Evaluation of benign paroxysmal positional vertigo following Le Fort I osteotomy.

The Le Fort I osteotomy is widely used to correct dentofacial deformities. Benign paroxysmal positional vertigo (BPPV) is a common vestibular end organ disorder characterized by short, often recurrent episodes of vertigo. Head trauma is one of the known causes of BPPV. During pterygoid osteotomy, the surgical trauma induced by percussion with the surgical mallet and osteotomes can displace otoliths into the semicircular canal, resulting in BPPV. The aim of this study was to evaluate the potential risk of occurrence of BPPV in individuals undergoing Le Fort I osteotomy. Twenty-three patients were included in this study. The Dix-Hallpike manoeuvre, positional tests using electronystagmography, and vestibular evoked myogenic potential (VEMP) tests were performed 1 week before surgery (T0), 1 week after surgery (T1), and 1 month after surgery (T2). The results were compared statistically. BPPV was observed in three patients. Eleven patients had nystagmus at the T1 evaluation and seven at the T2 evaluation. The difference between the T0 and T1 time points was statistically significant (P=0.001). BPPV is a possible complication of Le Fort I osteotomy. Surgeons should be aware of this complication, and the diagnosis of BPPV should be considered in patients who have undergone Le Fort I osteotomy.

Expression of disintegrin and metalloproteinase family proteins 10, 12 and 17 in cholesteatoma.

OBJECTIVE: Proteases of the disintegrin and metalloproteinase family (also known as ADAM proteins) are involved in various physiological and pathological processes. This study assessed the expression of disintegrin and metalloproteinase family proteins 10, 12 and 17 in cholesteatoma. MATERIALS AND METHODS: The study evaluated cholesteatoma specimens from 19 patients, and external ear canal skin samples from 7 of the same patients (as controls), for the expression of disintegrin and metalloproteinase family proteins 10, 12 and 17, using immunohistochemical methods. RESULTS AND ANALYSIS: The study observed over-expression of proteins 10 and 17 in blood vessels, and over-expression of proteins 12 and 17 in cholesteatoma stroma. Immunostaining scores for proteins 10, 12 and 17 in epithelial and inflammatory cells from cholesteatoma specimens versus control specimens showed no statistically significant differences. CONCLUSION: Over-expression of disintegrin and metalloproteinase family proteins 10, 12 and 17 in cholesteatoma may be related to cholesteatoma pathogenesis. These proteins deserve further study as they may represent potential targets for cholesteatoma treatment.

Role of Langerhans cells, Ki-67 protein and apoptosis in acquired cholesteatoma: prospective clinical study.

OBJECTIVE: To investigate the role of Langerhans cells in the pathogenesis and clinical picture of middle-ear cholesteatoma. SUBJECTS AND METHODS: The study included 40 patients operated upon for a diagnosis of chronic otitis due to acquired cholesteatoma. RESULTS AND ANALYSIS: A closed surgical technique was used in 20 per cent of patients and an open technique in 80 per cent. Langerhans cells were more densely accumulated in cholesteatoma epithelium, compared with external ear canal skin (p < 0.001). Staining for Ki-67 protein was greater in cholesteatoma epithelium (p < 0.001) and Apo2.7 protein staining (indicating apoptosis) was more prominent (p < 0.001), compared with ear canal skin. Regarding significant relationships between clinical and pathological findings, staining for Ki-67 (p = 0.046) and Apo2.7 (p = 0.037) was more prominent in patients undergoing open versus closed surgery. CONCLUSION: Using cell proliferation and apoptosis markers, a dense Langerhans cell infiltration was found to occur as a host response to middle-ear cholesteatoma.

Value of apparent diffusion coefficient calculation in the differential diagnosis of parotid gland tumors.

