Daniele Monzani

Psychological distress and disability in patients with vertigo

OBJECTIVE Vertigo is an extremely debilitating experience for the patient, especially during attacks; it is neither easy to identify nor control. The importance of psychosomatic factors has already been widely studied and discussed. In particular, it has been shown that stress factors are relevant in setting off episodes of dizziness, but there is no agreement if the presence of distress might influence the vestibular disability. METHODS This study is concerned with evaluating the quality of life (QOL) in a group of 206 patients suffering from vertigo and 86 control patients, using the UCLA-Dizziness Questionnaire (UCLA-DQ) scale. The results were correlated with those achieved using the Hospital Anxiety and Depression Scale (HADS) psychometric test. RESULTS What is clear is that, in patients suffering from vertigo as regards those who are not, there is a significant amount of anxiety and depression distress, especially in female subjects. There appears to be no relationship between psychological change and the various forms of clinical vertigo. In terms of the QOL parameter, what emerges is that, from a statistical point of view, fear of becoming dizzy is most closely correlated with the perception of disability. CONCLUSIONS There is a also a need for psycho-education here in collaboration with the E.N.T. specialist so that the patient can learn to recognise his/her medical condition and be aware of the factors that primarily contribute to the deterioration of their QOL.

Surgical anatomy of transcanal endoscopic approach to the tympanic facial nerve.

Until recently, tympanic facial nerve surgery had been performed using microscopic approaches, but in recent years, exclusive endoscopic approaches to the middle ear have increasingly been used, particularly in cholesteatoma surgery. The aim of this report was to illustrate the surgical anatomy of the facial nerve during an exclusive endoscopic transcanal approach.

Ossicular Chain Preservation After Exclusive Endoscopic Transcanal Tympanoplasty: Preliminary Experience

Objectives: The aim of the present study is to document and analyze the ossicular chain preservation rate in patients affected by acquired primary cholesteatoma with epitympanic involvement and with preoperative intact ossicular chain. Study Design: A retrospective case series in a tertiary university referral center. Methods: From January 2006 to February 2010, at the Otolaryngology Department of the University Hospital of Modena, 68 patients affected by acquired primary cholesteatoma with attic involvement underwent exclusive endoscopic transcanal tympanoplasty. In April 2010, we performed a retrospective chart and video review of these patients. Patients in whom the ossicular chain was found to be intact and not involved by the pathology at the beginning of the operation were included in the study. A cholesteatoma staging was introduced based on tympanic subsite involvement by pathology. Results: Out of 68 patients affected by acquired primary cholesteatoma and who underwent exclusive endoscopic transcanal tympanoplasty, 23 had intraoperative integrity of the ossicular chain (17 male and 6 female subjects; mean age, 40 yr) and were included in the study. An inverse correlation was found between number of subsites involved and chain preservation (Spearman rank correlation coefficient, r = -1; p = 0.017). Medial attic involvement was the factor that most negatively influenced the likelihood of chain preservation. Conclusion: Middle ear endoscopic techniques may increase the likelihood of ossicular chain preservation during cholesteatoma surgery. Medial attic involvement and a high number of subsites involved represent the most significant negative factors for chain preservation. The rate of residual disease requires more thorough evaluation in the future to validate the results.

Life events and benign paroxysmal positional vertigo: a case-controlled study.

Conclusions. Within the poorly understood mechanisms implicated in the aetiology of benign paroxysmal positional vertigo (BPPV), the results of this trial provide clinical evidence of a potential role of emotional stress connected to adverse life events as a trigger of otoconial dysfunction. High levels of anxiety, depression and somatization were recorded and considered psychogenic precursors of BPPV, thus emphasizing the role of psychological distress in precipitating peripheral vestibular disorders. Therefore, appraisal of life stress and psychological attitudes may have potential implications in the clinical assessment of this labyrinthine vertigo and its frequent relapses. Objectives. BPPV is one of the most common peripheral vestibular disorders, and although it has been the subject of several studies and debates, its aetiology still remains unknown in most cases. Because it has been shown that emotional stress is related to the onset or worsening of other inner ear dysfunctions such as Ménières disease and sudden hearing loss, this study investigated the hypothesis that life events, mood and psychological attitudes may have a causal relationship with BPPV. Patients and methods. Fifty patients (40 females and 10 men; mean age 43.5±10.1 years, range 30–65 years) were recruited and compared with 50 healthy volunteers matched for sex, age and socio-demographc variables. Patients were selected among dizzy patients who were referred to the ENT Clinic of the University of Modena and Reggio Emilia from the emergency unit with a primary diagnosis of ‘positional vertigo’ and enrolled in the study only if they had a paroxysmal positional nystagmus as diagnosed by Dix-Hallpike and Semonts manoeuvres. Patients with a history of recurrent vertigo and additional otoneurological diseases were excluded. The Paykel Life Events Scale, Spielberger State-Trait Anxiety Inventory, Symptom Check List-90 Revisited and Hamilton Depression Scale were the psychometric questionnaires used to complete the audiological and vestibular examinations. Results: Patients with BPPV reported significantly more life events than control subjects in the year preceding the onset of vertigo (p<0.005). Negative life events, objective negative impact and a poor degree of control were also significantly more frequent in patients compared with controls (p<0.005). There were no significant differences between groups concerning positive life events (p>0.05). Psychometric questionnaires recorded significantly higher levels of anxiety, depression and somatization in the pathological sample (p<0.005), as well as an increased obsessive-compulsive attitude (p<0.05).

