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Advances in Oto-rhino-laryngology

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https://read.qxmd.com/read/30947233/the-aging-vestibular-system-dizziness-and-imbalance-in-the-elderly
#1
REVIEW
Klaus Jahn
Aging in vestibular structures with loss of hair cells in the inner ear starts early in life, but vestibular function usually remains relatively unimpaired up to advanced ages. However, dizziness and imbalance are common in the elderly and have substantial impact on the quality of life. Dizziness interferes with the everyday activities of 30% of persons over age 70. As causes can be multiple, including vestibular and non-vestibular components, it is crucial to detect the factors leading to dizziness and imbalance to maintain mobility and avoid secondary complications like falls and anxiety...
2019: Advances in Oto-rhino-laryngology
https://read.qxmd.com/read/30947212/an-overview-of-central-vertigo-disorders
#2
REVIEW
Paul Ranalli
Head motion recorded by the vestibular labyrinths is conveyed to specific brainstem and cerebellar structures that relay velocity information to eye muscles to stabilize vision, and to the axial and limb muscles necessary to stabilize balance. Neural networks enhance and extend the primary vestibular signal, and create adaptation to movement when appropriate. Pathological lesions to one or more of these structures may cause central vertigo and imbalance, and may be localized by specific forms of nystagmus and other abnormal neurological signs...
2019: Advances in Oto-rhino-laryngology
https://read.qxmd.com/read/30947211/special-considerations-for-the-pediatric-patient
#3
REVIEW
Sharon L Cushing, Blake C Papsin
Children frequently present with complaints of vertigo and/or disequilibrium. The etiology of such diagnoses include inner ear pathology, migraine and its variants, lesions of the central nervous system as well as mental health disorders, among others. The ability to reliably evaluate vestibular end-organ function is central to accurate diagnosis, however, examining children can be challenging. The current chapter will focus on the approach to assessing vestibular end-organ function in children, as well as the causes of vestibular impairment that are unique to this population...
2019: Advances in Oto-rhino-laryngology
https://read.qxmd.com/read/30947210/systemic-disease-considerations-in-the-management-of-the-dizzy-patient
#4
REVIEW
Peter A Rea, Natalie Ronan
Patients with symptoms of dizziness may present to a wide range of medical services. Awareness of the full breadth of possible diagnoses is thus helpful in managing dizzy patients. This chapter provides a comprehensive review of systemic diseases that may contribute to the complex symptom of dizziness and provide a review of recent advances in each field.
2019: Advances in Oto-rhino-laryngology
https://read.qxmd.com/read/30947209/psychiatric-considerations-in-the-management-of-dizzy-patients
#5
REVIEW
Jeffrey P Staab
Research over the last 4 decades has revealed a great deal of information about psychiatric and functional causes, consequences, and comorbidity of vestibular syndromes. Primary care clinicians, neurologists, and otologists who are willing to set aside the 20th century notion of "psychogenic dizziness" and incorporate 21st century concepts about 5 behavioral entities into their practices will be rewarded for their efforts with a marked improvement in diagnostic acumen and therapeutic effectiveness...
2019: Advances in Oto-rhino-laryngology
https://read.qxmd.com/read/30947200/videonystagmography-and-posturography
#6
REVIEW
Carolyn Falls
Videonystagmography (VNG) and posturography are two vestibular assessment techniques that are still in use today. VNG: VNG allows clinicians to observe and record eye movements in real-time. Compared with electronystagmography (ENG), VNG tracings are more detailed and can capture subtle clinical findings. The utility of the monothermal caloric screen has been proposed in various studies. When appropriate cut-offs are used, the monothermal screen can be completed with a low false-negative rate. Air is often used as a medium for caloric testing, though not without some controversy...
2019: Advances in Oto-rhino-laryngology
https://read.qxmd.com/read/30947199/assessment-of-the-vestibular-system-history-and-physical-examination
#7
REVIEW
Miriam S Welgampola, Andrew P Bradshaw, G Michael Halmagyi
So common is vertigo that diverse healthcare professionals, from audiologists to orthopedic surgeons, will eventually encounter it in their patients, if not in themselves. So treatable are vestibular disorders that it is an immense advantage to know how to assess the vestibular system. This review summarizes the history and physical examination that will help diagnose common vestibular disorders presenting with vertigo.
