Benign paroxysmal positional vertigo following whiplash injury: a myth or a reality?

Abstract Objective The aim of the study was to evaluate the true incidence, diagnosis, and treatment of benign paroxysmal positional vertigo (BPPV) arising after whiplash injury and to distinguish this type of posttraumatic vertigo from other types of dizziness complained after trauma. Methods This was a retrospective study comprising patients referred to our center after whiplash injury. The patients were evaluated with neurotologic examination including bedside and instrumental tests. A Dizziness Handicap Inventory evaluating the symptoms of patients was submitted before and after treatment and was evaluated. The BPPV patients were separately evaluated from those with cervicogenic vertigo…

Management of chronic otitis by middle ear obliteration with blind sac closure of the external auditory canal.

Objective: Description of a technique of middle ear obliteration (MEO) with blind sac closure of the external auditory canal with discussion of the indications for its use in cases of recalcitrant chronic otitis and in far advanced disease. Patients: All patients underwent otologic examination and audiologic and radiologic assessments in a quaternary center. Results: Fifty-three cases of MEO were analyzed. For 9 patients, primary surgery was performed. One case of residual disease was identified. The minimum follow-up was 2 years. Conclusion: The decision to perform a MEO is one that is made only rarely. However, this is a technique that should be part of every otologist`s armamentarium. Wh…

Otoneurological management of petrous apex cholesterol granuloma

Objective: The aim of the study is to review the management of petrous apex cholesterol granuloma. The surgical approaches for drainage or total removal and the wait and see policy were analyzed, and outcomes were evaluated. Methods: Retrospective charts of 27 patients managed for petrous apex cholesterol granuloma with a minimum follow-up of 12 months were analyzed in a quartenary skull base center. Presenting symptoms and signs were recorded, and radiologic imaging was evaluated. Management options included wait and see policy and surgery by several approaches. Results: The mean age of patients affected by the lesion was 38.8 years. The mean follow-up was 56.7 months. Patients complained …

Tumours of Nasal Septum: A Retrospective Study of 32 Patients

Objective: Tumours of the nasal septum are a rare and heterogeneous group of lesions in the sinonasal tract. The management of the different lesions of this site is debated. The aim of this study is to share our experience on a rare clinical condition and stimulate other centres to publish theirs. Methods: We retrospectively analysed the databases of sinonasal tumours treated at the Sections of Otolaryngology (ENT) of two University Hospitals (Palermo and Genova) between 2012 and 2020. Results: From the two databases, a cohort of 32 patients with tumours of nasal septum were selected. All patients underwent an endoscopic examination. Large tumours underwent preoperative computed tomography …

Sleep-disordered breathing:Evaluation of dynamic patterns of the upper airways in obese subjects

MANAGEMENT OF LABYRINTHINE FISTULA IN CHRONIC OTITIS WITH CHOLESTEATOMA: CASE SERIES

Labyrinthine fistula is a complication of ear cholesteatoma that increase the risk of sensorineural hearing loss. The management of the fistula must be done contextually with mastoidectomy by: leaving cholesteatoma matrix over the fistula, or remove the matrix reconstructing the defect. Objective : analysis of the two techniques to treat labyrinthine fistula. Methods : retrospective review with case series analysis. Results: a labyrinthine fistula was present in 14% of cholesteatoma patients; CT scan was predictive in all cases; the hearing preservation was obtained with both techniques; a recurrence was detected only in one case; postoperative nystagmus incidence was higher in those cases …

Mastoidectomy in surgical procedures to treat retraction pockets: a single-center experience and review of the literature

Abstract Purpose Retraction pocket (RP) is a common event affecting the middle ear when a negative pressure within it causes a retraction of a single part of the tympanic membrane (TM). Patients can be asymptomatic or can experience hearing loss, fullness feeling and/or ear discharge. RP can be stable or develop a cholesteatoma; aim of the study was to investigate if mastoidectomy may play a role in the surgical management of patients suffering from RP, both reporting our experience and discussing the existing literature. Methods Fifty-one patients affected by RP were referred for surgery and randomly divided into two groups. Patients of G1 group underwent tympanoplasty with mastoidectomy, …

Chronic otitis caused by heterotopic brain tissue in pterygopalatine fossa

Summary Heterotopic brain tissue is a rare is congenital anomaly, it may present at any age but it is frequently in infancy. This anomaly can occur most frequently in nasal region, although rests elsewhere in the digestive tract, in facial tissue or in lungs have been reported. Heterotopic brain tissue has been defined as a mass composed of mature brain tissue, outside the cranial cavity or spinal canal. We present a 9 years old girl with history of left chronic otitis and nasal obstruction caused by heterotopic brain tissue in pterygopalatine fossa.

Management of pharyngeal collapse in patients affected by moderate obstructive sleep apnoea syndrome

This study reports our experience in a selected cohort of patients affected by mild-moderate OSAS, without tonsillar obstruction, and treated with pharyngoplasty.In a case-control retrospective study, we compared modified expansion sphincter pharyngoplasty (MESP) to modified barbed reposition pharyngoplasty (MBRP) in adult patients with oropharyngeal transversal collapse with a BMI ≤ 30 kg/mWe enrolled 20 patients: 10 treated with MESP and 10 treated with MBRP. Mean apnoea-hypoapnoea index (AHI) was 22.8 (± 5.63). We observed in both groups a significant reduction of AHI and oropharyngeal obstruction (p = 0.01), with a success rate, according with Sher's criteria, of 90% for MESP and 80% fo…

