Exploring the frontiers of vestibular migraine: A case series.

INTRODUCTION: Patients with episodic vestibular syndrome (EVS) whose symptoms resemble those of vestibular migraine (VM) but who do not meet the criteria for it are common. OBJECTIVE: To describe those patients suffering from EVS in whom defined etiologies have been ruled out in order to determine if their symptoms can be linked to VM. MATERIAL AND METHODS: Prospective multicenter study. The medical records of patients with VM and patients with EVS suggestive of VM but not meeting the criteria for it were examined. The characteristics of headache, the number and the length of attacks, the association of vestibular symptoms and headache, the intensity of symptoms and the response to treatment were recorded. RESULTS: 58 patients met the criteria for VM or probable VM; 30 did not. All of the symptoms improved significantly in the treated patients with VM or probable VM; in the rest of the treated patients, only the vestibular symptoms improved. CONCLUSION: A subgroup of patients that cannot be attributed to any known vestibulopathy according to present day VM criteria profited from migraine treatment, suggesting that their vestibular symptoms belong to the migraine spectrum; whereas some do not, yet our analysis could not identify distinctive features that allowed subgroup attribution.

Uncovered p1 and p2 waves preceding the N3 vestibular evoked neurogenic potential in profound sensorineural hearing loss.

BACKGROUND: The N3 wave is a vestibular evoked neurogenic potential detected in some patients with profound sensorineural hearing loss (PSNHL) during brainstem auditory evoked potential (BAEP) analysis. In 1998, Kato et al. mentioned two electropositive waves preceding N3, which we named p1-p2, but no further description was given. OBJECTIVE: We sought to demonstrate the reproducibility of these waves and hypothesize on their anatomic origin. METHODS: We used two cohorts of patients with PSNHL. The first cohort comprised 10 patients with N3, allowing us to establish a new test with adequate electrophysiological conditions headed to detect p1-p2 waves (PN3EP). The second cohort consisted of two groups: group A comprised 10 patients in whom N3 was not detected; and group B comprised 20 patients presenting N3. PN3EP was performed in both groups, of which 50% had cervical myogenic vestibular evoked potentials (cVEMPs). RESULTS: Only group B presented p1-p2. The PN3EP facilitated the identification of p1-p2 over BAEP analysis, and their presence correlated well with cVEMPs. CONCLUSIONS: P1-p2 may be covered due to inadequate BAEP setting conditions, and could be generated in the distal neural path that generates the N3 wave.

Subjective benign paroxysmal positional vertigo in patients with osteoporosis or migraine / Vertigem posicional paroxística benigna subjetiva em pacientes com osteoporose ou migrânea

Abstract Introduction Subjective benign paroxysmal positional vertigo is a form of benign paroxysmal positional vertigo in which during the diagnostic positional maneuvers patients only present vertigo symptoms with no nystagmus. Objective To study the characteristics of subjects with subjective benign paroxysmal positional vertigo. Methods Prospective multicenter case-control study. All patients presenting with vertigo in the Dix-Hallpike test that presented to the participating hospitals were included. The patients were separated into two groups depending on whether nystagmus was present or not. An Epley Maneuver of the affected side was performed. In the follow-up visit, patients were checked to see if nystagmus and vertigo were present. Both groups of patients were compared to assess the success rate of the Epley maneuver and also to compare the presence of 19 variables. Results 259 patients were recruited, of which 64 belonged to the subjective group. Nystagmus was eliminated in 67.2% of the patients with benign paroxysmal positional vertigo. 89.1% of the patients with subjective benign paroxysmal positional vertigo remained unaffected by nystagmus, thus showing a significant difference (p = 0.001). Osteoporosis and migraine were the variables which reached the closest to the significance level. In those patients who were taking vestibular suppressors, the percentage of subjective benign paroxysmal positional vertigo was not significantly higher. Conclusions Subjective benign paroxysmal positional vertigo should be treated using the Epley maneuver. More studies are needed to establish a relationship between osteoporosis, migraine and subjective benign paroxysmal positional vertigo. The use of vestibular suppressants does not affect the detection of nystagmus.

