Probable benign paroxysmal positional vertigo, spontaneously resolved: Incidence in medical practice, patients' characteristics and the natural course.

BACKGROUND: Probable benign paroxysmal positional vertigo, spontaneously resolved (pBPPVsr), is a variant of benign paroxysmal positional vertigo (BPPV) in which there is no observable nystagmus and no vertigo with any positional maneuver. OBJECTIVES: To calculate the incidence pBPPVsr, compare the characteristics of the patients with pBPPVsr and BPPV not spontaneously resolved and describe the spontaneous resolution in the natural course of BPPV. METHODS: Multicenter prospective descriptive study. During a one-year period, all patients with suspected BPPV that presented to the Neurotology Units of five participating centers were recruited. The incidence of pBPPVsr was calculated as a percentage of the total number of patients with BPPV. The prevalence of several variables was compared between pBPPVsr and BPPV not spontaneously resolved. The timing of spontaneous resolution was estimated using Kaplan-Meier curves. RESULTS: 457 patients met the inclusion criteria. The incidence of pBPPVsr was 33.5%. It was significantly higher in males, in patients with normal bone mass and in patients who were not taking sulpiride. A rate of 18% of spontaneous resolution after the first month and 51% after the first year was found. This percentage did not change in a significant way after this moment. The curves for males, patients under 50 and patients with normal blood pressure decreased significantly faster. CONCLUSIONS: In our serie, BPPV spontaneously resolved in half of the patients with BPPV during the first year. This seemed to occur more commonly in males and could have been hindered by sulpiride intake, osteoporosis, advanced age and high blood pressure.

Healing criteria: How should an episode of benign paroxistic positional vertigo of posterior semicircular canal's resolution be defined? Prospective observational study.

OBJECTIVES: To compare the outcome of the Epley maneuver (EM) in benign paroxysmal positional vertigo of the posterior canal (CSP-BPPV) depending on the definition used for recovery. DESIGN: Multicenter observational prospective study. SETTING: Otoneurology Units of 5 tertiary reference hospitals. PARTICIPANTS: All patients presenting with unilateral CSP-BPPV assisted for 1-year period. EXCLUSION CRITERIA: Spontaneous nystagmus, positive McClure-Pagnini maneuver, positive bilateral Dix-Hallpike maneuver (DHM), positive DHM for vertigo but negative for nystagmus and atypical nystagmus. MAIN OUTCOME MEASURES: Response to EM was measured after 7 days in 3 different outcomes: disappearance of nystagmus during the DHM in the follow-up visit, disappearance of vertigo during the DHM and general status (GS) during daily life activities. RESULTS: 264 patients were recruited (68 male/166 female, mean age 62 years). After the EM, nystagmus disappeared in 67% of them, vertigo in 54% and 36% were asymptomatic in their daily life. These outcomes were strongly correlated, but they were not concordant in a clinically significant group of cases; only the 26% of patients met all of them. The healing process follows the next sequence: negativization of positional nystagmus, then disappearance of positional vertigo and, finally, the improvement of GS during daily life activities. CONCLUSION: Nowadays, healing criteria for the resolution of an PSC-BPPV episode have not been specifically defined yet. Provided that other otoneurological disorders have been ruled out, the next resolution criterion is proposed: absence of nystagmus and specifically during control DHM and disappearance of symptoms during daily life activities.

Analysis of risk factors influencing the outcome of the Epley maneuver.

Benign paroxysmal positional vertigo (BPPV) is the most frequent type of vertigo. The treatment of canalithiasis of the posterior semicircular canal consists in performing a particle-repositioning maneuver, such as the Epley maneuver (EM). However, the EM is not effective in all cases. The objective of this study is to identify risk factors, which predict the EM failure, among the clinical variables recorded in anamnesis and patient examination. This is an observational prospective multicentric study. All patients presenting with BPPV were recruited and applied the EM and appointed for a follow-up visit 7 days later. The following variables were recorded: sex, age, arterial hypertension, diabetes, hyperlipidemia, smoking habit, alcohol consumption, migraine, osteoporosis, diseases of the inner ear, previous ipsilateral BPPV, previous traumatic brain injury, previous sudden head deceleration, time of evolution, sulpiride or betahistine treatment, experienced symptoms, outcome of the Halmagyi maneuver, laterality, cephalic hyperextension of the neck, intensity of nystagmus, intensity of vertigo, duration of nystagmus, occurrence of orthotropic nystagmus, symptoms immediately after the EM, postural restrictions, and symptoms 7 days after the EM. Significant differences in the rate of loss of nystagmus were found for six variables: hyperlipidemia, previous ipsilateral BPPV, intensity of nystagmus, duration of nystagmus, post-maneuver sweating, and subjective status. The most useful significant variables in the clinical practice to predict the success of the EM are previous BPPV and intensity of nystagmus. In the other significant variables, no physiopathological hypothesis can be formulated or differences between groups are too small.

