Our data, based on long-term follow-up, suggest that CRP remains an efficient and long-lasting noninvasive treatment for BPPV.

Background: Canalith repositioning procedure (CRP) has increasingly been utilized for the last 15 years for the treatment of benign paroxysmal positional vertigo (BPPV). We assess the short- and long-term efficacy of CRP on the treatment of patients with BPPV. Methods: Nine hundred sixty-five patients (481 men and 484 women, from 18 to 87 years of age) were enrolled in this prospective study during 1995–2010. Inclusion criteria were a patient history compatible with BPPV and a positive provocative maneuver (either Dix-Hallpike or Roll test). Reported duration of symptoms at the time of their first examination varied from 1 day to 18 months. Variants of the Epley and Barbeque maneuver were used for posterior and anterior canal involvement, and horizontal canal involvement, respectively. Short-term follow-up was obtained 48 h and 7 days after initial treatment, whereas long-term follow-up was obtained at repeated 6-month intervals. Results: Symptoms subsided immediately in 819 patients (85%) by the first CRP. Only 19 patients (2%) required CRP more than 3 times. Patients’ mean follow-up was 74 months; symptom recurrence was noted in 139 patients. A statistically significantly higher recurrence rate was noted in elderly people or those with head trauma or a history of vestibular neuropathy (p < 0.001). Conclusions: This study provides class IV evidence that CRP remains an efficient and long-lasting noninvasive treatment for BPPV, especially for younger patients without a history of head trauma or vestibular neuropathy. Elderly people have a significantly higher recurrence rate requiring additional education to minimize potential morbidity of their falls.

Summary:Bone marrow (BM) stem cell reserves and function and stromal cell hematopoiesis supporting capacity were evaluated in 15 patients with multiple sclerosis (MS) and 61 normal controls using flow cytometry, clonogenic assays, long-term BM cultures (LTBMCs) and enzymelinked immunosorbent assays. MS patients displayed normal CD34 þ cell numbers but a low frequency of colony-forming cells (CFCs) in both BM mononuclear and purified CD34 þ cell fractions, compared to controls. Patients had increased proportions of activated BM CD3 þ /HLA-DR þ and CD3 þ /CD38 þ T cells that correlated inversely with CFC numbers. Patient BM CD3 þ T cells inhibited colony formation by normal CD34 þ cells and patient CFC numbers increased significantly following immunomagnetic removal of T cells from BMMCs, suggesting that activated T cells may be involved in the defective clonogenic potential of hematopoietic progenitors. Patient BM stromal cells displayed normal hematopoiesis supporting capacity indicated by the CFC number in the nonadherent cell fraction of LTBMCs recharged with normal CD34 þ cells. Culture supernatants displayed normal stromal derived factor-1 and stem cell factor/kit ligand but increased flt-3 ligand levels. These findings provide support for the use of autologous stem cell transplantation in MS patients. The low clonogenic potential of BM hematopoietic progenitors probably reflects the presence of activated T cells rather than an intrinsic defect.

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Method: CCIQ is a 28-item, 5-point Likert-scale questionnaire that assesses physical and psychosocial benefits of CI. This was administered to patients who received bilateral CI at our center. Test-retest reliability and Cronbach's alpha were used to validate the CCIQ. Speech perception was tested using CNC, HINT, and AZBio. Results:We identified 103 adult bilateral CI patients from 2004 to 2011. Of 58 respondents, 21 completed a retest CCIQ. Testretest reliability was satisfactory, with 60% of items greater than 0.6. Coefficients for 6 of the 9 subdomains exceeded 0.6. Data suggest that internal consistency was acceptable (>0.7) for domains speech perception in quiet and noise, localization, and music, and good (>0.80) for subdomain vestibular effects. Descriptive statistics for speech perception on CNC were 62.4 ± 22.5% and 70.5 ± 18.4% using one versus bilateral CI, respectively. HINT scores were 68.0 ± 36.8% and 83.7 ± 15.4%, and AZBio 63.5 ± 34.6% and 91.6 ± 8.6%. Conclusion:Early CCIQ data indicate this as a promising measure in assessing quality of life specific to bilateral CI patients. Overall, patients reported improved quality of life. Quantitative data on speech perception demonstrate increased trend in audiometric scores after the second CI. However, further testing is needed to strengthen these findings.

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