February 1, 2008 John P. Leonetti, MD, Mobeen A. Shirazi, MD, Sam Marzo, MD, and Douglas Anderson, MD
article
Abstract
We describe what might have been the first reported case of a neuroendocrine carcinoma of the jugular foramen. A 50-year-old woman presented with progressive left-sided sensorineural hearing loss, vertigo, pulsatile tinnitus, headaches, and ataxia. Magnetic resonance imaging revealed a 4-cm left-sided jugular foramen tumor. The patient underwent near-total resection of the tumor. Despite lower cranial nerve preservation, postoperative paralysis of cranial nerves IX and X occurred, and vocal fold medialization was performed 5 days later. The final pathologic diagnosis was neuroendocrine carcinoma. The patient was treated with concurrent chemotherapy and intensity-modulated radiation therapy. This article will discuss the pathologic features and the management of jugular foramen tumors, along with the differential diagnosis of these rare tumors.
May 31, 2007 Kenneth H. Brookler, MD; Mohamed A. Hamid, MD, PhD
March 1, 2007 Jagan Gupta, MD; Troy Hutchins, MD; Enrique Palacios, MD
February 1, 2007 Kenneth H. Brookler, MD; Mohamed A. Hamid, MD, PhD
January 1, 2007 Joni K. Doherty, MD, PhD; Mona Yong, MD; Dennis Maceri, MD
July 31, 2006 Samuel L. Hill III, MD; E. Nicholas B. Digges, MD; Herbert Silverstein, MD, FACS
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Abstract
We conducted a retrospective study to evaluate the long-term effectiveness of gentamicin applied directly to the round window membrane via the Silverstein MicroWick system in patients with definite or probable Ménière's disease. The study population was made up of 69 patients who had received 3 drops of gentamicin 10 mg/ml three times daily; the duration of treatment was guided by objective data obtained from weekly electronystagmography and audiometry. Relief of vertigo was assessed by chart review and telephone interviews. After a minimum follow-up of 24 months, we found that vertiginous symptoms remained controlled in 53 patients (76.8%) after one or more courses of drug therapy. A single course of treatment was successful in 41 patients (59.4%). We conclude that long-term control of vertigo can be achieved in patients with Ménière's disease by direct application of gentamicin to the round window membrane via the Silverstein MicroWick. This minimally invasive self-treatment technique was well tolerated and free of long-term complications.
April 1, 2006 Kenneth H. Brookler, MD
January 1, 2006 Timothy P. Zajonc, MD; Peter S. Roland, MD
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Abstract
Vertigo is a sensation of movement when no movement is actually occurring. It is often accompanied by visceral autonomic symptoms including pallor, diaphoresis, nausea, and vomiting. Vertigo is similar to motion sickness in that both may be caused by vestibular stimulation that does not match an internal model of expected environmental stimuli. Indeed, a functioning vestibular system is necessary for the perception of motion sickness. For this reason, many of the same drugs are used to treat both conditions. The investigation of drugs that treat motion sickness helps to discover medications that may treat vertigo caused by disease of the vestibular system. In this article, we discuss the pharmacologic agents that are now available for the treatment of vertigo and those agents that are still under study.
December 1, 2005 Kenneth H. Brookler, MD
September 30, 2005 Aydin Mamak, MD; Süleyman Yilmaz, MD; Harun Cansiz, MD; Ender Inci, MD; Ender Güçlü, MD; Levent Dereköylü, MD
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Abstract
We investigated the prognostic significance of the presence or absence of vertigo and tinnitus, the timing of the initiation of treatment, the type and severity of hearing loss, and age in 72 patients who had experienced sudden hearing loss. We found that the factors associated with a positive prognosis were the absence of vertigo, the presence of tinnitus, initiation of treatment within 7 days, a greater degree of hearing loss in the low frequencies, and a hearing loss of less than 45 dB. Age had no effect on prognosis.
August 31, 2005 Timothy P. Zajonc, MD; Peter S. Roland, MD
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Abstract
Control of the symptoms of vertigo and motion sickness requires consideration of the neurophysiology of areas both intrinsic and extrinsic to the vestibular system proper. We review the essential anatomy and physiology of the vestibular system and the associated vomiting reflex.
February 1, 2005 Alev Uneri, MD
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Abstract
The author conducted a retrospective study to determine the prevalence of a falling sensation in patients who underwent the Epley canalith repositioning maneuver for the treatment of benign paroxysmal positional vertigo. The author studied a total of 436 maneuvers performed on 412 patients and observed 58 episodes (13%) of a strong falling sensation, some very severe. In almost every case, the sensation occurred when the patient was moved to the final (sitting) position; in 1 case, the sensation occurred nearly 30 minutes later. The author recommends that physicians who perform the Epley maneuver warn patients of the risk of a falling sensation, take steps to prevent its consequences, and monitor their patients for at least 30 minutes after the completion of the procedure.