Changes in Speech Range Profile Are Associated with Cognitive Impairment

Background and Purpose The aim of this study was to describe the variations in the speech range profile (SRP) of patients affected by cognitive decline. Methods We collected the data of patients managed for suspected voice and speech disorders, and suspected cognitive impairment. Patients underwent an Ear Nose and Throat evaluation and Mini-Mental State Examination (MMSE). To obtain SRP, we asked the patients to read 18 sentences twice, at their most comfortable pitch and loudness as they would do in daily conversation, and recorded their voice on to computer software. Results The study included 61 patients. The relationship between the MMSE score and SRP parameters was established. Increas…

Personal experience on inverted papilloma surgical treatment

Observational study on risk factors determining residual dizziness after successful benign paroxysmal positional vertigo treatment: The role of subclinical BPPV

Studio osservazionale sui fattori di rischio che causano residual dizziness dopo il trattamento della vertigine parossistica posizionale benigna: il ruolo della VPPB subclinica.Alcuni pazienti, dopo il trattamento della vertigine parossistica posizionale benigna concluso con successo, possono lamentare un disequilibrio residuo. La possibile spiegazione potrebbe essere: la persistenza di otoliti canalari insufficienti a provocare un nistagmo clinicamente evidente, una disfunzione utriculare, coesistenza di altri disordini del sistema vestibolare. Abbiamo condotto uno studio osservazionale prospettico caso-controllo, focalizzando l’attenzione sul ruolo di fattori di rischio che possono causar…

Is there an association between age at first words and speech sound disorders among 4- to 5-year-old children? An epidemiological cross-sectional study based on parental reports

To investigate the role of the period of emergence of the first words and its interactions with other risk factors in predicting the development of speech sound disorder (SSD) among 4- to 5-year-old children.After 373 children underwent otolaryngology and speech pathology examinations, their parents answered a questionnaire about potential risk factors for speech impairment. The presence of SSD was identified by a speech pathologist who administered Fanzago's Articulation Test to each child. Multivariate logistic analysis was used to explore the relationships between variables and outcomes.Mean age at first words was 17.8 ± 6.5 months of life; 25.7% of patients suffered from SSD, and 3.7% f…

Uvulopalatopharyngoplasty with tonsillectomy in the treatment of severe OSAS

Objective: To establish the efficacy of uvulopalatopharyngoplasty with tonsillectomy for treating selected patients with severe obstructive sleep apnea syndrome Methodology: Retrospective study of patients who underwent clinical/instrumental evaluation and surgical treatment. Setting: University ENT division with a tertiary snoring referral center Participants: Twenty-two patients with normal body mass index affected by severe obstructive sleep apnea syndrome- Main outcome measures: Pre and post operative cardiopulmonary monitoring during sleep, daytime sleepiness evaluation, post treatment complication recording. Results: Complete response to therapy was obtained in 78% of patients. Four p…

Treatment of central and sensorineural tinnitus with orally administered Melatonin and Sulodexide: personal experience from a randomized controlled study.

Since very little is understood about the exact aetiology of tinnitus, this has made treatment of the condition difficult. Even though approximately 10-15% of the general population suffer from tinnitus, only 2% consider it serious enough to warrant any treatment. The main problem arising from tinnitus is the disturbance it causes not only in day to day life but also in sleep, leading to fatigue and general discomfort. The present study focused on the effect of Melatonin in conjunction with Sulodexide as a treatment method for tinnitus. Overall, 102 patients suffering from tinnitus were evaluated in a prospective randomised controlled study conducted in a tertiary care ENT department. After…

Thyroid cartilage involvement in patient affected by IgA multiple myeloma: case report.

Neoplasms originating from plasma cell are rare in the head and neck region. A correct clinical evaluation is very important in order to formulate a differential diagnosis as well as to distinguish local from metastatic disease. We report a case of larynx involvement by an IgA multiple myeloma in a 69-year-old female diagnosed in October 2004 and treated with chemotherapy; the 1 year control do not show progression of disease and the laryngeal lesion is unchanged. We highlight the radiological findings and clinical features to suspect plasma cell tumors in cases with a similar presentation.

Treatment of sudden sensorineural hearing loss with transtympanic injection of steroids as single therapy: a randomized clinical study.

The aim of this study was to verify the efficacy and the safety of transtympanic dexamethasone to treat sudden sensorineural hearing loss as first and single drug method. Considering ethical implication of performing a mininvasive procedure on middle ear, we matched such proposed treatment with systemic prednisone administration that represents the widest adopted protocol. Randomized prospective study was conducted. The inclusion criterion was a sudden sensorineural hearing loss of at least 30 dB across three contiguous frequencies over a period of 24 h. Group A received transtympanic steroid injections; Group B received oral administration of steroids. 25 patients were treated with transty…

Comparison of repositioning maneuvers for benign paroxysmal positional vertigo of posterior semicircular canal: advantages of hybrid maneuver.

Objective: The prevalence of benign paroxysmal positional vertigo (BPPV) is becoming more frequent in elderly population. The presence of comorbid factors has to be considered before assessment as well as before commencing any repositioning treatment. Our aims were evaluation of the maneuvers efficacy and evaluation of the applicability of hybrid maneuver (HM) in patients with physical limitation. Study design and setting: This is a randomized study in 2 tertiary referral centers. Intervention: This is a therapeutic intervention. Patients: All consecutive patients with diagnosis of BPPV of posterior canal matching the inclusion criteria were enrolled. Patients underwent treatment soon after…

Eustachian Tube Function Assessment after Radiofrequency Turbinate Reduction in Atopic and Non-Atopic Patients.

