Journal of Otology最新文献

Objective tinnitus is defined as a type of tinnitus perceived by both the patient and external observer. This paper presents two cases of objective tinnitus related to palatal tremor, along with a literature review. Palatal tremor is a condition characterized by soft palate involuntary contractions. Two types of palatal tremor have been described: symptomatic palatal tremor and essential palatal tremor, with different clinical manifestations. Diagnostic workup is based on medical history and physical examination, including direct oropharynx exploration and cavum visualization through nasopharyngoscopy. Brain MRI is mandatory in all cases. If a secondary origin is suspected, additional lab tests should be performed based on clinical suspicion. First-line treatment is botulinum toxin injection into the levator veli palatini and tensor veli palatini muscles, with velopharyngeal insufficiency being its main adverse effect. Other medications have not been shown to be effective.

Objective

This study aims to analyze the clinical characteristics of persistent geotropic and apogeotropic positional nystagmus of LC-BPPV in view of light and heavy cupula discussion.

Material and method

The study group includes 184 patients with LC BPPV (98 apogeotropic, 86 geotropic type) who have been examined between 2009 and 2020. Ninety-nine females and 85 males, aged between 16 and 92 years were included (Ageotropic 49.32 ± 14.12, geotropic 44.49 ± 13.90 years). Average slow phase velocity (SPV) of positional nystagmus was documented and those with persistent direction-changing positional nystagmus lasting more than a minute were grouped separately. Age, gender difference, side of involvement, and recurrence pattern were particularly reviewed. Chi-square and One way ANOVA tests were used to compare the difference between groups. Statistical significance was set at P < 0.05.

Results

Thirty-seven patients with apogeotropic nystagmus (30.7%; 37/98) and 18 patients with geotropic nystagmus (20.9%; 18/86) had persistent nystagmus (p ˂0.05). Comparison of slow phase velocity (SPV) of persistent and non-persistent geotropic and apogeotropic positional nystagmus of the affected side was significant (p ˂0.05). Comparison of average age, male to female ratio, side of involvement, and the recurrence rate in patients with persistent and non-persistent geotropic and apogeotropic type positional nystagmus groups were not significant (p = 0.177, p = 0.521, p = 0.891, p = 0.702).

Conclusion

Persistent geotropic and apogeotropic positional nystagmus is mostly correlated with the size, amount, and position of otoconial debris. It is difficult to justify the light cupula as a new geotropic variant of cupular pathology. Patients with persistent positional nystagmus present similar therapeutic outcomes and recurrence rates.

Objective

To evaluate the audiologists’ attitudes and practice towards teleaudiology, as well as to assess the audiological services provided in Egypt and Saudi Arabia during the COVID-19 pandemic.

Methods

A cross sectional study was conducted among 112 audiologists who were recruited through convenience sampling . Multinomial logistic regression was used to test the association between practice of tele audiology as a dependent variable and some independent variables.

Results

25.4% of the studied sample were practicing tele audiology. Participants’ age and attitude toward telemedicine were the independent predictors of tele audiology practice at p value ≤ 0.05.

Conclusion

The tele audiology practice is essential. Therefore, raising the knowledge of audiologist about the great value of practicing tele audiology is very important, infrastructure, equipment, and technology especially telecommunication should be improved and facilitated for both audiologist and patients.

Objective

This study was conducted to determine whether there is a reliable method for measuring the thickness of the retroauricular skin before, during, and after cochlear implantation, which allows the assessment of the optimal force of the external magnet of the cochlear implant (CI).

Methods

The retroauricular skin thickness of 83 patients who received a CI was measured using three different methods. The thickness was measured on pre- and postoperative CT images, as well as intraoperatively. The magnet category chosen by the surgeon was recorded when the implant was switched on and during the first follow-up visit. Correlation analyses were performed on the different skin thickness measurements and between the skin thickness and magnet strength categories.

Results

Only six patients required an exchange of the magnet until the follow-up. Although the median absolute thickness differed significantly between the three measures (p < 0.0001), their thickness values showed highly significant correlations (Pearson's r = 0.457–0.585; p < 0.01). In addition, magnet strength, was significantly correlated with the flap thickness determined pre-, post-, and during surgery. The lowest correlation with magnet strength was found in the intraoperative needle method.

