Assessing the impact of migraine on benign paroxysmal positional vertigo symptoms and recovery.

BACKGROUND: During episodes of benign paroxysmal positional vertigo (BPPV), individuals with migraine, compared with individuals without migraine, may experience more severe vestibular symptoms because of their hyperexcitable brain structures, more adverse effects on quality of life, and worse recovery processes from BPPV. METHODS: All patients with BPPV were assigned to the migraine group (MG, n = 64) and without migraine group (BPPV w/o MG, n = 64) and completed the Vertigo Symptom Scale (VSS), Vertigo Dizziness Imbalance Symptom Scale (VDI-SS), VDI Health-Related Quality of Life Scale (VDI-HRQoLS), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI) at the time of BPPV diagnosis (baseline) and on the one-month follow-up. Headache Impact Test-6 and Migraine Disability Assessment Scale were used for an assessment of headache. Motion sickness was evaluated based on the statement of each patient as present or absent. RESULTS: Compared with the BPPV w/o MG, the MG had higher VSS scores at baseline [19.5 (10.7) vs. 11.3 (8.5); p < 0.001] and on one-month follow-up [10.9 (9.3) vs. 2.2 (2.7), p < 0.001]; experienced more severe dizziness and imbalance symptoms based on the VDI-SS at baseline (61.9% vs. 77.3%; p < 0.001) and after one month (78.9% vs. 93.7%, p < 0.001); and more significantly impaired quality of life according to the VDI-HRQoLS at baseline (77.4% vs. 91.8%, p < 0.001) and after one month (86.3% vs. 97.6%, p < 0.001). On the one-month follow-up, the subgroups of patients with moderate and severe scores of the BAI were higher in the MG (39.2%, n = 24) than in the BPPV w/o MG (21.8%, n = 14) and the number of patients who had normal scores of the BDI was lower in the MG than in the BPPV w/o MG (67.1% vs. 87.5%, p = 0.038). CONCLUSION: Clinicians are advised to inquire about migraine when evaluating patients with BPPV because it may lead to more intricate and severe clinical presentation. Further studies will be elaborated the genuine nature of the causal relationship between migraine and BPPV.

The effect of migraine and motion sickness on symptoms evoked by the caloric vestibular test.

BACKGROUND: The caloric vestibular test (CVT) may evoke headache and vestibular symptoms in susceptible people. Patients with migraines have higher susceptibility to motion sickness. In migraines, impaired habituation to repetitive stimuli is a well-known interictal abnormality. OBJECTIVE: This study is aimed at evaluating CVT-evoked headache, nausea, vomiting, and imbalance in patients with and without migraine and/or motion sickness. METHODS: A retrospective data analysis was performed on 554 patients with a complaint of dizziness who underwent bithermal CVT at a tertiary referral center. The occurrences of CVT-evoked headache, nausea, vomiting, and imbalance were observed in four groups: patients with only migraine (MG; n = 94), those with only motion sickness (MSG; n = 89), those with migraine and motion sickness (MMSG; n = 122), and those without migraine and motion sickness (non-MMSG; n = 146). The differences between the groups were assessed. RESULTS: The mean ages of groups were similar (p = 0.534). The proportions of females were higher in the MG, MSG, and MMSG (p = 0.001). The severity of nausea and headache for each gender was higher in the MG, MSG, and MMSG (p < 0.001). Vomiting was more common in MMSG among males (p = 0.003), while there was no difference between groups among females (p = 0.099). Imbalance was more common in MMSG among females (p < 0.001). A relationship was detected between age and imbalance (p < 0.001), where an increased risk for imbalance was evident with greater age. Three patients in the MMSG needed hospitalization after CVT. CONCLUSIONS: Special caution is needed when performing caloric testing for patients with migraines or MS since CVT-evoked symptoms may occur with higher incidence and intensity, which might be related to a lack of habituation in neuronal information processing after robust sensory stimuli like CVT.

Vestibular disorders in children: A retrospective analysis of vestibular function test findings.