LifeQuestionnaire. A new tool for the evaluation of quality of life in patients with hearing loss-using WhatsApp.

OBJECTIVE: Develop an online application that sends questions at different times of the day over an interval set by the user. It consists of a web interface that sends out WhatsApp messages containing questions from already validated or customized questionnaires (previous license) and shows the evolution of each question and patient over time and their average. MATERIAL AND METHOD: The Laboratory of Psychoacoustics developed a platform that allows patients to answer surveys from remote locations. RESULTS: Hence, the developed tool allows to: (1) answer a test repeatedly under different personal situations and (2) evaluate the patient remotely. Hence, obtaining a more reliable assessment of the patient's QoL. CONCLUSION: Preliminary results using 5 teenagers aged 12-18 that answered the KINDL questionnaire is used to evidence the value of this new tool.

AHL, SSD and bimodal CI results in children.

OBJECTIVE: This article aims to demonstrate that children with asymmetric hearing loss (AHL), specifically those with single side deafness (SSD condition) and pure SSD, with substantial hearing (>70% normal speech discrimination) in the ear with hearing aid (HA), obtain clinically relevant speech perception benefit after cochlear implantation in the contralateral side. RESULTS: Retrospective study of two groups: (1) 36 AHL children with bimodal hearing and (2) SSD children with SSD. They had follow-ups of 24 and 12 months duration, respectively. The AHL children where implanted on one ear and depending on the contralateral ear condition, they were divided into two groups: children who reach a disyllabic speech test score lower than 50% in quiet at 65dB-SPL without lip reading (27) and children with test score higher than 70% (9). The second group consisted on 2 children implanted to obtain SSD condition, as preliminary data, with 1 year of follow-up. They showed benefits of binaural stimulation. CONCLUSION: Children in a bimodal situation, with substantial hearing (>70% speech discrimination) in the ear with HA, obtain clinically relevant speech perception benefit after cochlear implantation in the contralateral side.

Sclerotherapy of face and oral cavity low flow vascular malformations: our experience.

We have reviewed our experience (15 patients during the period 2008-2012) in the treatment of low flow vascular malformations (LFVMs) of the face and oral cavity with polidocanol foam sclerotherapy. They were diagnosed clinically and with the help of Doppler ultrasound and magnetic resonance imaging. The maximum dose recommended for each session was 20mg/day and the minimum interval between sessions was 4 weeks. Embolisation was repeated as many times as needed until the size of the lesions and the symptoms had been reduced sufficiently. Patients were followed up 1, 6, and 12 months after treatment had finished, and the size of the lesions was assessed objectively. The 8 men and 7 women were aged between 18 and 71 (mean 44) years. The lesions had reduced and symptoms had improved in all cases. During the follow-up period, one patient relapsed and developed further symptoms. The pain and postoperative inflammation were successfully controlled with an analgesic and an anti-inflammatory drug. There was only one complication (superficial necrosis), which healed completely by second intention. Direct puncture and sclerosis with polidocanol foam are an effective treatment for LFVM of the face and oral cavity.

Use of platelet-rich plasma in the treatment of bisphosphonate-related osteonecrosis of the jaw.

Platelet-rich plasma is a concentrate of growth factors and osteoconductive proteins, which can play a major role in bone biology by accelerating and enhancing bone repair and regeneration. This paper describes the results of using platelet-rich plasma in the management of bisphosphonate-associated necrosis of the jaw. Eight patients with a diagnosis of bisphosphonate-associated necrosis of the jaw were surgically treated for debridement and removal of necrotic bone, followed by application of autologous platelet concentrate enriched with growth factors and primary suture of the wound. Patients underwent periodic clinical and radiological follow-up examinations. All patients showed clinical improvement and oral lesions resolved 2-4 weeks after treatment. After an average 14-month follow up period, patients remained asymptomatic. Although not conclusive, the combination of necrotic-bone curettage and platelet-rich-plasma to treat refractory osteonecrosis of the jaw yielded promising results.

APSCI panel discussion I: imaging and surgical issues.

This is a short overview on imaging techniques in pre-, peri- and postoperative evaluation of cochlear-implant patients. Surgery techniques are described as well as possible complications and how to avoid them.

