Vertical heterophoria was identified in a group of TBI patients with postconcussive symptoms and treatment of the vertical heterophoria with individualized prismatic spectacle lenses resulted in a 71.8% decrease in subjective symptom burden and a relative reduction in VHS-Q score of 48.1%. It appears that vertical heterophoria can be acquired from TBI.
Neutralizing prismatic lenses are an effective treatment of headache, dizziness and anxiety in patients with persistent post-concussive symptoms and VH.
Aim: Mal de debarquement syndrome (MdDS) is a neurological condition characterized by a constant sensation of self-motion; onset may be motion-triggered (MT) or non-motion-triggered/spontaneous (NMT/SO). People with MdDS experience similar symptoms to those with vertical heterophoria, a subset of binocular visual dysfunction. Hence, we aimed to explore potential visual symptom overlaps. Methods: MdDS patients (n = 196) and controls (n = 197) completed a visual health questionnaire. Results: Compared with controls, the MdDS group demonstrated higher visual disorder scores and visual complaints. NMT/SO participants reported unique visual symptoms and a higher prevalence of mild traumatic brain injury. Conclusion: Our findings suggest visual disorders may coexist with MdDS, particularly the NMT/SO subtype. The difference in visual dysfunction frequency and medical histories between subtypes, warrants further investigation into differing pathophysiological mechanisms.
Objective:
Among patients presenting with dizziness, visual dysfunction must be considered, including vertical heterophoria (VH), a frequently under-identified form of binocular vision dysfunction where there is vertical discrepancy between the lines of sight of the eyes when at physiologic rest. Current self-rated screening measures do not account for complex VH symptomatology including dizziness/ambulation difficulties, nausea, headache, anxiety, neck pain, and reading impairment. VH must be differentiated from vestibular/otolithic etiologies, as their treatment frequently provides inadequate relief, yet treatment of the VH can reduce/eliminate symptoms. The objective of this study is to create a valid measurement tool (binocular vision dysfunction questionnaire) to assist in identifying VH among dizzy patients to aid in appropriate referral.
Study Design:
Retrospective case series.
Setting:
Tertiary referral center.
Patients:
One hundred twenty-six patients presenting to an optometric binocular vision subspecialist diagnosed with VH.
Intervention:
Psychometric study. The measurement tool's internal consistency and test–retest reliability was assessed. Confirmatory and exploratory factor analyses were performed. Validity was estimated through correlations with a visual analog scale and validated instruments for headaches, dizziness, and anxiety.
Main Outcome Measures/Results:
Excellent reliability demonstrated including Cronbach's alpha of 0.91 and high test–retest reliability. Statistical correlations with established measurements established sound convergent/content validity. Analysis of participants who underwent treatment indicated change in BVDQ score correlates with perception of change in symptom burden.
Conclusions:
Results suggest the BVDQ is a valid, reliable screening tool to assist otologists in identifying VH among their dizzy patients. The BVDQ may also be useful for measuring changes with various treatments, and in identifying diverse symptoms associated with BVD/VH
POSTERSResults: Eleven faculty otolaryngologists evaluated the realism of upper airway passive anatomic fidelity of 3 adult and 5 pediatric mannequins, during a 1-day course. Mean scores and standard deviations were tabulated for each mannequin at each anatomic site, and displayed in "spidergrams." Differences in scores allow comparison of mannequin anatomic fidelity by site (maximum range, 2.8 for nasopharynx) and by mannequin (maximum range, 2.1). Because of the small number of responses in this pilot study, mannequins are deidentified.
Conclusion:Ratings by survey participants demonstrated variation in the anatomic fidelity of a range of commercially available mannequins. Spidergram display of the results may allow instructors to select mannequins with the best anatomic fidelity for their specific educational purposes and may contribute to recommendations for improving mannequin fidelity.
General Otolaryngology
Contrast-Enhanced Ultrasound for Monitoring Parotid tumorsLaura Klotz, MD (presenter); Dirk Clevert, MD; Robert Gurkov, MDObjective: Contrast-enhanced ultrasound (CE-US) can be used for noninvasive analysis of functional vascularization. Lesions of the parotid gland are associated with different vascularity compared to the normal gland. The aim of the clinical trial was to evaluate CE-US as a diagnostic tool for parotid lesion.Method: For CE-US measurements, following intravenous SonoVue injection, the intensity-time curve gradients were calculated from CE-US data.
Results:The intensity-time gradients derived from CE-US measurements revealed significantly higher perfusion in the malign lesions group than the benign lesions group. Area under curve was significantly higher for malign lesions.Conclusion: CE-US-derived area under curve parameters appear as an independent and quantitative marker for the monitoring of parotid lesions. Clinical experience and further studies will have to validate this method as a reliable diagnostic tool to decide especially whether to proceed with surgery. Results: Indications for TT were 58.4% infection (71.3% recurrent, 9.2% tonsilliths/halitosis, and 19.5% recurrent and tonsilliths/halitosis), 34.2% upper airway obstruction, 3.4% obstruction/infection, and 4.0% other medical. Indications for PIT were 77.8% infection (28.6% recurrent, 50.0% tonsilliths/ halitosis, and 21.4% recurrent and tonsilliths/halitosis), 19.4% upper airway obstruction, and 2.8% obstruction/infection. Complication rates were 16.5% for infection, 6.9% for upper airway obstruction, 16.7% for obstruction and infection, and 0% for other medical reasons. Complications occurred in 14.8% of TT (72.7% hemorrhage, 27.3% dehydration) and in 5.6% PIT (hemorrhage). No significant difference in complication rate was noted for technique (P = .17) or indication (P = .21).
General Otolaryngology
Conclusion:While recurrent infection remains the most common indication for adult tonsillectomy, there is a growing rate of tonsillectomies performed for upper airway obstruction. Complication rates varied according to indic...
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