Incidence and characteristics of Lyme neuroborreliosis in adult patients with facial palsy in an endemic area in the Netherlands.

Making a distinction between facial palsy due to Lyme neuroborreliosis (LNB) and idiopathic facial palsy (IFP) is of importance to ensure timely and adequate treatment. The study objective was to assess incidence and patient characteristics of facial palsy due to LNB. Hospital records were reviewed of adult patients with facial palsy visiting the departments of neurology and/or otorhinolaryngology of Gelre hospitals between June 2007 and December 2017. Gelre hospitals are located in an area endemic for Lyme borreliosis. Patients with LNB had pleocytosis and intrathecal antibody production or pleocytosis with positive IgG serology. Patients with IFP had negative serology. Clinical characteristics were compared between patients with LNB and patients with IFP. Five hundred and fifty-nine patients presented with facial palsy, 4.7% (26) had LNB and 39.4% (220) IFP. The incidence of facial palsy due to LNB was 0.9/100 000 inhabitants/year. Over 70% of patients with facial palsy due to LNB did not report a recent tick bite and/or erythema migrans (EM). Patients with facial palsy due to LNB presented more often in July to September (69.2% vs. 21.9%, P < 0.001), and had more often headache (42.3% vs. 15.5%, P < 0.01). To reduce the risk of underdiagnosing LNB in an endemic area, we recommend testing for LNB in patients with facial palsy in summer months especially when presenting with headache, irrespective of a recent tick bite and/or EM.

Introducing the DizzyQuest: an app-based diary for vestibular disorders.

BACKGROUND: Most questionnaires currently used for assessing symptomatology of vestibular disorders are retrospective, inducing recall bias and lowering ecological validity. An app-based diary, administered multiple times in daily life, could increase the accuracy and ecological validity of symptom measurement. The objective of this study was to introduce a new experience sampling method (ESM) based vestibular diary app (DizzyQuest), evaluate response rates, and to provide examples of DizzyQuest outcome measures which can be used in future research. METHODS: Sixty-three patients diagnosed with a vestibular disorder were included. The DizzyQuest consisted of four questionnaires. The morning- and evening-questionnaires were administered once each day, the within-day-questionnaire 10 times a day using a semi-random time schedule, and the attack questionnaire could be completed after the occurrence of a vertigo or dizziness attack. Data were collected for 4 weeks. Response rates and loss-to-follow-up were determined. Reported symptoms in the within-day-questionnaire were compared within and between patients and subgroups of patients with different vestibular disorders. RESULTS: Fifty-one patients completed the study period. Average response rates were significantly higher than the desired response rate of > 50% (p < 0.001). The attack-questionnaire was used 159 times. A variety of neuro-otological symptoms and different disease profiles were demonstrated between patients and subgroups of patients with different vestibular disorders. CONCLUSION: The DizzyQuest is able to capture vestibular symptoms within their psychosocial context in daily life, with little recall bias and high ecological validity. The DizzyQuest reached the desired response rates and showed different disease profiles between subgroups of patients with different vestibular disorders. This is the first time ESM was used to assess daily symptoms and quality of life in vestibular disorders, showing that it might be a useful tool in this population.

The DizzyQuest: to have or not to have a vertigo attack?

BACKGROUND: The DizzyQuest, an app-based vestibular diary, provides the opportunity to capture the number and nature of vertigo attacks in daily life. To accomplish this, the DizzyQuest provides different strategies: event sampling using an attack questionnaire, and time sampling using an evening questionnaire. Objective of this study was to investigate whether the number and nature of reported vertigo attacks was comparable between the two questionnaires. METHODS: Fifty-seven patients, who reported vertigo attacks, used the DizzyQuest for on average 24 days. The number and nature (including symptoms, triggers and duration) of vertigo attacks were compared between the attack and the evening questionnaire. RESULTS: The attack questionnaire was used 192 times. In contrast, at least 749 new vertigo attacks were reported in 446 evening questionnaires. A vertigo attack was not always reported in both questionnaires during the same day. Vertigo attacks that were most likely captured by both questionnaires were not always reported the same in both questionnaires regarding triggers and duration. CONCLUSION: Event sampling using an attack questionnaire has low recall bias and, therefore, reliably captures the nature of the attack, but induces a risk of under-sampling. Time sampling using an evening questionnaire suffers from recall bias, but seems more likely to capture less discrete vertigo attacks and it facilitates registration of the absence of vertigo attacks. Depending on the clinical or research question, the right strategy should be applied and participants should be clearly instructed about the definition of a vertigo attack.

