No abstract

Using a representative database, we found a much higher prevalence of VM in the United States than previously reported. Results from this study indicate likely under-diagnosis of VM.

Diagnosis of Menière's disease is made with a characteristic patient history, including discrete episodes of vertigo lasting 20 min or longer, accompanied by sensorineural hearing loss, which is typically low frequency at first, aural fullness, and tinnitus. Workup includes audiometry, a contrast enhanced MRI of the internal auditory canals, and exclusion of other diseases that can produce similar symptoms, like otosyphilis, autoimmune inner ear disease, perilymphatic fistula, superior semicircular canal syndrome, Lyme disease, multiple sclerosis, vestibular paroxysmia, and temporal bone tumors. A history of migraine should be sought as well because of a high rate of co-occurrence (Rauch, Otolaryngol Clin North Am 43:1011-1017, 2010). Treatment begins with conservative measures, including low salt diet, avoidance of stress and caffeine, and sleep hygiene. Medical therapy with a diuretic is the usual next step. If that fails to control symptoms, then the options of intratympanic (IT) steroids and betahistine are discussed. Next tier treatments include the Meniett device and endolymphatic sac surgery, but the efficacy of both is controversial. If the above measures fail to provide symptomatic control of vertigo, then ablative therapies like intratympanic gentamicin are considered. Rarely, vestibular nerve section or labyrinthectomy is considered for a patient with severe symptoms who does not show a reduction in vestibular function with gentamicin. Benzodiazepines and anti-emetics are used for symptomatic control during vertigo episodes. Rehabilitative options for unilateral vestibular weakness include physical therapy and for unilateral hearing loss include conventional hearing aids, contralateral routing of sound (CROS) and osseointegrated hearing aids.

MRI image quality with a cochlear implant magnet in situ depends on several factors, which can be modified to maximize image quality in this unique patient population.

c Kerstersia gyiorum is infrequently associated with human infection. We report the isolation of Kerstersia gyiorum from two patients: the first, a patient with chronic ear infections, and the second, a patient with a chronic leg wound. Both isolates were resistant to ciprofloxacin, which has not been previously reported. CASE REPORTSC ase 1. A 55-year-old man with a past medical history of chronic ear disease, alcoholism, and smoking (2 packs/day) was seen in the Barnes-Jewish Hospital otolaryngology clinic with a chief complaint of bilateral ear drainage. At the ages of 13 and 16, he had undergone canal wall-down mastoidectomies of the right and left ears, respectively. Since that time, he had reported some hearing loss and bilateral ear drainage. One month prior to his current encounter, the patient complained of increasing drainage from his left ear, which reportedly exhibited a reddish hue and an odor of "dead fish." At that time, the patient was prescribed 0.3% ciprofloxacin-0.1% dexamethasone otic solution (four drops, twice daily). At a follow-up visit 1 month later, he admitted to being only partially compliant with his prescribed regimen. During the same visit, the left mastoid cavity was suctioned and cleaned and a specimen was taken from the posterior pocket at the sinodural angle and submitted for aerobic bacterial culture. The patient was instructed to continue using ciprofloxacindexamethasone drops and expressed that he would make an effort to be more compliant.The direct Gram stain of the specimen submitted from the mastoid cavity showed no polymorphonuclear cells, moderate numbers of Gram-positive bacilli, and moderate numbers of Gram-negative bacilli. The culture grew abundant amounts of Corynebacterium amycolatum, as well as an abundant amount of a Gram-negative coccobacillus, which appeared in singles, pairs, and short chains on Gram stain (Fig. 1A). The isolate formed flat, opaque, gray colonies with spreading edges on blood (Fig. 1B) and chocolate agar, with a colony morphology somewhat resembling that of Alcaligenes spp. but lacking the characteristic "fruity" odor associated with this genus. On MacConkey agar, the isolate was non-lactose fermenting, but colonies had a slight lavender hue (Fig. 1C), which was especially evident when the colonies were picked up using a swab (Fig. 1D). The isolate was oxidase negative, spot indole negative, catalase positive, and nonmotile. An oxidation/fermentation (OF) glucose test was performed; the isolate was found to be a nonutilizer of glucose. Disks containing vancomycin and penicillin were added to subculture plates to obtain additional information about the isolate; there was no inhibition around the vancomycin disk, and a zone size of 16 mm was measured around the penicillin disk. A Vitek 2 Gram-negative identification (GNI) card (bioMérieux, Durham, NC) resulted in no identification. A RapID NF plus assay (Thermo Fisher Scientific, Lenexa, KS) was performed and gave a biocode of 010200, which resulted in an identification of Pseudomonas oryzihabi...

