Efficacy of medical therapy in the prevention of residual dizziness after successful repositioning maneuvers for Benign Paroxysmal Positional Vertigo (BPPV).

OBJECTIVES: The aim of this study was to investigate the efficacy of trimetazidine, betahistine, and ginkgo biloba extract in the treatment of residual dizziness after successful repositioning maneuvers for benign paroxysmal positional vertigo. METHODOLOGY: This was a randomized controlled clinical trial. Complete clinical data were analyzed from 100 patients (27 men and 73 women; mean age 52.16 ± 13.2 years, range 11-80 years) with BPPV who underwent succcessful repositioning maneuvers and then received betahistine, trimetazidine, gingko biloba extract, or no medication (n = 25 for each group) for 1 week. On days 1, 3, and 5 after the repositioning maneuver, scores obtained from the Dizziness Handicap Inventory (DHI) questionnaire were compared. RESULTS: There were no statistically significant differences in the premedication DHI scores of patients with residual dizziness among the four groups (p > 0.005). After 3 and 5 days of treatment, the mean DHI scores of the groups receiving medication did not differ significantly from the the mean DHI score of the control group (p > 0.005). CONCLUSIONS: Our study results suggest that betahistine, trimetazidine, and gingko biloba extract do not alleviate residual dizziness after successful repositioning maneuvers.

Comparing the effects of desflurane and isoflurane on middle ear pressure.

The aim of this study was to determine middle ear pressure changes during the operation performed under anaesthesia induced by isoflurane or desflurane. This was a prospective, case-control study. A total of 38 children with no middle ear pathology scheduled for inguinal hernia surgery were included in the study. Group I (n = 22) received isoflurane and Group II (n = 16) received desflurane. Baseline tympanometry was performed before the anaesthesia on both ears, and tympanometry was repeated 5, 10 and 15 minutes after the administration and 10 and 30 minutes after the withdrawal of anaesthetic agents. Data were analyzed using the Mann-Whitney U (inter-group) and the Wilcoxon test (intra-group) procedures. The mean middle ear pressure values in the 44 ears of the 22 children in Group I and the 32 ears of the 16 children in Group II did not show any significant difference before the anaesthesia by either anaesthetic agent (p > 0.05). Increase in the mean middle ear pressure values at the 5(th) and 10(th) minute of the operation was significant different between both groups (2.84 and 5.80 daPa for isoflurane; 59.06 and 72.81 daPa for desflurane; p ≤ 0.05). Desflurane is more increased than isoflurane on intra-tympanic pressure and isoflurane may be used more safely than desflurane in middle ear operations. The low effect of isoflurane on intra-tympanic pressure can be explained by the high blood/gas partition coefficient compared to desflurane.

New treatment strategy and assessment questionnaire for external auditory canal pruritus: topical pimecrolimus therapy and Modified Itch Severity Scale.

OBJECTIVE: We aimed to compare the efficacy of topical pimecrolimus versus hydrocortisone in treating external auditory canal pruritus, using the Modified Itch Severity Scale as an assessment tool. METHODS: We included in the study 40 patients with isolated itching of the external auditory canal who had not received any benefit from previous topical and systemic treatments. Topical 1 per cent pimecrolimus or topical hydrocortisone was applied to each patient's external auditory canal for three months. A Modified Itch Severity Scale was developed and used to assess treatment response. RESULTS: Compared with itching scores on initial assessment, the scores of patients receiving topical pimecrolimus had decreased by 52.3 per cent by the third week of treatment and by 77.6 per cent by the third month, whereas the scores of patients receiving topical hydrocortisone had decreased by 34.4 per cent by the third week and by 64.2 per cent by the third month. CONCLUSIONS: Topical pimecrolimus appears to be as effective as topical hydrocortisone in relieving external auditory canal pruritus. We used a novel scoring system, the Modified Itch Severity Scale, to evaluate external auditory canal pruritus; this is the first self-reporting questionnaire for the quantification of external auditory canal pruritus severity. Further studies are needed to validate this scoring system.

An unusual cause of dysphonia: laryngeal verruca vulgaris.

PROBLEMS/OBJECTIVES: Verruca vulgaris of the larynx (VVL) is an uncommon lesion with clinical and histopathological features that are easily misdiagnosed as verrucous carcinoma, and thus may lead to unnecessary surgery. This case study investigated clinical and pathological features that might distinguish VVL from other keratotic laryngeal lesions. METHODOLOGY: A 35-year-old man presented with a 3-month history of progressive hoarseness and superficial, keratotic, vocal cord lesions. The verrucoid configuration of the surface and lack of nuclear atypia enabled treatment by local excision. The biopsied lesion was sectioned and examined by immunohistochemistry, and in situ hybridization. RESULTS: The patient was disease-free up to 1 year and 6 months after surgery. The exophytic, keratotic lesions of the larynx had features of cutaneous verruca vulgaris. No human papilloma virus was detected. CONCLUSIONS: We described histopathological features of VVL that will facilitate its distinction from laryngeal keratosis, squamous papillomas, verrucous hyperplasia, and verrucous carcinoma.

