Cochlear, auditory brainstem responses in Type 1 diabetes: relationship with metabolic variables and diabetic complications.

AIMS: Few studies have analysed the presence of hearing abnormalities in diabetes. We assessed the presence of subclinical auditory alterations and their possible association with early vascular and neurological dysfunction in young adults with Type 1 diabetes of long duration. METHODS: Thirty-one patients with Type 1 diabetes (mean age 33 ± 2.3 years, disease duration 25.7 ± 4.2 years) and 10 healthy controls underwent pure tone audiometry (PTA), distortion product otoacoustic emission (DPOAE) and auditory brainstem response (ABR) analyses. Associations with metabolic variables and chronic complications were explored. RESULTS: Compared with healthy controls, patients with diabetes had significantly higher mean hearing thresholds, although still within the normoacusic range. DPOAE intensities at medium frequencies (2.8-4 kHz) were significantly lower in patients with diabetes. In ABR, in addition to waves I, III and V, we observed the appearance of a visible wave IV in patients with diabetes compared with controls (prevalence 61% vs. 10%, P < 0.05), and its appearance was related to a prolonged I-V interval (4.40 ± 0.62 ms vs. 4.19 ± 0.58 ms, P < 0.05). Diastolic blood pressure was higher in people with abnormal DPOAE (P < 0.05), whereas systolic blood pressure correlated with wave V and interpeak I-V interval latencies. A trend towards an association between evidence of wave IV and the presence of somatic neuropathy or abnormal cardiovascular autonomic tests was observed. CONCLUSIONS: Young adults with long-term Type 1 diabetes have subclinical abnormalities in qualitative auditory perception, despite normal hearing thresholds, which might reflect neuropathic and/or vascular alterations.

Noise-induced hearing loss and hearing aids requirement.

Subjective disturbances, due to hearing loss, are auditory disability and handicap which can be evaluated with a questionnaire. The present study refers to a population of industrial workers affected by noise-induced hearing loss. Aim of the study is to identify the minimal level of hearing loss over which the patient felt changes in his quality of life, and the average auditory threshold at which the patient considered the application of a hearing aid useful or necessary. The sample comprised 180 males with noise-induced hearing loss. Each subject received a questionnaire designed for this study. Data show a correlation between disability, handicap and the degree of noise-induced hearing loss. The most relevant problems in noise-induced hearing loss are correlated with disability rather than handicap. 35 dB can be considered as the level above which these devices can be suggested to patients. Hearing aids can become a therapeutic instrument even in the presence of a low degree of hearing loss.

Vertigo returning to the sitting position after the Semont manoeuvre. Is it a prognostic symptom?

SUMMARY: Benign paroxysmal positional vertigo (BPPV) is a frequent benign vestibular condition usually managed with particle repositioning manoeuvres, such as Semont manoeuvre (SM). Since few authors have described prognostic aspects of liberatory manoeuvres, the purpose of the present study was to investigate the possibility of considering vertigo in the final sitting position of the SM as a prognostic symptom in the outcome of posterior BPPV. One hundred and thirteen patients with diagnosis of unilateral posterior BPPV were taking into account in our retrospective cohort study: 41 men and 72 women, aged 22 to 85 years. All were submitted to one repositioning SM and afterwards controlled 3 to 5 days later by means of an additional Dix-Hallpike manoeuvre. The main outcomes investigated were the occurrence of Ny and vertigo in the different phases of the SM, as well as their characteristics in relation to outcome of the disease. Among all patients, 75 (66%) presented both orthotropic Ny and vertigo in the second SM position and 72% obtained a complete resolution of the disease after the liberatory manoeuvre. Contrarily, 17 subjects (15%) manifested vertigo in the final sitting position of the SM and among these, only 7 (41%) completely recovered from BPPV. According to our data, in case of sudden vertigo returning to the final sitting position of the SM, the failure rate of the liberatory manoeuvre was higher, even though not statistically significant: therefore, it can be considered as a negative prognostic factor of posterior BPPV after SM.

Age at diagnosis of deaf babies: a retrospective analysis highlighting the advantage of newborn hearing screening.

