Benign Paroxysmal Positional Vertigo Secondary to Acute Unilateral Peripheral Vestibulopathy: Evaluation of Cardiovascular Risk Factors.

BACKGROUND: Lindsay-Hemenway syndrome was first described as an acute unilateral peripheral vestibulopathy followed by positional vertigo. A vascular etiology was proposed. An association between cardiovascular risk factors and benign paroxysmal positional vertigo secondary to acute unilateral peripheral vestibulopathy has been described with contradictory evidence. The study aimed to evaluate the prevalence of cardiovascular risk factors in patients with benign paroxysmal positional vertigo secondary to acute unilateral peripheral vestibulopathy and analyze differences in prior history of benign paroxysmal positional vertigo, affected semicircular canals, and response to repositioning maneuvers between patients with idiopathic benign paroxysmal positional vertigo and secondary to acute unilateral peripheral vestibulopathy. METHODS: We performed a retrospective, descriptive study of all cases of benign paroxysmal positional vertigo between January/2017 and June/2020, with or without a history of acute unilateral peripheral vestibulopathy within the previous year. Cases secondary to trauma or otoneurological causes and acute unilateral peripheral vestibulopathy without confirmatory tests and cases with auditory symptoms were excluded. RESULTS: In total, 242 cases were obtained; 158 idiopathic benign paroxysmal positional vertigo and 84 secondary to acute unilateral peripheral vestibulopathy. No statistically significant differences were found in relation to age: 61.2 ± 14.6 versus 62.4 ± 16.2 years (P=.55), sex: female 78.5% versus 73.8% (P=.41), presence of cardiovascular risk factors: 52.5% versus 54.8% (P=.67), prior history of benign paroxysmal positional vertigo: 22.2% versus 27.7% (P=.43), affected semicircular canals (P=.16) or number of repositioning maneuvers (P=.57). CONCLUSION: Associations between age, cardiovascular risk factors, and benign paroxysmal positional vertigo secondary to acute unilateral peripheral vestibulopathy have been described with conflicting evidence. This is the first study to evaluate cardiovascular risk factors specifically for Lindsay-Hemenway syndrome, and we did not observe any differences between idiopathic benign paroxysmal positional vertigo cases and those secondary to acute unilateral peripheral vestibulopathy.

Bamboo Nodes as an Autoimmune Disease Laryngeal Manifestation. Case Series.

INTRODUCTION: Bamboo nodes are transverse creamy-yellow subepithelial nodes in the vocal folds (VF) midpoint, usually bilateral, resembling a bamboo stem. They appear almost exclusively in females, and are associated with underlying autoimmune diseases. CASE SUMMARY: Six female patients, 45.5 years median age, with underlying autoimmune diseases, consulted due to dysphonia. The laryngeal stroboscopy showed bilateral VF bamboo nodes in four patients, and unilateral in the remaining two. VF mobility was normal in all patients, while the mucosal wave was impaired in four of them. Treatment with speech therapy and proton pump inhibitors was indicated. All the patients were referred for rheumatologic evaluation and immunosuppressive treatment optimization. Follow-up in five patients showed vocal function self-perception and GRBAS scores improvement. DISCUSSION: VF bamboo nodes are an infrequent cause for dysphonia, associated with phonotrauma and autoimmune diseases. Speech therapy and a rheumatologic workup must be indicated, for immunosuppressive treatment enhancement.

Phantosmia May Predict Long-Term Measurable Olfactory Dysfunction After COVID-19.

