Branchial fistula: a rare presentation

Remains of cervical sinus of His may persist as a branchial cyst. A branchial sinus is formed when 2nd branchial arch fails to meet the 5th pharyngeal arch. Peak age for presentation of cysts is in the third decade and that of the congenital sinuses and fistulae is at birth. Rarely a branchial sinus is found to have an internal opening as well, thus forming a true branchial fistula. We present a case of true branchial fistula with external opening on the lateral side of neck and internal opening near the lower pole of tonsil

Efficacy of epley maneuver in BPPV

Benign paroxysmal positional vertigo [BPPV] is one of the most common causes of vertigo. The diagnosis is confirmed by observing a classical response during the Dix-Halipike maneuver. The cause of BPPV is usually idiopathic. There are two popular hypotheses described regarding the pathogenesis i.e. cupulolithiasis and canalithiasis. The clinical course of BPPV is spontaneous recovery in weeks or months. Treatments for BPPV have ranged from no intervention to surgical treatment. The new treatment, "Canal it h-repositioning procedure [CRP]" which was introduced by Epley in 1992 produces a very high rate of success. This treatment has caused interest and has been modified and studied worldwide in recent years. To determine the efficacy of Epley maneuver in BPPV. We recruited 100 patients with a history of positional vertigo and unilateral positional nystagmus on physical examination [Dix-Halipike maneuver]. Patients were randomized to either the Epley [n=50] or a prochlorperazine [n=50]. Measured outcomes included resolution of vertigo and positional nystagmus at follow-up examination. RESULTS: The mean duration of follow-up was 14 days for both groups. In Epley's group resolution of symptoms was reported by 36[72%] of the patients after first visit on single maneuver treatment and by 46 [92%] patients on second visit on repeating maneuver, while 4 patients had minimal symptomatic improvement and were offer other treatment options. While in prochlorperazine group, 11 [22%] patients reported improvement in symptoms on first visit and 17[34%] on second visit and 19 [38%] had improved by 14th day. The Epley's maneuver is safe, economical and effective treatment of benign paroxysmal positional vertigo and this procedure can be performed by general internists on outpatients with this disorder