Dorsal preservation rhinoplasty versus dorsal hump reduction: a randomized prospective study, functional and aesthetic outcomes.

PURPOSE: To compare the functional and esthetic outcomes of dorsal preservation rhinoplasty (DPR) and conventional dorsal hump reduction (DHR) in primary rhinoplasty using patient-reported outcome measures (PROMs) and cone beam computed tomography (CBCT). METHODS: In our randomized prospective double-blinded clinical trial, 50 patients had dorsal nasal hump surgery between October 2021 and November 2022 in our tertiary referral center. All surgeries were done by the same surgeon. Patients were randomly assigned to two groups: Group (A): 25 patients had DPR, and group (B): 25 patients underwent DHR. Pre-operative and post-operative evaluations were conducted using standardized cosmesis and health nasal outcomes survey (SCHNOS), surgeons' rhinoplasty evaluation questionnaire (SREQ), and the CBCT. RESULTS: Following an average of 7.22 ± 2.07 months, patients in both groups reported significantly higher levels of satisfaction, as measured by the SCHNOS score (p < 0.001) and the average of three SREQ scores (p < 0.001). These results align with the radiological analysis, which denoted an overall improvement in the average of both sides' internal nasal valve angle and cross-sectional area after surgery with (p = 0.001) and (p = 0.085), respectively, for the DPR group and with (p = 0.281) and (p = 0.014), respectively, for the DHR group. There was no statistically significant difference in outcomes between both groups (p > 0.05). CONCLUSION: Dorsal preservation is a viable alternative to conventional dorsal hump reduction in primary rhinoplasty. There was no difference in the functional and esthetic outcomes between both techniques, which were verified by radiological investigation.

Long-Term Safety and Reliability of Using Tutoplast-Processed Fascia Lata to Refine the Nasal Dorsum in Primary and Revision Rhinoplasty.

BACKGROUND: Tutoplast-processed fascia lata (TPFL) is an allograft substance employed alongside cartilaginous materials to achieve optimal augmentation in rhinoplasty. Alternatively, it can be utilized to conceal and smooth irregularities of the nasal dorsum during the procedure. Despite its application, there is limited available data on the extended safety of TPFL. Consequently, our objective was to assess the enduring long-term safety and reliability of TPFL in both primary and revision rhinoplasty. METHODS: A retrospective cohort study was conducted on 300 patients who underwent primary and revision rhinoplasty with TPFL grafts. Baseline characteristics, types of surgical techniques, and surgical outcomes were evaluated. The surgical success and satisfaction rates were assessed as primary outcomes. The Statistical Package for Social Sciences (SPSS), version 27 for Windows, was used to conduct the statistical analysis. RESULTS: TPFL was used in both primary and revision rhinoplasty, with septal cartilage being the most common conjunction graft material. The overall surgical success rate was 97.3%, with only 2.7% of patients experiencing complications. The satisfaction rate was 92.7%, with no significant difference between primary and revision cases. The highest satisfaction rate was found in patients who underwent the crushed cartilage in fascia technique (96.3%). CONCLUSIONS: TPFL in conjunction with cartilaginous materials; is a safe and reliable option for dorsal augmentation and camouflage material in primary and revision rhinoplasty, with low complication and high patient satisfaction rates. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266 .

Coblation tonsillectomy versus laser tonsillectomy: a systematic review and meta-analysis of randomized controlled trials.