OBJECTIVE: Aim of the study was to assess the mean age at diagnosis of bilateral congenital hearing loss in the Audiology and Phoniatry Centre of the University of Turin, pointing out, by North-West Italy experience, the role of the newborn hearing screening in anticipating the age of diagnosis. METHODS: This was a retrospective study. Forty-six congenital deaf babies were reviewed and age at diagnosis was assessed for each, taking in consideration the role of hearing loss risk factors. Eighteen babies (39%) were sent by the centres that participate to the newborn hearing screening program while 28 (61%) came for parental or pediatrician suspicion of hearing loss and for general language delay. Sixteen babies (35%) presented risk factors for hearing loss. RESULTS: The mean age of identification of severe to profound hearing loss was 20.5 months (S.D.=15.3) in the whole group; considering the group of 28 babies not screened the mean age was 29.3 months (S.D.=13.4). This value decreased to 6.8 months (S.D.=3.6) in the group which underwent screening programme. This difference was statistically significant at Student's t-test (p<0.001). The average ages of diagnosis for healthy versus high risk children were significantly different only in the group of screened babies (p<0.05). CONCLUSIONS: Childhood hearing impairment is one of the most common of congenital disorders, and even though there is a general trend of early identification, in reality age of diagnosis is as yet still too late even in developed countries. Our results show that newborn hearing screening could reduce the age at which infants with hearing loss are diagnosed and treated; this would improve speech, language, auditory outcome and the quality of parents and infant life.

Cochlear implantation in delayed sudden hearing loss after conservative vestibular schwannoma surgery.

This is a case of successful cochlear implantation in a 50-year-old man who experienced sudden hearing loss and developed ipsilateral severe tinnitus at three years following conservative stage 1 vestibular schwannoma retrosigmoid surgery. After cochlear implantation, tinnitus improved from THI grade 4 to 2. Localisation skills improved. Hearing in noise (S/N + 7 dB) with target signal from the operated side improved from 38 to 100% of correct answers. A significant improvement of spatial and speech items of the "speech, spatial and qualities of sounds" questionnaire was also measured. In conclusion, cochlear implantation is a feasible and effective solution after conservative vestibular schwannoma surgery should delayed hearing loss occur.

Informed consent in ENT. Patient's judgement about a specific consensus form.

The concept of informed consent was first used in the 60's. The meaning of this term is the need of a preliminary and valid consensus that places the doctor in an authorised condition whereby he is able to carry out his work. Notwithstanding the importance and delicacy of this topic and the potentially serious consequences, there is not, as yet, universal behaviour, on the part of doctors, regarding the mode of information and documentation on how the patient be informed. In a previous article, the authors outlined the best approach, on the part of the doctor in regard to the patient, in order to obtain valid informed consent. In particular, the specific information for each disease was proposed and this was not limited only to aspects related to type of treatment and possible risks, but thorough, with regard to adhering to the logical course (case history, objective tests, instrumental diagnosis carried out, etc.) that led the doctor to a certain diagnosis and a description of the proposed treatment possibilities as well as the treatment modalities excluded, with relative reasons. The study was designed in such a way as to define the degree of acceptance that this informative method has on the patients. This was achieved by means of a questionnaire filled in by 254 patients hospitalised in our department, about to undergo surgery. Judgement was substantially positive, in that, > 70% of patients agreed that the information was quite or very good, and 90% considered it sufficient or better. This demonstrates that even those subjects who received little information, were, in fact, satisfied with that given. The patient/doctor relationship was also judged positive. The patients felt that it was important to be kept informed about their condition, regardless of the form (written or spoken). In conclusion, the outcome of the questionnaire demonstrates the appreciation. on the part of the patients, regarding the procedure of information used in seeking consensus.

Intensity and fundamental frequency control in tracheoesophageal voice.

