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Objectives The aim of the present study was to evaluate the ability of head-shaking nystagmus (HSNy), evoked after the resolution of a vertigo spell, to predict an imminent crisis in the early stage of Meniere's disease (MD). Materials and methods A total of 20 patients in the early stage of MD were included in the study. The head-shaking test (HST) was performed twice, during the first visit within 24 h of vertigo spell (T0) and 48 h later (T1). The onset of a new vertigo episode during the 2 weeks following the first visit was recorded in each patient's medical record. The sensitivity and specificity of HSNy toward predicting a new vertigo episode were calculated. Results At T0, an evoked ipsilesional HSNy in 15 (75%) patients was observed; in four of them, the HSNy had a biphasic component. The HSNy was present and persistent at T1 in 8 (42.1%) patients; among these cases, 6 patients had ipsilesional HSNy, and 2 patients a contralesional HSNy. None of the patients presented with a biphasic HSNy at T1. Seven (36.8%) patients experienced the recurrence of a vertigo crisis. Among these, 6 patients had ipsilesional HSNy at T1. Only 8 patients with ipsilesional HSNy at T0 did not have recurrence. The sensitivity of the ipsilesional HSNy in predicting the recurrence of vertigo in patients with MD was 100% at T0 and 85.7% at T1. The specificity was 46.6% and 100% at T0 and T1, respectively. Conclusion The HST can be a useful test in the early stages of MD to predict a new vertigo attack.

We investigated if loop characteristics correlate with audio-vestibular symptoms or hemifacial spasm in patients with a vascular loop in the root entry zone (VII and VIII) and in the internal auditory canal. A retrospective, multicenter study analyzed 2622 consecutive magnetic resonance imaging (MRI) scans of the cerebellopontine angle of patients with asymmetric audio-vestibular symptom or hemifacial spasm; patients’ symptoms were confirmed by clinical tests. MRIs displaying vascular loops visible in the axial view were analyzed using multiplanar reconstruction. We evaluated (1) depth of penetration of the loop into the internal auditory canal (IAC); (2) largest diameter of the vessel; (3) nerve(s) involved in the vascular impingement, position of the loop relative to such nerve(s) and number of contacts between vessel and nerve(s); (4) length of such contact. The loop metrics described above were correlated with the patients’ audio-vestibular symptoms and hemifacial spasm. Three hundred ninety-nine patients displayed a loop visible in the MRI axial view and out of them only 118 displayed a direct contact between loop and nerve. The cochlear nerve was involved in a contact in 57.7%. Loops in direct nerve contact had a calibre > 0.85 mm, were located in the middle portion of the IAC, and correlated with vertigo (p = 0.002), tinnitus (p = 0.003), and hemifacial spasm (p

OBJECTIVES/HYPOTHESIS The need for class I and II studies on the efficacy of liberatory maneuvers in the treatment of lateral canal benign paroxysmal positional vertigo (LC-BPPV) motivated the present double-blind randomized trial on the short-term efficacy of the forced prolonged position (FPP). STUDY DESIGN Double-blind, randomized controlled trial. METHODS Two hundred twenty-one patients with unilateral LC-BPPV met the inclusion criteria for a multicentric study. Patients were randomly assigned to treatment by FPP (116 subjects) or sham treatment (105 subjects). Subjects were followed up at 24 hours with the supine roll test by blinded examiners. RESULTS Among the sample, 67.4% and 32.6% of the patients showed respectively geotropic and apogeotropic variant of LC-BPPV. At the 24-hour follow-up, the effectiveness of FFP compared to the sham maneuver was, respectively, 57.8% versus 12.4% (P

