Basic and Applied Medical Sciences Department, G. d Annunzio University of Chieti-Pescara, Chieti, Italy.

Clínica Universitaria de Navarra, Facultad de Medicina, Universidad de Navarra, Pamplona, Navarra, España. msboleas@unav.es

In the superior canal dehiscence syndrome, patients can have sound- or pressure-induced vertigo and oscillopsia.

They may also present conductive hearing loss or higher than normal bone conduction thresholds. Clinical manifestations are due to the effect of a third mobile window in the inner ear created by the dehiscence. Diagnosis is based on clinical manifestations, vertical and rotatory nystagmus induced by sound and pressure reflecting SSC stimulation, reduced threshold and increased amplitude of vestibular evoked myogenic potentials (VEMP) and temporal bone CT scan images showing the SSC dehiscence. Characteristic eye movements can be recorded with the scleral search coil technique.

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Department of Otolaryngology/Head and Neck Surgery, University of Michigan, Ann Arbor 48109-0506, USA.

OBJECTIVE: To determine whether antibodies to supporting cells are associated with response to corticosteroids in patients with autoimmune sensorineural hearing loss. DESIGN: Prospective analysis of antibody to inner-ear antigens. SETTING: Collaborating otology practices in Pennsylvania, Michigan, and Indiana. PATIENTS: Sixty-three patients with rapidly progressive unilateral or bilateral sensorineural hearing loss of unknown cause suggestive of autoimmune sensorineural hearing loss. INTERVENTIONS: Pretreatment audiometry, serum analysis by Western blot (WB) and immunofluorescence (IF) tests, corticosteroid therapy, and follow-up audiometry. MAIN OUTCOME MEASURES: Antibody reactivity and audiogram changes were analyzed for association with response to treatment. RESULTS: More than half of the patients (37/63) had antibodies to both a 68- to 72-kDa protein and to inner-ear supporting cells, 16 patients had positive results on one assay only, and 10 had negative results on both. Twenty-eight patients improved and 35 did not. The WB findings did not correlate with response. Of the WB-positive patients, 49% (21/43) improved, as did 35% (7/20) of the WB-negative patients (P = .30). In contrast, 53% (25/47) of IF-positive patients improved, compared with only 19% (3/16) in the IF-negative group (P = .02). Of those who improved, 89% (25/28) were IF positive. CONCLUSIONS: Antibody to an inner-ear supporting cell antigen was significantly associated with hearing improvement after corticosteroid therapy (relative rate, 2.8). Patients with IF-positive serum are nearly 3 times more likely to experience improved hearing with corticosteroid treatment than those who are IF negative. Antibodies to inner-ear supporting cell antigen may have value in diagnosis and treatment of patients with autoimmune sensorineural hearing loss.

link: http://archotol.ama-assn.org/cgi/content/full/131/8/665

Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil. nopenido@terra.com.br

The aim of this study was to analyze clinical aspects, hearing evolution and efficacy of clinical treatment of patients with sudden sensorineural hearing loss (SSNHL). This was a prospective clinical study of 136 consecutive patients with SSNHL divided into three groups after diagnostic evaluation: patients with defined etiology (DE, N = 13, 10%), concurrent diseases (CD, N = 63, 46.04%) and idiopathic sudden sensorineural hearing loss (ISSHL, N = 60, 43.9%). Initial treatment consisted of prednisone and pentoxifylline. Clinical aspects and hearing evolution for up to 6 months were evaluated. Group CD comprised 73% of patients with metabolic decompensation in the initial evaluation and was significantly older (53.80 years) than groups DE (41.93 years) and ISSHL (39.13 years). Comparison of the mean initial and final hearing loss of the three groups revealed a significant hearing improvement for group CD (P = 0.001) and group ISSHL (P = 0.001). Group DE did not present a significant difference in thresholds. The clinical classification for SSNHL allows the identification of significant differences regarding age, initial and final hearing impairment and likelihood of response to therapy. Elevated age and presence of coexisting disease were associated with a greater initial hearing impact and poorer hearing recovery after 6 months. Patients with defined etiology presented a much more limited response to therapy. The occurrence of decompensated metabolic and cardiovascular diseases and the possibility of first manifestation of auto-immune disease and cerebello-pontine angle tumors justify an adequate protocol for investigation of SSNHL.

http://www.scielo.br/pdf/bjmbr/v42n8/7515.pdf

OBJECTIVES: To present a new classification of 15 anatomical lip zones used to direct placement of injectable fillers during lip augmentation and to evaluate the new classification’s ability to customize lip contour and size. METHODS: Study participants were consecutive patients presenting to a facial plastic and reconstructive surgery practice for injectable lip augmentation with a nonanimal-sourced stabilized hyaluronic acid (Restylane; Medicis Aesthetic Inc, Scottsdale, Arizona). A nonrandomized, prospective case series. RESULTS: A total of 137 treatments were performed on lips of 66 patients. The mean (SD) satisfaction score was 4.5 (0.6) on an integral scale of 1 (dissatisfied) to 5 (most satisfied). The mean (SD) persistence until lips returned to preoperative appearance based on patient subjective evaluation was 4.9 (1.5) months. Patients were free of adverse effects. CONCLUSIONS: Using a new classification of lip anatomical zones to direct the injection of a nonanimal-sourced stabilized hyaluronic acid has increased my ability to better control lip shape and size in lip augmentation. This technique was met with high patient satisfaction and no adverse effects. Persistence of injected nonanimal-sourced stabilized hyaluronic acid was similar to that seen in other studies.