Tracheo-oesophageal voice prostheses are currently widely used following total laryngectomy. Data on maximum phonation time and spectrum have been studied by various Authors and are well known. On the contrary, intensity and fundamental frequency control have received little attention. Intensity and fundamental frequency play an important role in the prosodic aspects of speech. Fundamental frequency variations have been studied in tone language speakers, but the ability to voluntarily change intensity and fundamental frequency remain to be fully investigated. Aim of the present study was to analyse the ability of tracheo-oesophageal voice users to change intensity and fundamental frequency. A total of 12 male subjects who underwent total laryngectomy, in whom a tracheo-oesophageal prosthesis had been inserted, were considered. Maximum phonation time was calculated. Each subject was asked to utter an /a/ as loud as possible and an /a/ as soft as possible. Each subject was then asked to utter an /a/ at comfortable pitch and then at an interval of a fifth. Intensity as well as fundamental frequency variations were compared using Wilcoxon signed rank test. Correlation between maximum phonation time and variation in intensity and in fundamental frequency as well as between the two latter variables was calculated using Spearman's rank correlation coefficient. Mean maximum phonation time was 8 (+/- 3.8) sec. Mean energy was 50 (+/- 4.8) dB SPL for soft phonation and 68 (+/- 4.7) dB SPL for loud phonation. The difference observed was statistically significant (p < 0.02). Mean fundamental frequency values were 106 (+/- 14) Hz and 135 (+/- 34) Hz at the interval of a fifth. The difference observed was statistically significant (p < 0.02). Tracheo-oesophageal voice users were able to change intensity and fundamental frequency, but their control was rather poor. Variations in intensity, as well as fundamental frequency, did not show any correlation with maximum phonation time, and were not correlated with each other. In conclusion, the tracheo-oesophageal voice allows small fundamental frequency variations, but their control appears difficult. On the contrary, intensity variations appear larger and control somewhat easier.

Vestibular apparatus disorders after external radiation therapy for head and neck cancers.

External irradiation of different head and neck cancers may involve parts of the ear. The vestibular function of 25 patients in which the inner ear was comprised in the irradiated volume was investigated by electronystagmography (ENG). Doses administered to the vestibular system ranged between 2800 and 5120 cGy. Five patients suffered subjective vertigo or dizziness. Eleven patients (three out of five with vertigo) showed vestibular abnormalities to ENG (44% of the total). Altered responses to specific tests were as follow: six patients to the bithermal caloric stimulation, two to the pendular-sinusoidal test and the other three to both of them. Patients were evaluated 3 and 6 months after the ending of the radiation therapy course. At the first evaluation, abnormalities to caloric test were noted in three patients (12%) and to sinusoidal rotatory test in one patient (4%). At the second evaluation, rates of abnormal response increased to 36% and 20%, respectively. Vestibular disorders seemed to be scantly related to the total radiation dose. Data of literature are discussed in order to identify possible implications on treatment planning.

Pharyngocutaneous fistula as a complication of total laryngectomy: review of the literature and analysis of case records.

Pharyngocutaneous fistula is the most common complication of total laryngectomy. The management of this problem increases hospitalization time and delays initiation of postoperative radiotherapy, where indicated. To identify factors predisposing to the development of pharyngocutaneous fistula, we reviewed the postoperative courses of 293 patients who underwent total laryngectomy at our clinic. General factors taken into account were concurrent diseases such as diabetes, liver diseases, or chronic anemia; local factors included radiotherapy before and after surgery, preoperative tracheostomy, type of cervical lymph node removal, and method of pharyngeal closure. We then compared our data with those reported in the literature by other authors. Last, we applied the Fisher exact test to a correlation we found between the higher incidence of fistula in patients with diabetes, liver diseases, or anemia. The local factor that turned out to be statistically most significant for the development of fistula was preoperative radiotherapy.

Adjuvant radiotherapy influences the survival of patients with squamous carcinoma of the head and neck who have poor prognoses.

The treatment of carcinoma of the head and neck in recent years has improved significantly, chiefly thanks to progress in surgery and radiotherapy. Despite these advances, the survival statistics reported in the literature show no appreciable evidence of radical improvement. The aims of this study were to evaluate the impact on survival achieved with the combination of surgical and postoperative radiotherapy in patients with advanced head and neck carcinomas and to identify the prognostic value of several host- and tumor-related factors that can influence the results of combined treatment. We retrospectively reviewed the medical records of 394 patients with stage III and IV carcinoma of the head and neck, of whom 170 (43%) underwent surgery alone and 224 (57%) received combined surgery and postoperative radiotherapy. The 394 patients were stratified for a set of variables including the patient's condition, the characteristics of the tumor, and the modality of treatment. Univariate analysis revealed that coexistent medical diseases, the size and site of the primary lesion, the stage of the tumor, and certain pathologic features had a negative impact on survival. Multivariate analysis showed that the removal of lymph nodes and postoperative radiotherapy can have a positive influence and can improve the prognosis. We compared the survival rates of the patients treated with surgery alone with those of the patients who underwent combined treatment, and we observed that the two survival curves were comparable, even if there was a bias because the combined treatment group consisted of patients with negative prognostic factors. The meaning of these results, compared with data from the literature, has been discussed.