Resumo Introdução A vertigem posicional paroxística benigna subjetiva é um tipo de vertigem posicional paroxística benigna na qual, durante as manobras posicionais diagnósticas, os pacientes apresentam apenas sintomas vertiginosos sem nistagmo. Objetivo Estudar as características de indivíduos com vertigem posicional paroxística benigna subjetiva. Método Estudo prospectivo multicêntrico de caso-controle. Foram incluídos todos os pacientes com vertigem no teste de Dix-Hallpike, que se apresentaram nos hospitais participantes. Os pacientes foram separados em dois grupos, dependeu da presença ou não do nistagmo. Uma manobra de Epley foi realizada no lado afetado. Na consulta de seguimento, os pacientes foram avaliados para verificar a presença ou não do nistagmo e da vertigem. Ambos os grupos de pacientes foram comparados para avaliar a taxa de sucesso da manobra de Epley e também para comparar a presença de 19 variáveis. Resultados Foram recrutados 259 pacientes, dos quais 64 pertenciam ao grupo subjetivo. O nistagmo foi eliminado em 67,2% dos pacientes com vertigem posicional paroxística benigna. Em 89,1% dos casos, os pacientes com vertigem posicional paroxística benigna subjetiva mantiveram-se não afetados pelo nistagmo, mostraram uma diferença significativa (p = 0,001). Osteoporose e enxaqueca foram as variáveis que atingiram o nível mais próximo ao de significância. Nos pacientes que tomavam supressores vestibulares, a porcentagem de vertigem posicional paroxística benigna subjetiva não foi significativamente maior. Conclusões A vertigem posicional paroxística benigna subjetiva deve ser tratada com a manobra de Epley. Mais estudos são necessários para estabelecer uma relação entre osteoporose, enxaqueca e vertigem posicional paroxística benigna subjetiva. O uso de supressores vestibulares não afeta a detecção do nistagmo.

Subjective benign paroxysmal positional vertigo in patients with osteoporosis or migraine.

INTRODUCTION: Subjective benign paroxysmal positional vertigo is a form of benign paroxysmal positional vertigo in which during the diagnostic positional maneuvers patients only present vertigo symptoms with no nystagmus. OBJECTIVE: To study the characteristics of subjects with subjective benign paroxysmal positional vertigo. METHODS: Prospective multicenter case-control study. All patients presenting with vertigo in the Dix-Hallpike test that presented to the participating hospitals were included. The patients were separated into two groups depending on whether nystagmus was present or not. An Epley Maneuver of the affected side was performed. In the follow-up visit, patients were checked to see if nystagmus and vertigo were present. Both groups of patients were compared to assess the success rate of the Epley maneuver and also to compare the presence of 19 variables. RESULTS: 259 patients were recruited, of which 64 belonged to the subjective group. Nystagmus was eliminated in 67.2% of the patients with benign paroxysmal positional vertigo. 89.1% of the patients with subjective benign paroxysmal positional vertigo remained unaffected by nystagmus, thus showing a significant difference (p=0.001). Osteoporosis and migraine were the variables which reached the closest to the significance level. In those patients who were taking vestibular suppressors, the percentage of subjective benign paroxysmal positional vertigo was not significantly higher. CONCLUSIONS: Subjective benign paroxysmal positional vertigo should be treated using the Epley maneuver. More studies are needed to establish a relationship between osteoporosis, migraine and subjective benign paroxysmal positional vertigo. The use of vestibular suppressants does not affect the detection of nystagmus.

Normative data for static balance testing in healthy individuals using open source computerized posturography.

PURPOSE: Computerized posturography is the gold standard for balance assessment. Because of the great cost and dimensions of commercial equipments, low-cost and portable devices have been developed and validated, such as RombergLab, a software in open source term which works connected with a low-cost force platform. The objective of this study was to obtain normative posturography data using this software. METHODS: A multicentric prospective and descriptive study, with 350 healthy participants, was designed. Static postural stability (measured using the modified clinical test of sensory interaction on balance) was evaluated using the software connected to the force platform. Using the confidence ellipse area (CEA) in each condition, global equilibrium score (GES) was calculated and adjusted for significant variable factors using cluster analysis. RESULTS: Mean (SD) GES was 0.72 (0.22). Age (p < 0.01), height (p < 0.01) and recruitment center (p < 0.05) were found as influence factors for GES. Cluster analysis obtained 16 groups stratified by age and height. GES decreases with age and height (p < 0.005). No significant interaction of age nor height was found with GES in these clusters (p > 0.05). After correction for height and age, GES was no longer influenced by the recruitment center (p > 0.05). CONCLUSIONS: With the introduction of the global equilibrium score values of the present study into the software, we consider RombergLab v1.3 a reference posturography tool for healthy individuals. Further studies are needed for validating it as a suitable instrumented test for screening between healthy and pathologic subjects and its reliability over time for the follow-up of patients.

