Validation of the Mini-TQ in a Dutch-speaking population: a rapid assessment for tinnitus-related distress.

OBJECTIVE: Up to 30% of the adult population experiences tinnitus at some point in life. The aim of the present study was to validate the Mini-Tinnitus Questionnaire (TQ) in a Dutch-speaking population for measuring tinnitus-related distress and compare it with the extended version normally used in clinical practice and research. METHODOLOGY: We assessed 181 patients at the Tinnitus Research Initiative clinic of Antwerp University Hospital. Twelve items from the TQ chosen by Hiller and Goebel based on the optimal combination of high item correlation, reliability, and sensitivity were selected and correlated to the different subscale and global scores of the TQ. Internal consistency was evaluated using Cronbach's alpha coefficient, and the Guttman split-half coefficient was used to confirm reliability. RESULTS: Correlation to the global TQ score was .93, internal consistency was .87, and reliability was .89. This study further revealed that the Mini-TQ correlates better with the different subscales of the TQ in the Dutch-speaking population. The convergence validity was confirmed, ensuring that this new instrument measures distress. In addition, the norms suggested by Hiller and Goebel were verified and established. CONCLUSION: Based on these results, the Mini-TQ is recommended as a valid instrument for evaluating tinnitus-related distress in Dutch-speaking populations for a compact, quick, and economical assessment.

Massive swelling of Surgicel® Fibrillar™ hemostat after spinal surgery. Case report and a review of the literature.

BACKGROUND: Oxidized regenerated cellulose is commonly used in many surgical fields as a hemostatic agent. Complications related to swelling or compression after application of small portions of Surgicel® Fibrillar™ have not yet been described. PATIENTS: We report on a 65-year-old woman who was operated for a high-grade spinal stenosis at the L2-L3 level. Small portions of Surgicel® Fibrillar™ were used to control bleeding from the epidural venous plexus. The immediate postoperative course was uneventful. However, one day after surgery, the patient complained about progressive worsening pain at the operated level. A non-contrast lumbar CT scan showed no evidence of a postoperative hematoma or other complication. MR imaging showed a horseshoe-shaped mass compressing the dural sac at the operated level from posterior and both sides. Because we suspected a postoperative hematoma, the patient was re-operated. No hemorrhage was seen but instead we found large, swollen firm pieces of Surgicel® Fibrillar™ compressing the dural sac. These pieces were removed. RESULT: Postoperatively no neurological deficit or pain was present. Histological examination of the removed mass of Surgicel® Fibrillar™ revealed only the presence of blood, fibrin and an amorphous eosinophilic content. There was no sign of any inflammation. CONCLUSION: On the basis of this experience, we advise caution with the use of hemostatic agents during spinal surgery and - if used - strongly advise the removal of Surgicel® Fibrillar™ after the hemostasis has been achieved to avoid the development of complications due to a mass effect.

Burst transcranial magnetic stimulation: which tinnitus characteristics influence the amount of transient tinnitus suppression?

BACKGROUND: Transcranial Magnetic Stimulation (TMS) is a method capable of temporarily suppressing tinnitus by delivering tonic or burst stimuli. Burst TMS has a high interindividual variability and low effect size. Tinnitus type and laterality, tinnitus-related distress, and tinnitus duration might contribute to this large individual variation. METHODS: The effect of burst TMS on the auditory cortex in 100 male individuals is evaluated with coil placed over the auditory cortex. For unilateral tinnitus, this coil was placed contralaterally to the tinnitus, whilst for bilateral tinnitus the coil was placed over the right auditory cortex. The site of maximal tinnitus suppression is determined using 1-Hz stimulation with five pulses per burst (intensity of the stimulation set at 90% of the motor threshold). When tinnitus suppression is noted, the patients are asked to estimate the decrease in tinnitus in percentage using the numeric rating scale. The procedure is repeated with stimulations at 5, 10 and 20 Hz, each stimulation session consisting of 200 pulses. RESULTS: Results demonstrate that burst stimulation can decrease the perceived tinnitus intensity transiently in 57.83% of the patients. Patients with bilateral tinnitus respond better to burst TMS than patients with unilateral tinnitus and highly distressed patients presenting with unilateral pure tone tinnitus fail to bust TMS. CONCLUSIONS: Burst TMS modulates both unilateral and bilateral tinnitus, both high and low distress and both pure tones and narrow band tinnitus. However, the suppression effect is moderated by tinnitus type and laterality, tinnitus-related distress, and tinnitus duration.

An extensive spinal epidural abscess successfully treated conservatively.

A spinal epidural abscess (SEA) is an uncommon condition, appearing in 0.2-2 cases per 10,000 hospital admissions. Urgent surgical decompression in combination with long term antibiotics is the common treatment of choice for SEA. However, in some cases, a non-surgical treatment can also be considered. In this case report, a patient is presented with SEA extending from C2 to L3 which was successfully treated with antibiotic therapy without surgical intervention.

A simple technique for bridging small cranial dural defects without the use of grafts: technical note.

A watertight closure of the dura is important in preventing post-operative complications. Various techniques are described to close small dura defects. We present a simple technique that uses on site homologues dura tissue to bridge small dura defects by separating the periosteum from the inner meningeal layer. This provides a low-cost, tension-free repair without the use of synthetic materials or need to harvest autologous materials.