Cochlear electrode array misplacement into the superior semicircular canal: a case report and literature review / 临床耳鼻咽喉头颈外科杂志

Electrode array misplacement is a rare complication of cochlear implant. This article reports an 11-year-old boy who was mistakenly implanted the cochlear electrode array into the superior semicircular canal during the initial cochlear implant. After the diagnosis was confirmed, he underwent a second cochlear implant and the electrode array were successfully implanted into the cochlea. This article conducted a systematic review of the literature on electrode array misplacement, and the causes of electrode array misplacement were analyzed from different implantation position.

The influence of additional roll test on the repositioning procedure by SRM-vertigo diagnosis system for horizontal canal benign paroxysmal positional vertigo / 临床耳鼻咽喉头颈外科杂志

Objective:To evaluate the influence of an additional roll test on the repositioning procedure by SRM-vertigo diagnosis system for horizontal canal benign paroxysmal positional vertigo（HC-BPPV）. Methods:A total of 713 patients diagnosed with HC-BPPV in Department of Otolaryngology Head and Neck Surgery，the First Affiliated Hospital of Xi'an Jiaotong University from Jan 2020 to Feb 2022 were enrolled. The patients were divided into two groups by hospital card numbers, in which the number is odd were considered as group A, and the number is even were considered as group B. The group A underwent two circles of Barbecue repositioning procedure by SRM-vertigo diagnosis system, while the group B first performed an additional roll test and then underwent two circles of Barbecue repositioning procedure by SRM-vertigo diagnosis system, to observe the cure rate and compare influence of HC-BPPV by an additional roll test. The quality of life and sleep of patients before and one-month after the treatment were assessed by the dizziness handicap inventory（DHI） and the pittsburgh sleep quality（PSQI）. Results:The cure rate of group A was 63.21%, and the cure rate of group B was 87.68%，the difference between the two groups was statistically significant（P<0.05）; The DHI score of patients after the repositioning was significantly lower than that before the repositioning（P<0.05）. The PSQI score after the repositioning was significantly lower than that before the repositioning（P<0.05）. The DHI and the PSQI scores after the repositioning were significantly lower than that before the repositioning, with a statistically significant difference （P< 0.05）. The total score of DHI in group B after treatment was lower than that in group A, with a statistically significant difference（P<0.05）. The total score of PSQI in group B after treatment was lower than that in group A, with non-statistically significant difference （P< 0.05）. Conclusion:An additional roll test before the repositioning procedure by SRM-vertigo diagnosis system can significantly improve the cure rate of HC-BPPV, relieve anxiety, and improve the quality of life.

Study on the influence of Barbecure combined with Epley on residual dizziness of horizontal canal benign paroxysmal positional vertigo by SRM-vertigo diagnosis system / 临床耳鼻咽喉头颈外科杂志

Objective:To investigate the influence of Barbecure combined with Epley on residual dizziness of horizontal canal benign paroxysmal positional vertigo（HC-BPPV） by SRM-vertigo diagnosis system. Methods:A total of 406 patients diagnosed with HC-BPPV from Nov 2021 to Nov 2022 were enrolled by rapid axial roll test and Dix-Hallpike in the department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Xi'an Jiaotong University. The patients were divided into two groups by hospital card numbers, in which the numbers that were odd were considered as group A, and the numbers that were even were considered as group B. The group A underwent two circles of Barbecure repositioning procedure by SRM-vertigo diagnosis system, while the group B underwent two circles Barbecure combined with Epley repositioning procedure by SRM-vertigo diagnosis system. The treatment was stopped on the next day when two groups of patients were cured, and those who were not cured will continue treatment with the same method. Results:The cure rate of group A was 83.41%, and the cure rate of group B was 80.51%, the difference between the two groups was not-statistically significant difference（P>0.05）. The rate of residual dizziness of group A was 23.30%, the rate of residual dizziness of group B was 11.46%, the difference between the two groups was statistically significant（P<0.05）. Conclusion:The Barbecure combined with Epley otoliths repositioning maneuver by SRM-vertigo diagnosis system can significantly reduce the rate of residual dizziness after the treatment of HC-BPPV, and improve the quality of life of patients.

Complex benign horizontal canal positional vertigo: new perceptual management

Abstract Objective: Horizontal semicircular canal site pathology of benign paroxysmal positional vertigo demonstrating three types of nystagmi on positional test were studied. We have attempted to design a protocol for its diagnosis and treatment. Methods: 320 patients of HSC-BPPV were subjected to two types of positional tests. Of these, patients with bilateral steady apogeotropic nysatgmus were treated with VAV modification of Semont's maneuver. Patients with unsteady or changing apo/geotropic signs were converted into steady geotropic ones by repetitive positional tests; followed by barbecue maneuver with forced prolong positioning. Results: Overall 88% of patients had a total recovery. 92% of patients with geotropic nystagmus showed no symptoms after second maneuveral sitting. 85% of patients with apogeotropic nystagmus recovered fully after third maneuveral sitting. Conclusion: Correct identification of subtypes of HSC-BPPV is based on provoked nystagmus by positional tests. After locating the site and side on the basis of nystagmic pattern, physician can apply the appropriate PRM. Level of evidence: II a.