Posturographic stabilisation of healthy subjects exposed to full-length mirror image is inversely related to body-image preoccupations

Affective states, anxiety in particular, have been shown to negatively influence human postural control efficiency as measured by posturographic means, while exposure to a full-length mirror image of ones body exerts a stabilizing effect. We tested the hypothesis that body image concerns and preoccupations would relate negatively to this stabilising effect. Sixty-six healthy students, who screened negative for psychiatric disorders, completed rating scales for anxiety, depression and body image concerns. Posturography recordings of body sway were taken under three conditions: with eyes closed, looking at a vertical bar and looking at a full-length mirror. The Eyes Open/Mirror Stabilometric Quotient [EOMQ=(sway path with eyes closed/sway path looking at the mirror)x100], an index of how much postural control is stabilized by mirror feedback in comparison to the visual vertical bar condition, was significantly inversely related to body image concerns and preoccupations, and to trait anxiety. This finding confirms the impact of emotional factors on human postural control, which warrant further studies. If confirmed in clinical populations characterized by high levels of body image disturbances, e.g. eating disorders, it could lead to developments in the assessment and monitoring of these patients.

Vertigo “In the Pink”: The Impact of Female Gender on Psychiatric-Psychosomatic Comorbidity in Benign Paroxysmal Positional Vertigo Patients

BACKGROUND Comorbidity between vestibular and psychiatric disorders in predisposed individuals is underestimated, untreated, and may result in chronicization and poor quality of life. There are few studies concerning the type and the prevalence of psychiatric-psychosomatic distress in patients with benign paroxysmal positional vertigo (BPPV). OBJECTIVE The aim of this study was to evaluate psychiatric-psychosomatic comorbidities, in particular anxiety, depression, somatization symptoms, and alexithymia, in a group of BPPV patients compared with healthy subjects, and according to gender. METHODS Case-control study comparing 92 BPPV patients recruited at the ENT Unit of Modena General Hospital between November 2007 and December 2010, and 141 healthy controls. The Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Diagnostic Criteria for Psychosomatic Research (DCPR), Brief Symptom Inventory (BSI), and Toronto Alexithymia Scale (TAS-20) were used to perform psychometric assessment. RESULTS BPPV patients scored higher than controls, with statistical significance, at BDI, BSI somatization, anxiety, and phobic anxiety subscales, and STAI state anxiety; a larger proportion of BPPV patients suffered from clinically significant BDI depressive symptomatology; DCPR disease phobia, functional somatic symptoms secondary to a psychiatric disorder, and demoralization were more common among BPPV subjects. High levels of symptomatology were still found among BPPV female patients, but not among males, even after controlling for symptom severity. CONCLUSIONS Affective symptomatology, such as depression, demoralization, phobia and anxiety, and somatization, were significantly prevalent in BPPV patients, and female gender may be a predisposing factor.

Otolaryngology fantastica: The ear, nose, and throat manifestations of munchausen's syndrome†

Munchausens syndrome (MS) is a form of severe, chronic, factitious disorder with physical symptoms. Some essential features define MS, such as recurrent, feigned, or simulated illness; peregrination (traveling or wandering); pseudologia fantastica; and drug abuse. Munchausens syndrome by proxy (MSBP) classically involves a parent or other caregiver who inflicts injury or induces illness in a child. The aim of the present study was to summarize and study the main ear, nose, and throat (ENT) manifestations of MS and MSBP.

Tympanoplasty: an up-to-date pictorial review

The indications for tympanoplasty are mainly chronic ear pathologies, such as cholesteatoma, atelectasis and chronic tympanosclerotic otitis. Usually, modification of the mastoid and temporal tissues in general mostly involves bone work, which means bone removal by burs or appropriate bone curettes. It is for this reason that, in both the pre- and postoperative periods, the computed tomography (CT) scan is the primary radiological tool for studying the middle-ear, and temporal bone structures and pathologies. The aim of this review is to illustrate the most up-to-date postoperative results for tympanoplasty, including the emerging endoscopic techniques. The present work focuses on the five types of tympanoplasty that are likely to be encountered by the radiologist: radical surgery; open tympanoplasty; closed tympanoplasty; closed endoscopic tympanoplasty; and open endoscopic tympanoplasty. Understanding and interpreting temporal bone images in relation to the different types of surgery are important, especially at the postoperative stage, because of the high risk of recurrence of middle-ear pathologies, and a good working knowledge of surgical changes is fundamental for distinguishing iatrogenic bone demolition from complications and new pathological foci.

Herpes zoster oticus: a clinical model for a transynaptic, reflex pathways, viral transmission hypotheses

Reactivation of the varicella-zoster virus (VZV) along the sensory nerves innervating the ear, including the geniculate ganglion, is responsible for herpes zoster oticus (HZO). In some cases, HZO is associated with polyneuropathy of the cranial nerves, although the mechanism of this involvement is not known. To explain this phenomenon and based on some clinical considerations, the present authors hypothesize an intersynaptic spread of VZV along the reflex pathways of the brainstem.

Analogic and Symbolic Comparison of Numerosity in Preschool Children with Cochlear Implants

Abstract This study explores how preschoolers with cochlear implants process numerical comparisons from two different inputs: a) nonverbal (analogical) and b) verbal (symbolic). Preschool cochlear-implanted children (CI) ranging in age from 4;3 to 6;1 were compared with 99 age-matched hearing children (HC) in three numerical tasks: verbal counting, a digit comparison and a dot comparison. Results show that CI children may outperform HC in numerical tasks that require visuo-spatial analysis (e.g. analogical comparison). More importantly, they perform as well as HC in numerical tasks that require symbolic processes (digit comparison) and in verbal counting. However, when the influence of childrens verbal counting skills on digit comparison is examined differences between the two groups emerge. HCs capacity to compare digits was influenced by their knowledge of the verbal counting system, but this knowledge was not influential when CI childrens performance in the same task was considered. These findings suggest that different strategies may characterize the way the two groups tackle symbolic numerical comparisons. The educational and instructional implications of these findings are discussed.