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Objectives: Persistent postural-perceptual dizziness (PPPD) is a chronic functional vestibular disorder which is also the most common cause of chronic dizziness. Effective treatment is dependent on the awareness of the provider's knowledge of PPPD and correct provision of treatment. This study was aimed to assess the awareness of PPPD and practice patterns among a diverse group of providers who care for patients with chronic dizziness in the outpatient clinics. Materials and Methods: A 12-question web-based survey was distributed to a cross-sectional convenience sample of medical providers from primary care including general practitioners, otorhinolaryngology (ORL) and internal medicine all over Malaysia. We analyzed the responses using multivariate logistic regression. Results: Of the 186 included responses, only 46.7% (85 respondents) replied they have heard of PPPD and 158 (84.9%) have actually encountered patients with symptoms describing PPPD. Those in primary care had less odds of having heard of PPPD (adjusted odds ratio [aOR] 0.37 confidence interval [CI] 0.18–0.76) nor treated patients with PPPD symptoms (aOR 0.18 CI 0.07–0.49) when compared to the General Medical and ORL providers. In terms of treatment of PPPD, gender, level of training, and practice setting predicted the provision of therapy. Conclusion: PPPD awareness is still lacking among our providers and the current practices reflect that the management of chronic dizziness is focused on ruling out systemic causes. Now is the time to invest in health communication strategies to improve the awareness and knowledge of managing chronic dizziness especially PPPD. [ABSTRACT FROM AUTHOR]

Context: The Fukuda stepping test (FST) is used to assess the labyrinthine function via the vestibulospinal reflex. The test is meant to be conducted in a quiet room, but in a busy clinic setting, it is often performed in the clinic itself, and individuals are exposed to environmental sounds. Aims: The aim of this study was to assess the effects of environmental sounds and the effects of fixed directional sound on the outcome of FST. Settings and Design: This is an observational study. Subjects and Methods: Thirty healthy participants performed the FST in the otorhinolaryngology clinic, in a sound-treated room, and then in a sound-treated room with the presence of a fixed directional sound where the angle of rotation, angle of displacement, and distance of displacement were compared. Statistical Analysis Used: Independent t-test and Chi-squared test were used for statistical analysis. Results: There was no statistical difference in the angle of rotation and angle of displacement in all three settings. Although the mean distance of displacement was above 50 cm in all three settings, there was a significant reduction between clinic versus sound-treated room (P = 0.016) and clinic versus room with sound-treated directional sound (P = 0.002). Fixed directional sound had no significant influence on the direction of rotation in all the participants. Conclusions: Performing FST in the standard clinic will not affect the results. Concurrently, we suggest omitting measurement of the distance of displacement in FST as it is not reproducible in our normal sample and is highly susceptible to auditory cues but to focus on the angle of rotation. [ABSTRACT FROM AUTHOR]

Temporal lobe meningoencephalocele is a rare entity and the acquired etiology is commoner especially from iatrogenic injury to the tegmen during mastoidectomy. Non-specificity of its clinical presentations often lead to delay in diagnosis and its neurological sequalae can be devastating. Hence, both clinical suspicion and imaging are both complementary. Various approaches have been described in meningoencephalocele repair. Here, we described a successful repair of the disease via transmastoid method for a huge tegmen defect, with simple materials, included surgicel and temporalis fascia graft. [ABSTRACT FROM AUTHOR]

We present our experience in managing pathologies involving the anterior and middle cranial base using an endoscopic transnasal approach, highlighting the surgical technique, indications, and complications. The different types of endoscopic approaches used include the transtuberculum/transplanum, transcribiform, transsellar, and cavernous sinus approaches. The common indications include repair of cerebrospinal fluid leaks (both spontaneous and post traumatic) and excision of pituitary adenomas, meningiomas, craniopharyngiomas, esthesioneuroblastomas, and other malignancies of the anterior cranial base. Careful reconstruction is performed with the multilayer technique utilizing fat, fascia lata, and fibrin sealant. The endoscopic transnasal approach, coupled with the present-day sophisticated neuronavigation systems, allows access to lesions in the midline extending from the cribriform plate to the craniovertebral junction. However, preoperative planning and careful selection of cases with evaluation of each case on an individual basis with regard to the lateral extension of the lesion are imperative. [ABSTRACT FROM AUTHOR]