Correlation between vitamin D deficiency and benign paroxysmal positional vertigo

Background: Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of peripheral vertigo. Vitamin D3 is an indispensable part of bone mineralization and calcium homeostasis. Vitamin D3 also plays a role in BPPV and therefore may offer a therapeutic option. Aim and Objective: This study aims to evaluate the relationship of BPPV with Vitamin D deficiency. Materials and Methods: This observational case–control study was done on 80 subjects out of which 40 were confirmed cases of BPPV patients and 40 were controls. Ear, throat, and nose were examined in all patients. Measurement of Vitamin D3 was done in all subjects. Assessment of quality of life was done using Dizziness Handicap Inventory score (DHI) and Visual Vertigo Analog Scale (VVAS). Results: In our study among cases, 14 patients (35%) had normal Vitamin D levels, Vitamin D deficiency was seen in 15 cases (37.5%) and 11 patients (27.5%) had Vitamin D insufficiency. In control group, 22 patients (55%) had normal Vitamin D levels and 9 patients (22.5%) each had Vitamin D insufficiency and deficiency. Mean of Vitamin D concentration in the case group was 23.78 ± 10.43 and in the control group had 35.99 ± 15.99. The relationship between the two groups was significant (P = 0.001). The mean of body mass index in case and control group was 22.46 ± 2.48 and 23.43 ± 2.38, respectively, with P-value of 0.032 indicating significant relationship statistically. Furthermore, VVAS and DHI scores were higher in cases with deficiency and insufficiency of Vitamin D. Conclusion: The present study shows a significant relationship of reduced concentration of Vitamin D with idiopathic BPPV.

Diagnosis and treatment of the short-arm type posterior semicircular canal BPPV / Diagnóstico e tratamento da VPPB de braço curto do canal semicircular posterior

Abstract Introduction The Epley maneuver is useful for the otoconia to return from the long arm of the posterior semicircular canal into the utricle. To move otoconia out of the posterior semicircular canal short arm and into the utricle, we need different maneuvers. Objective To diagnose the short-arm type BPPV of the posterior semicircular canal and treat them with bow-and-yaw maneuver. Methods 171 cases were diagnosed as BPPV of the posterior semicircular canal based on a positive Dix-Hallpike maneuver. We first attempted to treat patients with the bow-and-yaw maneuver and then performed the Dix-Hallpike maneuver again. If the repeated Dix-Hallpike maneuver gave negative results, we diagnosed the patient with the short-arm type of BPPV of the posterior semicircular canal and considered the patient to have been cured by the bow-and-yaw maneuver; otherwise, probably the long-arm type BPPV of the posterior semicircular canal existed and we treated the patient with the Epley maneuver. Results Approximately 40% of the cases were cured by the bow-and-yaw maneuver, giving negative results on repeated Dix-Hallpike maneuvers, and were diagnosed with short-arm lithiasis. Conclusion The short-arm type posterior semicircular canal BPPV can be diagnosed and treated in a convenient and comfortable manner.

Resumo Introdução A manobra de Epley é útil para o retorno da otocônia do braço longo do canal semicircular posterior para o utrículo. Diferentes manobras são necessárias para mover a otocônia para fora do braço curto do canal semicircular posterior e para dentro do utrículo. Objetivo Diagnosticar a VPPB do tipo braço curto do canal semicircular posterior e tratá-la com a manobra de incline and balance. Método Foram diagnosticados 171 casos como VPPB de canal semicircular posterior com base na manobra de Dix-Hallpike positiva. Primeiro tentamos tratar os pacientes com a manobra de incline and balance e, em seguida, executamos a manobra de Dix-Hallpike novamente. Se a repetição da manobra de Dix-Hallpike desse resultados negativos, diagnosticávamos o paciente como VPPB do canal semicircular posterior do tipo braço curto e considerávamos que ele ou ela havia sido curado pela manobra de incline and balance; caso contrário, provavelmente o paciente apresentava VPPB do canal semicircular posterior do tipo braço longo e tratávamos o paciente com a manobra de Epley. Resultados Aproximadamente 40% dos casos foram curados pela manobra de incline and balance, com resultados negativos nas manobras de Dix-Hallpike repetidas, e foram diagnosticados com litíase de braço curto. Conclusão A VPPB de canal semicircular posterior do tipo braço curto pode ser diagnosticada e tratada de maneira conveniente e confortável.

