Evaluation of postural stability in patients wit unilateral vestibular hypofunction: effect of feet orientation

Objective To investigate effect of feet orientation on the evaluation of the postural stability in patients with unilateral vestibular hypofunction(UVH) by timed standing tests and static posturography (SPG). Methods 65 subjects with UVH and 92 healthy subjects regarded as control group took the postural stability tests in four different stances including(1) standard Romberg test, (2) feet-apart stance test, (3) tandem and (4) unilateral standing tests. In each stance, the postural stability was measured in both eyes open (EO) and eyes closed(EC) conditions. The average time that subjects kept balance before falling in each test conditions was recorded by stopwatch as the timed result. In addition, the sway velocity(SV) of center of foot pressure in the upright stance during standard Romberg test and feet apart stance, regarded as postural stability, was also recorded as SPG. Results (1) The balance-maintaining time of the UVH group in tandem and unilateral standing with EO and EC was decreased(P < 0.001) compared with the control group. (2) The SVs during standard Romberg test and foot-apart stance with EO were not different between the UVH group and control group (P = 0.118 and 0.110 respectively), but significant with EC condition(P < 0.001). (3) For both groups, the SV during foot-apart standing was shorter than standard Romberg test both with EO and EC(P < 0.05 and P < 0.001). (4) There was no correlation between the balance time and SV for either groups(P > 0.05). Conclusions The results suggest that the tandem and unilateral stance tests may provide additional information about the upright stance to the SPG measurement in patients with UVH. The effect of feet orientation on SPG measurements should be considered.

Quick repositioning maneuver for horizontal semicircular canal benign paroxysmal positional vertigo

Objective:To investigate the efficacy of quick repositioning maneuver for horizontal semicircular canal benign paroxysmal positional vertigo (H-BPPV). Methods:Clinical data of 67 patients with H-BPPV who underwent quick repositioning maneuver in our hospital from July 2009 to November 2014 were retrospectively analyzed. The maneuver involved rotating the patient in the axial plane for 180? from the involved side towards contralateral side as quickly as possible. Results:Complete symptom resolution was achieved in 61 patients (91.0%) at one week and in 64 patients (95.5%) at 3 months post-treatment. During the repositioning maneuver process, there were no obvious untoward responses except transient nausea with or without vomiting in a few patients. Conclusion:The results indicate that the quick repositioning maneuver is an easy and effective alternative treatment in the management of H-BPPV. Copyright ? 2015 The Authors. Production & hosting by Elsevier (Singapore) Pte Ltd On behalf of PLA General Hospital Department of Otolaryngology Head and Neck Surgery. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Modified Titration Intratympanic Gentamicin Injection for Unilateral Intractable Ménière's Disease

This study looked into the efficacy of a modified titration protocol of intratympanic gentamicin injection（ITG） in the patients with unilateral intractable Ménière＇s disease（MD）. Modified titration protocol of ITG at a low dose（20 mg/m L） was administered to 10 patients with definite unilateral intractable MD. After initial first two fixed ITGs on weekly basis,the patients might or might not be given any more injections,depending on the appearance of unilateral vestibular loss（UVL）. ITG was terminated if the patients satisfied the criteria of UVL. All patients were followed-up for at least two years. The effects of ITG on the vertigo attack,functional level scores and postural balance were evaluated. Of the 10 cases,8 showed the sign of UVL after receiving initial two ITGs and were not given any more intratympanic injections,and the other 2 patients were administered three ITGs. A two-year follow-up revealed that complete and substantial vertigo control was achieved in 9 cases,and limited vertigo control in 1 patient. Hearing level was lowered in 2 patients. The posture stability and functional level scores were improved. Our study showed that the modified titration protocol of ITG at a low dose could effectively control vertigo in patients with unilateral intractable MD.

New views on benign paroxysmal positional vertigo

Benign paroxysmal positional vertigo(BPPV)is the most common vestibular peripheral disease,and has increasingly become the focus of research on vertigo diseases in recent years.In particular,otolaryngology and neurology societies worldwide have placed a greater focus on the study of BPPV.This article reviews the current diagnosis and treatment status and research progress of benign paroxysmal positional vertigo in China from the aspects of disease etiology,pathology,and pathophysiology.We will also consider potential future research in this field.