Hearing function after betahistine therapy in patients with Ménière's disease / Função auditiva após terapia com beta-histina em pacientes com doença de Ménière

ABSTRACT INTRODUCTION: Preventing or reversing hearing loss is challenging in Ménière's disease. Betahistine, as a histamine agonist, has been tried in controlling vertigo in patients with Ménière's disease, but its effectiveness on hearing problems is not known. OBJECTIVE: To examine the effect of betahistine on hearing function in not-previously-treated patients with Ménière's disease and to define possible contributors in this regard. METHODS: A total of 200 not-previously-treated patients with definite unilateral Ménière's disease received betahistine by mouth (initial dose, 16 mg three times a day; maintenance dose, 24-48 mg daily in divided doses). Changes in indicators of hearing status before and six months after treatment were documented. Hearing loss was considered as the mean hearing level >25 dB HL at five frequencies. RESULTS: The mean duration of disease was 3.37 years. Six months after treatment the mean hearing level decreased by 6.35 dB compared to that at the baseline (p < 0.001). Both patients' age and the duration of disease correlated negatively with the improvement in hearing function. Post treatment hearing loss was independently associated with age, the initial hearing level and the chronicity of disease. The corresponding optimal cut-off points for predicating a persistent hearing loss 6 months after treatment were 47 years, 38 dB HL, and 1.4 years, respectively. CONCLUSION: Oral betahistine was significantly effective in preventing/reversing hearing deterioration in patients with Ménière's disease. Age, the hearing level on admission, and the disease duration were independent predictors of hearing status after treatment.

Resumo Introdução: Prevenir ou reverter a perda auditiva é um desafio na doença de Ménière. A betahistina, um agonista de histamina, tem sido testada no controle de vertigem em pacientes com doença de Ménière, mas sua eficácia em problemas de audição ainda não é conhecida. Objetivo: Analisar o efeito da betahistina na função auditiva em pacientes com doença de Ménière não tratados previamente, e definir possíveis contribuintes a esse respeito. Método: Um total de 200 pacientes sem tratamento prévio, e com diagnóstico definido de doença de Ménière unilateral, recebeu beta-histina por via oral (dose inicial de 16 mg três vezes ao dia; dose de manutenção de 24-48 mg por dia, em doses divididas). Alterações dolimiar auditivo antes e após seis meses de tratamento foram documentadas. Considerou-se como perda auditiva uma média do nível de audição > 25 dB NA em cinco frequências. Resultados: A média de duração da doença foi de 3,37 anos. Seis meses após o tratamento, a média do limiar auditivo diminuiu em 6,35 dB, em comparação com o valor da linha de base (p < 0,001). Tanto a idade dos pacientes quanto a duração da doença apresentaram correlação negativa com a melhora da função auditiva. A perda auditiva após o tratamento foi independentemente associada à idade, ao nível inicial de audição e à cronicidade da doença. Os pontos de corte ótimos correspondentes para prever uma perda auditiva persistente seis meses após o tratamento foram 47 anos, 38 dB HL e 1,4 ano, respectivamente. Conclusão: A betahistina oral foi significantemente eficaz na prevenção/reversão da deterioração auditiva em pacientes com doença de Ménière. Idade, nível de audição na admissão e duração da doença foram fatores preditivos independentes da condição auditiva após o tratamento.

Bilateral Facial Paralysis Caused by Temporal Bone Fracture: A Case Report.

INTRODUCTION: Although bilateral facial nerve palsy is a rare condition, its etiology is more detectable than the unilateral type. A temporal bone fracture is one cause of bilateral facial nerve palsy, contributing in 3% of the cases. CASE PRESENTATION: Here, we report the case of a 35-year-old man complaining of bilateral incomplete eye closure, two weeks after a closed head injury caused by a motor vehicle accident. CONCLUSIONS: The high resolution computed tomography findings revealed a bilateral temporal bone fracture line, which extended to the fallopian canal. With regard to treatment, near complete recovery was obvious after two weeks of treatment with oral corticosteroids. Overall, bilateral facial palsy is hard to diagnose; therefore, clinical suspicion and the early detection of facial nerve injuries is necessary for good nerve recovery in temporal bone fractures.

Hearing function after betahistine therapy in patients with Ménière's disease.

