Observational study on risk factors determining residual dizziness after successful benign paroxysmal positional vertigo treatment: The role of subclinical BPPV

After successful treatment for benign paroxysmal positional vertigo, many patients may complain of residual dizziness. Possible explanations may be the persistence of otolith into canal insufficient to provoke noticeable nystagmus, utricular dysfunction and undiagnosed coexisting vestibular disorder. We conducted a prospective observational case-control study, focusing on the role of risk factors in determining residual dizziness after BPPV treatment. In the present study, 148 patients were recruited and residual dizziness was documented in the 57.5% of the cohort. Among patients with residual dizziness 36 had subclinical BPPV and after retreatment, although nystagmus was not clinically evident, there was resolution of dizziness. We conclude that residual otoliths may play a role in determining post-maneuver residual dizziness that is often linked to subclinical BPPV; this conclusion is also supported by the high prevalence of BPPV recurrence in patients with residual dizziness, as confirmed by our analysis. The main cause appears to be linked with dispersed otolith in semicircular canals

Management of laryngeal precancerous lesions

Objective: The identification of precancerous lesions is the basis of an early diagnosis, and of a treatment that allows, in the great part of cases, the preservation of organ functions. The aims of this study were: the evaluation of the less invasive treatment for precancerous lesion of the larynx to minimize the recurrences, the estimation of number of further operation required. Methods: A prospective study was clone on patients with clinical diagnosis of laryngeal precancerosis. The patients were treated by a transoral endoscopic approach with direct microlaryngoscopy (DML) doing an excision-biopsy with cold blade, consisting in excision of the whole visible lesion with vocal ligament preservation. Results: A recurrence of a clinically evident precancerous lesion was present in 13.2% of patients that had a laryngeal intraepithelial lesion (LIN) 1 lesion and in 28.95% of patients that had a LIN 2 lesion. Conclusion: In order to achieve a control of a precancerous lesion, we suggest: excisional biopsy/subepithelial cordectomy (type 1 cordectomy) for LIN 1 lesions and subligament cordectomy (type 2 cordectomy) in case of LIN 2 cases. In case of recurrences of LIN 1 lesion we suggest directly a type 2 cordectomy

Surgical management of retraction pockets: Does mastoidectomy have a role?

Introduction Retraction pocket is a condition in which the eardrum lies deeper within the middle ear. Its management has no consensus in literature. Objective To assess the role of mastoidectomy in the management of retraction pockets added to a tympanoplasty. Methods Prospective study of patients with retraction pocket and referred to surgery. The patients were randomly assigned to two groups: one managed with tympanoplasty and mastoidectomy and the other group with tympanoplasty only. The minimum follow-up considered was 12 months. The outcomes were: integrity of eardrum, recurrence, and hearing status. Results This study included 43 patients. In 24 cases retraction occurred in the posterior half of the eardrum, and in 19 patients there was clinical evidence of ossicular interruption. The two groups of treatment were composed by: 21 patients that underwent tympanoplasty with mastoidectomy and 22 patients had only tympanoplasty. One case of the first group had a recurrence. In 32 cases patients follow up was longer than 48 months. The average air-bone gap changed from 22.1 dB to 5 dB. The percentage of air-bone gap improvement was assessed at 60% in those patients treated with mastoidectomy, and 64.3% in those without it (p > 0.5). Conclusion Tympanoplasty and ossiculoplasty should be considered to treat atelectatic middle ear and ossicular chain interruption. Mastoidectomy as a way to increase air volume in the ear seems to be a paradox; it does not add favorable prognostic factor to management of retraction pockets

Obstructive sleep apnoea syndrome (OSAS): effects on the vestibular system

Aim of the present study was to evaluate the effects of obstructive sleep apnoea syndrome (OSAS) on the peripheral and central vestibular system, by means of a case series prospective study at the University referral centre of Otolaryngology Head and Neck Surgery; 45 consecutive patients suffering from OSAS were compared with a control group of 30 volunteer subjects selected from among the department employees. Severity of the disease was evaluated by means of cardio-respiratory function monitoring during sleep; the apnoea-hypopnoea index was calculated. Both groups underwent: 1) head and neck examination; 2) fibre-optic examination; 3) pure tone audiometry; 4) evaluation of eye movement disorders using oculomotility tests recorded with the help of video-nystagmography; 5) caloric vestibular responses recorded with video-nystagmography; 6) auditory brainstem response. Results, when evaluating our data, showed that the peripheral vestibular system may become asymmetric due to hypoxic damage while the central vestibular system corrects this disequilibrium

Otosclerosis associated with type B-1 inner ear malformation

Malformations of bony inner ear are rare anomalies occurring in approximately 20% of patients with congenital sensorineural hearing loss. Conductive hearing loss is usually associated with abnormalities of the external and middle ear. Recent reports of patients with lateral semicircular canal malformations indicate inner ear malformations to be associated with sensorineural or conductive hearing loss. Differential diagnosis of conductive hearing loss should include otosclerosis, isolated ossicular deformities, inner ear anomalies or a combination of these. In this report, a case is described with right vestibule-lateral semicircular canal dysplasia presenting at our centre with bilateral otosclerosis

