[Diagnosis of otolith disorders in routine otolaryngology]. / Otolithendiagnostik im HNO-ärztlichen Alltag.

Nowadays, specific and reproducible side-separated neurotologic testing of all vestibular receptors is possible. Assessment of saccular function by measuring cervical vestibular-evoked myogenic potentials (cVEMP) is well established. Reliable screening tests exist for the isolated assessment of utricular function. These tests can be performed even in less well-equipped surroundings to generate information regarding a possible partial dysfunction of the otolith organs. Apart from assessing the functionality of the semicircular canals by caloric irrigation and the head impulse test, screening for otolith disorders should be part of a comprehensive modern vestibular examination. Neurofeedbacktraining is an effective therapy in the treatment of otholith disorders.

[Cochlear implants in isolated temporal bones: evaluation of electrode position with 64-slice computed tomography]. / Kochleaimplantate im Felsenbeinpräparat : Evaluation der Elektrodenlage mittels 64-Zeilen-Computertomographen.

BACKGROUND: For the functional outcome after cochlear implant surgery, the electrode position is of essential importance. Therefore, radiological techniques to localize the electrode within the cochlea are becoming increasingly important. In our study, we used multi-slice computed tomography (CT) to find radiological criteria to allocate the electrode within the cochlea. METHODS: Ten Nucleus 24 RCA electrodes were implanted into isolated human temporal bones using an extended cochleostomy and the Advance Off-Stylet technique. Five electrodes were implanted into the scala tympani and five into the scala vestibuli. After implantation, the temporal bones were blinded to the radiologist, and 64-slice CT scans were performed and analysed. RESULTS AND CONCLUSIONS: In all 10 cases, the surgical positioning of the electrode was equal to the radiological analysis of the CT scans. Radiological criteria were found that permit correct identification of the electrode within the cochlea. We think that this technique is sufficient for most questions concerning quality control and is widely available.

Treatment of Bell palsy with prednisone: a prospective, randomized study.

Two hundred thirty-nine patients with Bell palsy were randomly distributed into prednisone-treated and control groups. Patients were followed until complete recovery or for 1 year. In the steroid-treated and control groups, respectively, incomplete recovery of facial strength occurred in 12 percent and 20 percent; motor synkinesis in 9 percent and 15 percent; autonomic synkinesis in 1 percent and 10 percent; and electromyographic evidence of severe denervation in 9 percent and 17 percent. The differences reached statistical significance only for autonomic synkinesis. In the total series recovery of facial strength was incomplete in 16 percent. Residual weakness was mild in 14 percent and moderate in 2 percent. No patient remained with severe weakness. Age, hyperacusis, and severity of the initial palsy were associated with an increased risk of poor outcome.

Patient- and provider-reported adherence: toward a clinically useful approach to measuring antiretroviral adherence.

We seek to develop a clinically useful measure of antiretroviral medication adherence. Because there is no gold standard for adherence, we will assess the clinical validity of patient- and provider-reported adherence by the strength of their expected associations with current viral load, depressive symptoms, alcohol and illicit drug use, and homelessness. The Veterans Aging Cohort 3 Site Study (VACS 3) is a multisite study of 881 patients at Cleveland, Houston, and Manhattan Veterans Affairs health care systems. Data was collected on adherence using patient report and provider assessment; depressive symptoms using the Center for Epidemiological Studies Depression (CESD) and provider assessment; alcohol use using the Alcohol Use Disorders Identification Test (AUDIT) and provider assessment; and homelessness using patient report only. Viral load was collected from electronic laboratory data. Although agreement between providers and patients about the patient's adherence was not better than chance (61%; weighted kappa =.07), both patient and provider-reported adherence were related to viral load (P <.001), current alcohol use (P <.01), current drug use (P <.01), and depressive symptoms (P <.001). Patient-reported adherence was also associated with homelessness (P <.05). In multivariate regression models, provider assessment of adherence demonstrated independent associations with viral load (P <.001), current alcohol use (P <.001), current drug use (P <.001), and depressive symptoms (P <.001) after adjustment for the patient's report of adherence (also significantly associated). The consistent and largely independent association between patient and provider reported adherence and a range of variables previously shown to be associated with adherence suggests that patient- and provider-reported adherence independently measure actual adherence. Future work will explore how patient- and provider-reported adherence might best be combined, and whether the measure may be further enhanced with pharmacy refill data.

