Long-Term Quality of Life and Nutritional Status of Patients with Head and Neck Cancer.

Disease and therapy of head and neck cancer impair quality of life (QOL). QOL varies profoundly during therapy and follow-up. AIM: We sought to monitor QOL and nutritional status of patients before, during and after therapy (AT). PATIENTS AND METHODS: This study evaluates QOL by using the EORTC-questionnaires QLQ-C30 and H&N35, body weight and plasma albumin up to two years AT. RESULTS: Chemoradiotherapy is the period of the most profound QOL-impairment. Postoperative QOL almost reaches preoperative levels just before adjuvant therapy and does not differ significantly from pretherapeutic QOL. Long-term QOL is not significantly deteriorated. Patients have an average weight loss of 17%. Nutritional supplements are used continuously. Xerostomia and sticky saliva are chronic symptoms that persist AT. CONCLUSIONS: QOL is an important parameter for the evaluation of therapy success. Head and neck cancer and its therapy cause permanent xerostomia, sticky saliva and need of nutritional supplements. Adequate patient information, psychooncological counseling, analgesia and nutritional support may alleviate QOL impairment.

Amiodarone-associated bilateral vestibulopathy.

BACKGROUND: Bilateral vestibulopathy (BVP) is a debilitating disorder characterized by the hypofunction of both vestibular end organs or nerves. The most frequent identifiable causes of BVP are ototoxic drug effects, infectious and autoimmune disorders. The majority of cases, however, remain idiopathic. METHODS: Medical records of patients diagnosed with idiopathic BVP were examined in five dizziness clinics. RESULTS: We identified 126 patients with "idiopathic" BVP. Out of these, 15 patients had a history of Amiodarone treatment before the diagnosis of BVP, resulting in a 12% prevalence. CONCLUSION: The present report supports the hypothesis that Amiodarone can cause BVP. Vestibular examination in patients taking Amiodarone and suffering from balance-related symptoms are recommended, to recognize this adverse effect as early as possible and allow for an informed judgement on a potential dose reduction or withdrawal for recovery of the vestibular function.

The effect on snoring of using a pillow to change the head position.

PURPOSE: Although not a disease, primary snoring often leads to social problems. In an earlier retrospective pilot study, we found hints that individuals were snoring less in a lateral versus a supine head position. The aim of this study is to elucidate on the effect of an anti-snoring pillow which changes the head position. METHODS: We designed an interventional, controlled, and randomized crossover study. It included 22 participants, between 18 and 78 years, who snored, had a BMI ≤ 30, and a sleep partner. Obstructive sleep apnea was ruled out by polysomnography (PSG) or by respiratory polygraphy (PG). Two potential participants dropped out. The first two phases were done at home (4 weeks in total), followed by two nights of polysomnography in our sleep laboratory. During all phases, questionnaires regarding snoring, sleep quality, and pillow tolerance were completed by the patients and, as relevant, by their partners. RESULTS: The PSG parameters revealed a significant reduction in the snoring index (p = 0.03) when on the activated pillow without a deterioration in other respiratory parameters. This correlated well with the visual analog scale (VAS) that showed a significant decrease in snoring with the activated pillow according to the bed partners (p < 0.001). Subjective acceptance of the pillow during the study period was 100%. CONCLUSIONS: This study shows that by using a pillow to change the head position, it is possible to reduce both subjective and objective snoring severity. GERMAN CLINICAL TRIAL NUMBER: DRKS 00008744 AND ETHICS COMMISSION REGISTRY NUMBER REGISTRY NUMBER 2013-406 M-MA.

[Isolated High Frequency hVOR Lesion in Patients with Chronic Dizziness]. / Isoliert hochfrequente vestibuläre Läsion bei Patienten mit chronischen Schwindelbeschwerden.

