Apogeotropic variant of lateral semicircular canal benign paroxysmal positional vertigo: Is there a correlation between clinical findings, underlying pathophysiologic mechanisms and the effectiveness of repositioning maneuvers?

OBJECTIVE: The apogeotropic variant of horizontal semicircular canal (h-SCC) benign paroxysmal positional vertigo (BPPV) is attributed to canalithiasis of the anterior arm or cupulolithiasis. This study is an attempt to distinguish the most effective maneuvers for each case, by investigating any correlation, between the clinical findings or the treatment options and the possible location of the displaced debris. DATA SOURCES: A review of the literature (1990-2012) was conducted via the PubMed database with the search terms "apogeotropic nystagmus and benign paroxysmal positional vertigo." STUDY SELECTION: Articles on central nervous system lesions were excluded. DATA EXTRACTION: The studies included in the analysis provided detailed diagnostic and therapeutic protocols, supported by the resolution of the signs and symptoms through repositioning maneuvers. DATA SYNTHESIS: Descriptive statistics were used to summarize the findings. Intergroup and intragroup comparisons were performed through Pearson's χ or Fischer's exact test. CONCLUSION: Protocols vary considerably among studies. Nystagmus from seated to supine position is the best studied secondary clinical sign and possibly a clinical indication of cupulolithiasis. In patients with symmetrical responses in the head yaw test, no significant differences can be detected in the occurrence of secondary signs of lateralization compared to patients with asymmetrical responses. The Gufoni maneuver seems to be effective in all pathophysiologic types of apogeotropic h-SCC BPPV. The Barbeque and Vannucchi-Asprella maneuvers mainly target at lithiasis of the anterior ampullary arm. The results of this analysis may imply that different clinical subgroups of h-SCC BPPV may regard to different pathophysiologic and therapeutical mechanisms. © 2013, Otology &Neurotology, Inc

Canalithiasis of the anterior semicircular canal (ASC): Treatment options based on the possible underlying pathogenetic mechanisms

Benign paroxysmal positional vertigo (BPPV) of the anterior semicircular canal (ASC) is an uncommon disorder currently diagnosed with the Dix-Hallpike (D-H) examination. According to the literature, nystagmus and vertigo may be more pronounced when the affected ear is either up or down. In some patients, both right and left D-H tests can trigger nystagmus with the same direction. The proposed treatment options with the addition of a different manoeuvre applied by the authors of the present study in cases of ASC lithiasis, seem to present a respective variety regarding the position of the affected ASC during the procedure of canalith repositioning. The aim of this study is to analyse the mechanisms underlying both the proposed treatment options and the clinical findings in the D-H examination. The results of this analysis stimulate further investigation, since they probably imply that repositioning manoeuvres might vary in their effectiveness when applied to different clinical subgroups of ASC BPPV. © 2010 British Society of Audiology, International

Aggressive psammomatoid ossifying fibroma of the inferior turbinate and lateral nasal wall.

OBJECTIVE: Fibroosseous lesions are rare entities of the nose and paranasal sinuses, the terminology and classification of which are still confusing. Psammomatoid or aggressive (juvenile) ossifying fibroma is a benign messenchymal tumor usually met in the young age (5-15 years), in the sinonasal tract, bearing distinctive histomorphologic features and a tendency towards locally aggressive behaviour. METHODOLOGY: We report here a rare case of an aggressive psammomatoid ossifying fibroma of the inferior turbinate and the lateral nasal wall, with obstruction of the nasolacrimal duct, in a 68-year-old woman. RESULTS: Diagnosis was based on physical examination, CT scan imaging and histopathological examination. Treatment consisted of endoscopic intranasal resection of the tumor accompanied by removal of the lateral nasal wall. CONCLUSIONS: Fibro-osseous tumors of the nose and paranasal sinuses require aggressive surgical approach in order to avoid recurrence. Complete surgical excision may not always be possible mainly due to the tumor's extent and location

Objective assessment of subjective tinnitus through contralateral suppression of otoacoustic emissions by white noise; suggested cut-off points

