The objective was to investigate vestibular evoked myogenic potentials (VEMP) in benign paroxysmal positional vertigo (BPPV) and Meniere's disease, and to determine if this type of testing is valuable for assessing the vestibular system. A prospective controlled clinical study was designed in a tertiary referral center setting. The 62 participants included 17 healthy controls and 45 other subjects selected from patients who presented with the complaint of vertigo (25 diagnosed with BPPV and 20 diagnosed with Meniere's disease). The main outcome measures of VEMP were recorded in all subjects and findings in each patient group were compared with control findings. The VEMP for the 30 affected ears in the 25 BPPV patients revealed prolonged latencies in eight ears and decreased amplitude in one ear (nine abnormal ears; 30% of total). The recordings for the 20 affected ears in the Meniere's disease patients revealed four ears with no response, six ears with prolonged latencies (ten abnormal ears; 50% of total). Only two (5.9%) of the 34 control ears had abnormal VEMP. The rate of VEMP abnormalities in the control ears was significantly lower than the corresponding rates in the affected BPPV ears and the affected Meniere's ears that were studied (P=0.012 and P<0.001, respectively). The results suggest that testing of VEMP is a promising method for diagnosing and following patients with BPPV paroxysmal positional vertigo and Meniere's disease. Further investigations with this method in other neurotologic pathologies might also be informative.
Dysphagia is a common presenting complaint in otolaryngology practice, and there are many causes. Forestier syndrome is a rare cause of dysphagia. It is also known as diffuse idiopathic skeletal hyperostosis (DISH) syndrome or vertebral ankylosing hyperostosis. Forestier syndrome consists of anterolateral perivertebral ligament calcification. It was first described by Forestier and Rotes-Querol in 1950; diagnosis is primarily radiological and the etiology is unknown. In addition to dysphagia Forestier syndrome has been reported to cause laryngeal stridor, dyspnea, snoring and hoarseness. Other important symptoms associated with Forestier syndrome are stiffness and pain in the back, pain related to tendinitis, myelopathy related to core compression associated with the ossification of the posterior longitudinal ligament, and pain related to vertebral complications such as fracture or subluxation. We report six cases of Forestier syndrome as an etiologic factor in dysphagia and present clinical and radiological findings.
OBJECTIVE: To test the efficacy of misoprostol as a treatment for tinnitus. DESIGN: A prospective, placebo-controlled, double-blind study. SETTING: Başkent University Otolaryngology Clinic. PATIENTS: Forty adult patients who had had tinnitus for a minimum of 6 months and were free of systemic or otolaryngologic disease. Twenty-eight patients were randomly assigned to the experimental group (group I) and 12 to the control group (group II). INTERVENTION: The respective groups received active drug and placebo in increasing doses for 4 months. The effect of medications on tinnitus were evaluated by determining improvement rates in tinnitus loudness and subjective tinnitus scoring. RESULTS: In the experimental group, 18 of 28 patients showed improvement in tinnitus loudness, representing an improvement rate of 64%. The improvement rate based on subjective tinnitus scoring was 36% (10 of 28 patients). In the control group, the improvement rate for tinnitus loudness was 33% (n = 4), and the rate for subjective tinnitus scoring was 17% (n = 2). The difference between improvement rate for tinnitus loudness of the experimental group and control group was found to be statistically significant ( P = 0.039), but difference between improvement rate based on subjective tinnitus scoring was insignificant ( P = 0.119). When results in the experimental group were analyzed according to etiological factors, the improvement rate was highest in the sudden-onset subgroup (77%). CONCLUSIONS: Misoprostol provided therapeutic relief for some patients with tinnitus we studied, but further investigation of larger groups is needed. (Otolaryngol Head Neck Surg 2004;130:604-10.)
We report a case of human nasal myiasis caused by fruit fly larvae in a 33-year-old man who visited the south coast of Turkey. The fruit fly (Drosophila melanogaster) is endemic in the southern part of Turkey. Infestation with fruit fly larvae must be considered in patients who are visiting areas of the world where Drosophila is endemic. This is the first reported case of fruit fly larvae causing human nasal myiasis. The clinical presentation and treatment strategies are discussed.
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