In the presented study video-head impulse test (vHIT) was performed in 72 patients with complaints of dizziness for more than 3 months who did not show any pathology in rotatory chair testing or caloric test, in order to analyzed high frequency vestibular-ocular-reflex (VOR). Retrospective data analyzed of rotatory chair testing, caloric tests and vHIT results were accomplished in 72 patients. Gain, gain variance and the occurrence of catch-up saccades were measured. 10 patients (n=10; 13.8%) showed pathologic vHOR results with reduced gain. In the remaining 62 patients, a median gain of 0.85 when tested to the right respectively 0.87 when tested to the left side was assed. Especially in patients with normal results in rotatory chair testing and caloric testing, who complain of persistent dizziness and imbalance, high frequency hVOR should also be evaluated using vHIT in order to objectify and document an isolated high frequency hVOR lesion.

[Handling and reprocessing of semicritical medical devices in the ENT - a prospective study]. / Umgang und Aufbereitung semikritischer Medizinprodukte in der HNO ­ eine prospektive Studie.

Numerous laws, guidelines and recommendations govern the handling and reprocessing of semi-critical medical devices in the field of ENT. Although mechanically reprocessing is characterized as a preferential, manual reprocessing is still conducted in most ENT clinics and medical practices for reasons of cost and practicability. In the presented study, we developed an optimized hygienic concept for reprocessing of medical products in the field of ENT.A demand analysis of rigid endoscopes and of ENT equipment was carried out based on hypothesis that only mechanical reprocessing was performed for the entire instrumentation. Additionally, patient-free activities like preparing instrumentation for examination were investigated. As a result, we could demonstrate that such patient-free activities represent a considerable time factor and as a consequence a cost factor in daily patient care. Necessary investments for only mechanical reprocessing of instrumentation including rigid endoscopes are considerably high, since number of endoscopes have to be kept very high.

[Using a Standardized Questionnaire for Coagulation Assessment in Children Undergoing Tonsillectomy]. / Standardisierte Gerinnungsanamnese vor Tonsillektomie und Adenotomie im Kindesalter.

Introduction A 2006 position paper suggests assessing coagulation status via a standardized questionnaire instead of performing routine coagulation testing for children undergoing tonsillectomy/adenotomy. The aim of the presented study was to evaluate whether this paradigm change led to a change in the incidence of secondary bleeding. Methods Descriptive statistical analysis of existing clinical data was performed to evaluate the incidence and characteristics of secondary bleeding in children after tonsillectomy/adenotomy in 2003 vs. 2009. Result In 2003, 352 children underwent surgery. Secondary bleeding occurred in 25 cases (7.1%), 18, (6.1%) of which required surgical treatment. In 2009, 20 out of 293 children who had undergone tonsillectomy/adenotomy suffered from secondary bleeding, 14 required (4.7%) surgical treatment. There was no significant difference in the incidence of bleeding between those years. In 5 children who suffered from secondary bleeding in 2003, preoperative diagnostic blood coagulation testing was performed, none of them showed abnormal results. Furthermore, none of the diagnostic blood coagulation tests performed after secondary bleeding in both groups showed any abnormalities. Conclusion Using a standardized questionnaire instead of a diagnostic blood coagulation testing for preoperative coagulation assessment does not have an influence on the incidence of secondary bleeding after tonsillectomy/adenotomy. The results of this study suggest that secondary bleeding is not is not caused by abnormal hemostasis.

Detection of human utricular otoconia degeneration in vital specimen and implications for benign paroxysmal positional vertigo.