Gorlin's syndrome with a thin corpus callosum and a third ventricular cyst.

Gorlin's syndrome (naevoid basal cell carcinoma) is an autosomal dominant tumor-predisposition syndrome, classically consists of multiple basal cell carcinomas of the skin, odontogenic keratocyst of the jaw, various skeletal abnormalities, and lamellar falx calcifications. Many associated lesions have been reported. We report a case of Gorlin's syndrome in a 22-year-old man in whom CT and MR images showed unusual findings of the thin corpus callosum and third ventricular cyst. We present a case of this syndrome with special emphasis on its unusual neuroradiological findings and radiological management.

Effect of WEB 2170 BS, platelet activating factor receptor inhibitor, in the guinea pig model of middle ear inflammation.

Platelet activating factor (PAF), a potent inflammatory mediator, is a biologically active phospholipid. Recent studies have shown that PAF may play an important role in the pathogenesis of otitis media (OM). WEB 2170 BS has been shown to be a PAF antagonist both in vitro and in vivo. In this study, the anti-inflammatory effects of WEB 2170 BS were investigated in a guinea pig model of OM induced by middle ear (ME) inoculation of killed Staphylococcus aureus. The outcome of treatment was determined by measurement of myeloperoxidase activity in the samples of ME mucosa, evaluation of temporal bone histopathology, and the presence of ME fluid. The myeloperoxidase activity in the WEB 2170 BS-treated group was found to be significantly lower than that in the control group. Histopathology of the temporal bones indicated decreased inflammation in the treated group as compared to the controls. In addition, ME fluid was absent in 16 of the 20 ears of the 10 treated animals. These results demonstrate that WEB 2170 BS can produce significant anti-inflammatory effects in this model of OM.

Evaluation of eustachian tube function with ventilation scintigraphy by using 133Xe gas.

The aim of this study was to evaluate Eustachian tube function by ventilation scintigraphy. In 13 patients with normal tube function and 16 with one-sided tube dysfunction, 50 MBq 133Xe was applied into the nasopharyngeal space through a tube inserted into the nasal cavity. Immediately after the insufflation, the patients were asked to perform three Valsalva manoeuvres. The visualization of the middle ear was possible in 10 of the 13 patients (77 per cent) with normal tube function. Decreased uptake of the middle-ear region in the side of dysfunction was demonstrated in 11 of the 16 patients (68.7 per cent) with one-sided tube dysfunction. Quantitative evaluation by region of interest technique revealed that by using percentage retention of activity and uptake rates, there were significant differences between the sides of dysfunction and sides of normal tube function (p < 0.05) and also between sides of dysfunction and both sides of controls (p < 0.05). There was no significant differences between normal sides of patients and both sides of controls (p > 0.05). As a conclusion, this method is non-invasive, easy- to perform and has a low radiation burden in the evaluation of Eustachian tube function. Although the number of patients is limited, the test seems to be applicable with a success rate of about 74 per cent.

Haemangiopericytoma of the middle ear with benign histological features.

Haemangiopericytoma is a rare vascular tumour, particularly in the head and neck region. We described the first case of haemangiopericytoma arising from the middle ear in 1995. The present case is the second example of a primary middle-ear haemangiopericytoma with benign histological features. Clinical photography, computed tomography (CT) and magnetic resonance imaging (MRI) scans and histological photographs depict the findings.

Leiomyosarcoma of the auricle: case report and literature review.

Leiomyosarcoma is a malignant tumour of smooth muscle origin. These tumours are rarely encountered in the head and neck region. A case of leiomyosarcoma of the auricle is presented. There are two cases of external auditory canal leiomyosarcoma in the literature. To our knowledge the present case is the first example of leiomyosarcoma of the auricle.

A case of a large dentigerous cyst containing a canine tooth in the maxillary antrum leading to epiphora.

A case of a large dentigerous cyst containing a canine tooth in the maxillary antrum is presented. This case is of interest due because of its extensiveness and the presence of a canine tooth in the roof of the maxillary sinus. In addition, this caused a right-sided epiphora. Enucleation of the cyst containing the ectopic tooth was made.