2019: Advances in Oto-rhino-laryngology
https://read.qxmd.com/read/30947198/benign-paroxysmal-positional-vertigo
#8
REVIEW
Ryan S Instrum, Lorne S Parnes
Purpose of Chapter: This chapter discusses the recent progress made in understanding the pathophysiology, diagnosis, and treatment of benign paroxysmal positional vertigo (BPPV). Recent Findings: Recent evidence supports the canalolithiasis model as the pathophysiological mechanism and predominant subtype of BPPV. Scanning electron micrographs of extracted posterior semicircular canal contents show free-floating otoconia of utricular origin. Calcium homeostasis has also been shown to contribute to the pathogenesis of the disorder by creating an environment in which otoconia are more prone to dislodging from their native gelatinous substrate...
2019: Advances in Oto-rhino-laryngology
https://read.qxmd.com/read/30947191/aminoglycoside-vestibulotoxicity
#9
REVIEW
John Rutka
Many pharmaceuticals have ototoxicity (both cochlear and/or vestibular) as part of their adverse medication profile. The aminoglycoside class of antimicrobials has been especially well studied in this regard. Many questions remain unanswered as to how to best monitor and prevent this complication. A bilateral vestibular loss profoundly affects an individual's quality of life, physical activities, and overall independence. Paradoxically, the effects of gentamicin ototoxicity have provided further insight into the workings of the vestibular system, especially the vestibulo-ocular reflex...
2019: Advances in Oto-rhino-laryngology
https://read.qxmd.com/read/30947187/vestibular-testing-rotary-chair-and-dynamic-visual-acuity-tests
#10
REVIEW
Yoav Gimmon, Michael C Schubert
The human vestibular system is exquisitely sensitive to detect linear and rotational head acceleration signals, processed in the brainstem and subsequently relayed to the extraocular motor neurons to generate a compensatory eye rotation. This vestibulo-ocular reflex (VOR) ensures clear and stable vision during head rotation, enabling humans to keep gaze on their desired target. In this chapter, we describe the rotary chair - one physiologic measure of the VOR, and the dynamic visual acuity (DVA) test - one behavioral measure of the VOR...
2019: Advances in Oto-rhino-laryngology
https://read.qxmd.com/read/30947185/otolith-function-testing
#11
REVIEW
Rachael L Taylor, Miriam S Welgampola
Two technically simple tests, vestibular evoked myogenic potential (VEMP) and subjective visual vertical/horizontal (SVV/H) test, have the potential to transform otolith function testing from the research laboratory to the outpatient clinic. Cervical- and ocular-VEMPs are short latency surface potentials produced through the activation of saccular and utricular afferents by sound and vibration. They are tests of dynamic otolith function. The SVV/H test in peripheral lesions probes static asymmetries in utricular function and represents a perceptual error in perceived gravitational vertical/horizontal...
2019: Advances in Oto-rhino-laryngology
https://read.qxmd.com/read/30947184/vestibular-neuritis-recent-advances-in-etiology-diagnostic-evaluation-and-treatment
#12
REVIEW
Trung N Le, Brian D Westerberg, Jane Lea
Purpose of Chapter: This chapter highlights the recent advances in etiology, diagnostic evaluation, and management of vestibular neuritis (VN). Recent Findings: The viral hypothesis has been strengthened with new evidence as the main etiology of VN. Recent evidence indicates that bedside oculomotor findings play a critical role in differentiating VN from stroke. The implementation of cervical and ocular vestibular evoked myogenic potential, and video head impulse test in vestibular function testing has made it possible to diagnose selective damage of the vestibular nerves...
2019: Advances in Oto-rhino-laryngology
https://read.qxmd.com/read/30947183/video-head-impulse-testing
#13
REVIEW
Miriam S Welgampola, Rachael L Taylor, G Michael Halmagyi
The bedside head impulse, first described nearly 20 years ago, is the single most useful clinical test of the human vestibulo-ocular reflex (VOR). The video head impulse test (vHIT), its laboratory counterpart, now enables the objective assessment of the VOR. We examine how the vHIT can be utilized in three common clinical scenarios: the acute vestibular syndrome, recurrent spontaneous vertigo, and chronic imbalance. Combined with vestibular evoked myogenic potentials (VEMPs), vHIT enables assessment of all five vestibular end-organs by a clinician within the clinic itself...
2019: Advances in Oto-rhino-laryngology
https://read.qxmd.com/read/30947180/advances-in-vestibular-rehabilitation
#14
REVIEW
Shaleen Sulway, Susan L Whitney
Vestibular rehabilitation is an exercise-based program that has been in existence for over 70 years. A growing body of evidence supports the use of vestibular rehabilitation in patients with vestibular disorders, and evolving research has led to more efficacious interventions. Through central compensation, vestibular rehabilitation is able to improve symptoms of imbalance, falls, fear of falling, oscillopsia, dizziness, vertigo, motion sensitivity and secondary symptoms such as nausea and anxiety. Early intervention is advised for falls prevention and symptom management; however, symptomatic patients with chronic vestibular disorders may still demonstrate benefit from a course of vestibular rehabilitation...
