The remote neuro-otology assessment - managing dizziness in the coronavirus disease 2019 era.

BACKGROUND: Coronavirus disease 2019 and other factors have driven interest in conducting remote consultations, but there has been little research on this topic in neuro-otology. With suitable preparation, neuro-otology patients with dizziness can have remote assessments that include elements of neuro-otological physical examination, with tailored management and onward pathways arranged. METHODS: This paper reports experience with remote consultation in over 700 neuro-otology patient consultations and suggests a systematic approach, illustrated by a clinical case report and data on 100 consultations. CONCLUSION: Remote consultations can play a role in neuro-otology clinics. Further research is needed to establish patient acceptability, diagnostic accuracy, safety and efficiency of remote models of care for this patient group.

Publishing Trends in Otology and Neurotology.

OBJECTIVES: 1) Describe publishing trends for otologic/neurotologic disorders over a 35-year span. 2) Compare trends in publishing with disease prevalence. 3) Evaluate changes in topic and journal specific ranking scores over time. METHODS: PubMed searches were performed on 35 otologic/neurotologic disorders using medical subject headings (MeSH) terms from 1980 to 2015. Searches were limited in scope to the English language. A Mann-Kendall trend analysis evaluated changes in publication frequency as a discrete variable while correcting for total number of articles published per year. Scopus was used to identify SCImago Country and Journal Rank (SJR) indicator scores and weighted-averages used to calculate changes over time. RESULTS: The total number of publications on the 35 topics increased from 853 in 1980 to a peak of 3,068 in 2013. Otitis media (τ = -0.799, p < 0.001) and Menière's disease (τ = -0.724, p < 0.001) showed strong decreasing publication trends. Temporal bone encephaloceles (τ = 0.743, p < 0.001) and cochlear implants (τ = 0.740, p < 0.001) showed strong increasing publication trends. Rapid rise in publications on superior canal dehiscence and vestibular migraine illustrate novel diagnoses. The weighted-average SJR score increased from 0.816 in 2000 to 1.160 in 2015 (p < 0.001). CONCLUSION: This study displays trends in the literature over the past 35 years that are often inconsistent with common disorders seen by otologists/neurotologists. Certain diagnoses that are currently being researched less commonly continue to impact patients with the same regularity. Quality of otologic/neurotologic literature has become more reputable with regards to SJR scores.

Encuesta sobre la situación de la otoneurología en España / Survey on the state of otoneurology in Spain

La otoneurología es una subespecialidad de la otorrinolaringología-neurología que ha experimentado avances extraordinarios en los últimos 50 años y que en este momento se encuentra plenamente consolidada en nuestro medio. Mediante este trabajo, elaborado por la Comisión de Otoneurología de la Sociedad Española de Otorrinolaringología (SEORL), se ha querido hacer una aproximación que aporte información sobre cuál es la situación actual en cuanto a su ejercicio en España, tratando de determinar quién la práctica y dónde, con qué medios se cuenta y cuál es la actividad docente y la producción científica. Los resultados obtenidos, en general, son satisfactorios y reflejan la solidez del ejercicio de la otoneurología. El número de centros que cuentan con Unidad de Otoneurología es significativo, y la mayor parte de centros que carecen de unidad la consideran necesaria. No obstante, quedan por establecer aspectos relacionados con los requerimientos mínimos para su ejercicio en condiciones satisfactorias, así como establecer las directrices futuras que garanticen la mejora en la docencia y el incremento en la producción científica (AU)

Otoneurology is a subspecialty of otolaryngology-neurology, which has experienced extraordinary progress in the last 50 years and is currently fully consolidated in our environment. Through this study, prepared by the Otoneurology Commission of the Spanish Society of Otorhinolaryngology (SEORL), we have attempted to design an approach to provide information on what the current situation regarding the exercise in Spain is, trying to determine who practice it and where, what resources are available and what the teaching and scientific productions are. The results obtained are generally satisfactory and reflect the strength of the exercise of otoneurology. The number of centres with otoneurology units is significant and the majority of centres that lack such a unity consider it necessary. However, there are aspects to establish related to minimum requirements for its performance in satisfactory conditions, as well as determining future guidelines to ensure improved teaching and increased scientific production (AU)

