M. Russolo

Benign Positional Vertigo Without Detectable Nystagmus

Objectives To demonstrate that for treatment of benign positional vertigo it is not necessary to identify a positional nystagmus.

Prognostic indicators of occult metastases in oral cancer.

Objective We evaluated the importance of several tumor factors related to predicting the presence of occult metastases in the oral cavity.

360-Degree canalith repositioning procedure for the horizontal canal.

OBJECTIVES: To evaluate the efficacy of modifications to the standard canalith repositioning procedure (CRP) in the treatment of benign positional vertigo (BPV) of the horizontal semicircular canal (HSC). STUDY DESIGN AND SETTING: Prospective trial of 72 patients with BPV of the HSC treated with a modified 360-degree CRP. RESULTS: 51 of the 62 patients treated for canalolithiasis made a complete recovery (82.2%) after a single 360-degree CRP. CONCLUSIONS AND SIGNIFICANCE: It is proposed a full 360-degree rotation of the HSC involved. It is essential to begin rotation of the patient departing from the affected side towards the healthy side, especially for canal side cupulolithiasis and for canalithiasis of the ampullar branch of the HSC. The head resting on the chest at angle of 30-degree during rotating encourages free-floating debris in the HSC to move into the utricle. Instead of using an oscillator for oscillation of the mastoid bone the head is shaken manually.

Modifications of the Stapedius Muscle Reflex Under Spontaneous and Experimental Brain-Stem Impairment

An oscilloscopic plus a graphic method of recording of the stapedius muscle reflex has revealed peculiar modifications in the latency, threshold, and shape of development of the reflex in cases of brain-stem impairment. Many subjects have been examined who were affected by nucleo-reticular vestibular syndrome, vascular insufficiency, disseminated sclerosis, tumours, etc. and a comparison has also been made in normal subjects and in the same subjects during a temporary impairment of the brain-stem structures following barbiturate administration. The greatest semeiological value is attributed to the modifications in the shape of the reflex.

Modified Particle Repositioning Procedure

Objectives To evaluate the efficacy of modifications to traditional particle repositioning maneuvers in the treatment of benign paroxysmal positional vertigo.

Lateralization, Impedance, Auditory Brain Stem Response and Synthetic Sentence Audiometry in Brain Stem Disorders

Applied individually, the conventional audiometric tests are unsatisfactory in the diagnosis of retrocochlear disorders. An accurate identification of a retrocochlear lesion, however, is not always possible using a single test, and only an appropriate test battery provides the basis for correct prediction of a retrocochlear lesion. Because of this observation, lateralization tests, impedance studies, auditory brain stem responses and speech audiometry with synthetic sentences have been applied to patients affected with retrocochlear disorders (acute nucleoreticular vestibular syndrome, multiple sclerosis and focal lesions). Analysis of the results has demonstrated the value of the tests employed, but the various tests were not strongly correlated and are therefore complementary.