Otoconia are assumed to be involved in inner ear disorders such as benign paroxysmal positional vertigo (BPPV). Up to now, the distinct structure and morphology of intact and degenerate human utricular otoconia has been only poorly investigated on vital specimen. In this study, human otoconia were obtained from the utricle in five patients undergoing translabyrinthine vestibular schwannoma surgery. Specimens were examined by environmental scanning electron microscopy. Intact and degenerate otoconia as well as fracture particles of otoconia and bone were analyzed by energy dispersive X-ray microanalysis (EDX) and powder X-ray diffraction (XRD). Intact otoconia reveal a uniform size showing characteristic symmetry properties. Degenerative changes can be observed at several stages with gradual minor and major changes in their morphology including fragment formation. EDX analyses reveal the characteristic chemical composition also for otoconia remnants. XRD shows that intact and degenerate otoconia as well as remnants consist of the calcite modification. In conclusion, electron microscopy serves as a standard method for morphological investigations of otoconia. Human utricular otoconia show a uniform outer morphology corresponding to a calcite-based nanocomposite. Morphological changes provide further evidence for degeneration of utricular otoconia in humans, which might be a preconditioning factor causing BPPV. In case of uncertain origin, particles can be clearly assigned to otoconial origin using EDX and XRD analyses.

Influence of craniocervical and craniomandibular dysfunction to nonrestorative sleep and sleep disorders.

Objective: Nonrestorative sleep and sleep disorders are commonly reported in patients suffering from craniomandibular (CMD) and craniocervical dysfunctions (CCD). This study aimed to investigate polysomnographic characteristics and the reduction of pain before and after treatment in these patients.Methods: Seventy-four patients with sleep disorders and evident CMD and CCD were included. Manual therapy and an Aqualizer® were used in the therapeutic group. Polysomnographic measurements were conducted pre- and post-therapy.Results: The number of sleep stage alterations and the sleep stage index differed significantly between pre- and post-therapeutic measurements. Between both groups, these parameters were significantly different, as well (p = .001 and p = .012). The subjective perception of sleep quality improved in 81.6% post-therapy (p < .001).Discussion: Manual therapy and the application of an Aqualizer® may improve sleep quality in patients suffering from CMD and CCD. Pain may not be the main cause for the sleep disorders in CMD and CCD.

Reducing the number of impulses in video head impulse testing - It's the quality not the numbers.

OBJECTIVES: The video-Head-Impulse-Test (vHIT) is widely used to evaluate vestibular function. Nevertheless, there is no consensus on the necessary or ideal number of impulses performed for robust VOR gains. Therefore, the aim of our study is to analyze how many impulses are needed to receive reliable VOR gains in difficult testing situations like testing children younger than 48 months and in children with vestibular loss. METHODS: A retrospective data analysis was performed in which existing vHIT results of 25 healthy children aged 5-48 months were included as well as vHIT results of 25 children with vestibular loss aged 2-16 years. Descriptive data analysis was performed and further statistical analysis was conducted to determine if the number of head impulses could be reduced using internal consistency (Cronbach's alpha) and paired t-test. RESULTS: Median gain was 0.95 (±0.16) for impulses to the right and 0.97 (±0.16) for impulses to the left in healthy children and ranged from 0.01 (±0.11) to 0.75 (+/- 0.23) in children with vestibular hypfunction. Analyzing Cronbach's Alpha, a 99.6% (α = 0.996) true score variance was achieved when two impulses were performed to the right and 98,1% to the left in healthy children and 99.9% in children with impaired vestibular function. CONCLUSION: These results indicate that two high velocity artifact-free impulses from an experienced tester are sufficient to evaluate vestibular function in difficult vHIT testing conditions like testing very young children. Further impulses do not improve test reliability.

Peripheral Vestibular Disorders: An Epidemiologic Survey in 70 Million Individuals.

