Vestibulocochlear derangements have been studied in three groups of patients: 200 unselected patients with migraine (Series I), 80 migrainous patients referred because of their symptoms for full neuro-otological examination (Series II), and 116 patients with tension headache who served as controls (Series III). Significant differences were established between tension headache and migraine in respect of incidence and severity of symptoms and their time of onset in relation to the headache. In migraine, vestibulocochlear disturbances can occur as an aura, accompanying the headache or during headache-free periods, the highest incidence occurring during the headache. In Series I, 59 per cent reported vestibular and/or cochlear symptoms and these were of disabling severity in 5 per cent. Significantly, 50 per cent had a history of motion sickness and 81 per cent experienced phonophobia during the headache, the probable mechanism of which is discussed. Persisting vestibulocochlear derangements were found in 77.5 per cent of Series II, largely vestibular and of both central and peripheral origin. Involvement of the vertebrobasilar vascular system appears to be the most likely explanation. Possible links between Ménière's disease, benign paroxysmal vertigo and migraine are discussed.
Tinnitus is a condition that is difficult to treat, and treatment outcomes are difficult to measure The majority of people who experience tinnitus are not troubled by it; however, the troubled minority are referred by an otorhinolaryngologist for specialist clinic help. The aim of this study was to investigate how the impact of tinnitus changes following attendance at a tinnitus clinic and to find out how acceptable the questionnaires used were for measuring recovery. Fifty-seven tinnitus sufferers completed three questionnaires covering the characteristics of tinnitus, and its effect on daily life, quality of life, and quality of family life, before and after treatment at the Nottingham Tinnitus Clinic. Questionnaires were answered at patients' homes while they were on the waiting list to attend the clinic, and again I year after their first attendance. Measures of functional and social handicap were significantly reduced following attendance at the clinic (mean change in functional handicap = 13%, p<0.01, and mean change in social handicap = 8%, p<0.01). Quality of life was significantly better after treatment at the clinic (mean visual analog scale difference = 6.5%, p = 0.01). We conclude that attendance at the Nottingham Tinnitus Clinic had a positive effect on the impact of tinnitus on patients and their families, and that the questionnaires gave an accurate measure of patient distress.
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