunae, with infiltration of lymphocytes and histiocytes. In nine cases, there was histological or cytological diagnosis of suspicious osteomyelitis. No correlation was observed between the intraoral lesions and myelosuppression secondary to antineoplastic therapy. CONCLUSION Based on the patients' respective histories, clinical presentations and responses to surgical and antibiotic treatments, it appears that the pathogenesis of this osteonecrotic process is most consistent with localized vascular insufficiency. In our opinion, the mechanism by which bisphosphonates compromise bone vascularity may be related to their effect on the osteoclasts. The potent bisphosphonate-mediated inhibition of osteoclast function serves to decrease bone resorption and inhibit normal bone turnover remodeling, resulting in microdamage accumulation and a reduction in some mechanical properties of the bone.
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Abstract
18628 Background: Intravenous bisphosphonates are the current standard of care for the treatment of hypercalcemia of malignancy and for the prevention of skeletal complications associated with bone metastases. Generally, the i.v. administration of bisphosphonates is well tolerated. Recently, retrospective case studies have reported an association between long-term bisphosphonate therapy and osteonecrosis of the jaws. Methods: We reviewed data for 12 patients referred to either an oral and maxillofacial surgeon or an oral medicine specialist for the management of clinically apparent chronic oral osteonecrosis of unknown etiology. All had received therapy cancer-related simultaneously with bisphosphonate management. Results: Typical presenting symptoms were pain and exposed bone at the site of a previous tooth extraction. In most patients, lesions initially occurred after dental extraction or other odontostomatological procedures, and 5 had a spontaneous event. Biopsy of the involved area showed the presence of necrotic lacunae, with infiltration of lymphocytes and histiocytes. In 9 cases, histological or cytological diagnosis of suspicious osteomyelitis was done. There was no observed correlation of the intraoral lesions with myelosuppression secondary to antineoplastic therapy. Conclusions: Based on these patients’ respective histories, clinical presentations, and responses to surgical and antibiotic treatments, it appears that the pathogenesis of this osteonecrotic process is most consistent with localized vascular insufficiency. In our opinion, the mechanism by which bisphosphonates could compromise bone vascularity may be related to its effect on the osteoclasts. The potent bisphosphonate mediated inhibition of osteoclast function serves to decrease bone resorption and inhibit normal bone turnover remodeling, resulting in microdamage accumulation and a reduction in some mechanical properties of bone. No significant financial relationships to disclose.
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Neuro-otological features of benign paroxysmal vertigo and benign paroxysmal positioning vertigo in children: a follow-up study. Brain Dev 2006; 28:80-4. [PMID: 16168599 DOI: 10.1016/j.braindev.2005.05.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2004] [Revised: 05/06/2005] [Accepted: 05/06/2005] [Indexed: 11/17/2022]
Abstract
BACKGROUND Causes of benign episodic vertigo in paediatric age include benign paroxysmal vertigo of childhood (BPV) and benign paroxysmal positional vertigo (BPPV). OBJECTIVE The aim is to review the clinical, audiological and vestibular findings in a cohort of children with BPV and in a group of children with BPPV and to highlight the differences useful to formulating a differential diagnosis. METHODS Eighteen children, aged 4-9 years, consecutively examined for paroxysmal attacks of dizziness and/or vertigo attacks between January 2002 and December 2002 entered our study. The clinical characteristics of vertigo, presence of triggering factors, family history of migraine, presence of motion sickness, migraine and other accompanying symptoms were considered. Neurological, ophthalmologic, vestibular and auditory functions were assessed. RESULTS Eight children suffered from BPPV and ten children from BPV. In the BPPV group, the vestibular examination was normal except for the Dix-Hallpike maneuver. Liberatory maneuvers were immediately effective in all patients and all remained symptom-free during the follow-up. In the BPV group, the vestibular examination was positive in 3 patients but none had positive Dix-Hallpike maneuver. All patients with BPV have a positive family history of migraine and seven had a history of motion sickness. In all, migraine was present one year before the vertigo symptoms, with a frequency of at least two migraine episodes a month. CONCLUSION BPV differs from BPPV in terms of family history, clinical symptoms, otoneurological signs, therapy and clinical evolution. BPPV is characterized by specific otoneurological signs, and must be treated with liberatory maneuvers: neither medical therapy nor strict follow-up is needed.
