Rainer O. Seidl

Management of posttraumatic vertigo

OBJECTIVE: To evaluate patients after blunt trauma of the head, neck, and craniocervical junction (without fractures) with vertigo and to report the results of treatment after extensive diagnostics. STUDY DESIGN: Prospective study of consecutive new cases with vertigo after trauma at different periods of onset. During 2000–2002, 63 patients were examined and treated. SETTING: Regional trauma medical center for the greater Berlin Area, tertiary referral unit. RESULTS: The primary disorders included labyrinthine concussion (18), rupture of the round window membrane (6), and cervicogenic vertigo (12). The secondary disorders included otolith disorders (5), delayed endolymphatic hydrops (12), and canalolithiasis (9). The patients were free of vertigo symptoms (except cervicogenic and otolith disorder) after treatment, which consisted of habituation training, medical and surgical therapy options. The follow-up was 1 year. CONCLUSION: Posttraumatic vertigo can be treated with a high success rate once the underlying disorder has been identified. The extent of the neurotological test battery determines the precision and quality of diagnostics. Surgical measures should be an integral part of treatment modalities if conservative treatment is not effective. SIGNIFICANCE: Minor trauma of the head, neck, and craniocervical junction can have major impact on the vestibular system at different sites. Patients need to be carefully diagnosed, even if the onset of vertigo occurs a few weeks or months after the initial trauma.

MRI scanning and incus fixation in vibrant soundbridge implantation.

Objective: Presentation of patient data after Vibrant Sound-bridge (VS) implantation/explantation with respect to magnetic resonance imaging (MRI) compatibility and stability of incus fixation of the implant. Study design: In a retrospective case review, we report on two patients who had to be diagnosed by cranial MRI scans after previous implantation of a VS. Moreover, in one of these cases, the incus was removed after explantation of the VS because of a peripheral hearing loss. This enabled a microscopic evaluation of the incus. At the long process of the incus, the floating mass transmitter (FMT) has been fixed for 4 years. Setting: Tertiary referral center. Subjects: Two patients who fulfilled, at the time of implantation, the criteria for implantation of a VS. Results: In both cases, no demagnetization of the external magnet nor of the FMT were found. Device function after the MRI scans were normal. Pure-tone audiometric thresholds remained unchanged after the MRI scanning and the scanning-related magnetic forces. In both cases, the FMT fixation of the incus was found to be regular. In one case, the fixation was checked by an additional tympanoscopy 1 year after the implantation, and in the other case it was assessed by recording the functional gain of the VS (which was normal) after the MRI scanning. One patient complained about a transient hyperacuity due to the loudness during the MRI scanning procedure. MRI scans showed a blackening of the implant area with spherical distortions of the picture. Conclusion: Although MRI scanning (at 1.5 tesla [T]) with the FMT in place did not lead to adverse effects in the two patients, systematic in vitro studies are required to determine a possible magnetization threshold that could impair the VS function when MRI scans are applied in those patients. The microscopically observed erosions of the long process of the incus after 4 years of FMT clamp fixation show similarities to findings after stapes revision surgery. However, this limited experience in one case does not allow us to make conclusions on the long-term stability of the incus fixation.

MRI scanning in patients implanted with a Vibrant Soundbridge.

To observe the in vivo effects of MRI scanning on the Vibrant Soundbridge system.

Hearing Benefit of Patients after Vibrant Soundbridge Implantation

The present paper compares the audiometric results of different digital Vibrant Soundbridge audio processors (D and Signia) of patients with mild to severe sensorineural hearing loss. In a retrospective study, the audiometric results were evaluated and compared in terms of functional gain of warble tone measurements and speech audiometric data. 23 patients implanted between 1998 and 2003 with the Vibrant Soundbridge were included. At the time of implantation, they fulfilled the indication criteria for an implantation (7 patients with a D type, 16 with a Signia type while 3 patients changed from the D to the Signia type). The mean functional gain was increased from 22.8 dB (±6.5 dB SD) in the D type to 29.8 dB (±2.9) in the Signia type group. The speech-in-noise understanding was better in the Signia compared to the D type (59.3 ± 11.5 dB and 65.7 ± 10.1 dB, respectively). The latest upgrade of the external processor from the 3-channel, digital D type to the 8-channel, digital Signia type led in our data to an auditory benefit in all patients.