A novel maneuver for diagnosis and treatment of torsional-vertical down beating positioning nystagmus: anterior canal and apogeotropic posterior canal BPPV / Uma nova manobra para diagnóstico e tratamento de nistagmo vertical para baixo com componente de torção: forma apogeotrópica da VPPB do canal anterior e canal posterior

Abstract Introduction In patients with benign paroxysmal positional vertigo, BPPV; a torsional-vertical down beating positioning nystagmus can be elicited in the supine straight head-hanging position test or in the Dix-Hallpike test to either side. This type of nystagmus can be explained by either an anterior canal BPPV or by an apogeotropic variant of the contralateral posterior canal BPPV Until now all the therapeutic maneuvers that have been proposed address only one possibility, and without first performing a clear differential diagnosis between them. Objective To propose a new maneuver for torsional-vertical down beating positioning nystagmus with a clear lateralization that takes into account both possible diagnoses (anterior canal-BPPV and posterior canal-BPPV). Methods A prospective cohort study was conducted on 157 consecutive patients with BPPV. The new maneuver was performed only in those with torsional-vertical down beating positioning nystagmus with clear lateralization. Results Twenty patients (12.7%) were diagnosed with a torsional-vertical down beating positioning nystagmus. The maneuver was performed in 10 (6.35%) patients, in whom the affected side was clearly determined. Seven (4.45%) patients were diagnosed with an anterior canal-BPPV and successfully treated. Two (1.25%) patients were diagnosed with a posterior canal-BPPV and successfully treated with an Epley maneuver after its conversion into a geotropic posterior BPPV. Conclusion This new maneuver was found to be effective in resolving all the cases of torsional-vertical down beating positioning nystagmus-BPPV caused by an anterior canal-BPPV, and in shifting in a controlled way the posterior canal-BPPV cases of the contralateral side into a geotropic-posterior-BPPV successfully treated during the followup visit. Moreover, this new maneuver helped in the differential diagnosis between anterior canal-BPPV and a contralateral posterior canal-BPPV.

Resumo Introdução Em pacientes com vertigem posicional paroxística benigna, VPPB, um nistagmo vertical para baixo com componente de torção pode ser provocado no teste head hanging supino executado na posição reta ou no teste de Dix-Hallpike para qualquer um dos lados. Esse tipo de nistagmo pode ser explicado por uma VPPB do canal anterior ou por uma variante apogeotrópica da VPPB do canal posterior contralateral. Até agora, todas as manobras terapêuticas propostas abordam apenas uma possibilidade, sem antes fazer um diagnóstico diferencial claro entre elas. Objetivo Propor uma nova manobra para nistagmo vertical para baixo com componente de torção com uma lateralização clara que leve em consideração os dois diagnósticos possíveis, VPPB do canal anterior e VPPB do canal posterior. Método Um estudo de coorte prospectivo foi conduzido em 157 pacientes consecutivos com VPPB. A nova manobra foi feita apenas nos pacientes com nistagmo vertical para baixo com componente de torção, com lateralização nítida. Resultados Vinte pacientes (12,7%) foram diagnosticados com nistagmo vertical para baixo com componente de torção. A manobra foi feita em 10 (6,35%) pacientes, nos quais o lado afetado foi claramente determinado. Sete (4,45%) pacientes foram diagnosticados com VPPB do canal anterior e tratados com sucesso. Dois (1,25%) pacientes foram diagnosticados com VPPB do canal posterior e tratados com sucesso com a manobra de Epley após sua conversão para VPPB geotrópica de canal posterior. Conclusão Essa nova manobra mostrou-se eficaz na resolução de todos os casos de VPPB com nistagmo vertical para baixo com componente de torção causada por VPPB do canal anterior. E na mudança de forma controlada dos casos de VPPB do canal posterior do lado contralateral para uma VPPB geotrópica de canal posterior tratada com sucesso durante a consulta de seguimento. Além disso, essa nova manobra auxiliou no diagnóstico diferencial entre a VPPB do canal anterior e a VPPB do canal posterior contralateral.

Association of Serum Calcium and Vitamin D with Benign Paroxysmal Positional Vertigo

Abstract Introduction Benign paroxysmal positional vertigo (BPPV) is one of the common disorders of the peripheral vestibular system. The prevalence of BPPV is found to be higher among middle-aged women. Objectives To estimate the serum levels of calcium and vitamin D in patients with BPPV, and to study their association. Methods The present is a hospital-based prospective case-control study. Venous blood samples of the 49 patients with BPPV and an equal number of age- and gender-matched individuals were recruited and submitted to an analysis of the serum levels of calcium and vitamin D. Results Among the cases, 67.3% were found to be females, and 32.7% were males. Most of the 30 cases (61.3%) were aged >40 years. The mean age of the cases was 44.39 years. The mean serum level of vitamin D in the cases was of 21.26 ng/ml compared with 17.59 ng/ml in the controls. The mean serum level of calcium was of 9.33 mg/dl in the cases, compared with 8.95 mg/dl in the controls. There was no significant difference in the serum levels of vitamin D and calcium between cases and controls. Conclusion We could not establish any correlation between the serum levels of calcium and vitamin D with BPPV. However, a negative relationship was found between the serum levels of vitamin D and the number of episodes of BPPV (p = 0.012).

