Harefuah最新文献

Introduction: The demand for urgent psychiatric services provided in emergency departments demonstrates high variability throughout the year. Seasonality and holidays may influence this demand. While these two phenomena are widely documented for mental healthcare, the unique climate and Israeli population, which is mostly Jewish, raises doubts regarding the relevance of prior results.

Introduction: Vestibular Schwannoma, a benign slow growing tumor on the eight cranial nerve, will eventually cause in most patients, a severe sensory neural hearing loss in the ipsilateral ear. Patients with asymmetric hearing loss experience difficulties in hearing in the presence of noise, in sound localization and an increase in listening effort, especially if contralateral hearing loss exists. Cochlear implant is the treatment of choice for hearing rehabilitation in severe to profound sensorineural hearing loss. This treatment was shown to be effective in patients with vestibular schwannoma whether they were treated by surgery, radiation or conservative surveillance only. In this case report we present 2 patients with stable growth of over 10 years, who presented with a severe decrease in hearing loss on the ipsilateral side and a known contralateral moderate loss. Both underwent cochlear implant with no other intervention and demonstrated great speech perception results and continue to use the implant regularly for several years. The cochlear implant is an effective tool for hearing rehabilitation for patients with a stable vestibular schwannoma under conservative surveillance. It is of grave importance to properly educate these patients on hearing rehabilitation and recommend cochlear implant for appropriate patients.

Introduction: The video head impulse test (vHIT) is a new tool in the vestibular tests' arsenal. It is based on the clinical Head Impulse Test, where the integrity of the vestibulo-ocular reflex is tested by high frequency excitation of the semi-circular canals. The vHIT system is composed of an accelerometer measuring the head movements, and a high frequency infra-red camera for eye tracking mounted on a light-weighted goggles. The main measures obtained are the vestibulo-ocular reflex gain - the ratio between the head and eye velocities, and the recording of corrective saccades taking place during the head movement (covered saccades) or following it (overt saccades).

Introduction: While the bedside head impulse test evaluates the presence of refixation saccades (RS) as a measure of failing vestibulo-ocular reflex (VOR) the VOR gain calculated by the video head-impulse test (vHIT) is considered the primary measure for semicircular canal function while the role RS is still under evaluation.

Aims: To evaluate the benefit of various RS characteristics towards the diagnosis of the left horizontal semicircular function by vHIT.

Methods: The vHIT recordings of 40 patients with left sided horizontal VOR gains <0.8 were retrospectively evaluated for the presence of RS. The study groups included 20 patients with a final diagnosis of left horizontal semicircular canal dysfunction and 20 patients for whom vestibular dysfunction was ruled out.

Results: Gain values > 0.72 were found in all patients with no vestibular disease, and in 4 (20%) patients having vestibulopathy. Significantly higher average left-sided RS velocity and frequency were found among the vestibular patients. VOR gain < 0.72 was found to be highly specific for the diagnosis of vestibular dysfunction. However, for gain values in the range of 0.72-0.79 the presence of RS with frequency > 80% improved vHIT sensitivity.

Conclusions: Although VOR gain<0.8 is considered to reflect dysfunction, a significant false positive rate for left-sided horizontal vHIT was found for gains in the range of 0.72-0.79. The presence of RS with frequency >80% could improve vHIT diagnostic accuracy in these patients.

Introduction: The vestibular system - the sixth sense - allows humans to preserve balance, stable vision, and body orientation in space. This system performs a continuous integration of the activity of the vestibular end-organ in the inner ear, the sense of sight, and the proprioceptive sense. Damage to the components of the vestibular system causes dizziness, imbalance, and poor orientation in space. Following vestibular injury, central compensation mechanisms are recruited to reduce the symptoms and improve the functional ability of the dizzy patient. Dizziness is a subjective complaint. Yet, the development that has taken place in the field of vestibular function testing allows accurate diagnosis, targeted treatment, and disability assessment of the dizzy patient. The dizzy patient must be examined meticulously, taking into account all the levels on which the vestibular impairment can affect (physiological, behavioral, and functional). Meaning, clinical and laboratory evaluation of the vestibular function together with functional testing of the patient. In this article, the authors present the range of existing innovative tests of the vestibular system. Vestibular tests are accepted in advanced vestibular laboratories in Israel and around the world, and enable assimilation in vestibular clinics and medical committees in Israel.

Introduction: Machado-Joseph disease (MJD) is an inherited neurodegenerative disease with progressive cerebellar ataxia manifested through lack of coordination and balance. MJD patients also present significant Vestibulo-Ocular Reflex (VOR) deficit but their whole vestibular features have not been previously evaluated. We aimed to evaluate whether MJD patients have vestibular features fitting the diagnostic criteria of Bilateral Vestibulopathy established by the International Society for Neuro-otology.

Methods: Sixteen MJD patients and 21 healthy controls underwent a detailed clinical neuro-otological examination including a quantitative evaluation of the VOR gain using the video Head Impulse Test (vHIT). Vestibular-related symptoms were evaluated by the Dizziness Handicap Inventory (DHI), the Activities-specific Balance Confidence Scale (ABC), the Vertigo Visual Scale (VVS). In addition, anxiety that is frequently present in vestibular disorders, was evaluated by the Beck Anxiety Inventory (BAI).

Results: MJD patients had significantly reduced horizontal VOR gain with significantly higher scores in all vestibular-related symptoms questionnaires. These symptoms scores were like those reported in studies evaluating patients with bilateral peripheral vestibular loss.