OBJECTIVE: This study was designed to describe the most common vestibular disorders in children and their associated findings on vestibular function testing. METHOD: Data from 203 children with a mean age of 11.16 ± 3.87 (range, 1-17) years were collected from among 3400 patients who underwent vestibular assessment at a vertigo center in a tertiary hospital over a 3-year period. A retrospective data analysis was performed for 203 children. RESULTS: Vestibular disorders were diagnosed in 78.3% (n = 159) of 203 children among 3400 patients, which revealed a 3-year incidence of 4.67% in our study. Benign paroxysmal positional vertigo (BPPV) was the most common diagnosis in our group of children (49%; n = 100), which involved both primary BPPV, and secondary BPPV that was associated with other vestibular pathologies. Vestibular migraine (VM) was the second most common diagnosis (41%; n = 83) followed by benign paroxysmal vertigo of childhood (BPVC; 4.5%, n = 9), vestibular neuritis (VN; 4.5%, n = 9), and psychogenic vertigo (4.5%, n = 9). Our study showed that Meniere's Disease (MD; 1.5%, n = 3) and central vertigo (1.5%, n = 3) were less commonly diagnosed in children. Perilymphatic fistula (PLF) was diagnosed and surgically confirmed in only one child. CONCLUSION: BPPV and VM were the most common pediatric vestibular disorders in our study. Clinicians should be aware of the prevalence, signs, and symptoms of the most common vestibular disorders in children to enable diagnosis, treatment, and rehabilitation. Vestibular function testing with age-appropriate adaptations results in improved differential diagnosis, which guides medical treatment and rehabilitation.

Research on the Effects of a Web-Based System With Oculomotor and Optokinetic Stimuli on Vestibular Rehabilitation.

OBJECTIVE: The variety and use of technologies used in vestibular rehabilitation are very limited. The purpose of this study was to investigate the effects of a Web-based system on vestibular rehabilitation in patients with vestibular hypofunction. DESIGN: A total of 20 patients with unilateral vestibular hypofunction were randomly assigned to two groups. Conventional vestibular rehabilitation was applied to the control group, whereas the study group received treatment with the Web-based system supporting the vestibulo-ocular reflex with oculomotor and optokinetic stimulus (Simulation of Vestibulo-Ocular Reflex Exercises). Vestibular and balance tests, oculomotor level, the Tampa Kinesiophobia Scale, and the Dizziness Handicap Inventory were used to evaluate the treatment's efficacy. RESULTS: Vestibular symptoms and findings, balance tests, oculomotor functions, Tampa Kinesiophobia Scale, and Dizziness Handicap Inventory improved significantly in both groups after the interventions (P < 0.05). In the intergroup analysis, improvement was found in eyes closed Romberg, semitandem, and left one-foot position balance tests in favor of the study group (P < 0.05). CONCLUSION: The new vestibular technology, Simulation of Vestibulo-Ocular Reflex Exercises, was found to be effective in vestibular rehabilitation.

Effect of the Fascia Graft Size on Healing Rate of Cavities in Patients Undergoing CWD Tympanomastoidectomy: A Clinical Prospective Study.

OBJECTIVES: To evaluate the effects of size of temporal fascia graft on healing of the mastoid cavity in patients undergoing canal wall down (CWD) procedures. MATERIALS AND METHODS: The study included 32 patients (ages from 10 to 69 years) who were performed CWD tympanomastoidectomy from 2016 to 2018. Patients were divided into 2 different groups randomly based on size of fascia used in the operations. Group 1 consisted of 19 patients with temporal muscle fascia large enough to extend up to antrum by passing through over the facial ridge. Group 2 consisted of 13 patients with fascia of a size hardly enough to create a middle ear space, which were quite smaller than those the first group. It was also observed that whether or not the type of pathology (cholesteatoma, granulation tissue or both) had an effect to the epithelialization time of the cavity. RESULTS: Thirty-two patients met inclusion criteria. Nineteen patients were randomized to study (large fascia) group and 13 patients were to control (small fascia) group. The mean duration for epithelialization of cavities with study group-large grafts was 34.10 days and that was 39.76 days in control group-small grafts. According to type of pathology; in cases with cholesteatoma, with granulation, and cases of coexisting granulation with cholestatoma; the mean epithelialization times were 38.73, 31.33 and 34.42 days, with respectively. CONCLUSION: Placement of larger fascia graft to line the mastoidectomy cavity facilitate rapid epithelialization and healing in patients undergoing CWD tympanomastoidectomy. Further studies with larger groups would be beneficial to confirm this result in the aspect of statistical significance.

Determination of Anxiety, Health Anxiety and Somatosensory Amplification Levels in Individuals with Benign Paroxysmal Positional Vertigo.