INTRODUCTION: Preventing or reversing hearing loss is challenging in Ménière's disease. Betahistine, as a histamine agonist, has been tried in controlling vertigo in patients with Ménière's disease, but its effectiveness on hearing problems is not known. OBJECTIVE: To examine the effect of betahistine on hearing function in not-previously-treated patients with Ménière's disease and to define possible contributors in this regard. METHODS: A total of 200 not-previously-treated patients with definite unilateral Ménière's disease received betahistine by mouth (initial dose, 16mg three times a day; maintenance dose, 24-48mg daily in divided doses). Changes in indicators of hearing status before and six months after treatment were documented. Hearing loss was considered as the mean hearing level >25dB HL at five frequencies. RESULTS: The mean duration of disease was 3.37 years. Six months after treatment the mean hearing level decreased by 6.35dB compared to that at the baseline (p<0.001). Both patients' age and the duration of disease correlated negatively with the improvement in hearing function. Post treatment hearing loss was independently associated with age, the initial hearing level and the chronicity of disease. The corresponding optimal cut-off points for predicating a persistent hearing loss 6 months after treatment were 47 years, 38dB HL, and 1.4 years, respectively. CONCLUSION: Oral betahistine was significantly effective in preventing/reversing hearing deterioration in patients with Ménière's disease. Age, the hearing level on admission, and the disease duration were independent predictors of hearing status after treatment.

Mastoid cavity obliteration with combined palva flapand bone pâté.

INTRODUCTION: This study was designed to evaluate the usefulness of mastoid cavity obliteration with combined bone pâté and Palva flap in the prevention of problematic mastoid cavities after canal wall down mastoidectomy. MATERIALS AND METHODS: In a prospective longitudinal study with a mean follow-up of 28 months conducted between 2008-2012, a series of 56 ears in 48 patients with chronic otitis media due to a cholesteatoma underwent canal wall down mastoidectomy that their mastoid cavity obliterated with combined bone pâté and Palva flap. Seventeen (30%) ears were managed via revision surgery, with the reminder via primary surgery. Data included mastoid cavity status, results at second-look surgery with ossiculoplasty, and postoperative complications. RESULTS: All patients underwent second-look surgery. Forty-six (82%) ears maintained a very small, dry and healthy mastoid cavity. Seven (13%) ears had occasional otorrhea, and three (5%) ears had small granulation tissue. Seven (12.5%) ears had residual cholesteatoma pearl in the middle ear at second-look surgery. Four (7%) ears exhibited wound infection. CONCLUSION: Canal wall down mastoidectomy and mastoid cavity obliteration with combined bone pâté and Palva flap is a effective option for the complete removal of cholesteatoma and prevention of postoperative mastoid cavity problems.

Reconstruction of saddle nose deformity with calvarial bone graft.

OBJECTIVE: To evaluate the efficacy of calvarial bone in the reconstruction of saddle nose deformity. METHODS: The cross-sectional study was conducted at the Plastic Surgery Unit of Imam Reza Hospital, Tabriz University of Medical Sciences, Iran, from July 2004 to October 2009. It comprised 19 patients who underwent saddle nose deformity reconstruction with calvarial bone graft. All patients were operated upon under general anaesthesia. They were followed up periodically. RESULTS: The patients followed up for 25 to 61 months for an average period of 39.2 +/- 4.3 months. In 14 (74%) patients the result of the surgical intervention was excellent, while in 5 (26%) it was acceptable. All patients were satisfied and there was not displacement, absorption, distortion or infection of the graft. CONCLUSION: Calvarial bone graft is a viable option for the reconstruction of saddle nose deformity, especially in severe cases.

Labyrinthine fistula in chronic otitis media with cholesteatoma.

OBJECTIVE: To present the experience in the operative management of labyrinthine fistula caused by cholesteatoma. METHODS: The clinical charts of 16 patients who underwent surgical procedures for cholesteatoma complicated by labyrinthine fistula between 2003 and 2008 were reviewed retrospectively. In this period, 108 ears were operated for cholesteatoma. In each patient, the site and size of the fistula were evaluated during surgery and the hearing thresholds were compared before and after surgery. RESULTS: The fistula involved the lateral semicircular canals in 15 patients. Multiple fistulae were observed in one patient. Postoperative hearing levels were unchanged or improved in 88% patients. Favourable outcomes were obtained in patients treated with surgical sealing of the interrupted labyrinth. CONCLUSION: The current study confirmed that careful manipulation of the labyrinthine fistula is mandatory to preserve hearing function in these patients. According to the author's experience, the canal wall down transmastoid approach with mastoid cavity obliteration is a favourite technique of labyrinthine fistula treatment.