Carcinoma of the external auditory meatus and middle ear. Results of the treatment of 28 cases.

AIMS: The authors report their experience on the treatment of 28 cases of middle ear (3) and external auditory meatus (EAM) cancers (25) with surgery and/or radiation therapy. According to histologic type, there were 23 squamous cell carcinomas, 4 basal cell carcinomas and 1 adenocystic carcinoma. METHODS: Surgery alone was performed in 2 cases, surgery combined with radiotherapy in 11 cases, and radiotherapy alone in 15 cases. Postoperative radiation therapy dose ranged between 4500 and 5500 cGy; the definitive dose was 6000-7000 cGy. The median follow-up was 61 months. RESULTS: Complete response rate 6 weeks after the end of the treatment, evaluated by CT scan, was 85.7% (24/28). Definitive local control was obtained in 20/28 cases for the primary site and in 26/28 cases for the neck. Nine of the 10 recurrences were retreated with low-dose radiotherapy combined with surgery, chemotherapy or hyperthermia. A new local control was obtained in 2 cases. Four patients were lost during the follow-up at 13, 14, 17 and 23 months after the end of the treatment. The survival rate was 54% (13/24); disease-free survival was 50% (11/22). CONCLUSIONS: Despite a not very aggressive treatment, our results are quite good.

Cochlear blood flow modifications induced by anaesthetic drugs in middle ear surgery: comparison between sevoflurane and propofol.

OBJECTIVE: Because it is necessary to maintain controlled hypotension during middle ear surgery in order to avoid bleeding and as it is known that cochlear blood flow (CBF) is related to blood pressure (BP), it is useful to evaluate CBF modifications induced by anaesthetics in order to prevent cochlear damage. The aim of this paper is to evaluate, using laser Doppler flowmetry, which anaesthetic drug, out of sevoflurane and propofol, has the smallest effect on CBF. MATERIAL AND METHODS: Twenty consenting adult patients scheduled for myringoplasty under general anaesthesia for simple tympanic membrane perforation were studied. Patients were divided into two groups: the first group was treated with sevoflurane and the second with propofol. For the first group, CBF measurement was carried out on three different occasions: (i) at a basal low drug dosage; (ii) having increased the drug dosage to a higher level; and (iii) having reduced the drug dosage to the basal low level again. For the second group, CBF measurement was carried out on three different occasions: (i) 10 min after injecting a bolus of propofol; (ii) immediately after a second propofol injection; and (iii) 10 min after a third injection of propofol. A probe was placed over the promontory in order to measure CBF levels. RESULTS: In the subjects treated with sevoflurane, after having increased the drug dosage, BP decreased significantly while CBF did not change significantly. In the subjects treated with propofol we recorded a significant reduction in BP, as well as a decrease in CBF. CONCLUSION: The results obtained show that sevoflurane has a hypotensive effect without modifying CBF, while propofol, although having a similar effect on BP to sevoflurane, has less of a protective effect on inner ear microcirculation.

Differential expression and topography of adhesion molecules in laryngeal and oropharyngeal carcinomas.

This work describes the different patterns of expression of integrins and extracellular matrix proteins in normal and transformed mucosa in laryngeal and oropharyngeal carcinomas. Samples from each tumor group were sectioned and examined by immunohistochemistry using monoclonal antibodies raised against integrin chains (alpha2, alpha3, alpha6, beta1 and beta4) and their ligands (laminins 1 and 5, collagen type IV and two fibronectin isoforms: ED-A and ED-B). Controls were provided by samples of tumor-free laryngeal and oropharyngeal mucosa that had been removed during the surgical procedure. We found that the known distinct topographical pattern of integrins and the continuity of basement membrane components was altered in both groups but that the extent of changes was significantly more marked in oropharyngeal tumors, which are known to be more infiltrating and diffusive and to have a bad prognosis. These molecular patterns of expression can be used as an additional prognostic factor as they suggest a greater biological tumor aggressiveness of oropharyngeal tumors. We suggest that performing immunohistochemical analysis on biopsy samples may help in selecting the correct therapeutic strategy for these tumors and enable more accurate follow-up. The above-mentioned molecules may become part of the diagnostic toolbox of head and neck surgical pathologists.

Qualitative and quantitative evaluation of some vocal function parameters following fitting of a prosthesis.

