Influence of Age and Cardiovascular Risk Factors in Vestibular Neuritis: Retrospective Cohort Study.

To analyze the influence of age and cardiovascular risk factors (CVRFs) in the evolution of vestibular neuritis (VN). METHODS: Retrospective cohort study. VN-diagnosed patients were included and divided into two groups: those with and without CVRFs. We analyzed the mean vestibular-ocular reflex (VOR) gain, measured through the video head impulse test (vHIT) at the diagnosis and one-year follow-up. We conducted a factorial analysis of variance (ANOVA) to evaluate the effect of age, sex, and CVRFs in the mean VOR gain. RESULTS: Sixty-three VN-diagnosed patients were included. There were no statistically significant differences in the mean VOR gain between both groups. However, in the subgroup analysis, there were statistically significant differences when comparing the mean VOR gain at the one-year follow-up between the group over 55 years of age 0.77 ± 0.20 and the group under 55 years 0.87 ± 0.15 (p = 0.036). Additionally, the factorial ANOVA demonstrated a significant main effect of age group on the mean VOR gain at the one-year follow-up (p = 0.018), and it also found a significant interaction between the factors of gender, age group, HTN (p = 0.043). CONCLUSIONS: CVRFs do not independently affect the mean VOR gain in VN patients' follow-ups. However, age significantly impacts VOR gain in VN and could be modulated by gender and hypertension.

Factors Impacting the Use or Rejection of Hearing Aids-A Systematic Review and Meta-Analysis.

PURPOSE: To examine the prevalence of adherence to hearing aids and determine their rejection causes. METHODS: This study was conducted according to the Preferred Reporting terms for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We performed an electronic search using PubMed, BVS, and Embase. RESULTS: 21 studies that met the inclusion criteria were selected. They analyzed a total of 12,696 individuals. We observed that the most common causes for positive adherence to hearing aid use included having a higher degree of hearing loss, patients being aware of their condition, and requiring the device in their daily life. The most common causes for rejection were the lack of perceived benefits or discomfort with the use of the device. The results from the meta-analysis show a prevalence of patients who used their hearing aid of 0.623 (95% CI 0.531, 0.714). Both groups are highly heterogeneous (I2 = 99.31% in each group, p < 0.05). CONCLUSIONS: A significant proportion of patients (38%) do not use their hearing aid devices. Homogeneous multicenter studies using the same methodology are needed to analyze the causes of rejection of hearing aids.

Early Diagnosis of Central Disorders Mimicking Horizontal Canal Cupulolithiasis.

BACKGROUND: Horizontal Canal Cupulolithiasis (hc-BPPV-cu) can mimic a pathology of central origin, so a careful examination is essential to prevent misdiagnosis. METHODS: Retrospective cross-sectional cohort study of 45 patients suffering from suspected hc-BPPV-cu. We recorded whether patients first presented through an ENT Emergency Department (ED) or through an Outpatient Otolaryngology Clinic (OC). RESULTS: We found statistically significant differences (p < 0.05) between the OC versus the ED in relation to the time between symptom onset and first assessment (79.7 vs. 3.6 days, respectively), the number of therapeutic maneuvers (one maneuver in 62.5% vs. 75.9%, and more than one in 25.1% vs. 13.7%), and multi-canal BPPV rate (43.8% vs. 3.4%). hc-BPPV-cu did not resolve in 2 patients (12.5%) from the OC and in 3 (10.3%) from de ED, all of which showed central pathology. DISCUSSION: There are no prior studies that analyze the approach to hc-BPPV-cu in the ED. The benefits of early specialist input are early identification of central positional nystagmus, a decrease in symptom duration, reduced number of therapeutic maneuvers required for symptom resolution, and lower rates of iatrogenic multi-canal BPPV. CONCLUSION: A comprehensive approach to hc-BPPV-cu in the ED allows both more effective treatment and early identification of central disorder mimics.