Clinical application of video nystagmography in the diagnosis and treatment of benign paroxysmal positional vertigo / 中国基层医药

Objective:To analyze the application of video nystagmography in the diagnosis and treatment of benign paroxysmal positional vertigo (BPPV) so as to provide evidence for clinical diagnosis.Methods:A total of 120 patients with suspected BPPV who received treatment in Yueqing People's Hospital from January to July 2020 were included in this study. There were anterior ( n = 24), posterior ( n = 80) and horizontal semicircular canal ( n = 16) BPPV according to the disease type. The detection rates of anterior, posterior and horizontal semicircular canal BPPV by video nystagmography and naked eyes were determined. Therapeutic effects of video nystagmography on three types of BPPV were compared. Results:The diagnostic rates of anterior, posterior and horizontal semicircular canal BPPV were 91.68%, 92.50% and 93.75%, respectively, and the difference was not statistically significant ( χ2 = 0.06, P > 0.05). The detection rates of anterior, posterior and horizontal semicircular canal BPPV by video nystagmography were 91.68%, 92.50% and 93.75% respectively, which were significantly higher than those by naked eyes (58.34%, 78.75%, 56.25%, χ2 = 7.11, 6.14, 3.86, all P < 0.05). After 1 week of treatment, total response rates of anterior, posterior and horizontal semicircular canal BPPV were 62.50%, 66.25%, 68.75%, respectively. After 3 months of treatment, total response rates of anterior, posterior and horizontal semicircular canal BPPV were 95.83%, 96.25% and 100.00%, respectively. There were no significant differences between anterior, posterior and horizontal semicircular canal BPPV after 1 week and 3 months of treatment ( χ2 = 0.18, 0.64, P > 0.05). At 3 months after surgery, the recurrence rates of anterior, posterior and horizontal semicircular canal BPPV were 4.16%, 5.00% and 6.25%, respectively, and the difference was not statistically significant ( χ2 = 0.08, P > 0.05). Conclusion:Video nystagmography is highly effective in the diagnosis and treatment of BPPV. It can accurately judge the occurrence of nystagmus in BPPV and increase the detection rate, which is worthy of clinical application.

Analysis of the diagnosis maneuver of lateral semicircular canal benign positional paroxysmal vertigo and observation of the otolith movement using physical engine / 解剖学报

Objective To analysis the diagnosis maneuvers of lateral semicircular canal benign positional paroxysmal vertigo (BPPV) and to explore the diagnostic mechanism. Methods The three-dimensional BPPV labyrinth model was established based on the physical engine. The otolith in different positions of the lateral semicircular canal was set up. The otolith movement in different positions during the horizontal roll test was analyzed, and the induced nystagmus could be inferred. Results Horizontal roll test nystagmus manifestations were diverse, including bilateral ageotropic nystagmus, which could be judged as otolith in ampullary and crista, and weak side of nystagmus was the affected side; bilateral geotropic nystagmus could be judged as otolith in the long arm of the lateral semicircular canal, and strong side of nystagmuss was the affected side; Ageotropic nystagmus in one side and geotropic nystagmus in another side, considering otolith in ampullary of long arm. The horizontal roll test may restore otolith to utricle and reduce the sensitivity of the diagnostic tests. The result of 10 repetitions were consistent. Conclusion Sixty degree horizontal roll test effectively corrects the defects of 90 degree horizontal roll test. The analysis of diagnostic tests based on the physical engine is of great significance for us to understand the diagnostic mechanism of BPPV in the lateral semicircular canal and to improve and innovate diagnostic maneuver.

Dehiscencia del canal semicircular superior: análisis de la producción científica / Superior semicircular canal dehiscence: analysis of scientific production