Etiología y consideraciones terapéuticas en otitis media crónica. Análisis de un período de 5 años / Aetiology and therapeutic considerations in chronic otitis media. Analysis of a 5 year period

Fundamento: El objetivo de este estudio es revisary actualizar la etiología bacteriana de la otitis media crónica y la sensibilidad antibiótica de los microorganismos implicados. Método: Se ha realizado un estudio retrospectivo en el que se incluyen 127 pacientes adultos con otitis media crónica, entre los años 2000 y 2004. A las bacterias aisladas se les realizaron pruebas de sensibilidad antibiótica a: quinolonas, aminoglucósidos, colistina, oxacilina, amoxicilinaclavulánico y cefalosporinas. Resultados: Los aislamientos más frecuentes fueron bacilos gram-negativos, principalmente Pseudomonas aeruginosa en el 47,6%, Staphylococcus aureus en el 21%. Entre los resultados destaca la resistencia del 18% de las cepas de P. aeruginosa a ciprofloxacino y del 21,6% de resistencia de S. aureus a levofloxacino. Además el 10,8% de las cepas de S. aureus fue resistente a betalactámicos. Conclusión: El principal patógeno encontrado es P. aeruginosa, seguido de S. aureus. Existe un incremento del desarrollo de las resistencias bacterianas a los antibióticos, por lo que es necesario realizar antibiograma sistemáticamente

Background: This study provides an update on thebacterial aetiology of chronic otitis media in our area and the antibiotic sensivity of the bacteria involved in this pathology. Methods: A retrospective study from 2000 to 2004, is carried out in a total of 127 adults diagnosed of chronic otitis media. Isolated bacteria were tested in vitro regarding sensitivity to fluoroquinolones, aminoglyosides, colistin, oxacilin, amoxicillin-clavulanic acid and cephalosporins. Results:The most common pathogens we found were gramnegativeorganisms, especially Pseudomonas aeruginosa (47,7%), but among gram positive organisms, Staphylococcus aureus, was involved in a significant number of infections (21%). The main findings that we found were as follows: 18% of P. aeruginosa strains were resistant to ciprofloxacinand 21,8% S. aureus strains were resistant to levofloxacin. 10,8% of S. aureus strains showed resistance to â-lactams. Conclusion: The most important pathogen in our study was P. aeruginosa along with a variety of other gram-negative organisms and S. aureus. There is growing concern over the use of antibiotics and the development of resistance. We need to evaluate the antimicrobial activity by determining the susceptibility of a particular antibiotic against a specific bacterial strain

[Aetiology and therapeutic considerations in chronic otitis media. Analysis of a 5 year period]. / Etiología y consideraciones terapéuticas en otitis media crónica. Análisis de un período de 5 años.

BACKGROUND: This study provides an update on the bacterial aetiology of chronic otitis media in our area and the antibiotic sensivity of the bacteria involved in this pathology. METHODS: A retrospective study from 2000 to 2004, is carried out in a total of 127 adults diagnosed of chronic otitis media. Isolated bacteria were tested in vitro regarding sensitivity to fluoroquinolones, aminoglyosides, colistin, oxacilin, amoxicillin-clavulanic acid and cephalosporins. RESULTS: The most common pathogens we found were gram-negative organisms, especially Pseudomonas aeruginosa (47.7%), but among gram positive organisms, Staplhylococcus aureus, was involved in a significant number of infections (21%). The main findings that we found were as follows: 18% of P. aeruginosa strains were resistant to ciprofloxacin and 21.8% S. aureus strains were resistant to levofloxacin. 10.8% of S. aureus strains showed resistance to beta-lactams. CONCLUSION: The most important pathogen in our study was P. aeruginosa along with a variety of other gram-negative organisms and S. aureus. There is growing concern over the use of antibiotics and the development of resistance. We need to evaluate the antimicrobial activity by determining the susceptibility of a particular antibiotic against a specific bacterial strain.

[Antimicrobial therapy in chronic suppurative otitis media]. / Terapéutica antimicrobiana en otitis media crónica supurada.

A randomized study was made of 125 patients with chronic middle ear infection. The most frequently isolated microorganisms were: Pseudomonas aeruginosa, Staphylococcus aureus and Enterobacteriaceae. Ciprofloxacin is very active against the microorganisms usually isolated and it has been shown to provide effective therapy in ear infections. In order to study the effectiveness of ciprofloxacin in chronic otitis media, we selected four different treatment groups: oral ciprofloxacin (500 mg/12 h); 0.5 and 0.2% topical solutions of ciprofloxacin (3 drops/8 h), and oral ciprofloxacin plus 0.2% topical solution. Topical polymyxin and neomycin were used as controls. Topical ciprofloxacin (0.2%) was the most effective regimen of those tested for the treatment of chronic otitis media.

Cochlear implants for adults obtaining marginal benefit from acoustic amplification: a European study.

