Repositioning maneuver for the treatment of the apogeotropic variant of horizontal canal benign paroxysmal positional vertigo

Objective: The purpose of this study was to determine the effectiveness of a new physical maneuver in the treatment of the apogeotropic variant of horizontal canal benign paroxysmal positional vertigo. Study Design: Case review. Setting: Outpatient clinic. Patients: The diagnosis of apogeotropic horizontal canal benign paroxysmal positional vertigo was based on the history of recurrent sudden crisis of vertigo associated with bursts of horizontal apogeotropic paroxysmal nystagmus provoked by turning the head from the supine to either lateral position. The patients were three men and five women ranging in age from 31 to 73 years (average, 49.2 yr). Interventions: All patients were treated with a repositioning maneuver based on the hypothesis that the syndrome is caused by the presence of free-floating dense particles inside the endolymph of the anterior arm of the horizontal canal. The maneuver favors their shifting into the posterior arm of the canal. Patients were reexamined immediately after the treatment and underwent Gufoni's liberatory maneuver for the geotropic variant of horizontal canal benign paroxysmal positional vertigo. Main Outcome Measure: The treatment outcome was considered as responsive when, after one repositioning maneuver, nystagmus shifted from apogeotropic to geotropic. Results: The repositioning maneuver resulted in a transformation from the apogeotropic variant into a geotropic variant of horizontal canal benign paroxysmal positional vertigo in all patients. Conclusion: This maneuver represents a simple and effective approach to the treatment of the apogeotropic variant of horizontal canal benign paroxysmal positional vertigo. It favors the shifting of the canaliths from the anterior into the posterior arm of the horizontal canal from where they can migrate into the utricle with Gufoni's maneuver

Vestibular Evoked Myogenic Potentials and Glycerol Testing

Objectives/Hypothesis: The objective was to evaluate dizziness as the first symptom of endolymphatic hydrops, which could provide valuable information on the initial stages of endolymphatic hydrops development. Study Design: The present investigation was specifically designed to establish whether a combination of the traditional glycerol test and the vestibular evoked myogenic potential (VEMP) glycerol test is capable of diagnosing endolymphatic hydrops early and to identify potential Meniere's disease. The study was limited to patients who complained of dizziness as their only vestibular symptom. Methods: Thirty-eight consecutive patients with dizziness who had received no treatment were investigated. Each patient underwent glycerol testing measured with both conventional pure-tone audiometry and vestibular evoked myogenic potential testing. For the vestibular evoked myogenic potential glycerol test, an increase of more than 20% in both latency and amplitude after glycerol intake was considered an improvement. Results: In one patient, the reappearance of the vestibular evoked myogenic potentials was observed. In another six patients, there was an increase in the vestibular evoked myogenic potential amplitudes, unilaterally in four cases and bilaterally in two. One patient showed a bilateral improvement in amplitude and an unilateral amelioration in latency. Conclusion: The assumption of saccular dilation as a sign of early Meniere's disease was not supported by the literature, which considered saccular hydrops as the final progression of the dilation of the endolymphatic compartments into the cochlea. These data seem to indicate that in our patients a saccular dysfunction rather than an early saccular hydrops has been documented, confirming vestibular evoked myogenic potential testing as an intriguing diagnostic option for a lesion of this structure. The vestibular evoked myogenic potential glycerol test proved capable of identifying dysfunctions of the saccule that were not otherwise detectable by the routine methods. Therefore, the vestibular evoked myogenic potential glycerol test should be considered as an additional method of diagnosis in patients with vertigo or dizziness

Elastofibroma and the external auditory canal.

An elastofibroma is a rare fibro-elastic pseudotumor, first reported in 19611. It is usually located at the lower pole of the scapula and rarely at other sites. The etiology is unclear, but may be related to abnormal elastogenesis caused by repetitive trauma or friction between the scapula and chest wall2,3. The choice of treatment is controversial: some have suggested a marginal excision because it carries a low recurrence risk whereas others adopt a wait-and-see approach in asymptomatic patients because malignant transformation of the lesion has not been reported4. We present the case of a man with an elastofibroma of the external auditory canal (EAC). To our knowledge, this is the first case of elastofibroma localized in the EAC to be reported in the English language literature

Unilateral vestibular schwannoma associated with a Jacobson's schwannoma

Coexistence of unilateral vestibular schwannoma and Jacobson's schwannoma growing in the same intracranial site is rarely observed. We present the case of 36-year-old woman with primary diagnosis of vestibular schwannoma and subsequent appearance of schwannoma to the Jacobson's nerve. Initial wait and see strategy was performed offered us the opportunity to describe Jacobson's lesion features at computed tomography over a period of 4 years. Subtotal petrosectomy with infralabyrinthine approach was subsequently executed to remove the growing mass of the temporal bone. The Jacobson's schwannoma increased its size from 0.4 cm for years whereas vestibular schwannoma size was unchanged after 7 years observation. The concomitant removal of both schwannomas is still associated with the size of the CPA lesion and to patient's symptoms

Solitary nonfamilial desmoplastic trichoepithelioma of the external auditory canal

Solitary desmoplastic trichoepithelioma is a benign adnexal neoplasm first described by Brownstein and Shapiro in 1976. It can be solitary or multiple, familial or not familial. We present the case of a young man affected by solitary non familial desmoplastic trichoepithelioma of the external auditor canal (EAC). Clinical and histological findings are described. To our knowledge this is the first reported case of solitary desmoplastic trichoepithelioma of the EAC