Objective: Normative otoacoustic emission (OAE) suppression values are currently lacking and the role of cochlear efferent innervation in tinnitus is controversial. The aim of this study was to investigate the association between tinnitus and medial olivocochlear bundle (MOCB) malfunction. Potential suppression amplitude cut-off criteria that could differentiate participants with tinnitus from those without were sought. Design: Mean suppression amplitudes of transient evoked OAEs and distortion product OAEs by contralateral white noise (50 dBSL) were recorded. Six mean suppression amplitudes criteria were validated as possible cut-off points. Study sample: The population consisted of normal hearing (n = 78) or presbycusic adults (n = 19) with tinnitus or without (n = 28 and 13, respectively) chronic tinnitus (in total, n = 138 78 females/60males, aged 49 ± 14 years). Results: Participants with mean suppression values lower than 0.5–1 dBSPL seem to present a high probability to report tinnitus (specificity 88–97%). On the other hand, participants with mean suppression values larger than 2–2.5dBSPL seem to present a high probability of the absence of tinnitus (sensitivity 87–99%). Correlations were stronger among participants with bilateral presence or absence of tinnitus. Conclusions: This study seem to confirm an association between tinnitus and low suppression amplitudes (<1 dBSPL), which might evolve into an objective examination tool, supplementary to conventional audiological testing. © 2016 British Society of Audiology, International Society of Audiology, and Nordic Audiological Society

Aggressive psammomatoid ossifying fibroma of the inferior turbinate and lateral nasal wall.

Item does not contain fulltextOBJECTIVE: Fibroosseous lesions are rare entities of the nose and paranasal sinuses, the terminology and classification of which are still confusing. Psammomatoid or aggressive (juvenile) ossifying fibroma is a benign messenchymal tumor usually met in the young age (5-15 years), in the sinonasal tract, bearing distinctive histomorphologic features and a tendency towards locally aggressive behaviour. METHODOLOGY: We report here a rare case of an aggressive psammomatoid ossifying fibroma of the inferior turbinate and the lateral nasal wall, with obstruction of the nasolacrimal duct, in a 68-year-old woman. RESULTS: Diagnosis was based on physical examination, CT scan imaging and histopathological examination. Treatment consisted of endoscopic intranasal resection of the tumor accompanied by removal of the lateral nasal wall. CONCLUSIONS: Fibro-osseous tumors of the nose and paranasal sinuses require aggressive surgical approach in order to avoid recurrence. Complete surgical excision may not always be possible mainly due to the tumor's extent and location

Operational Products of the Space Weather Application Center Ionosphere (SWACI) and capabilities of their use

The Space Weather Application Center Ionosphere (SWACI) established at DLR Neustrelitz is a project which is essentially supported by the German State Government of Mecklenburg-Vorpommern. Since the project will finish by the end of 2010, the talk will present the final version of data products provided by the SWACI service to registered customers. SWACI operates a powerful data processing system working both in real-time and post-processing modes in order to provide actual information to the registered customers (http://swaciweb.dlr.de). In this talk we will focus on describing transionospheric link related data products offered in near real time for operational use in various applications such as GNSS based navigation and positioning and radar techniques in remote sensing. Typical data products include European and global maps of the Total Electron Content (TEC) and corresponding derivatives such as latitudinal and longitudinal gradients and rate of change, updated every 5 minutes. Global TEC maps are generated by GPS data provided by the International GNSS Service (IGS) networks in the near-real-time streaming mode. Whereas near-real-time TEC maps help to correct range errors in navigation (e.g. range error for single frequency users) and remote sensing applications (e.g. correction of polarization plane rotation), high precision and safety of life applications need actual information on the perturbation degree of the ionosphere. Consequently, to fulfil practical needs, SWACI offers two product types. Scintillation activity characterizing small scale ionospheric irregularities (e.g. S4 index) is obtained along a Pan-European meridional chain of GPS stations with 1 minute update. Furthermore, SWACI provides a so-called Disturbance Ionosphere Index (DIX) which characterizes in particular medium and large scale ionospheric disturbances. Definition and use of this index is discussed. To inform potential users, web-presentation, data management and provision is briefly described. SWACI is already available for interested users at a service level reached so far. In favour of further improving the service, enhanced data exchange with SWENET is foreseen