Monitoring of caloric response and outcome in patients with benign paroxysmal positional vertigo.

OBJECTIVE: To analyze the time course of caloric response in patients with Benign Paroxysmal Positional Vertigo (BPPV). PATIENTS: Seventy-four individuals with diagnosis of BPPV during Dix-Hallpike (DH) test. STUDY DESIGN: A prospective, longitudinal study. SETTING: A tertiary referral center. INTERVENTION: Patients were treated by particle repositioning maneuvers according to the affected canal, and the effectiveness was evaluated at 180 and 360 days. Bithermal caloric response was obtained by using 44 and 30 degrees C water irrigations at diagnosis, 6 months, and 1 year after. MAIN OUTCOME MEASURE: Canal paresis (CP) and response to DH after treatment. RESULTS: The effectiveness of the treatment for BPPV (absence of vertigo and positional nystagmus during DH) was 65.2% (45 of 69) after 1 year of follow-up. Twenty-five percent of (16 of 64) individuals with BPPV presented CP at diagnosis, 27% (12 of 44) at 6 months, and 16% (9 of 56) 1 year after. One year after, seven individuals with CP showed a normal caloric response, another seven demonstrated persistent CP, and one case developed a bilateral CP. The effectiveness of particle repositioning maneuvers was not significantly different between subjects with or without CP after 1 year of follow-up (odds ratio, 1.31 [95% confidence intervals, 0.35-4.89], p = 0.88). CONCLUSION: Canal paresis is not associated with a lower outcome to repositioning.

Dynamics of canal response to head-shaking test in benign paroxysmal positional vertigo.

CONCLUSIONS: Time constant and maximum slow phase velocity (SPV) of head-shaking nystagmus (HSN) demonstrated a differential canal response to head shaking in 24% of patients with posterior canal benign paroxysmal positional vertigo (BPPV). We suggest that vestibular lithiasis has a limited contribution to the mechanism that generates HSN. OBJECTIVE: To determine the canal response to head shaking in BPPV. PATIENTS AND METHODS: This was a case-control study including 104 individuals with BPPV. The diagnosis was based on the presence of vertigo and nystagmus during the positional test. Subjects were examined by the horizontal and vertical head-shaking test. Eye movements were recorded on a video camera to analyze the nystagmus. The head was shaken passively in the horizontal and sagittal planes, respectively, for horizontal and vertical HSN at a frequency of 2 Hz. HSN was considered when six consecutive beats of nystagmus with an SPV of at least 2 degrees/s were detected. Main outcome measures were the presence of horizontal and vertical HSN, maximum SPV of HSN, time constant of HSN, and canal paresis. RESULTS: Maximum SPV of vertical HSN was higher in BPPV patients with posterior canal BPPV (n = 10) than in controls (p = 0.04). Moreover, the time constant of vertical HSN was significantly lower for posterior canal BPPV when compared with controls (p < 0.02).

Multiple positional nystagmus suggests multiple canal involvement in benign paroxysmal vertigo.

CONCLUSION: Video-oculography demonstrates a higher occurrence of atypical positional nystagmus in patients with benign paroxysmal positional vertigo (BPPV). This includes anterior and horizontal canal variants and multiple positional nystagmus, suggesting combined lesions affecting several canals. OBJECTIVE: To analyse the video-oculographic findings of positional tests in patients with BPPV. MATERIAL AND METHODS: Seventy individuals with symptoms of BPPV and positional nystagmus were included in this study. The diagnosis was based on a history of brief episodes of vertigo and the presence of positional nystagmus as confirmed by video-oculographic examination during the Dix-Hallpike test, the McClure test or the head-hanging manoeuvre. Patients were treated by means of different particle repositioning manoeuvres according to the affected canal (Epley's manoeuvre for the posterior or anterior canals and Lempert's manoeuvre for the lateral canal) and the effectiveness was evaluated at 7 and 30 days. RESULTS: Twenty-nine individuals (41.43%) presented an affected unilateral posterior canal. Fifteen patients (21.43%) presented a pure horizontal direction-changing positional nystagmus consistent with a diagnosis of horizontal canal BPPV. Twelve individuals (17.14%) presented a unilateral down-beating nystagmus, suggesting possible anterior canal BPPV. In addition, 14 patients (20%) showed multiple positional nystagmus during the examination corresponding to simultaneous multi-canal BPPV, 5 had bilateral posterior canal BPPV and 2 presented a positional down-beating nystagmus in both left and right Dix-Hallpike manoeuvres and the head-hanging manoeuvre, which is highly suggestive of anterior canal BPPV. However, seven individuals showed positional horizontal and vertical side-changing nystagmus that could not be explained by single-canal BPPV. These patients with multiple positional nystagmus showed changing patterns of positional nystagmus at follow-up.

[A pilot study of sexual health in patients with Ménière's disease]. / Estudio piloto de la salud sexual en pacientes con enfermedad de Ménière.