The insertion of a prosthesis and restoration with pectoralis major myocutaneous flaps for patients subjected to total pharyngolaryngectomy is a technique now universally accepted; however the literature on the subject is lacking. Our study considers 10 patients subjected to total pharyngolaryngectomy and restoration with pectoralis major myocutaneous flaps who were fitted with vocal function prostheses and a control group of 50 subjects treated with a total laryngectomy without pectoralis major myocutaneous flaps and who were fitted with vocal function prostheses. Specific qualitative and quantitative parameters were compared. The quantitative measurement of the levels of voice intensity and the evaluation of the harmonics-to-noise ratio were not statistically significant (p > 0.05) between the two study groups at either high- or low-volume speech. On the contrary, statistically significant differences were found (p < 0.05) for the basic frequency of both the low and the high volume voice. For the qualitative analysis seven parameters were established for evaluation by trained and untrained listeners: on the basis of these parameters the control group had statistically better voices.

[Annular wedge tympanoplasty: a variation of overlay myringoplasty]. / Annular wedge tympanoplasty: una variante della miringoplastica overlay.

Myringoplasty has been increasingly refined in recent years and today the most frequently employed are the "overlay", the "underlay" and the "interlay". Of these the overlay technique appears to best guarantee graft stability. However, with this technique there is the risk of blunting and neotympanum lateralization which can compromise functional recovery. To obviate these drawbacks, the authors propose a modification of the classical overlay technique. This modification consists of detachment of the anterior portion of the Gerlach annulus and the adjacent protympanum mucosa in order to insert the graft between the bony and fibrous portions of the annulus. This technique is defined as the "Annular Wedge Tympanoplasty" (AWT). From January 1993 to July 1994 a total of 74 tympanoplasties were performed using the AWT technique to reconstruct the tympanic membrane. In 71 (96%) of these, the opening closed completely. As regards incomplete healing, 2 cases showed signs of blunting, 3 showed posterior lateralization and 1 full lateralization with a reduction in the hearing level recovery. The work is not conclusive although it does present a technique which is easy to perform and which provides good functional recovery.

[Smooth pursuit eye movements evoked by head-phone acoustic stimulation]. / Studio dei movimenti oculari di smooth pursuit evocati mediante stimolazioni acustiche in cuffia.

Smooth pursuit eye movement evoked by binaural acoustic stimulation is examined in the present work. The effect of lateralization was achieved by modulating the interaural difference in intensity, within the headphone, following a pendular pattern. The test was performed on 10 healthy subjects; oscillation frequencies of the acoustic target being 0.15, 0.5 and 0.83 Hz, stimulus intensity 65 and 92 dB SPL. The acoustic signal consisted of white noise. Each trial was performed with eyes closed and then with eyes open. The results demonstrate that sinusoidal eye movement can only be obtained in a few subjects when the acoustic target has the lowest velocity and especially at the higher intensity. In all other cases eye movement was characterized by multiple saccades. The variability in eye movement amplitude is reduced and the value of this parameter decreases significantly under open-eye conditions. The data obtained are in agreement with other reports obtained with free field acoustic stimulation and demonstrate that smooth pursuit eye movement is principally an ocular reflex. In conclusion, acoustic smooth pursuit eye movement appears normally to be characterized by multiple saccades whose pattern can be modulated by intensity and oscillation frequency of the acoustic target as well as by the presence of visual inputs and attentional factors.

[Balance disorders: a proposal of a new diagnostic methodology from the medico-legal standpoint]. / I disturbi dell'equilibrio: nuova proposta di metodologia valutativa in ambito medico-legale.

Balance impairment is the object of requests for remuneration in 20-50% of the cases of cranial trauma. Most patients present slight disequilibrium following cranial traumas not involving concussion or cervical distraction. The various methods used in Italy to evaluate the biological damage score balance annoyances on a percentage basis ranging from 1% to 25% and base evaluation on vestibular testing results. The Authors feel that such evaluation approaches are limited. Indeed, since compensation mechanisms come into play, vestibular lesions are not always symptomatic. This means that the lesions detected solely through vestibular testing are not necessarily indicative of the extent to which the subject is affected. Furthermore, some extravestibular lesions can give rise to balance impairments which will go undetected by vestibular examination. Finally, an universally accepted diagnostic protocol still doesn't exist. In this work the Authors present a new method for balance impairments evaluation. While this technique still involves the normal evaluation range for vestibular damage (1-25%), it is based on the disturbance indicated by the patient rather than on the instrumentally detected damage. To objectively determine the real existence of the symptom, the Authors also propose a specific diagnostic strategy for each symptom, thus overcoming the problem of a diagnostic standard. The initial results, obtained on 56 subjects evaluated for post-traumatic balance impairment, show substantial agreement with previous methods. Our method allows to better recognize modest damage--for the most part extravestibular which go unrecognized with the conventional methods--and significantly modify the amount of more extensive damage, expression of vestibular damage which does not correspond to equally significant symptoms.