Efectividad del corticoide intratimpánico en el tratamiento de la enfermedad de Ménière. Estudio de cohortes / Efectivity of intratympanic corticosteroids in the treatment of Meniere's disease. Cohort study

Introducción y objetivo: La enfermedad de Ménière (EM) es una patología auditiva crónica que se caracteriza por la presencia de hipoacusia, vértigo episódico y tinnitus. El objetivo de este estudio es valorar la mejora auditiva y la disminución de las crisis vertiginosas en pacientes con enfermedad de Ménière tras la administración de corticoide intratimpánico (CIT).Método: Estudio de cohortes retrospectivo, de una muestra de 55 pacientes diagnosticados con EM definitiva y tratados con corticoide intratimpánico.Resultados: De los 39 pacientes que fueron tratados con CIT por las crisis de vértigo, al mes, 27 no sufrieron ninguna crisis, 11 pocas (<5) y solamente 1 paciente tuvo varias crisis (5-10). A los seis meses de la primera inyección, 19 no padecieron crisis de vértigo, 13 pocas, 5 varias y 2 muchas crisis (>10). Los pacientes tratados con CIT por hipoacusia fueron 16 y reflejaron una media de pérdida auditiva de 46,61 dB previa al tratamiento. Al mes de la inyección, la media de la pérdida fue de 42,77 dB (1,84) y a los seis meses de 41,66 dB (2,95).Discusión: El beneficio audiométrico obtenido es de ?3 dB y se refleja una clara disminución del número de crisis vertiginosas tras la administración de CIT, otros autores en sus estudios han obtenido resultados similares a los nuestros.Conclusiones: Nuestros resultados evidencian que el corticoide intratimpánico es una terapia efectiva para el control de las crisis vertiginosas y la pérdida de audición. (AU)

Introduction and objective: Meniere ́s disease (MD) is a chronic auditory pathology charac-terized by the presence of hearing loss, episodic dizziness and tinnitus. The objective of this studie is to value the hearing improvement and the reduction of vertiginous crises in patients with Meniere ́s disease after the administration of intratympanic corticosteroids (ITS). Method: Retrospective cohort study of a sample of 55 patients diagnosed with definitive Meniere ́s disease and treated with intratympanic corticosteroids. Results: Of the 39 patients who were treated with ITS for vertigo attacks, one month into the treatment, 27 had no attacks, 11 experienced a few (<5) and only 1 had several attacks (5-10). Six months after the first injection, 19 had no seizures, 13 reported a few, 5 had several, and 2 manifested numerous attacks (> 10). There were 16 patients treated with ITS for hearing loss and they reflected a mean hearing loss of 46.61 dB prior to the treatment. One month after the injection, the mean loss was 42.77 dB (1.84) and at six months it was 41.66 dB (2.95). Discussion: The audiometric benefit obtained is ≈3 dB und a clear decrease in the number of vertiginous crises after ITS, other authors in their studies have obtained results similar to ours. Conclusions: Our results show that intratympanic corticosteroids is an effective therapy for the control of vertiginous crises and hearing loss. (AU)

Cuerpo extraño cervical de larga permanencia / Long-term extraneous body in the neck

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[Fast-growing atypical cervical mass]. / Masa cervical atípica de rápido crecimiento.

Aneurysms of the jugular vein are an uncommon condition, typical of childhood and adolescence although they can appear at any age. Clinically, they normally constitute an asymptomatic cervical mass which increases when Valsalva's manoeuvre is applied. Doppler echography is the most effective diagnostic test, with CT or NMR for doubtful situations. Treatment is conservative except for complications or major aesthetic repercussions. We present here the case of a 65-year-old female patient, and review the literature regarding aneurysms of the jugular vein.

Masa cervical atípica de rápido crecimiento / Fast-growing atypical cervical mass

Los aneurismas de la yugular interna son una entidad poco frecuente, propia de la infancia y la adolescencia, aunque pueden aparecer a cualquier edad. Clínicamente se observa una masa cervical asintomática que aumenta al realizar maniobras de Valsalva. La prueba diagnóstica más eficaz es la ecografía Doppler y, en situaciones dudosas, la tomografía computarizada y la resonancia magnética. El tratamiento es fundamentalmente conservador salvo con complicaciones o repercusiones estéticas importantes. Presentamos el caso de una paciente de 65 años afecta de esta enfermedad y revisamos la literatura publicada al respecto

Aneurysms of the jugular vein are an uncommon condition, typical of childhood and adolescence although they can appear at any age. Clinically, they normally constitute an asymptomatic cervical mass which increases when Valsalva's manoeuvre is applied. Doppler echography is the most effective diagnostic test, with CT or NMR for doubtful situations. Treatment is conservative except for complications or major aesthetic repercussions. We present here the case of a 65-year-old female patient, and review the literature regarding aneurysms of the jugular vein

[Clinical picture of 8th pair schwannoma. Is it expressive enough?]. / Caracterización clínica del schwannoma del VIII par. Son suficientemente expresivos sus síntomas?