OBJECTIVE: This study aimed to examine the application of a speech recognition score of 30% on open-set word materials as the upper limit for preoperative performance in determining cochlear implant (CI) candidacy for European non-English-speaking hearing-impaired persons. This study also aimed to determine the effect of implantation on residual pure-tone hearing thresholds and to determine the incidence and benefit of a contralateral hearing aid postimplant. STUDY DESIGN: The single-subject design study, involving 20 postlinguistically deafened subjects, compares preoperative performance with hearing aids to postoperative performance with a CI at 6 months after surgery. Subjects were implanted with either the Nucleus Mini 22 or the Nucleus 24 CI systems implementing the MPEAK and SPEAK coding strategies. Fourteen subjects meeting the selection criteria were accrued consecutively specifically for inclusion in the study, whereas the remaining 6 retrospectively implanted subjects were identified for inclusion via patient records. PATIENTS: The investigation included 8 clinics over 3 countries (France, Germany, and Spain) and involved 20 postlinguistically deafened subjects who obtained marginal benefit from acoustic amplification before surgery. Nineteen subjects were older than 18 years of age with 1 subject being 14 years old included in the data report as well. MAIN OUTCOME MEASURES: Open-set speech recognition was evaluated before and after surgery using recorded word lists and sentence lists in the subject's native language to determine benefit from the treatment. Baseline audiograms were obtained before surgery for frequencies of 0.25-8.0 kHz for both ears and compared to pure-tone hearing thresholds measured at 1 month after surgery to determine the effect of the implantation on residual hearing. Additionally, a questionnaire was administered to determine the incidence and benefit of continued hearing aid use in the contralateral ear postimplant. RESULTS: Nineteen of the 20 study subjects displayed a significant benefit after surgery at 6 months after switch-on for open-set speech recognition. The remaining subject displayed no significant change in performance on objective testing. The implantation resulted in a significant downward shift in hearing thresholds for the implant ear in the majority of subjects. However, 50% of subjects displayed conservation of some residual hearing. For the majority of subjects, hearing aid use in the contralateral ear was discontinued because of lack of perceived benefit after surgery. CONCLUSIONS: The Nucleus Multichannel CI provides a significant benefit for postlinguistically deafened adults who display marginal benefit from acoustic amplification. Therefore, in French-, German-, and Spanish-speaking clinics, a speech recognition score of 30% on open-set word materials is considered an appropriate upper limit for preoperative performance in determining CI candidacy. In view of a significant downward shift in pure-tone thresholds in the implant ear for the majority of subjects, in cases of asymmetry, it is recommended that the poorer ear be implanted. After surgery, the majority of subjects did not perceive an added benefit from continued use of their contralateral hearing aid.

[Beta-lactamase-producing bacteria in recurrent childhood tonsillitis]. / Bacterias productoras de betalactamasa en amigdalitis recurrente infantil.

Beta-lactamase production by the normal pharyngeal flora could account for the failure of penicillin treatment in patients with recurrent tonsillitis. We studied the microbial flora of tonsils from 22 healthy children (control group) and from 40 children with recurrent tonsillitis who were treated with penicillin. Cultures were made before treatment and repeated 15 days after the first culture. Streptococcus pyogenes was recovered in 25% of the patients in the recurrent tonsillitis group. Beta-lactamase producing bacteria were recovered in 100% of children with tonsillitis and in 86.4% of the healthy children. We found a 65% failure rate of penicillin therapy in recurrent tonsillitis. Our results suggest that beta-lactamase production by pharyngeal organisms does not fully explain the failure of penicillin therapy for recurrent tonsillitis.

[Malignant fibrohistiocytoma of the larynx]. / Fibrohistiocitoma maligno de laringe.

The paper deals with 2 malignant fibrohistiocytoma cases sitting on the larynx, one of them associated with a laryngeal cancer "in situ". These are uncommon growths particularly in this location, of difficult anatomopathologic diagnosis. Placing of these exceptional tumors were the epiglotis and piriform sinus. The treatment of choice is a large resection alone or followed with radiotherapy, at least that is the opinion shared by several authors.

[Involvement of the facial nerve in tumors of the neck and face. Report of 17 cases]. / Afectación del nervio facial en los tumores de localización cervico-facial. Presentación de casos.

Seventh nerve involvement for tumors of the neck of the face is an event not too much infrequent. The paralysis can present due to direct propagation or for not close vicinity. Seventeen (17) patients with facial palsies in association with neoplasties seen in a four years term (1989 - 1992) are contemplated. This figure represents a 6.6 percent of the whole number studied (N. = 270). The paper deals with clinical, etio-pathogenic features and especially with the so-called "alarm signals".

[Therapeutic possibilities in recurrent infantile tonsillitis]. / Posibilidades terapéuticas en la amigdalitis recurrente infantil.

The present study compares two therapy protocols in 40 children with recurrent tonsillitis. Twenty of them were randomly treated with penicillin, and the remaining 20 received penicillin + metronidazole. Clinical and microbiological assessment of the results was made. The association of penicillin and metronidazole was most efficient, probably due to its activity against Streptococus pyogenes and anaerobic betalactamase-producing bacterias. The high failure rate in the penicillin group states the necessity to change the therapy with this antibiotic in the treatment of childhood recurrent tonsillitis.