BACKGROUND: Dizziness is a common complaint in medicine. Nevertheless, there is a lack of valid data concerning the age and gender distribution of dizziness disorders within a larger population. Therefore, the aim of the present study is to undertake a representative epidemiological survey that examines all age groups of an entire population and describes the age and gender distribution of the most common peripheral vestibular disorders. METHODS: A population-based epidemiological survey based on confirmed ICD-10 codes, of an entire national population was performed. The population-based data of 70,315,919 patients were leveraged, as provided by 123 statutory health insurance companies in Germany. Patients of all age groups were analyzed. Outcome measures were age and gender distribution and the prevalence of unspecific vertigo, Meniere's disease, benign paroxysmal positional vertigo, vestibular neuritis, and other peripheral vestibular disorders. RESULTS: The prevalence among the recorded diagnoses was 6.5% (6,461/100,000 individuals), with women (N = 2,973,323; 65.4%) being significantly more frequently affected by vertigo than men (N = 1,570,240; 34.6%; p < 0.001). Vertigo is rare in childhood (i.e., up to 10-14 yr of age). Subsequently, the prevalence of the analyzed diseases increases with age, up to a peak between 74 and 94 years. CONCLUSIONS: The results demonstrate that peripheral vestibular disorders are common in a developed country, across all age groups and a specific distribution of these disorders can be identified for every age group and gender. The impact of these disorders on the German healthcare system is currently underestimated.

Influence of static magnetic fields on human myoblast/mesenchymal stem cell co­cultures.

The results of surgical repair of extensive muscle tissue defects are still of primary concern, leaving patients with residual cosmetic and functional impairments. Therefore, skeletal muscle tissue engineering attempts to grow functional neo­tissue from human stem cells to promote tissue regeneration and support defect closure. Despite intensive research efforts, the goal of stable induction of myogenic differentiation in expanded human stem cells by using clinically feasible stimuli, has not yet been reached to a sufficient extent. Therefore, the present study investigated the differentiation potential of static magnetic fields (SMFs), using co­cultures of human satellite cells and human mesenchymal stem cells (MSCs). It has previously been demonstrated that SMFs may act as a promising myogenic stimulus. Tests were performed on co­cultures with and without SMF exposure, using growth medium [high growth factor concentrations (GM)] and differentiation medium [low growth factors concentrations (DM)]. AlamarBlue® assay­based cell proliferation analysis revealed no significant difference between co­cultures with, vs. without SMF stimulation, regardless of growth factor concentrations in the cell culture medium. To determine the degree of differentiation in co­cultures under stimulation with SMFs, semi­quantitative gene expression measurements of the following marker genes were performed: Desmin, myogenic factor 5, myogenic differentiation antigen 1, myogenin, adult myosin heavy chain 1 and skeletal muscle α1 actin. In neither GM nor DM was a steady, significant increase in marker gene expression detected. Verifying the gene expression findings, immunohistochemical antibody staining against differentiation markers revealed that SMF exposure did not enhance myogenic maturation. Therefore, SMF treatment of human satellite cell/MSC co­cultures did not result in the desired increase in myogenic differentiation. Further studies are required to identify a suitable stimulus for skeletal muscle tissue engineering.

Diagnosis and Treatment of Vestibular Neuritis/Neuronitis or Peripheral Vestibulopathy (PVP)? Open Questions and Possible Answers.

: The acute vestibular syndrome is a clinically defined entity consisting of vertigo or dizziness that develops acutely over minutes to hours and is accompanied by nausea/vomiting, gait instability, head motion intolerance, and nystagmus, while persisting over a day or more. When it is caused by a peripheral vestibular lesion and is not associated with clinically manifest auditory deficits, it is mostly labeled vestibular neuritis/neuronitis/neuropathy or sometimes peripheral vestibulopathy. Here, we propose hypotheses and discuss current research advances on viral or vascular factors in the pathogenesis, the recurrence, the site of lesion, old and new treatment options, contraindicated measures, the differential diagnosis, and the prognosis of vestibular neuritis/neuronitis/neuropathy or vestibulopathy. Possibly, other structures than the vestibular nerve are also involved in the pathogenetic process and the label peripheral vestibulopathy would be more apt.

Electrocochleography summating potential seen on auditory brainstem response in a case of superior semicircular canal dehiscence.

