Contralateral delayed endolymphatic hydrops: Clinical features and long term outcome

Background: Contralateral delayed endolymphatic hydrops (CDEH) is a clinical entity characterized by fluctuating low frequency hearing loss and/or vertigo, mimicking Ménière's disease (MD), that manifests after the appearance of severe non-hydropic hearing loss (NHHL) at the other ear. Objectives: to describe the clinical features and the course of 57 patients affected by CDEH. Method: this is a retrospective study; 57 patients affected by CDEH, out of 1065 patients seen in the same period and affected by MD, were subjected to otoscopy, PTA threshold evaluation, impedance testing, ABR, research of positioning nystagmus, vestibular function evaluated by means of bithermal caloric test under video-oculographic, and MRI with gadolinium. Results: the CDEH was definite in 24 cases (42%), probable in 2 (4%) and possible in 31 (54%). The mean PTA threshold at the hydropic ear was 41 dB. At the last follow-up, 40 patients (70%) did not report vertigo or fluctuating hearing loss. Among the 17 patients who still reported symptomatology, 11 (64%) were affected by fluctuating hearing loss alone, 4 (23%) reported a subjective worsening of hearing loss and 2 (12%) an acute vertigo crisis. Conclusions: contralateral delayed endolymphatic hydrops is a relatively rare form of Ménière disease that manifests more frequently as a definite form or with fluctuating low-frequency hearing loss. The prognosis at a long term follow-up is relatively good in terms of vertigo resolution. Contralateral delayed endolymphatic hydrops rarely determines a severe hearing loss in the better ear

Analysis of an underwater vehicle’s model for linearization and control purpose

In the present paper, a geometric-differential approach is employed to analyze the properties of a nonlinear model for the dynamics of Unmanned Underwater Vehicles. In particular, local accessibility, observability and feedback linearizability are investigated. The system is shown to be linearizable and a controller based on linearizing feedback and optimal control techniques is designed. Control performances and robustness properties of the control scheme are investigated by means of suitable simulations and discusse

Vertigo returning to the sitting position after the semont manoeuvre. Is it a prognostic symptom?

Benign paroxysmal positional vertigo (BPPV) is a frequent benign vestibular condition usually managed with particle repositioning manoeuvres, such as Semont manoeuvre (SM). Since few authors have described prognostic aspects of liberatory manoeuvres, the purpose of the present study was to investigate the possibility of considering vertigo in the final sitting position of the SM as a prognostic symptom in the outcome of posterior BPPV. One hundred and thirteen patients with diagnosis of unilateral posterior BPPV were taking into account in our retrospective cohort study: 41 men and 72 women, aged 22 to 85 years. All were submitted to one repositioning SM and afterwards controlled 3 to 5 days later by means of an additional Dix-Hallpike manoeuvre. The main outcomes investigated were the occurrence of Ny and vertigo in the different phases of the SM, as well as their characteristics in relation to outcome of the disease. Among all patients, 75 (66%) presented both orthotropic Ny and vertigo in the second SM position and 72% obtained a complete resolution of the disease after the liberatory manoeuvre. Contrarily, 17 subjects (15%) manifested vertigo in the final sitting position of the SM and among these, only 7 (41%) completely recovered from BPPV. According to our data, in case of sudden vertigo returning to the final sitting position of the SM, the failure rate of the liberatory manoeuvre was higher, even though not statistically significant: therefore, it can be considered as a negative prognostic factor of posterior BPPV after SM

Clinical features and long-term outcome of ipsilateral delayed endolymphatic hydrops

BACKGROUND: Ipsilateral delayed endolymphatic hydrops (IDEH) is a disease characterized by recurrent acute vertigo that manifests after the appearance of a severe sensorineural non-hydropic hearing loss without symptomatology at the other ear. The cause of hearing loss can be congenital or acquired and, in the latter group, the hearing loss is usually sudden or secondary to head or acoustic trauma, ear surgery, viral infection, otitis media, streptomycin, meningitis, inner ear abnormality or idiopathic. METHODS: Data from 37 IDEH patients, who account for 3.4% of the overall sample of menieric patients at our institution, were analyzed in this retrospective study. RESULTLTS: The mean age of the sample was 58 years. Mean duration of the disease at the moment of diagnosis was 57 months. Follow-up ranged from 24 to 180 months (average: 87 months). Hearing loss at the ear cause of IDEH was due to sudden hearing loss in 23 cases (62%), chronic otitis operated on in five cases (14%) and congenital in one case (3%); in eight cases (21%) the cause of hearing loss was unknown. Mean age of appearance of IDEH was 54 years, mean interval between the appearance of HL and IDEH was 82 months and mean duration of the disease at the time of diagnosis was 57 months. Mean PTATA threshold at the affected ear was 88 dB. After dietetic and medical treatment, with a follow-up of 24 to 180 months (average: 87 months), we have obtained the resolution of vertigo crisis, or an acceptable reduction in crisis intensity and/or frequency, in 50 patients (88%). In the remaining seven patients intratympanic gentamicin, following the titration method, was applied, with the resolution of vertigo in six of them (88%); in one cases we have carried out the labyrinthectomy, that solved vertigo crisis. CONCLUSIONS: In conclusion IDEH is a not frequent form of Ménière's disease with good long-term prognosis and in case on vertigo not responsive to medical therapy intratympanic gentamicin labyrinthectomy can solve symptomatology

Comparison of VEMPs, VHIT and caloric test outcomes after vestibular neurectomy in Menière's disease

Objective: Selective unilateral vestibular neurectomy (VN) is considered a reliable surgical treatment in case of recurrent vertigo in Menière's disease (MD) because of hearing preservation and a minimally invasive posterior fossa retrosigmoid approach. The present study aimed to assess the quality of life and the long-term vestibular function in patients submitted to yearly follow-up after VN because of intractable MD. Methods: Retrospective series of 15 MD patients undergoing retrosigmoid VN for recurrent vertigo. Outcome measures included cVEMPs and oVEMPs (cervical and ocular vestibular evoked myogenic potentials), VHIT (Video Head Impulse Test) and caloric test, besides to DHI (Dizziness Handicap Inventory) and PTA (Pure Tone Audiometry). Results: Mean DHI score resulted within normal values in 74% of patients, significantly correlated to the duration of the follow-up. In the operated side, cVEMPs and oVEMPs have not been elicited respectively in 11 patients (73%) and 13 patients (87%), whereas it was not possible to evoke any response at bithermal caloric test in 4 cases. The gain of VOR from VHIT resulted always below normal values after VN except in one patient, who has also undergone an episode of posterior BBPV. The difference between average PTA threshold before and after VN resulted not significant. Conclusion: The vestibular outcomes prove VN to be an effective and safe surgery in MD; furthermore, the unexpected occurrence of BPPV after VN can justify the presence of neural anastomosis between the inferior vestibular nerve and the cochlear nerve, allowing to still perceive vestibular symptomatology despite of a proper neurectomy

Quale ruolo per l\u2019arboricoltura da legno italiana nel protocollo di Kyoto? Indicazioni da una \u201cKyoto forest\u201d della pianura emiliana

The carbon balance of an afforested area in the Emilia-Romagna floodplain has been monitored for a 4-year period. Detailed measurements covering both above- and below-ground components of biomass production and accumulation were complemented by eddy-covariance measurements at the ecosystem level. Experimental results have been extrapolated in time by means of a process-based ecosystem model, so as to better assess the potential role of afforestation towards the carbon-reduction goals of the Kyoto Protoc