Noise-Induced Hearing Loss in Police Officers: Systematic Review

Introduction: Noise-induced hearing loss (NIHL) is defined as the sensorineural hearing loss caused by acute acoustic trauma or chronic exposure to high-intensity noises. Exposure to noises can lead to irreversible damage to the inner ear and, consequently, to a permanent shift of the hearing threshold. Police officers are particularly at risk of acute or chronic hearing damages. The aim of this study is to evaluate the hearing loss of police officers in relation to the occupational risk factors and clinical-anamnestic characteristics by collecting and analyzing existing data and evidence available in public databases. Materials and Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses group (PRISMA). Studies were included if they met inclusion and exclusion criteria. Study selection, data extraction, and quality assessment were conducted independently by two researchers. Results: Our initial literature search yielded 29 peer-reviewed articles. Out of 29 papers, only 10 were included in the review, after inclusion and exclusion criteria were applied the. Conclusions: Hypertension, smoking and alcohol intake significantly affect hearing performance. In addition, a history of acoustic trauma, use of ototoxic drugs, exposure to noise in leisure-time activities and failure to use ear protectors are often found in a fair number of subjects. NIHL is also related to the age of the subjects as well as the extent and duration of noise exposure. Furthermore, NIHL is also influenced by shooting practice sessions police officers are required to undertake as well as by the chronic exposure to traffic noise, especially in motorcycle police officers

Efficacy and pharmacological appropriateness of cinnarizine and dimenhydrinate in the treatment of vertigo and related symptoms

Vertigo is not itself a disease, but rather a symptom of various syndromes and disorders that jeopardize balance function, which is essential for daily activities. It is an abnormal sensation of motion that usually occurs in the absence of motion, or when a motion is sensed inaccurately. Due to the complexity of the etiopathogenesis of vertigo, many pharmacological treatments have been tested for efficacy on vertigo. Among these drugs, cinnarizine, usually given together with dimenhydrinate, appears to be the first-line pharmacotherapy for the management of vertigo and inner ear disorders. Based on these considerations, the present non-interventional study aimed to investigate the clinical efficacy and tolerability of a fixed combination of cinnarizine (20 mg) and dimenhydrinate (40 mg) in patients suffering from vertigo-related symptoms. To this end, we enrolled 120 adults—70 males, and 50 females—with an average age of 64 years. Before beginning pharmacological treatment, all patients were screened for the intensity of vertigo, dizziness, and concomitant symptoms through the Visual Scale of Dizziness Disorders and Dizziness Handicap Inventory scales. At the end of the anamnestic evaluation, patients received the fixed-dose combination of cinnarizine (20 mg) plus dimenhydrinate (40 mg) 3 times daily, for 60 days. The results of this study provide further insight regarding the efficacy of the fixed combination when used to reduce symptoms of vestibular vertigo of central and/or peripheral origin, after both the 15-and 60-day therapies. Independent of the type of vertigo, the fixed combination was able to reduce dizziness-and vertigo-associated symptoms in more than 75% of all patients treated, starting from 15 days of therapy, and improving 60 days after starting the therapy. Interestingly, we also found differences between male and female patients in the framework of the pharmacological effects of therapy. This study provides further details concerning the therapeutic efficacy of the fixed combination of cinnarizine and dimenhydrinate, and also focuses attention on the possibility that these drugs could act in a gender-specific manner, paving the way for further research

Management of labyrinthine fistula in chronic otitis with cholesteatoma: case series.

Labyrinthine fistula is a complication of ear cholesteatoma that increase the risk of sensorineural hearing loss. The management of the fistula must be done contextually with mastoidectomy by: leaving cholesteatoma matrix over the fistula, or remove the matrix reconstructing the defect. Objective: analysis of the two techniques to treat labyrinthine fistula. Methods: retrospective review with case series analysis. Results: a labyrinthine fistula was present in 14% of cholesteatoma patients; CT scan was pre-dictive in all cases; the hearing preservation was obtained with both techniques; a re-currence was detected only in one case; postoperative nystagmus incidence was higher in those cases with matrix left in situ and when the size of the fistula was lar-ger than 2 mm. Conclusions: the labyrinthine fistula have to be treated contextually with cholesteatoma removal, both techniques had good postoperative hearing preser-vation rate. The postoperative vertigo with nystagmus is more frequent in larger fistu-las

Uvulopalatopharyngoplasty with tonsillectomy in the treatment of severe OSAS

Objective: To establish the efficacy of uvulopalatopharyngoplasty with tonsillectomy for treating selected patients with severe obstructive sleep apnea syndrome Methodology: Retrospective study of patients who underwent clinical/instrumental evaluation and surgical treatment. Setting: University ENT division with a tertiary snoring referral center Participants: Twenty-two patients with normal body mass index affected by severe obstructive sleep apnea syndrome- Main outcome measures: Pre and post operative cardiopulmonary monitoring during sleep, daytime sleepiness evaluation, post treatment complication recording. Results: Complete response to therapy was obtained in 78% of patients. Four patients had relief of symptoms but retained apnea-hypopnea index scores greater than 5 Conclusions: Uvulopalatopharyngoplasty associated with tonsillectomy can be employed safely to treat patients with normal body mass index who suffer from severe obstructive sleep apne