Visual-vestibular mismatch correlates with headache.

BACKGROUND: Dizziness affects 20-30%of the general population. A subgroup of dizzy patients with chronic migraine suffers vertigo implying that the migraine has a vestibular component. Vestibular migraine remains a diagnosis of exclusion based on history. OBJECTIVE: A link between headaches and dizziness suggests that these individuals would demonstrate dizziness and instability in complex, dynamic visual environments as a result of an inability to correctly process conflicting visual and vestibular signals. METHODS: A convenience sample of 74 patients (22 men and 52 women; average age 56.2 years) who presented with complaints of dizziness participated. Effects of Visual-Vestibular Mismatch (VVM) were measured using a modified VVM questionnaire. Visual dependence was measured as the error to subjective visual vertical using a computerized Rod and Frame test. RESULTS: Forty-two participants (56.8%) tested positive for VVM. Of these, 68.9%were patients with concomitant complaints of headaches. Visual dependence was present in 41.5%of all patients but showed no significant correlation with headache. 22.2%of patients had visual dependence and complained of headaches. CONCLUSIONS: These results demonstrate that sensory reweighting occurs in patients experiencing dizziness and headache, supports the role of vestibular involvement in this disorder, and provides future direction for novel interventions.

Successful Cochlear Implantation in the Face of Persistent Stapedial Artery: Surgical Technique and Imaging Features.

The stapedial artery is an embryologic structure that very rarely persists into adulthood. Termed the persistent stapedial artery (PSA), it is most often asymptomatic, identified retrospectively, and can complicate middle ear surgery. A 70-year-old woman presented with profound bilateral sensorineural hearing loss and elected to undergo cochlear implantation. During surgery, a pulsatile, cord-like structure was found obscuring the round window niche. A high-resolution computed tomography (HRCT) imaging review confirmed PSA diagnosis. A cochleostomy was made using a cochleostomy burr and gentle vessel compression. Complete insertion of the cochlear implant was achieved and its placement confirmed. The patient went on to develop open-set discrimination. We report the first successful case of cochlear implantation in the face of a PSA. Inverted HRCT imaging was found to enhance PSA visualization and may aid preoperative diagnosis. A cochleostomy technique is recommended for electrode insertion to minimize the risk of bleeding.

Tongue symptoms, suspension force and duration during operative laryngoscopy.

PURPOSE: Suspension laryngoscopy is a commonly performed procedure in otolaryngology. During the procedure, the laryngoscope applies direct force to the tongue. Postoperative tongue symptoms include pain, swelling, numbness, taste disturbance, and rarely motor deficits. Duration and magnitude of force applied have previously been associated with post-operative throat and tongue pain, respectively. We sought to correlate postoperative tongue symptoms with magnitude of force applied and/or duration of suspension and investigate any risk factors for tongue morbidity. MATERIALS AND METHODS: A sample of patients undergoing suspension laryngoscopy between 2015 and 2018 were prospectively recruited. Those with preexisting tongue symptoms, disease or surgery were excluded. Patients completed preoperative and postoperative questionnaires evaluating tongue swelling, numbness, motion and taste disturbance. Symptoms were subjectively scored on a visual scale from 0 to 10. Patient demographics, past medical and social history were also recorded. Intraoperative pressures were measured using a spring force scale, positioned between the suspension arm and Mayo stand. Initial and end suspension forces and duration of suspension were recorded. RESULTS: 120 patients met inclusion criteria, of which 63 completed both preoperative and postoperative questionnaires. 6 patients (9.5%) experienced postoperative tongue symptoms. Suspension force and duration of suspension were not significantly predictive of postoperative tongue symptoms. While all symptomatic patients were current or former cigarette smokers, smoking status was not found to be a statistically significant factor. CONCLUSIONS: Neither suspension forces nor duration of suspension were predictive of postoperative tongue morbidity. Further research is needed to evaluate the role of smoking status on postoperative tongue symptoms.