(1) Background: Inferior turbinates&rsquo

Oropharyngeal dysphagia in elderly population suffering from mild cognitive impairment and mild dementia: Understanding the link

Abstract Purpose To evaluate the prevalence of oropharyngeal dysphagia in elderly patients suffering from minimal or mild cognitive decline. Patients and methods We retrospectively collected the data of patients suffering from mild cognitive impairment or mild dementia and were undergoing management for suspected oropharyngeal dysphagia, in our department. All our patients were subjected to Mini Mental State Examination test, MD Anderson dysphagia inventory and caregiver mealtime and dysphagia questionnaire. We performed a mealtime observation study and endoscopic evaluation of swallowing in all our patients. Following evaluation, we then analysed the data statistically. Results Out of 708 …

MICRORNA-21 EXPRESSION IN VESTIBULAR SCHWANNOMA: POTENTIAL EFFECT ON GROWTH AND POSSIBLE PROGNOSTIC FACTOR

Background: Vestibular schwannomas are benign slow growing tumors arising from VIII cranial nerve. They are potential life threatening benign tumor because of intracranial located. The management could be surgical or conservative, but, left untreated, the tumor preserve the possibility to further growth and complication may arise. The natural history is however not predictable and prognostic factor to select patients manageable conservatively should be studied. The molecular pathways that lead to tumorigenesis and growth are not completely defined and a role could be played by microRNA. Elevated levels of microRNA-21 may contribute to tumor growth by deregulating the tumor suppressor phosph…

Imaging of Vestibular Schwannoma With Prevalent Cystic Component

Not available

Analysis of visually guided eye movements in subjects after whiplash injury

Abstract Objective The aims of present research were to analyze the visually guided eye movements of subjects suffering from the consequences of whiplash injury and the possibility to differentiate patients from feigning subject. We analyzed the role of video-nystagmography for clinical and forensic aspects. Methods It was a prospective case–control study. Detailed history was taken and patients were thoroughly investigated. Smooth pursuit and saccadic eye movements were assessed in 33 patients affected by imbalance following a whiplash injury. A control group of 20 subjects was also evaluated. All tests were executed in neutral neck position and after left and right trunk rotation. Results…

Solitary Vestibular Schwannoma: Decision Making of Treatments

Therapeutic strategies of vestibular schwannomas treatment are changed in the last years. The improvement of surgical equipments and skills allowed increasing the numbers of successful operations in the last 10 years. The results improved in terms of survival, quality of life, recurrences, facial nerve function, and hearing preservation. Also the age of operated patients, once a restriction, becomes progressively a relative limitation to surgical indication. However the progressive widening of MRI availability give to the Otoneurologist the possibility to follow-up the patients with a relative simple radiological examination, delaying the decision to treat surgically the neoplasm only in ca…

Are postural restrictions necessary for management of posterior canal benign paroxysmal positional vertigo?

Objectives: An important component of management of benign paroxysmal positional vertigo (BPPV) has been the application of postural restrictions after use of a canalith repositioning maneuver (CRM) to prevent the return of otolithic debris into the posterior semicircular canal (PSC). This study was designed to explore the effectiveness of postural restrictions in patients with BPPV caused by otolithic debris in the PSC. Methods: Seventy-four adult patients with unilateral PSC BPPV were enrolled into this study. All patients were managed with a CRM — Either the modified Epley maneuver or the Semont maneuver. The patients were divided randomly into 2 groups: Group A, with postural restrictio…

Sudden Sensorineural Hearing Loss: Results of intratympanic steroids as salvage treatment

Objective: The aim of the present study was to verify the efficacy and the safety of intratympanic dexamethasone to treat sudden sensorineural hearing loss as salvage therapy. Materials and methods: A prospective study was conducted on patients affected by idiopathic sudden hearing loss who were treated before with some systemic therapy, but without recovery of the hearing The patients able to undergo the study, but who refused salvage treatment were considered as control group. A solution of Dexamethasone 4 mg/ml was then injected through the posterior–inferior quadrant filling completely the middle ear. The follow-up in the following 6 months included an audiogram every month. Results: Th…

A multicenter observational study on the role of comorbidities in the recurrent episodes of benign paroxysmal positional vertigo

Objective: Primary objective of this study was to find a statistical link between the most worldwide comorbidities affecting the elderly population (hypertension, diabetes, osteoarthrosis, osteoporosis and depression) and recurrent episodes of BPPV. Secondary objective was defining possible "groups of risk" for people suffering recurrent positional vertigo related to the presence of a well documented comorbidity. Methods: This was an observational, cross-sectional, multicenter, spontaneous, non-pharmacological study. The data of 1092 patients suffering BPPV evaluated in 11 different Departments of Otolaryngology, Otoneurology and Neurology, referring Centers for positional vertigo evaluatio…

Treatment of bilateral vocal cord paralysis following permanent recurrent laryngeal nerve injury.