RESUMEN Introducción: La dehiscencia del canal semicircular es una vestibulopatía periférica rara y poco prevalente, que se caracteriza por una falta de cobertura ósea del canal semicircular superior en la zona más próxima a la duramadre de la fosa cerebral media. Objetivo: Conocer el estado actual y la calidad científica de las publicaciones sobre la dehiscencia del canal semicircular superior (DCSS). Material y método: Se ha realizado una búsqueda bibliométrica con posterior revisión, selección y análisis a partir de ítems relacionados con estudios DCSS en la base de datos Pubmed desde el año 1998 hasta 2017. Resultados: Al estudiar el tipo de publicaciones, el 77% eran artículos originales, 12% revisiones, 9% casos clínicos, 2% cartas al director y respuestas al editor. Los artículos han sido publicados en un total de 108 revistas, siendo Otology and Neurotology la que mayor número de manuscritos presenta con un total de 87, seguida de Head and Neck Surgery con 28 y Laryngoscope con 22. Estados Unidos se posiciona como el principal contribuyente a la literatura mundial sobre este tema (42%), seguido de Europa (33%). El idioma de referencia es el inglés con 91% de publicaciones (382). Según el índice de Lotka, la actividad productiva de los autores es de tipo medio/bajo, ya que de los 217 autores que firman en primer lugar, solo 19 tienen más de 10 artículos. Según el índice de impacto Journal Citation Reports, 60% de las publicaciones se localiza en los cuartiles Q1 (116 publicaciones) y Q2 (141 publicaciones), lo que indica que la calidad de los trabajos es alta. La temática ha ido variando con el paso del tiempo, siendo actualmente el diagnóstico con 34,3%, seguido del tratamiento con 25,7%, los temas que más interesan. Aunque se trata principalmente de un tema del campo de la otorrinolaringología, en los últimos años ha despertado interés en otras áreas como la neurología y la radiología. Conclusión: Este estudio revela como los trabajos sobre DCSS presentan un escaso número de autores, las publicaciones se concentran en pocas revistas, pero de una alta calidad, y el estado actual del tema está en fase de crecimiento exponencial.

ABSTRACT Introduction: The dehiscence of the semicircular canal is a rare and not very prevalent peripheral vestibulopathy, characterized by a lack of bony coverage of the superior semicircular canal in the area closest to the dura of the middle cerebral fossa. Aim: To know current status and scientific quality of publications of the superior semicircular canal dehiscence (SSCD). Material and method: Bibliometric research with review, selection and analysis from ítems related with SSCD studies in the Pubmed database from 1998 to 2017. Results: 77% of publications were original articles, 12% reviews, 9% clinical cases, 2% letters and answers to the editor. The articles have been published in 108 journals. The top publishing journal is Otology and Neurotology with 87 publications, followed by Head and Neck Surgery with 28 and Laryngoscope with 22. USA is the main global contributor to the world literature on this subject (42%) followed by Europe (33%). The publication reference language is English, with the 91% of publications (382). According to Lotka's index, the general production activity of the authors is at the middle/low level. According to JCR impact factor, there are 60% of the publications in Q1 (116 articles) and Q2 (141 articles) quartiles, which indicates that the quality is high. The subject of the publications has varied over time, being currently diagnostic with 34.3%, followed by treatment with 25.7%, the subjects that most interest. In recent years it has aroused interest in other areas such as neurology or radiology. Conclusion: The work on DCSS has a small number of authors, the publications are limited to a few journals, but of a high quality, and the current state of the subject is in phase of exponential growth.

Normal Vestibulo Ocular Reflex (VOR) gain Measured Using the Video Head Impulse Test (vHIT) in Healthy Young Adults

@#Introduction: Many new objective tests to assess the function of specific structures of the vestibular organ are currently adopted in vestibular clinics. One of the objective assessments include the video head impulse test (vHIT) where gain & velocity responses of eye relative to the head movements are recorded using an infrared camera. Methods: Thirty normal hearing subjects age between 18 to 25 years old participated in this study. At least ten Lateral, Left Anterior Right Posterior (LARP), and Right Anterior Left Posterior (RALP) responses were recorded for each participant by making small and rapid unpredictable head movements. Results: The average velocity gain for Lateral responses at 40 ms, 60 ms and 80 ms were 1.05 ± 0.003, 1.03 ± 0.002 and 1.01 ± 0.003 respectively. The LARP average velocity regression were 1.01 ± 0.24 for Left Anterior and 1.05 ± 0.25 for Right Posterior, with an average gain asymmetry of 5.13%. The RALP average velocity regression were 1.08 ± 0.31 for Right Anterior and 1.12 ± 0.30 for Left Posterior, with an average gain asymmetry of 5.87%. One sample T-test were conducted to compare Lateral responses to a previous study by Mossman et al. (2015) where significant differences in velocity gain at 60 ms and 80 ms between studies were found where, t (59) = 5.56, p <0.01 and t (59) = 2.86, p < 0.01 respectively. Conclusion: This indicates the importance of establishing on-site norms for every clinical settings as techniques used and equipment differences could affect the results.