Objective To study osteoradionecrosis (ORN) of the temporal bone Study Design Retrospective case review Setting Academic medical center Patients Patients were included who had previously undergone radiation to the head and neck and then developed exposed necrotic bone within the ear canal that persisted at least three months Intervention(s) Patients were treated with a variety of modalities, including conservative therapy with antibiotic ear drops and in-office debridements, hyperbaric oxygen therapy and surgery. Main Outcome Measure(s) To describe the presentation and management of patients with temporal bone osteoradionecrosis. Results 33 patients with temporal bone osteoradionecrosis were included. The most common site of primary tumor was the parotid gland (n=11), followed by the nasopharynx (n=7). The time to development of ORN varied between 1 and 22 years, with mean 7.9 years. The mean radiation dose was 62.6 Gy to the primary tumor, 53.1 Gy to the affected temporal bone, and 65.2 Gy to the affected tympanic bone. The most common symptoms of ORN were otorrhea (n=15), hearing loss (n=13), and otalgia (n=12). 15 patients had bacterial superinfection, most commonly S. aureus (n=9). Conservative therapy was successful at managing symptoms but not in eradicating exposed bone in most patients. Surgery was used for recalcitrant pain, infection, cholesteatoma, cranial neuropathies, and intracranial complications. Conclusions Osteoradionecrosis is a rare complication of radiation to the temporal bone. Management should be aimed at relief of symptoms, eradication of superinfection, and treatment of other commonly present radiation effects like cholesteatoma and hearing loss.

Objective: Currently available patient reported outcomes questionnaires for dizzy patients give limited insight into the cognitive dysfunction patients often report. Using the newly developed English version of the neuropsychological vertigo inventory (NVI), we aimed to quantify the cognitive impairment of dizzy patients. Study Design: Prospective cohort study. Setting: Tertiary neurotology clinic. Patients: Adults with vestibular diagnoses seen between June 2018 and October 2018. Patients with neurologic disorders affecting cognition were excluded. Interventions: None. Main Outcome Measure: NVI score. Secondary measures: dizziness handicap inventory (DHI) score, cognitive failure questionnaire (CFQ) score, 20-item short form health survey scores (SF20). Results: Of 67 subjects, 13 had BPPV, 11 had Menière's disease (MD), and 20 had vestibular migraine (VM). VM patients were significantly younger (43.5 versus 61.1 yrs, p = 0.016), and had significantly higher NVI (67.5 versus 51.0, p = 0.040) scores than BPPV patients. MD patients had significantly higher CFQ scores (44.8 versus 23.4, p = 0.015) than BPPV patients. NVI scores were similar between MD (67.3) and VM (67.5) patients (p = 1.000). DHI scores were similar for all patients (p = 0.102). NVI scores were highly correlated to CFQ scores (r = 0.864, p < 0.001). Conclusions: VM patients have levels of cognitive dysfunction similar to MD patients, but greater than BPPV patients. A lack of difference in DHI scores among these patients reflects its limitation in assessing the cognitive domain.

Objectives We examined whether scores on a motion sensitivity questionnaire (MSQ) could distinguish between vestibular migraine (VM) and Meniere's disease (MD). As a secondary goal, we examined whether scores on the MSQ correlated with results from caloric testing. Study Design This study administered a telephone questionnaire to subjects who met clinical criteria for vestibular migraine, Meniere's disease, and controls. Methods A MSQ was administered to 20 subjects meeting American Academy of Otolaryngology (AAO) criteria for MD, 30 subjects meeting Neuhauser criteria for both probable vestibular migraine (pVM) and definite vestibular migraine (dVM), and 22 controls. Results The average score on the MSQ was 5.9 for VM, 4.25 for MD, and 0.4 for controls. Both VM and MD scored significantly higher than controls (p= 0.0001), but results were not statistically different from each other (p= 0.17). However, average score for subjects with dVM was 7.1, which was significantly higher than subjects with pVM, whose average score was 4.2 (p= 0.045), and higher than subjects with MD (p=0.048). When each question of the MSQ was analyzed, motion sensitivity to riding in a car was found to be significantly different between VM (average score 1.1) and MD (average score 0.5), with p value of 0.048. Scores of MSQ did not correlate with total eye speed on caloric testing. Conclusions Subjects with VM and MD had elevated levels of motion sensitivity compared to controls. Subjects with VM had more motion sensitivity to riding in a car than those with MD, but their TES were not different.