Vestibular thresholds for yaw rotation about an earth-vertical axis as a function of frequency

Perceptual direction detection thresholds for yaw rotation about an earth-vertical axis were measured at seven frequencies (0.05, 0.1, 0.2, 0.5, 1, 2, and 5Hz) in seven subjects in the dark. Motion stimuli consisted of single cycles of sinusoidal acceleration and were generated by a motion platform. An adaptive two-alternative categorical forced-choice procedure was used. The subjects had to indicate by button presses whether they perceived yaw rotation to the left or to the right. Thresholds were measured using a 3-down, 1-up staircase paradigm. Mean yaw rotation velocity thresholds were 2.8degs−1 for 0.05Hz, 2.5degs−1 for 0.1Hz, 1.7degs−1 for 0.2Hz, 0.7degs−1 for 0.5Hz, 0.6degs−1 for 1Hz, 0.4 degs−1 for 2Hz, and 0.6degs−1 for 5Hz. The results show that motion thresholds increase at 0.2Hz and below and plateau at 0.5Hz and above. Increasing velocity thresholds at lower frequencies qualitatively mimic the high-pass characteristics of the semicircular canals, since the increase at 0.2Hz and below would be consistent with decreased gain/sensitivity observed in the VOR at lower frequencies. In fact, the measured dynamics are consistent with a high pass filter having a threshold plateau of 0.71degs-1 and a cut-off frequency of 0.23Hz, which corresponds to a time constant of approximately 0.70s. These findings provide no evidence for an influence of velocity storage on perceptual yaw rotation threshold

Extreme sensitivity of hearing to decreases of ICP in Menière's disease

We report the case of a Menière's disease patient affected by normal pressure hydrocephalus (NPH) who presented a cerebrospinal fluid (CSF) pressure-dependent hearing impairment after shunting. This side-effect was not only reversible and reproducible but occurred at a high opening pressure when the valve setting was lowered by only 0.7mmHg (10mmH2O). This observation suggests that hearing in Menière's disease might be very sensitive to small reductions of intracranial pressure (ICP) and that these patients should be informed of this potential risk, which can compromise the efficacy of the shun

Vestibular thresholds for yaw rotation about an earth-vertical axis as a function of frequency.

Perceptual direction detection thresholds for yaw rotation about an earth-vertical axis were measured at seven frequencies (0.05, 0.1, 0.2, 0.5, 1, 2, and 5 Hz) in seven subjects in the dark. Motion stimuli consisted of single cycles of sinusoidal acceleration and were generated by a motion platform. An adaptive two-alternative categorical forced-choice procedure was used. The subjects had to indicate by button presses whether they perceived yaw rotation to the left or to the right. Thresholds were measured using a 3-down, 1-up staircase paradigm. Mean yaw rotation velocity thresholds were 2.8 deg s(-1) for 0.05 Hz, 2.5 deg s(-1) for 0.1 Hz, 1.7 deg s(-1) for 0.2 Hz, 0.7 deg s(-1) for 0.5 Hz, 0.6 deg s(-1) for 1 Hz, 0.4 deg s(-1) for 2 Hz, and 0.6 deg s(-1) for 5 Hz. The results show that motion thresholds increase at 0.2 Hz and below and plateau at 0.5 Hz and above. Increasing velocity thresholds at lower frequencies qualitatively mimic the high-pass characteristics of the semicircular canals, since the increase at 0.2 Hz and below would be consistent with decreased gain/sensitivity observed in the VOR at lower frequencies. In fact, the measured dynamics are consistent with a high pass filter having a threshold plateau of 0.71 deg s(-1) and a cut-off frequency of 0.23 Hz, which corresponds to a time constant of approximately 0.70 s. These findings provide no evidence for an influence of velocity storage on perceptual yaw rotation thresholds

Quality of life after gamma knife radiosurgery treatment in patients with a vestibular schwannoma: the patient’s perspective

This study evaluates the impact of gamma knife radiosurgery (GKRS) on the quality of life (QOL) of patients with a sporadic vestibular schwannoma (VS). This study pertains to 108 VS patients who had GKRS in the years 2003 through 2007. Two different QOL questionnaires were used: medical outcome study short form 36 (SF36) and Glasgow benefit inventory (GBI). Radiosurgery was performed using a Leksell 4C gamma knife. The results of the QOL questionnaires in relation to prospectively and retrospectively gathered data of the VS patients treated by GKRS. Eventually, 97 patients could be included in the study. Their mean tumor size was 17 mm (range 6–39 mm); the mean maximum dose on the tumor was 19.9 Gy (range 16–25.5 Gy) and the mean marginal dose on the tumor was 11.1 (range 9.3–12.5 Gy). SF36 scores showed results comparable to those for a normal Dutch population. GBI showed a marginal decline in QOL. No correlation was found between QOL and gender, age, tumor size, or radiation dose. Increased audiovestibular symptoms after GKRS were correlated with a decreased GBI score, and decreased symptoms were correlated with a higher QOL post-GKRS. In this study shows that GKRS for VS has little impact on the general QOL of the VS patient. However, there is a wide range in individual QOL results. Individual QOL was influenced by the audiovestibular symptoms. No predictive patient, tumor, or treatment factors for QOL outcome after GKRS could be determined. Comparison with microsurgery is difficult because of intra group variability

Major bleeding of the upper aerodigestive tract due to oral anticoagulant/antibiotic interactions

INTRODUCTION Although a well-known complication in certain medical specialties, major bleeding due to the interaction between oral anticoagulants and antibiotics has been rarely reported concerning the upper aerodigestive tract. We report three cases of life-threatening bleeding of the upper aerodigestive tract in a context of antibiotic therapy in patients treated with oral anticoagulants. CASE SERIES Three male patients under coumadin anticoagulation therapy presented major bleeding in three different contexts (epistaxis, peritonsillar abscess and postoperative course after total laryngectomy). Surgical intervention for hemostasis was required in all cases, with coagulation correction in two. Complications were severe anemia (2/3) and chronic heart failure (1/3). DISCUSSION/CONCLUSIONS Interactions between two drugs commonly used in otolaryngology can result in major bleeding. The goal of this article is to raise practitioners' awareness of a potentially fatal, although rare, complication. We also review the main preventive strategies