Objective characteristics of nystagmus in patients with posterior semicircular canal benign paroxysmal positional vertigo / 中华耳鼻咽喉头颈外科杂志

Objective@#To analyze and discuss the parameters and clinical significance of nystagmus in patients with benign positional paroxysmal vertigo (BPPV) of posterior semicircular canal.@*Methods@#The subjects of the study were 564 BPPV patients diagnosed with posterior semicircular canal canalithis (PSC-can) from January 2016 to July 2017 in Tianjin No.1 Central Hospital, including 186 males and 378 females, with a median age of 57 years. The induced nystagmus in Dix-Hallpike test was recorded by video nystagmuo graph(VNG), and the direction, latency, duration time and intensity characteristics of nystagmus were compared with the position of hanging and sitting.SPSS17.0 software was used for statistical analysis.@*Results@#Vertical torsional nystagmus was both induced with the position of hanging and sitting during Dix-Hallpike test. The vertical direction of the induced nystagmus was upward and downward respectively. The latency, duration time and intensity of lesion side were L(2.65±1.92; 1.44±1.24), D(14.90±10.46; 15.28±8.06), and P(29.75±21.26; 14.08±9.48). The latency and intensity in hanging position were higher than those of sitting. The intensity rate was about 2∶1, with statistically significant difference (t=13.831, and 17.296, P all<0.01). The direction of the induced nystagmus was opposite to turning in HSC-Can BPPV. The intensity turning to normal side was larger than lesion side obviously. The intensity rate was about 2∶1, the difference was statistically significant (t=17.296, P<0.01). There was no statistical difference of nystagmus during time between the two positions(t=-0.735, P>0.05).@*Conclusions@#The nystagmus intensity rate in Dix-Hallpike test between hanging and sitting position of lesion side in PSC-Can is 2∶1, which conforms to the Ewald′s law. The direction, latency and intensity of nystagmus can be used as a reference index for the localization diagnosis of PSC-Canotolith.

Can Wideband Tympanometry Be Used as a Screening Test for Superior Semicircular Canal Dehiscence?

OBJECTIVES: We explored whether wideband tympanometry (WBT) could be used as a screening test for superior semicircular canal dehiscence (SSCD), and obtained new WBT data (given that the test is not yet in common clinical use) on patients with SSCD. METHODS: We compared the WBT data of patients clinically and radiologically diagnosed with SSCD in our hospital between 2013 and 2018 to those of healthy volunteers. We compared the resonance frequency (RF), maximum absorbance frequency (MAF), and maximum absorbance ratio (MAR). The t-test was used for statistical analysis with the significance level set to P<0.05. In addition, we used receiver operating characteristic analysis to derive cutoff values for SSCD diagnosis in terms of sensitivity and specificity. RESULTS: Seventeen patients (four with bilateral and 13 with unilateral disease; 17 ears) diagnosed with SSCD and 27 healthy volunteers (47 ears) were included. The mean RFs of the SSCD patients and healthy subjects were 548.7 Hz (range, 243 to 853 Hz) and 935.1 Hz (range, 239 to 1,875 Hz), respectively (P<0.001). The mean MARs of the SSCD patients and healthy subjects were 89.4% (range, 62% to 100%) and 82.4% (range, 63% to 99%), respectively (P=0.005). The mean MAFs of the SSCD patients and healthy subjects were 1,706.3 Hz (range, 613 to 3,816 Hz) and 2,668 Hz (range, 876 to 4,387 Hz), respectively (P<0.001). In terms of SSCD diagnosis, a MAR above 86% afforded 81% sensitivity and 77% specificity; an RF below 728 Hz, 86% sensitivity and 81% specificity; and an MAF below 1,835 Hz, 79% sensitivity and 67% specificity. CONCLUSION: WBT may be a useful clinical screening test for SSCD. The RF and MAF were lower, and the MAR higher, in SSCD patients than in normal controls.

Tumarkin-like phenomenon as a sign of therapeutic success in benign paroxysmal positional vertigo / Fenômeno Tumarkin-like como sinal de sucesso terapêutico na vertigem posicional paroxística benigna

ABSTRACT Objective: To describe an unusual patient reaction to maneuvers used in the treatment of posterior canal benign paroxysmal positional vertigo (PC-BPPV) that we termed the "Tumarkin-like phenomenon". Methods: At a private practice, 221 outpatients were diagnosed and treated for PC-BPPV. The treatment consisted of performing the Epley or Semont maneuvers. At the end of these maneuvers, when assuming the sitting position, the patients' reactions were recorded. Results: Thirty-three patients showed a Tumarkin-like phenomenon described by a self-reported sensation of suddenly being thrown to the ground. In the follow-up, this group of patients remained without PC-BPPV symptoms up to at least 72 hours after the maneuvers. Conclusion: The occurrence of a Tumarkin-like phenomenon at the end of Epley and Semont maneuvers for PC-BPPV may be linked with treatment success.

RESUMO Objetivo: Descrever uma reação incomum dos pacientes às manobras utilizadas no tratamento da vertigem posicional paroxística benigna do canal posterior (VPPB-CP), a qual denominamos de fenômeno Tumarkin-like. Métodos: Em uma clínica privada, 221 pacientes ambulatoriais foram diagnosticados e tratados para VPPB-CP. O tratamento consistiu em realizar as manobras de Epley ou de Semont. Ao término da manobra, ao serem colocados na posição sentado, as reações dos pacientes foram filmadas. Resultados: Trinta e três pacientes apresentaram o fenômeno de Tumarkin-like, descrito como uma sensação súbita de ser jogado no chão. O acompanhamento mostrou que todos eles permaneceram sem sintomas de VPPB até pelo menos 72 horas após as manobras. Conclusão: A ocorrência do fenômeno Tumarkin-like no final das manobras de Epley e Semont para VPPB-CP pode estar associado ao sucesso terapêutico.