Sound-evoked Postural Responses in Normal Subjects

A pattern of sound-induced paroxysms of the eye and head and other spinal motor neuron synkinesis (Tullios phenomenon) in human subjects always implies either a pathological contiguity of the tympano-ossicular chain and membranous labyrinth or a dehiscence of the bone overlying the superior semicircular canal. However, it has become clear in the last decade that sound-evoked vestibular stimulation is not only a sign of disease but also a physiological phenomenon. The examination of such physiologically sound-induced vestibular (saccular) responses contributes today to the clinical testing of the vestibular organ, mainly in the form of vestibular-evoked myogenic potentials. In this study it was observed that, in a group of 20 normal subjects, a 500 Hz tonal stimulus of high intensity (105 dB HL=118.5 dB SPL), applied monoaurally, elicited postural responses. Each subject was studied under 4 different conditions: (i) head facing forwards, eyes open; (ii) head facing forwards, eyes closed; (iii) head rotated , 90° to the right, eyes closed; and (iv) head rotated 90° to the left, eyes closed. Body sway, measured using a force platform, was recorded in all subjects, with eyes either open or closed. Postural responses, which were also elicited with a 250 Hz tonal stimulus, were not observed with a tone of 2000 Hz, with legs slightly flexed or with binaural stimulation. The postural sway (head facing forwards, eyes open or closed) was in a lateral direction towards the stimulated ear: with the stimulus applied to the right ear the subject had postural sway towards the right, with the stimulus applied to the left ear towards the left. When the head was rotated , 90° sideways and the stimulus was given facing forwards (i.e. head rotated contralaterally to stimulated ear) the postural sway was in a forward direction; when the head was rotated , 90° sideways and the stimulus was given facing backwards (i.e. head rotated ipsilaterally to stimulated ear) the postural sway was in a backward direction. The mean values (mm) of body sway obtained with the head facing forwards and the eyes closed were higher than those with the eyes open (21.7 and 22.8 vs 15.7 and 14.7 for the right and left ears, respectively); higher mean values were obtained with the head turned to the side contralateral to the ear stimulated and the eyes closed (29.3 and 24.8 for the right and left ears, respectively). Under this condition the body sway was mainly in a forward direction. The sound-evoked vestibulopostural reflex seems to be a useful test for exploring the saccular function and, as a click-evoked vestibulocollic reflex, can be considered a physiological Tullio phenomenon.

External osteotomy in rhinoplasty.

Objectives To compare external and internal lateral osteotomy in rhinoplasty.

Directional hearing, temporal order and auditory pattern in peripheral and brain stem lesions.

Tests have been applied to the following subjects: (1) 25 normal individuals; (2) the same individuals during temporary impairement of the brain stem by barbiturate (3 mg/kg); (3) 32 patients affected by acute nucleo-reticular vestibular syndrome; (4) 7 patients affected by unilateral Menières disease, and (5) 1 patient affected by acoustic neuroma with well preserved hearing. Directional hearing was tested by changing the delta i and delta t of two pure tones 400 and 600 Hz) presented through earphones or two fixed loudspeakers placed at +/- 30 degrees from the azimuth and with balanced intensity: temporal order and auditory patterns were tested with the same frequencies by changing the delta t or the order of presentation of the stimuli at fixed intensity. On the basis of the results obtained in the normal subjects, a distinction can be made between the patients affected by brain stem impairment and those affected by Menières disease. In these patients it was very difficult to obtain reliable discriminations due to the failure of the affected cochlea, especially during an acute phase of the disease, to perform adequate time, intensity and frequency analysis. In brain stem patients, spontaneous or pharmacological, the directional hearing judgments were impaired whereas temporal order and auditory pattern discrimination were normal. It is suggested, therefore, that these various central-hearing tests do not investigate analogous performances, but on the contrary different ones. This difference can be attributed to different structures, or to different performance along the same pathways but also to an identical structure of different sensitivity to the noxious agents.

Acute Idiopathic Auditory Failure: Prognosis: A Review of 65 Cases

The prognostic value of some clinical otovestibular measures was evaluated in 40 cases of acute idiopathic hypoacusis and 25 cases of acute idiopathic anacusis (AIA) observed within 15 days of the onset. The mean PTA for the 500-, 1 000-, 2 000-Hz frequencies has great prognostic value. A mean PTA better than 70 dB HL was associated with a complete or good recovery in 86% of patients. A mean PTA poorer than 70 dB HL was associated with only a fair or poor recovery (76% of these patients). Only 1 subject out of 25 affected with AIA had a complete recovery; all the others showed a poor improvement in hearing. When the different severities of hearing loss have been allowed for, the audiometric contour has probably a slight prognostic value. Flat audiograms seem to have poorer recoveries than sloping (up or down) audiograms or those showing midfrequency losses. The presence or absence of the acoustic stapedius muscle reflex for the 500- to 1000-Hz frequencies and the presence or absence of pathological staped...