Vestibular neuritis: a follow-up study.

Seven to eight years after a disease period of vestibular neuritis 19 patients previously examined at our department were given a questionnaire about whether they had experienced any audiovestibular symptoms since they first fell ill. All 19 patients responded and 18 consented to participate in the long-term follow-up study. The patients were subjected to a clinical evaluation, a bithermal caloric test and audiological examinations with stapedius reflex measurements with use of the same technique as at the first examinations. Ten of the 18 patients had experienced recurrent vestibular symptoms with sensation of dysequilibrium and vertigo. Six of these 10 patients also had periods of positional vertigo. The remaining nine patients were free of symptoms. None of the patients had noticed any change in their hearing ability. The mean caloric side difference at the 7- or 8-year follow-up was not significantly higher in the group of patients with symptoms than in the group without symptoms. Neither did the group of patients with pathologically elevated stapedius reflex thresholds at onset display a larger mean caloric side difference than the group of patients with normal thresholds. However, a small caloric side difference at onset of the disease served as a predictor for residual vestibular symptoms. It is speculated whether the group of patients with residual symptoms had a different pathophysiological localization of their disease within the vestibular system than the group of patients with no symptoms at follow-up.

Oculomotor and nystagmus tests in subjects with strabismus.

Smooth pursuit (SP) and saccades (SC) as well as nystagmus were recorded with electro-oculography in 21 healthy subjects with manifest non-paralytic strabismus. A normal SP function under binocular conditions could be recorded in 67% of the subjects and complementary monocular recordings increased the figure to 81%. The corresponding figure for the SC test was 38 and 67%, respectively. However, a minority of the subjects presented a normal test result under both binocular and monocular conditions. Spontaneous nystagmus and/or nystagmus after headshaking was present in 67%. These findings may indicate that subjects with strabismus have a combination of a 'subclinical' vestibular and oculomotor dysfunction.

Audiovestibular findings in patients with vestibular neuritis: a long-term follow-up study.

During the years 1980-1981, 19 patients with a mean age of 39 years, given the diagnosis vestibular neuritis were subjected to a caloric bithermal test, a pure tone audiogram and stapedius reflex measurements within 1 week, 3 weeks, 9 weeks and 1 year after the onset of symptoms, respectively. In a majority of the patients the feeling of dysequilibrium and vertigo diminished within the first 3 weeks and the difference in caloric reaction between the two sides also diminished during this period. In 9 of the patients, a uni- or bilaterally elevated stapedius reflex threshold was found. The return of the caloric response was somewhat slower in this group of patients.

Some considerations on caloric test results.

The caloric test procedure as suggested by Fitzgerald & Hallpike is still widely used. With a carefully standardized procedure it is well suited to identify the affected side in patients with unilateral vestibular impairments. By repeated testing it is also possible to follow the course of a vestibular affection.

Discrimination of purulent from nonpurulent maxillary sinusitis. Clinical and radiographic diagnosis.

For the rational treatment of sinusitis, it is essential to distinguish sinusitis of bacterial origin from that of other etiologies. In maxillary sinusitis, antral purulence indicates a significant amount of pathogenic bacteria, whereas the presence of bacteria seems to be of less or no relevance in nonpurulent sinusitis. Hence, from a therapeutic point of view one important diagnostic goal is the differentiation of purulent from nonpurulent sinusitis. In this respect clinical examination is fairly reliable. Sinus radiography cannot distinguish purulent from nonpurulent sinusitis and offers few advantages when deciding on antibiotic therapy. Antral aspiration offers the most comprehensive information on which to base a reliable diagnosis.