Conclusion

All three measurements methods provided a suitable base for determining the ideal magnetic force. However, of particular interest were the pre- and postoperative CT measurements. The first enabled the early assessment of the required magnetic strength and thus a timely postoperative supply, whereas the latter helped to estimate the need for magnetic strength reduction during follow-up care and the feasibility of an early swith-on.

Background

Vestibular symptoms on sitting-up are frequent on patients seen by vestibular specialists. Recently, a benign paroxysmal positional vertigo (BPPV) variant which elicits vestibular symptoms with oculomotor evidence of posterior semicircular canal (P-SCC) cupula stimulation on sitting-up was described and named sitting-up vertigo BPPV. A periampullar restricted P-SCC canalolithiasis was proposed as a causal mechanism.

Objective

To describe new mechanisms of action for the sitting-up vertigo BPPV variant.

Methods

Eighteen patients with sitting-up vertigo BPPV were examined with a pre-established set of positional maneuvers and follow-up until they resolved their symptoms and clinical findings.

Results

All patients showed up-beating torsional nystagmus (UBTN) and vestibular symptoms on coming up from either Dix-Hallpike (DHM) or straight head-hanging maneuver. Sixteen out of 18 patients presented a sustained UBTN with an ipsitorsional component to the tested side on half-Hallpike maneuver (HH). A slower persistent contratorsional down-beating nystagmus was found in eleven out 18 patients tested on nose down position (ND).

Conclusions

Persistent direction changing positional nystagmus on HH and ND positions indicative of P-SCC heavy cupula was found in 11 patients. A sustained UBTN on HH with the absence of findings on ND, which is suggestive of the presence of P-SCC short arm canalolithiasis, was found on 5 patients. All patients were treated with canalith repositioning maneuvers without success, but they resolved their findings by means of Brandt-Daroff exercises. We propose P-SCC heavy cupula and P-SCC short arm canalolithiasis as two new putative mechanisms for the sitting-up vertigo BPPV variant.

Introduction

The role of objective parameters in terms of improvement of the accuracy of high-resolution computed tomography (HRCT) of the temporal bone in the diagnosis of otosclerosis remains unclear.

Objectives

To investigate the relationship between the density of the fissula antefenestram (FAF) and of the width of the transversal section of the basal turn of the cochlea (BTC), and the diagnosis of otosclerosis.

Methods

This is a retrospective study in which preoperative HRCT data from ears of patients submitted to stapedotomy due to otosclerosis (case group) were evaluated. For the control group, normal hearing ears having undergone HRCT for other purposes were included. Case and control HRCT images were objectively assessed by an experienced blinded radiologist. During this evaluation, measurements of the relative radiological density of the FAF and of the transversal section of the BTC were obtained. The results were compared between the groups. Also, a receiver operating characteristic curve was created and the area under the curve (AUC) was calculated for each variable. Significance level was set at .05.

Results

40 ears were included in each group. Case ears presented reduced values for the relative radiological density on the FAF (p-value<0.0001). Moreover, ears with otosclerosis (p-value: 0.022) presented lower transversal section of the BTC. The AUC for these variables reached 0.929 and 0.646, respectively.

Conclusions

Otosclerotic ears present reduced radiological density on the FAF and narrower BTC. The relative density of the FAF also shows a great diagnostic power in the context of this disease.

Objective

Patients with dizziness may present with symptoms of tilting, swaying, rocking, floating or with disequilibrium. This may be suggestive of an isolated otolithic dysfunction yet, there is little emphasis on this emerging clinical entity. To characterize and describe the prevalence of isolated otolith dysfunction in a local tertiary hospital and correlate them with clinical diagnosis.

Methodology

Retrospective medical chart review of patients who presented with dizziness to the specialist outpatient Otolaryngology clinic, who required vestibular laboratory investigation.

Results

Of the 206 patients, more than half of them (52.4%) fulfilled the criteria for either probable or definite isolated otolith dysfunction. When there are clinical symptoms of otolith dysfunction reported, there is a 1.62 odds of a remarkable laboratory otolith finding. The most common clinical finding was “no clear diagnosis” (65.5%) followed by Vestibular Migraine (13.6%).

