Therapeutic efficacy of the Galletti-Contrino manoeuvre for benign paroxysmal positional vertigo of vertical semicircular canals in overweight subjects.

OBJECTIVE: To compare the Galletti-Contrino manoeuvre with the more widely used Semont-Toupet in overweight subjects presenting with benign paroxysmal positional vertigo (BPBV) of vertical semicircular canals (posterior and anterior canals). STUDY DESIGN: Prospective cohort study. PATIENTS: 204 patients (BMI range 25-30) with a diagnosis of BPPV of vertical semicircular canals were randomly divided in two groups treated with two different maneuvers: Galletti-Contrino (Group A) and Semont-Toupet manoeuvre (Group B). The results were compared with those obtained from a control group (204 non-overweight subjects with BPV of vertical semicircular canals.) INTERVENTION: Galletti Contrino/ Semont Toupet manoeuvres. MAIN OUTCOME MEASURE(S): Liberatory nystagmus or vertigo after maximum 2 maneuvers. Vertigo and dizziness intensity scores (Visual analogue scale VAS 0-10) from day 0 to day 5 following the repositioning manoeuvre were also recorded in responsive patients. RESULTS: While in non-overweight subjects no significant difference comparing the effectiveness of the two manoeuvres was found, liberatory nystagmus and vertigo were more frequently observed after Galletti Contrino manoeuvre in overweight subjects; this difference was statistically significant when posterior canals were involved (P < 0.03). Vertigo and dizziness VAS scores reduced significantly from day 0 to day 5 after therapy in all groups. A more significant reduction of dizziness VAS was recorded in patients undergoing Galletti-Contrino manoeuvre at days 4-5 (P < 0.005). CONCLUSION: Galletti-Contrino manoeuvre seems to be significantly more effective than Semont-Toupet manoeuvre in the treatment of BPPV of posterior semicircular canal and may be preferential in patients with limited body movements.

Oral gabapentin and intradermal injection of lidocaine: is there any role in the treatment of moderate/severe tinnitus?

The objective of our work is to evaluate recovery induced by gabapentin alone and in association with intradermal infiltration of lidocaine in patients affected by moderate/severe tinnitus. Seventy-two patients suffering from moderate/severe unilateral non-pulsatile subjective tinnitus were enrolled. Severity and behaviour of tinnitus were assessed by Tinnitus handicap Index (THI) on the 8th, 22nd and 36th days from onset of therapy, and on the 3rd and 6th month after the end of therapy in patients treated with oral gabapentin (Group I), oral gabapentin and intradermal injection of lidocaine (Group II), and placebo (Group III) Significant differences in THI scores from the 8th day of therapy to the 22nd (p < 0.0001) and from the 22nd day to the 36th (p = 0.0002 and p = 0.0004, respectively) were found in Group I and Group II. In Group II, another relevant decrease of THI scores from the 36th day of therapy to 3 months from the end of treatment (p = 0.0004) was found. A significant difference in THI scores between Group I and Group II was found after 8 days of treatment (p = 0.05) with a more relevant decrease registered in Group II; significant differences were also found in THI scores between Group I and Group III after 8 days of treatment (p = 0.01), with a more relevant decrease registered in Group III; significant differences in THI scores between Group II and Group III were found after 36 days of treatment (p = 0.009), 3 and 6 months after the end of therapy (p = 0.005 and p = 0.007, respectively), with a more relevant decrease registered in Group II. In conclusion, the use of gabapentin associated to lidocaine seems to be superior to placebo and gabapentin in relieving tinnitus.

Classic and reversal steps stapedotomy performed with CO2 laser: a comparative analysis.

The objective of this paper is to evaluate and compare hearing outcomes, intraoperative and postoperative complications and tinnitus characteristics, with particular regard to the effects of stapes surgery on the course of tinnitus. Two groups were evaluated: one group of patients were treated with classical stapedotomy and the second group was composed of patients who underwent reversal technique. Eighty-four patients aged between 22 and 62 years with otosclerosis were divided into two groups: group 1 (n = 49, 17 male, mean age 38, patients treated with classic stapedotomy) and group 2 (n = 35, 13 male, mean age 40, patients treated with reversal stapedotomy). Classical and reversal stapedotomy techniques were performed using CO2 laser; self-crimping titanium piston prosthesis were positioned in patients treated with reversal stapedotomy and classical stapedotomy. Preoperative and postoperative audiometric evaluation using pure tone audiometry (air-bone gap (ABG), bone-conduction thresholds and air-conduction thresholds). Tinnitus handicap inventory (THI) scale and intraoperative/postoperative complications were assessed in both groups. Wilcoxon's test and Friedman's test followed by post hoc analysis were used. There were no statistically significant differences in ABG, air conduction, bone conduction, and THI score variations after surgery between the two groups. Complications in both groups were not significant, and different. In conclusion, reversal and classic stapedotomies performed with CO2 laser can be considered efficient, safe and reliable techniques considering the hearing outcomes and complications recorded.

Use of 3D Volume Rendering Based on High-Resolution Computed Tomography Temporal Bone in Patients with Cochlear Implants.

BACKGROUND The purpose of this study is to demonstrate the advantages of 3D volume rendering in postoperative control of implants placement compared to high-resolution computed tomography (HRCT). CASE REPORT We describe 3 patients who underwent HRCT study with and without 3D volume rendering after surgery for cochlear implantation. In 2 patients, the traditional HRCT showed a suspected malposition of the array, excluded only by the rendering reconstruction. In the other patient, thanks to the 3D rendering, we were able to identify the complete migration of the array out of the cochlea and the tip of the electrode near the opening of internal auditory canal, while the traditional images showed only that the array was not rolled up inside the cochlea. CONCLUSIONS HRCT showed complex anatomic structures of the inner ear and contents of the middle ear cavity. The volume rendering, in the postoperative control, generates interactive 3D images of the cochlear implant, facilitating a clearer representation of the topographic complex of the cochlea, giving more detailed diagnostic information than the HRCT.

Penetrating foreign body in the nasal floor through nasolacrimal duct.

Clinical otolaryngologists frequently encounter nasal foreign bodies (FBs) particularly among children. The removal of nasal FBs is a common otolaryngological practice. However, occasionally trauma results from FBs being lodged in the nasal cavity especially through the nasolacrimal duct. In this article we present an unusual case of a FB that from the left medial canthus went inside the nasolacrimal duct, then through the inferior turbinate and stuck in the floor of the nose. We describe the transnasal endoscopic approach used and we recommend that the treatment be done as soon as possible to avoid complications.