Bilateral vocal cord paralysis is a serious illness requiring emergency intervention to resolve the potentially life-threatening respiratory distress. Several surgical procedures were proposed to help improve the airway and to eliminate the tracheostoma in those patients with permanent paralysis. All the procedures have their own advantages and disadvantages. We conducted a retrospective study of 30 patients affected by bilateral vocal cord paralysis following total thyroidectomy. All the patients underwent total thyroidectomy for benign thyroid pathology. In 26 patients (86.6%), cord paralysis occurred during the perioperative stage; and in the remaining 4 cases (13.3%), it occurred within…

Trattamento chirurgico endoscopico della paralisi ricorrenziale in adduzione

Corrigendum to “A multicenter observational study on the role of comorbidities in the recurrent episodes of benign paroxysmal positional vertigo” [Auris Nasus Larynx 41 (2014) 31–36]

Alessandro De Stefano *, Francesco Dispenza , Hamlet Suarez , Nicolas Perez-Fernandez , Raquel Manrique-Huarte , Jae Ho Ban , Min-Beom Kim , Michael Strupp , Katharina Feil , Carlos A. Oliveira , Andres L. Sampaio , Mercedes F.S. Araujo , Fayez Bahmad Jr., Mauricio M. Gananca , Fernando F. Gananca , Ricardo Dorigueto , Hyung Lee , Gautham Kulamarva , Navneet Mathur , Pamela Di Giovanni , Anna Grazia Petrucci , Tommaso Staniscia , Leonardo Citraro , Adelchi Croce a

Localisation of mediterranean Kaposi's sarcoma in Morgagni's ventricle

Objective: Head and neck involvement in Kaposi’s Sarcoma (KS) is not unusual . However, laryngeal involvement is a relatively infrequent manifestation and ENT specialists should consider it in differential diagnosis in laryngeal lesions of AIDS patients and/or subjects from the Mediterranean area. Methods: Case report and review of the literature in English Clinical Case: Male patient presenting with a three- month history of cough and acute dispnoea. Laryngoscopy identified a laryngeal mass occluding the glottic plane. Tracheotomy was then performed and the laryngeal lesion was removed. Histopathology showed neoplastic spindle cells that were positive to immunostain with CD-31 and CD-34, a…

The Role of Cartilage-perichondrium Tympanoplasty in the Treatment of Tympanic Membrane Retractions: Systematic Review of the Literature.

Abstract Introduction Tympanic retraction is a condition characterized by the displacement of the tympanic membrane toward the structures of the middle ear. Clinically, tympanic retractions can lead to hearing loss, ear discharge and/or ear pain. In most of the cases, however, tympanic retractions are asymptomatic and are found accidentally during an ear, nose, and throat (ENT) examination. This condition has created numerous debates regarding the optimal choice of treatment, especially in the asymptomatic forms. The main controversy is regarding the relationship between retraction and the development of cholesteatoma, which would justify a surgical intervention performed for preventive pur…

Facial nerve schwannoma involving middle cranial fossa: When the unilateral sensorineural hearing loss guide to the correct diagnosis

The Facial Nerve Schwannoma is a rare tumor and it seldom involved the middle cranial fossa. Facial nerve schwannoma has various manifestations, including facial palsy but unfortunately facial nerve is very resistant to compression and often facial nerve paralysis or a facial weakness are not present. We present a case of giant facial nerve schwannoma involved the middle cranial fossa without facial nerve paralysis. In these cases the unilateral hearing loss (if present) guide to a correct diagnosis.

Vertigo in childhood: A methodological approach

Children complaints dizziness merit meticulous evaluation to differentially diagnose a vestibular disease. A syndrome mimicking certain classic signs and symptoms of adult vestibular disorders may be presents in children, such as benign paroxysmal positional vertigo, usually associated with aging. Benign paroxysmal vertigo, in which migraine is a manifestation, with sudden onset of dizziness is a rare peripheral vestibular disorder that is commonly ignored or misdiagnosed. This review covers the development of the diagnosis, evaluation and treatment approaches of vertigo of childhood, a valid support for physician that approach dizzy children (Ref. 25). Full Text in PDF www.elis.sk.

Valutazione del pattern dinamico delle vie aeree superiori nei grandi obesi mediante manovra di Muller

Decision making for solitary vestibular schwannoma and contralateral Meniere's disease.

The existence of dual inner ear pathology such as unilateral Meniere’s disease (MD) with a contralateral vestibular schwannoma (VS) is very rare, but provides the otologist with a significant management dilemma. In this study, we present 5 cases of unilateral disabling MD with a contralateral VS in the better hearing ear. Conservative management of the VS is mandated unless there are impending complications, with management directed toward controlling the vertigo attributed to MD. If and when the VS requires intervention, or the hearing in that ear deteriorates to unserviceable levels, cochlear implant of the ear affected by MD prior to addressing the VS provides optimal management.

The Role of Modified Expansion Sphincter Pharyngoplasty in Multilevel Obstructive Sleep Apnea Syndrome Surgery

Introduction Obstructive sleep apnea syndrome (OSAS) is a sleep disorder caused by an excessive narrowing of the pharyngeal airway that also collapses during inspiration, with an important role played by the lateral pharyngeal wall in the development of the obstruction. Objective To describe our surgical experience with modified expansion sphincter pharyngoplasty (MESP) in the management of lateral collapse in upper airway multilevel surgery. Methods A total of 20 patients with moderate to severe OSAS were recruited in the Ear, Nose and Throat (ENT) Department of the University of Palermo, Italy. All of the enrolled patients refused the ventilatory therapy. The subjects were evaluated for …

Features of biopsy in diagnosis of metatypical basal cell carcinoma (Basosquamous Carcinoma) of head and neck

Metatypical Basal Cell Carcinoma, also known as Basosquamous Carcinoma is a subtype of Basal Cell Carcinoma. It is similar to Basal Cell Carcinoma for the gross aspect and regional recurrences, but it has the capacity to spread and develop metastasis. This terrible characteristic endangers the life of the patient if it is not readily recognized by the physicians. Herein we present a report of two patients affected by BSC originating in the nasal region and external ear that after a series of devastating local recurrences metastasized to the lung and bones in one case. The true incidence of Basoquamous Carcinoma may be higher, with underreporting arising because of rarity of diagnosis and la…