Background Clinical heterogeneity is a peculiarity of vestibular migraine, in contrast to other vestibular disorders that have a more stereotypical expression. Migraine presents a range of variability in symptoms depending on the age of the patient. Supposing that migraine headache and vestibular migraine share the same pathogenetic mechanisms, a multiparametric analysis was performed to verify the hypotheses of an age-related influence on the clinical features of vestibular migraine at the onset. Methods In this retrospective study, we analysed the clinical records of 72 consecutive patients affected by vestibular migraine from June 2012 to November 2018: 64 females and eight males; mean age 38.2 ± 9.6. We considered only patients that reported onset of vestibular symptoms within 12 months preceding inclusion into the study. Results Statistical analysis shows a significant increase in the diagnosis of probable vestibular migraine with increasing age and a decrease in vestibular migraine diagnosis ( p = 0.034). The incidence of spontaneous dizziness increases with age ( p = 0.012); by contrast, external spontaneous vertigo, and visually induced vertigo decrease after 40 years of age ( p = 0.018), clinically characterising the onset of juvenile forms. Spontaneous vertigo, head motion-induced vertigo/dizziness, and positional vertigo did not show significant variations with age. Conclusion Our data show that the type of vestibular symptoms in vestibular migraine varies according to the age of onset.

Purpose This study aims to quantitatively compare the Jankovic assessment (JA) with electromyography (EMG)-based measures for assessing changes in facial movements in patients with facial dystonia. Materials and methods Thirteen patients (five males and eight females) affected with different forms of facial dystonia (hemifacial spasm and synkinesis) participated in this study. All patients were treated with Botulinum Toxin (BTX) and evaluated with the JA scale and EMG-based measures, including motor unit potentials (MUP) latency and presence of polyphasic potentials before and after BTX injection. Correlation between the JA scores and the EMG-based measures was calculated. Statistical analysis was performed with the Pearson test. Results Correlation between the JA scores and the EMG-based measures was found to be statistically significant, both before and after treatment with BTX. Conclusion and relevance JA scores significantly correlated with more objective EMG-based measures, suggesting that the JA scale can be used to assess facial movement changes, for example elicited by a treatment such as BTX injection. Thus, in facial dystonia patients, the JA scale may be used for evaluating treatment outcomes as a valid and low-cost alternative to EMG.

OBJECTIVES This observational study aimed to investigate the presence of potential vestibular system subclinical dysfunction among migraineurs without a history of vertigo and dizziness compared with healthy controls. METHODS Patients diagnosed with episodic migraine with and without aura were enrolled. All patients and healthy controls underwent vestibular examination using the following conventional tests: sitting position, Pagnini-McClure's, Dix-Hallpike's, head hanging, video head impulse, subjective visual vertical, Romberg, Fukuda, and caloric vestibular stimulation by Fitzgerald-Hallpike's tests. Nystagmus and angular velocity of the slow phase during culmination phase was analyzed by video-nystagmography. RESULTS Overall, 33 patients (76% female, 7 with aura and 26 without aura; mean age (mean ± SD): 29.1 ± 4.3 years) and 22 controls (33% female, mean age: 30.8 ± 9.4 years) were enrolled. There were no statistically significant differences in demographic features between patients and controls. Caloric vestibular stimulation test results were found to differ among patients and controls. In particular, right and left angular velocity (AV) were highly correlated one another (r = 0.88, P

Conjugated cyclotorsion of the eyes toward the affected side can commonly be observed in vestibular neuritis. The aim of this study was to assess the differences in cyclotorsion between the ipsi- and contralesional eye during selective involvement of the superior branch of the vestibular nerve. We studied binocular cyclotorsion through ocular fundus photographs in 10 patients affected by acute superior vestibular neuritis (SVN). Cyclotorsion was also studied in 20 normal subjects. All SVN patients showed an ipsilesional cycloversion of the eyes. Normal subjects exhibited a constant mild excyclovergence (6.42 ± 2.34°). In SVN patients, contralateral incyclotorsion (8.4 ± 8.14°) was lower and not normally distributed compared to ipsilateral eye excyclotorsion (17.9 ± 4.36°) with no correlation between them. The interocular difference in cyclodeviation could be related to the starting physiological excyclovergence, to different tonic effects on the extraocular muscles of the two eyes and to the different influence of spontaneous nystagmus on cyclodeviation in the two eyes. We recommend referring only to ipsilateral excyclotorsion in the evaluation of utricular function during SVN and its subsequent compensation. Further studies are required to determine the binocular cyclotorsion in the case of other kinds of selective involvement of the vestibular nerve.La ciclotorsione binoculare nella neurite vestibolare superiore.La ciclotorsione coniugata degli occhi verso il lato malato può comunemente essere osservata in corso di neurite vestibolare. Lo scopo di questo studio è stato quello di valutare le differenze nell’entità della ciclotorsione tra l’occhio ipsi- e contra- lesionale in caso di un coinvolgimento selettivo della branca superiore del nervo vestibolare. Abbiamo studiato la ciclotorsione binoculare ottenendo fotografie del fondo oculare in 10 pazienti affetti da neurite vestibolare superiore acuta (NVS). La ciclotorsione è stata studiata anche in 20 soggetti normali. Tutti i pazienti con NVS hanno mostrato una cicloversione ipsilesionale degli occhi. I soggetti normali invece hanno mostrato una exciclovergenza lieve costante (6,42 ± 2,34 °). Nei pazienti con NVS, l’inciclotorsione controlaterale (8.4 ± 8.14 °) era minore e non normalmente distribuita tra i soggetti rispetto alla exciclotorsione dell’occhio ipsilaterale (17,9 ± 4,36 °). Non è stata osservata correlazione significativa tra la ciclotorsione dei due occhi. La differenza interoculare della ciclotorsione potrebbe essere legato in parte alla presenza della exciclovergenza fisiologica, in parte ai diversi effetti tonici sui muscoli estrinseci dei due occhi, e infine alla diversa influenza del nistagmo spontaneo sulla ciclotorsione dei due occhi. Alla luce di questo studio consigliamo di far riferimento solo alla exciclotorsione ipsilaterale nella valutazione della funzione utricolare durante una NVS e del suo successivo compenso. Ulteriori studi sono necessari per determinare il comportamento della ciclotorsione binoculare in caso di coinvolgimento selettivo delle altre componenti del nervo vestibolare.

Background This paper examines the subjective sense of orientation during asymmetric body rotations in normal subjects. Methods Self-motion perception was investigated in 10 healthy individuals during asymmetric whole-body rotation with different head orientations. Both on-vertical axis and off-vertical axis rotations were employed. Subjects tracked a remembered earth-fixed visual target while rotating in the dark for four cycles of asymmetric rotation (two half-sinusoidal cycles of the same amplitude, but of different duration). Results The rotations induced a bias in the perception of velocity (more pronounced with fast than with slow motion). At the end of rotation, a marked target position error (TPE) was present. For the on-vertical axis rotations, the TPE was no different if the rotations were performed with a 30° nose-down, a 60° nose-up, or a 90° side-down head tilt. With off-vertical axis rotations, the simultaneous activation of the semicircular canals and otolithic receptors produced a significant increase of TPE for all head positions. Discussions This difference between on-vertical and off-vertical axis rotation was probably partly due to the vestibular transfer function and partly due to different adaptation to the speed of rotation. Such a phenomenon might be generated in different components of the vestibular system. The adaptive process enhancing the perception of dynamic movement around the vertical axis is not related to the specific semicircular canals that are activated; the addition of an otolithic component results in a significant increase of the TPE.Panichi R, Occhigrossi C, Ferraresi A, Faralli M, Lucertini M, Pettorossi VE. Adaptive changes in the perception of fast and slow movement at different head positions. Aerosp Med Hum Perform. 2017; 88(5):463-468.

Objectives/Hypothesis The need for class I and II studies on the efficacy of liberatory maneuvers in the treatment of lateral canal benign paroxysmal positional vertigo (LC-BPPV) motivated the present double-blind randomized trial on the short-term efficacy of the Gufoni liberatory maneuver (GLM). Study Design Double-blind randomized controlled trial. Methods Seventy-two patients with unilateral LC-BPPV were recruited for a multicentric study. Patients were randomly assigned to treatment by GLM (n = 37) or sham treatment (n = 35). Subjects were followed up twice (at 1 hour and 24 hours) with the supine roll test by blinded examiners. Results At 1- and 24-hour follow-up, 75.7% and 83.8% of patients, respectively, undergoing GLM had recovered from vertigo, compared to around 10% of patients undergoing the sham maneuver (P < 0.0001). Conclusion To the best of our knowledge, this is the first class I study on the efficacy of the GLM in the treatment of LC-BPPV in both geotropic and apogeotropic forms. GLM proved highly effective compared to the sham maneuver (P < 0.0001). The present class I study of the efficacy of the GLM changes the level of recommendation of the method for treating LC-BPPV from level U to level B for the geotropic variant and from level B to level A for the apogeotropic variant of LC-BPPV. Level of Evidence 1b. Laryngoscope, 2013

Self-motion perception and vestibulo-ocular reflex (VOR) were studied during whole body yaw rotation in the dark at different static head positions. Rotations consisted of four cycles of symmetric sinusoidal and asymmetric oscillations. Self-motion perception was evaluated by measuring the ability of subjects to manually track a static remembered target. VOR was recorded separately and the slow phase eye position (SPEP) was computed. Three different head static yaw deviations (active and passive) relative to the trunk (0°, 45° to right and 45° to left) were examined. Active head deviations had a significant effect during asymmetric oscillation: the movement perception was enhanced when the head was kept turned toward the side of body rotation and decreased in the opposite direction. Conversely, passive head deviations had no effect on movement perception. Further, vibration (100 Hz) of the neck muscles splenius capitis and sternocleidomastoideus remarkably influenced perceived rotation during asymmetric oscillation. On the other hand, SPEP of VOR was modulated by active head deviation, but was not influenced by neck muscle vibration. Through its effects on motion perception and reflex gain, head position improved gaze stability and enhanced self-motion perception in the direction of the head deviation.

The aim of this work is to reexamine our experience with the treatment of conductive and mixed hearing loss using the Baha system. The system was implanted in 47 patients (16 adults and 31 children under the age of 14), bilaterally in two cases. The causes of hypoacusis were bilateral congenital aural atresia (31 patients), bilateral chronic otitis media or outcomes of middle-ear surgery (Gillett et al. in J laryngol Otol 120:537-542, 2006), and otosclerosis (Pazzaglia et al. in Acta Orthop Scand 54:574-579, 1983). The following parameters were assessed: mean preoperative air- and bone-conduction thresholds for the frequencies of 500, 1,000, 2,000 and 4,000 Hz; mean postoperative threshold with the Baha; hearing improvement calculated by subtracting the postoperative threshold with the Baha from the preoperative threshold for air conduction in the better ear; speech audiometry test; improvement in the quality of life, calculated using the Glasgow Benefit Inventory for the adult patients and the Glasgow Children's Benefit Inventory for paediatric patients; frequency and type of surgical complications. Follow-up ranged from 6 to 38 months. The audiological results were satisfactory, with air-bone gap closure in 85.1% of cases. In terms of quality of life, assessment using the Glasgow Benefit Inventory showed a clear-cut improvement in health for all the 45 patients that answered to the questionnaires in our study. Out of the 49 operations that were performed, complications were reported in 3 cases (6.1%): 2 cases of skin regrowth around the titanium screw and one in which the abutment was not osseointegrated. The data from this study show that the Baha system offers a high percentage of success, which can significantly improve the patient's quality of life, and a low rate of complications.

Residual dizziness (RD) following the resolution of a benign paroxysmal positional vertigo (BBPV) episode is frequently reported by patients. Possible causes are still under debate in the literature. This study discusses the possible role of otolithic function and of elapsed time from onset of symptoms to diagnosis in the genesis of RD. In total, 116 patients younger than 65 years with their first episode of BPPV and without any other comorbidities were enrolled in the study. Before a bedside examination, subjective visual vertical (SVV) was determined in the case of a history suggestive of BPPV. SVV was tested 1 week later in those patients with BPPV of the posterior semicircular canal, and in whom positioning maneuvers showed resolution of BPPV. At 1 week control, reported RD and Dizziness Handicap Inventory (DHI) were recorded. Diagnosis and treatment of BPPV occurred within 4 days in 43 patients (group A), between 5 and 8 days in 38 patients (group B) and in more than 9 days in 35 patients (group C). Higher values of reported RD and DHI were recorded in group C, while higher values of SVV deviation were recorded in group A with an inverse relationship between SVV and DHI. Initial peripheral vestibular function asymmetry due to BPPV can induce a new central adaptation. This adaptation becomes better established the longer otoconia remain floating in the endolymph. Because of these changes, the brain is unable to quickly readapt to the old pattern after resolution resulting in more persistent RD.

This is a study of Subjective Visual Vertical (SVV) perception during acute attacks of Ménière's disease (MD) with comparative evaluation of concurrent nystagmus. We studied 21 patients with unilateral MD during the acute phase and 7 days later. Of the nine patients with an initial attack of MD, seven had an alteration of SVV perception and of these, three indicated a match with canal functional signs, while four patients showed an opposite trend of SVV perception relative to the spontaneous nystagmus. Nine of the 12 patients with definite MD had a pathological SVV perception always in correspondence with the same type of canal event. At 1-week control, no patient with an initial MD attack had alteration of SVV perception, whereas 5 patients with definite MD presented a pathological SVV perception toward the affected side. In the course of acute attacks of unilateral MD, clinical manifestations may include otolithic involvement and this may have an opposite trend compared to concomitant canal signs, especially during initial attacks. This behavior allows us to distinguish clinical signs of maculo-canal "correspondence" and "dissociation" with a significant prevalence of the second indication in those subjects with an initial MD attack.

Objective: Comparative evaluation of two tests that, as a visual reference, respectively use a static light source (static testing) and a dynamic one (dynamic testing) to analyze subjective visual vertical in patients with unilateral vestibular dysfunction. Study Design: Prospective study. Setting: Otolaryngology and Cervicofacial Surgery Division, Department of Medical-Surgical Specialization, University of Perugia, Italy. Patients: Forty-two patients with unilateral vestibular dysfunction. Interventions: Determination of subjective visual vertical 1 to 2 days (first test) after the onset of vertigo. Repetition of 8 to 10 days (second test) and 90 days (third test) after onset. Main Outcome Measures: Test sensitivity and specificity. Results: The sensitivity of the static test was 85.7, 73.3, and 59.5% during the first, second, and third test, respectively. The dynamic test showed a sensitivity of 91.3, 86.8, and 78.1%, respectively. Specificity was 100% for the static test and 96.7% for the dynamic test. Conclusion: The dynamic test proved to be more useful in the weeks after the onset of dysfunction. Given the greater sensitivity of this test, the reduction in perception error time makes it more suitable for revealing false negatives that emerged when using the static test alone.

CHARGE syndrome is a rare, polymalformative disease, representing one of the major causes of associated blindness and deafness. Bilateral, severe-profound, sensorineural hearing loss is common in CHARGE children. Aim of this study is to present our results in children with "CHARGE syndrome" submitted to cochlear implantation (CI). The frequency of anatomic anomalies, possible variations in the surgical technique of CI, and the audiological/rehabilitative benefits attained in our patients are reported. we submitted 5 children affected by CHARGE syndrome with profound, bilateral, sensorineural hearing loss to CI. Otoacoustic emissions, auditory brainstem response, acoustic impedance testing, cranial computed tomography and magnetic resonance were carried out preoperatively in all children. CI was performed using the mastoidotomy-posterior tympanotomy approach in two cases, and the suprameatal approach in three children. Infant toddler-meaningful auditory integration scale was used to evaluate kid's audiological performance before and after CI. Intra-operatory findings and postsurgical complications were evaluated. Among our patients, intraoperative anatomical malformations were cochlear hypoplasia (100 %), ossicles malformations (100 %), semicircular canals aplasia (100 %), oval window atresia (60 %), round window atresia (40 %), widening of the aqueduct of the vestibule (20 %), and aberrant course of the facial nerve (20 %). No intra- or postoperative complication was recorded in relation to implant positioning. After a follow-up ranging from 1 to 4.5 years, only 2/5 patients used oral language as the sole mean of communication, 1 started utilizing oral language as the main mean of communication, while 2 patients did not develop any linguistic ability. In conclusion, CI in patients with CHARGE association is feasible and, despite results variability, it should be carried out in CHARGE children with severe hearing loss as soon as possible. Although the selection of a specific surgical technique does not seem to influence the audiological outcome, the suprameatal access is valuable when important surgical landmarks (i.e. lateral semicircular canal and incus) are absent.

The need for Class I and II studies on the efficacy of Semont’s liberatory maneuver (SLM) in the treatment of posterior canal benign paroxysmal positional vertigo (PC-BPPV) motivated the present double-blind randomized trial on the short-term efficacy of SLM. A total of 342 patients with unilateral PC-BPPV were recruited for a multicenter study. Patients were randomly assigned to treatment by SLM (n = 174) or sham treatment (n = 168). Subjects were followed up twice (1 and 24 h) with the Dix–Hallpike maneuver by blinded examiners. At the 1 and 24 h follow-up, 79.3 and 86.8%, respectively, of patients undergoing SLM had recovered from vertigo, compared to none of the patients undergoing the sham maneuver (p < 0.0001). Patients who manifested liberatory nystagmus at the end of SLM showed a significantly higher percentage of recovery (87.1 vs. 55.7%; p < 0.0001). To the best of our knowledge, this is the first Class I study on the efficacy of SLM. SLM proved highly effective with respect to the sham maneuver (p < 0.0001). Liberatory nystagmus was demonstrated to be a useful prognostic factor for the efficacy of treatment. The present Class I study of efficacy of SLM changes the level of recommendation of the maneuver for treating PC-BPPV from level C to level B.

Aims Aural atresia is a congenital disease constituted by partial or complete lack of development of the external auditory canal, which is generally associated with malformations of the auricle and middle ear. Reconstruction of the auditory canal and correction of any deformities of the middle ear have yielded unpredictable results and variable functional outcomes, and there is a high rate of complications. Therefore, the use of bone-conduction hearing aids, such as the Baha, may represent a valid alternative for subjects who have conductive hearing loss with cochlear reserve that, as a rule, is fully conserved. The aim of this work is to reexamine our experience with the management of conductive and mixed hearing loss using the Baha system in children with bilateral aural atresia. Methods We examined 31 patients with bilateral congenital aural atresia in whom a Baha system had been implanted. The patients, 16 males and 15 females, were between 5 and 14 years of age (mean 8.7). The following parameters were assessed for each patient: mean preoperative air and bone conduction for frequencies between 0.5 and 4 kHz; mean preoperative threshold with conventional bone-conduction hearing aids; mean postoperative threshold with the Baha system; improvement in quality of life evaluated with the Glasgow Children's Benefit Inventory; rate and type of surgical complications. Results The mean preoperative air- and bone-conduction thresholds were 51.2 ± 12.5 and 14.1 ± 6.3 dB HL, respectively. The mean preoperative threshold with a conventional bone-conduction hearing aid was 29.3 ± 7.2 dB HL, and the mean postoperative threshold with the Baha system was 18.1 ± 7.5 dB HL. Quality of life improved for all operated patients. Conclusions The results of our study of the Baha system to treat patients with bilateral aural atresia were extremely satisfactory compared both with those of surgical reconstruction of the auditory canal and those of traditional bone-conduction hearing aids. Furthermore, great improvement was noted in quality of life, while the rate of complications was very low. Therefore, we are convinced that the Baha system is the treatment of choice for hearing loss due to bilateral congenital aural atresia.

Objective The study analyses the behavior of subjective visual vertical (SVV) in benign paroxysmal positional vertigo (BPPV) before and after treatment, and offers a clinical-pathogenic interpretation. Methods We studied 30 consecutive patients with BPPV of the posterior semicircular canal treated with the Epley repositioning maneuver. SVV was determined at three different stages: at the time of diagnosis (1st test), after the repositioning maneuver (2nd test), and then 7 days after the resolution of the clinical picture (3rd test). The main study parameter was represented by the mean of 6 consecutive measurements (SVV0) for each patient. SVV was also examined in 20 healthy subjects, who represented the control group. The comparison between mean values and standard deviations showed a statistical significance of p Results During the first test, the degree of deviation of SVV was significantly higher in the patient group than in the control group. Tilting towards the affected side was observed in all cases. The 2nd test showed an inversion in the orientation of SVV in 16 patients, and as a result of the Epley maneuver there was a statistically significant variation in SVV0 values in 20 patients with respect to the previous test (2nd test vs. 1st test). This involved 87% (23 patients) of those who then had a negative Dix–Hallpike test, and none of the ones in whom paroxysmal positional nystagmus persisted. Lastly, no differences emerged in the behavior of the patient group vs. the control group during the third test. Conclusions SVV is often altered during active BPPV. The degree of otolithic dysfunction is never high and, in all cases, it is brief in duration. Tilting towards the dysfunctional side is essentially a constant in untreated BPPV. This could be due to a substantial loss of otoconia, with a decrease in the density and specific weight of the macula, and thus hypofunction of the receptor. The observation of a significant variation in SVV after therapeutic maneuvers has a favorable predictive value, as it probably reflects the migration of otoliths to the utricle, where saturation mechanisms can often have irritative effects leading to the inversion of SVV.

We present the results of tinnitus retraining therapy (TRT) in a group of patients suffering from tinnitus and/or hyperacusia. Based on the scores from a specific questionnaire and the Tinnitus Handicap Inventory (THI), the patients were classified into five categories and began therapy according to Jastreboff's criteria. Depending on the individual case, therapy envisaged counselling sessions, ambient sound enrichment, sound generators and hearing aids. At the end of the 18-month period, therapeutic success was observed in 79% of the patients. The initial numerical values of the scale of the symptoms and the THI seem predictive of treatment outcome. The use of instruments (sound generators) increases the success rate, but the study also demonstrates the effectiveness of counselling and ambient sound enrichment. Failures mainly involved patients with hypacusia who refused to wear hearing aids, as this influenced the effectiveness of ambient sound enrichment and counselling. Paralleling the data in the literature, the results demonstrate the effectiveness of TRT, which cannot be attributed to a placebo effect given the extended duration of treatment.

The aim of the study was to ascertain the validity of a personal protocol used for the diagnostic classification of a group of 20 patients suffering from migraine without aura and with recurrent vertigo and postural disorders. A series of ten factors (anamnestic and constitutional) considered predictive of migrainous vertigo and four types of response to sensory provocation made it possible to identify two types of patients: type A, simultaneous presence of at least 5 (or =50%) of the 10 factors considered and at least 2 (or =50%) of the four established responses; type B, presence of fewer than five factors (or =50%), or of more than five (or =50%) but fewer than two (or =50%) of the responses envisaged by the protocol. All patients underwent migraine prophylaxis for 4 months. Vertigo and postural status were evaluated using a questionnaire, i.e. the Dizziness Handicap Inventory (DHI), and a posturographic test before and after prophylaxis. The treatment was considered effective by 30% of the total group of 20 patients and by 75% of type A patients. No improvement was recorded in type B patients. Furthermore, the latter group did not show significant changes in the DHI or posturographic tests. Instead, type A patients demonstrated a statistically significant reduction in sway area and DHI score at the end of prophylaxis (P = 0.001). Research into a particular constitutional functional habitus, thus, proved useful for the diagnostic definition of migraine-associated vertigo.

Our goal was to verify the existence of otolithic dysfunction or mental stress in patients with dizziness following an episode of benign paroxysmal positional vertigo (BPPV) that was treated and resolved.Prospective study.Forty patients with BPPV were examined 2, 7, and 14 days after resolution. Based on residual symptoms reported during three follow-ups, they were classified as type A (with dizziness) or type B (without dizziness). During the first follow-up, they were asked to compile a self-rating anxiety scale (SAS), and we then determined subjective visual vertical (SVV). The determination of SVV was repeated during the subsequent follow-ups. For each patient, we also evaluated the rate of BPPV episodes that were recurrent and resistant to treatment and examined distribution by age and gender during the follow-ups.A comparison of type A (1.20 +/- 0.45) and type B (0.64 +/- 0.58) patients showed a significant difference in determining SVV only at the first follow-up (p = .002). Among type A patients, the rate of resistant BPPV was 75%, whereas the rate of recurrent BPPV was 100% at the third follow-up, during which the SAS revealed a significant increase (p = .005) among type A (52 +/- 3.74) versus type B (41.6 +/- 4.7) patients; the male to female ratio was 1:5 (type A) and 4:5 (type B), and the mean ages were, respectively, 56.4 +/- 4.98 and 43.6 +/- 10.2.Otolithic dysfunction explains only brief dizziness. The persistence of dizziness is correlated with mental stress that is affected by the duration and recurrence of BPPV, age, and gender.