INTRODUCTION AND OBJECTIVES: Ménière's disease (MD) is a chronic disorder of the inner ear affecting health-related quality of life in 85% of patients. Although different studies have evaluated the impact of MD on quality of life, sexual health has not been investigated in these patients. The aim of this study was to assess sexual health in patients with MD. MATERIAL AND METHODS: A cross-sectional pilot study was carried out using the general health instrument SF-36, the Dizziness Handicap Inventory Short Form (DHI-S) and two specific questionnaires on sexual functioning, the Female Sexual Function Index (FSFI) for women and the International Index of Erectile Function (IIEF) for men. A statistical analysis of domains of the instruments was performed to compare the score obtained to reference values, and correlation coefficients were calculated to determine the association among different instruments. The level of significance accepted was p<0.05. RESULTS: Forty-eight individuals (26 women and 22 men) with a mean age of 55 and a low-medium culture level were studied. Men showed a high prevalence of erectile dysfunction, twice the national reference values; women had alterations in the sexual satisfaction and pain domains. In both situations, sexual function disorders were dependent upon the SF-36 emotional domains. CONCLUSIONS: Emotional problems associated with Ménière's disease may be associated with sexual function disorders, including sexual desire in women and erectile dysfunction in men.

Dynamic visual acuity during head-thrust test in canal planes in healthy subjects and patients with vestibular neuritis.

CONCLUSIONS: Dynamic visual acuity (DVA) during the head-thrust test (htDVA) is reliable in normal subjects, having a high specificity for the horizontal canal, so it may be useful to monitor vestibular rehabilitation in patients with vestibular neuritis (VN). OBJECTIVE: To obtain reference values for htDVA in healthy individuals and to investigate the potential application in subjects with unilateral VN. METHODS: A total of 73 healthy individuals and 50 patients with unilateral VN were included. The DVA test was performed by adjusting a sensor on the subject's head to measure head velocity. During head thrust, the optotype flashed if the head velocity reached 150°/s, as previously defined, and a DVA score was obtained for each canal. RESULTS: The htDVA was reliable in normal subjects (intra-class correlation coefficient (ICC) = 0.44-0.71; p = 0.001-0.007). The htDVA score showed an age-dependent increase for all canals (p < 0.0001). The 95th percentile of htDVA was used as the criterion to consider htDVA as abnormal in patients with VN. In all, 44%, 30%, and 16% of patients had an increase in htDVA score for one, two or all three canals on the affected side. The sensitivity and specificity of the htDVA test for the horizontal canal were 22% and 85%, respectively.

Estudio piloto de la salud sexual en pacientes con enfermedad de Ménière / A pilot study of sexual health in patients with Ménière's disease

Introducción y objetivos: La enfermedad de Meniere (EM) es una enfermedad crónica del oído interno que afecta la calidad de vida relacionada con la salud en el 85% de los pacientes. Aunque numerosos trabajos han evaluado el impacto de la EM sobre la calidad de vida, la salud sexual no ha sido investigada en estos pacientes. El objetivo de este trabajo es el estudio de la salud sexual en los pacientes con EM. Métodos: Se ha realizado un estudio piloto transversal, utilizando el cuestionario de salud general SF-36, el Dizziness Handicap Inventory Short Form (DHI-S) y los cuestionarios específicos de la función sexual, el Female Sexual Function Index (FSFI) para mujeres y el Internacional Index of Erectile Function (IIEF) para hombres. El análisis estadístico de los cuestionarios compara las puntuaciones con valores de referencia, así como una correlación entre dominios de los distintos cuestionarios. El nivel de significación aceptado es p < 0,05. Resultados: Se estudiaron 48 individuos (26 mujeres y 22 hombres) con una media de edad de 55 años y un nivel cultural bajo-medio. Los varones mostraban una alta prevalencia de disfunción eréctil, que dobla la media nacional. Las mujeres presentaron alterados los dominios de satisfacción sexual y dolor. En ambos casos, las alteraciones de la función sexual fueron dependientes de los dominios del SF-36 que hacen referencia a problemas emocionales. Conclusiones: Los problemas emocionales asociados a la EM pueden provocar alteraciones de la función sexual, concretamente problemas de deseo sexual en las mujeres y de disfunción eréctil en los hombres (AU)

Introduction and objectives: Ménière's disease (MD) is a chronic disorder of the inner ear affecting health-related quality of life in 85% of patients. Although different studies have evaluated the impact of MD on quality of life, sexual health has not been investigated in these patients. The aim of this study was to assess sexual health in patients with MD. Material and methods: A cross-sectional pilot study was carried out using the general health instrument SF-36, the Dizziness Handicap Inventory Short Form (DHI-S) and two specific questionnaires on sexual functioning, the Female Sexual Function Index (FSFI) for women and the International Index of Erectile Function (IIEF) for men. A statistical analysis of domains of the instruments was performed to compare the score obtained to reference values, and correlation coefficients were calculated to determine the association among different instruments. The level of significance accepted was p<0.05. Results: Forty-eight individuals (26 women and 22 men) with a mean age of 55 and a low-medium culture level were studied. Men showed a high prevalence of erectile dysfunction, twice the national reference values; women had alterations in the sexual satisfaction and pain domains. In both situations, sexual function disorders were dependent upon the SF-36 emotional domains. Conclusions: Emotional problems associated with Ménière's disease may be associated with sexual function disorders, including sexual desire in women and erectile dysfunction in men (AU)