Modified fronto-lateral laryngectomy in treatment of glottic T1(a-b) cancer with anterior commissure involvement

Abstract Objective Evaluation of clinical and oncological safety of the modified fronto-lateral laryngectomy in the treatment of T1a-b glottic cancer. Methods Retrospective review of charts of patients managed with classical fronto-lateral laryngectomy or with our modified technique using a cervical fascia flap and a false cord flap to reconstruct the defect. Results No recurrence of cancer was observed in the present series and slight dysphonia was present in all cases. The patients managed with classical technique required a revision surgery for granulations or anterior synechia in 4 cases; those managed with modified technique did not need a second intervention. Conclusion The fronto-lat…

Current trends on subtotal petrosectomy with cochlear implantation in recalcitrant chronic middle ear disorders

Objective. To establish the safety and effectiveness of subtotal petrosectomy with cochlear implantation in patients affected by chronic middle ear disorders to refractory to previous surgical treatments. Methods. A multicentre, retrospective study was conducted on patients affected by recalcitrant chronic middle ear disorders who underwent cochlear implantation in combi-nation with subtotal petrosectomy. Patients’ details were collected from databases of 11 Italian tertiary referral centres. Additionally, a review of the most updated literature was carried out. Results. 55 patients were included with a mean follow-up time of 44 months. Cholestea-toma was the most common middle ear recurren…

Management of nasal septal abscess in childhood: our experience.

Summary A nasal septal abscess is usually the result of an infected hematoma of the septum. A secondary septal abscess may be the result of infections extending from any of the neighbouring tissues. The necrosis of septal cartilage may lead to nasal deformities and severe impairment of nasal patency and growth. Objectives: Assess if the drainage of the abscess and the immediate reconstruction of the destroyed nasal septum in the acute phase is the best treatment to prevent short- and long-term effect on nasal and midface growth. Methods: Three pediatric patients treated with drainage and immediate implantation of homologous bank cartilage prior to 1990 and four treated with mosaic plastic u…

Predictive factors of severity and persistence of oropharyngeal dysphagia in sub-acute stroke.

Purpose: This study aims to understand the factors contributing to the severity of oropharyngeal dysphagia and its persistence in the sub-acute phase of stroke. Methods: We retrospectively collected the data of all the patients suffering from a stroke in the last year. The severity of stroke was reported according to the NIHSS score. All the patients were evaluated with the Dysphagia Risk Score and with a FEES. We classified the Dysphagia Risk Score and FEES results using the PAS score and ASHA-NOMS levels. The data were analysed statistically with ANOVA test, Student’s t test and Pearson’s correlation coefficient. Results: A series of 54 patients were evaluated. The ANOVA test did not find…

Audiologic profile of infants at risk: experience of a Western Sicily tertiary care centre.

Objective: To identify the incidence of sensorineural hearing loss (SNHL) on infant at risk and to classify the degree and type of hearing loss describing the main causes associated in Western Sicily. To compare single TEOAE and combined TEOAE/ABR techniques studying the referral rate, the false-positive and false-negative rates through concordance test (κ coefficient), sensitivity (TPR) and specificity (TNR) for each protocol. Methods: From January 2010 to June 2011, 412 infants at risk, ranging from 4 to 20 weeks of life, transferred to Audiology Department of Palermo from the births centers of Western Sicily, underwent to audiological assessment with TEOAE, tympanometry and ABR. The foll…

Malignant paroxysmal positional vertigo

Objective: An insidious percentage of paroxysmal positional vertigo appears to be intractable with canalith repositioning maneuver and also is not self-limiting. This type of positional vertigo is sustained by the action of intracranial tumors that mimics the clinical aspects of benign paroxysmal positional vertigo.Aim of this study is to clarify the features of these forms of positional vertigo, which we indicate as malignant paroxysmal positional vertigo. Methods: We retrospectively reviewed the clinical records of all the patients who presented with vertigo spells and were managed at our tertiary care referral centre over a three years period. Two hundred and eleven patients with diagnos…

Diagnostic Role of Combined Electrocochleography and Pure-Tone Audiometry Monitoring During Dehydrating Test in Ménière's Disease: A Case Series

Objectives: To evaluate the diagnostic role of combined electrocochleography and pure-tone audiometry monitoring during dehydrating test in Ménière's disease and consider its suitability as a diagnostic tool to differentiate those patients with unclear differential diagnosis and therefore identify those with clear endolymphatic hydrops responsive to dehydrating test. To study the efficacy of dehydrating therapy on vertiginous symptoms and hearing loss in patients with Ménière's disease. Study design: Prospective case series. Settings: University hospital, secondary referral center. Patients: Thirty patients, 20 women and 10 men, age range of 25 to 75 years, matching the criteria for definit…

Respiratory epithelial adenomatoid hamartoma: An unusual case report

Respiratory epithelial adenomatoid hamartoma is a rare lesion of the nasal cavity whose etiology and pathogenesis are unknown and symptoms are unspecific. It can be isolated or associated with inflammatory process, first of all nasal polyposis. It’s considered a rare lesion because it’s poorly known and consequently correctly diagnosing is important to a right surgical treatment and follow-up. A 54-year-old man presented with a 10-year history of epistaxis, rhinorrhea and anosmia. Computed tomography showed soft tissue densities in all sinus cavities consistent with nasal polyposis and without bilateral widening of the olfactory cleft >10 mm and without bone erosion. Functional endoscopi…

Cystic vestibular schwannoma: classification, management, and facial nerve outcomes.