Conclusions: Beyond the cerebellar deficits, MJD patients have vestibular signs and symptoms fitting the diagnostic criteria of Bilateral Vestibulopathy established by the International Society for Neuro-otology. These findings are of relevance not only for the diagnosis and evaluation of progressive cerebellar diseases but also for the possible beneficial effect of vestibular rehabilitation techniques on dizziness, balance and the emotional, physiological and functional aspects of MJD.

Background: Benign paroxysmal positional vertigo (BPPV) is effectively treated with a variety of repositioning maneuvers but one-third to one-half of patients experience recurrence, usually within 2 years after the first attack.

Objectives: The aim of this study was to investigate possible prevention of recurrent BPPV by sleep habit modification.

Methods: Patients diagnosed with posterior semicircular canal BPPV (p-BPPV) were asked their preferred lying side during nocturnal sleep. Following Epley maneuver they were recommended to change their head lying side at least every 2 hours during nocturnal sleep and to come back in case of recurrence.

Results: A total of 266 patients were diagnosed with p-BPPV. The mean patient's age was 57 years (range 14-87 years). There were 167 patients with right p-BPPV and 99 patients with left p-BPPV; 134 (50%) patients habitually slept on the right side. Of those, 112 (84%) were diagnosed with right p-BPPV (P= 0.0006); 87 patients (33%) habitually slept on the left side; 56 of them (64%) were diagnosed with left p-BPPV (P <0.0001). Among the 45 patients (17%) who expressed no preference concerning their sleeping positions, the right versus left p-BPPV was nearly even. During the follow-up period (1-80 months, mean 41) 11 patients (4%) were diagnosed with recurrent p-BPPV. Of those, 9 had a recurrence in the same posterior semicircular canal and 2 in the contralateral one. All of them reported that they had not modified their sleep habits.

Conclusions: The results of our study can shed some light on the etiology of BPPV and may be helpful in preventing recurrent BPPV by changing sleep-position habits.

Introduction: Spontaneous cerebrospinal fluid (CSF) leak into the temporal air spaces is a prominent risk factor for meningitis, often leading to debilitating neurological morbidities and even death. CSF leaks may arise due to trauma, congenital malformation, or surgery, but in most cases, they develop spontaneously. In spontaneous CSF leaks, no obvious triggering event is apparent in the patient's clinical history that points to this diagnosis, in contrast to some of the other etiologies. The clinical presentation of spontaneous CSF leaks is not unique and is characterized by patients' complaints, such as hearing loss and aural fullness. These symptoms are commonly associated with prevalent conditions, such as serous otitis media. For these reasons, a typical diagnostic delay of spontaneous CSF leaks, which can last for years in some cases, leaves the patients exposed to meningeal infection without being offered an efficient surgical treatment to keep them safe and protected.

Background: Cochlear implants are valuable in the auditory rehabilitation of patients with severe to profound hearing loss. However, there is limited data on the outcomes of cochlear implantation in patients with Meniere's disease (MD).

Objectives: In this study, we aim to evaluate the auditory outcomes of cochlear implantation in patients with MD.

Methods: A retrospective case series of patients with MD and severe to profound sensorineural hearing loss (SNHL), who underwent cochlear implantation at a tertiary academic center between 2006-2017. Patient's clinical characteristics and audiometric data were reviewed.

Results: The study included 20 ears in 19 patients with MD who underwent cochlear implantation with available pre- and postoperative audiometric data. There were 10 males and 9 females with a mean age of 63 years and a mean follow-up duration of 70.8 months. Pre- and post-implant CNC word recognition scores were 18.31% and 66.89%, respectively (p<0.001). Pre- and post-implant AzBio and/or HINT sentence recognition scores were 12.25% and 68.28% in quiet, respectively (p<0.001), and 18.25% and 63.43% in noise, respectively (p<0.001).

Conclusions: Cochlear implantation resulted in an improvement of word and sentence recognition scores in MD patients. These results support the role of cochlear implants in the auditory rehabilitation of MD.

Discussion: Dr. Samy received research support from Cochlear Corporation.

Background: Cochlear implants (CI) are the treatment of choice for individuals with severe to profound sensorineural hearing loss. A small group of patients, with pathology central to the cochlea, cannot benefit from CI. Examples in children include absence of the cochlear-nerve or cochlear aplasia. In these cases, implantation of an auditory brainstem implant (ABI), directly stimulating the cochlear nucleus, bypassing the inner-ear and auditory-nerve, may be beneficial.

Objectives: Describe a series of children with ABI's treated in Shaare-Zedek, including the first ABI implantation in Israel (2017).

Methods: Of 9 patients with ABI's treated in Shaare Zedek Medical Center ,7 were children implanted between ages 2-8.6 years. Five boys and two girls. Surgeries were conducted in collaboration between neurosurgeons, neurotologists and audiologists (five implanted in Shaare-Zedek and two in New-York University). Follow-up was between 2-6 years. Hearing evaluation was conducted, mainly, with audiograms, categories of auditory performance (CAP), speech perception testing when possible and estimation of device use per day.

Results: Six of the seven children, who initially underwent unsuccessful CI, had deficient auditory-nerves. One child had cochlear-aplasia. In 3 children hearing loss was part of the CHARGE syndrome. CAP scores ranged from 0-7 (0,1,3,5,5,7). One child was able to achieve open-set speech perception.

Conclusions: Although functional auditory outcomes for children with ABI are inferior to CI recipients and are highly variable, some children were able to obtain significant benefit. In these children, who are not candidates for CI, the ABI presents the only chance for auditory awareness and may be recommended.

Discussion: John Thomas Roland is a consultant and recipient of research support from Cochlear Americas.