OBJECTIVE: To describe the stage-related clinical features of 8th cranial nerve schwannoma. MATERIAL AND METHOD: Descriptive study of 71 patients whose diagnosis and/or treatment have been carried out at our centre between 1997-2003. Gender, age, and symptoms were considered, with special attention to gender. Determination of tumoral stage following Tos and Thomsen image criteria. RESULTS: The mean age was 64.6 (range, 20-87) with a marked incidence between 52 and 70 years (62 % of the whole), slightly higher in females and in the left ear. The main symptoms were those derived from involvement of the 7th and 8th cranial nerves, with other cranial nerves and cerebello-pontine structures being involved in larger tumours, although a high variability was noted in clinical patterns of same-stage cases and in the first symptom. Our study also found a high variability in hearing conservation and a marked frequency of vestibular or facial (motor and sensory) symptoms. There were also very infrequent forms of presentation that are highlighted. CONCLUSIONS: There is no typical clinical pattern and no typical first symptom in 8th cranial nerve schwannomas. Any audiovestibular or facial symptom, even the slightest, may be the first expression of 8th cranial nerve schwannoma. There is no stage-specific symptom except for those with involvement of the cerebello-pontine or cerebral structures.

Caracterización clínica del schwannoma del VIII par. ¿Son suficientemente expresivos sus síntomas? / Clinical picture of 8th pair schwannoma. Is it expressive enough?

Objetivo: Determinar la semiología característica del schwannoma del VIII par craneal en función de su estadio por imagen. Material y método: Estudio descriptivo a partir de 71 sujetos diagnosticados en nuestra consulta o remitidos a nuestro centro para tratamiento entre 1997 y 2003. Se recoge el sexo y la edad, así como los síntomas que presentaba el paciente, diferenciando el síntoma de inicio. Determinación del estadio del tumor según criterios de imagen de la clasificación de Tos y Thomsen. Resultados: La media de edad es de 64,6 (intervalo, 20-87) años. Llama la atención que el tramo de edad entre los 52 y 70 años acumula el 62 % de los casos. La incidencia es levemente mayor en mujeres y en el oído izquierdo. Los síntomas predominantes son los derivados de la afección del VIII y el VII pares craneales, asociándose síntomas por afección de otros pares craneales y del ángulo pontocerebeloso en tumores mayores, aunque existe una enorme variabilidad tanto entre casos del mismo estadio como en la clínica de inicio (first sympthom). Destacamos en nuestro estudio la variabilidad de la preservación de la audición entre los diferentes pacientes y el alto número de casos afectos de clínica vestibular o facial, tanto motriz como sensitiva. Asimismo, hay formas de inicio sorprendentes por su infrecuencia. Conclusiones: No existe patrón clínico típico de comienzo del schwannoma del VIII par. Cualquier síntoma audiovestibular o facial, por sutil que fuere, puede ser la primera expresión clínica de un schwannoma del VIII par. Ningún síntoma es patrimonio de ningún estadio, con la excepción de los propios de la afección de la fosa posterior

Objective: To describe the stage-related clinical features of 8th cranial nerve schwannoma. Material and method: Descriptive study of 71 patients whose diagnosis and/or treatment have been carried out at our centre between 1997-2003. Gender, age, and symptoms were considered, with special attention to gender. Determination of tumoral stage following Tos and Thomsen image criteria. Results: The mean age was 64.6 (range, 20-87) with a marked incidence between 52 and 70 years (62 % of the whole), slightly higher in females and in the left ear. The main symptoms were those derived from involvement of the 7th and 8th cranial nerves, with other cranial nerves and cerebello-pontine structures being involved in larger tumours, although a high variability was noted in clinical patterns of same-stage cases and in the first symptom. Our study also found a high variability in hearing conservation and a marked frequency of vestibular or facial (motor and sensory) symptoms. There were also very infrequent forms of presentation that are highlighted. Conclusions: There is no typical clinical pattern and no typical first symptom in 8th cranial nerve schwannomas. Any audiovestibular or facial symptom, even the slightest, may be the first expression of 8th cranial nerve schwannoma. There is no stage-specific symptom except for those with involvement of the cerebello-pontine or cerebral structures