OBJECTIVES: Persistent olfactory dysfunction (OD) after 6 months caused by SARS-CoV-2 infection has been reported with a variable prevalence worldwide. This study aimed to determine the prevalence of long-term OD and identify predisposing factors. METHODS: A prospective cohort study was conducted on 100 adults with COVID-19. Olfactory function was assessed with the University of Pennsylvania Smell Identification Test and a symptom survey at the onset of disease and 30 days later. Patients with persistent quantitative OD at the second assessment were reevaluated after 1 year. Demographic variables, symptoms, and the degree of smell loss were analyzed. RESULTS: Participants included 100 patients. The mean age was 42.2 ± 15.6 years, 55 (55%) were female, and 56 (56%) were outpatients. Baseline smell loss was identified in 75/100 (75%) patients, decreasing to 39/95 (40%) after 1 month, and persisting in 29 patients after 1 year. Phantosmia at baseline was the only risk factor identified for persistent OD after 1 year (relative risk 2.51; 95% confidence interval 1.53-4.12; p < 0.001). Regardless of the outcome in smell function, a significant decline in olfaction was associated with the presence of phantosmia at 1 month (ß = -12.39; 95% CI -19.82 to -4.95; p < 0.01). CONCLUSIONS: SARS-CoV-2 (2019-2020 variants) produced a highly frequent OD that persisted in 29% of the patients after 1 year. The presence of phantosmia at baseline and 1 month was associated with a worse evolution, but phantosmia may interfere with the performance in an identification smell test. A longer follow-up is required in these patients. LEVEL OF EVIDENCE: 2 Laryngoscope, 132:2445-2452, 2022.

The impact of COVID-19 preventive lockdowns on the prevalence of benign paroxysmal positional vertigo. / El impacto de la cuarentena preventiva por COVID-19 sobre la prevalencia de vértigo posicional paroxístico benigno.

INTRODUCTION: The implementation of preventive lockdowns worldwide due to the COVID-19 pandemic has radically altered our daily lives. We have observed an increase in vertigo consultations during this period, mainly benign paroxysmal positional vertigo. OBJECTIVE: To determine the impact of preventive lockdown on the prevalence and characteristics of benign paroxysmal positional vertigo. METHODS: We did a retrospective study. All patients with benign paroxysmal positional vertigo during July and August 2020 who visited the clinic in Red de Salud UC Christus, Santiago, Chile, were included. Demographic data, clinical characteristics, need for repositioning maneuvers, and medical history was compared with patients seen in July and August 2019. Cases secondary to trauma and with incomplete records were excluded. RESULTS: During July and August 2020, 99 patients consulted with a medical history compatible with benign paroxysmal positional vertigo, average age 54.5 years, 68.9% were female. Repositioning maneuvers were required in 40.2% of cases. Of 28 patients with vitamin D levels, 27 showed deficiency/insufficiency. In 2019, for July and August, 54 patients were seen in the clinic with an average age of 61.7 years, and 83.3% were female. Repositioning maneuvers were required in 79.6%, and of the nine patients with vitamin D levels, seven presented deficiency/insufficiency. Statistically significant differences were observed regarding age, sex, and need for repositioning maneuvers. CONCLUSIONS: A high prevalence of benign paroxysmal positional vertigo was observed during preventive lockdown for COVID-19 in our clinic. Patients were generally younger, and although it was more frequent in women, the incidence by sex was not as striking as in the previous year.

INTRODUCCIÓN: La pandemia por COVID-19 ha alterado radicalmente nuestro diario vivir, con la implementación de una cuarentena preventiva a nivel mundial. Observamos un aumento en las consultas por vértigo durante este periodo, principalmente vértigo posicional paroxístico benigno. OBJETIVO: Determinar el impacto de la cuarentena preventiva en relación a la prevalencia y características del vértigo posicional paroxístico benigno. METODOLOGÍA: Estudio retrospectivo. Se incluyeron todos los pacientes con diagnóstico de vértigo posicional paroxístico benigno evaluados durante los meses de julio y agosto de 2020 en la Red de Salud UC Christus, Santiago, Chile. Se compararon datos demográficos, características clínicas, realización de maniobras de reposición y antecedentes médicos, con pacientes diagnosticados de vértigo posicional paroxístico benigno en julio y agosto de 2019. Se excluyeron casos secundarios a traumatismos y con fichas incompletas. RESULTADOS: Durante los meses de julio y agosto de 2020, 99 pacientes consultaron por un cuadro compatible con vértigo posicional paroxístico benigno, con un promedio de edad de 54,5 años, siendo el 68,9% sexo femenino. El 40,2% requirió maniobras de reposición. De 28 pacientes con niveles de vitamina D, 27 presentaron deficiencia/insuficiencia. En los meses de julio y agosto del año 2019, consultaron 54 pacientes, con promedio de edad de 61,7 años, siendo el 83,3% sexo femenino. El 79,6 % requirió maniobras de reposición, y de los nueve pacientes con niveles de vitamina D, siete presentaron alteraciones. Se observaron diferencias estadísticamente significativas en relación a la edad, sexo, y necesidad de maniobras de reposición. CONCLUSIÓN: Se observó una prevalencia elevada de vértigo posicional paroxístico benigno durante la cuarentena preventiva por COVID-19. Los pacientes fueron, en general, más jóvenes y si bien fue más frecuente en mujeres, la incidencia por sexo no fue tan marcada como el año anterior.