Angioedema por inhibidores de la enzima convertidora de angiotensina / Angioedema caused by ACE inhibitor

No disponible

No disponible

Los patrones normal y vestibular en la posturografía dinámica de pacientes con enfermedad de Menière / Normal and vestibular patterns in dynamic posturography in patients with Meniere's disease

Introducción: La prueba de organización sensorial (POS) de la posturografía dinámica permite hacer un estudio fiable de la capacidad del paciente para mantener una estabilidad adecuada cuando las condiciones del entorno visual y/o de la superficie de apoyo son deliberadamente modificadas. Los resultados de esta prueba se pueden analizar de acuerdo con las normas del equipo o mediante la aplicación de fórmulas particulares como es el caso de las de Cevette. Objetivos: Valorar si las fórmulas de Cevette disciernen satisfactoriamente entre el patrón normal y el vestibular, así como ver las diferencias entre estos dos grupos de pacientes (normal y vestibular), obtenidos ya sea a partir del cálculo estandarizado como mediante las fórmulas de Cevette. Se ha restringido el trabajo a pacientes diagnosticados de enfermedad de Menière unilateral que presentaran una forma activa de la enfermedad y que no hubieran sufrido una crisis recientemente. Material y métodos: Se estudiaron 63 pacientes que cumplían los criterios para este estudio. Se realizó un estudio audio-vestibular clínico e instrumental. Los resultados de la POS se analizaron a partir del patrón ofrecido por el equipo y tras la aplicación de las fórmulas de Cevette. Resultados: En 63 pacientes el patrón obtenido fue normal o vestibular. En 41 pacientes el patrón obtenido por uno o por otro sistema de análisis era coincidente, pero en 22 no. La categorización de los pacientes mediante el uso de las fórmulas de Cevette aporta una mayor capacidad de discriminación clínica, pero es sensible al sesgo introducido por la edad; ahora bien, combinado con la clasificación que aporta el equipo logra diferenciar dos poblaciones (normal y vestibular) con una muy buena correlación audio-vestibular. Conclusión: El análisis de la POS, siguiendo las normas aportadas por el equipo complementado con las fórmulas de Cevette, aporta una información más real de las diferencias clínicas en pacientes con enfermedad de Menière cuando el resultado es normal o de déficit vestibular (AU)

Introduction: The Sensory Organization Test of dynamic posturography allows a reliable assessment of the ability of any given patient to maintain a correct stability when conditions in the visual surrounding and/or support surface are deliberately modified. The results of this test can be analyzed according to the norms of the manufacturer of the device or through the application of specific formulae such as those by Cevette. Objectives: To evaluate if the Cevette formulae distinguish correctly between the normal and vestibular patterns, as well as observing the differences between these two groups of patients (normal and vestibular), obtained either through standardized calculation or by the Cevette formulae. The work has been restricted to patients diagnosed with unilateral Menière's disease who presented an active form of the disease and who had not suffered a recent crisis. Material and methods: 63 patients were studied who fulfilled the inclusion criteria for this study. A clinical and instrumental audio-vestibular study was carried out. The results of the sensory organization test were analyzed according to the pattern offered by the device and through the application of the Cevette formulae. Results: In 63 patients the pattern obtained was normal or vestibular. In 41 the pattern obtained through one system of analysis or the other coincided but in 22 they did not. The analysis of patients using the Cevette formulae offers a higher capacity for clinical discrimination but is not sensitive to the bias introduced by age; however, combined with the classification offered by the device, it manages to differentiate two populations (normal and vestibular) with a very good audio-vestibular correlation. Conclusion: The combined assessment of the results of the sensory organization test using both the equipment analysis and the Cevette formulae provides much better and real information of clinical differences amongst patients with Menière's disease when the result is normal or of vestibular deficiency (AU)

Normal and vestibular patterns in dynamic posturography in patients with Meniere's disease.

