Tuberculous cervical lymph node inflammation: a diagnosis to be considered in ear, nose and throat practice

Involvement of the cervical lymph nodes is one of the commonest forms of extrapulmonary tuberculosis. Given this, we carried out a retrospective study of those cases diagnosed in our health region from 1995-1997, looking at the diagnostic criteria and treatment regimes and comparing our findings with those of other authors.     

Results from the Balance Rehabilitation Unit in Benign Paroxysmal Positional Vertigo

Posturography is a useful new tool to study the influence of vestibular diseases on balance.Aimto compare the results from the Balance Rehabilitation Unit (BRU) static posturography in elderly patients with Benign Paroxysmal Positional Vertigo (BPPV), before and after Epley's maneuver.Materials and Methodsa prospective study of 20 elderly patients with a diagnosis of BPPV. The patients underwent static posturography and the limit of stability (LE) and ellipse area were measured. We also applied the Dizziness Handicap Inventory (DHI) questionnaire to study treatment effectiveness.Results80% were females, with a mean age of 68.15 years. After the maneuver, the LE increased significantly (p=0.001). The elliptical area of somatosensory, visual and vestibular conflicts (2,7,8,9 situations) in BRU and the DHI scores decreased significantly (p<0.05) after treatment.Conclusionthe study suggests that elderly patients with BPPV may present static postural control impairment and that the maneuver is effective for the remission of symptoms, to increase in the stability and improvement in postural control in situations of visual, somatosensory and vestibular conflicts.     

Vertigo induced by noise or pressure to the left ear

A 49-year-old male patient presented with recently acquired vertigo induced by noise or pressure to the left ear. With appropriate stimulation, oscillopsia with a rotatory component could be reproduced in videooculography. Cervical vestibular evoked myogenic potentials (VEMP) showed increased amplitudes and a lowered threshold on the left side. CT of the petrous bone showed a bony dehiscence of the left superior semicircular canal. Conservative therapy was initiated as a first step.     

Evaluation of provocation tests in tonsillogenic focal infection from the standpoint of fibrinolytic activity.

In this paper, we carried out provocation tests by means of ultra-short wave stimulation in patients with focal infection including palmoplantar pustulosis and examined the changes in fibrinolytic activity of the circulating blood. In the positive group with palmoplantar pustulosis, the t-PA level was slightly increased after the provocation and the FDP level in the positive group was increased. On the other hand, the AT-III activity in the positive group with palmoplantar pustulosis was decreased and the antiplasmin activity in the positive group was increased. The changes of antiplasmin activity observed in this experiment did not correspond with the pathophysiological explanation of an increased fibrinolytic activity in the circulating blood. It was suggested that a positive provocation test is accompanied by an increase in fibrinolytic activity in the circulating blood of patients with focal infection of the tonsil, and the increase in fibrinolytic activity is closely related to the positiveness of the provocation test.     

Vertigo and pathology of the cerebellospinal system

Central vertigo is most often expressed by a feeling of dizziness, non or badly systematized, but it can also appear, more seldom, like an isolated acute vertigo or associated to other neurological signs. A precise clinical exam can lead to evidence essential clinical informations (significant ataxia, neurological signs, gaze nystagmus, pursuit anomaly,...). Almost all acute lesions of central vestibular pathways, as for the peripheral ones, lead to a harmonious vestibular syndrome. The vascular lesion of the vertebro-basilar territory and multiple sclerosis are two main causes to it. The pseudo-labyrinthine forms are essentially described in occlusion infarcts of the AICA and PICA, but a hematoma can lead to the same picture; the diagnostic of multi- or monosymptomatic forms with a peripheral lesion is often very difficult, the classical classification of the central and peripheral vestibular syndromes has become obsolete and should be abandoned.     

Vertigo and pathology of the cerebello-pontine angle

Many pathologies of the cerebello-pontine angle can induce vertigo or dizziness. Usually they are due to benign or malignant tumors. Pathophysiology of this vertigo involve lesion of the labyrinth with erosion, of the endolymphatic sac by invasion or compression, or directly by lesion of the vestibular nerve like in vestibular schwannomas. The vestibular nerve can also be injured by extrinsic compression like in meningiomas. Finally very big tumors can be compressive on the cerebellum or on the brainstem inducing also dizziness. Vertigo is often an important symptom of cerebello-pontine angle tumors. In association with others it will guide the diagnosis. Nevertheless, auditory evoked potentials, video-nystagmography, and otolithic evoked potentials are very important to determine exactly if the vestibular nerve is injured and if there are signs of central compression before surgery.     

Vertigo secondary to hypotension: the relationship between therapeutic effects and hearing

Patients with vertebrobasilar insufficiency tend to develop transient, repeated vertigo. However, diagnostic criteria by which to definitively diagnose circulatory disturbance of the vertebrobasilar system have yet to be established. Thus, in order to determine such criteria the relationship between the therapeutic effects on clinical symptoms and hearing in 40 patients with vertigo secondary to hypotension were investigated in the present study. In most patients, vertigo was perceived as a floating or spinning sensation which occurred spontaneously or during positional changes and lasted for a short period of time without hearing disturbance. Audiometry revealed bilateral low-frequency hearing loss or a tendency to low-frequency hearing loss in all patients. Low-frequency hearing loss is an important audiometric indication of vertebrobasilar insufficiency. Such hearing loss is very responsive to therapeutic circulatory agents and is considered to be an index for the evaluation of the effects of treatment for vertebrobasilar insufficiency.     

Vertigo as the sole complaint of tympanomastoid paraganglioma

BackgroundTympanomastoid paragangliomas are usually benign, slowly growing, painless tumors. The common presenting symptoms of this tumor are pulsatile tinnitus and conductive hearing loss. Vertigo as the cardinal or initial symptom is extremely rare, especially in the early stages of the disease.Case presentationA 53-year-old female patient presented only with intermittent recurrent vertigo and was later found to have a tympanomastoid paraganglioma. Her symptoms disappeared completely after resection of the tumor. This is the first report in literature of a case of tympanomastoid paraganglioma with vertigo as the single symptom.ConclusionThe tympanomastoid paraganglioma is rare and its clinical symptoms are nonspecific, so it is easy to be misdiagnosed or missed. It is worth noting that although clinically uncommon, vertigo can also be the first or sole symptom of tympanomastoid paraganglioma. Detailed physical examination and imaging examination of the ear are necessary and should be carried out meticulously.