The Effects of the Vestibular Rehabilitation on the Benign Paroxysmal Positional Vertigo Recurrence Rate in Patients with Otolith Dysfunction

BACKGROUND AND OBJECTIVES: Although repositioning maneuvers have shown remarkable success rate in treatments of benign paroxysmal positional vertigo (BPPV), the high recurrence rate of BPPV has been an important issue. The aims of present study were to examine the effects of otolith dysfunction on BPPV recurrence rate and to describe the effect of vestibular rehabilitation exercises on BPPV recurrence in BPPV patients with concomitant otolith dysfunction. SUBJECTS AND METHODS: Forty-five BPPV patients included in this study (three groups). Patients in group 1 had no otolith dysfunction and patients in groups 2 and 3 had concomitant otolith dysfunction. Otolith dysfunction was determined with ocular/cervical vestibular evoked myogenic potential (oVEMP and cVEMP) abnormalities. Epley’s maneuver was performed for the patients in all groups but patients in group 3 also received a 2-month vestibular rehabilitation program (habituation and otolith exercises). RESULTS: This study showed that BPPV recurrent rate was significantly higher in patients with otolith dysfunction in comparison to the group 1 (p < 0.05). Vestibular rehabilitation resulted in BPPV recurrence rate reduction. Utricular dysfunction showed significant correlation with BPPV recurrence rate. CONCLUSIONS: Otolith dysfunction can increase BPPV recurrence rate. Utricular dysfunction in comparison to saccular dysfunction leads to more BPPV recurrence rate. Vestibular rehabilitation program including habituation and otolith exercises may reduce the chance of BPPV recurrence.

Saccular function in otosclerosis patients: bone conducted-vestibular evoked myogenic potential analysis

Vestibular involvements have long been observed in otosclerotic patients. Among vestibular structures saccule has the closest anatomical proximity to the sclerotic foci, so it is the most prone vestibular structure to be affected during the otosclerosis process. The aim of this study was to investigate the saccular function in patients suffering from otosclerosis, by means of Vestibular Evoked Myogenic Potential [VEMP]. The material consisted of 30 otosclerosis patients and 20 control subjects. All participants underwent audiometric and VEMP testing. Analysis of tests results revealed that the mean values of Air-Conducted Pure Tone Average [AC-PTA] and Bone-Conducted Pure Tone Average [BC-PTA] in patients were 45.28 +/- 15.57 and 19.68 +/- 10.91, respectively and calculated 4 frequencies Air Bone Gap [ABG] was 25.64 +/- 9.95. The VEMP response was absent in 14 [28.57%] otosclerotic ears. A statistically significant increase in latency of the p13 was found in the affected ears [P=0.004], differences in n23 latency did not reach a statistically significant level [P=0.112]. Disparities in amplitude of p13-n23 in between two study groups was statistically meaningful [P=0.009], indicating that the patients with otosclerosis had lower amplitudes. This study tends to suggest that due to the direct biotoxic effect of the materials released from the otosclerosis foci on saccular receptors, there might be a possibility of vestibular dysfunction in otosclerotic patients

Frozen section as a diagnostic test for major salivary gland tumors

Major salivary gland tumors are uncommon and the exact nature of these tumors is not obvious. This study was carried out to compare the histological results of intraoperative frozen sections against those of permanent reports for major salivary glands masses. One hundred thirty-nine patients with major salivary gland masses who were candidates for surgery underwent an intraoperative frozen section biopsy. A permanent histological examination was then performed for definite diagnosis and its result was compared with that of the frozen section. Sensitivity, specificity, accuracy and the positive and negative predictive values were analyzed. The frozen section had 98.4% sensitivity, 87% specificity, 97.1% accuracy, 98.4% positive predictive value and 87% negative predictive value in differentiating between non-neoplastic and neoplastic lesions. In addition, the frozen section's identification of a mass as either benign or malignant showed 98% sensitivity, 100% specificity, 99.2% accuracy, 100% positive predictive value and 99% negative predictive value. Based on the current study's findings, it can be suggested that the frozen section is considerably accurate in the diagnosis of malignant versus benign lesions of major salivary glands, regardless of the exact histopathological type of the malignant tumors.

Associations between HLA-C alleles and definite Meniere's disease

Both genetic and environmental factors seem to play role in the etiology of Meniere's disease [MD]. Several genes may be involved in susceptibility of MD including Human Leukocyte Antigens [HLA]. The associations between MD and HLA alleles have been previously studied in other populations and certain HLA alleles were shown to be predisposing. The aim of this study was to determine the association between HLA-C allele frequencies and definite MD in patients who refer to Amir-Alam otolaryngology tertiary referral center in Tehran. Patients with definite MD [N=22] enrolled according to the diagnostic criteria of American Academy of Otolaryngology-Head and Neck Surgery [AAO-HNS]. Cases with all 3 symptoms of MD [Vertigo, Tinnitus and lower frequency of sensory-neural hearing loss] were included and those with suspected MD were excluded from study. HLA-Cw allele frequencies were determined in patients non-related healthy controls [N=91] using PCR -SSP. We found that the frequency of HLACw[*]04 was significantly higher in patients compared to the controls [P = 0.0015, OR; 20, 95% CI [3.7-196.9]]. Our results revealed that HLA-C is a genetic predisposing factor in definite MD in patients who refer to Amir-Alam otolaryngology tertiary referral center

Reporting a right sided 4th branchial anomaly; case report and reporting the technical issues

Fourth branchial pouch anomaly [4BPA] is a rare condition that often presents an extreme diagnostic and therapeutic challenge. It usually causes recurrent left thyroid or perithyroid tissue inflammation, but it can be situated in the right side too. In this case report we present a nine-year-old girl with right sided 4BPA. She was referred for evaluation of recurrent right muscular space mass and fistula that was unresponsive to any medical or surgical procedures. This paper demonstrates the proper technical issues about diagnostic work up and surgical approach that we used to manage her dilemma. In patients with both skin fistula and pyriform sinus opening, external cannulation is more convenient and less traumatizing than internal cannulation