INTRODUCTION: The Sensory Organization Test of dynamic posturography allows a reliable assessment of the ability of any given patient to maintain a correct stability when conditions in the visual surrounding and/or support surface are deliberately modified. The results of this test can be analyzed according to the norms of the manufacturer of the device or through the application of specific formulae such as those by Cevette. OBJECTIVES: To evaluate if the Cevette formulae distinguish correctly between the normal and vestibular patterns, as well as observing the differences between these two groups of patients (normal and vestibular), obtained either through standardized calculation or by the Cevette formulae. The work has been restricted to patients diagnosed with unilateral Menière's disease who presented an active form of the disease and who had not suffered a recent crisis. MATERIAL AND METHODS: 63 patients were studied who fulfilled the inclusion criteria for this study. A clinical and instrumental audio-vestibular study was carried out. The results of the sensory organization test were analyzed according to the pattern offered by the device and through the application of the Cevette formulae. RESULTS: In 63 patients the pattern obtained was normal or vestibular. In 41 the pattern obtained through one system of analysis or the other coincided but in 22 they did not. The analysis of patients using the Cevette formulae offers a higher capacity for clinical discrimination but is not sensitive to the bias introduced by age; however, combined with the classification offered by the device, it manages to differentiate two populations (normal and vestibular) with a very good audio-vestibular correlation. CONCLUSION: The combined assessment of the results of the sensory organization test using both the equipment analysis and the Cevette formulae provides much better and real information of clinical differences amongst patients with Menière's disease when the result is normal or of vestibular deficiency.

[Myringoplasty: auditory follow-up and study of prognostic factors]. / Miringoplastia: seguimiento auditivo y estudio de factores pronósticos.

OBJECTIVE: To perform a five-year study of hearing evolution in patients undergoing myringoplasty to determine whether eardrum repair correlates with improved hearing. We also studied factors that might predispose to failure and their usefulness as prognostic factors. MATERIAL AND METHOD: In a serial case study, we reviewed all myringoplasties performed at our centre during 2000, 2001, and 2002. We reviewed 83 case histories and studied the closure of the perforation, auditory function pre-operatively, postoperatively and after 5 years, as well as different associated factors. RESULTS: The perforation was closed in 75.9 % of cases. The mean gain of auditory function was 1.5 dB at five years, without statistical significance. The hearing evolution presented a post-surgical improvement and a subsequent deterioration, both statistically significant. We found a statistically significant relationship between the size of the perforation and the condition of the contralateral ear. CONCLUSIONS: Perforation closure in our series (75.9 %) is similar to that reported in the literature. We found contralateral ear pathology and the perforation extension to be associated with poor prognosis after myringoplasty.

Miringoplastia: seguimiento auditivo y estudio de factores pronósticos / Myringoplasty: auditory follow-up and study of prognostic factors

Objetivo: Realizar un estudio a 5 años de la audición de los pacientes sometidos a miringoplastia a fin de probar si la restitución timpánica tiene correlación con la mejora auditiva. Se investigan también posibles factores predisponentes al fracaso y averiguar si podemos describirlos como factores pronósticos. Material y método: Se realiza estudio tipo serie de casos y una revisión de las miringoplastias realizadas en nuestro centro en los años 2000, 2001 y 2002. Se revisaron 83 historias y se estudió el cierre de la perforación, la función auditiva prequirúrgica, posquirúrgica y a 5 años, así como diferentes factores relacionados. Resultados: Se obtiene un cierre de la perforación en el 75,9 % de los casos. En cuanto a la función auditiva, obtenemos una ganancia sin significación estadística de 1,5 dB a los 5 años. La evolución auditiva presenta una mejora posquirúrgica y un empeoramiento posterior, ambos estadísticamente significativos. Se ha obtenido una relación estadística en el tamaño de la perforación y el estado del oído contralateral. Conclusiones: Se presenta un resultado de cierre de la perforación acorde con la mayoría de las series. El estado patológico del oído contralateral y la extensión de la perforación son factores de mal pronóstico de la miringoplastia (AU)

Objective: To perform a five-year study of hearing evolution in patients undergoing myringoplasty to determine whether eardrum repair correlates with improved hearing. We also studied factors that might predispose to failure and their usefulness as prognostic factors. Material and method: In a serial case study, we reviewed all myringoplasties performed at our centre during 2000, 2001, and 2002. We reviewed 83 case histories and studied the closure of the perforation, auditory function pre-operatively, postoperatively and after 5 years, as well as different associated factors. Results: The perforation was closed in 75.9 % of cases. The mean gain of auditory function was 1.5 dB at five years, without statistical significance. The hearing evolution presented a post-surgical improvement and a subsequent deterioration, both statistically significant. We found a statistically significant relationship between the size of the perforation and the condition of the contralateral ear. Conclusions: Perforation closure in our series (75.9 %) is similar to that reported in the literature. We found contralateral ear pathology and the perforation extension to be associated with poor prognosis after myringoplasty (AU)

[Stapedotomy outcomes in the treatment of otosclerosis: our experience]. / Resultados de la estapedotomía en el tratamiento de la otosclerosis: nuestra experiencia.