AIM: This systematic review and meta-analysis of randomized controlled trials (RCTs) evaluated coblation versus laser (carbon dioxide and diode) tonsillectomy, with regard to various surgical and clinical outcomes. METHODS: We searched PubMed, CENTRAL, Scopus, and Web of Science for relevant from inception until March 2021. We evaluated risk of bias using the Cochrane Collaboration Tool. We summarized the outcomes as risk ratio (RR) or mean difference/standardized mean difference (MD/SMD) with 95% confidence interval (CI). We conducted subgroup analysis based on the day of postoperative pain (day 1, day 7, and day 14) and type of postoperative hemorrhage (reactionary and secondary). In addition, we conducted subgroup analysis according to the type of laser. RESULTS: Five RCTs were analyzed. Three and two RCTs were evaluated as having "some concerns" and "low risk of bias", respectively. Coblation tonsillectomy correlated with lower intraoperative blood loss (MD = -5.08 ml, 95% CI [- 7.33 to - 2.84], P < 0.0001) and lower operative time (MD = - 4.50 min, 95% CI [- 6.10 to - 2.90], P < 0.0001) compared with the laser tonsillectomy. However, there was no significant difference between both groups regarding the postoperative pain score (SMD = - 0.27, 95% CI [- 0.72 to 0.17], P = 0.27) and rate of postoperative hemorrhage (RR = 0.95, 95% CI [0.27-3.40], P = 0.23). Subgroup analysis reported similar insignificant difference between both groups according to the day of postoperative pain and type of postoperative hemorrhage. CONCLUSIONS: Coblation tonsillectomy correlated with a significant reduction in intraoperative blood loss and operative time compared with the laser technique. Nevertheless, these effects do not seem clinically meaningful in surgical practice.

Postoperative complications following tonsil and adenoid removal in Kuwaiti children: A retrospective study.

BACKGROUND: Adenoidectomy and adenotonsillectomy are two of the most common procedures that are performed by otolaryngologists around the world. Complications, ranging from major to minor ones, are affected by the preoperative symptoms and health status of the patient. We aimed to identify the prevalence of major postadenoidectomy and adenotonsillectomy complications, including bleeding, and minor complications, including malodor, fever, and snoring. MATERIALS AND METHODS: We conducted a retrospective chart review of 825 patients who underwent surgery between January 2002 and 30 December 2016 at our institution. RESULTS: The bleeding complications prevalence was 4.1% (14/344) among patients with adenotonsillectomy and 1.3% (6/480) among those who underwent adenoidectomy. Results revealed that tonsil grade 3 patients were at a reduced risk (86% reduced risk) of developing bleeding complications, compared to those with tonsil grade 2 [odds ratio (OR) = 0.141, 95% confidence interval (CI): (0.028, 0.715)]. Grade C tympanogram patients had ten times the odds of bleeding complications compared to those with tympanogram grade A [OR = 10.6, 95% CI: 0.917, 122.54], a marginally significant difference (probability value (PV) = 0.054). Upper respiratory tract infections (URTIs) patients had three times the odds of bleeding complications compared to those without URTIs [OR = 3.03, 95% CI: (0.979, 9.439)], also a marginally significant difference (PV = 0.055). Postoperatively, 71% experienced no malodor, 23% had malodor lasting 3-7 days, and 1% had malodor for 7-10 days. Our analysis showed that 71% of the patients did not complain of snoring, 25% had snoring for 3-7 days, and 2% had snoring for 7-10 days. 80% of the patients did not develop fever, 13% had fever for 3-7 days, and no patients experienced fever for longer than 7 days. CONCLUSIONS: Nearly 4% of the patients developed bleeding after adenotonsillectomy and only 2% of the patients had only bleeding after adenoidectomy. Conversely, 15-25% of the patients developed minor complications, including malodor, snoring, and fever, independent of their preoperative symptoms.

Kimura disease manifesting as synchronous bilateral parotid swelling in a young middle-eastern patient.

Kimura disease is a rare, benign, chronic inflammatory swelling of the subcutaneous tissue, lymph nodes, and glandular tissue. Characteristic features of the disease include, but not limited to, painless subcutaneous head and neck swelling, blood and tissue eosinophilia, and markedly elevated immunoglobulin E (IgE) levels. Herein, we report a rare case of Kimura disease manifesting as synchronous bilateral parotid swelling of 12 years duration in a 33-year-old Middle-Eastern man. To our knowledge only few cases have been reported in the literature involving bilateral parotid glands, and this is the first case to be reported in the Middle East.

Concha bullosa mucocele and mucopyocele: a series of 4 cases.