Mejora de la planificación de las cirugías endoscópicas nasosinusales a partir de imágenes en 3 dimensiones con Osirix (R) y estereolitografía / Improved planning of endoscopic sinonasal surgery from 3-dimensional images with Osirix(R) and stereolithography

Introducción y objetivos: La elevada variabilidad anatómica de los senos paranasales requiere disponer del mejor conocimiento de su conformación tridimensional para afrontar la cirugía con mayor seguridad y eficiencia. El objetivo del estudio fue validar la utilidad de Osirix® y la estereolitografía en la mejora de la planificación de las cirugías endoscópicas nasosinusales. Métodos: Se utilizó Osirix® como visor y gestor de imágenes DICOM en 3 dimensiones (3D) en la planificación de 114 cirugías endoscópicas nasosinusales por poliposis (86) y rinosinusitis crónica (28) junto con prototipos rápidos estereolitográficos en 7 mucoceles frontoetmoidales. Resultados: Se identificaron mayor número de estructuras anatómicas, más rápidamente y con una correlación clínico-radiológica estadísticamente significativa (p < 0,01) a favor de Osirix y estereolitografía, que con placas en 2D de la TAC. Con una participación de los residentes superior al 75% de la cirugía, se redujo el tiempo quirúrgico en 38 ± 12,3 min en sinusitis crónicas y en 42 ± 27,9 en poliposis nasosinusales, alcanzando los residentes de cuarto año una competencia quirúrgica del 100% en los hitos quirúrgicos cruciales con 16 cirugías (IC: 12-19). Conclusiones: La utilización sistemática de Osirix® para visualización y tratamiento autónomo de imágenes nasosinusales en 3D desde archivos DICOM permite a los cirujanos efectuar las cirugías endoscópicas nasosinusales con mayor confianza y seguridad y en menos tiempo que utilizando imágenes en 2D. Los residentes también alcanzan la competencia quirúrgica más rápidamente, con mayor seguridad y con menos complicaciones. La mejora en la planificación se incrementa cuando el equipo quirúrgico dispone de prototipos rápidos estereolitográficos en los casos de mayor complejidad (AU)

Introduction and objectives: The high variability of sinonasal anatomy requires the best knowledge of its three-dimensional (3D) conformation to perform surgery more safely and efficiently. The aim of the study was to validate the utility of Osirix® and stereolithography in improving endoscopic sinonasal surgery planning. Methods: Osirix® was used as a viewer and Digital Imaging and Communications in Medicine (DICOM) 3D imaging manager to improve planning for 114 sinonasal endoscopic operations with polyposis (86) and chronic rhinosinusitis (CRS) (28). Stereolithography rapid prototyping was used for 7 frontoethmoidal mucoceles. Results: Using Osirix® and stereolithography, a greater number of anatomical structures were identified and this was done faster, with a statistically-significant clinical-radiological correlation (P<.01) compared with 2D CT plates. With a share of more than 75% of surgery performed by residents, surgical time was reduced by 38 ± 12.3 min in CRS and 42 ± 27.9 in sinonasal polyposis. The fourth-year residents reached 100% surgical competence in critical surgical milestones with 16 surgeries (CI 12-19). Conclusions: The systematic use of Osirix® for visualisation and treatment of 3D sinonasal images from DICOM data files, along with the surgical team's ability to manipulate them as virtual reality, allows surgeons to perform endoscopic sinonasal surgery with greater confidence and in less time than using 2D images. Residents also achieve surgical competence faster, more safely and with fewer complications. This beneficial impact is increased when the surgical team has stereolithography rapid prototyping in more complex cases (AU)

[Neurotology and cochlear implants]. / Neurotologia e implantacion coclear.

In this review we analyse cochlear implantation in terms of the fundamental aspects of the functioning of the auditory system. Concepts concerning neuronal plasticity applied to electrical stimulation in perinatal and adult deep hypoacusis are reviewed, and the latest scientific bases that justify early implantation following screening for congenital deafness are discussed. Finally, this review aims to serve as an example of the importance of fostering the sub-specialty of neurotology in our milieu, with the aim of bridging some of the gaps between specialties and thus improving both the knowledge in the field of research on auditory pathologies and in the screening of patients. The objectives of this review, targeted above all towards specialists in the field of otorhinolaryngology, are to analyse some significant neurological foundations in order to reach a better understanding of the clinical events that condition the indications and the rehabilitation of patients with cochlear implants, as well as to use this means to foster the growth of the sub-specialty of neurotology.

