The Value of Vestibular Rehabilitation in Patients with Bilateral Vestibular Dysfunction.

OBJECTIVE: The value of vestibular rehabilitation in patients with bilateral vestibular dysfunction was investigated. MATERIALS AND METHODS: This study assessed 17 patients (9 males, 8 females) with bilateral vestibular dysfunction. Vestibular rehabilitation continued for 1.5 months. Videonystagmography tests (including oculomotor testing, positional testing, and caloric tests), vestibular evoked myogenic potential (VEMP) testing, and computerized dynamic posturography were performed during the pre-, mid-, and post-treatment periods. The patients underwent cranial and internal acoustic canal MRI. Consultant physicians from the neurology and physical medicine and rehabilitation departments reviewed all patients. RESULTS: The post-treatment anteroposterior somatosensorial (APSO), anteroposterior global (APGLO), mediolateral visual (MLVI), and mediolateral global values and anteroposterior and mediolateral trials and conditions were significantly higher than those measured in the pre-treatment period. Similarly, mid-treatment values of the APSO, APGLO, and the anteroposterior sensory organization test (SOT) 2 were significantly higher than those measured in the pre-treatment period. CONCLUSION: Vestibular rehabilitation was effective in patients with bilateral vestibular dysfunction. As the vestibular rehabilitation duration increased, so did the efficacy of the treatment.

Toxoplasmosis lymphadenitis mimicking a parotid mass.

Toxoplasmosis is caused by an obligate intracellular protozoan, Toxoplasma gondii, which can infect birds and mammals including humans. The disease is common throughout the world, and the most common clinical form is generalized or localized lymphadenopathy. However, in the literature, toxoplasmosis manifesting as a parotid mass is extremely rare. A 37-year-old female was admitted to our department with a painless mass in the parotid region, which had been present for one month. Upon physical examination, a hard, mobile, superficially located, and painless parotid mass with a size of 2x2 cm was detected. Following the diagnosis of a parotid neoplasm, a superficial parotidectomy was performed. Histopathological examination of the surgical specimen supported a diagnosis of toxoplasmosis lymphadenitis. Specific serum immunoglobulin levels were studied and results also confirmed the diagnosis of toxoplasmosis. The patient was given rovamycine for three weeks, and on 12 months follow-up, the patient was still free of recurrence.

[A case of isolated aspergillosis of the maxillary sinus]. / Maksiller sinüste izole aspergillus enfeksiyonu: Olgu sunumu.

Aspergillosis of the maxillary sinus is rarely seen in nonimmunocompromised patients. Among paranasal sinus infections associated with aspergillosis, the most common subtype is Aspergillus fumigatus. A 41-year-old woman presented with facial pain. She had a five-year history of root canal filling in the right upper molar teeth. Paranasal sinus tomography showed fungal sinusitis of radiopaque appearance, giving the impression of a foreign body in the maxillary sinus. The patient underwent endoscopic sinus surgery to purge infection of the maxillary sinus. Pathological examination revealed aspergillosis of the maxillary sinus.

Angiolipoma of the neck: a case report.

Angiolipomas of the neck are extremely rare; to our knowledge, only 2 cases have been previously reported. We report a new case, which occurred in a 28-year-old woman. The mass was totally resected, and the patient showed no recurrence at the 18-month follow-up.

Thyroid hemiagenesis: a case report.

Thyroid hemiagenesis is usually diagnosed incidentally during examination for other thyroid gland diseases. Iodine-123 thyroid scan of a 25-year-old woman showed a normal homogeneous right thyroid lobe, but no uptake in the left lobe. Ultrasonography of the neck confirmed the absence of the left thyroid lobe, while the right lobe was homogeneous and normal. Thyroid hemiagenesis should be included in the differential diagnosis of thyroid diseases.

Factors that affect the outcome of open-technique procedures performed in the treatment of cholesteatoma.

OBJECTIVES: We evaluated the factors that have considerable significance on the outcome of open cavity procedures in the treatment of cholesteatoma. PATIENTS AND METHODS: The study included 66 patients (43 males, 23 females; mean age 47 years; range 21 to 69 years) who underwent surgery for cholesteatoma. Of these, 56 patients completed at least a five-year follow-up. RESULTS: Mucosal infections and granulation tissue formation occurred in seven patients (10%) in the early postoperative period. Retraction pockets developed in three patients (4%); of these, only one patient required excision because of deep localization. Drum perforations that occurred in two patients (3%) were repaired by myringoplasty. Revision surgery was performed in four patients (7.1%) due to residual cholesteatoma within a five-year follow-up. CONCLUSION: The height of the facial ridge was found as the most important factor related to a successful outcome of open-technique procedures. Other factors included the creation of a smooth mastoid cavity with round edges, removal of all diseased mastoid cells, and an extensive conchameatoplasty.

Auditory brain stem responses in the detection of brain death.

OBJECTIVES: We evaluated comatose patients by auditory brain stem responses (ABR) to determine the role of ABR in the diagnosis of impending brain death. PATIENTS AND METHODS: Sixty comatose patients in the intensive care unit were evaluated by brain stem evoked response audiometry. Correlations were sought between the absence or presence of ABRs and the presenting pathology, the Glasgow Coma Scale (GCS) scores, and ultimate diagnoses. RESULTS: The brain stem responses were totally absent in 41 patients. Presence of wave I could be obtained in only 10 patients. All the waveforms were found in nine patients; however, in eight patients the potentials disappeared as the GCS scores decreased to 3. Detection of wave I alone strongly suggested dysfunction of the brain stem. However, loss of wave I particularly in trauma patients aroused doubt as to whether the absence was associated with auditory end organ injury or brain stem dysfunction. CONCLUSION: The results suggest that evaluation of ABR may support brain death in a comatose patient (i) when wave I is present alone, (ii) the absence of wave I is accompanied by a documented auditory end organ injury, or (iii) when previously recorded potentials are no longer detectable.