Comparison of the Efficacy of Video Head Impulse and Bi-Thermal Caloric Tests in Vertigo.

OBJECTIVE: To compare video head impulse test (vHIT) and caloric test efficacy in decompensated and compensated vertigo patients and to further investigate whether vHIT alone can be used as a diagnostic tool in vertigo. METHODS: This study included 25 patients diagnosed with vertigo and without any previous history of vertigo or hearing loss before their admission to our clinic. The control group consisted of 16 healthy adult volunteers. Patients were classified into 2 groups, compensated and decompensated. Video head impulse test and caloric tests were performed and the results were compared between the groups. RESULTS: The difference of caloric test values between control-compensated groups and compensated-decompensated groups was statistically significant (P < .001, Pearson χ2). However, there was no statistically significant difference between the compensated and control groups according to vHIT gain asymmetry values (P = .087). In the very early stages of the disease with spontaneous nystagmus, the diagnostic significance of vHIT was similar to that of the caloric test. When both sides were compared, vHIT gain asymmetry values were close to the caloric test asymmetry values. In the compensated stage, caloric test was superior to vHIT in differentiating compensated vestibular pathologies. When vHIT sensitivity was evaluated according to the bi-thermal caloric test results, the sensitivity of the vHIT gain asymmetry value was 85.71% and 23.08% for decompensated and compensated patients respectively. CONCLUSION: In the early decompensated stages of the disease with spontaneous nystagmus, vHIT shows similar diagnostic accuracy to that of the caloric test. Since patients can tolerate vHIT more easily, our results suggest that vHIT can be considered as a primary evaluation method in the early (decompensated) period of the disease and should be preferred over the caloric test during the acute phase. Caloric test is more reliable at the compensated stage. Video head impulse test is inadequate in evaluating the compensated vestibular hypofunctional states after compensation has been restored. LEVEL OF EVIDENCE: Level 2b.

Relationships between clinical behavior of laryngeal squamous cell carcinomas and expression of VEGF, MMP-9 and E-cadherin.

The biological mechanisms of cancer and associations with behavior of tumours need to be studied to understand progression and determine appropriate treatments. Here we investigated expression of VEGF, MMP-9 and E-cadherin in laryngeal SCCs and their relations with clinical behavior. This prospective study was based on 38 surgical specimens from patients with primary laryngeal SCC and data recorded in their cards. Expression of the three factors in tumor tissue was examined using immunohistochemistry and correlations with clinical parameters of primary tumors, regional lymph node metastases, stage of disease, histopathologic differentiation, and vascular/cartilage invasion were investigated. Regarding the cases with positive MMP-9 expression, the difference between well and moderately/poorly differentiated tumors was statistically significant. However, differences between early stage (stage I and II) and late-stage (stage III and IV) tumours, and between positive and negative for pLN metastasis were not. No significant relationship between positive VEGF and tumor differentiation or stage was apparent, but E-cadherin levels significantly differed between well and moderately/ poorly differentiated tumours and with the presence of pLN metastasis. E-cadherin staining did not vary between MMP-9 positive and negative cases. In conclusion, MMP-9 may be a negative predictor of differentiation in laryngeal SCC, while E-cadherin is a predictor of differentiation and nodal metastases. Even if the difference between VEGF expression and tumor stage was not statistically significant, it seems that there exists some relationship, which might be clarified with a greater number of cases.

Protective effects of pentoxifylline and nimodipine on acoustic trauma in Guinea pig cochlea.

OBJECTIVE: To examine the protective effects of the vasodilator and hemorheologically active drug pentoxifylline and the calcium channel blocker nimodipine on the cochlea after acoustic overexposure in guinea pigs. METHODS: Eighteen guinea pigs were used. The animals were divided into 5 groups: 1) control, 2) acoustic trauma, 3) nimodipine plus acoustic trauma, 4) pentoxifylline plus acoustic trauma, and 5) pentoxifylline plus nimodipine plus acoustic trauma. Nimodipine was given to the guinea pigs 3 mg/kg intraperitoneally in a single dose; pentoxifylline was given 150 mg/kg in a single dose intraperitoneally. A gunnery range was used to create acoustic trauma. The auditory brainstem response of each guinea pig was determined first; then, the animals were killed, and their cochleas were examined under an electron microscope. RESULTS: In the acoustic trauma group, negative auditory brainstem response potentials were seen as was well-adjusted cellular damage to the organ of Corti. In the pentoxifylline group, near-normal auditory brainstem response recordings and organ of Corti histologic findings were found. Organ of Corti damage was seen in the pentoxifylline plus nimodipine plus acoustic trauma group. CONCLUSION: We determined that pentoxifylline was highly protective against noise, but nimodipine was not. Also, pentoxifylline and nimodipine, when used together, increased damage to the organ of Corti.

Ocular vestibular evoked myogenic potentials in patients with migraine.

