The apogeotropic variant of horizontal semicircular canal benign paroxysmal positional vertigo (HC-BPPV) is attributed to free floating particles in the anterior arm of the lateral semicircular canal – particles attached to the cupula facing the canal or particles attached to the cupula facing the utricle. Zuma e Maia described a new treatment for both canalithiasis of the anterior arm of the horizontal semicircular canal (HC) and cupulolithiasis of the HC. Seventeen patients with apogeotropic HC-BPPV were enrolled and treated with Zuma’s Maneuver. During the repositioning of the particles to the utricule, we observed the direction of the nystagmus evoked in each step of this maneuver in order to know where the otoliths were probably located. Eight patients were diagnosed with canalithiasis of the anterior arm, six patients with cupulolithiasis with the particles facing the canal and three patients with cupulolithiasis with the particles facing the utricle. Our data suggest that we can assume where the otoliths are probably located by observing the pattern of the nystagmus evoked in each step of the Zuma’s Maneuver in patients with apogeotropic HC-BPPV.

Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vestibular vertigo. It is caused by free-floating otoconia moving freely in one of the semicircular canals (canalolithiasis) or by otoliths adhered to the cupula (cupulolithiasis). The posterior canal is the most common canal affected, followed by the lateral canal. Diagnosis of the side affected is critical for successful treatment; therefore, suppressing visual fixation is essential to examination of these patients' eye movement. On the basis of our experience, we have adopted the Zuma maneuver and the modified Zuma maneuver for both apogeotropic and geotropic variants of lateral canal BPPV. Knowledge of the anatomy and pathophysiologic mechanisms of the semicircular canals is essential for correct management of these patients. Hence, using a single maneuver and its modification may facilitate daily neurotological practice.

The mean changes in the low-frequency PTA comparing postoperative against preoperative thresholds were 28.03 ± 6.77 dB in group 1, 30 ± 14.53 dB in group 2, and 7.23 ± 6.12 dB in group 3. There was statistical difference when comparing group 3 with groups 1 and 2 using one-way ANOVA (p = 0.002) followed by Scheffé post hoc test.

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PURPOSE: To determine whether the lower pole of the spleen grows after subtotal splenectomy following ligature of major spleen blood vessels. METHODS: Thirty-nine Wistar rats (328.8 ± 27.8 g) submitted to subtotal splenectomy with preservation of the lower splenic pole were divided into two groups: group 1 (control, n=20), immediate removal of the lower pole; group 2 (n=19), removal of the pole on postoperative day 80. The length, width and thickness of the pole were measured. In the control group, mean percent pole weight was calculated immediately after surgery in a direct and indirect manner. In the first case, the weight of the lower pole was divided by overall spleen weight; in the second case, pole weight was divided by the ideal weight of the spleen obtained by linear regression analysis. The results of the two calculations were compared. Macro- and microscopic examinations of the pole were performed. RESULTS: In group 1, no significant difference in mean percent pole weight was observed between the direct and indirect method. In group 2, mean percent pole weight obtained by indirect calculation on day 80 was higher than in group 1 (p<0.001). In group 2, mean length, width and thickness of the pole remnant increased from the first to the 80th day (p<0.05). Histological analysis showed preserved tissue architecture and features compatible with cell hyperplasia in group 2. CONCLUSION: The lower pole splenic remnant presented statistically significant growth up to postoperative day 80 after subtotal splenectomy, even after ligature of the major spleen vessels. Light microscopy revealed changes compatible with cell hyperplasia.

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ASSR thresholds were comparable to pure-tone thresholds in normal hearing adults. Nevertheless it should not be used as the only method of hearing evaluation.