OBJECTIVE: The main objective of our study is to identify whether there is measurable audiometric deterioration in patients undergoing stapedotomy with a follow-up of more than eight years. MATERIAL AND METHOD: We conducted a retrospective clinical study in which we reviewed a total of 150 case histories of patients with stapedotomy at our department between 1993 and 1997, with a successful initial audiological assessment using tone audiometry in the first three months after surgery and later audiometrical follow-up. RESULTS: We obtained a significant mean post-operative hearing impairment of 1.02 dB per year, with a pre-operative mean PTA of 51.45 dB, going on to early post-operative mean PTA of 26.71 dB, and later post-operative mean PTA of 35.42 dB, with all these changes turning out to be statistically significant. CONCLUSIONS: The auditory level obtained after surgery worsens as the years go by, but always without exceeding the hearing loss prior to surgery.

Resultados de la estapedotomía en el tratamiento de la otosclerosis: nuestra experiencia / Stapedotomy outcomes in the treatment of otosclerosis: our experience

Objetivo: Nos propusimos valorar el deterioro audiométrico de los pacientes intervenidos de estapedotomía, con un seguimiento mayor de 8 años. Material y método: Realizamos un estudio clínico retrospectivo en el que revisamos un total de 150 historias de pacientes intervenidos de estapedotomía entre los años 1993 y 1997 en nuestro servicio, con buen resultado audiológico inicial valorado mediante audiometría tonal en los primeros 3 meses tras la cirugía y con seguimiento audiométrico posterior. Resultados: Obtuvimos una media de deterioro auditivo postoperatorio significativa (1,02 dB por año), con una media auditiva preoperatoria de 51,45 dB, que pasa a una media de 26,71 dB en el postoperatorio temprano, y una media de 35,42 dB en el postoperatorio tardío; todos estos cambios son estadísticamente significativos. Conclusiones: El nivel auditivo obtenido tras la cirugía empeora con el paso de los años; pero siempre sin sobrepasar la pérdida auditiva previa a la cirugía (AU)

Objective: The main objective of our study is to identify whether there is measurable audiometric deterioration in patients undergoing stapedotomy with a follow-up of more than eight years. Material and method: We conducted a retrospective clinical study in which we reviewed a total of 150 case histories of patients with stapedotomy at our department between 1993 and 1997, with a successful initial audiological assessment using tone audiometry in the first three months after surgery and later audiometrical follow-up. Results: We obtained a significant mean post-operative hearing impairment of 1.02 dB per year, with a pre-operativemean PTA of 51.45 dB, going on to early post-operativemean PTA of 26.71 dB, and later post-operative mean PTA of 35.42 dB, with all these changes turning out to be statistically significant. Conclusions: The auditory level obtained after surgery worsens as the years go by, but always without exceeding the hearing loss prior to surgery (AU)

[Abnormal internal carotid artery in the middle ear and severe otorrhagia after myringotomy]. / Arteria carótida aberrante. A propósito de un caso.

We present a clinical-surgical case of a 72-year-old woman referred from another Hospital due to presentation of otorrhagia following myringotomy. We later determined by means of imaging studies that it was a case of an aberrant internal carotid artery. All masses in the middle ear, especially pulsing masses, must be studied by imaging methods such as computerized tomography and, preferably, magnetic resonance angiography.

Arteria carótida aberrante. A propósito de un caso / Abnormal internal carotid artery in the middle ear and severe otorrhagia after myringotomy

Los autores presentan un caso clínico-quirúrgico de una mujer de 72 años de edad, remitida desde otro centro hospitalario por una otorragia grave tras una miringotomía. Mediante estudios de imagen se determinó que se trataba de un caso de arteria carótida aberrante de oído derecho. Toda masa en oído medio, especialmente las que son pulsátiles, deben ser estudiadas mediante pruebas de imagen como tomografía computarizada y, preferentemente, angiografía por resonancia magnética

We present a clinical-surgical case of a 72-year-old woman referred from another Hospital due to presentation of otorrhagia following myringotomy. We later determined by means of imaging studies that it was a case of an aberrant internal carotid artery. All masses in the middle ear, especially pulsing masses, must be studied by imaging methods such as computerized tomography and, preferably, magnetic resonance angiography