Benign Paroxysmal Positional Vertigo Secondary to Mild Head Trauma.

OBJECTIVES: We studied the clinical characteristics, nystagmographic findings, and treatment outcome of a group of patients with benign paroxysmal positional vertigo (BPPV) secondary to mild head trauma and compared them with a group of patients with idiopathic BPPV. METHODS: The medical records of 33 patients with BPPV associated with mild head trauma were reviewed. Data of a complete otolaryngological, audiological, neurotologic, and imaging evaluation were available for all patients. Three hundred and twenty patients with idiopathic BPPV were used as a control group. RESULTS: The patients with BPPV secondary to mild head trauma presented the following features, in which they differed from the patients with idiopathic BPPV: (1) lower mean age, with more intense symptoms; (2) increased rate of horizontal and anterior semicircular canal involvement and frequent multiple canal and bilateral involvement; (3) greater incidence of canal paresis and presence of spontaneous nystagmus; (4) poorer treatment results, attributed mainly to coexisting canal paresis in many patients, and higher rate of recurrence. CONCLUSIONS: Benign paroxysmal positional vertigo associated with mild head trauma differs from idiopathic BPPV in terms of several epidemiological and clinical features; it responds less effectively to treatment and is prone to recurrence.

Benign paroxysmal positional vertigo secondary to vestibular neuritis.

The aim of this study was to present the demographic, pathogenetic and clinical features of benign paroxysmal positional vertigo (BPPV) secondary to vestibular neuritis (VN). The medical records of 22 patients, who presented with BPPV within 12 weeks after the onset of VN, were reviewed. Data of a complete otolaryngological, audiological, neurotologic and imaging evaluation were available for all patients. Two hundred and eighty-four patients with idiopathic BPPV were used as a control group. The patients with BPPV secondary to VN presented the following features, in which they differed from the patients with idiopathic BPPV: (1) a lower mean age; (2) involvement of the posterior semicircular canal; (3) presence of canal weakness; (4) more therapeutic sessions needed for cure and a higher rate of recurrence. It may be, thus, concluded that BPPV associated with VN differs from idiopathic BPPV in regard to several epidemiological and clinical features, it responds less effectively to treatment and may follow a protracted course, having a tendency for recurrence.

Benign paroxysmal positional vertigo associated with Meniere's disease: epidemiological, pathophysiologic, clinical, and therapeutic aspects.

OBJECTIVES: We studied the demographic, pathogenetic, and clinical features of benign paroxysmal positional vertigo (BPPV) associated with Meniere's disease. METHODS: The medical records of patients with BPPV associated with Meniere's disease were reviewed. In all patients, results of a complete otolaryngological, audiological, and neurotologic evaluation, including nystagmography, were available. Patients with idiopathic BPPV were used as a control group. RESULTS: Twenty-nine patients with both disorders were found and were compared with 233 patients with idiopathic BPPV. The patients with BPPV associated with Meniere's disease presented the following features, in which they differed from the patients with idiopathic BPPV: 1) a higher percentage of female patients; 2) a longer duration of symptoms; 3) common involvement of the horizontal semicircular canal; 4) a greater incidence of canal paresis; and 5) more therapeutic sessions needed for cure and a higher rate of recurrence. CONCLUSIONS: The BPPV associated with Meniere's disease differs from idiopathic BPPV in regard to several epidemiological and clinical features, may follow a different course, and responds less effectively to treatment.

Etiology of vertigo in children.

OBJECTIVE: To detect the most common causes of vertigo in children. METHODS: Fifty-four children (20 boys and 34 girls) aged 3-16 years, who presented with vertigo attacks during a 3-year period, were studied. A detailed medical history for vestibular symptoms and migraine was obtained from our patients or their parents. All patients underwent otolaryngologic, ophthalmologic and neurologic clinical evaluation. A detailed laboratory examination, including serologic tests for viral infections, was also obtained. Additionally, a complete audiological and neurotologic evaluation was performed. Computed tomography (CT) scans and magnetic resonance imaging (MRI) were obtained in selected cases. RESULTS: Viral infections, benign paroxysmal vertigo of childhood and migraine were the most common causes of vertigo accounting for approximately 65% of our patients. Otitis media, head trauma, benign paroxysmal positional vertigo, Meniere's disease and brain tumor were less common causes of vertigo. CONCLUSIONS: A peripheral type of vertigo was found in most cases. Diagnostic approach in vertigo in children should include a detailed history and clinical examination in conjunction with a test battery of audiological and neurotologic tests. When a central cause of vertigo is suspected an MRI or CT scan should be ordered.

Bilateral spontaneous hemotympanum: case report.

BACKGROUND: The most common causes of hemotympanum are therapeutic nasal packing, epistaxis, blood disorders and blunt trauma to the head. Hemotympanum is characterized as idiopathic, when it is detected in the presence of chronic otitis media. A rare case of spontaneous bilateral hemotympanum in a patient treated with anticoagulants is presented herein. CASE PRESENTATION: A 72-year-old male presented with acute deterioration of hearing. In the patient's medical history aortic valve replacement 1 year before presentation was reported. Since then he had been administered regularly coumarinic anticoagulants, with INR levels maintained between 3.4 and 4.0. Otoscopy revealed the presence of bilateral hemotympanum. The audiogram showed symmetrical moderately severe mixed hearing loss bilaterally, with the conductive component predominating. Tympanograms were flat bilaterally with absent acoustic reflexes. A computerized tomography scan showed the presence of fluid in the mastoid and middle ear bilaterally. Treatment was conservative and consisted of a 10-day course of antibiotics, anticongestants and temporary interruption of the anticoagulant therapy. After 3 weeks, normal tympanic membranes were found and hearing had returned to previous levels. CONCLUSION: Anticoagulant intake should be included in the differential diagnosis of hemotympanum, because its detection and appropriate treatment may lead to resolution of the disorder.