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Abstract
OBJECTIVE The study explored the hypothesis that spontaneous nystagmus (Ny) in migraine patients can be triggered or modulated by painful trigeminal stimulation, providing evidence of a functional connection between vestibular and trigeminal systems. BACKGROUND Vertigo attacks are reported by subjects with migraine or a familiar history of migraine, also independently of headache episodes. Idiopathic vertigo is three times more frequent in migraine patients than in controls. Vestibular investigations in migraine patients have consistently demonstrated spontaneous Ny both of central and peripheral origin. DESIGN In the first phase of the study 10 outpatients experiencing migraine without aura (MO) and 10 healthy volunteers were submitted to the registration of spontaneous primary-position Ny in the dark by Ulmer's video-ocular-nystagmographic equipment. Two electrodes for electrical stimulation were applied on the supraorbital point of one side of the head and the intensity of stimulation corresponding to pain threshold was calculated. Spontaneous ocular movements were recorded for 5 minutes at baseline and after a sequence of five electric pulses (square waves of .5 Hz frequency and 50 micros duration, at pain threshold intensity). Nystagmographic responses were expressed as latency after stimulation, direction of the quick phase, and duration. The second phase of the study explored, with the same procedure, the effects on Ny of supraorbital versus median nerve stimulation in other 10 MO patients. Responses to stimulation were considered the appearance of de novo Ny after stimulation in subjects without baseline Ny, or the change of the frequency (at last a 50% variation) or of the direction of Ny after stimulation in subjects with baseline Ny. The latency and the duration of responses to stimulation were also calculated. RESULTS In the first series supraorbital painful electric stimulation was able to modify or to evoke Ny in 8 of 10 migraineurs and in none of 10 volunteers (Fisher's exact test, P<.01). Both the baseline and the induced Ny were second degree, stationary persistent, with a linear slow phase and were suppressed by visual fixation. In the second series, supraorbital nerve stimulation was able to induce or modify Ny in all of 10 patients but only in 1 patient Ny was induced by median nerve stimulation. Characters of Ny were the same as previously described. Statistical comparison of the responses at the two sites of stimulation was significant (Fisher's exact test, P<.01). In those 7 patients who presented de novo Ny after stimulation it was possible to calculate Ny latency and duration. The mean latency was 25 s (SD: 16, range: 14 to 60). The mean duration was 120 s (SD: 94, range: 20 to 290). CONCLUSION The main result of our study is that in migraine patients painful trigeminal stimulation elicits de novo, or modifies pre-existing spontaneous Ny, generally increasing it. The finding was obtained after trigeminal stimulation, but not after median nerve stimulation. We suggest that painful trigeminal stimulation can induce an imbalance of the vestibular system in migraine patients and possibly explain their predisposition to vertigo. Our data require confirmation by other studies.
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Abstract
BACKGROUND Noise-induced cochlear epithelium damage can cause hearing loss in industrial workers. In experimental systems, noise induces the release of free radicals and may damage the cochlear sensorial epithelium. Therefore, genes involved in regulating the reactive oxygen species manganese-superoxide dismutase (SOD2) and the antioxidant paraoxonase (PON) could influence cochlea vulnerability to noise. We evaluated whether susceptibility to noise-induced hearing loss (NIHL) is associated with SOD2, PON1, and PON2 polymorphisms in workers exposed to prolonged loud noise. METHODS We enrolled 94 male workers from an aircraft factory in the study. The SOD2 gene was screened by denaturing reversed-phase HPLC, and the PON1 (Q192R and M55L) and PON2 (S311C) polymorphisms were analyzed by PCR amplification followed by digestion with restriction endonucleases. RESULTS Three known (A16V, IVS3-23T/G, and IVS3-60T/G) and two new SOD2 polymorphisms (IVS1+ 8A/G and IVS3+107T/A) were identified. Regression analysis showed that PON2 (SC+CC) [odds ratio (OR) = 5.01; 95% confidence interval (CI), 1.11-22.54], SOD2 IVS3-23T/G and IVS3-60T/G (OR = 5.09; 95% CI, 1.27-20.47), age (OR = 1.22; 95% CI, 1.09-1.36), and smoking (OR = 49.49; 95% CI, 5.09-480.66) were associated with NIHL. No association was detected for PON1 (QQ+RR) and PON1 (LL) genotypes. CONCLUSIONS Our data suggest that SOD2 and PON2 polymorphisms, by exerting variable local tissue antioxidant roles, could predispose to NIHL. However, caution should be exercised in interpreting these data given the small sample size and the difficulty in matching cases to controls regarding the overwhelming risk factor, i.e., smoking at least 10 cigarettes/day.