BACKGROUND: Superior canal dehiscence syndrome (SCDS) is a condition in which an abnormal communication between the superior semicircular canal and the middle cranial fossa causes patients to hear internal noises transmitted loudly to their affected ear as well as to experience vertigo with pressure changes or loud sounds. Patients with SCDS can have an elevated ratio of summating potential (SP) to action potential (AP) as measured by electrocochleography (ECochG). Changes in this ratio have been observed during surgical intervention to correct this abnormal communication. CASE DESCRIPTION: We present a case of SCDS along with history, physical examination, vestibular function testing, and computed tomography imaging. Due to the disabling symptoms, the patient elected to undergo surgery for plugging of the superior semicircular canal by middle cranial fossa approach. Simultaneous intraoperative ECochG and auditory brainstem response (ABR) were performed. Changes in SP/AP ratio, SP amplitude, and ABR wave I latency were observed during surgery, with a large ECochG SP amplitude generating a new wave, identifiable on the ABR and preceding the traditional wave I. The patient's symptoms resolved after surgery, and no long-term detriment to hearing was observed. CONCLUSIONS: This case demonstrates the intraoperative changes in ECochG during surgery for repair of a SCDS. The substantial intraoperative changes in the summating potential can create a novel wave on intraoperative ABR.

Development of a new software and test setup for analyzing hVOR in very young children by vHIT.

INTRODUCTION: Earlier work revealed that vHIT examination is often difficult to perform on very young children. In particular, the calibration of the system can be difficult, as active cooperation of the patient is required. Additionally, the patient must be able to follow the examiner's instructions, which is challenging for very young children. Therefore, the aim of the present study was to develop and validate a new, software-based approach enabling vHIT testing of young children and infants. METHODS AND MATERIALS: Six patients (3 boys and 3 girls) aged 5-36 months were included in a prospective, monocentric study between January 2015 and August 2015.The newly developed intuitive software enabled calibration of the eye position signal with the subjects fixating on animated animal graphics which were projected on a screen. Testing ten healthy adults validated this new calibration and measurement method. After calibration, a vHIT goggle (EyeSeeCam ©) was used to perform head impulses in the horizontal plane while the patient was watching a movie sitting on their parent's lap or in a baby chair. At least 15 impulses to each side were obtained and the occurrence of refixation saccades was analyzed. All tests were performed by one of two experienced examiners. RESULTS: The new calibration method and modified test setup provided reproducible results for all patients tested. An increased incidence of artifacts was not observed. In 2 patients, more than one test was needed. None of the included children showed catch-up overt or catch-up covert saccades. There was no gain reduction of more than two standard deviations as compared to the normative results published in the literature on vHIT examinations of children. CONCLUSION: The proposed protocol allows vHIT testing in very young children and infants (aged 5 months to 3 years). The study emphasizes that vHIT is an easy and sensitive screening tool to evaluate vestibular function in children and should be used as the gold standard in pediatric vestibular assessment.

Heated air humidification versus cold air nebulization in newly tracheostomized patients.

BACKGROUND: After tracheostomy, the airway lacks an essential mechanism for warming and humidifying the inspired air with the consequent functional impairment and discomfort. The purpose of this study was to compare airway hydration with cold-air nebulization versus heated high-flow humidification on medical interventions and tracheal ciliary beat frequency (CBF). METHODS: Newly tracheostomized patients (n = 20) were treated either with cold-air nebulization or heated humidification. The number of required tracheal suctioning procedures to clean the trachea and tracheal CBF were assessed. RESULTS: The number of required suctions per day was significantly lower in the heated humidification group with medians 3 versus 5 times per day. Mean CBF was significantly higher in the heated humidification group (6.36 ± 1.49 Hz) compared to the cold-air nebulization group (3.99 ± 1.39 Hz). CONCLUSION: The data suggest that heated humidification enhanced mucociliary transport leading to a reduced number of required suctioning procedures in the trachea, which may improve postoperative patient care.

Lapatinib-induced mesenchymal-epithelial transition in squamous cell carcinoma cells correlates with unexpected alteration of ß-catenin expression.

