A woman with a 42-year history of Ménière's syndrome

December 1, 2005     Kenneth H. Brookler, MD

A study of prognostic factors in sudden hearing loss

September 30, 2005     Aydin Mamak, MD; Süleyman Yilmaz, MD; Harun Cansiz, MD; Ender Inci, MD; Ender Güçlü, MD; Levent Dereköylü, MD
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.

Vertigo and motion sickness. Part I: Vestibular anatomy and physiology

August 31, 2005     Timothy P. Zajonc, MD; Peter S. Roland, MD
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.

Falling sensation in patients who undergo the Epley maneuver: A retrospective study

February 1, 2005     Alev Uneri, MD
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.

Efficacy of the Epley maneuver for posterior canal BPPV: A long-term, controlled study of 81 patients

January 1, 2005     Wietske Richard, MD; Tjasse D. Bruintjes, MD, PhD; Peter Oostenbrink; Roeland B. van Leeuwen, MD, PhD
We assessed the efficacy of the Epley maneuver (canalith repositioning) in a study of 81 patients with posterior semicircular canal benign paroxysmal positional vertigo (BPPV). A group of 61 patients underwent the maneuver, while a control group of 20 patients received no therapy. All patients were evaluated at 1 and 6 months. The percentage of patients who experienced subjective improvement was significantly higher in the treatment group at both 1 month (89% vs. 10%) and 6 months (92% vs. 50%). Three patients in the treatment group who did not improve after treatment underwent a second maneuver, and all achieved a positive result. In addition, 4 successfully treated patients experienced a recurrence between 1 and 6 months following treatment; 3 were retreated, and 2 of them responded well. We conclude that the Epley maneuver provides effective and long-term control of symptoms in patients with BPPV.

Migraine and benign paroxysmal positional vertigo: An outcome study of 476 patients

December 1, 2004     Alev Uneri, MD
To investigate whether migraine is more common in patients with benign paroxysmal positional vertigo (BPPV) than in the general population, the author conducted a retrospective study of 476 patients with BPPV seen over 12 years at a tertiary referral center. Records of patients with a confirmed diagnosis of BPPV followed for 1 to 7 years were reviewed. The typical history of BPPV and the characteristic torsional positional nystagmus were identified in all patients. A modified Epley maneuver was performed for all patients with posterior semicircular canal BPPV, with a 98% success rate. The survey consisted of detailed patient questionnaires and vestibular tests. Migraine and motion sickness were three times more common in patients with BPPV than in the general population. A family history of migraine (58.4%) and vertigo (44.9%) was also more common in patients than in a control group.

Perilymphatic fistula

September 30, 2004     Marie Noelle Calmels, MD; Olivier Deguine, MD

Intratympanic steroid perfusion for the treatment of Ménière's disease: A retrospective study

May 31, 2004     Kelley M. Dodson, MD; Erika Woodson, MD; Aristides Sismanis, MD, FACS
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