OBJECTIVES: Psychiatric comorbidities may intensify peripheral vertigo and increase the number of repositioning maneuvers required. This study was designed to examine the relationship between benign paroxysmal positional vertigo (BPPV) and anxiety and assess its association with somatic amplification and health anxiety. MATERIALS AND METHODS: Sixty patients with BPPV (43 women, 17 men; age range: 24-81 years, mean age 40.4±13.3), and 60 healthy participants (29 women, 31 men; age range: 18-71, mean age 38.2±11.43) were prospectively enrolled. The participants completed the Beck Anxiety Inventory (BAI), Short Health Anxiety Inventory (SHAI), and Somatosensory Amplification Scale (SSAS) questionnaires. RESULTS: The BAI scores of the patients with BPPV were higher than those of the control group participants and were as follows: (16.4 vs. 12.7; p=0.01). The SHAI (p=0.44) and SSAS (p=0.60) scores were not significantly different between the two groups. The BAI scores were positively correlated with the SHAI (rho: 0.273, p=0.035) and SSAS (rho: 0.357, p=0.005) scores. Neither the number of BPPV attacks nor the number of Epley maneuvers required showed any correlation with the BAI [(rho: 0.208, p=0.11); (rho: -0.007, p=0.96)], SHAI [(rho: 0.068, p=0.06); (rho: 0.021, p=0.87)], and SSAS [(rho: -0.081, p=0.53); (rho: -0.012, p=0.92)] scores. CONCLUSION: Our findings indicate that patients with BPPV had higher anxiety scores than healthy participants. Although our findings indicated normal health anxiety and somatic amplification levels in patients with BPPV, regular evaluation of psychological status would be a good strategy to prevent chronic dizziness.

Carotid sheath-like foreign body in the neck.

In otolaryngology practice, we see young children who have inserted a foreign body (FB), which is usually found at home, into their ears or nose. Uncommon complications of an ingested FB are penetration and migration into the neck. Interestingly, among such FBs, sharp fish bones are the most commonly observed in Turkey. In our patient, the FB caused deep neck infection because of FB reaction. In our patient, we could not find any clue of a FB during examination. We were able to see the FB by magnetic resonance imaging (MRI). Interestingly, the FB looked like a carotid sheath on the MR image.

Follicular dendritic cell sarcoma of the parotid gland recurring 6 times within 12 years.

Follicular dendritic cell sarcoma is a rare neoplasm of low to intermediate malignant potential. It can occur in any location where follicular dendritic cells reside, and nearly all the cases reported in clinical notes have occurred as primary lymph node tumors. Carcinosarcoma or true malignant mixed tumor of the salivary gland is a tumor composed of both carcinomatous and sarcomatous elements. It is an exceedingly rare tumor of the salivary glands, and only approximately 60 clinical notes have been reported. In this report, we describe a recurrent carcinosarcoma of the parotid gland that contained an unusual mesenchymal component (follicular dendritic cell sarcoma) in a 42-year-old woman with cytohistologic and immunohistochemical findings. The predominant sarcomatous component made the diagnosis in the current report difficult because only one clinical note on follicular dendritic cell sarcoma in the parotid gland has been previously reported in the English literature. During the 12-year follow-up period, 6 local recurrences were also detected.

[Lipoma of the cerebellopontine angle: two cases report and review of literature]. / Serebellopontin köse lipomasi: Iki olgu sunumu ve literatürün degerlendirilmesi.

Here we report two cases with cerebellopontine angle lipoma. Cerebellopontine angle lipomas previously reported in the literature were reviewed. The review of the literature revealed the condition is more prevalent in women. The median tumor size was 10.26 (range: 1 to 26) mm. It was noted that these tumors are most frequently associated with hearing loss (56%) and tinnitus (40%), while 9% demonstrate no symptoms. Fifty-six percent of these patients had been operated, however complete resection had been accomplished in only 36% of patients. In our cases, the tumor sizes were 7 x 4 and 5 x 3 mm. Tinnitus and ear fullness were major complaints in both cases. One case had hearing loss and vertigo in addition to these complaints. Surgery was not performed for these cases. The patients have been followed up using same approach without any complication. Histopathological diagnosis is rarely necessary with the widespread use of magnetic resonance imaging. Because of the potential for significant morbidity with resection of these lesions, conservative follow-up is the best approach for cerebellopontine angle lipoma.

Huge arteriovenous malformation in masseter muscle.

Arteriovenous malformation is a tumor characterized by direct connection between an artery and vein without capillaries in-between, and it is commonly located intracranially. Intramuscular arteriovenous malformations are rare in the head and neck region. Less than 1% of the vascular tumors are localized in a muscle, 15% of them are in the head and neck muscles. Among the head and neck muscles, masseter muscle is the most common location, with the rate of 4.9%. The condition of a 36-year-old patient who applied to our clinic with the complaints of progressively increasing pain and progressively growing mass in the right cheek that appeared 1.5 years ago was diagnosed as arteriovenous malformation located in the masseter muscle. After preoperative embolization, the mass was successfully treated with total excision. In this case report, diagnostic and therapeutic tools addressing arteriovenous malformation located in the masseter muscle are discussed in the light of current literature.