Concha bullosa is an aerated turbinate in the nose. It is a common anatomic variant that can develop a mucocele if obstructed, which can further progress to become a mucopyocele if infected. A mucopyocele can expand and cause destruction of neighboring tissues. A review of the literature revealed only 10 cases previously reported. We describe 2 cases of mucocele and 2 cases of mucopyocele.

Connexin 26 gene mutations in non-syndromic hearing loss among Kuwaiti patients.

OBJECTIVE: To study connexin 26 (Cx26) gene mutations among autosomal recessive non-syndromal hearing loss in Kuwaiti patients and evaluate their effect on phenotypes. SUBJECTS AND METHODS: This cross sectional study included 100 patients aged between 6 months and 18 years, who were referred to the Sheikh Salem Al-Ali Centre for audiology and speech evaluation of autosomal recessive non-syndromic sensorineural hearing loss confirmed by clinico-genetic evaluation and a battery of diagnostic tests. Gene profiling and sequencing were performed to detect the presence and nature of Cx26 mutation. RESULTS: Of the 100 patients, mutation of Cx26 gene was detected in 15 patients (15%) of which 9 (60%) cases were heterozygous and 6 cases (40%) were homozygous. Eighty per cent of the 15 Cx26 positive cases resulted from the 35delG mutation. Among the heterozygous cases, 6 (66.6%) were positive for 35delG. All 6 homozygous patients were positive for the 35delG mutation. A significant correlation was found between genetic findings (p = 0.013) and family history (p = 0.029), as well as the onset (p = 0.015), course (p = 0.033), degree and configuration of hearing loss (p = 0.001). CONCLUSION: Among the selected Kuwaiti population sample, the Cx26 gene mutation was responsible for 15% of autosomal recessive non-syndromic sensorineural hearing loss. We recommend that screening for Cx26 gene mutation be considered in the screening strategy of patients with non-syndromic childhood hearing loss for counselling and management purposes. .

Late onset vitiligo and audiological abnormalities: is there any association?

BACKGROUND: There is scarce published data on late onset vitiligo. All the studies showing association of audiological abnormalities have been done on younger age group of patients. AIM: To study the clinical characteristics of the patients with late onset vitiligo. Also, to investigate the audiological abnormalities seen in these patients and compare them with age and sex matched healthy volunteers. METHODS: One hundred and ninety-seven consecutive patients developing vitiligo after the age of 40 were studied. These patients were examined for the audiological abnormalities, and compared with those seen in age and sex matched healthy volunteers. RESULTS: Vitiligo started between 40 and 50 years of age in 68.02% of our patients. Vitiligo vulgaris was the commonest clinical pattern, and most patients reported onset of their vitiligo on the upper extremities. Fifty four had diabetes mellitus, 19 patients had autoimmune thyroid diseases, and 32 showed hypoacusis on audiometric examination. Eighteen controls (age and sex matched healthy volunteers) also showed hypoacusis. The difference in frequency was not significant (22.37% vs 18%, χ2-test, P>0.05). The sensorineural type of audiologic impairment was more commonly seen both in patients as well as in controls. CONCLUSION: Late onset vitiligo was not found to have statistically significant association with audiological abnormalities in this study.

Extraluminal perforation complicating foreign bodies in the upper aerodigestive tract.

OBJECTIVES: Ingestion of a foreign body is a common problem in nearly all otolaryngology practices. One of the uncommon complications of ingested foreign bodies is penetration and migration of the object, which may lead to serious morbidity and/or death. This study will evaluate the presentation, complications, and management of different sites of penetration. METHODS: We present a retrospective study of a series of 11 patients who presented with a penetrating foreign body of the upper aerodigestive tract in the past 10 years. RESULTS: All of the patients had radiologic evidence of a foreign body, but negative findings on rigid endoscopy. A computed tomographic scan was done to confirm the presence of a penetrating foreign body. The foreign body was lodged in the extrapharyngeal tissue in 6 patients, was lodged in the upper thyroid pole in 2 patients, had penetrated a Zenker's diverticulum in 2 patients, and had migrated to the thoracic retroesophageal tissue in 1 patient. All patients underwent extraction of the foreign body by an external approach. CONCLUSIONS: Although the occurrence is rare, impacted foreign bodies in the upper digestive tract can perforate and migrate into the soft tissue of the neck. In the presence of negative findings on endoscopy, a computed tomographic scan of the neck is essential for the prompt diagnosis and management of perforating foreign bodies.

