Δευτέρα 25 Ιανουαρίου 2021

Lateral semicircular canal-BPPV: Prospective randomized study on the efficacy of four repositioning maneuvers

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Lateral Semicircular Canal BPPV…Are We Still Ignorant?
Jaskaran Singh & Bhanu Bhardwaj
Indian Journal of Otolaryngology and Head & Neck Surgery volume 72, pages175–183(2020)Cite this article

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Abstract
Benign Paroxysmal Vertigo is one of the most common causes of vertigo. The most common semicircular canal involved in pathogenesis of BPPV is Posterior semicircular canal. However anterior and lateral semicircular canals can also sometimes be responsible for BPPV but their involvement in pathogenesis is still underrated. The incidence of lateral semicircular canal BPPV is in literature is around 10–12% while anterior canal is about 3%. The main objective of this study was to provide the database for incidence of lateral canal BPPV from a tertiary care hospital with the aim that more clinicians incorporate this entity into their differential diagnosis when their cases of posterior canal BPPV are refractory. This was an observational cross-sectional study of 300 patients of BPPV who were coming in ENT OPD as primum or as referral. All the patients underwent both the Dix–Hallpike maneuver as well as the supine roll test. The patients who were having upbeating torsional vertical nyst agmus on Dix–Hallpike were treated on lines of posterior canal BPPV whereas those with horizontal nystagmus on supine roll test were treated on lines of lateral canal BPPV. The data was tabulated and analysed for the incidence of lateral canal BPPV. Out of 300 patients; 188 were males and 122 were females. Most commonly affected age group by BPPV was 40–50 years. Out of 300 cases 260 cases (86.6%) had posterior BPPV and 37 cases (12.3%) had lateral canal BPPV. 3 cases (1%) also had anterior canal BPPV. 30/37 cases of lateral BPPV had geotropic nystagmus while 7 cases had apo-geotropic nystagmus. Posterior canal BPPv was treated by Epleys maneuver. Superior canal BPPV was treated by Yacovino maneuver. The cases of lateral canal BPPV were treated by either Vannucchi-asprella; Gufoni; Lempert maneuver or by the combination of two maneuvers. Lateral canal BPPV is an important diagnosis to consider in all cases of BPPV. Its true incidence is still under blanket as many clinicians are not using supine roll test routinely in their practice while diagnosing BPPV. Many refractory cases of BPPV can be cured if the involvement of other canals in its pathogenesis is kept in the mind so that correct diagnostic and repositioning maneuvers can be applied. We also encourage more institutional studies on lateral canal BPPV so that a standard treatment protocol with clear indications can be designed for this entity as is available for BPPV.

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Author information
Affiliations
Sri Guru Ram Das Institute of Health Sciences and Research, Amritsar, India

Jaskaran Singh & Bhanu Bhardwaj

Mohali, India

Jaskaran Singh

Amritsar, India

Bhanu Bhardwaj

Corresponding author
Correspondence to Bhanu Bhardwaj.

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The authors declare that they have no conflict of interest.

Ethical Approval
Before starting the study Ethical Clearance was taken from the institutional ETHICAL Committee as per DECLARATION OF HELSINKI.

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Informed consent was duly taken from all the patients.

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Cite this article
Singh, J., Bhardwaj, B. Lateral Semicircular Canal BPPV…Are We Still Ignorant?. Indian J Otolaryngol Head Neck Surg 72, 175–183 (2020). https://doi.org/10.1007/s12070-019-01737-4

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Received
06 September 2019

Accepted
09 September 2019

Published
26 September 2019

Issue Date
June 2020

DOI
https://doi.org/10.1007/s12070-019-01737-4

Keywords
Horizontal canal BPPV
Lateral canal BPPV
Geotropic nystagmus
Apo-geotropic nystagmus
Supine roll test
Bow and bean test
Vannucchi asprella maneuver
Gufoni maneuver
Lempert maneuver

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Therapeutic options in Meniere's disease: Our experience

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Arch Otolaryngol
1977 Oct;103(10):589-93. doi: 10.1001/archotol.1977.00780270057007.
Therapeutic options in Meniere's disease
I K Arenberg, R F Bayer
PMID: 303093 DOI: 10.1001/archotol.1977.00780270057007


