Subjective visual vertical and subjective visual horizontal measures in patients with chronic dizziness.

OBJECTIVES: We aimed to find the frequency of otolith organ pathologies in the clinical picture of common dizziness etiologies in the chronic stage. METHOD: Subjective visual vertical and subjective visual horizontal measures were assessed in patients who had persistent or recurrent dizziness at least 2 months after the acute period. Every patient was tested in three head positions: neutral, right, or left deviation in the roll plane. Test results were compared with those of the control group. RESULTS: Seventy-three patients and 18 controls were examined. Fifty-eight of the patients had peripheral vestibular disease; 15 of them had central vestibular disease. Left subjective visual horizontal (SVH) and right SVH measures of the peripheral group were significantly different from those of the control group (p < .01). There was no difference in any test between the peripheral and central groups. When we put a cut off point for abnormality (0, 1) according to mean +/- 2 SD of the control group, the peripheral and central groups had very high significant differences from the control group. Approximately 25 to 50% of our patients had pathologic subjective visual vertical or SVH measures according to test type. CONCLUSION: These results showed that the otolith system must be evaluated in the chronic period of dizziness, especially in patients who frequently visit their physician, and modifications in treatment programs must be conducted.

Experimental sinusitis in a rhinogenic model.

OBJECTIVES/HYPOTHESIS: The objectives were to determine the optimal sinusitis induction period and to examine microbiological and histopathological changes of sinusitis recovery stage in a rhinogenic sinusitis model. METHODS: A synthetic sponge was inserted into the right-side nasal cavities of rabbits. The sponge was impregnated with a Streptococcus pneumoniae strain in group 1 and with sterile saline solution in groups 2 and 3. After the fourth day of sponge insertion, sinuses were examined by coronal computed tomography scans at two-day intervals until any radiological evidence of sinusitis was observed. When sinusitis was detected radiologically, five rabbits each from groups 1 and 2 were killed for histological examination. To determine the recovery period of sinusitis, sponges were removed from the rest of the rabbits in groups 1 and 2. Rabbits were selected randomly and killed on the 15th and the 30th days of the recovery period, immediately after radiological examinations. Group 3 was considered a sham group. RESULTS: Sinusitis induction was performed in all rabbits in groups 1 and 2 until the 8th day. After the sponges were removed, inflammation persisted until the 30th day of the study. CONCLUSION: In a rhinogenic sinusitis model, although histological features of sinusitis were demonstrated, further studies are required to standardize this model and to examine whether or not the studied bacterial strain spreads from nasal cavity into sinus.

Migraine patients with or without vertigo: comparison of clinical and electronystagmographic findings.

OBJECTIVE: To find the differences between patients with migraine with and without vertigo. STUDY DESIGN: A prospective study. SETTING: Ambulatory dizziness centre of a tertiary referral hospital. METHODS: Eighty-four patients with migraine (31 with headache, 53 with headache and vertigo) according to the diagnostic criteria of migraine published by the International Headache Society in 1988 were included in the study. Patient history, vestibular tests, electronystagmography (ENG), and imaging studies were performed for differential diagnosis. MAIN OUTCOME MEASURES: Clinical findings and ENG parameters. RESULTS: Fifty-three of 84 patients (63%) had episodic vertigo attacks. Vertigo was independent from headache in 24 patients (45%). Vertigo symptoms always appeared later in the history of migraine headache. Headache started at age 27 +/- 8.3 years and vertigo symptoms began 7.7 +/- 8.7 years later. The beginning age of the migraine and female-to-male ratio were significantly greater in the vertigo group. Fifty-eight of the 84 patients had ENG testing. Fifty-eight percent of the patients with migraine and 55% of the patients with migraine + vertigo had abnormal ENG findings. None of the tests except the Dix-Hallpike manoeuvre had a statistically significant difference between the two groups. CONCLUSION: The presence of the same ENG abnormalities in patients with pure headache shows that the vestibular pathways are also affected in these patients, even when there are no vestibular symptoms.