Determination of variables for a more accurate diagnostic approach in suspected acute invasive fungal rhinosinusitis: A non-concurrent cohort study.

OBJECTIVE: To describe a group of patients with suspected acute invasive fungal rhinosinusitis (AIFRS) diagnosis, and identify factors associated with a greater risk of presenting this disease. DESIGN: Non-concurrent cohort study. SETTING: A single-centre non-concurrent follow-up of patients with suspected AIFRS between August 2015 and July 2018. PARTICIPANTS: 50 inpatients referred due to suspected AIFRS at Hospital Clínico Universidad Católica based on the association of a predisposing factor (neutropenia/immunodeficiency/poorly controlled diabetes) with fever of unknown origin. MAIN OUTCOME MEASURE: The primary outcome was AIFRS diagnosis, defined as a concordant tissue biopsy. RESULTS: Acute invasive fungal rhinosinusitis was confirmed in 18% (9/50) of the evaluated patients. AIFRS was significantly associated with a positive galactomannan (P = .04), and a paranasal sinus MRI with lack of contrast enhancement (LoCE) (P = .04) orbit compromise (P = .03) or global extrasinusal extension (P = .04). LoCE and extrasinusal extension in the paranasal sinus/brain MRI were risk factors for AIFRS (OR 16; CI 1.2-210.6 and OR 12.75; CI 1.3-128.8, respectively). Conversely, a nasal endoscopy showing healthy mucosa was identified as a protective factor for AIFRS (OR 0.06; CI 0.007-0.57). CONCLUSIONS: In patients with suspected AIFRS, we identified laboratory and radiologic variables associated with the disease, which may help for a more accurate diagnostic algorithm and approach in this population.

Spasmodic Dysphonia: Standardized Spanish Tool for Ambulatory Consult Diagnosis.

INTRODUCTION: Spasmodic dysphonia (SD) is a focal dystonia of the larynx where involuntary spasms of its intrinsic muscles are triggered by specific phonemes. The diagnosis is challenging and is performed by listening to the patient's voice, supported by nasolaryngoscopy. There is no diagnostic tool in Spanish for SD. The objective of our study is to establish phonetically studied vocal tasks in Spanish language to diagnose patients with SD. MATERIAL AND METHOD: This is a prospective study in three groups of patients: 11 with SD, 11 with another vocal disease, and 11 with no vocal disease, recruited in the Voice Unit of Hospital Clínico Universidad Católica. Of the patients with SD, 10 (90.9%) had adductor SD and 1 (9.1%) abductor SD. Vocal tasks phonetically studied by a speech language pathologist as laryngeal spasm triggers were recorded. The audio recordings were randomized and analyzed by nine evaluators: three experts and six otolaryngology residents. The correlation between the different professionals for the correct diagnosis was analyzed. RESULTS: The audio recordings were analyzed and patients with SD presented irregular voice breaks that occurred during the trigger phonemes. Evaluators classified the audio recordings: the expert group presented 100% sensitivity, 95-100% specificity and individual consistency of κ=0.73-0.82. The interrater agreement was 81.8%. The resident group presented 55-100% sensitivity, 58-95% specificity, and individual consistency of κ=0.36-0.82. The interrater agreement was 67.0%. DISCUSSION AND CONCLUSIONS: We obtained a strong to almost perfect interrater agreement in experts and fair to almost perfect in residents. This study shows that the established list of phonetically studied and standardized words can be a useful tool for the diagnosis of SD.