TITLE: Neurotologia e implantacion coclear.En esta revision se analiza la implantacion coclear en relacion con los fundamentos del funcionamiento del sistema auditivo. Se revisan los conceptos sobre plasticidad neuronal aplicados a la estimulacion electrica en la hipoacusia profunda perinatal y del adulto, y se comentan las bases cientificas actuales que justifican la implantacion precoz tras el cribado de la sordera congenita. Finalmente, se propone esta revision como un ejemplo de la importancia de fomentar la subespecialidad de neurotologia en nuestro medio, a fin de tender puentes entre especialidades que mejoren tanto el conocimiento en el campo de la investigacion de la patologia auditiva como en el cuidado de los pacientes. Los objetivos de esta revision, dirigida sobre todo a especialistas del campo de la otorrinolaringologia, son los de analizar algunos fundamentos neurologicos de relevancia para comprender mejor los eventos clinicos que condicionan las indicaciones y la rehabilitacion de los pacientes con implantes cocleares, asi como estimular por este medio la potenciacion de la subespecialidad en neurotologia.

Survey on the state of otoneurology in Spain.

Otoneurology is a subspecialty of otolaryngology-neurology, which has experienced extraordinary progress in the last 50 years and is currently fully consolidated in our environment. Through this study, prepared by the Otoneurology Commission of the Spanish Society of Otorhinolaryngology (SEORL), we have attempted to design an approach to provide information on what the current situation regarding the exercise in Spain is, trying to determine who practice it and where, what resources are available and what the teaching and scientific productions are. The results obtained are generally satisfactory and reflect the strength of the exercise of otoneurology. The number of centres with otoneurology units is significant and the majority of centres that lack such a unity consider it necessary. However, there are aspects to establish related to minimum requirements for its performance in satisfactory conditions, as well as determining future guidelines to ensure improved teaching and increased scientific production.

Early practice: neurotology.

Besides technical and surgical proficiency, some of the most important skills for a young Neurotologist to refine include communication and critical thinking abilities. This Early Practice article provides perspectives on common challenges and career development from a current Neurotology fellow and his mentor.

The history and future of neuro-otology.

PURPOSE OF REVIEW: The field of neuro-otology has advanced substantially over the past 150 years. The function of the vestibular system was presumed to be audiologic prior to the groundbreaking work of Prosper Ménière in the late 1800s. Since that time, scientific discovery has advanced our knowledge of the physiology and the pathophysiology of the vestibular system. This article describes where we have been, where we are now, and where we need to go from here. RECENT FINDINGS: Some of the important recent advances include: (1) improved imaging of the brain and inner ear, (2) development of new eye movement recording and analysis techniques, (3) development of new tests of otolith function, (4) particle repositioning maneuvers for all types of benign paroxysmal positional vertigo, and (5) improved bedside diagnosis and treatment of vestibular neuritis. SUMMARY: The cause and treatment for some common neuro-otologic disorders is now well delineated. The diagnosis and management of less common disorders has improved as well. Future work is still required to advance the science of vestibular physiology and pathophysiology and ultimately to discover new ways to improve the health of patients with these disorders.

Progress in neuro-otology research in the last year.

Herein, we summarize articles in the field of neuro-otology published in the Journal of Neurology over the last year. Topics included acute and chronic vertigo as well as auditory and ocular motor disorders. Characteristic lesion locations in Pusher syndrome are reported and the usefulness of bedside ocular motor tests in vertebrobasilar stroke is revisited. Probing the vestibular system and its value in predicting the outcome in vegetative state is discussed. Several articles address new diagnostic and therapeutic approaches in different disorders associated with chronic vestibular, auditory or gait deficits. In a series of case reports, we focus on different eye movement disorders in the vertical plane, which are often difficult to assess.