Caloric test and simultaneous recording of sympathetic skin response.

CONCLUSIONS: It was found that there was a close correlation between sympathetic skin response (SSR) parameters and nystagmus parameters obtained in caloric tests. Further studies are needed to investigate the clinical correlation of these findings. OBJECTIVES: To investigate whether the caloric response creates a measurable SSR and, if so, to compare the SSR parameters with the nystagmus parameters and the feelings of the patient. MATERIAL AND METHODS: Patients completed an autonomic symptom questionnaire (ASQ) regarding their past history of autonomic symptoms. They used a visual analog scale (VAS) to assess the severity of symptoms during simultaneous SSR and caloric tests. Symptoms were also noted separately by the investigator. RESULTS: Eighteen patients were included in the study (13 females, 5 males). Eight of the patients had central and 10 had peripheral vertigo. The mean VAS score was 6.6+/-1.9 and the mean ASQ score was 7.2+/-3.6. In terms of the recorded parameters, there were no significant differences between patients with central and peripheral vertigo, males and females or warm and cold irrigation. The number of SSR waves increased significantly when the slow-phase velocity was > 26 degrees/s (p<0.01) and the nystagmus latency was < or = 27 s (p<0.05). The VAS score was also correlated with the number of SSR waves (p<0.01)

Is psychogenic dizziness the exact diagnosis?

The main goal of the study is to determine the exact ratio of pure psychogenic dizziness. Patients from vertigo outpatient clinic were evaluated by SCL-90 R questionnaire, interviews, vestibular tests and magnetic resonance imaging (when needed). Five hundred and eighteen patients were evaluated for this study. While 45.2% of the patients have at least one abnormal psychogenic scale (somatization, obsessive-compulsiveness, interpersonal sensitivity, depression, anxiety etc.), only 9% of the patients were diagnosed as psychogenic dizziness according to the interview. One percent of 518 had no organic cause for dizziness and also diagnosed as pure psychogenic dizziness. Our results suggest that patients with dizziness need to be evaluated by psychological tests routinely and patients with high-test scores must consult a psychiatrist who is familiar with dizziness symptomatology

Does the stapes reflex remain the same after Bell's palsy?

OBJECTIVE: The authors investigated the integrity and function of nervus stapedius 1 year after facial paralysis. STUDY DESIGN: Patients with Bell's palsy were observed prospectively for 1 year and compared with healthy patients. SETTING: The follow-up of patients was done in the outpatient clinic and tests were applied in the audiology unit. PATIENTS: The mean age of 32 patients was 41.03 years. Eight of 32 patients were grade II (25%), 11 were grade III (35%), and 13 were grade IV (40%) according to House-Brackman grading system. The mean age of the control group (10 persons) was 36.5 years. INTERVENTION: Contralateral stimulus was used in acoustic reflex test at 500 and 1,000 Hz with 80-, 90-, 100-, and 110-dB stimulus intensity. Tests were applied in three ways: normal position, eye-closed position, and grin position. Tests were done in the first 15 days of facial paralysis and repeated at least 1 year thereafter. The millimeter difference in amplitude of impedance recording of middle ear between the normal ear and paralyzed ear was accepted as criterion. MAIN OUTCOME MEASURES: There were 6- to 9-mm amplitude differences between normal side and healed side of grade IV patients with 100- and 110-dB stimuli. RESULTS: In the second test (after 1 year), statistically significant differences were present between control group and grade IV patients on 1,000 and 500 Hz frequencies with 100- and 110-dB stimulus intensity (p < 0.05). There were no significant differences between grade II and control group and between grade III and control group. CONCLUSIONS: A permanent partial denervation is present on the stapedial nerve, especially after grade IV paralysis, and it affects the function of stapes muscle in high decibel sounds. But it does not affect the stapes reflex threshold. No synkinetic innervation was found in the authors' patient group with their test method

Impact of multiple etiology on dizziness handicap.

