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Objective: Vestibular migraine is in the process of recognition as an individual clinical entity. At present, no guidelines exist for its management. This study aimed to conduct a systematic review and meta-analysis to determine the effectiveness of available prophylactic medication. Method: A literature search was performed using PubMed, Ovid and Embase databases. Qualitative and quantitative analysis were performed as well as risk of bias analysis. Meta-analysis for the mean differences for pre- and post-treatment impact based on Dizziness Handicap Inventory and Vertigo Symptom Scale were performed. Proportionate transformation meta-analysis for the successful event rate based on complete symptoms control was explored. Results: Thirteen publications were identified: 3 were randomised, controlled trials and 10 were non-randomised, controlled trials. Propranolol and venlafaxine improved the Vertigo Symptom Scale score by −13.31 points and −4.16 points, respectively, and the Dizziness Handicap Inventory score by −32.24 and −21.24, respectively. Only propranolol achieved statistically significant impact with 60 per cent of patients achieving complete symptom control. Conclusion: Propranolol should be offered as the first-line treatment for vestibular migraine followed by venlafaxine. Amitriptyline, flunarizine and cinnarizine showed a trend for symptom improvement, but this was not statistically significant. [ABSTRACT FROM AUTHOR]

Background:Functional voice rehabilitation is becoming increasingly important following total laryngectomy and pharyngolaryngectomy. Tracheoesophageal voice via a shunt valve is currently regarded as the ‘gold standard’ for voice rehabilitation. Traditional techniques usually allow for the replacement of valves in the out-patient setting; however, patient factors such as altered anatomy may occasionally prevent this.Objective:This paper describes a novel approach for speech valve insertion that is safe, quick and cost-effective, and which uses equipment commonly available in ENT wards and the operating theatre. [ABSTRACT FROM PUBLISHER]

Objective: To investigate postoperative audiological outcomes and complication rates for fully endoscopic and microscopic stapes surgery carried out by a single surgeon in one center., Patients: All patients having undergone endoscopic and non-endoscopic stapes surgery for otosclerosis from September 2009 to August 2016 under a single surgeon., Intervention(s): Stapedotomy using either an operating microscope or endoscope for visualization. Stapedotomy was carried out using a standard approach., Main Outcome Measure(s): Pre- and postoperative audiometry and complications., Results: Thirty-four patients who underwent endoscopic stapes surgery and 47 patients who underwent non-endoscopic stapes surgery were included in this study. Seventy-nine percent of both endoscopic and non-endoscopic groups had the average air-bone gap closed to less than 10 dBHL, respectively; the difference was not significant (p = 0.940, χ test). No patients with sensorineural hearing loss, vertigo, or facial nerve paresis were reported. Two of 34 patients (6%) of the endoscopic group had the chorda tympani cut intraoperatively for access compared with 11 of 47 patients (23%) of the non-endoscopic group. Sixteen of 47 patients (34%) required an endaural incision for access in the non-endoscopic group; no endaural incisions were made in the endoscopic group., Conclusion: Air-bone gap closure and patient complications did not vary significantly between endoscopic and non-endoscopic groups in this study of 34 endoscopic procedures. There is a requirement for further studies with larger sample sizes and longer follow-up periods to fully gauge the safety and effectiveness of this technique.

Objective: Patients with systemic vasculitis (SV) have an increased risk of all-cause mortality, often due to infection, compared to the healthy population. We investigated whether humoral response to vaccination and biomarkers of immune dysfunction were associated with infection and death., Methods: Patients with SV in remission were vaccinated with pneumococcal 7-valent conjugate, Haemophilus influenzae type b, and meningococcal group C conjugate vaccine and meningococcal polysaccharide groups A, C, Y, and W135 vaccines. Total IgG and antibody titers against specific antigens and lymphocyte subset analysis were performed before vaccination. Postvaccination antibody titers were measured at 4 weeks and 2 years, from which an antibody response score was calculated. Infections and death following vaccination were collected prospectively following vaccination., Results: A total of 92 patients were safely vaccinated with no increase in disease relapse, median followup 4.6 years (interquartile range [IQR] 3.6-4.8 years). Eighteen patients died at a median of 2 years and the overall infection rate was 0.4 (IQR 0.2-1.3) infections/patient/year. Reduced serum IgG, B cell count, and CD4+ cell counts predicted poor vaccine response and infection but not death. The response rates to individual vaccine antigens was highly variable, with a median response rate of 46% (IQR 39-58%) of patients responding to each individual antigen. Vaccine response, age, and reduced renal function were independent predictors of all-cause mortality in multivariate analysis., Conclusion: Total IgG and B cell counts predict infection and response to vaccination. Vaccination in patients with SV in remission is safe and the response predicts all-cause mortality. Vaccine response is a surrogate marker of immune system health., (© 2016, American College of Rheumatology.)