Benign paroxysmal positional vertigo in the elderly.

BACKGROUND: Benign paroxysmal positional vertigo (BPPV) is the most frequent peripheral vertigo in the elderly. It is a well-characterized entity and generally easy to treat. OBJECTIVE: To evaluate the main symptoms, time to consult for the problem, vertigo characteristics, treatment and follow-up in patients over 70 with BPPV. METHODS: This was a retrospective cohort study. Four hundred and four patients were diagnosed to have BPPV (between January 2006 and December 2012); 211 of them were ≥70 years old (mean 77.7 years) and 193 <70 years old (mean 53.82 years). RESULTS: Patients over 70 with BPPV took longer to consult for the problem (Spearman rho, p = 0.01). The frequency of a clinical presentation consisting of unsteadiness or imbalance without vertigo sensation is higher among elderly patients (χ(2), p = 10(-6)). The effectiveness of the repositioning maneuver is lower than in patients under 70 (χ(2), p = 0.002), and the recurrences are more frequent (χ(2), p = 0.04). CONCLUSION: BPPV is a frequent entity in the elderly, and it is necessary to take it into account when older patients complain about imbalance. An appropriate treatment with repositioning maneuvers and prolonged follow-up are required in order to detect recurrences.

Control of vertigo after intratympanic corticoid therapy for unilateral Ménière's disease: a comparison of weekly versus daily fixed protocols.

OBJECTIVE: This study aimed to evaluate the long-term effects of intratympanic corticoid therapy on vertigo control and hearing changes. STUDY DESIGN: The study design was retrospective. SETTING: Tertiary medical centers. PATIENTS: Fifty-six patients with definite unilateral Ménière's disease, diagnosed using the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines, were included. Twenty-two patients were treated with a fixed protocol of 3 consecutive daily intratympanic injections of a 4 mg/ml dexamethasone commercial preparation. Thirty-four patients were treated with a fixed protocol of 3 consecutive weekly injections of the same preparation. MAIN OUTCOME MEASURE: The 1995 AAO-HNS criteria for reporting treatment outcome in MD were used. The treatment results were expressed in terms of vertigo control. A Kaplan-Meier analysis was used to evaluate the control of vertigo over a 2-year period. Separate curves were created depending on the protocol used and the class of vertigo control obtained. RESULTS: Complete vertigo control (class A) was achieved in 40.9% and 44.1% of patients on the daily and weekly protocols, respectively. Substantial vertigo control was obtained in an additional 18.2% and 14.7% of patients on the daily and weekly protocols, respectively. No significant differences were found between the 2 fixed protocols. CONCLUSION: Intratympanic dexamethasone (4 mg/ml) perfusion provides an alternative treatment for definite Ménière's disease. The Kaplan-Meier analysis was useful for analyzing the control of vertigo and the recurrence of Ménière's disease.

[Oncogenic osteomalacia due to phosphaturic mesenchymal tumour in infratemporal fossa]. / Osteomalacia oncogénica por tumor mesenquimal fosfatúrico en fosa infratemporal.

Oncogenic osteomalacia is an uncommon syndrome characterized by phosphaturic tumours that produce mineral metabolism abnormalities. Head and neck is the second most frequent location of these tumours. We describe a case of a phosphaturic mesenchymal tumour in the infratemporal fossa that caused oncogenic osteomalacia, resolved by means of surgical excision.