Conclusion

The prevalence of isolated otolith dysfunction is quite high. Laboratory tests of otolith function should be performed more routinely. This can be done in a sequential way to optimize cost effectiveness in countries with no insurance reimbursement. Prospective cohort studies on isolated otolith dysfunction, will lay the groundwork for achieving diagnostic consensus and formulating rehabilitation plans to aid this group of patients.

Background

Benign paroxysmal positional vertigo (BPPV) is characterized by vertigo lasting from seconds to minutes, induced by head movements.

Objectives

Our study aimed to investigate the clinical significance of the caloric vestibular and video head-impulse tests (vHIT) diagnosing the disorder.

Methods

68 patients suffering from posterior canal BPPV (25 male, 43 females, mean age $\pm$ SD, 54.5 $\pm$ 13.2 years) and 56 patients with a normal functioning vestibular system as control were investigated. Bithermal caloric test and vHIT was performed during the same medical check-up. Canal paresis (CP%), gain (GA) and asymmetry (GA%) parameters were calculated.

Results

The Dix-Hallpike manoeuvre was only positive in 4% of this population. The CP% parameter was only pathologic in two patients, and there was no significant difference between control and BPPV patients (p = 0.76). The GA value was never under 0.8 in this population, but GA% was abnormal in 63.2%. A significant difference comparing the GA% values to the control group was seen (p = 0.034). There was no correlation detected between the CP% and GA% values in BPPV. Regarding the GA% value, 61% sensitivity and 76% specificity was seen.

Conclusion

The Dix-Hallpike manoeuvre was not often positive in the non-acute phase of BPPV; therefore, objective testing is essential. The caloric test does not have clinical significance in BPPV, but vHIT can be helpful based on the GA% parameter.

Objectives

Stance and gait unsteadiness along with vertigo contribute to a central vestibular disorder. For objective analysis ultrasound-computer-craniocorpography (US-COMP-CCG) can be used. Aim of the study was to characterize the unsteadiness in central vestibular disorders and discuss the possible diagnostic usage of US-COMP-CCG.

Methods and results

Hundred-and-ninety patients (70 male and 120 female, mean age ± SD, 58.94 ± 15.27) suffering from central vestibular disorder and 230 healthy control patients (78 male and 152 female, mean age ± SD, 50.94 ± 15.27) were enrolled. Stance and gait analysis was according to vestibulospinal tests of US-COMPCCG. IBM SPSS V24 software was used for statistical analysis. Mann-WhitneyU test and Chi-square test were used, along with sensitivity and specificity categorization. The significance level was p < 0.05. According to schematic and statistical analysis instability and postural sway were increased in the vertigo population and statistically significant difference was shown. Upon categorical analysis significant correlation was detected [standing test: longitudinal sway (p < 0.00001), lateral sway (p < 0.00001), forehead covering area parameters (p = 0.0001); stepping test: longitudinal deviation (p = 0.05), lateral sway (p = 0.011) parameters].

Conclusions

Clinicians should consider that postural instability is prominently present in this population and might be of a diagnostic importance.

The association between tinnitus and psychological resilience is an underdeveloped area of research. This cross-sectional study investigated such associations and factors potentially affecting resilience in 61 patients. Demographic and psychometric data were collected by questionnaires. The Connor–Davidson Resilience Scale (CD-RISC), Medical Coping Modes Questionnaire (MCMQ), Satisfaction with Life Scale (SWLS), General Self-Efficacy Scale (GSES), Big Five Inventory (BFI) and Perceived Social Support Scale (PSSS) were completed by participants. Data were analyzed using independent t-test and Pearson's correlation analysis and multiple linear regression modeling. The CD-RISC score was relatively low (66.97 ± 15.71), negatively correlated with tinnitus (r = −0.276, p < 0.001) and associated with age (r = 0.270，P＜0.001). As protective factors, SWLS (r = 0.486, p < 0.001), GSES (r = 0.555, p < 0.001), PSSS (r = 0.538, p < 0.001) and extraversion were positively correlated with CD-RISC and BFI scores (r = 0.287, p < 0.001). We also detected a negative correlation with neuroticism (r = −0.395, p < 0.001), which is a known risk factor for worse CD-RISC scores. Identifying protective and risk factors for psychological resilience can be used to predict treatment outcomes in tinnitus patients, which will help devise personalized solutions and improve patients' quality of life.