The application of vestibular-evoked myogenic potentials in otoneurosurgery

Objective To evaluate the applicability of vestibular-evoked myogenic potentials (VEMPs) in the diagnostics, intraoperative monitoring, and postoperative follow-up of patients in otoneurosurgery. Study Design A prospective study of patients who underwent either cochlear implantation (CI, n = 18) or were diagnosed with an acoustic neuroma (AN, n = 9) or with neuro(micro)vascular compression of the VIIIth nerve (NVC, n = 27) in the period 2002 to 2004. The follow-up was 1 year for all patients. Setting A tertiary-referral unit. Results VEMPs could be recorded in 64% of all patients before CI and in 22% after surgery. The patients with AN had normal VEMPs in 22% of all cases when first diagnosed. Normal VEMPs were found in 37% of those patients with NVC. From the 5 AN patients who had to be operated, only 1 had intact VEMPs after surgery. In contrast, after microvascular decompression all patients (4) had normal VEMPs. Conclusions VEMPs are helpful in diagnosing patients with vertigo to better identify saccular defects. They are highly sensitive in the early diagnosis of retrocochlear lesions. Significance VEMPs can help to reliably identify patients with a retrocochlerar lesion at an early stage and can be used in intraoperative, neurophysiological monitoring. EBM rating: C-4

Pilot study of a neurophysiological dysphagia therapy for neurological patients

Objective: To investigate the success of a neurophysiological dysphagia therapy in patients with neurological disorders. Design: A pre- and post-intervention group study. Setting: Acute rehabilitation unit. Subjects: Ten patients (swallowing rate <1/5 minutes, Frühreha—Barthel Index <—150, tracheostomy as a result of a swallowing disorder) with dysphagia as a result of a head injury or cerebral haemorrhage. Interventions: Therapy was given based on facio-oral tract therapy for three weeks (15 sessions of 1 hour each). Measures: The general scales used were the Frühreha—Barthel Index and Coma Remission Scale. Measures of swallowing rate, alertness and swallowing ability were undertaken before, during and after the treatment sessions and at intervals of 30 minutes for 2 hours after the treatment sessions. Results: On the treatment days, the therapy did not lead to an increase in swallowing rate, but did lead to a significant increase in alertness. After completion of a single treatment session, there was a statistically significant decrease in alertness and swallowing rate for 90 minutes. An increase in alertness (Frühreha—Barthel Index and Coma Remission Scale), swallowing ability (measured using an endoscopic examination) and protection of the respiratory tract was observed over the entire therapy period. Conclusion: Facio-oral tract therapy led to a statistically significant increase in alertness during the treatment session and, over the entire therapy period, to an increase in swallowing rate, alertness and swallowing ability. The decrease in alertness following therapy sessions must be taken into account in planning rehabilitative measures. Further studies on larger populations as well as studies currently in progress should further elucidate the strategies employed to rehabilitate dysphagic patients.

Perioperative recordings of vestibular-evoked myogenic potentials in otosclerosis.

Objectives: The aim of the present study was to investigate saccular function in patients with otosclerosis. Furthermore, the influence of stapedotomy on the vestibular-evoked myogenic potentials (VEMPs) should be demonstrated. Study Design: Prospective study. Setting: Tertiary referral center. Methods: Bone-conducted tone-burst-evoked VEMPs were measured in 23 patients (25 ears) with unilateral or bilateral otosclerosis preoperatively and postoperatively. Results: Preoperatively, VEMPs could be recorded in 11 ears (44%). There was no statistically significant correlation among the extent of preoperative sensorineural hearing loss, age, and VEMP measurements. Postoperatively, VEMPs were found in 14 ears (56%). In three cases (12%), VEMPs reappeared after surgery. The rare cases of preoperative vertigo could not be correlated to the nonappearance of VEMPs. Conclusion: Stapedotomy surgery does not influence VEMPs, implying that the saccular receptors are not injured by surgery. Moreover, in some cases, the elicitability of VEMPs was improved by stapedotomy surgery. Seemingly, otosclerosis can influence the generation of VEMPs most probably due to an involvement of the otolith organs saccular receptors. No correlation was found between the clinical occurrence of vertigo and the elicitability of VEMPs.