The epithelial-mesenchymal transition (EMT) is a key developmental program that is often activated during cancer progression, and may promote resistance of cancer cells to therapy. Inhibiting EMT appears to be crucial to inhibit drug resistance. The mesenchymal-epithelial transition (MET), which is the reverse program of EMT in metastases, is characterized by the upregulation of epithelial adhesive proteins such as E-cadherin, and downregulation of mesenchymal proteins such as vimentin. The sensitivity of cancer cells to epithelial growth factor receptor (EGFR) inhibitor may be increased by inducing MET in these cells. Therefore, it is of clinical importance to specify the phenotype of cancer cells in order to overcome the phenomenon of drug resistance. The aim of the present study was to investigate the expression pattern of specific markers in squamous cell carcinoma (SCC) cells following stimulation with lapatinib and gefitinib. For this purpose, the head and neck (HN) SCC cell lines HNSCC22B and HNSCC11A were incubated with 0.5 and 2 µg/ml lapatinib and gefitinib, and the levels of E-cadherin, vimentin, matrix metalloproteinase-14, c-kit and ß-catenin were detected by immunocytochemistry and enzyme-linked immunosorbent assay at 5, 24 and 96 h post-incubation. The results indicated that, compared with HNSCC22B cells, the protein expression levels of vimentin increased, whereas those of E-cadherin reduced, in non-stimulated HNSCC11A cells. In addition, the protein expression levels of ß-catenin were altered in the epithelial- and mesenchymal-associated SCC cell lines following treatment with lapatinib and gefitinib. Furthermore, lapatinib induced the downregulation of vimentin and upregulation of E-cadherin in HNSCC11A cells in a time-dependent manner. This suggests that the sensitivity of cancer cells to lapatinib may be improved by inducing MET in these cells. In summary, the results of the present study demonstrated that lapatinib-induced MET led to an unexpected alteration of the protein expression levels of ß-catenin in SCC cells. Further studies on the mechanistic role of MET are required in order to increase the sensitivity of cancer cells to EGFR inhibitor and block the EMT process in these cells.

CpG-Oligodeoxynucleotides in Chronic Rhinosinusitis Cell Culture.

UNLABELLED: In chronic rhinosinusitis (CRS) an important feature is the infiltration of eosinophils, triggered by T-helper type 2 cells (TH2). Binding of the CpG oligodeoxynucleotide (CpG-ODN) ligand to toll-like receptor 9 (TLR9) induces a shift from a TH2- to a TH1-type response. We evaluated the hypothesis that CpG-ODN could reduce the predominantly TH2-driven response in our cultures. MATERIALS AND METHODS: Twenty samples from CRS patients with (CRSwNP) and without nasal polyposis (CRSsNP) were cultivated. The expression of interleukin 5 (IL-5), eotaxin 3 and matrix metalloprotease 9 (MMP-9) were evaluated with and without CpG-ODN. RESULTS: Addition of CpG did not influence the expression of IL-5 and eotaxin-3 DNA. Elevated MMP-9 expression in cultures from CRSwNP and CRSsNP patients could be established. CONCLUSION: CpG does not reduce the attraction of eosinophils since no reduced IL-5 expression was measured in our cultures. Yet, MMP-9 - an important factor in tissue remodelling - was elevated in cultures from CRS patients.

Adaptation and Compensation of Vestibular Responses Following Superior Canal Dehiscence Surgery.

