Analysis of the Skew Deviation to Evaluate the Period of Onset of a Canalolithiasis After Macular Damage

Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular end-organ disease, and it is one of the first causes of access to the emergency room. The moment of migration of the otoconial debris in a semicircular canal does not necessarily coincide with the moment of detachment of the debris themselves. Consequently, the paroxysmal positional vertigo could arise with a variable delay with respect to the mechanical damage suffered by the macula. The aim of this work is to try to identify objective criteria to establish whether a canalolithiasis is synchronous or diachronic to the damage. The analysis of skew deviation in the context of ocular tilt reaction in patients with canalolithiasis could provide useful information to understand if macular damage occurred at the origin of the disease and when the damage may have occurred. In this study, 38 patients with BPPV were analyzed based on the type of skew deviation that was presented. We found that if the eye on the side of the canalolithiasis is hypotropic the damage of the utriculus is likely recent (last 10 days), if it is hypertropic the damage is not recent (20 days before) and finally if the eyes are at the same height it could be an utricular damage in compensation (occurring the last 10-20 days) or a secondary labyrinth canalolithiasis, without associated utricular damage. Our results show that the evaluation of skew deviation in patients suffering from BPPV could be useful to evaluate: (a) if a positional paroxysmal nystagmus can be related to an previous relevant injury event (for example a head injury that occurred days before the crisis); (b) if it is a BPPV of recent onset or a re-entry of the debris into the canal

Italian survey on benign paroxysmal positional vertigo

Benign paroxysmal positional vertigo (BPPV) is the most common type of peripheral vertigo. BPPV often relapses after the first episode, with a recurrence rate between 15% and 50%. To date both the aetiopathogenetic processes that lead to otoconia detachment and the factors that make BPPV a relapsing disease are still unclear, but recent epidemiological studies have shown a possible association with cardiovascular risk factors. The aim of the present study (Sesto Senso Survey) was to evaluate in the Italian population through an observational survey, the main demographic and clinical characteristics of patients with BPPV (first episode or recurrent) with particular focus on the potential cardiovascular risk factors. The survey was conducted in 158 vestibology centres across Italy on 2,682 patients (mean age 59.3 ± 15.0 years; 39.1% males and 60.9% females) suffering from BPPV, from January 2013 to December 2014. The results showed a high prevalence of cardiovascular risk factors such as high blood pressure (55.8%), hypercholesterolaemia (38.6%) and diabetes (17.7%), as well as a family history of cardiovascular disease (49.4%). A high percentage of patients also had hearing loss (42.9%), tinnitus (41.2%), or both (26.8%). The presence of hypertension, dyslipidaemia and pre-existing cardiovascular comorbidities were significantly related to recurrent BPPV episodes (OR range between 1.84 and 2.31). In addition, the association with diabetes and thyroid/autoimmune disease (OR range between 1.73 and 1.89) was relevant. The survey results confirm the significant association between cardiovascular comorbidities and recurrent BPPV and identify them as a potential important risk factor for recurrence of BPPV in the Italian population, paving the way for the evaluation of new therapeutic strategies in the treatment of this disease

Metabolomics in Otorhinolaryngology

Otorhinolaryngology (Ear, Nose and Throat-ENT) focuses on inflammatory, immunological, infectious, and neoplastic disorders of the head and neck and on their medical and surgical therapy. The fields of interest of this discipline are the ear, the nose and its paranasal sinuses, the oral cavity, the pharynx, the larynx, and the neck. Besides surgery, there are many other diagnostic aspects of ENT such as audiology and Vestibology, laryngology, phoniatrics, and rhinology. A new advanced technology, named metabolomics, is significantly impacting the field of ENT. All the “omics” sciences, such as genomics, transcriptomics, and proteomics, converge at the level of metabolomics, which is considered the integration of all “omics.” Its application will change the way several of ENT disorders are diagnosed and treated. This review highlights the power of metabolomics, including its pitfalls and promise, and several of its most relevant applications in ENT to provide a basic understanding of the metabolites associated with these districts. In particular, the attention has been focused on different heterogeneous diseases, from head and neck cancer to allergic rhinitis, hearing loss, obstructive sleep apnea, noise trauma, sinusitis, and Meniere’s disease. In conclusion, metabolomics study indicates a “fil rouge” that links these pathologies to improve three aspects of patient care: diagnostics, prognostics, and therapeutics, which in one word is defined as precision medicine

Acute Unilateral Vestibulopathy

Acute unilateral vestibulopathy (AUV) is the recommended term (rather than the more widely used vestibular neuritis) for all pathologies involving sudden impairment of the unilateral peripheral vestibular function regardless of the exact location of the lesion. The clinical picture of AUV is characterized by acute severe rotatory vertigo, nausea, vomiting and static and dynamic postural instability. The diagnosis is based on the presence of spontaneous nystagmus (horizontal/torsional, unidirectional), gait imbalance (falling toward the side of lesion) and a positive head impulse test. Typically, no associated auditory or neurological symptoms and signs are present. AUV is thought to be caused by a viral or post-viral inflammation of the vestibular nerve (vestibular neuritis), but a vascular origin of the disease cannot be excluded, especially in the presence of several vascular risk factors.  A careful bedside examination and a complete battery of instrumental test (video head impulse test, cervical and ocular VEMPs) could provide accurate information enabling to correctly diagnose AUV, both in acute and chronic stage of the disease also allowing to exclude a possible central nervous system involvement (vertebrobasilar stroke syndromes may mimic peripheral disorders). After a short course of symptomatic treatment with vestibular suppressants to alleviate the patient’s neurovegetative symptoms and intense rotatory vertigo, vestibular rehabilitation is the treatment of choice although recent reports suggest that an early steroid treatment may improve long-term outcome

Posterior BPPV

Benign positional paroxysmal vertigo (BPPV) represents the most frequently reported vestibular disorder in neurootological clinical practice and is the most frequent cause of vertigo with a prevalence in the general population of about 24%.1,2 is disorder is characterized by the recurrence of brief and violent crises of true vertigo (spinning dizziness) triggered by horizontal and vertical movements of the head. Each episode of vertigo has an abrupt and sudden onset that lasts for a short time (few seconds to 1 minute) and tends to disappear as rapidly as it appears if the patient remains still. e disorder is de ned as paroxysmal on the basis of the intensity of the vertigo perceived and on the particular trend of the nystagmic ndings linked to each positional crisis (positional paroxysmal nystagmus— PPNy) that tends to increase rapidly, reaching a peak that is maintained for a few seconds, and then decreasing quickly until it completely, and just as suddenly, stops. Sometimes the symptomatology appears to such an extent as to induce patients, often unconsciously, to reduce any move- ments of the head and of the body in order to attenuate the symptoms as much as possible. Other types of vertigo may be correlated to the choosing of certain positions but they do not reveal this particular trend