OBJECTIVE: Our aim was to find the ratio of multiple diagnosis in dizziness patients and to evaluate the effect of multiple etiologies on handicap level of the patient. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary referral center. INTERVENTION: The data of 703 patients (178 men and 525 women) were included in the study. Diagnoses of the patients were made in a multiple-specialty environment including otolaryngology, neurology, cardiology, internal medicine, and rehabilitation medicine. MAIN OUTCOME MEASURES: All patients filled the dizziness handicap inventory and pointed the severity of dizziness on a 10-point visual analog scale. RESULTS: Four hundred thirty-three patients (61.6%) have only one diagnosis, whereas 183 (26%) had two. Three diseases have been found in 34 patients (4.8%), and four diseases were present in eight patients (1.1%). The mean number of diagnosis in one patient was 1.32 +/- 0.71. There was a significant difference between two sexes on the number of disease. There was no correlation between age and the number of diagnosis. There was no significant difference in functional scale, but the statistically significant increases are present in both physical (p < 0.05) and emotional (p < 0.01) scales. There was no correlation between age and handicap levels. CONCLUSION: Multiple diagnoses were important factors on physical and emotional handicaps. It was also found that this problem is not limited with older age group

Efficacy of vestibular rehabilitation on chronic unilateral vestibular dysfunction.

OBJECTIVE: To assess the efficacy of vestibular rehabilitation exercises on patients with chronic unilateral vestibular dysfunction. DESIGN: Prospective study. SETTING: Physical Medicine and Rehabilitation Clinic and Otolaryngology Clinic of a tertiary referral hospital. SUBJECTS: One-hundred and twenty-five patients with unilateral chronic vestibular dysfunction were included in the study. INTERVENTIONS: Eight-week, two-staged (clinic and home) vestibular rehabilitation programme with components of Cawthorne-Cooksey and Norre exercises was applied. MAIN OUTCOME MEASURES: Dizziness Handicap Inventory (DHI) and visual analogue scale (VAS) were completed three times (at the beginning, end of the second week and end of the treatment). RESULTS: Data for 112 patients in the first stage and 93 patients in the second stage were evaluated because of insufficient compliance of the other patients. The mean DHI score was decreased from 50.42 +/- 24.12 points to 21.21 +/- 15.97 points (p < 0.001) at the end of first two weeks, and to 19.93 +/- 19.33 points at the end of the whole treatment. The mean VAS score was decreased from 5.87 +/- 2.27 to 2.02 +/- 1.75 (p < 0.001) at the end of second week, and to 1.51 +/- 1.29 at the end of eighth week. In respect to both VAS and DHI scores, improvement was noted in 67 patients (77.4%). Age, gender and disability level had no predictive value about therapy outcome. CONCLUSIONS: There was a fast recovery in the supervised exercise session, whereas there was no significant difference in the home exercise session. These findings suggest that either supervised exercise is better than home exercise or that 10 supervised sessions are sufficient to get the end result

Subjective visual vertical and subjective visual horizontal measures in patients with chronic dizziness.

OBJECTIVES: We aimed to find the frequency of otolith organ pathologies in the clinical picture of common dizziness etiologies in the chronic stage. METHOD: Subjective visual vertical and subjective visual horizontal measures were assessed in patients who had persistent or recurrent dizziness at least 2 months after the acute period. Every patient was tested in three head positions: neutral, right, or left deviation in the roll plane. Test results were compared with those of the control group. RESULTS: Seventy-three patients and 18 controls were examined. Fifty-eight of the patients had peripheral vestibular disease; 15 of them had central vestibular disease. Left subjective visual horizontal (SVH) and right SVH measures of the peripheral group were significantly different from those of the control group (p < .01). There was no difference in any test between the peripheral and central groups. When we put a cut off point for abnormality (0, 1) according to mean +/- 2 SD of the control group, the peripheral and central groups had very high significant differences from the control group. Approximately 25 to 50% of our patients had pathologic subjective visual vertical or SVH measures according to test type. CONCLUSION: These results showed that the otolith system must be evaluated in the chronic period of dizziness, especially in patients who frequently visit their physician, and modifications in treatment programs must be conducted

High-frequency hearing and reflex latency in patients with pigment disorder.