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Changes in clinical and instrumental vestibular parameters following acute exposition to auditory stress. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2003; 23:251-6. [PMID: 15046413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Besides Tullio's phenomenon, resulting from anatomic changes in the labyrinth, a hypersensitivity to acoustic stimuli of the saccular structures appears to be the underlying cause of the vestibular responses detected in some patients. In order to evaluate the incidence of vestibular symptoms triggered by acute exposure to auditory stress (disco music), 40 subjects aged between 18 and 26 years, with no audiological and vestibular disorders, were submitted to otoneurologic tests. Subjects were exposed to disco music [intensity 128 dB (C)], for 3 hours. Tests have been carried out before and immediately after exposure. Canalar and macular functions have been evaluated using vestibular investigation techniques and vestibular evoked myogenic potentials. When compared to baseline data, post-exposure test results did not reveal any canalar damage. Pre- and post-exposure recordings of the vestibular-oculomotor reflex threshold have shown no significant changes. Conversely, post-stimulus recordings have shown a significant increase in the amplitude of the vestibular evoked myogenic potential response, thus indicating a possible irritative involvement of the macular receptor. This result suggests a direct action upon the receptor by acoustic stimulation which could, therefore, be the underlying cause of vestibular symptoms reported by patients following exposure to sufficiently intense acoustic stimuli. Prior to this study. a questionnaire concerning the relationship between habitual disco visiting and audio-vestibular symptoms has been completed by 310 students at the University of Catanzaro. This survey revealed a significant incidence of vestibular symptoms due to acoustic stress (Tullio's phenomenon) which led us to hypothesise that balance disorders due to auditory stress are much more frequent than commonly held, particularly since, in many cases, diagnoses is unknown or not easy due to the difficult procedures by which these conditions are diagnosed.
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Abstract
Benign paroxysmal positional vertigo (BPPV) is the most frequent labyrinthopathy in humans. Treatment consists mainly of liberatory maneuvers aiming to remove otolithic debris and subsequent postural restrictions in order to prevent debris from returning into the canal. The reappearance of symptoms after an effective liberatory maneuver was studied in a group subjected to restrictions and in a second group free from restrictions. The effects of these restrictions were evaluated. No statistically significant difference was found between the groups. Accordingly, restrictions seem to have no effect upon symptom recurrence. The slight supremacy of the Semont maneuver and the prevalence of subsequent relapse compared with the Epley maneuver suggests that these maneuvers could operate on different disorders (cupulolithiasis versus canalolithiasis). Finally, late recognition of relapse in patients who undergo restrictions might even make the liberatory maneuver less effective.
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Middle ear involvement in children with chronic rheumatoid juvenile arthritis. Eur Arch Otorhinolaryngol 1997; 254 Suppl 1:S30-3. [PMID: 9065621 DOI: 10.1007/bf02439717] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In a selected sample of patients affected by juvenile rheumatoid arthritis (JRA) little is known about middle ear involvement, even though many synovial joints are affected. Multifrequency tympanometry was used to measure admittance, conductance, susceptance and phase angle at different probe frequencies and resonant frequencies. In all, 35 children with JRA and a control group (30 children) were studied. Findings showed that mean resonant frequency values in all children with JRA were greater than in the control children. The multifrequency tympanometry parameters measured in acute JRA subjects are not different from parameters of remission JRA subjects except for a change in the phase angle. The changes found are due to involvement of the incudomalleolar and incudostapedial joints.
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Type 2 autoimmune hepatitis and hepatitis C viraemia. RIVISTA EUROPEA PER LE SCIENZE MEDICHE E FARMACOLOGICHE = EUROPEAN REVIEW FOR MEDICAL AND PHARMACOLOGICAL SCIENCES = REVUE EUROPEENNE POUR LES SCIENCES MEDICALES ET PHARMACOLOGIQUES 1996; 18:3-6. [PMID: 8766775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We present 10 Italian patients with type 2b autoimmune hepatitis (anti-LKMI positivity) and HCV infection. 6 patients had IgG concentrations above the upper limit of normal and all had histological features of chronic autoimmune hepatitis or chronic persistent hepatitis or cirrhosis. ANA and SMA were positive in 2 patients, pANCA in 3 patients. Anti-GOR were negative in all patients, 6 of them were HLA B8 DR3 and 2 HLA B8 DR4. Antibodies to HCV (tested by ELISA 2nd and 3rd generation) were positive in all patients and in 9 subjects were detected HCV RNA. The two patients with positivity for ANA and SMA were treated successfully with corticosteroids, but they relapsed after the drug withdrawal; the others received interferon, that had to be suspended in 2 patients because inducing an autoimmune thyroiditis. Although, at present, it is still not known if HCV is a really trigger factor in developing autoimmunity or if the two diseases are coincidental, the authors suggest that it is important for clinicians to use appropriate treatment strategies on the basis of the predominant illness.
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