RESUMO
VEMP abnormalities in individuals with BPPV are often reported to be associated with utricle and saccule degeneration. The aim of the present study is to assess the frequency of VEMP abnormalities using vestibular evoked myogenic potentials in individuals with Posterior canal Benign Paroxysmal Positional Vertigo (BPPV) after Epley's manoeuvre. 36 individuals (36 ears) with definite posterior canal BPPV and 36 healthy controls were considered for the present study. All the them underwent otoscopic examination, Dix-Hallpike manoeuvre to diagnose posterior canal BPPV. Further Audiological Evaluation including pure tone audiometry was carried out to rule out vestibular disorders associated with hearing loss. Epley's manoeuvre was performed on all individuals with BPPV by an experienced otorhinolaryngologist. Cervical and Ocular Vestibular Evoked Myogenic Potentials (VEMP) were used to investigate the saccule and utricle functions following Epley's manoeuvre. Cervical VEMP and ocular VEMP abnormalities were observed in 8/36 (22.22%) and 18/36 (50%) affected ears with BPPV respectively. Cervical VEMP responses were reduced in amplitude among 1/36 (2.77%) and absent in 7/36 (19.44%) of affected ears with BPPV. Ocular VEMP responses were reduced in amplitude on 11/36 (30.55%), followed by absent responses in 5/36 (13.88%) ears with BPPV. Two patients with posterior canal BPPV i.e., 4/64 (5.55%) ears had bilateral absence of ocular VEMP responses. Two ears with BPPV 2/36 (5.55%) had absence of both cervical and ocular VEMP responses in BPPV affected ear. T test showed significant difference (p < 0.01) in the amplitude of ocular VEMP among posterior canal BPPV individuals when compared to cervical VEMP. The present study highlights individuals with Posterior canal BPPV may have otoconia dislodgement or macular degeneration of utricle, saccule, both utricle and saccule unilaterally, or bilaterally. VEMP may be useful in evaluating degeneration of both otolith organs associated with BPPV.
RESUMO
OBJECTIVE: To evaluate the efficacy, safety and tolerability of fixed dose combination of Rabeprazole (enteric-coated, EC) 20 mg + Domperidone (sustained release, SR) 30 mg for treatment of laryngopharyngeal reflux disease (LPRD). DESIGN: A prospective, single centre, open-label, non-comparative, observational study SETTING: The study was conducted at an otolaryngology clinic in India between May 2012 and November 2012. PATIENTS: Patients (>18 yrs) with suspicious LPR-related symptoms, reflux symptom index (RSI) score >13 and reflux finding score (RFS) >7, willing to undergo rigid laryngoscopy and requiring fixed dose combination of Rabeprazole (enteric-coated, EC) 20 mg + Domperidone (sustained release, SR) 30 mg capsule treatment according to the investigator's discretion were eligible for enrolment in the study. METHODS: Fixed dose combination of Rabeprazole (enteric-coated, EC) 20 mg + Domperidone (sustained release, SR) 30 mg capsule treatment was given for a total duration of 90 days and efficacy was assessed by the change in RFS and RSI score at Day 90. The safety and tolerability of the study drug was assessed by monitoring adverse events, vital signs and physical examination. RESULTS: Overall, 50 patients were enrolled and completed the study. After 12 weeks of fixed dose combination of Rabeprazole (enteric-coated, EC) 20 mg + Domperidone (sustained release, SR) 30 mg capsule treatment there was a significant change in mean RSI scores [mean (SD) RSI: 19.18 (3.24) at baseline to 2.52 (2.31) at end of study; (p<0.0001)] as well as mean RFS score [mean (SD) RFS: 12.62 (1.48) at baseline to 0.30 (0.51) at end of study; (p<0.0001)]. No adverse event was reported by any patient during the study period. CONCLUSION: Twelve weeks of treatment with combination of fixed dose combination of Rabeprazole (enteric-coated, EC) 20 mg + Domperidone (sustained release, SR) 30 mg capsule significantly improved reflux symptoms in patients with LPR. The combination was found to be safe and well tolerated.