Securebox: a multibiopsy sample container for specimen identification and transport.

OBJECTIVE: To describe an original multicompartment disposable container for tissue surgical specimens or serial biopsy samples (Securebox). STUDY DESIGN: The increasing number of pathology samples from a single patient required for an accurate diagnosis led us to design and manufacture a unique container with 4 boxes; in each box 1 or more biopsy samples can be lodged. A magnification lens on a convex segment of the plastic framework allows inspection of macroscopic details of the recovered specimens. We investigated 400 randomly selected cases (compared with 400 controls) who underwent multiple biopsies from January 2006 to January 2007 to evaluate compliance with the new procedure and detect errors resulting from missing some of the multiple specimens or to technical mistakes during the procedure or delivery that might have compromised the final diagnosis. RESULTS: Using our Securebox, the percentage of oatients whose diagnosis failed or could not be reached was O.5% compared to 4% with the traditional method (p = 0.0012). Moreover, the percentage of medical and nursing staff who were satisfied with the Securebox compared to the traditional methodwas 85% vs. 15%, respectively (p < 0.0001). The average number of days spent bto reach a proper diagnosis based on the usage of the Securebox was 3.38 +/- 1.16 SD compared to 6.76 +/- 0.52 SD with the traditional method (p < 0.0001). CONCLUSION: The compact Securebox makes it safer and easier to introduce the specimens and to ship them to the pathology laboratories, reducing the risk of error.

An innovative method to evaluate the suture compliance in sealing the surgical wound lips.

BACKGROUND AND AIM: The increasing number of surgical procedures performed with local anesthesia, followed by immediate patient discharge from the hospital, emphasizes the need for a tight waterproof suture that is capable of maintaining its tensile strength in the postoperative phase when the wound tumescence, edema due to the anesthetic drug, and surgical trauma disappear. Moreover, the issue of having an accurate surgical wound closure is very relevant in vivo in order to prevent hemorrhage and exogenous microbial infections. This study aimed at designing a new a lab technique that could be used for evaluating the best surgical material. Using such a technique, we compared the wound-lip-sealing properties of three commonly-used suture threads, namely polyurethane, polypropylene, and polyamide. MATERIALS AND METHODS: The mechanical properties of same-size suture threads made from polyurethane, polypropylene, and polyamide, were compared in order to define the one that possess the best elastic properties by being able to counteract the tension-relaxation process in the first 12 hours following surgery. The tension holding capacity of the suture materials was measured in both in vivo and in vitro experiments. The surface area of the scar associated with the three different suture threads was measured and compared, and the permeability of the three different suture threads was assessed at 0 minute, 2 minute, 4 minute, 6 minute, and 8 minute- interval. RESULTS: Results showed that polyurethane suture threads had significantly (P < 0.05) better tensile strength, elongation endurance before breakage, and better elasticity coefficient as compared to polypropylene and polyamide suture threads. Moreover, polyurethane suture threads were significantly (P < 0.05) more impermeable as compared to the other two suture thread types (polypropylene and polyamide). This impermeability was also associated with a tighter wound-lip-sealing ability, and with significantly (P < 0.05) less scar formation. CONCLUSION: Among the main concerns that surgeons, physicians, and patients often have is the development infection, oozing, and scar at the incision site following suturing. This always raises the question about which suture to use to avoid the above problems. This study provides evidence that the new technique developed in our lab could be used to compare the wound-lip sealing properties of different surgical suture threads. Using such a technique, the results show that polyurethane is significantly better than other commonly-used suture threads, like polypropylene and polyamide, in relation to wound sealing and scar formation.

