Overall, VEMP response parameters were found to have fair to good test-retest reliability. The intraclass correlation coefficient value for amplitude was found to be more reliable than latency, with the latency of n23 more reliable than the latency of p13. Clinicians should consider these findings when interpreting VEMP responses. Maintenance of symmetric head rotation with and without EMG monitoring produced reliably reproducible results, the VEMP amplitude being the best criteria.

Objective: To compare the difference in pre- to postoperative speech performance of patients qualifying for a cochlear implant (CI) in quiet, +10 dB signal-to-noise ratio (SNR), and +5 dB SNR. Study Design: Retrospective. Setting: Tertiary referral center. Patients: Fifty-eight post-lingually deafened, unilateral CI recipients from three Groups were included: 1) those who met CI candidacy criteria with AzBio sentences in quiet, 2) in noise at +10 dB SNR but not in quiet, 3) and in noise at +5 dB SNR but not in quiet or +10 dB SNR. Intervention: Unilateral CI. Main Outcome Measures: Pre- and 1 year postoperative speech recognition scores. Results: Best-aided AzBio speech recognition of individuals in Group 1 improved significantly for all test conditions and improved significantly for Groups 2 and 3 in the +10 and +5 dB SNR test conditions postoperatively. When tested with their CI alone however, while AzBio speech recognition of individuals in Group 1 and Group 2 improved significantly in the quiet and +10 dB SNR conditions, speech recognition was not significantly changed postoperatively under any testing condition for individuals in Group 3. Conclusions: While individuals qualifying for a CI only in the +5 dB SNR condition may derive significant benefit from implantation in best aided conditions, speech understanding outcomes can be more variable thus warranting additional counseling before implantation and case-by-case consideration of listening needs and goals.

If the first CRP clears the posterior canal, there is an elevated risk of reentry or canal conversion if another Dix-Hallpike is performed immediately. These complications can be treated by additional maneuvers; if unfamiliar with these techniques, the risk can be reduced by waiting at least 15 minutes between repetitions of CRP.

Benign paroxysmal positional vertigo (BPPV) frequently recurs after treatment, so a home exercise would be desirable. We designed a self-administered exercise, the half somersault, for home use. In this randomized single-blind study, we compare the efficacy of our exercise to self-administered Epley maneuvers in patients with BPPV. Subjects performed exercises twice while observed, were re-tested with the Dix Hallpike, and then reported on exercise use for 6 months. Outcome measures were the reduction of nystagmus intensity, tolerability of induced dizziness, and long-term efficacy. Both exercises resulted in a significant reduction in nystagmus after two self-applications. The Epley maneuver was significantly more efficacious in reducing nystagmus initially, but caused significantly more dizziness during application than the half somersault. During the 6-month follow-up, the Epley group had significantly more treatment failures than the half somersault group. We believe that both exercises can be self-applied to control symptoms, but the half somersault is tolerated better and has fewer side effects as a home exercise.

The clinical diagnosis of chronic rhinosinusitis is based on the major and minor critera described by the 1997 Task Force in Rhinology (TFR). This study attempts to discriminate among the various criteria to identify individual symptom predictors of CRS as well as to evaluate the predictive accuracy of the TFR criteria in aggregate. METHODS: A retrospective chart review of 187 patients referred to a tertiary care rhinology clinic for evaluation of suspected chronic rhinosinusitis. Data reviewed included each patient's symptoms, as recorded in a standarized survey that included all of the major and minor criteria and each patient's diagnosis (CRS or other). RESULTS: Of 187 patients who met inclusion criteria, 112 (60%) were diagnosed with CRS and 75 (40%) were diagnosed with conditions other than CRS. Chronic purulent rhinorrhea and hyposmia individually and in combination were significant predictors of CRS [odds ratio (OR) 2.2, 2.3, and 3.8, respectively]. The major criteria (facial pain, congestion, nasal obstruction, nasal discharge, and hyposmia) also predicted CRS (OR 1.9) but the minor criteria (headache, fever, halitosis, fatigue, dental pain, cough, ear pain) did not predict CRS (OR 0.3). CONCLUSION: The major criteria of the 1997 TFR predict CRS but the minor criteria do not. Refinement of the symptomatic criteria for the diagnosis of suspected CRS may improve the accuracy of a clinical diagnosis of CRS. SIGNIFICANCE: This study identifies hyposmia and purulent rhinorrhea as independent predictors of CRS and confirms the predictive value of the major criteria. However, it also suggests that symptoms considered minor factors by the AAO-HNS TFR are not predictive of CRS.