Search

The evaluation of the patient with recurrent vertigo requires knowledge of vestibular anatomy and physiology. The patient's medical history and physical examination provide the majority of the information necessary for diagnosis. Many diagnostic tests are available to the clinician to aid in the diagnosis. Videonystagmography is useful for the evaluation of peripheral vestibular function and provides some information about central processes as well. Rotary chair testing provides excellent information about central processes and can aid in diagnosing peripheral vestibular impairment. Vestibular-evoked myogenic potential testing is sensitive for testing inferior vestibular nerve and saccule function. Many different medical and surgical options are available for the patient with recurrent vertigo.

Objective: To delineate 2-year efficacy of Meniett device therapy in people with classic, unilateral, Ménière's disease unresponsive to traditional medical treatment., Design: A 2-year long-term unblinded follow-up after a prior randomized, placebo-controlled, multicenter clinical trial of the Meniett device for Ménière's disease., Setting: Follow-up was performed remotely by using diaries and questionnaires mailed to the data coordinating center by the participants. Those who failed to mail their diaries were interviewed by telephone., Participants: Sixty-one study participants agreed to use the Meniett device and report their symptoms for 2 years. All had active, unilateral cochleovestibular disease. Outcomes are available for 58 participants; 2 were unavailable for follow-up and 1 was excluded because of a concurrent condition that precluded Meniett device use., Interventions: Participants were advised to adhere to a low-sodium diet, use the Meniett device 3 times daily, and maintain a patent tympanostomy tube in the affected ear. Diuretic and vestibular suppressant medications were used as needed., Main Outcome Measures: Outcomes were based on the participants' daily diary, questionnaires, and telephone interviews. Three different analyses were prepared: tracking of vertigo frequency throughout the study, comparison of vertigo frequency before and at the end of Meniett device use (American Academy of Otolaryngology-Head and Neck Surgery Foundation reporting guideline), and Kaplan-Meier estimates of vertigo remission and recurrence., Results: Vertigo levels gradually improved for most but not all participants. American Academy of Otolaryngology-Head and Neck Surgery Foundation class A (remission) or class B (greatly improved) results occurred in 67% (39/58) of participants, and class F (dropped out to receive surgical therapy) results occurred in 24%. Of the 44 nondropout participants, 39 (89%) had American Academy of Otolaryngology-Head and Neck Surgery Foundation group A or B outcomes. People who went into remission were highly likely (80%) to remain in remission long term; participants who achieved remission (20/43; 47%) did so within the first year of follow-up., Conclusions: Use of the Meniett device was associated with a significant reduction in vertigo frequency in about two thirds of the participants, and this improvement was maintained long term. Therapy with the Meniett device is a safe and effective option for people with substantial vertigo uncontrolled by medical therapy.

Objective: To evaluate the efficacy of a portable low-intensity alternating pressure generator, the Meniett device, in controlling the symptoms of Ménière's disease., Design: A randomized, placebo-controlled, double-blind, multicenter clinical trial of 4 months' duration., Setting: Four study sites: 3 academic medical centers and 1 private practice., Patients: Sixty-seven people aged 33 to 71 years with established, active, unilateral cochleovestibular Ménière's disease randomly assigned to a treatment or control group. Five cases were excluded (2 dropouts, 3 protocol violations), leaving 62 evaluable cases., Intervention: The Meniett device was self-administered 3 times daily. The placebo Meniett device was identical but exerted no pressure. All participants had a tympanostomy tube inserted in the affected ear., Main Outcome Measures: Participants rated vertigo and activity each day on a symptom report card. Hearing tests, electrocochleography, and questionnaires were completed at baseline, 2 months, and 4 months., Results: The treatment group experienced significantly less severe vertigo, fewer days with definitive vertigo, and fewer days lost from work (sick days) during the follow-up period than did the control group. Hearing and electrocochleographic results did not differ between the groups. Outcomes did not differ by age, gender, laterality, or duration of symptoms. Outcomes were affected by vestibular loss and baseline level of vertigo. The tympanostomy tube had no short-term effect on vertigo symptoms. There were no complications from using the Meniett device., Conclusion: The Meniett device is a minimally invasive, safe, and efficacious intermediate treatment for people with substantial vertigo uncontrolled by medical therapy.

Objective: To report operative findings, postoperative course, and postimplantation performance in patients with cochlear malformations who underwent cochlear implantation., Design: Case study and intervention study (before-after trial). Minimum follow-up of 12 months; average follow-up of 24 months., Setting: Academic tertiary referral center., Patients: Six patients, including five children who underwent implantation at ages 3.5 to 13 years and one adult who underwent implantation at age 27 years. malformations included common cavity deformity (n = 1), cochlear hypoplasia (n = 2), and incomplete partition (n = 3). All patients with cochlear malformations who underwent implantation at the University of Michigan, Ann Arbor, are included, selected from a group of 196 patients so treated since 1986., Intervention: Implantation with a standard multichannel cochlear implant., Main Outcome Measures: Operative findings described include round window and facial nerve anatomy and cerebrospinal fluid leak. Postoperative roentgenographic findings, electrode activation, and reason for non-use of electrodes were investigated. Standard tests of speech perception were used to compare preoperative and postoperative performance for each subject., Results: Operative findings included round window abnormalities (three patients), anomalous facial nerve (one patient), and cerebrospinal fluid leak (three patients). No surgical complications occurred. A minimum of 10 electrodes were activated for all patients. Electrode thresholds and discomfort levels were variable for several months after implantation. All patients demonstrated improved performance after implantation. Four subjects demonstrated open-set speech perception. Two other subjects, whose poor language skills precluded administration of standard tests, showed increased awareness of environmental sounds and increased vocalization after implantation., Conclusions: Cochlear implantation can be a successful method of rehabilitation in patients with congenital deafness who have cochlear malformations.

Involvement of the temporal bone by lymphoreticular neoplasm is rare; all reported cases have been of secondary involvement. This article presents what we believe to be the first two reported cases of primary temporal bone lymphoma. The patients, an elderly man and a boy, both presented with infection of the ear, hearing loss, and facial nerve paresis. In both cases, facial paresis resolved after appropriate chemotherapeutic treatment. Patient presentation and clinical course are discussed in light of published work on temporal bone malignancy. Further investigation, including computed tomography and biopsy, should be considered for patients who present with an apparent middle ear infection unresponsive to medical therapy. The development of facial paralysis in such a patient warrants heightened suspicion of malignancy.

Although postimplant rehabilitation is generally considered to be an important aspect of a cochlear implant program, the literature reports widely varying practices in the implementation of such programs. The National Institutes of Health consensus statement on cochlear implantation (May 1988), while recognizing that aural rehabilitation facilitates maximal use of the implant, offers no specific guidelines or recommendations. A questionnaire survey was made of over 200 otolaryngologists to determine current practices in a variety of aspects of their cochlear implant programs. Results were obtained from a total of more than 1400 patients, including adults, adolescents, and children. Rehabilitation is an integral part of the cochlear implant program in the vast majority of active programs surveyed. General aspects of cochlear implant programs, as well as those of rehabilitation programs in particular, are discussed.