Management of paragangliomas in otolaryngology practice: review of a 7-year experience.

BACKGROUND AND AIMS: Paragangliomas of the head and neck are highly vascular lesions originating from paraganglionic tissue located at the carotid bifurcation (carotid body tumors), along the vagus nerve (vagal paragangliomas), and in the jugular fossa and tympanic cavity (jugulotympanic paragangliomas) and should be considered in the evaluation of all lateral neck masses. The aim of this study is to review an institutional experience in the management of these tumors. MATERIALS AND METHODS: Twenty-six patients with 27 paragangliomas were treated in our institution during a period of 7 years (2000-2007). There were 15 women (57.6%) and 11 men (42.4%) with a mean age of 33.5 years. A painless lateral neck mass was the main finding in 16 patients (61.5%). There was no evidence of a functional tumor. Carotid angiography was performed on all of our patients (100%) to define the vascular anatomy of the lesion. Twenty-two paragangliomas (of the 25 operated paragangliomas; 88%) underwent selective embolization of the major feeding arteries. We performed surgery on 24 (92.3%) patients. Two patients were treated with radiotherapy. RESULTS: Most lesions were paragangliomas of the carotid bifurcation (n = 14 [51.8%]), whereas 6 patients were diagnosed with jugular (22.2%), 1 with a vagal (3.7%), 1 with a tympanic paraganglioma (3.7%), 2 with jugulotympanic paraganglioma (7.4%), and 1 with laryngeal paraganglioma (3.7%). In 1 patient (3.8%), bilateral paragangliomas in the carotid bifurcation were detected. There was an evidence of malignancy in all cases (3.8%). Preoperative embolization has proven successful in reducing tumor vascularity in approximately 22 (of 25 who accepted surgery; 88%) paraganglioma patients. The common preoperative complication was vascular injury, which occurred in 6 (23%) of 26 patients; the main postoperative complication was transient cranial nerve deficit in 4 (15.3%) of 26 patients; and a permanent Horner syndrome was documented in 2 patients (7.6%). Cerebrospinal fluid leak occurred in 1 patient (3.7%). Postoperatively, stroke was occurred in 1 patient (3.7%). Two patients with jugular paraganglioma were treated with irradiation because of skull base extension with significant symptomatic relief. CONCLUSIONS: The primary therapeutic option for paragangliomas is complete excision of tumor with preservation of vital neurovascular structures. Combined therapeutic approach with preoperative selective embolization followed by surgical resection is the safe and the effective method for complete excision of the tumors with a reduced morbidity rate.

Intravascular papillary endothelial hyperplasia (Masson lesion) of the hypopharynx and larynx.

Masson lesion is characterized by a benign intravascular papillary hyperplasia and subsequent thrombosis. Clinically, this lesion can be misdiagnosed as mucocele, hemangioma, Kaposi sarcoma, angiosarcoma, pyogenic granuloma, and several other lesions. In this article, we report a case of intravascular papillary endothelial hyperplasia of the hypopharynx and larynx, which caused dysphagia in an 18-year-old female patient. The lesion was excised entirely via a lateral pharyngotomy approach. We discuss the clinical and histopathologic features, differential diagnosis, and treatment of this uncommon entity.

Unusual extension of the first branchial cleft anomaly.

First branchial cleft is the only branchial structure that persists as the external ear canal, while all other clefts are resorbed. Incomplete obliteration and the degree of closure cause the varied types of first branchial cleft anomalies. They were classified based on the anatomical and histological features. We present an unusual type of first branchial cleft anomaly involving the external auditory canal, the middle ear and the nasopharynx through the eustachian tube.

Laryngeal cancer: in relation to oxidative stress.

This study was designed to investigate the oxidative stress parameters in laryngeal cancer and cancer-free adjacent tissues. Lipid peroxidation end product and the endogenous antioxidant components-CuZn superoxide dismutase (CuZn SOD) glutathione peroxidase (GSH Px), glutathione reductase (GSSG Rd) and glutathione (GSH)-were analysed by spectrophotometric and kinetic methods. Laryngeal cancer tissue exhibited higher lipid peroxidation than cancer free adjacent tissue. CuZn SOD and GSH Px activities and GSH level were significantly higher and GSSG Rd activity significantly lower in the cancer tissue. Detection of the antioxidant status may be useful to determine the tumour resistance to therapy, to choose the correct radiotherapy/chemotherapy and to monitor the effectiveness of the therapetic strategy.