The head impulse test is a simple clinical test comprising high acceleration head rotation. In the presence of a severe unilateral vestibular weakness the normal vestibulo-ocular reflex is replaced by a misalignment of the eye followed by a series of corrective saccades which are evident to the examiner. Previous reports have shown the high sensitivity of the head impulse test in detecting complete unilateral weakness, but indicate poor sensitivity for mild weaknesses. This prospective, blinded study examined the head impulse test in a general clinical population of balance disorder patients to examine the sensitivity and specificity of the test, and to determine the degree of vestibular weakness that is required before the test becomes positive. One hundred and fifty patients were examined and the head impulse test results were compared to results from bithermal caloric testing. Results show that the overall sensitivity of the head impulse test is 34% with a specificity of 100%. The test does not detect mild or moderate vestibular weaknesses but is very sensitive to the presence of a severe paresis (87.5%). Head impulse testing will not replace caloric testing but is a very useful adjunct to it.
Many centres include a communication course as part of their auditory rehabilitation. These usually take the form of a small group and include discussion of the effects of hearing loss, use of the hearing aid, hearing tactics and lip reading. To investigate the efficacy of such a rehabilitation programme a randomized, controlled trial of a communication course was undertaken. All subjects were first time hearing aid users; handicap was measured using the Quantified Denver Scale of Communication Function (QDS) at the time of hearing aid fitting, and then 13 weeks later. All subjects had a hearing aid follow-up appointment, but the treatment group (n = 22) also underwent a four-week communication course, while the control group (n = 25) had no further rehabilitation. The reduction in handicap measured by the change in QDS was significantly greater for the treatment group than for the control group (Mann Whitney U test, tied p value = 0.014). This indicates that such a communication course is efficacious in reducing handicap. Further research is required to identify the populations that will benefit most from such a course.
The investigation and treatment of vestibular schwannomas is an increasingly specialized area in which major advances have been seen over recent years. The effect of these advances on the referral patterns to a centre specializing in such surgery is reviewed. The proportion of referrals with a known diagnosis has increased substantially, allowing the specialist centre to focus on appropriate management rather than diagnosis. The vast majority of vestibular schwannomas are referred by otolaryngologists. The caseload referred by neurologists or neurosurgeons have different presenting symptoms. The incidence of vestibular schwannoma in the Cambridge district is found to be 1 per 50,000 population per year. This is a higher incidence than that recorded in other studies. This may be due to a tight diagnostic strategy and the high level of clinical awareness of the local general practitioners.
Benign paroxysmal positional vertigo (BPPV) is a common condition that often resolves spontaneously, but can cause significant distress to a patient. Management of this condition includes no intervention, medication, surgery, physical exercises and more recently 'particle repositioning' manoeuvres. Repositioning manoeuvres aim to relocate free-floating particles from the posterior semicircular canal into the utricle where they will no longer cause vertiginous symptoms. This article describes the different exercises and repositioning manoeuvres in use and examines their efficacy. In the light of this review a management strategy for BPPV is suggested.
We report a case of a cerebe llopontin e angle cholesteatoma whose initial sign was benign paroxysmal positional vertigo (BPPV). Positional vertigo caused by a central pathology is extremely rare and is usually accompanied by other suspicious feat ures. In this case, there were no additional neurotol ogic symptoms or signs. The only abnormalities were seen on Dix-Hallpike testing, but because they were not consistent with a diagnosis of BPPV, the decision was made to proc eed to imaging. Diagnostic rigor is required when evaluating positional vertigo, as with all symptoms ofimbalance, if such cases are not to be over looked. From the Department of Audio logy (Mr. Beynon and Mr. Bagu ley) and the Department of Neur o-Otolo gy (Mr.
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