Dehiscencia del canal semicircular superior como causa de tinnitus pulsátil / Superior semicircular canal dehiscence as cause of pulsatile tinnitus

RESUMEN El tinnitus se presenta en forma crónica en alrededor del 10% de los adultos, siendo el 4% de estos casos tinnitus pulsátil (TP). El TP se caracteriza por ser rítmico y sincrónico al latido cardiaco. Existen múltiples causas descritas, pero en un grupo importante de casos, no se logra objetivar su origen. Nuestro objetivo es presentar casos de dehiscencia del canal semicircular superior (DCSS) como causa de tinnitus pulsátil y su estudio. Se presentan dos pacientes evaluadas por tinnitus pulsátil. En ambos casos se descartan causas sistémicas, ECO doppler carotídeo sin alteración, angio TAC y RNM sin hallazgos. En reconstrucción de Pöschl se sospecha DCSS, por lo que se estudia con potenciales miogénicos evocados cVEMP y oVEMP con disminución de umbral y respuesta aumentada en oído afectado. En los casos expuestos el tinnitus aparece como síntoma único asociado a la presencia de DCSS, que fue confirmada con estudio imagenológico y VEMPs. El estudio con angio TAC permite pesquisar diversas causas asociadas. Los VEMPs confirman el diagnóstico, teniendo el oVEMP mayor sensibilidad. Como conclusión la DCSS es una entidad a tener presente como diagnóstico diferencial del tinnitus pulsátil y ante su sospecha se debe explorar con VEMPs.

ABSTRACT Tinnitus occurs chronically in about 10% of adults, being pulsatile tinnitus a 4% of these cases (TP). TP is characterized by being rythmic and sychronous to the heart beat. There are many described causes, but in a significant group of cases it is not possible to determine its origin. Our aim is present clinical cases of superior semicircular canal dehiscence (SSCD) as the cause of pulsatile tinnitus and its study. Clinical cases: Two patients present pulsatile tinnitus in her right ear. System causes were discarded, normal Carotid Doppler ultrasonography, Anglo CT scan and MRI without findings. In Pöschl reconstruction SSCD can be observed. Evoked myogenic potentials (VEMPs) by suspicion of SSCD Syndrome, cVEMP and oVEMP with a elevated amplitudes and lower thresholds ipsilateral response. In the cases exposed, tinnitus appears as a single symptom associated with the presence of SSCD which was confirmed with imaging studies and VEMPs. The AngioTAC allows to investigate several associated causes. The VEMPs confirm the diagnosis, with oVEMP having a greater sensitivity. The SSCD is an entity to have in my mind as a differential diagnosis of pulsatile tinnitus and, if suspected, should be explored with VEMPs.

Assessment of the horizontal semicircular canal function after cochlear implantation by video head impulse test and caloric test / 临床耳鼻咽喉头颈外科杂志

To analyze the functional change of horizontal semicircular canals after cochlear implantation.Eighteen patients were enrolled in this study.Their vestibular function was evaluated by using the caloric test and video head impulse test before and one week,one month after CI surgery,respectively.The unilateral weakness(UW),slow phase velocity(SPV)in caloric test and gain in video head impulse test(vHIT-G)were observed.Caloric test was abnormal when UW>25% or SPV mean<6°/s,while vHIT was abnormal when vHIT-G<0.8.The SPV of the implanted ear were[(10.36±8.01)°/s;(14.77±14.24)°/s]pre-operatively,[(6.45±7.52)°/s;(5.14±4.67)°/s]1 week post-operatively and[(6.05±3.86)°/s;(6.27±4.17)°/s]1 month post-operatively.Statistically significant difference(<0.05)was found between pre-and post-operative period.The vHIT-G of the implanted ear were(0.73±0.33)pre-operatively,(0.65±0.32)1 week post-operatively and(0.71±0.36)1 month post-operatively.There was no statistically significant difference of vHIT-G between preand post-operative period((pre-operative/1 week post-operative)=0.084,(pre-operative/1 month post-operative)=0.679).Four patients presented with vertigo and one of them manifested slight unsteadiness post-operatively.All symptoms resolved within 7 days.These symptoms had no correlate with age,gender,implantedear and results of vestibular test.Cochlear implantation can affect the horizontal semicircular canal function,and the video head impulse test and caloric test should be used in a complementary fashion.