[Motion sickness in motion: from carsickness to cybersickness]. / Bewegingsziekten in beweging.

- Motion sickness is not a disorder, but a normal response to a non-normal situation in which movement plays a central role, such as car travel, sailing, flying, or virtual reality.- Almost anyone can suffer from motion sickness, as long as at least one of the organs of balance functions. If neither of the organs of balance functions the individual will not suffer from carsickness, seasickness, airsickness, nor from cybersickness. - 'Cybersickness' is a form of motion sickness that is stimulated by artificial moving images such as in videogames. Because we are now exposed more often and for longer periods of time to increasingly realistic artificial images, doctors will also encounter cases of motion sickness more often. - The basis for motion sickness is the vestibular system, which can be modulated by visual-vestibular conflicts, i.e. when the movements seen by the eyes are not the same as those experienced by the organs of balance.- Antihistamines can be effective against motion sickness in everyday situations such as car travel if taken before departure, but the effectiveness of medication for motion sickness is limited.

A functional anatomic study of the relationship of the nasal cartilages and muscles to the nasal valve area.

The functioning of the nasal valve area is largely determined by the stability and the mobility of the lateral nasal wall. To gain insight into the kinematics of the lateral nasal wall, we studied the functional anatomy of the nasal muscles and the intercartilaginous and osseous-cartilaginous junctions. We performed gross and microscopic nasal dissection and serial sectioning in 15 human cadaveric noses. In addition, two noses were used for three-dimensional reconstruction of the nasal cartilages. We conclude that the lateral nasal wall can be seen as made up of three parts. At the level of the osseous-cartilaginous chain of bone, lateral nasal cartilage, and lateral crus, the lateral nasal wall is relatively stable, limited mobility being allowed by translation and rotation in the intercartilaginous joint and a coupled distortion of the cartilages. At the level of the hinge area the lateral nasal wall is supported by one or more accessory cartilages, embedded in soft tissue, and therefore much more compliant. The alar part of the nasalis muscle, which originates from the maxilla and inserts on these cartilages, may dilate the valve area by drawing this hinge area laterally. The third and most compliant part of the lateral nasal wall is the part that is not supported by cartilage, the ala. The dilatator naris muscle largely occupies the ala and is attached to the lateral crus; it opens the vestibule and nostril. The third nasal muscle that influences the lateral nasal wall is the transverse part of the nasalis muscle. It overlies the nose but is not attached to it. This muscle stabilizes the lateral nasal wall, in particular, the lateral nasal cartilage, the intercartilaginous junction, and the hinge area, by moving the nasal skin.

The interdomal ligament does not exist.

Some authors consider the interdomal ligament to be an important structure of nasal tip support, whereas in other studies of lobular anatomy such a ligament is not mentioned at all. To clarify this question, we performed an anatomical investigation, which included macroscopical dissection and histological sectioning of 14 human cadaveric noses. Our anatomical study failed to reveal the presence of an actual ligament in the interdomal area.

Functional anatomy of the premaxillary area.