OBJECTIVE: Review of postoperative morbidity and facial nerve outcomes of cystic vestibular schwannoma (CVS) patients compared with solid vestibular schwannoma (SVS) patients and a proposal for a new CVS classification system. STUDY DESIGN: Retrospective review. SETTING: Tertiary care facility. PATIENTS: Ninety-six patients with surgically treated CVS (1998-2008). Outcomes were assessed in a subpopulation of 57 patients with greater than or equal to 1-year follow-up compared with 57 SVS patients. INTERVENTION: Fifty-six CVS patients underwent the enlarged translabyrinthine approach with transapical extension (Type I), and 1 patient underwent a transcochlear/transzygomatic approach. MAIN OUT…

Intermediate nerve schwannoma: A rare tumour

The intermediate nerve (IN), also called the nerve of Wrisberg, is a relatively small nerve with a variable anatomical course. Currently, this nerve is not addressed well in the pertinent literature. Pre-operative diagnosis of IN tumours is clinically challenging due to the lack of related symptoms. Symptoms are typically caused by the functional deterioration of neighbouring anatomical structures. In this report, we describe a patient with a schwannoma that arose at the porus acusticus of the internal auditory canal; during surgery, this proved to originate from the IN. We discuss our findings in the context of previously reported cases of IN schwannomas and analyse the vague characteristi…

Meningioma of the cerebellopontine angle mimicking benign paroxysmal positional vertigo.

Not available

Sudden sensorineural hearing loss as prodromal symptom of anterior inferior cerebellar artery infarction.

Sudden sensorineural hearing loss is a clinical condition characterized by a sudden onset of unilateral or bilateral hearing loss. In recent years sudden deafness has been frequently described in association with anterior inferior cerebellar artery (AICA) infarction generally presenting along with other brainstem and cerebellar signs such as ataxia, dysmetria and peripheral facial palsy. The authors report a rare clinical case of a 53-year-old man who suddenly developed hearing loss and tinnitus without any brainstem or cerebellar signs. Computed tomography of his brain was normal, and the audiological results localized the lesion causing deafness to the inner ear. Surprisingly, magnetic re…

Intratympanic gentamicin: a 1-day protocol treatment for unilateral Meniere's disease

Abstract Purpose The objective of this study was to assess the usefulness of low-dose intratympanic gentamicin administration in patients with Meniere's disease (MD). Materials and Methods We carried out a retrospective review of the charts of 55 patients with definite MD in accordance with the AAO-HNS (American Academy of Otolaryngology–Head and Neck Surgery) Diagnostic Scale who were treated at Gruppo Otologico (Piacenza, Rome, Italy). The treatment protocol consisted of 3 intratympanic injections of gentamicin at a 12-hour interval between each administration. Results Results were resumed in accordance with AAO-HNS criteria and showed complete control of vertigo spells in 60% (class A), …

Management of intralabyrinthine schwannomas

Abstract Objectives Our protocol to manage the intralabyrinthine schwannoma (ILS). Methods Retrospective chart review of 7 consecutive patients managed for ILS. Results Five patients underwent surgical removal of the lesions and none experienced significant complications or recurrent disease. One patient refused surgical treatment and was closely followed by serial MRI scans with no signs of tumor growth. One patient is presently managed conservatively due to a good hearing. Conclusions Diagnosis of ILS is based on high resolution MRI scans and should be included in the differential diagnosis of patients investigated for cochleovestibular symptoms. Treatment modality of ILS is controversial…

Surgical Management of Retraction Pockets: Does Mastoidectomy have a Role?

Abstract Introduction Retraction pocket is a condition in which the eardrum lies deeper within the middle ear. Its management has no consensus in literature. Objective To assess the role of mastoidectomy in the management of retraction pockets added to a tympanoplasty. Methods Prospective study of patients with retraction pocket and referred to surgery. The patients were randomly assigned to two groups: one managed with tympanoplasty and mastoidectomy and the other group with tympanoplasty only. The minimum follow-up considered was 12 months. The outcomes were: integrity of eardrum, recurrence, and hearing status. Results This study included 43 patients. In 24 cases retraction occurred in t…

The prognostic value of subjective nasal symptoms and SNOT-22 score in middle ear surgery

Background: The relationship between nasal functions and middle ear surgery is still under debate. Nasal obstruction is considered as a negative prognostic factor in middle ear surgery. This is based on the theory that it may cause Eustachian tube dysfunction (ETD) by leading to reduced ventilation of the middle ear, as found in several patients with nasal septal deviation, chronic rhinitis and nasal polyps. Objectives: To assess how the subjective feeling of nasal function, evaluated by a preoperative questionnaire, may be predictive of surgical outcome and/or risk of failure in middle ear surgery. Methods: We prospectively evaluated data of patients undergoing middle ear surgery for chron…

Linfomas malignos primários nas glandulas salivares

Primary malignant lymphomas in the salivary glands are relatively rare. Clinical presentation is not characteristic and the disease is often overlooked resulting in diagnosis and treatment delays. AIM: To stress the importance of the diagnostic process and combined management, we present a series of eight patients with malignant lymphoma of the parotid who were diagnosed only after surgery and managed with radiation and chemotherapy. METHODS: Retrospective series of patients with primary malignant lymphoma of the parotid gland managed with radiotherapy and diagnostic surgical partial resection. RESULTS: After treatment completion we achieved a loco-regional control rate of 87.5%. Toxicity w…

Inferior turbinate surgery.Proceedings in V European Congress of Otorhinolaryngology Head and Neck Surgery. Rodos 11-16 September 2004. pp. 197-199.

