Vestibular system dysfunction in patients after mild traumatic brain injury.

INTRODUCTION: In the literature there are some discrepancies concerning the occurrence of vertigo and disequilibrium, as well as the type of vestibular dysfunction in patients after mild traumatic brain injury (MTBI). OBJECTIVE: The aim of the study was to assess the type of vestibular system dysfunction in MTBI patients after injury at baseline and 6-month follow-up. MATERIAL AND METHODS: From a group of 188 patients with vertigo/dizziness and balance instability after MTBI, prospective analysis in 50 patients with abnormal videonystagmography (VNG) were conducted. Anamnesis, otoneurological examination, self-assessed Dizziness Handicap Inventory (DHI) and VNG test were carried in each patient twice - at baseline and after 6 months. RESULTS: A significant improvement in the DHI total score (9.8 points, p<0.001) and in the subscales was found after 6 months. At baseline, VNG test showed the peripheral vestibular system dysfunction in 19 cases (38%), central vestibular dysfunction in 20 patients (40%) and mixed vestibular dysfunction in 11 cases (44%). After 6 months, the VNG records normalization was observed in 19 patients (38%), an improvement was significantly more frequently related to peripheral disorders, compared to central ones (p,0.001). CONCLUSIONS: In patients after mild traumatic brain injury, about one-fourth of them had vestibular system dysfunction with the same frequency of peripheral, central and mixed lesions in videonystagmography. Subjective post-traumatic symptoms and vestibular system dysfunction in patients after MTBI decrease after 6-month follow-up. However, more than half of patients still have abnormal VNG results, which indicate dysfunction of the central vestibular system.

Benign paroxysmal positional vertigo in patients after mild traumatic brain injury.

BACKGROUND: Post-traumatic vertigo, dizziness and balance disorders following head trauma range from 15% to 78% in the general population. Benign paroxysmal positional vertigo (BPPV) is the most common vestibular disorder in such patients. OBJECTIVES: The aim of the study was to assess the occurrence of BPPV in patients with mild traumatic brain injury (MTBI) and determine the outcome of treatment. MATERIAL AND METHODS: A group of 179 patients, with a mean age of 45.2 years, complaining of vertigo/ /dizziness and balance instability after MTBI, was enrolled into the study. All these patients were diagnosed and treated in the Department of Otolaryngology (Medical University of Lodz, Poland) between the years 2012 and 2014. Anamnesis and otoneurological examination were conducted in each patient. The diagnosis was based on the medical history, the Dix-Hallpike test or the rollover test. The treatment comprised the Epley, barbecue and particle repositioning (RM) maneuvers. RESULTS: Nineteen patients (10.6%) complained about attacks of vertigo elicited by positional changes. The diagnosis of BPPV was confirmed in 9 (47.4%) patients: 8 cases with a positive Dix-Hallpike test and 1 with the roll test. In 10 cases, a high probability of BPPV was diagnosed based on the medical history. Eight patients were treated by a single Epley maneuver and 1 patient by the barbecue roll. In 4 (44.4%) patients, the maneuvers were repeated. On the follow-up examination, the patients were not found to have vertigo. CONCLUSIONS: Benign paroxysmal positional vertigo should be diagnosed and treated successfully in patients after head trauma.

[Clinical evaluation of CT scans of nasal cavity and paranasal sinuses]. / Kliniczna ocena tomografii komputerowej nosa i zatok przynosowych.