BACKGROUND: Subclinical cerebello-vestibular impairment has been described in migraine patients. OBJECTIVES: Our aim was to investigate the presence of subclinical vestibulopathy in migraine patients using ocular vestibular evoked myogenic potentials (oVEMP). PATIENTS AND METHODS: Forty-three patients suffering from migraine without aura who had no vestibular complaints and 29 healthy controls were included in the study. The responses were recorded from contralateral lower eyelid just above of the inferior oblique muscle during 120 dB click stimulation. RESULTS: Eight migraine patients (18.6%) disclosed no response. Bilateral or unilateral response rates in the migraine group were 46.5% (n = 20) and 34.9% (n = 15) respectively. In controls, bilateral or unilateral responses could be obtained from 25 (86.7%), and 4 (13.2%) cases, respectively. In migraineurs group mean latencies of N1 and P1 were significantly longer, while N1-P1 amplitudes were found meaningfully lower. CONCLUSION: These data demonstrate that using oVEMP subclinical vestibular dysfunction can be elicited in migraine patients without vestibular complaints.

Choanal polyps: an evaluation of 53 cases.

BACKGROUND: The aim of this study was to evaluate our experience on the diagnosis and treatment of choanal polyps (CP). METHODS: This study consists of 53 patients with CP diagnosed by means of rhinoscopy, nasal endoscopy, computerized tomography, surgical, and histologic findings between 1996 and 2005. RESULTS: The origins of the CPs were the unilateral maxillary sinus in 47 patients, simultaneously bilateral maxillary sinus in 2 patients, septum in 2 patients, sphenoid sinus in I patient, anterior ethmoid sinus in 1 patient. The most common presenting symptoms were unilateral nasal obstruction, snoring, and rhinorrhea. In the cases of the antrochoanal polyps, the most common preoperative radiological finding was the total opacification of the maxillary sinus. CONCLUSION: Endoscopic approach for complete removal of the CPs is an extremely safe and effective procedure. It should be focused on the detection of the exact origin and the extent of the polyp to prevent recurrence.

Soft tissue response of the larynx to silicone, Gore-Tex, and irradiated cartilage implants.

OBJECTIVE: The aim of the study is to compare the efficiency of three different materials (Silicone, Gore-Tex, and irradiated cartilage) used in medialization laryngoplasty. Local tissue reaction to implants in laryngeal skeleton has been examined for this purpose. STUDY DESIGN AND METHODS: In this prospective study, New Zealand rabbits were used. Different materials have been implanted in the paraglottic space of both sides of the larynx to enable a better comparison of the different materials used. Limited medialization was applied. Special care has been taken not to narrow the airway and cause breathing problems. The reaction of the tissue in this region against the materials used has been studied. Each material was implanted 14 times in total. The rabbits were killed 6 months after the implementation to study their larynx. For each material, the fibrous capsule formation, histiocyte infiltration, foreign body giant cell infiltration, eosinophil infiltration, neutrophil infiltration, and lymphoplasmacytic infiltration levels were investigated histologically. RESULTS: Best fibrous capsule formation has been observed around silicone. Allergic reactions and inflammatory responses were minimal for this material. Fibrous capsule formation was more limited with Gore-Tex. Some degree of chronic inflammatory response (in few cases) has been observed against this material. Severe allergic response was observed against irradiated cartilage, and the implant material was resorbed completely in most cases. CONCLUSION: According to histopathologic results of this study (tissue compatibility of three materials), silicone is the most suited material among the study materials for medialization. Gore-Tex can also be used for this purpose. Irradiated cartilage, on the other hand, appears not to be a suitable material for medialization laryngoplasty.

A genotype-phenotype correlation with gender-effect for hearing impairment caused by TECTA mutations.

BACKGROUND: Alpha-tectorin is a noncollagenous component of the tectorial membrane which plays an essential role in auditory transduction. In several DFNA12 families mutations in TECTA, the gene encoding alpha-tectorin, were shown to cause hearing impairment (HI) with different phenotypes depending on the location of the mutation. METHODS/RESULTS: Here we report a Turkish family displaying autosomal dominant inherited HI. Linkage analysis revealed significant cosegregation (LOD score: 4.6) of the disease to markers on chromosome 11q23.3- q24. This region contains the TECTA gene which was subsequently sequenced. A nucleotide change in exon 13, 4526T>G, was detected leading to a substitution from cysteine to glycine at codon 1509 of the TECTA protein. This cysteine is located in vWFD4 domain, a protein domain which is supposed to be involved in disulfide bonds and protein-protein interactions. CONCLUSIONS: It is conspicuous that the phenotype in this family correlates with other families, also displaying mutations involving conserved cysteines. In all three families these mutations result in progressive HI involving high frequencies. In contrast, mutations which are not affecting the vWFD domains seem to provoke mid-frequency sensorineural HI. Furthermore, evaluation of clinical data in our family revealed a gender effect for the severity of hearing impairment. Males were significantly more affected than females. The identification of the third family displaying a missense mutation in the vWFD domain of alpha-tectorin underlines the phenotype-genotype correlation based on different mutations in TECTA.

[A case of natural killer T-cell lymphoma in the nasal cavity]. / Nazal kaviteyi tutan natural killer T hücreli lenfoma: Olgu sunumu.

CD56 positive natural killer T cell lymphoma is characterized by destructive lesions in the nasal cavity and nasopharynx. Severe tissue necrosis makes histopathologic diagnosis difficult, generally necessitating multiple biopsies. A thirty-three-year-old male patient presented with complaints of nasal obstruction, hemorrhagic discharge of fetid odor, and rhinolalia. Immunohistochemical studies on biopsy specimens obtained from the lesion in the nasal septum and posterior nasal cavity revealed CD56 positive natural killer T cell lymphoma. The patient was treated with eight courses of combination chemotherapy, since then he has been in remission for more than 1.5 years.