PURPOSE: To investigate the activities of inner ear melanin in patients with pigment variations and disorders. Our purpose was to find evidence on the effects of melanin-containing cells by measuring the high-frequency threshold and the latency of stapes reflex in patients with vitiligo. PATIENTS AND METHODS: Twenty-nine patients with active vitiligo and 41 healthy subjects were included in this study. Pure tone thresholds were determined at frequencies between 250 and 16,000 Hz. Ipsilateral and contralateral stapes reflexes were measured at 1,000, 2,000, and 4,000 Hz. After we compared the results in the control and vitiligo groups by using the Mann-Whitney U test for each frequency, we compared women and men separately to eliminate gender differences. RESULTS: Pure tone thresholds of the vitiligo group were significantly lower than the control group at 4,000, 6,000, 8,000 and 10,000 Hz (P < .05). The statistically different thresholds were 8,000 and 10,000 Hz in women, compared with 4,000, 6,000, 8,000, 10,000, 12,500, and 16,000 Hz in men (P < 0.05). Reflex latencies for the two groups were not statistically different. CONCLUSION: Vitiligo, which is a type of pigment disorder, seems to be an effective factor in hearing loss, and men are more susceptible to it than women. The mechanism for this condition might be the absence of the preventive function of melanin-containing cells in the inner ear

Improvement of hearing results by bone cement fixation in endoscopic stapedotomy.

OBJECTIVE: This study aimed to compare the hearing results of two different stapedotomy techniques used in the clinic at different time points. METHODS: An endoscopic surgery group (group 1; n = 37) were compared retrospectively with a microscopic surgery group (group 2; n = 57). A small fenestra and Teflon piston technique were used in all patients. Bone cement was used for fixation between the prosthesis and incus in the endoscopic group only. Bone conduction threshold and air-bone gap were used as the comparison parameters. RESULTS: The pre-operative air-bone gap was 31.26 dB in group 1 and 32.51 dB in group 2. The post-operative air-bone gap was 8.93 dB in group 1 and 14.28 dB in group 2. There was a significant difference between the groups in post-operative air-bone gaps. There was no significant difference between the groups in post-operative bone conduction thresholds. CONCLUSION: The endoscopic technique using bone cement fixation was better for closing the air-bone gap

Low dose sultamicillin in acute sinusitis.

OBJECTIVES: To study the effectiveness of low dose sultamicillin in the treatment of acute sinusitis. METHODS: A total of 108 patients, between 16-56 years of age (mean 32.8), suffering from acute sinusitis took part in the trial. Patients received orally 2 x 375 mg sultamicillin, and compared with patients receiving 3 x 500 mg amoxicillin. The first control was made between the 5th and 7th days. A patient was considered clinically cured when all pretreatment signs and symptoms of infection were eliminated. Clinical improvement was defined as the partial disappearance of pretreatment signs and symptoms. In either result, study drugs were reconstituted for additional 5 days. Failure was defined as no change or worsening of signs and symptoms; and study drug was changed. The second control was made between 10-12th days, and the third was four weeks later. RESULTS: The clinical success (improvement + cure) rate was (17+11)/42 (66.6%) and (28+21)/66 (74.2%) for amoxicillin and sultamicillin respectively, at first control. All improved patients were cured at the second control. No significant side-effects were noted in either amoxicillin or sultamicillin treated patients. All side effects were gastrointestinal, 11.9% and 3.0% in the same order. CONCLUSIONS: Low dose sultamicillin was comparable to amoxicillin; sultamicillin has fewer side effects than amoxicillin (p>0.05)