Canal switch and re-entry phenomenon in benign paroxysmal positional vertigo: difference between immediate and delayed occurrence

Studio prospettico ideato per la valutazione delle differenze tra la conversione canalare o il rientro degli otoliti nei canali semicircolari successivo alle manovre terapeutiche nei pazienti affetti da VPPB. Sono stati valutati 196 pazienti affetti da VPPB, 127 dei quali corrispondevano ai criteri di inclusione. L’età media dei pazienti era di 54.74 anni. Il canale orizzontale è stato coinvolto in 30 casi e il canale posteriore in 97 pazienti. I pazienti con sordità neurosensoriale presentavano forme ricorrenti di VPPB, rispetto a quelli con udito normale. L’immediato rientro canalare è stato diagnosticato in 3 pazienti con VPPB del canale laterale, tutti con nistagmo geotropo. 7 pazienti …

Endoscopic Sinus Surgery Associated with Rhinoseptoplasty: A Case-control Study

Objective: To examine the difference between outcomes in the administration of concurrent endoscopic sinus surgery (ESS), septoplasty (SP), and rhinoplasty (RP) and concurrent ESS and SP in 1 single surgical session. Methods: Patients who underwent concurrent ESS and SP from September 2004 to July 2015 were identified. Furthermore, patients among them who underwent functional primary RP were selected. Subjects who had been administered concurrent ESS, SP, and RP (primary RP) were matched for sex, age, sinonasal surgical procedures for treatment of chronic rhinosinusitis with patients underwent concurrent ESS and SP, used as control subjects. A literature review was performed to find previou…

Management of naso-septal deformity in childhood: long-term results.

Abstract Objective The classical teaching advocates a conservative approach for children presenting with various naso-septal deformities. It may not be appropriate especially when it causes nasal obstruction to the growing child. This study has two main purposes: to contribute in identifying the correct selection criteria for surgical management of pediatric patients and in selecting the most appropriate surgical technique. Material and method We reviewed a series of 46 cases of post-traumatic septal and naso-septal deformity not managed promptly or with recurrence of nasal deviation, following bones fracture correction alone. The mean follow-up was 10 years. Results Patients with naso-sept…

Laryngeal involvement in relapsing polychondritis: Case report and review of literature

Relapsing polychondritis is a rare multisystem autoimmune disease of unknown origin characterised by recurrent episodes of inflammation and progressive destruction of the cartilaginous structures and connective tissue of the whole body. The diagnosis of relapsing polychondritis is difficult. We present a review of the literature and describe a case of 49-year old woman. Her symptoms began in June 2004 with sore throat, dysphonia, pain in the thoracic wall and some joints, a slightly raised temperature and cough. The objective picture was immediately apparent after carrying out a high definition neck-thorax computed tomography and a laryngoscopy with fiber optics, which showed considerable l…

Management of Naso-Septal Deformity in Childhood: Long Term Results

Post-traumatic lipoma of the parotid gland: case report

The incidence of lipoma among parotid tumours ranges from 0.6% to 4.4%, with most series reporting an incidence of 1%. The most common origin of these tumours, in the parotid gland, is from the superficial lobe and, only rarely, from the deep lobe. Lipomas, upon clinical history, are found to be most frequently related to an episode of trauma. Computed Tomography scan and Magnetic Resonance Imaging can lead to a pre-operative diagnosis of lipoma. The case is described of lipoma of the superficial lobe of the parotid gland.

A conservative treatment for chronic obstructive sialoadenitis by intraductal instillation of mucolytic, steroids and antibiotic solution

Abstract Purposes Reporting our experience in treating chronic obstructive sialadenitis with a protocol consisting of sialoendoscopy and intraductal instillation of antibiotics, steroids and n-acetyl-cysteine (NAC) solution. Methods Prospective study of patients with chronic obstructive sialadenitis with no apparent lithiasic obstructions, with recurrent non-lithiasic sialoadenitis and patients with lithiasic sialoadenitis not solved with sialoendoscopy. In all cases, a sialoendoscopy was performed. All the patients affected by lithiasic sialoadenitis where the chronic inflammation was resolved with sialoendoscopy were excluded from the study. The mid-term follow-up was performed at 12 mont…

Understanding benign paroxysmal positional vertigo: the management of lateral canal involvement

Benign paroxysmal positional vertigo (BPPV) represents the most common cause of peripheral vertigo. The treatment of this apparently intractable disease is actually a physical treatment: performing manoeuvres on the patient to restore the normal condition of the inner ear. However, the following information will help readers who are unfamiliar with BPPV to improve their knowledge of the condition.

Fat plug myringoplasty: Analysis of a safe procedure for small tympanic perforations

Objective: Assessment of value of fat plug myringoplasty as office-based procedure in small tympanic membrane perforations. Material and Methods: Prospective study of consecutive patients undergoing fat plug myringoplasty under local anesthesia. Minimum follow-up considered was 6 months, which included several microscopic examinations. All data were recorded and analyzed statistically. Results: 33 patients matched the inclusion criteria; the mean perforation size was 2.8 mm. No change in PTA was noted after surgery in the whole series. Recurrence of perforation was detected in 7 cases (21%), which was statistically related with the cause of perforation rather than location or size (p-value …

COMPARSA DI COMPLICANZE GASTRO-INTESTINALI NELL'UTILIZZO DI ANTI-INFIAMMATORI NELLE MALATTIE DEGENERATIVE CRONICHE DELLE ARTICOLAZIONI

Management of benign paroxysmal positional vertigo of lateral semicircular canal by Gufoni's manoeuvre