BACKGROUND: The differential diagnosis of parotid gland tumors is often difficult with conventional magnetic resonance imaging. PURPOSE: To determine whether the calculation of the apparent diffusion coefficient (ADC) is valuable for making the differential diagnosis of parotid tumors. MATERIAL AND METHODS: Thirty parotid masses in 28 patients and 24 healthy parotid glands in 12 controls were examined in this prospective study. Diffusion-weighted magnetic resonance imaging with echo-planar spin-echo sequences was used to evaluate each subject. The ADC of each tumor and each healthy parotid gland was calculated. Tumor diagnoses were confirmed by the results of histopathologic analysis. RESULTS: The following types of masses were identified: 11 Warthin tumors, nine pleomorphic adenomas, seven malignant tumors, one basal cell adenoma, and two benign cysts. The mean ADC value for the Warthin tumors was 0.97+/-0.16 x 10(-3) mm(2)/s, for the pleomorphic adenomas was 1.74+/-0.37 x 10(-3) mm(2)/s, for the malignant tumors was 1.04+/-0.35 x 10(-3) mm(2)/s, and for the normal parotid glands was 0.34+/-0.20 x 10(-3) mm(2)/s. The respective ADC value for the single basal cell adenoma was 1.40 x 10(-3) mm(2)/s. Statistically significant differences were identified between the subjects with pleomorphic adenoma and those with another type of parotid tumor, and between subjects with healthy parotid glands and those with a tumor. CONCLUSION: Calculating the ADC appears to be useful in differentiating pleomorphic adenomas from other types of parotid gland tumors.

The canalith repositioning maneuver in patients with benign positional vertigo.

The canalith repositioning maneuver (CRM), as defined by Epley, can be an effective treatment for benign paroxysmal positional vertigo (BPPV). The staff at Baskent University's Ear Nose and Throat Clinic performed CRM on 68 cases of canalithiasis in 64 BPPV patients from June 1996 to August 1997. Symptoms resolved after the first session in 49 patients (72%) and after the second session in 11 cases (16.2%). It was necessary to repeat the maneuver three times in two cases (2.9%) and four times in one patient (1.5%). Discounting three patients who were lost to follow-up, only two patients in our study did not respond to CRM treatment. There was no co-existing pathology found in all but two of the patients studied. Our experience indicates that unless there is no response to CRM or there is suspicion of an incorrect diagnosis, it is not necessary to perform diagnostic studies routinely for differentiating other neuro-otologic disorders prior to using CRM in BPPV patients diagnosed by the Dix-Hallpike test.

Video endoscopy-assisted vestibular neurectomy: a new approach to the eighth cranial nerve.

Disequilibrium, ranging from lightheadedness to severe vertigo, is frequently of great concern to the patients with a variety of inner ear diseases, and may cause occupational and social disability. Vestibular nerve section may be considered when vestibular symptoms are resistant to medical therapy and associated with serviceable hearing in the involved ear. During the last century, numerous authors described several routes for intracranial section of the eighth nerve, such as lateral suboccipital craniotomy, middle cranial fossa approach, and retrolabyrinthine approach to the vestibular fossa. Control of vertigo by all routes to the vestibular nerve has a success rate of 80% to 90%. The potential for endoscopic approach to intracranial cavities was recognized early in this century but, due to technical limitations, was largely abandoned after a few attempts. Advances in optics, and the introduction of very fine instruments made endoscopy worth reconsideration. Since the early 1980s, rigid endoscopes have been used in otorhinolaryngology for paranasal sinus surgery and the visualization of the facial and vestibulocochlear nerves during acoustic tumor surgery. We performed endoscopic section of the vestibular nerve through a retrolabyrinthine approach in two cadavers and in two patients with the symptoms of disequilibrium. In the literature survey, we could find no reports on vestibular neurectomy performed by endoscopic technique. We describe technical details of the approach, and conclude that the technique is safe and effective.

Auditory P300 abnormalities and leukocyte activation in HIV infection.

To evaluate whether P300 testing might serve as a screening modality for the early detection of HIV-related neuropathology, we tested 26 HIV-infected men (23 without neurologic symptoms, 2 with peripheral neuropathy, 1 with AIDS-associated dementia) and 15 controls. Although they had no overt neurologic symptoms, the P300 latency was delayed or undetectable in 30% of patients without clinically evident neurologic disease. P300 latencies did not correlate with peripheral blood CD4 T-cell count, serum quinolinic acid or p24 antigen levels, or the numbers of activated peripheral blood monocytes. Three individuals with abnormal P300 latencies had been HIV-seropositive for < or = 1 year, suggesting that delayed evoked responses detect early neurologic dysfunction. P300 responses do not predict imminent dementia. In only one previously asymptomatic individual with abnormal P300 waveforms have overt neurologic symptoms developed during a 2-year followup. Extended longitudinal studies will be necessary to define the predictive value of P300 latencies in the development of AIDS-related dementia. However, the sensitivity, quantitative nature, and speed of administration of this test suggest that it may be useful for identification of early neurologic involvement in HIV infection.