Vestibular evoked myogenic potentials.

Vestibular Evoked Myogenic Potentials (VEMP) are commonly recorded in patients experiencing vertigo or chronic instability. This test evaluates the patient's otolith function and is often combined with both Videonystagmography and Video Head Impulse Test. VEMP is a simple, reproducible test, in the absence of any pre-existing conductive hearing loss. Cervical VEMP explore both saccular function and the inferior vestibular nerve, whereas ocular VEMP assess utricular function and the superior vestibular nerve. In combination with previously described tests, VEMP allows characterization of vertigo and provides support for the diagnosis of superior semicircular canal dehiscence syndrome, Menière's disease, vestibular neuritis, vestibular schwannoma or idiopathic bilateral vestibulopathy. A good knowledge of these electrophysiological tests is essential in order to precisely assess the presence or absence of vestibular function impairment. We describe the test recording technique and the most common pitfalls in interpretation of the results. We then outline the results observed in various diseases impacting vestibular function.

Peripharyngeal space tumors: Can magnetic resonance and multidetector-row computed tomography help predict location, malignancy and tumor type?

PURPOSE: The goal of this study was to assess the performances of magnetic resonance imaging (MRI) and multidetector-row computed tomography (MDCT) in determining tumor location, suggesting the specific diagnosis of tumors involving the peripharyngeal space and identifying findings suggestive for malignancy using histopathological findings as standard of reference. MATERIAL AND METHODS: The MDCT and MRI examinations of 99 patients with a total of 102 tumors located in the retropharyngeal, carotid and parapharyngeal spaces were retrospectively reviewed. MDCT and MRI examinations were independently analyzed for tumor location and specific histological type of tumor. Finally, benign or malignant criteria were evaluated. Agreement between imaging features and final histopathological diagnosis that served as the standard of reference was assessed with the Kappa statistic. RESULTS: Regarding tumor location almost perfect agreement was obtained between imaging findings and histopathological findings (kappa=0.86 and 0.92 for MDCT and MRI, respectively). Agreement between the results of imaging and histopathological findings regarding malignancy was substantial for MDCT (Kappa=0.73), MRI (Kappa=0.65). A definite histopathological diagnosis was suggested on the basis of imaging findings for 84 tumors and in agreement with the final histopathological diagnosis in 77/84 tumors (92%). CONCLUSION: MDCT and MRI provide accurate information to localize and characterize peripharyngeal tumors. These two examinations provide complementary data to identify imaging criteria that suggest malignancy.

[Parapharyngeal tumors: management and postoperative results]. / Tumeurs de l'espace parapharyngé: prise en charge et résultats postopératoires.

OBJECTIVES: Parapharyngeal space tumours are rare and mostly benign, and their access is difficult. The aim of the study was to define the optimal treatment of these tumours. MATERIAL AND METHODS: Clinical retrospective study, with histological, treatment, prognosis analysis of the parapharyngeal space tumours occurred between 1994 and 2012 and the surgical approach considerations. RESULTS: 35 patients were included with a male sex ratio predominance (51.43%, p = ns). The mean age of diagnosis was 49 years. The majority of tumours were benign (75.76%, p < 0.001). 54.5% originated from salivary gland with a majority of pleomorphic adenomas (42.42%). The second most frequent aetiology found was schwannoma (21.21%). 2 patients refused the treatment. Accidentally discovered were frequent (28.57%). In the symptomatic forms, dysphagia dominated (25.71%). Oropharyngeal (20%) and/or cervical (17.14%) mass were rare. A CT scan and a MR imaging were performed in 82.86% and 71.43% of the cases. A fine needle aspiration cytology was achieved in 10 cases with a positive predictive value of 60%. The cervical submandibular trans digastric approach was the most accomplished (40%). Other approaches were also used: Trans oral (25.71%), parotidectomy (14.71%), combined trans oral and cervical or parotidectomy (14.71%) and the cervical approached associated to a mandibulotomy (5.71%). A complementary treatment was proposed in 85.7% of the cases of malignant tumours. Post-operative complications were dominated by Horner's syndrome (n = 3), a temporary facial palsy (n = 5), definitive (n = 1), a velar insufficiency (n = 1), persistent pain (n = 6). CONCLUSIONS: The presence of 25% of malignant tumours and 40% of pleomorphic adenomas require removal of parapharyngeal tumours, even if non symptomatic.