ABSTRACT
The opportunity to treat neurotologic patients when the patient and physician are in separate locations is an important clinical delivery mechanism. The authors developed their applications of neurotologic telemedicine in the aftermath of Hurricane Katrina and found this to be an effective way to deliver clinical care, develop a clinical neurotology practice, and train residents and fellows and to manage a growing neurotologic clinical practice remotely. This article outlines the technical requirements, current uses, clinical applicability, and implementation details of the Our Lady of the Lake - LSU neurotology telemedicine program; administrative issues surrounding telemedicine; and future considerations.
Subject(s)
Otolaryngology/organization & administration , Telemedicine/organization & administration , Disasters , Female , Forecasting , Humans , Male , Neurology/organization & administration , Program Development , Program Evaluation , Remote Consultation/organization & administration , Risk AssessmentABSTRACT
OBJECTIVES: 1) To compare the incidence of elevated visually enhanced vestibular-ocular reflex (VVOR) rotational gain during rotational chair testing in a normal control group versus a group of patients diagnosed with migraine vestibulopathy; 2) to discuss the possible application of VVOR gain during rotational chair testing for diagnosing migraine vestibulopathy. STUDY DESIGN: Prospective normal control group and retrospective cohort comparison. METHODS: 1) Prospective rotational chair studies including VVOR in 20 normal control patients; 2) retrospective review of vestibular studies including VVOR in 100 consecutive patients with migraine vestibulopathy. RESULTS: Twenty of the normal controls and 69 of the migraine vestibulopathy patients met all inclusion criteria. One of 20 (5%) normal control patients had elevated VVOR gain, whereas 49 of 69 (71%) of migraine vestibulopathy patients had elevated VVOR gain. CONCLUSIONS: VVOR gain normal criteria were appropriate in 95% of our normal control test group. VVOR gain was more frequently elevated in migraine vestibulopathy patients than in the normal controls, and the difference was significant (P < .001). VVOR gain elevation was the most common vestibular test abnormality in this cohort of patients with migraine vestibulopathy. Because VVOR measures visual-vestibular interaction and its central connections, this parameter may be a useful diagnostic tool for migraine vestibulopathy in patients manifesting disequilibrium and motion sensitivity.
