ABSTRACT
OBJECTIVES: To determine the sensitivity and specificity of the head-shaking nystagmus test (HSN), the nystagmus elicited in response to a vigorous rotation of the head in the horizontal plane, in the study of patients with peripheral unilateral vestibular disease. PATIENTS AND METHODS: Retrospectively, we analyze the relationships between the HSN and the rest of the videonystagmographic tests on eighty-three patients with peripheral unilateral vestibular disease. RESULTS: Twenty-three patients showed a positive head-shaking nystagmus; twenty-one of them had unilateral caloric hypofunction and only two had a symmetric caloric test, but both of them showed some type of vestibular dysfunction on other videonystagmographic test. In our series, the HSN sensitivity for the existence of peripheral vestibular disease was 48.8%, while the specificity was 95% in relation to the caloric test, reaching 100% when the gold standard was the presence of any abnormal videonystagmographic test. CONCLUSION: HSN is a simple test that can be useful to identify patients having unilateral vestibular hypofunction.
Subject(s)
Head/physiopathology , Nystagmus, Pathologic/diagnosis , Nystagmus, Pathologic/physiopathology , Adolescent , Adult , Aged , Caloric Tests , Female , Humans , Male , Middle Aged , Nystagmus, Pathologic/etiology , Retrospective Studies , Severity of Illness Index , Vestibular Function TestsABSTRACT
AIM: Lipomas are exceptional tumors at the Cerebellopontine Angle (CPA) or the Internal Auditory Canal (IAC). We evaluate clinical, histological and radiological characteristics of the cases diagnosed in our Hospital and the results of conservative versus surgical treatment. MATERIAL AND METHODS: We report 4 cases of CPA and/or IAC and review 99 previously reported in the literature. RESULTS: Unilateral tinnitus was the most frequent symptom (100%). All lesions showed hyperintensity on T1 and hypo/isointensity on T2--weighted MNR images. Two patients underwent a retro-sigmoidal approach without complete tumoral resection and with additional neurological consequences. Another two cases were followed up by annual MNRs. During the follow-up period (4.2 years average), neither clinical nor radiological changes were detected. CONCLUSION: The surgical resection of CPA y/o IAC lipomas is associated to a significant morbidity due to the high vascularization and the dense adherence of these lesions to the surrounding tissues. The MNR is the suitable technique for differential diagnosis between lesions at this location.
Subject(s)
Cerebellar Neoplasms/diagnosis , Cerebellopontine Angle , Ear Neoplasms/diagnosis , Labyrinth Diseases/diagnosis , Lipoma/diagnosis , Adult , Female , Humans , Male , Middle AgedABSTRACT
Although the use of antibiotic prophylaxis has significantly reduced the frequency of postoperative wound infections, they continue to be a critical issue in head and neck cancer surgery. A study was made of possible risk factors for the development of these infections. A prospective study was made of 159 patients with pharyngo-laryngeal squamous-cell carcinoma who underwent open-pharynx surgery in order to analyze the factors associated with wound infections. Postoperative wound infection was defined as purulent drainage or mucocutaneous fistula formation, or both, in the first 10 days after surgery. Potential risk factors examined were age, medical illnesses, prior surgery and radiotherapy, TNM stage, type of operative procedure, method of reconstruction, and operative time. The overall wound infection rate was 23%. Although the incidence of wound infection was higher in patients who received preoperative radiotherapy, in patients with advanced stage disease, and in those who required flap reconstruction, the only preoperative factor that significantly increased the rate of wound infection was the concurrence of medical illnesses (chronic obstructive pulmonary disease and diabetes mellitus; p = 0.018). In conclusion, the presence of prior medical diseases was the main risk factor in the development of postoperative wound infections.