Abstract Benign paroxysmal positional vertigo (BPPV) of lateral semicircular canal (LSC) is one of the rarer forms of BPPV as compared to posterior semicircular canal BPPV. Various particle repositioning manoeuvres have been described in the literature as a mode of treating this condition. Purpose Evaluation and discussion of the procedure of the Gufoni's manoeuvre and its advantages in the treatment of BPPV of LSC. Material and methods Prospective study of 58 patients affected by LSC BPPV who were office-treated with Gufoni's manoeuvre. Results Seventy-nine percent of the patients so treated had complete resolution of symptoms, and 6.9% did not show any improvement in their symptoms. The r…

The EBV-DNA Can be Used as a Diagnostic and Follow-up Parameter of the Rhinopharyngeal Tumors in the Non-Endemic Population of the Western Sicily

To evaluate whether EBV-DNA can be used as a diagnostic and follow-up parameter for nasopharyngeal tumors in a non-endemic population. The study was carried out in a university hospital. A retrospective study was conducted on 40 paraffin samples of histological preparations. EB-DNA was detected by real-time PCR technique. A prospective study was also conducted on a group of 30 patients who underwent nasopharyngeal biopsy for suspected nasopharyngeal carcinoma (NPC) by comparing EBV-DNA concentrations between the histological specimen and the serum. Quantification of genomic copies of EBV-DNA in serum and detection of anti-EBV antibodies was performed. In both groups the presence of high vir…

Evolution of migraine vertigo in overlapping syndrome with ménière’s disease: Prognostic role of instrumental examination

Migraine vertigo (MV) and Ménière's disease (MD) share several signs and symptoms such as tinnitus, fullness, photophobia, phonophobia, headache and vertigo spells lasting hours.The aim of the present study was to prospectively observe patients with MV with a sporadic audiological symptom evaluated with clinical examination, Vestibular Evoked Myogenic Potentials (VEMPs), ECochG and v-HIT.The finding of VEMP asymmetry, according to our cut-off of 33% of difference between sides, resulted in 20 cases, of which 6 had asymmetry of both c-VEMPs and o-VEMPS, all with development of fluctuating hearing during follow-up. ECochG was positive for endolymphatic hydrops in 12 patients.The evolution of …

Textbook of Vertigo: Diagnosis and Management

Following you will find a brief description of the book done, as accorded with Alessandro De Stefano, to publish in Int Tinnitus J Vertigo: Diagnosis and Management of Jaypee Brother Publisher, is a new book in the field of vestibular disorders. This publication includes several topics ranging from anatomy of vestibular system to the rehabilitation after a vestibular disease. The book, edited by Dr. Francesco Dispenza and Dr. Alessandro De Stefano, had the contribution of about 30 Professors worldwide, experts in the fields of vertigo. The first part of the book includes the information about anatomy, physiology of vestibular system and general approach to the dizzy patients, with a window …

Comparison of Electrocochleography and Video Head Impulse Test findings in Vestibular Migraine and Ménière Disease: A Preliminary Study

OBJECTIVES: To evaluate electrophysiological findings among patients with vestibular migraine (VM) and to compare them with those of patients suffering from definite Ménière disease (MD) without migraine. MATERIALS and METHODS: Twenty-one consecutive patients suffering from VM were enrolled; all subjects were selected according to the criteria proposed by the Bàràny Society for Neuro-otology. Each patient underwent a careful otological and neurotological examination. After completing a questionnaire regarding migraine and vertigo complaints, they were assessed by audiometric testing, video head impulse test (vHIT), and elec-trocochleography (EcochG). Data were compared with those of 21 pati…

Efficacy and pharmacological appropriateness of cinnarizine and dimenhydrinate in the treatment of vertigo and related symptoms

Vertigo is not itself a disease, but rather a symptom of various syndromes and disorders that jeopardize balance function, which is essential for daily activities. It is an abnormal sensation of motion that usually occurs in the absence of motion, or when a motion is sensed inaccurately. Due to the complexity of the etiopathogenesis of vertigo, many pharmacological treatments have been tested for efficacy on vertigo. Among these drugs, cinnarizine, usually given together with dimenhydrinate, appears to be the first-line pharmacotherapy for the management of vertigo and inner ear disorders. Based on these considerations, the present non-interventional study aimed to investigate the clinical …

Management of laryngeal precancerous lesions.

Abstract Objective The identification of precancerous lesions is the basis of an early diagnosis, and of a treatment that allows, in the great part of cases, the preservation of organ functions. The aims of this study were: the evaluation of the less invasive treatment for precancerous lesion of the larynx to minimize the recurrences, the estimation of number of further operation required. Methods A prospective study was done on patients with clinical diagnosis of laryngeal precancerosis. The patients were treated by a transoral endoscopic approach with direct microlaryngoscopy (DML) doing an excision-biopsy with cold blade, consisting in excision of the whole visible lesion with vocal liga…

Larynx Carcinoma epidemiology

Imaging of cervical lymph node metastases in malignant jugular paraganglioma: Imaging of paraganglioma metastases

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Intratympanic gentamicin: a one day protocol treatment for unilateral Meniere’s disease.

Purpose: The objective of this study was to assess the usefulness of low-dose intratympanic gentamicin administration in patients with Meniere’s disease (MD). Materials and Methods: We carried out a retrospective review of the charts of 55 patients with definite MD in accordance with the AAO-HNS (American Academy of Otolaryngology–Head and Neck Surgery) Diagnostic Scale who were treated at Gruppo Otologico (Piacenza, Rome, Italy). The treatment protocol consisted of 3 intratympanic injections of gentamicin at a 12-hour interval between each administration. Results: Results were resumed in accordance with AAO-HNS criteria and showed complete control of vertigo spells in 60% (class A), good c…