The effect of the number of averaged responses on the measurement of transiently evoked otoacoustic emissions in newborns.

OBJECTIVE: The aim of this study was to examine the effect of the number of averaged responses on the measurement of transiently evoked otoacoustic emissions (TEOAEs). METHODS: The study was performed on the background of a universal newborn hearing screening program implemented in Iaso Maternity Hospital. Two groups of full-term newborns with normal otoacoustic emissions were studied. The first group included 58 newborns (115) ears, in which 260 low-noise samples, provided by the default setting of the equipment used (ILO88), were presented. The second group included 58 newborns (113) ears, in which 20-50 averaged responses were presented, until the "pass" criteria would be met. Statistical comparison between the following parameters recorded during TEOAE measurement was performed: Overall response, signal-to-noise ratios, reproducibility (whole and partial), stimulus intensity, stimulus stability, input noise, noise rejection level and duration of testing. RESULTS: Statistically significant differences were found in most of these parameters, except for overall response, stimulus intensity and noise rejection level. CONCLUSIONS: Although a smaller number of clicks is usually sufficient to obtain a "pass" in newborn hearing screening programs, the quality of recording of TEOAEs is significantly improved by increasing the number of averaged low-noise responses.

Correlation of transiently evoked to distortion-product otoacoustic emission measures in healthy children.

OBJECTIVE: Transiently evoked (TEOAEs) and distortion-product otoacoustic emissions at the 2f1-f2 frequency (DPOAEs) are being used as a clinical tool for diagnosis of peripheral auditory pathology. Because both tests are fast and non-invasive, they may be an excellent method for hearing screening in infants and children. The purpose of this study was to compare the TEOAE and DPOAE measures obtained in a group of healthy children. METHODS: Sixty-six school-aged children with normal hearing were included in the study. Subjects with recent otologic disease or abnormal tympanograms were excluded. TEOAEs and DPOAEs were performed using a DP Echoport ILO 292 Otodynamics analyzer connected to a portable personal computer. Correlation between TEOAE amplitudes and DPOAE levels was estimated. RESULTS: Correlation between TEOAE amplitudes and DPOAE levels was highly significant across all measured frequencies. Correlation was more significant at the middle frequencies than at the low and high frequencies. CONCLUSIONS: Although frequency specific information may be obtained by both tests, most reliable results were obtained at the middle frequencies. TEOAE values were more prominent at low frequencies, whereas DPOAEs were more effective at high frequencies. Both methods are reliable, objective, fast and useful tests of the cochlear status and should be included in the standard audiological diagnostic work-up of children.

Fibromatosis presenting as acute mastoiditis: a case report.

We describe the case of a middle-aged man who presented with manifestations of acute mastoiditis caused by fibromatosis of the mastoid region. A lesion of the right mastoid bone had eroded its wall and extended toward the middle and posterior cranial fossae. The macroscopic and microscopic appearance of an excised portion of the lesion established the diagnosis of mastoid fibromatosis. After a more detailed work-up, a second procedure involving extensive removal of the tumor was performed, and the diagnosis was confirmed. The patient's postoperative period was uneventful, and he showed no evidence of recurrence during 3 years of follow-up.

Rhinology resources on the internet: a critical review.

During recent years, the Internet has gradually evolved into a worldwide network, allowing access to vast amounts of information and providing various services. The benefits of medical professionals of using it are growing rapidly, as even more scientific, technical and biomedical resources become available on line. The Internet has always provided useful resources to rhinologists, with the number of relevant sites increasing daily, at a rapid pace. In this article, a review of the information included in several selected rhinology web sites is presented, in order to provide guidance and context for the vast amount of information which is available on the Internet, and to promote the use of the medium to rhinologists who do not have extensive experience in computers or telecommunications.

Correlation of transiently evoked otoacoustic emission measures to auditory thresholds.

BACKGROUND: The presence of otoacoustic emissions is objective evidence of normal cochlear status. However, this test cannot be used to predict absolute auditory thresholds with accuracy. The criteria of normal otoacoustic emissions are not yet standardized and different measures of otoacoustic emissions have been used in various settings. In this study, the measures of reproducibility and otoacoustic emission amplitude are compared with regard to their correlation to pure-tone auditory (PTA) thresholds. MATERIAL/METHODS: One hundred and seventeen subjects with normal hearing were included in the study. Subjects with previous audiological, otolaryngologic, or vestibular disease were excluded. A complete ENT and audiological work-up was performed, including transiently evoked otoacoustic emissions (TEOAEs). The equipment used for TEOAE testing was a DP Echoport ILO 292 Otodynamics analyzer connected to a portable personal computer. A full 260 low-noise samples were averaged. Correlation between PTA thresholds and either overall TEOAE amplitude or whole reproducibility was estimated using multiple regression analysis. RESULTS: Correlation between acoustic thresholds at 250, 500, 1000, 2000, 4000 and 8000 Hz and either whole reproducibility or emission amplitude was highly significant for both measures. However, whole reproducibility was better correlated to acoustic thresholds at 250, 500, 1000, 2000, 4000 and 8000 Hz than was emission amplitude, and was more accurately predicted from multiple regression equations. CONCLUSIONS: Reproducibility measures performed better than TEOAE amplitude levels in the prediction of auditory thresholds.