Efficacy of Intratympanic Gentamicin in Menière's Disease With and Without Migraine.

OBJECTIVE: To compare the efficacy of intratympanic gentamicin injection (ITG) on vertigo control, drop attacks, and functional level in Menière's disease patients with and without a history of migraine. PATIENTS: Menière's disease patients (patients with migraine and age- and sex-matched control patients without migraine) treated from 2002 to 2012 who failed medical management and received ITG, with a minimum 2-year follow up. INTERVENTION: ITG. MAIN OUTCOME MEASURES: Vertigo control, drop attack prevalence, and change in functional level. RESULTS: Twenty-eight Menière's disease patients were included in this study (14 with migraine and 14 matched patients without migraine). There were three men and 11 women in each groups, with a mean age of 53 ±â€Š8.9 years. Baseline characteristics (Menière's stage, vertigo frequency, drop attack prevalence, and functional level) before ITG were not significantly different between the two groups. Two years after ITG, 71% of Menière's disease with migraine patients and 78% of Menière's disease without migraine patients had class A, B, or C vertigo control (p > 0.999). Change in prevalence of drop attacks (43-7% versus 50-0%, respectively) was also similar (p > 0.999). However, significantly fewer vertigo control class A, B, and C migraine patients achieved functional level 1 or 2 (40%) compared with non-migraine patients (91%) (p = 0.007). CONCLUSIONS: Although ITG appears equally effective in treating vertigo and drop attacks in Menière's disease with and without migraine, patients with migraine derive significantly less benefit in terms of functional improvement.

VHI-10 and SVHI-10 Differences in Singers' Self-perception of Dysphonia Severity.

OBJECTIVE: Previous investigations of the Voice Handicap Index (VHI)-10 in clinical practice noted that specific information relevant to singers was not forthcoming. Consequently, a second index, the Singing Voice Handicap Index (SVHI) as well as its shortened counterpart the SVHI-10, was developed. The purpose of this study was to directly compare the differences in scores between the VHI-10 and the SVHI-10 in a group of 50 singers. METHODS: A retrospective chart review of 50 singers (26 women, 24 men) was performed between June 2014 and November 2014 at Weill Cornell Medical College, New York. Subjects completed both the VHI-10 and the SVHI-10 at their initial evaluation. The results from the VHI-10 and the SVHI-10 were then compared using paired t test and two-way analysis of variance. RESULTS: The SVHI-10 scores from the performers were significantly higher than those of the VHI-10 (P < 0.0001). The mean score on the VHI-10 was 12.1 compared with 20.4 on the SVHI-10 (maximum score for each questionnaire is 40). There were no significant gender differences when comparing the VHI-10 and the SVHI-10 on the overall scores or for individual items. The analysis of variance also found no significant gender difference (P = 0.865) and confirmed a significant difference between VHI-10 and SVHI-10 (P = 0.0003). CONCLUSION: Whereas singers may have general complaints about their voice, they also have specific complaints that relate only to their singing voice. Finding a significant difference between the scores of the VHI-10 and the SVHI-10 suggests the importance of assessing the singer's perception of voice severity using a tool that focuses on the singing voice.

Effect of genioglossus, geniohyoid, and digastric advancement on tongue base and hyoid position.

OBJECTIVES/HYPOTHESIS: To assess the effect of genioglossus, geniohyoid, and anterior digastric muscle advancement on base of tongue and hyoid position. STUDY DESIGN: Cadaver experiments. METHODS: In fresh cadavers, the mandibular attachments of the genioglossus, geniohyoid, and anterior digastric muscles were advanced anteriorly by 6, 10, or 14 mm, and the anterior displacement of the base of tongue and hyoid was measured. The degrees of displacement of the tongue base and hyoid by the individual muscles and combinations of muscles were compared to one another. RESULTS: In 11 cadavers, 462 measurements were taken. Genioglossus advancement alone produced significantly greater tongue base advancement than any other muscle (P < .001). No combination of muscles produced significantly more tongue base advancement than the genioglossus alone. Geniohyoid (P < .001) and anterior digastric muscle (P < .001) advancement both produced significantly greater hyoid advancement than the genioglossus, but there was no difference between the two (p = .615). No combination of muscles produced significantly more hyoid advancement than the geniohyoid or anterior digastric alone. CONCLUSIONS: Genioglossus muscle advancement produces the greatest base of tongue advancement. Geniohyoid or anterior digastric muscle advancement produces the greatest hyoid advancement. Advancement of neither base of tongue nor hyoid was superior when combinations of muscles were moved. LEVEL OF EVIDENCE: NA Laryngoscope, 127:1938-1942, 2017.

Congenital nasal pyriform aperture stenosis in association with solitary median maxillary central incisor: unique radiologic features.

Solitary median maxillary central incisor (SMMCI) coexists in 34%-65% of patients initially diagnosed with congenital nasal pyriform aperture stenosis. SMMCI, a genetic syndrome, warrants consideration for further screening because of its high prevalence of other diagnostic possibilities-specifically central defects, like nasal obstruction and hypothalamo-pituitary axis abnormalities. We report on a presentation of SMMCI with congenital nasal pyriform aperture stenosis which highlights the unique radiologic features and notes the relationship between these two central associated findings in the literature.