Emphasis on treatment in Meniere's disease has recently shifted from a concentration on the vertiginous component alone to include conservation or improvement of hearing as well. This presentation tabulates the current otological literature's reports of both the medical and surgical options available in the treatment of Meniere's disease. The authors conclude that these more recent reports deemphasize the importance of the vertiginous component, while emphasizing the importance of the hearing component in evaluation of the efficacy of any therapeutic modality. Furthermore, these reports indicate that endolymphatic sac decompression and drainage surgery alone offers a considerable chance for conservation or improvement in hearing, as well as relief of vertigo in early cases of reversible, fluctuating hearing deficits. In nonreversible or nonfluctuating hearing deficits with hearing worth conserving, vestibular neurectomy with excision of Scarpa's ganglion yields the best results.

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Abstract

We read with great interest the work of Boer et al [1] that explores the role of mechanical stress as a potential triggering factor for hidradenitis suppurativa (HS). The authors reported two cases of patients who developed HS along the striae distensae (SD). The hypothesis proposed by the authors to explain this ectopic lesions is the fact that SD are characterized by a decrease of dermal thickness due to destruction of collagen fibres which may reduce the mechanical support to the pilosebaceous structures and if combined to frictional forces, may trigger the onset of HS by promoting skin inflammation. Matrix metalloproteinases (MMPs) are proteases able to degrade the major components of the extracellular matrix (ECM).

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Abstract

Objectives

The purpose of this review is to summarize evidence‐based data regarding the ototoxic effects of potential COVID‐19 therapeutics to treat patients suffering from SARS‐CoV‐2.

Methods

Medications under investigation as novel therapeutics to treat COVID‐19 were identified using the search term coronavirus therapeutics, COVID therapeutics and SARS‐CoV‐2 therapeutics on ClinicalTrials.gov and the PubMed Database. A literature review was performed using the PubMed Database for each proposed COVID‐19 therapeutic to identify relevant articles. Search criteria included Medical Subject Headings (MeSH) and key word search terms for ototoxicity, vestibulotoxicity, hearing disorders and vertigo.

Results

Six proposed COVID‐19 therapeutics were identified as possessing ototoxic side effects including chloroquine and hydroxychloroquine, azithromycin, lopinavir‐ritonavir, interferon, ribavirin and ivermectin.

Conclusions

Available evidence suggests that ototoxic effects may be improved or mitigated by stopping the offending agent. Recognition of hearing loss, tinnitus or imbalance/vertigo is therefore crucial to facilitate early intervention and prevent long‐term damage. Hospitals should consider the inclusion of audiologic monitoring protocols for patients receiving COVID‐19 therapeutics with known ototoxicity, especially in high risk patient groups such as the elderly and hearing impaired.

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Objective/Hypothesis

Despite the importance of symptom management and end‐of‐life (EOL) care in head and neck cancers (HNC), there is little literature on care practices in this population. This study examines EOL care practice patterns using nationally established metrics.

Study Design

Retrospective chart review.

Methods

Review of HNC patients who were actively followed and treated (defined as one clinic note within 90 days, two within preceding 9 months, and having received treatment at our institution) and died between January 1, 2017 and December 31, 2018. The cohort was reviewed for performance on Quality Oncology Practice Initiative (QOPI®) and other metrics.

Results

Of 133 patients identified, 52 met inclusion criteria. The average age at death was 69.8 years. About 59% had distant metastases, 30% had locoregional disease, 11% were undergoing primary treatment. Twenty‐three percentage received chemotherapy within the last 14 days of life. Fifty percentage of patients were admitted in the last 30 days of life, and 33% died in the hospital. Fifty‐four percentage of patients had either Physician Orders for Life‐Sustaining Treatment or Advanced Directive on file. Eighty‐one percentage of patients had any type of goals of care discussion documented. Sixty‐five percentage of all patients received referrals to palliative care and 46% of all patients enrolled in hospice. The median days in hospice was 12. Having a goals of care discussion was significantly associated with utilization of palliative and hospice care.

Conclusions

Provider‐documented goals of care discussions were strongly correlated to referrals and enrollment in palliative and hospice care. Areas for improvement include better documentation of treatment directives and reducing low‐utility treatments.

Level of Evidence

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Abstract

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