Timpanoplastias: factores asociados al resultado anatómico y auditivo / Tympanoplasty: factors associated with anatomical and audiometric results

INTRODUCCIÓN: La timpanoplastia es una cirugía frecuente en otorrinolaringología. Su mayor indicación es la perforación timpánica, y con menor frecuencia la otitis adhesiva. Su objetivo primario o anatómico es restaurar la integridad timpánica, previniendo infecciones, y secundario o auditivo es preservar o mejorar la audición. MATERIAL Y MÉTODO: Estudio retrospectivo de los pacientes operados de timpanoplastia en nuestro hospital. Se registraron características biodemográficas, de la patología del oído, de la cirugía y se analizaron los resultados anatómicos y auditivos. RESULTADOS: Se incluyeron 182 pacientes, la mayoría de sexo femenino (57,1%), edad promedio de 36,1 años. La principal indicación fue la perforación timpánica (89,0%), seguida de otitis adhesiva (7,1%). La mayoría de las timpanoplastias correspondió a cirugía primaria (84,1%), tipo I (62,6%), por abordaje endoaural (83,5%) y técnica medial o Austin (90,1%). El injerto más utilizado fue el compuesto de cartílago-pericondrio (87,9%). El éxito anatómico fue 84,6% y el auditivo 66,8%. Los pacientes operados de miringoplastia (sin elevación de colgajo timpanomeatal) presentaron mejor resultado auditivo (p = 0,003). No se identificaron factores asociados a mejor resultado anatómico. CONCLUSIONES: Los resultados anatómicos y auditivos obtenidos son comparables a lo publicado en la literatura. Se requieren más estudios prospectivos para definir factores asociados a un mejor resultado anatómico y auditivo

INTRODUCTION: Tympanoplasty is a frequent surgery in otolaryngology. Its main indication is tympanic perforation, followed by adhesive otopathy. Its main and (or) anatomic objective is to restore the tympanic membrane's integrity, preventing infections, and its secondary or audiometric objective is to preserve or improve hearing. MATERIAL AND METHOD: Retrospective study of all patients submitted to tympanoplasty at our hospital. Biodemographic, ear pathology and surgery characteristics were registered, and anatomic and audiometric success rates were analyzed. RESULTS: A total of 182 patients were included, most female (57.1%), with average age of 36.1 years. The main surgical indication was tympanic perforation (89.0%), followed by adhesive otopathy (7.1%). Most tympanoplasties were primary surgeries (84.1%), type I (62.6%), performed by endoaural approach (83.5%) using medial or Austin technique (90.1%). Compound cartilage-perichondrium grafts were most frequently used (87.9%). The anatomic success rate was 84.6%, and the audiometric success rate was 66.8%. Patients who underwent myringoplasty (without raising of tympanomeatal flap) presented a better audiometric result (p = .003). No factors associated with better anatomical results were identified. CONCLUSIONS: Our anatomic and audiometric results are comparable to those previously published. Further prospective studies are required to define factors associated with improved anatomic and audiometric results

Tympanoplasty: factors associated with anatomical and audiometric results. / Timpanoplastias: factores asociados al resultado anatómico y auditivo.

INTRODUCTION: Tympanoplasty is a frequent surgery in otolaryngology. Its main indication is tympanic perforation, followed by adhesive otopathy. Its main and (or) anatomic objective is to restore the tympanic membrane's integrity, preventing infections, and its secondary or audiometric objective is to preserve or improve hearing. MATERIAL AND METHOD: Retrospective study of all patients submitted to tympanoplasty at our hospital. Biodemographic, ear pathology and surgery characteristics were registered, and anatomic and audiometric success rates were analyzed. RESULTS: A total of 182 patients were included, most female (57.1%), with average age of 36.1 years. The main surgical indication was tympanic perforation (89.0%), followed by adhesive otopathy (7.1%). Most tympanoplasties were primary surgeries (84.1%), type I (62.6%), performed by endoaural approach (83.5%) using medial or Austin technique (90.1%). Compound cartilage-perichondrium grafts were most frequently used (87.9%). The anatomic success rate was 84.6%, and the audiometric success rate was 66.8%. Patients who underwent myringoplasty (without raising of tympanomeatal flap) presented a better audiometric result (p=.003). No factors associated with better anatomical results were identified. CONCLUSIONS: Our anatomic and audiometric results are comparable to those previously published. Further prospective studies are required to define factors associated with improved anatomic and audiometric results.