Although the gross anatomy of the nasal septum is well-understood, the exact anatomy of its ventrocaudal or premaxillary area is not. More precisely, there is some confusion about the course of the perichondrial and periosteal fibers in this particular region. This paper considers the detailed anatomy of the chondro-spinal and chondro-premaxillary junction. Six cadaver noses were sectioned in the coronal (n = 4) or the transverse (n = 2) plane. The sections were stained according to the Mallory-Cason and the Haematoxylin-Eosine method and examined by light microscopy. At the chondrospinal junction a relatively wide suture line filled with loose connective tissue fibers was found. The caudal margin of the cartilaginous septum is flanked by paraseptal cartilages. These broaden the septal base to fit onto the flat cranial surface of the anterior nasal spine. At the chondro-premaxillary junction a narrow suture with several crossing fibers between the perichondrium and periosteum was seen. Paraseptal cartilages, surrounded by their own perichondrium, cover the periphery of this area. It was concluded that the chondro-spinal junction provides stabilization while allowing some mobility of the septum, whereas the chondro-premaxillary complex stabilizes the septum without allowing mobility.

Review of the functional anatomy of the cartilages and muscles of the nose.

This paper reviews the anatomy of the nasal cartilages and muscles. Accurate anatomical knowledge of these structures may facilitate the design of a model to study the mobility and support of the lateral nasal wall and ala and may thus provide information on the dynamics of valve area. It is concluded that a uniform description of nasal cartilages and muscles is still lacking. This is especially true for the attachments of the nasal cartilages to neighbouring structures, as well as the location and function of the muscles influencing the valve area. The use of uniform, preferably anatomical, terminology is encouraged.

Recurrent vestibulopathy: natural course and prognostic factors.

OBJECTIVE: To evaluate the natural course of recurrent vestibulopathy. STUDY DESIGN: Retrospective analysis. PATIENTS: One hundred and five adult patients with attacks of vertigo without auditory or neurological symptoms. METHODS: A structured interview was conducted over the telephone, 12 to 62 months after the patient's first visit to the out-patient department. RESULTS: Two-thirds of patients experienced spontaneous resolution of vertigo, while one-third continued to have symptoms. The diagnosis was subsequently changed to migraine in 2 per cent of patients and to Ménière's disease in 1 per cent. CONCLUSION: The prognosis for patients with recurrent vestibulopathy is good. In a few cases, the diagnosis is provisional and will be subsequently changed to migraine or Ménière's disease.

Allergy due to topical medications in chronic otitis externa and chronic otitis media.

Thirty-four patients suffering from chronic otorrhoea were tested for delayed type contact allergy. Patch testing showed a relevant positive reaction in 19 patients (56%). The most frequent allergens were aminoglycosides with neomycin and framycetin as major offenders. Other antimicrobial agents (clioquinol, polymyxin B), cream bases (lanolin) and corticosteroids (tixocortol) were less common allergens encountered. These results indicate that it is almost obligatory to perform patch testing in any patient with long-standing otitis which does not respond to local therapy. Scoring of the patch tests has to be extended to 7 days, as notably the aminoglycosides and corticosteroids only become positive after such a long interval. Because of the high risk of sensitization, topical preparations containing neomycin and framycetin should not be used routinely. We recommend the use of either a topical antiseptic or a topical antibiotic with low allergenic potential for the initial treatment of otorrhoea.

Electromyography of the human nasal muscles.

Electromyographic (EMG) activity of six nasal muscles was monitored in 17 male volunteers without nasal complaints. Surface electrodes were placed on the nasal skin in such a way that they selectively recorded the activity of these muscles. Recordings were made under different breathing conditions and during voluntary nasal movements. Inspiratory EMG activity was observed during nasal and oral breathing in one or more of the following muscles: dilator naris, nasalis muscle (alar and transverse parts) and apicis nasi. EMG activity increased markedly in response to physical exercise and was more often present in subjects with decreased nasal patency. During voluntary nasal movements a combined activity of the six nasal muscles was consistently found. We conclude that the function of the dilator naris, the nasalis muscle and the apicis nasi strongly relates to respiration. These muscles probably contribute to the prevention of collapse of the nasal valve. The role of the procerus and levator labii superioris alaeque nasi seems to be primarily concerned with facial expression.