Adding Kinetic Energy Does Not Further Improve Treatment Outcomes With a Mechanical Reposition Chair: A Randomized Controlled Trial.

OBJECTIVE: To test if the addition of abrupt deaccelerations (kinetic energy) during treatment with a mechanical repositional chair (MRC) provides improved treatment efficacy with treatment of posterior benign paroxysmal positional vertigo (BPPV). STUDY DESIGN: Randomized two-armed parallel open-labeled clinical trial. SETTING: Tertiary referral center. PATIENTS: Seventy patients diagnosed with posterior canalolithiasis BPPV were included. INTERVENTIONS: All patients underwent diagnostics and treatment with an MRC. Patients were randomized to either a traditional Epley maneuver or a potentiated version of the Epley maneuver where kinetic energy was applied in five positions with 45-degree turns between each step. MAIN OUTCOME MEASURES: Primary endpoint was the number of treatments needed before complete resolution of both subjective symptoms and objective signs of BPPV within the semicircular canal of interest. Secondary endpoints included the following: 1) number of patients requiring more than 10 treatments, 2) length of treatment in days before treatment(s) were successful, and 3) changes in total Dizziness Handicap Inventory scores before and after treatment. RESULTS: No significant difference in the number of required treatments between the two treatment arms was found. Approximately three of four subjects were cured after two repositional maneuvers regardless of type of treatment. An equal length of treatment was seen with both groups, and the Dizziness Handicap Inventory scores were significantly lowered after treatment with no significant differences between the two types of treatment. CONCLUSIONS: Both the traditional and the potentiated Epley maneuver are efficient in treatment of canalolithiasis of the posterior semicircular canals with MRC. Addition of kinetic energy with this subgroup of BPPV patients does not seem to add further efficacy to the treatment.

Retropharyngeal oedema as an atypical presentation of multiple inflammatory syndrome in children.

Multiple inflammatory syndrome in children (MIS-C) has casuistically been reported in conjunction with retropharyngeal oedema. This case report details the diagnosis and treatment of MIS-C in a 13-year-old girl where the initial treatment was targeted against the retropharyngeal oedema. The aim is to highlight the atypical presentation of MIS-C.

Treatment of Benign Paroxysmal Positional Vertigo with the TRV Reposition Chair.

OBJECTIVES: The primary objective of this study was to evaluate how successful the reposition of retractable benign paroxysmal positional vertigo (BPPV) was when treating patients with the Thomas Richard Vitton (TRV) reposition chair. MATERIALS AND METHODS: This is a prospective clinical trial. A total of 81 BPPV patients who were referred to the tertiary Balance - Dizziness Centre at the Department of Otolaryngology, Head - Neck Surgery and Audiology, Aalborg University Hospital, Denmark were included and analyzed. All the patients were diagnosed and treated with the TRV reposition chair. RESULTS: The patients were successfully treated after an average of 2.23 (± 1.66 SD) treatments with the TRV reposition chair. There was a significant difference between the number of treatments needed in the single semicircular canal group and the multicanal group. Seventeen (22.6%) of the patients experienced either dislocation of otoconia, relapse, or new onset of BPPV during the trial period. The number of patients with BPPV located to the anterior, lateral, and multiple semicircular canals in this study was significantly higher than that in similar studies. Six patients (7.4%) were classified as treatment failures. CONCLUSION: We found the TRV reposition chair to be very successful in the diagnostics and treatment of patients with retractable and atypical BPPV. However, 7.4% experienced treatment failure.

Vestibular Deficits Correlating to Dizziness Handicap Inventory Score, Hearing Loss, and Tumor Size in a Danish Cohort of Vestibular Schwannoma Patients.

OBJECTIVE: To test the degree of vestibular end-organ dysfunction by means of contemporary vestibular testing and examine to which extend these findings correlate to the hearing loss, tumor size, and dizziness handicap registered in vestibular schwannoma patients. SETTING: Tertiary referral center. PATIENTS: Eighty-nine patients diagnosed with unilateral vestibular schwannoma. INTERVENTION(S): Patients were evaluated by means of the Dizziness Handicap Inventory (DHI), magnetic resonance imaging scan as well as an extensive audiovestibular test-battery including pure-tone audiometry, ocular vestibular evoked myogenic potentials, cervical vestibular evoked myogenic potentials, and video head impulse test of all six semicircular canals. MAIN OUTCOME MEASURE(S): Patients were divided into four groups according to their number of dysfunctional vestibular end-organs. These groups were subsequently analyzed for differences in DHI score, pure-tone average, and tumor size. The group of patients with zero abnormal vestibular test results was used as index group. RESULTS: For the group with three or more abnormal vestibular test results it was possible to find a statistical significant increase in both DHI score, pure-tone average, and tumor size. This was only found for the latter two parameters in the group with dysfunction of two vestibular end-organs. It was not possible to detect any statistical significant differences in the group with only one dysfunctional end-organ. CONCLUSIONS: Substantial loss of vestibular function is correlated to a higher degree of dizziness-induced handicap, hearing loss, and tumor size in vestibular schwannoma patients. Tumor size and audiometry may potentially be used as rough markers of residual vestibular function.

Thresholds for Oxford Knee Score after total knee replacement surgery: a novel approach to post-operative evaluation.

BACKGROUND: In a prospective cohort study, we wanted to detect thresholds distinguishing between patients with a satisfactory and an unsatisfactory outcome after total knee replacement (TKR) based on Patient-Reported Outcome Measures (PROMs), namely the Oxford Knee Score (OKS), using patient satisfaction and patient-perceived function as global transition items. METHODS: Seventy-three TKR patients completed the OKS questionnaire before surgery and were invited to complete the same questionnaire again 6 (4 to 9) months after surgery. Correlations between outcome measures and anchors were calculated using Pearson's correlation coefficient. Thresholds were established by receiver operating characteristics (ROC) analysis, using multiple anchor-based approaches. RESULTS: Patients showed a mean increase of 16.5 (SD 9.5) in OKS following TKR. Significant positive correlations were found between outcome measures and anchors. Six different thresholds were determined for outcome measures coupled with satisfaction, patient-perceived function and a combination thereof using a cut-off of 50 and 70. CONCLUSIONS: This study has established a set of clinically meaningful thresholds for Oxford Knee scores that may help to detect TKR patients who might be in need of post-operative evaluation.