Symptom improvement after transtympanic tube placement in Ménière's disease: preliminary observations.

OBJECTIVE: The treatment of choice for Ménière disease (MD) aims at preventing severity and frequency of vertigo attacks. The purpose of this study was to evaluate the effectiveness of ventilation tube (VT) placement on vertigo control in patients affected by MD with no response to standard medical therapy. METHODS: 76 consecutive outpatients diagnosed with definite MD who failed medical therapy received VT insertion at the Department of Otolaryngology Head and Neck Surgery, "Ospedale del Mare", Naples, Italy, with a 3-year follow up. RESULTS: Over the long term, VT placement was effective in controlling vertigo in 61.8% of patients. In the control group treated with standard preventive care (SPC) alone, all patients continued to experience recurrent vertigo during the entire study. Comparison of survival curves by using the log-rank test shows that significant differences in survival exist between subjects treated with VT placement and the control sample (p = 0.001). CONCLUSIONS: Our long-term follow-up confirms that VT placement is an effective and safe management option in intractable definite MD, especially in the elderly or in those refusing more invasive treatments.

Pseudo-spontaneous nystagmus increases Bow and Lean Test accuracy.

OBJECT: The aim of this study was to evaluate the effectiveness of the Bow and Lean Test (BLT) based on nystagmus intensity and direction evaluation (NID-BLT) in the diagnosis of benign paroxysmal positional vertigo of the lateral semicircular canal (LSC-BPPV). We hypothesised that the presence of a pseudo-spontaneous nystagmus increases the diagnostic accuracy of the test. METHODS: The BLT was performed in 32 subjects affected by LSC-BPPV. RESULTS: BLT was positive in 27 cases with a sensitivity of 84.3% and an accuracy of 70.4%. In other words, it was possible to carry out a BPPV root canal diagnosis (LSC) with BLT in 27 patients, of whom 19 also received a diagnosis of side and form. Pseudo-spontaneous nystagmus was detected in 15 patients, all of whom were BLT positive. In these patients, a clear diagnosis of form and side was also obtained in 14 cases (accuracy 93.3%). In the 12 patients without pseudo-spontaneous nystagmus and BLT positive, a diagnosis of side and form was reached in 5 cases (accuracy 41.6%). The comparison between percentages (Chi square test) showed a significant difference (p = 0.038). CONCLUSIONS: The presence of a pseudo-spontaneous nystagmus, as an expression of more mobile debris within the canal or a more deflectable cupula, increases the accuracy of the BLT.