[The evaluation of isoflurane's effect on the cochlear blood flow by laser doppler flowmetry]. / Valutazione mediante flussimetria laser Doppler degli effetti dell'isoflurano sul flusso ematico cocleare.

Laser-Doppler flowetry is actually the method of choice in cochlear blood flow measurement. The Authors analyze, by means of laser doppler flowmetry, the effect of isoflurane, an anesthetic drug with an hypotensive effect, on cochlear blood flow on 10 patients submitted to miringoplasty. A slight increase of cochlear blood flow was recorded in each subject nevertheless a significative reduction of systemic pressure. Since normally hypotension determines a reduction of cochlear blood flow, the Authors state that isoflurane has a protective effect on this microcircular district.

[Functional results in the reconstruction of the ossicular chain in partial or total atrophy of the incus. Comparison between reconstruction using a moulded incus and hydroxyapatite PORP]. / Risultati funzionali nella ricostruzione della catena ossiculare nell'atrofia parziale o totale dell'incudine. Confronto tra ricostruzione mediante incudine modellata e PORP in idrossiapatite.

Ossicular chain defects modifying sound transmission through the middle ear can be treated with (re)implantation of remodeled autologous o homologous ossicles. In recent years, thanks to improved biocompatibility of the materials on the market, prostheses have been increasingly used in the partial or total ossicular chain reconstruction. The present study evaluates auditory ossicle reconstruction as a result of partial or total atrophy of the incus, comparing the use of the remodeled autologous incus with the use of partial hydroxyapatite prostheses (PORP). The study involved 79 patients of which 59 (74.7%) underwent ossicular chain reconstruction using a remodeled, inverted autologous incus while in the remaining 20 cases (25.3%) a hydroxyapatite prosthesis (PORP) was used. The effectiveness of the ossicular chain was evaluated by comparing pre- and postoperative audiometry and evaluating the average thresholds at frequencies of 0.5, 1, 2 and 3 KHz. The average preoperative audiometric gap (understood as the relationship between the air-bone gap) was 23 dB (Standard Deviation 11.2) while postoperatively it was 11 dB (SD 8.5) (p < 0.0001). Therefore the improvement in the air-bone gap was 12 dB (SD 11) for the overall population: 13 dB (SD 10) in those cases where reconstruction was performed using a remodeled incus and 8 dB (SD 11) when PORP was used. The postoperative cumulative gap between the air and bone pathways fell between 0 and 20 dB in 84% of the total population: 89% of those reconstructed with a remodeled incus and 73% of those using PORP. The middle ear ossicular chain reconstruction was performed using remodeled, inverted autologous incus in those cases where ossicular damage did not compromise its use while prostheses made of a biocompatible material (hydroxyapatite PORP) were reserved for those cases where the incus was absent or severely worn. The results obtained are satisfactory, remained stable in time and reflect the average values reported in the Literature.

[Modified Semont's maneuver in the treatment of benign paroxysmal positional vertigo]. / La manovra di Semont modificata nel trattamento della vertigine parossistica posizionale benigna.

Benign paroxysmal positional vertigo (BPPV) is one of the most frequent causes of vertigo. It is characterized by a peripheral balance impairment which occurs during specific movements or positions of the head. The etiology of BPPV is not clear although recent studies by Harada have given more weight to the otolithic theory. The present author has found frequent otoconia attached to the dark cell area around the crista of the semicircular canals. The treatment of BPPV is based on functional re-education of the patient (Semont maneuvers, the Brandt Daroff technique, Norre's V.H.T). The present study involves 62 patients affected by BPPV. The Hallpike maneuver was employed to define the affected side and then the modified Semont maneuver was performed. Recovery was obtained in all patients. The cure rate proved to be 82% after the first examination. The modified Semont maneuver is easier to perform than the traditional maneuver and has given excellent therapeutic results.