INTRODUCTION: Computed tomography is a basic imaging technique in nose and paranasal sinuses disease's nowadays. AIM: The aim of the study was to outline current methodology of CT scanning of nose and paranasal sinuses. MATERIAL AND METHODS: This study is based on the experience of Department of Otorhinolaryngology of Medical University of Lódz in evaluation by CT scanning patients with nose/paranasal sinuses problems and on the literature concerning this problem. RESULTS: Pictures in three planes (axial, coronal, sagittal) are obtained from multi-row CT scanner. However in some cases 3D reconstructions are useful. The thickness of the single layer is 0.625 or 1 mm. In case of tumor suspicion contrast CT scanning is a routine procedure. The analysis of pictures is preceded by anamnesis and careful rhinologic examination. Coronal scans are evaluated as first and they are divided into four zones (frontal sinus, anterior ethmoid cells, posterior ethmoid cells and sphenoid sinus zones) for more systematic analysis. Then axial and sagittal scans are examined. Every single structure and its anatomical variations are named by using current terminology outlined during International Conference of Sinus Disease in Princeton in 1993 by The Anatomic Terminology Group. CONCLUSIONS: Quality and quantity of the information from CT of nose and paranasal sinuses depends on keeping some rules concerning the stage of performing the examination and the stage of its evaluation and applying current anatomic terminology.

[Maxillary sinus cyst--methods of surgical treatment]. / Torbiel zatoki szczekowej--metody leczenia operacyjnego.

INTRODUCTION: Retention cysts of maxillary sinus are therapeutic problem for laryngologists and maxillo-facial surgeons. They develop slowly and often without symptoms. The aim of the work was to compare the different methods of surgical treatment of maxillary sinus cysts performed in Department of Otolaryngology, Medical University of Lodz between 2003 and 2007. MATERIAL AND METHODS: 113 patients with cyst of maxillary sinus were treated surgically between 2003 and 2007--74 men and 39 women. Between 2003 and 2005 Caldwell-Luc procedure was performed on 75 patients. In 2006 and 2007 38 patients underwent endoscopic removal of maxillary sinus cyst. RESULTS: The average time of the endoscopic removal of maxillary sinus cyst was 10 minutes sorter than in Caldwell-Luc procedure (34 min versus 44 min, p < 0.05). 84.2% cases of the endoscopically treated patients had no pain after surgery. There was no discomfort in the operation area. In the Caldwell-Luc group only 5.3% patients had no pain and in 78.7% cases discomfort on the face was present (p < 0.05). Endoscopically treated patients were discharged from hospital after 3,6 days and in the Caldwell-Luc procedure patients stayed in hospital for 5.8 days. CONCLUSION: Endoscopic sinus surgery is an effective treatment for retention cysts and should be widely used. Computer tomography should be performed before each procedure.

[Sphenoidotomy--the treatment of patients with isolated sphenoid sinus diseases]. / Sphenoidotomia w leczeniu izolowanych chorób zatoki klinowej.

INTRODUCTION: The standart terms and definitions for paranasal sinuses operations were published in 2005 by Simmen and Jones. Sphenoidotomy is a surgical procedure when the natural ostium of sphenoid sinus is enlarged in varying degrees. Microscopic, endoscopic or ballon-assisted endoscopic sphenoidotomy are performed in endonasal sinus surgery and endonasal neurosurgery. This approach is considered for cases of isolated lesions of the sphenoid sinus, the sella lesions, the cerebrospinal fluid leaks into the sphenoid sinus and also for the treatment pathological conditions in the skull base. Isolated lesions of the sphenoid sinus are very rare with uncharacteristic symptoms. Headache is the most common. Vision disturbances occur occasionally. Endoscope assisted physical examination and CT scans of paranasal sinuses are necessary to make a diagnose. MATERIAL AND METHODS: 5 patients suffering from the isolated sphenoid sinus lesion were diagnosed and treated at the Otolaryngology Department of Medical University of Lodz in 2007. Clinical data of these patients were analysed retrospectively. 4 underwent the transnasal endoscopic sphenoidotomy. There were 3 patients with chronic sinusitis, 1 with pyocele. 1 patient didn't agree for the operation. RESULTS: All treated patients noted improvement in the preoperative symptoms. There were no complications during and after the operation. CONCLUSIONS: Endoscopic sphenoidotomy is an effective and safe method of treatment of the isolated sphenoid sinus diseases. Nasal endoscopy and CT imaging are necessary for a precise diagnosis and treatment decision.