Enhancing substance abuse treatment with case management. Its impact on employment.

This article examines the effectiveness of strengths-based case management in assisting persons with substance abuse problems improve employment-related functioning. In a study of 632 veterans seeking treatment for substance abuse problems, Wright State University's Enhanced Treatment Project found that veterans in substance abuse treatment had improved in several areas of employment functioning, including number of days employed. Among clients who expressed interest in receiving assistance with employment-related issues, those who received strengths-based case management demonstrated additional improvement in employment functioning including more days employed, fewer employment problems and being less troubled about their employment situation. Correlations between improved employment functioning and improved functioning in other life areas further support the value of case management. The implications of these findings for the inclusion of case management services in substance abuse treatment programs will be discussed.

The strengths perspective of case management: a promising inpatient substance abuse treatment enhancement.

The medical model or disease concept approach to substance abuse treatment is practiced in most residential substance abuse treatment programs. Despite wide acceptance, many of the factors inherent in this approach may actually increase patient noncompliance with treatment regimens. These factors are related to the pathology-based nature of substance abuse treatment, an overemphasis on patient denial, and the paternalistic role that treatment staff often take in the treatment of substance abusers. The Strengths Perspective of Case Management/Advocacy has demonstrated usefulness as an adjunct to treatment that remedies these detrimental factors and improves compliance with, and retention in, treatment. The specific activities that lead to this improvement are discussed.

Presenting problems of substance abusers in treatment: implications for service delivery and attrition.

This study used the Addiction Severity Index (ASI) to identify the various problems substance abuse clients present when seeking treatment at a Department of Veterans Affairs Medical Center. The sample was 98% male and 73% African-American, with a mean age of 37 years. Cluster analysis was used to identify commonalities and divergences in self-reported employment, legal, family, substance abuse, psychological, and medical problems. Four distinct clusters emerged, each of which could be characterized by a dysfunctional pattern. The utility of this approach in designing treatment regimens, addressing client problems in addition to their substance abuse, increasing client satisfaction with service provided, and decreasing treatment attrition is discussed.

Association of hypocholesterolaemia with hepatitis C virus infection in HIV-infected people.

OBJECTIVE: To study the impact of hepatitis C virus (HCV) status on serum cholesterol levels in HIV-infected patients. METHODS: We retrospectively analysed data from the 881 participants of the Veterans Ageing Cohort 3 Site Study. Four different models were constructed using total cholesterol, low-density lipid (LDL) cholesterol, high-density lipid (HDL) cholesterol and triglycerides as dependent variables. The relevant covariates included HCV antibody status, HIV medication class, CD4 count, HIV viral load, glucose level, lipid-lowering drug use, gender, race, age, liver function test results, ethanol use, drug use, and HIV exposure category. Variables excluded from the final model included niacin use, gender, race, age, current ethanol use, and HIV exposure category. RESULTS: Of the 881 HIV-positive patients enrolled in the study, 700 (79%) were screened for HCV antibody, with 300 (42.8%) HCV antibody positive and 400 (57.2%) HCV antibody negative. A positive HCV antibody status was independently associated with lower total cholesterol levels (P=0.001) and LDL cholesterol levels (P<0.001) but not with lower HDL cholesterol or triglyceride levels. HCV-positive patients had predicted LDL levels 19 mg/dL lower than those of HCV-negative subjects. HCV infection was also associated with a decreased use of lipid-lowering medication, and protease inhibitor use was associated with increased LDL and total cholesterol levels. CONCLUSIONS: HCV infection has been associated with lower cholesterol levels in HIV-negative individuals, and the same appears to be true with HIV-infected patients. This is an interesting finding given that HCV particles bind to LDL receptors in vitro and also because HCV-lipid interactions appear to be important in the HCV replication cycle.