Three new strategies to improve the accuracy of monothermal caloric screening testing.

OBJECTIVE: The objective was to find a way to estimate the value of inter-ear difference (IED) through monothermal caloric screening testing (MCST) that can be used at any laboratory, controlling and minimising the resulting error. METHODS: We retrospectively included in this study 2304 patients from our department to whom a videonystagmography with caloric testing was performed between 2003 and 2011. The IED was calculated in 3 different ways: Using the values of the 4 caloric stimulations (bithermal form) and using only the 2 same-temperature values (warm monothermal and cool monothermal forms). We studied 3 strategies to improve the accuracy of MCST: Analysis of variables that could impair the prediction, delimitation of a grey area of insufficient prediction and location of a maximum utility cut-off point. RESULTS: Correcting Jongkees' formula with the value for spontaneous nystagmus makes it possible to include subjects with spontaneous nystagmus or nystagmus inversion. Establishing 2 cut-off points to classify the subjects avoids approximately 38% of bithermal stimulations performed with a sensitivity and specificity of 95%. Maximum utility was obtained diagnosing as healthy those subjects with IED values lesser than or equal to 16% in warm MCST when the pathological IED was set as greater than 20%. CONCLUSION: New statistical tools help clinicians to make decisions that affect their patients based on the results of MCST.

Wegener's granulomatosis causing bilateral facial paralysis and deafness.

Bilateral facial paralysis (BFP) is an uncommon condition that typically occurs as a manifestation of systemic disease. We present a female patient with Wegener's granulomatosis (WG), particularly upper respiratory and ear impairment who develops hypoacusis and BFP, resistant to immunosuppressive therapy and steroid boluses. Her imaging tests showed no involvement of the facial nerve as it passed through the ear structures. The patient finally improved the BFP; however, deafness is permanent and she has entered into a cochlear implant program. Published papers on BFP are rare and they make no reference to WG as a possible aetiology.

[Ramsay-Hunt syndrome presenting laryngeal paralysis]. / Síndrome de Ramsay-Hunt causante de parálisis laríngea.

The Ramsay-Hunt syndrome is the association of facial palsy and varicella-zoster virus infection with involvement of the ear canal and eardrum. It may be associated with deafness, tinnitus and dizziness. It can sometimes affect the lower cranial nerves. A case of an immunocompetent patient with affectation of the VII, VIII and X cranial nerves is presented.

Cricopharyngeal myotomy in the treatment of oculopharyngeal muscular dystrophy.

Oculopharyngeal muscular dystrophy (OPMD) is an autosomal dominant myopathic disease which provokes oropharyngeal dysphagia, palpabral ptosis and proximal limb weakness. It is the abnormal expression of the GCG triplet in the PABPN1 gene on chromosome 14 that causes this disease. The study of the oropharyngeal dysphagia that these patients suffer from should include upper gastrointestinal endoscopy, barium video-radiology and oesophageal manometry. Genetic study confirms the diagnosis. We report 6 patients (3 of whom were siblings) referred to our department with a confirmed diagnosis of OPMD, who underwent cricopharyngeal myotomy to achieve normal swallowing.

[Benign paroxysmal positional vertigo: analysis of our population and role of caloric tests]. / Vértigo posicional paroxístico benigno: análisis de nuestra población y del papel de las pruebas calóricas.

INTRODUCTION AND OBJECTIVES: Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo in those patients who seek medical care. Although videonystagmography seems the most indicated diagnostic test, we tried to decrease the requested caloric tests to optimise resources and reduce associated costs. METHODS: We developed a diagnostic-therapeutic algorithm for patients with suspected BPPV whose provocation tests are positive to evaluate the need for caloric testing. We analysed the results of its application on 98 patients who were referred to our Neuro-otology Unit over 15 months requesting videonystagmography and caloric tests. RESULTS: Only 24% of the requested tests were performed. No significant difference was found in our recurrence rate compared with other series of Spanish patients. CONCLUSIONS: Videonystagmography and caloric tests are not strictly necessary in most patients with BPPV and they should be performed only in patients whose diagnosis is unclear.