Application of video head impulse test in detecting damage and recovery features of semicircular canal of patients with acute vestibular neuritis / 第二军医大学学报

Objective To investigate the application of video head impulse test in detecting the impairment of semicircular canal of patients with acute vestibular neuritis and the recovery features of the damaged semicircular canal. Methods The clinical data of 28 patients with acute vestibular neuritis, who were diagnosed in the Department of Neurology, Changzheng Hospital, Second Military Medical University from Mar. 2015 to Mar. 2016, were analyzed and regularly followed up. The damage and recovery of each semicircular canal function were evaluated by video head impulse test. Results During the onset period, the horizontal semicircular canal function was abnormal in 28 patients (100.00%), the anterior semicircular canal function was abnormal in 24 cases (85.71%), and the posterior semicircular canal function was abnormal in 4 cases (14.29%). After 2 months of follow-up, the gain of the patients with severe damage of horizontal semicircular canal (gain0.5) at onset did not return to normal, while that of 80.00% (12/15) of the patients with less damage of horizontal semicircular canal (gain ranged from 0.5 to 0.8) recovered; 82.35% (14/17) of the patients with severe damage of anterior semicircular canal (gain0.5) at onset did not recover, while that of the patients with less damage of anterior semicircular canal (gain ranged from 0.5 to 0.7) returned to normal. Conclusion In patients with vestibular neuritis, the damage of semicircular canal dominated by superior vestibular nerve is more severe than that dominated by inferior vestibular nerve. Video head impulse test is suitable for the detection and follow-up of the function of impaired semicircular canal. The recovery of impaired semicircular canal is related to its severity at onset.

Revisión sobre los conocimientos actuales de dehiscencia del canal semicircular posterior / Review of current knowledge of the dehiscence in the semicircular posterior canal

La dehiscencia del canal semicircular posterior es una patología rara y con baja incidencia, por ello hemos realizado una revisión de los conocimientos actuales de esta entidad. Se ha realizado una búsqueda bibliográfica desde 1998 hasta diciembre de 2016 de toda la literatura publicada sobre la misma en las bases de datos Allied and Complementary Medicine Database and the Embase, Health Management Information Consortium, Scopus, Consortium, Medline, PsycINFO y Scielo. Se han encontrado y revisado 53 trabajos relacionados con el tema. La dehiscencia del canal semicircular posterior presenta una prevalencia variable; 0,3%-4,5% en adultos y 1,2%-20% en niños. Su localización puede ser hacia el golfo de la yugular o fosa cerebral posterior. Los pacientes pueden ser asintomáticos o presentar clínica auditiva y/o vestibular. La tomografía computarizada y la prueba de potenciales vestibulares miogénicos evocados permiten establecer el diagnóstico de certeza. En el tratamiento quirúrgico la vía de abordaje de elección es la transmastoidea y las técnicas del cierre del canal son el "plugging" y el "resurfacing".

The posterior semicircular canal dehiscence is a rare pathology and it has a low incidence. We have realized a review about the current knowledge of this entity. We have performed a bibliographic research from 1998 to 2016 December about the literature published in this subject, in the data basis Allied and Complementary Medicine Database and the Embase, Health Management Information Consortium, Scopus, Consortium, Medline, PsycINFO y Scielo. I thas been found and reviewed 53 papers about the topic. The posterior semicircular canal dehiscence has a variable prevalence: 0,3%-4-5% in adults and 1,2%-20% in children. The location can be in the jugular bulb or in the posterior brain fossa. Some patients can be asymptomatic, whereas others can have auditory and/or vestibular signs and symptoms. Computed tomography and test of vestibular evoked myogenic potentials allow the diagnosis of certainty. In the surgical treatment the approach of choice is transmastoid and techniques to close the canal are plugging and resurfacing.

Superior Semicircular Canal Dehiscence Syndrome - Diagnosis and Surgical Management

Abstract Introduction Superior semicircular canal dehiscence syndrome was described by Minor et al in 1998. It is a troublesome syndrome that results in vertigo and oscillopsia induced by loud sounds or changes in the pressure of the external auditory canal or middle ear. Patients may present with autophony, hyperacusis, pulsatile tinnitus and hearing loss. When symptoms are mild, they are usually managed conservatively, but surgical intervention may be needed for patients with debilitating symptoms. Objective The aim of this manuscript is to review the different surgical techniques used to repair the superior semicircular canal dehiscence. Data Sources PubMed and Ovid-SP databases. Data Synthesis The different approaches are described and discussed, as well as their limitations.We also review the advantages and disadvantages of the plugging, capping and resurfacing techniques to repair the dehiscence. Conclusions Each of the surgical approaches has advantages and disadvantages. The middle fossa approach gives a better view of the dehiscence, but comes with a higher morbidity than the transmastoid approach. Endoscopic assistance may be advantageous during the middle cranial fossa approach for better visualization. The plugging and capping techniques are associated with higher success rates than resurfacing, with no added risk of hearing loss.