Further observations on the effects of head position on vertical OKN and OKAN in normal subjects.

Vertical optokinetic nystagmus (VOKN) and vertical optokinetic after-nystagmus (VOKAN) were studied in three head positions (upright, lateral, and head-hanging) in normal subjects by use of full-field OKN stimulation. Mean vertical OKN gain asymmetry (downbeating greater than upbeating) was noted for the upright position at stripe velocities of 40, 50, and 60 deg/sec. In three subjects, mean VOKN gain asymmetry was eliminated in the head-hanging position, but only slightly reduced in the lateral position. In one subject, mean gain asymmetry was reversed in the head-hanging position. Down-beating VOKAN (usually about 2 to 20 beats) was found in 11 of 21 subjects in the upright position, but was not generally affected by position change. Upbeating VOKAN never occurred following stripes-down stimulation (appropriate stimulation). Inappropriately directed upbeating VOKAN did occur, however, after stripes-up stimulation at 60 deg/sec for 2 of 21 subjects. Downbeating after-nystagmus that was opposite to the direction of previously elicited optokinetic nystagmus (inappropriately directed after-nystagmus), but which occurred from about 2 to 10 seconds after lights-off, was seen in seven subjects.

Carcinoma of the nasal septum.

Twenty-two patients with nasal septal carcinoma have been treated at the University of Texas Medical Branch, Galveston, during the 18-year period from 1961 to 1979. Squamous cell carcinoma of the nasal septum was found in 18 patients (82%), with single instances of reticulum cell sarcoma, basal cell carcinoma, histiocytic lymphoma, and transitional cell carcinoma. One of the squamous cell carcinoma group had palpable cervical metastasis at diagnosis, with metastatic neck disease developing in eight patients from three to 25 months after treatment. Squamous cell carcinoma of the nasal septum is aggressive and often undertreated. Our experience suggests that patients with septal carcinoma of any size should be treated by wide surgical excision (via lateral rhinotomy) and irradiation to the primary site and neck. Control of the primary tumor was achieved in 17 of 18 patients, with neck control in ten patients. The five-year absolute survival rate for squamous cell carcinoma of the nasal septum was 66%.

Diagnostic accuracy of rotation testing vs. standard vestibular test battery--a long-term study.

Interpretation of vestibular test results derived from rotational and other electronystagmography studies often give confusing diagnostic and prognostic information. We have reviewed 90 consecutive patients seen in the Vestibular Clinic at the University of Texas Medical Branch comparing the accuracy of the damped torsion swing test (DTS) with a conventional vestibular test battery (VTB) to predict vestibular function abnormality (peripheral or central). These predictions were compared with vestibular diagnoses obtained by long-term follow-up (24-36 months). VTB and DTS results were evaluated in a double-blind study by two of the authors (W.C.L. and M.J.C.). Agreement of both VTB and DTS interpretation was uncommon (23/77) (30%); however, when present, it resulted in a 91% accuracy in predicting correct final diagnosis. Where VTB and DTS diagnoses differed, the DTS was more accurate in determining final vestibular system abnormality. In fact, while DTS testing correctly detected abnormality in 17 patients, the VTB was normal in 11. Rotation testing alone may provide a useful and accurate screening test prior to initiating further vestibular testing, particularly when central pathology is suspected.

Observations on optokinetic nystagmus in patients with congenital nystagmus.

Nystagmus responses to horizontal optokinetic stimuli are studied in 15 patients with congenital nystagmus (CN). Varying waveforms of CN designed to prolong foveation are evident. Pendular, jerk, and inverted responses are recorded alone and in combination. As in acquired brain disease, flat and asymmetric optokinetic responses occur, but in the study group other features of CN are also invariably present, especially inversion. Optokinetic inversion may be confined to CN.

Recurrent vestibulopathy.

Recurrent vestibulopathy is defined as an illness of unknown cause characterized by more than a single episode of vertigo of duration characteristic of that occurring with hydrops but without auditory or clinical neurological symptoms or signs. Eighty-six patients with this condition were diagnosed in the Dizziness Unit, and data on age and sex distribution, natural history and caloric pattern are presented. On follow-up of mean duration 3.5 year, 6 cases evolved to classic Ménière's disease, and 4 to benign positional vertigo, but none developed brain disease. The prognosis regarding vertigo is generally good. We consider the term recurrent vestibulopathy a logical designation of a distinctive clinical disorder with unknown cause but with probable peripheral vestibular origin, and hope that its use would spur research into previously unrecognized causes of recurrent vertigo.

Delayed endolymphatic hydrops.

Eighteen patients with delayed endolymphatic hydrops are presented. This distinctive entity typically affects young adults and is characterized by episodic vertigo of Ménière's type occurring years after a sudden hearing loss. Measles or mumps were thought to have caused the hearing loss in eight patients. In the entire group of 18 patients the delay between identification of hearing loss and vertigo averaged 22.6 years. The diagnosis is aided by electronystagmography and labyrinthotomy in selected cases. Medical treatment may be effective and surgical treatment is curative.

Indications for internal maxillary artery ligation in the treatment of epistaxis.

Following a review of 13 cases of epistaxis treated by internal maxillary artery with anterior ethmoidal artery ligation over a three year period at the Toronto General Hospital certain indications for ligation have evolved. These are: 1) hospital stay longer than five days, 2) total number of nasal packs more than three, 3) concomitant disease aggravating control, 4) blood transfusion in excess of five units, 5) massive epistaxis.

Unusual parapharyngeal lesions.

Six cases of unusual parapharyngeal lesions are presented in detail along with discussions of the anatomy, pathology, clinical aspects, and treatment methods of lesions in the parapharyngeal space. Newer techniques of CT scanning and selective embolization are discussed as they apply to management of such lesions. A plasmalymphocytic tumor with amyloidosis is described. The authors believe that such a lesion has not been reported previously in the parapharyngeal space.