OBJECTIVE: To describe vestibulo-ocular function and compensatory mechanisms in the immediate postoperative period after superior canal dehiscence surgery. STUDY DESIGN: Prospective longitudinal study. SETTING: Tertiary medical center. PATIENTS: Five patients who underwent plugging of superior semicircular canal via middle cranial fossa approach. INTERVENTIONS: Bedside quantitative video head impulse testing (vHIT). MAIN OUTCOME MEASURES: Dynamic measures of vestibulo-ocular reflex (VOR) function including VOR gain and compensatory saccades during vHIT. RESULTS: Mean VOR gain of the ipsilateral superior semicircular canal (SC) decreased from 0.71 ±â€Š0.1 preoperatively to 0.28 ±â€Š0.07 on postoperative day (POD) 2-4 (p = 0.0031), consistent with plugging. There was also a significant immediate postoperative decrease of VOR gain for the other ipsilateral canals (posterior canal (PC) from gain 0.91 ±â€Š0.33 down to 0.55 ±â€Š0.14, p = 0.040; horizontal canal (HC) from 0.81 ±â€Š0.08 down to 0.54 ±â€Š0.19, p = 0.038). On PODs 1-2, compensatory saccades after testing the plugged SC occurred exclusively after the head stopped moving (overt) with latency of 186.2 ms ±â€Š19.9 ms. By POD 7 saccade latency decreased to 141.0 ±â€Š17.5 ms (p = 0.032), and saccades were occurring during the vertical head rotation (covert saccades). Follow-up >40 days was consistent with previous findings in that mean SC gain remained low. HC gain recovered fully, but some cases did not have full recovery of PC gain. CONCLUSION: When the SC is plugged surgically, early quantitative vHIT demonstrates significantly reduced VOR gain for all of the ipsilateral canals. Possible mechanisms include labyrinthine inflammation and loss of perilymph at the time of surgery. Full recovery is typical for the horizontal canal but not always for the PC. Evidence of central compensation occurred by the elicitation of compensatory saccades and by reducing their latencies within the first week after surgery.

Clinical experience with video Head Impulse Test in children.

BACKGROUND: A standardized diagnostic protocol for children's vestibular assessment is still missing in daily clinical life. As rotatory chair testing and caloric test are usually not tolerated well by children, the aim of our study was not only to evaluate the importance and practicability of the video head impulse test performed in children with and without balance problems, but also to outline a diagnostic algorithm for children with balance problems. METHODS: Fifty-five children aged 3-16 years have been included in this prospective monocentric study. Balance was assessed using results from health screening examinations of the participants and results from a specific dizziness questionnaire for children. The children were then divided in two groups: group I without any sign of vestibular development disorder and group II with possible signs for a pathological equilibrium development. Horizontal vestibulo-ocular reflex (HVOR) was assessed using a video-oculography system device (EyeSeeCam(©)). Gain at 40, 60, and 80ms and gain variance has been measured. Furthermore, it was evaluated how calibration of the system was tolerated by the participants, how the test itself was accomplishable in children, and which difficulties arose during testing. RESULTS: Reproducible test results were accomplished in 42 children (75%). Children with no balance problems in history showed a median gain of 1.02 (±0.28). A significant gain reduction between 40 and 80ms was found (P<0.05). Catch-up saccades were found in none of the children. Children with balance problems had a significantly reduced gain. (0.47±0.3; P<0.05) In this group, catch-up saccades could be detected in 4 out of 6 patients. For both groups, performing the test approximately took 20min, which is significantly longer than in adults (P<0.05). Calibration of the system with laser dots was easily doable in children aged 6 and older, whereas children between 3 and 5 years had better calibration results using colorful little icons. CONCLUSIONS: Video head impulse test is a sensitive and efficient vestibular test in children, which is tolerated well by children aged 3-16 years. Therefore, video head impulse test can be easily used as a screening tool to detect vestibular dysfunction in the pediatric population.

Superior canal dehiscence syndrome in children--a case report.

Initially described in 1998, superior semicircular canal dehiscence syndrome (SCDS) has become a well-studied neurootologic entity in adults by now. Unfortunately, experience with children is limited and a diagnostic and therapeutic algorithm is lacking. The article therefore wants to provide an overview of the existing literature on superior semicircular canal dehiscence syndrome in children. Furthermore a diagnostic algorithm for daily clinical life based on a case report from an eleven-year-old girl is presented.