2019: Advances in Oto-rhino-laryngology
https://read.qxmd.com/read/30947176/migraine-associated-vertigo
#15
REVIEW
Timothy Hain, Marcello Cherchi
This chapter is a brief overview of migraine associated vertigo (MAV), focusing on the points most relevant to the practicing clinician. We review the definition of MAV, theories regarding its underlying pathophysiology, clinical presentation, epidemiology, findings on physical examination and oto vestibular testing, differential diagnosis, management and prognosis.
2019: Advances in Oto-rhino-laryngology
https://read.qxmd.com/read/30947173/perilymphatic-fistulas-and-superior-semi-circular-canal-dehiscence-syndrome
#16
REVIEW
Heather M Weinreich, John P Carey
Perilymphatic fistulas (PLF) and superior semi-circular canal dehiscence syndrome (SCDS) are 2 conditions that can present with sound and/or pressure-induced vertigo. PLF should be suspected in cases of trauma or surgery, while a spontaneous PLF is a diagnosis of exclusion. Research is ongoing to identify an ideal biomarker for perilymph. The diagnosis of SCDS continues to evolve with further research into vestibular-evoked myogenic potentials, electrocochleography, and higher resolution CT imaging. Treatment advances include the transmastoid approach, smaller middle fossa craniotomies, and usage of endoscopes...
2019: Advances in Oto-rhino-laryngology
https://read.qxmd.com/read/30947172/meniere-s-disease
#17
REVIEW
William P R Gibson
This article reviews 3 aspects of Meniere's disease (MD), which have been recently revisited: namely, the pathologic mechanism causing the attacks of vertigo, the clinical diagnosis, and the medical and surgical treatments. The characteristic attacks of vertigo are unlikely to be due to membrane ruptures, so a hypothesis that the vertigo is caused by a volume of endolymph shifting suddenly from the cochlea into the pars superior is suggested. The definite diagnosis according to the American Academy of Otolaryngology HNS 1995 criteria [<citeref rid="ref13">13</citeref>] failed to exclude vestibular migraine sufficiently and a revision in 2015 [<citeref rid="ref14">14</citeref>] has partly addressed this problem but another method which stresses the interaction of the cochlear and vestibular symptoms is described...
2019: Advances in Oto-rhino-laryngology
https://read.qxmd.com/read/30947168/imaging-of-temporal-bone
#18
REVIEW
I Pyykkö, J Zou, R Gürkov, S Naganawa, T Nakashima
Multidetector computed tomography has been the benchmark for visualizing bony changes of the ear, but has recently been challenged by cone-beam computed tomography. In both methods, all inner ear bony structures can be visualized satisfactorily with 2D or 3D imaging. Both methods produce ionizing radiation and induce adverse health effects, especially among children. In 3T magnetic resonance imaging, the soft tissue can be imaged accurately. Use of gadolinium chelate (GdC) as a contrast agent allows the partition of fluid spaces to be visualized, such as the bulging of basilar and Reissner's membranes...
2019: Advances in Oto-rhino-laryngology
https://read.qxmd.com/read/30947165/post-traumatic-dizziness-clinical-and-medicolegal-aspects
#19
REVIEW
Brian D Westerberg, Jane Lea, Anne F Cameron
Subjective complaints of dizziness after mild-to-moderate traumatic brain injury are common. Alterations in the mode of injury have changed the presentation symptoms. Evolutions in neuroimaging challenge conventional concepts regarding lack of evidence of injury following mild head trauma and provide hope for elucidating the site of lesion in patients with post-traumatic balance symptoms. Yet the vestibular clinician must maintain a healthy level of suspicion regarding potential exaggeration of symptoms and disability in patients with a financial incentive...
2019: Advances in Oto-rhino-laryngology
https://read.qxmd.com/read/30943517/treatment-options-for-hypopharyngeal-cancer-in-developing-countries-in-africa-south-america-asia
#20
REVIEW
Johannes J Fagan, Pankaj Chaturvedi, Luiz P Kowalski
Most cancers occur in developing countries, and therefore, a discussion about cancer care would be incomplete without providing a developing world perspective. This chapter focuses on challenges and practices relating to hypopharyngeal cancer in limited-resource public healthcare systems in developing countries and specifically in Sub-Saharan Africa, India and South America and by extension, most patients in the developing world. Management of hypopharyngeal cancer must be adapted to the availability of specialised diagnostic and therapeutic services, radiotherapy and surgical expertise, and tailored to patient factors such as reliability of follow-up and social support...
2019: Advances in Oto-rhino-laryngology
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