Polydimethylsiloxane: An effective immune adjuvant and slow-release cytokine medium for local cancer treatment.

BACKGROUND AND AIM: Silicone oil or gel has well-defined chemotactic properties on monocytes and lymphocytes in vivo . It results in fibrotic reaction when spread into the human tissues either incidentally or purposely and can slowly release any physically-enclosed lyophilized compounds due to its viscosity. Our aim is to investigate whether polydimethylsiloxane could be considered as an effective medium in the local treatment of cancer. MATERIALS AND METHODS: Our study was conducted between January 2004 and December 2006 on 15 patients with various types of cancer. The criteria for selection included patients with locally-advanced tumor that was rapidly growing and life threatening and those who had poor quality of life and general wellbeing. The patients were already discharged from the cancer centre before joining the study, after they had already received their chemoradiation protocol. Once a week for one month, different areas of the tumor were injected with 0.25 ml of polydimethylsiloxane medical grade (viscosity: 350 centistokes at 30 degrees C), mixed with 300,000 units of lyophilized human IL-2. Tumor biopsies were taken before the study was started and one week after the last injection for the histopathological analysis of the percentage of severe inflammatory reaction using an image analysis system. CT scans of the tumor were taken before the injection cycle was started and one week after the last injection in order to determine the percentage change in the size of the tumor. The quality of life and general wellbeing of the patients was assessed at the beginning of the stud, and one week after the study was over by using the Karnofsky performance test. RESULTS: Our treatment was well tolerated by the patients. They had a significant improvement in their quality of life and general well being ( p = 0.0005). The prognosis of the patients before the beginning of the study ranged between 1 and 6 months, while their overall survival after treatment was between 2 and 12 months, with three patients still remaining alive. A significant decrease in the tumor size was observed at the end of the study in 12 patients ( p p 2 = 0.968; p CONCLUSION: Polydimethylsiloxane could be used as an effective cytokine medium in the local treatment of cancer. When injected inside the tumor, it is capable of creating and modulating an effective, slow and persistent antitumor immune response. Moreover, it is capable of improving the overall survival as well as the quality of life and general well being of the cancer patients.

Adenotonsillar granuloma: histopathological correlation.

OBJECTIVES: This study was undertaken to investigate the presence and nature of granulomatous changes in the adenotonsillar tissues and their relation to systemic disorders. MATERIALS AND METHODS: The study was a retrospective clinicopathological review; 21,410 specimens of tonsil and adenoid tissue were subjected to histological examination during the period from 1995 to 2003. Twenty-three cases of tonsillar and adenoid granuloma (12 males and 11 females) were identified. Haemotoxylin and eosin stains were reviewed and clinical features noted. RESULTS: Of 23 cases, 11 were adenotonsillectomies, 10 tonsillectomies, 1 adenoidectomy and 1 excision biopsy of the right tonsil. Histologically, the slides reviewed showed 4 types of granulomatous inflammation that can affect the adenotonsillar tissues. The most common type was non-caseating epithelioid granulomas. Clinically, 22 cases presented with symptoms of chronic tonsillitis, nasal obstruction and obstructive sleep apnoea. None had any systemic granulomatous disorders. Only 1 case had tuberculosis. CONCLUSION: In all the cases but one there was no obvious systemic aetiology for the granulomatous changes in the adenotonsillar tissues. Hence, the cost effectiveness of clinicopathological examination of the resected adenoid and tonsil is still questionable.

Perforating and migrating pharyngoesophageal foreign bodies: a series of 5 patients.

Ingestion of a foreign body is a problem seen in nearly all otolaryngologic practices. One of the least common complications of foreign-body ingestion is penetration and migration, which may lead to serious morbidity or even death. We report the findings of a retrospective review of a series of 5 patients who had presented with a complete foreign-body penetration. All of them had radiologic evidence of a foreign body, but findings on rigid endoscopy were negative. Computed tomography is the radiologic study of choice to identify penetrating foreign bodies. The foreign bodies in all 5 patients were extracted via an external approach.

Early identification of rhinocerebral mucormycosis.