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Dysphagia is a frequent finding in neurological patients and is a symptom related to the severity of the clinical picture. The swallowing impairments, in these patients, increase the risk of aspiration pneumonia, that leads to death, in at least 6% of patients, within the first year. Therefore, evaluation of the swallowing status is essential in patients with dysphagia and videofluoroscopic study of swallowing (VFSS) is the method of choice. It cannot be performed in all patients on account of the complexity of the procedure and since they must be brought to the Radiology Unit. In the 1980, a new bedside method was introduced, namely: fiber-optic endoscopic study of swallow (FESS) which is easy, low-cost, well-tolerated and repeatable. We use this bedside technique to assess swallowing function in patients with dysphagia admitted to acute care units, neurological and internal medicine units. The evaluation aims to indicate the safer nutritional method (oral intake, feeding tube or percutaneous gastrostomy) and, consequently, reducing the risk of aspiration pneumonia during hospitalization. We found that more than 50% of the dysphagic patients present cerebrovascular injuries and in 2% of the population, the first diagnostic hypothesis of Myasthenia Gravis can be made with the FESS technique. In 60%, we indicate a change in nutritional method: in 20% we indicate percutaneous endoscopic gastrostomy (PEG). With these indications, none of those patients had aspiration pneumonia. Our protocol for the bedside fiberoptic study of neurological patients with dysphagia has demonstrated its efectiveness by eliminating the incidence of aspiration pneumonia.

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Various aetiopathological mechanisms have been postulated to be at the root of Menière’s disease (MD), and some data suggest that there may be also an underlying autoimmune factor. In fact, Menière patients manifest certain characteristics that are typical of autoimmune involvement association of particular human leucocyte antigen haplotypes, the presence of antibodies against internal ear antigens. In this study, we evaluated the association between thyroid autoimmunity and MD in a non-selected group of patients. We recruited 50 consecutive MD patients and two groups as controls: group A, 82 healthy volunteers; and group B, 50 subjects suffering from acute unilateral peripheral vestibulopathy. All subjects were submitted to instrumental assessment of cochlear–vestibular function and analysis of thyroid-stimulating hormone (TSH), free triiodothyronine, free thyroxine, anti-TSH receptor antibody (TR-Ab), anti-thyroperoxidase antibody (TPO-Ab) and anti-thyroglobulin antibody (Tg-Ab) in the blood. The prevalence of autoimmune thyroiditis in group B [6/50 (12%); 66·7% TPO-Ab and 33·3% Tg-Ab] was superimposable with the healthy controls [6/82 (7%); 66·7% TPO-Ab and 33·3% Tg-Ab]. In contrast, 38% of the MD patients (P = 0·0001 versus group A and group B) had significant autoantibody levels (68·4% TPO-Ab; 15·8% TPO-Ab + TR-Ab; 10·5% Tg-Ab; 5·2% TPO-Ab + Tg-Ab). Furthermore, 14% of the MD patients were hyperthyroid under l-thyroxine therapy, while no dysfunction was seen in the control groups. Overall, our data demonstrate a significant association between MD and thyroid autoimmunity, which suggests that an autoimmune factor is involved in the aetiopathogenesis of this disease. These findings suggest that it should be useful to submit MD patients to multi-disciplinary clinical investigations.

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Dipartimento di Scienze Chirurgiche, Sperimentali e Cliniche, sezione di Otorinolaringoiatria, Università degli Studi G. d’Annunzio Chieti-Pescara, Italy

PROBLEM: Facial nerve paralysis following middle ear surgery is a nightmare for the otology surgeon. Usually this is caused by surgical trauma or local anaesthetic use. It is uncommon to see onset of facial nerve palsy more than 72 hours following the surgery.

METHODOLOGY: We report a case of facial nerve paralysis appearing 11 days following a successful canal wall-down mastoidectomy.

RESULTS: Viral screening for Herpes Virus type 1 confirmed the viral aetiology of the delayed facial paralysis.

CONCLUSION: When an ipsilateral facial nerve palsy appears more than 72 hours after an uneventful middle ear procedure, without symptoms of any infection, suspect a viral reactivation.

B-ENT. 2009;5(1):47-50.

http://www.b-ent.be/

Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Canada. y.chan@utoronto.ca

PURPOSE OF REVIEW:Dizziness is one of the most common complaints among patients presenting to primary care physicians, neurologists, and otolaryngologists. This symptom is nonspecific and includes a broad differential diagnosis. The current review aims to present a general overview of the approach to dizziness as well as to discuss the more common causes in detail.

RECENT FINDINGS: The term dizziness encompasses a large spectrum of symptomatology. Understanding how to differentiate between vestibular disorders and other types of dizziness is the key to the evaluation and management of dizzy patients. The distinction between central and peripheral vertigo will be emphasized and the various causes of each type of vertigo will be presented.

SUMMARY: Dizziness is a common medical condition that impacts significantly on patients’ activities of daily living. This review outlines the clinical approach to dizziness to facilitate timely diagnosis and management of this complex symptom.

Curr Opin Otolaryngol Head Neck Surg. 2009 Jun;17(3):200-3

http://www.ncbi.nlm.nih.gov/pubmed/19365263?ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum