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Purpose To assess if a polyphenol compound supplementation (Vertigoval®) could improve residual dizziness earlier after benign paroxysmal positional vertigo (BPPV) and relieve patients from this disabling symptomatology. Methods In this prospective, multicentric study, 127 patients were randomized in the treatment group (TG), who received a 60-day supplementation, while 131 patients were randomized in the control group (CG), who did not receive any medication. The dizziness handicap inventory (DHI) score, static posturography, and the visual analog scale (VAS) for both dizziness (D-VAS) and nausea/vomit (N/V-VAS) were used as measures of outcome at baseline and after 30 and 60 days. Patients were asked about efficacy and tolerance to the treatment. Side effects were examined. Results A statistically significant greater decrease was established in the TG for DHI, D-VAS, and N/V-VAS compared to the CG. On the other hand, static posturography did not show statistical differences between the two groups, though a better clinical improvement after 60-day supplementation was shown in the TG in comparison to the CG. We counted mild side effects in only 2 patients. Most patients reported an excellent or good efficacy and tolerance to the treatment. Conclusion Residual dizziness is a frequent condition of unknown origin that manifests as persistent disabling imbalance after successful repositioning maneuvers for BPPV. The decreasing postural control can affect the quality of life, contributing to falling and psychological problems. The supplementation with the polyphenol compound used in our study is safe, manageable, and appeared to be able to reduce subjective symptoms and improve instability earlier, decreasing the risk of potential complications.

The purpose of this study was to define the proteome profile of fine needle aspiration (FNA) samples of malignant major salivary gland tumors (MSGT) compared to benign counterparts, and to evaluate potential clinical correlations and future applications. Patients affected by MSGT (n = 20), pleomorphic adenoma (PA) (n = 37) and Warthin’s tumor (WT) (n = 14) were enrolled. Demographic, clinical and histopathological data were registered for all patients. FNA samples were processed to obtain the protein extracts. Protein separation was obtained by two-dimensional electrophoresis (2-DE) and proteins were identified by mass spectrometry. Western blot analysis was performed to validate the 2-DE results. Statistical differences between groups were calculated by the Mann–Whitney U test for non-normal data. Spearman’s rank correlation coefficient was calculated to evaluate correlations among suggested protein biomarkers and clinical parameters. Twelve and 27 differentially expressed spots were found for MSGT versus PA and MSGT versus WT, respectively. Among these, annexin-5, cofilin-1, peptidyl-prolyl-cis–trans-isomerase-A and F-actin-capping-alpha-1 were able to differentiate MSGT from PA, WT, and healthy samples. Moreover, STRING analysis suggested cofilin-1 as a key node of protein interactions. Some of the overexpressed proteins are related to some clinical factors of our cohort, such as survival and outcome. Our results suggest potential protein biomarkers of MSGT, which could allow for more appropriate treatment plans, as well as shedding light on the molecular pathways involved.

OBJECTIVES: This cross-sectional study aims to describe the features of the suppression head impulse paradigm (SHIMP) in acute unilateral vestibulopathy (AUV) and to define its role in predicting the recovery of patients. METHODS: Thirty patients diagnosed with AUV were retrospectively analyzed. The dizziness handicap inventory score and video head impulse test parameters performed 4–8 weeks from the AUV onset constituted the main outcome measures. Patients with a worse recovery (Group 1) and patients who recovered spontaneously (Group 2) were compared. RESULTS: The SHIMP vestibulo-ocular reflex (VOR) gain was statistically significantly lower than the conventional head impulse paradigm (HIMP) VOR gain (P

Objective To assess patterns of end-organ involvement in acute unilateral vestibulopathy (AUV) and to define the recovery. Study design Retrospective chart review. Setting Tertiary academic referral hospital. Patients and interventions Fifty-nine patients fulfilling clinical criteria for AUV and evaluated using the caloric vestibular test, video head impulse test, and both cervical and ocular vestibular evoked myogenic potentials, up to 10 days from symptoms onset were included. Main outcome measures Vestibular tests and requirements for vestibular rehabilitation were analyzed. Results The most affected end-organ was the horizontal canal (97%), followed by the anterior canal (83%), utricle (73%), posterior canal (46%), and saccule (44%). Nineteen (32%) patients exhibited complete receptors lesion, while 13 (22%) exhibited damage to receptors connected with the superior division of the vestibular nerve (VN). The proportion of patients who underwent vestibular rehabilitation was higher in the latter two groups (58% for both). Partial involvement of the receptors innervated by both the division of the VN, rather than by its superior division, was detected in 22 and 24% of patients, respectively. Total or partial damage to receptors innervated by the inferior VN was not found. Conclusion Deeper understanding of AUV may be achieved through identification of its patterns. Slightly more than one-half of AUV cases seemed to be associated with a nerve lesion, with a worse clinical outcome. The remaining patients exhibited selective involvement of vestibular receptors, more probably consistent with an intralabyrinthine lesion pattern and experienced better spontaneous recovery.

Menière’s disease is a disorder of the inner ear that causes vertigo, tinnitus, fullness, and hearing loss. Several pharmacological treatments are available, but none of them has shown significant results. Betahistine has been largely used but its effect on the main symptoms of Menière’s disease remains unclear. In order to improve clinical appropriateness and to reduce the heterogeneity of the therapeutic approaches for Menière’s disease, we proposed a European Consensus Conference on Betahistine’s prescription. A group of European experts in vestibular disorders completed a questionnaire, prepared by opinion leaders, on the use of betahistine in Menière’s disease. The Delphi method was used as an iterative investigation method in order to increase and establish the consensus. While betahistine was considered useful to reduce the number of the vertigo attacks during the intercritical phase of the disease, its use during attacks was considered helpful only when associated with other drugs. Betahistine was not considered useful for preventing hearing loss. The experts support the use of betahistine during the intercritical phase of the disease to reduce the number and severity of vertigo episodes. They also defined the parameters for a good clinical approach to evaluate the efficacy of betahistine treatment for Menière’s disease.

OBJECTIVE To assess, in patients referred to vestibular rehabilitation (VR) for persistence of disability after acute unilateral vestibulopathy (AUV), whether the video head impulse test (vHIT) can be a useful technique to define the efficacy of the treatment. STUDY DESIGN Prospective clinical study. SETTING Tertiary academic referral hospitals. PATIENTS Thirty patients with residual symptoms after AUV were included. INTERVENTION Patients underwent a 10-week VR program. MAIN OUTCOME MEASURES Evaluation of dizziness handicap inventory score, high-velocity vestibulo-ocular reflex gain, asymmetry index, and catch-up saccade parameters before and after VR. RESULTS All patients reported a clear clinical improvement after VR, also demonstrated by better dizziness handicap inventory scores (p

Objectives (1) To describe the relationships among the main instrumental features characterizing an acute unilateral vestibulopathy and (2) to clarify the role of the video head impulse test in predicting the development of chronic vestibular insufficiency. Study Design Case series with chart review. Setting Tertiary referral center. Subjects and Methods Sixty patients suffering from acute unilateral vestibulopathy were retrospectively analyzed: 30 who recovered spontaneously (group 1) and 30 who needed a vestibular rehabilitation program (group 2). The main outcome measures included Dizziness Handicap Inventory score, canal paresis, high-velocity vestibulo-oculomotor reflex gain, and catch-up saccade parameters. The tests were all performed between 4 and 8 weeks from the onset of symptoms. Results The high-velocity vestibulo-oculomotor reflex gain correlated with the Dizziness Handicap Inventory score ( P = .004), with the amplitude of covert and overt saccades ( P < .001), and with the prevalence of overt saccades ( P < .001). Patients in need for vestibular rehabilitation programs had a significantly lower gain ( P < .001) and a higher prevalence and amplitude of overt saccades ( P = .002 and P = .008, respectively). Conversely, we found no differences in terms of response to the caloric test ( P = .359). Conclusions Lower values of high-velocity vestibulo-oculomotor reflex gain and a high prevalence of overt saccades are related to a worse prognosis after acute unilateral vestibulopathy. This is of great interest to clinicians in identifying which patients are less likely to recover and more likely to need a vestibular rehabilitation program.

Chronic rhinosinusitis (CRS) is the most common illness among chronic disorders that remains poorly understood from a pathogenic standpoint and has a significant impact on patient quality of life, as well as healthcare costs. Despite being widespread, little is known about the etiology of the CRS. Recent evidence, showing the presence of biofilms within the paranasal sinuses, suggests a role for biofilm in the pathogenesis. To elucidate the role of biofilm in the pathogenesis of CRS, we assessed the presence of biofilm at the infection site and the ability of the aerobic flora isolated from CRS patients to form biofilm in vitro. For selected bacterial strains the susceptibility profiles to antibiotics in biofilm condition was also evaluated.Staphylococci represented the majority of the isolates obtained from the infection site, with S. epidermidis being the most frequently isolated species. Other isolates were represented by Enterobacteriaceae or by species present in the oral flora. Confocal laser scanning microscopy (CLSM) of the mucosal biopsies taken from patients with CRS revealed the presence of biofilm in the majority of the samples. Strains isolated from the specific infection site of the CRS patients were able to form biofilm in vitro at moderate or high levels, when tested in optimized conditions. No biofilm was observed by CLSM in the biopsies from control patients, although the same biopsies were positive for staphylococci in microbiological culture analysis. Drug-susceptibility tests demonstrated that the susceptibility profile of planktonic bacteria differs from that of sessile bacteria in biofilms.

Objectives/Hypothesis The objective was to explore the role of specific patient-related and operator-related factors in pain perception during flexible laryngoscopy, which is one of the most common ENT procedures. Study Design Monocentric, randomized, individual prospective study. Methods A total of 532 patients (145 men and 387 women), without any relevant ENT diseases, underwent laryngoscopy performed by otolaryngologists with various degrees of experience. Patient discomfort was reported using visual analog scores, and willingness to repeat the experience was also recorded. Results Statistical analysis showed that greater pain was significantly associated with female patients and female otolaryngologists, whereas the pain was less severe in the cases of experienced laryngologists and older patients. Pain plays an important role in determining the willingness to repeat the examination; in fact, patients who experienced lower levels of pain during laryngoscopy were more prone to repeat the experience. Conclusion This article explores the importance of the extrinsic factors that are related to the patient and the otolaryngologist in determining the level of pain associated with laryngoscopy. Our study indicated that laryngoscopy is generally a well-tolerated procedure, causing little overall discomfort, but that a subgroup of patients may experience more pain than others, which may affect the patient's perspective toward undergoing a similar future experience. Our analysis may be helpful for clinicians in understanding pain perception during a routine procedure, enabling them to focus more on that subgroup of patients who are more prone to pain. Level of Evidence 1b. Laryngoscope, 124:1648–1652, 2014

Disequilibrium is one of the most common complaints that older adults bring to their physician and falling is a frequent complication; because of the increasing number of elderly patients in western society the problem grows. The increasing susceptibility to falling can be consequence of age-related physiological changes and of a higher prevalence of comorbidities causing dizziness, vertigo and imbalance; these symptoms can worse the already poor balance of old adults increasing the risk of falling. Among the major reasons of vertigo and dizziness, central vertigo and orthostatic vertigo are very common; also vestibular disorders have a great role and are currently thought to account for 48% of dizziness reported by older adults. An early identification of the treatable condition underlying dizziness in elderly would surely ameliorate the outcome of these patients.

OBJECTIVES To analyze and compare, in two groups of patients affected by definite Meniere's disease (MD) but treated differently, the Video Head Impulse Test findings especially by putting them in relationship with canal paresis, hearing loss, and duration of the disease. STUDY DESIGN Retrospective chart review. PATIENTS Seventy patients affected by unilateral definite MD (16 in Group 1 and 54 in Group 2) observed between March 2014 and May 2015 in a tertiary referral center were retrospectively studied and then divided into two groups: Group 1 was previously treated with intratympanic gentamicin, whereas Group 2 underwent only a conservative therapy. Instrumental tests included audiometry, caloric test, and Video Head Impulse Test. All the findings were statistically analyzed; significance was set at p = 0.005. INTERVENTION Diagnostic. MAIN OUTCOMES MEASURES If MD is treated conservatively the high-frequency vestibulo-oculomotor reflex gain determined with Video Head Impulse Test is normal; it is pathological if MD is treated with gentamicin. RESULTS High-frequency vestibulo-oculomotor reflex gain showed a statistically significant reduction in Group 1; at the same time, it showed no correlation in both groups with hearing loss, duration of disease or canal paresis. CONCLUSION High-frequency vestibulo-oculomotor reflex is naturally preserved even in late stage MD if the patient has been treated conservatively; the dissociation between Caloric Test and Video Head Impulse Test findings could be considered an instrumental hallmark of MD. Gentamicin significantly reduces high-frequency vestibulo-oculomotor reflex gain: this reduction can be taken into account when determining the effectiveness of an ablative treatment.

Objectives. (1) To compare the results of the 2 regimens of treatment at 2-year follow-up and (2) to evaluate the need and the efficacy of retreatment after the recurrence of ver- tigo attacks in a longer period of follow-up (using the Kaplan-Meier method of analysis). Study Design. Retrospective chart review. Setting. Tertiary referral center. Subjects and Methods. We analyzed 77 patients treated with intratympanic gentamicin (ITG). Thirty-five patients were treated with high-dose (HD) ITG (in total 6 injections, twice a day, repeated every 3 days) and 42 with low-dose (LD) ITG (1-2 injections). The results of treatment were evalu- ated in terms of functional level scale, control of vertigo, and hearing impairment. Results. At 2-year follow-up, a similar percentage of vertigo control was obtained in the 2 groups; the incidence of hear- ing loss and posttreatment disequilibrium was significantly higher in patients treated with HD-ITG. The long-term follow-up showed a control of vertigo attacks with a single round of treatment in 71.4% of patients treated with HD- ITG and in 55% of those treated with LD-ITG. With repeated rounds, an effective control of vertigo could be achieved in 88.5% using a HD-ITG protocol and 97.7% using a LD-ITG protocol. Conclusions. LD-ITG allows obtaining good results in term of vertigo attacks associated with a limited occurrence of side effects. The long-term follow-up showed that LD-ITG needed repeated rounds more frequently than the HD-pro- tocol. HD-ITG ran less risk of needing repeated rounds, but retreatment was ineffective in 40% of the cases requiring surgical therapy.

Objectives:1) Analyze the recurrence rate of vertigo and the need for repeated injections of two different regimens of intratympanic gentamicin (ITG) (low dose and multiple daily dose). 2) Evaluate the efficacy of retreatment after long-term recurrence of vertigo attacks.Methods:We retrospectively analyzed 2 series of patients suffering from unilateral Meniere’s disease treated with low dose ITG (42) and multiple daily dose ITG (35) in a tertiary referral center. The mean period of follow-up was 4.8 years, and the outcome measurements were a) control of vertigo attacks, b) need of repeated treatment for recurrent vertigo evaluated using the Kaplan-Meyer method, and c) incidence of side effects (post-treatment dizziness, hearing loss).Results:At 2-year follow-up, complete control of vertigo was obtained with only 1 round of treatment in 30 (71%) low dose patients and 28 (80%) multiple daily dose patients. Side effects of ITG were significantly higher in the multiple daily dose group. At long-term follow-up...

The objective was to explore the role of specific patient-related and operator-related factors in pain perception during flexible laryngoscopy, which is one of the most common ENT procedures.Monocentric, randomized, individual prospective study.A total of 532 patients (145 men and 387 women), without any relevant ENT diseases, underwent laryngoscopy performed by otolaryngologists with various degrees of experience. Patient discomfort was reported using visual analog scores, and willingness to repeat the experience was also recorded.Statistical analysis showed that greater pain was significantly associated with female patients and female otolaryngologists, whereas the pain was less severe in the cases of experienced laryngologists and older patients. Pain plays an important role in determining the willingness to repeat the examination; in fact, patients who experienced lower levels of pain during laryngoscopy were more prone to repeat the experience.This article explores the importance of the extrinsic factors that are related to the patient and the otolaryngologist in determining the level of pain associated with laryngoscopy. Our study indicated that laryngoscopy is generally a well-tolerated procedure, causing little overall discomfort, but that a subgroup of patients may experience more pain than others, which may affect the patient's perspective toward undergoing a similar future experience. Our analysis may be helpful for clinicians in understanding pain perception during a routine procedure, enabling them to focus more on that subgroup of patients who are more prone to pain.1b.