OBJECTIVES: Mucormycosis is an acute and often fatal infection caused by a fungus of the Mucorales order of the Zygomycetes class. In the majority of cases, it is associated with an underlying disorder, such as diabetes mellitus with ketoacidosis, or with immunocompromising factors, but it may appear in healthy people, although rarely. Early diagnosis and treatment are critical to prevent an otherwise fatal outcome. This article presents and discusses the early (alarming) signs and symptoms and the predisposing factors that should be considered to avoid delays in diagnosis. METHODS: We review seven cases of rhinocerebral mucormycosis admitted to our hospitals from 1998 to 2003. RESULTS: All patients had an underlying immunocompromising factor and/or diabetes mellitus. Five patients had palatal necrotic ulcers and/or black eschars. Three patients had unilateral blindness, and two patients required orbital exenteration. Four patients died because of a delayed diagnosis. CONCLUSIONS: Early diagnosis is critical in the prevention of intracranial extension of the infection, which is the cause of death in 80% of cases. Therefore, a high index of clinical suspicion is essential in immunocompromised or diabetic patients with acute sinus infection. Identification of a fungal organism on histopathology is the most specific element for diagnosis. A team approach to management is recommended for early surgical debridement, correction of diabetic ketoacidosis, and systemic antifungal agents. Timely medical-surgical treatment proves extremely important for prognosis.

Adenoidectomy: selection criteria for surgical cases of otitis media.

OBJECTIVE: Nasopharyngeal adenoids may serve as a mechanical obstruction to the eustachian tube and contribute to the pathophysiology of otitis media (OM). The purpose of this study was to determine whether abutment of adenoids laterally against the torus tubaris affects the outcome of patients requiring pressure equalization tubes (PET) for OM. STUDY DESIGN: Randomized, controlled, prospective clinical trial. METHOD: Patients requiring PET for recurrent acute OM or OM with persistent effusion were randomized into two groups: 1) PET placement and 2) PET placement and adenoidectomy, regardless of whether the adenoids were abutting or not abutting the torus tubaris. Patients were followed for a minimum of 1 year to determine rate of treatment failure, defined as recurrence of acute OM (>3 times/year), OM with effusion, or reinsertion of PET. RESULTS: Of the 34 patients in the abutting group, 16 patients underwent only PET insertion, of whom 8 (50%) failed, whereas 18 patients had combined PET placement and adenoidectomy, of whom 3 (17%) failed. There was a statistical difference between these two groups (P < 05). Of the 29 patients in the nonabutting group, 24 patients underwent only PET insertion, of whom 9 (37.5%) failed, whereas 5 patients underwent combined PET placement and adenoidectomy, of whom 2 (40%) failed. There was no statistical difference between these two groups (P =.92). CONCLUSION: This study demonstrates that the position of hypertrophied adenoids may alter the final otologic outcome of patients requiring PET insertion for OM. Patients with adenoids abutting the torus tubaris may benefit most from an adjuvant adenoidectomy.

Non-traumatic cerebrospinal fluid rhinorrhea: diagnosis and management.

BACKGROUND: Although the majority of cerebrospinal (CSF) fistulas in the anterior skull base are traumatic in nature, the minority is non-traumatic or primary. Non-traumatic CSF leak can be a diagnostic and treatment challenge. PATIENTS AND METHODS: We describe the diagnosis, modified methods of localization, and surgical repair of a series of nine patients who presented with non-traumatic CSF rhinorrhea and were managed between July 2000 and October 2002. RESULTS: Eight patients were managed via an endoscopic approach and one patient through an intracranial approach. The RI/T2-FLAIR test was used for localization of the site of the leak. The test confirmed the site of CSF leak in 6 patients. Successful repair of CSF rhinorrhea was achieved in 7 of 8 patients with a single endoscopic procedure; one patient required two procedures after a re-leak 18 months following the first repair. CONCLUSION: Non-traumatic CSF rhinorrhea is a relatively rare condition and occurs secondary to different etiologies. Among multiple techniques available for localization, MRI/FLAIR is effective, but requires further evaluation and polishing. In the absence of a large skull base lesion or tumor, endoscopic repair of CSF fistula carries a high success rate with a high margin of safety and low morbidity rate.