Iatrogenic tracheal rupture in children: A retrospective study

Iatrogenic injuries to the trachea are rare, but life‐threatening complaints. Causes and treatment methods have been described for adults, but there is no literature on aetiology and treatment in children. We performed a retrospective study to examine the frequency, aetiology, and treatment of iatrogenic injuries to the trachea in children and to develop guidelines for their treatment and prevention.

Hör- und Gleichgewichtsstörungen nach Kopfanpralltraumen

Hör- und Gleichgewichtsstörungen sind nach nicht-knöchernen Verletzungen des Kopfs sowie der Halswirbelsäule (HWS) keine Seltenheit. Insbesondere Anprallverletzungen mit einem direkten Anschlagen des Kopfs bzw. dem Anschlagen eines Gegenstands am Kopf können durch den Unfallmechanismus der Labyrintherschütterung (Commotio labyrinthi) eine Innenohrhörstörung, z. B. Tinnitus, mit oder ohne Schwindelbeschwerden, hervorrufen. In der vorliegenden Arbeit wird über eine Patientenpopulation von 63 Patienten berichtet, die in den letzten Jahren (1998–2000) wegen isolierter Beschwerden in diesem Bereich in der HNO-Klinik diagnostiziert und therapiert wurden. Es fanden sich verschiedene Unfallmechanismen (z. B. Treppensturz, HWS-Weichteildistorsion mit Kontakttrauma, Stauchungsverletzung der HWS durch Abwurf vom Pferd usw.) sowie eine unterschiedliche Symptomausprägung. Als Leitsymptome wurden überwiegend Schwindel (84%), Tinnitus (63%) sowie eine Hörstörung (23%) gesehen. In der Regel wurde nach einer Funktionsdiagnostik des Hör- und Gleichgewichtsorgans mit einer konservativ-medikamentösen Therapie begonnen, wobei sich die Beschwerden nicht immer vollständig zurückbildeten. Der Tinnitus (18%) sowie die Schwindelbeschwerden (12%) bedurften ¶einer Zusatztherapie im Intervall. Eine operative Therapie wegen persistierender Schwindelbeschwerden wurde 2-mal notwendig.Audiovestibular disorders frequently follow injuries sustained to the head or the cervical spine without any fracture. The main symptoms include sensorineural hearing loss (SNHL) and tinnitus, with or without vertigo. The present paper reports on 63 patients diagnosed and treated over the last 2 years in this department (1997–1999). Several trauma mechanisms were encountered (e.g., falling downstairs, soft tissue distorsion of the neck with or without contact trauma, blunt trauma of the cervical column caused by falling off a horse with the head down) and various combinations of symptoms. The main symptoms were vertigo (84%), tinnitus (63%) and SNHL (23%). After audiovestibular diagnostic tests, conservative treatment was started. The therapy was not completely effective in all cases: 18% of the patients with tinnitus and 12% of those with vertigo needed further treatment, and 2 of the patients in the latter subpopulation required surgery.

Sound-induced vertigo after cochlear implantation.

Aim Postoperative vertigo is a well-known complication after cochlear implantation. The aim of the study was to investigate whether the electrical stimulation of the auditory structures via cochlear implant electrodes can affect the vestibular system and induce vertigo. Materials and Methods In the first group, 114 patients were surveyed retrospectively via questionnaires to evaluate the occurrence and frequency of sound-induced vertigo after cochlear implantation. In the second group of 26 patients, the effects of electrical stimulation on the vestibular system were studied prospectively. Results In the first group of patients without any preoperative sound-induced vertigo (n = 104), 20 patients (18%) reported sound-induced vertigo, which occurred after cochlear implantation. In the second group, an acoustic stimulus delivered via the speech processor of the cochlear implant elicited a vestibular evoked myogenic potential response in 4 of the 26 patients as a sign of vestibular costimulation (of the macula sacculi as part of the otolith organs). Horizontal and vertical nystagmus was triggered, whereas utricular function and postural stability remained unchanged. No correlation was found between C/M levels and the vestibular evoked myogenic potentials and nystagmus responses. Conclusion Sound-induced vertigo can occur in cochlear implantees. This seems to be primarily caused by electrical costimulation of the sacculus as part of the otolith organs.