Our study examined the posture of 15 patients who had sustained a simple unilateral or bilateral fracture of the condylar head of the mandible as a result of sports or traffic accidents. Following preliminary testing of vestibular function, the patients underwent balance testing: Romberg test with eyes closed (EC), Romberg EC and bite test (ECBT), EC and head retroflexed (ECR). The study parameters were: surface (S) of the statokinesigram, stomatognathic influence index related to S (SSI), and postural oscillations on the frontal plane (X). In keeping with the literature, we felt that the following pattern in static balance suggested a posture destabilised by the stomatognathic system: SSI values of less than 60, reduction of S in the transition from EC to ECR, pathological increase of postural oscillations on the X plane. The study was completed by obtaining a list of new symptoms reported by the patients (altered bite, fullness, tinnitus, pain, loss of balance). The most significant patterns were observed in patients with vestibular dysfunctions and neck pain. It seems that a fracture of the condylar head can affect postural behaviour, although proprioceptive changes alone are not enough to cause true loss of balance and there must be concomitant vestibular dysfunction. The stabilometric pattern is not conditioned by the extent of the trauma or the related treatment. In terms of proprioceptive elements, the presence of muscle pain seems to point to cervical muscle tension as the main culprit in the onset of posttraumatic instability.

OBJECTIVE The study provides a qualitative evaluation of unilateral vestibulopathy by comparing otolithic and canal function, to establish possible relationships between the type of dysfunction observed and the evolving clinical pictures associated with it. STUDY DESIGN Retrospective study of a series of cases. SETTING Department of Medical-Surgical Specialization, Otolaryngology and Cervicofacial Surgery Division, University of Perugia, Perugia, Italy. PATIENTS Twenty patients whose medical history showed at least one episode corresponding to the clinical parameters of acute vestibulopathy. INTERVENTIONS Study of vestibular function by recording VEMPs and repeating canal function testing at least 6 months after the first episode of vertigo. MAIN OUTCOME MEASURES Relationship between the type of vestibulopathy (canal and otolithic) and the clinical pictures observed. RESULTS Paroxysmal positional vertigo, observed in 4 patients, was correlated with the presence of vestibular evoked myogenic potentials (VEMPs) and the absence of an ipsilateral canal response in all cases (100%). Persistent dizziness was observed in nine patients, and VEMPs were absent in all of them (100%); three (33.3%) showed the recovery of previously absent canal function. Comparison of responses in six patients with recurrent acute vestibulopathy showed persistent and complete loss of canal function in five cases (83.3%), whereas impairment of otolithic response was less constant (40%). CONCLUSION The combined VEMPs-canal test study shows predictive value regarding certain evolving clinical pictures of vestibulopathy. The absence of VEMPs confirms the role of otolithic dysfunction in the onset of dizziness. Likewise, it suggests that a vestibular origin of these disorders should be considered in cases that have shown aspecific symptoms since onset, without frank vertigo and with normal vestibular response to canal function testing.

Objectives – The aim of the study was to investigate the occurrence of equilibrium disturbances in headache patients, during the interictal period, by computerized static stabilometry. Materials and methods – Sixty-seven patients were studied: 35 with migraine without aura (MwoA), 12 with tension-type headache (TTH) in the episodic form (ETTH) + MwoA, and 20 with only TTH [10 ETTH + 10 chronic (CTTH)]. The stabilometric parameters considered were: statokinesigram length (L) and surface (S) in open (EO) and closed (EC) eyes conditions with/without occlusal bite, EC with head retroflexion (ECR), and optokinetic stimulation (OKN). Results – The alteration of at least one of the stabilometric parameters was observed in 45 patients (67.2%): 21 MwoA, 8 ETTH + MwoA, and 16 TTH (8 ETTH + 8 CTTH). Conclusion – In TTH patients (ETTH, CTTH, ETTH + MwoA), the stabilometric findings show a proprioceptive alteration induced by cervicofacial muscle contraction, which was peripheral in origin. In MwoA patients the alterations appear under OKN and support a control impairment in involuntary oculomotility of central origin.