Surgical management of nonmalignant parotid masses in the pediatric population: the Montreal Children's Hospital's experience.

Nonmalignant parotid masses in children can have protean etiologies ranging from infective parotitis to a benign neoplastic, vascular, or congenital origin. We review the 10-year experience of a tertiary care pediatric centre with respect to the surgical management of nonmalignant parotid masses. In total, 15 patients with nonmalignant masses of the parotid gland region underwent surgery. Five children were diagnosed with lymphoepithelial cyst or first branchial cleft cyst. Three children were diagnosed with parotid abscess, one of whom had atypical mycobacteria. Other diagnoses included lymphangioma (three cases), chronic inflammation (two cases), and epidermoid cyst (one case). One patient who presented with a parotid cyst was diagnosed postoperatively with plexiform neurofibroma of the facial nerve. She was the only patient with postoperative facial nerve paresis, affecting the orbital branch. Presentation and postoperative complications of these surgically managed nonmalignant parotid masses are reviewed. The history and physical examination are of the utmost importance in predicting the diagnosis, although ultrasonography and computed tomography can be useful. Fine-needle aspiration cytology was not well tolerated by children and appears of little use as the accurate diagnosis was provided by the surgical pathology specimen.

Vestibular-evoked myogenic potentials as a test of otolith function.

OBJECTIVES: To evaluate the use of 75 auditory clicks rather than the usual 100-256 for production of the vestibular-evoked myogenic potential (VEMP) response and to assess if the VEMP correlates with measures of cochlear function such as hearing loss (decibels on pure-tone testing) or auditory brainstem response (ABR). SUBJECTS AND METHODS: Testing of the VEMP was carried out on 24 subjects: 7 normal individuals and 13 hard-of-hearing patients, 2 patients with known vestibular lesions, 1 with profound sensorineural hearing loss and 1 patient with unilateral acoustic neuroma prior to resection. The recording was performed using a conventional ABR machine. Using 75 refraction clicks as auditory stimuli, VEMP responses were measured from a surface electrode applied to the sternocleidomastoid muscle. The 75 responses were averaged. RESULTS: A consistent unilateral biphasic response, the first negative and the second positive (nI, pII), was elicited from 39 of 40 ears (7 normal and 13 hard-of-hearing subjects with no known vestibular dysfunction). No statistical difference was found between the right and left ear responses for nI or pII wave latencies. Two patients with loss of peripheral vestibular function showed no VEMP responses on the affected side. The responses, however, were elicited bilaterally in a patient with congenital profound sensorineural hearing loss. In addition, ABR latencies did not correlate with VEMP latencies. CONCLUSION: Clear VEMP responses were elicited by using only 75 auditory clicks. This shortens the testing time and facilitates the procedure for the tested subject. Our data also indicate that the VEMP is generated secondary to auditory stimulation of the vestibular end organs (specifically the saccule) and does not correlate with cochlear function.

Evaluation of vestibular evoked myogenic potentials.

In previous studies, electromyographic potentials, recorded in response to auditory clicks, have been attributed to stimulation of the otolith (saccule) and have been termed vestibular evoked myogenic potentials (VEMPs). In this study, we assessed the VEMPs in subjects with normal auditory brainstem evoked responses, with no history of vestibular symptoms or neck and other skeletal muscle abnormalities. To this effect, 32 subjects (64 ears), after ethics committee approval, were exposed to 75, 150, and 300 clicks at 100 dB, and the responses were averaged. Electromyographic activity was recorded by applying surface electrodes over the sternocleiodomastoid muscle under the following three conditions: no muscle contraction/no clicks, muscle contraction/no clicks, and muscle contraction/clicks. Our findings suggest that electromyographic responses have to be obtained, during muscle contraction, first without and then with clicks. Our data also suggest that comparison of these two recordings is necessary for meaningful results.