Ménière's syndrome and allergy.

The role of allergic and autoimmune factors in both the production and amplification of symptoms of Ménière's disease has yet to be clearly defined. Reasons to suspect an allergic factor influencing Ménière's disease include a relationship with symptoms to seasons or a suspect food, a known history of allergy in a Ménière's patient, bilaterality of symptoms, and refractoriness to the usual medical and surgical treatments. The majority of patients tested in this study were found to have rather low levels of sensitivity to inhalant allergens as measured by SET, and to have food reactions to very common "hidden" foods that are frequently ingested in the diet. By proper recognition and treatment of the underlying allergic factors affecting Ménière's disease, significant clinical improvement may be obtained even in longstanding or refractory cases.     

The causes of the development of cicatrical stenosis of the larynx and trachea in the patients presenting with Guillain-Barré syndrome

The problem of rehabilitation of the patients presenting with post-intubation stenosis of the larynx and trachea remains unresolved despite the development of new methods for the diagnostics and treatment of this condition. One of the indications for long-term artificial lung ventilation is the severe form of Guillaine-Barret syndrome associated with paralysis of breathing muscles, development of bulbar symptoms, and disturbances of trophic process in the skin and mucous membranes. However, prolonged (mean 26 days) artificial lung ventilation may result in the formation of many-layer stenosis of the larynx and trachea whereas disturbed trophic processes in the skin and mucous membranes coupled to inadequate innervation complicate the postoperative conditions of the patients and promote restenosis of the tracheal lumen.     

The role of free radicals and plasmatic antioxidant in Ménière's syndrome

The objective of this study was verification, through suitable hematochemical tests, of the supposition that central-systemic microtoxicosis plays a role either in the etiopathogenesis of Ménière's syndrome or in labyrinthine pathological processes or hypoacusis. We did not, therefore, exclude other well-known hypotheses in the causality of these pathologies. Nonetheless, one finds, particularly in the Ménière's cases, a constant homogeneous distribution of the metabolic products of this microtoxicosis, such as a high concentration of free radicals and low natural defenses (e.g., antioxidant plasmatic capacity). Therefore, there exists a kind of dangerous central and systemic presence of reactive molecules, aimed toward the polyunsaturated fatty acids and homeostatic complex enzymes, that is not compensated for by the natural antioxidant defense. The presence of this lack of balance, verified by suitable tests, has shown the rationality of use of a product made from reduced glutathione, thioctic acid, cysteine, and other antioxidants as a multipurpose antidote to this element of etiopathogenesis. Patients were divided into three groups (control, conventional therapy, and antioxidant treatment), and those in the antioxidant treatment group, especially those with Ménière's syndrome, demonstrated a net and more significant improvement. Also, parallel clinical and instrument evaluations of this new therapeutic solution, the efficacy of which has already been positively demonstrated, are expected to provide further evidence to support the primary hypothesis.     

Gradenigo's syndrome: Is fusobacterium different? Two cases and review of the literature

Gradenigo's syndrome is a rare but life threatening complication of acute otitis media (AOM), which includes a classic triad of otitis media, deep facial pain and ipsilateral abducens nerve paralysis. The incidence of Fusobacterium necrophorum infections has increased in recent years. We describe two cases of Gradenigo's syndrome caused by F. necrophorum. Additional four cases were identified in a review of the literature. Gradenigo's syndrome as well as other neurologic complications should be considered in cases of complicated acute otitis media. F. necrophorum should be empirically treated while awaiting culture results.     

Détermination of salivary pH by contact pH metry. Study of ph on the tongue and of the orifices of Wharton's and Stenon's ducts]

The authors describe an electrochemical technique for the measurement of salivary pH by contact. They present a critical study fo 167 cases. The values obtained are characteristic in terms of age and the site of determination (dorsal surface of the tongue, orifice of Wharton's or Stenon's ducts).     

Is shoulder impingement syndrome a problem in otolaryngologists?

Shoulder problems are well-documented as an occupational illness. The incidence of occupational shoulder problems is increasing. A postal questionnaire survey was conducted to see if otolaryngologists are more susceptible to shoulder impingement syndrome because of their occupation. Endocrinologists were used as the control group. Among 556 questionnaires sent to otolaryngologists, 367 (64.6%) responses were returned compared with 210 questionnaires sent to endocrinologists, of which 138 (65.7%) responses were returned. A total of 88 (24.0%) of the otolaryngologists had suffered from impingement syndrome compared with 15 (10.9%) of the endocrinologists, which was significantly different. Of those with impingement syndrome, more endocrinologists gave a history of injury or overuse compared with otolaryngologists. There must be another factor, leading to increased incidence of impingement syndrome, which may be because of the continuous flexion, and abduction of their shoulders during examination and operating on patients.     

Prognostic value of the blink reflex test in Bell’s palsy and Ramsay-Hunt syndrome

Objective

This study was designed to evaluate the prognostic value of the blink reflex (BR) test in patients with Bell’s palsy (BP) or Ramsay Hunt syndrome (RHS).

Comparing the sensitivity and specificity of cervical vestibular-evoked myogenic potentials and electrocochleography in the diagnosis of Ménière’s disease

Abstract

Objective: To compare the sensitivity and specificity of objective cervical vestibular-evoked myogenic potential (cVEMP) tuning curves and electrocochleography (ECochG) for the diagnosis of Ménière’s disease (MD).

Design: Sensitivity and specificity were calculated from 95% normative ranges of 500?Hz cVEMP threshold and ECochG SP/AP amplitude ratios.

Measures: Extra-tympanic ECochG testing to 90?dB nHL clicks and cVEMP threshold tuning curves (250–1000?Hz).

Study sample: We tested 15 patients (30 ears) diagnosed with definite bilateral MD based on the clinical criteria proposed by the American Academy of Otolaryngology Head and Neck surgery, 1995 (assumed gold standard) and 20 controls.

Results: 500?Hz cVEMP threshold was the most promising parameter to differentiate MD ears from controls. cVEMP and ECochG showed high specificity (83.3 and 100%, respectively) and low to moderate sensitivity (22.2 and 71.4%) for long term MD. ECochG sensitivity increased to 89% during a symptomatic period, compared to 33% for cVEMP. However, ECochG can be difficult to schedule during symptomatic periods. Sensitivity of cVEMP for the diagnosis of MD appears limited.

Conclusions: ECochG has higher sensitivity than cVEMP in the diagnosis of Ménière’s patients, but the ECochG SP/AP amplitude ratio measure is not perfect for the diagnosis of MD.     

Usefulness of snoreplasty in the treatment of simple snoring and mild obstructive sleep apnea/hypopnea syndrome – Preliminary report

The aim of the study: To assess the effectiveness of sodium tetradecyl sulfate injection in the region of the soft palate to treat primary snoring and mild obstructive sleep apnea/hypopnea syndrome. Sodium tetradecyl sulfate, a preparation belonging to detergents, widely applied in Poland to treat varices by the method of compressive sclerotherapy was used in the study.     

Obstructing lesions of the endolymphatic sac and duct mimicking Ménière's disease

In this retrospective case series and literature review, we demonstrate that temporal bone lesions that obstruct the endolymphatic sac or duct can cause symptoms of Ménière's disease. This finding is likely attributable to endolymphatic hydrops; initially, such cases typically masquerade as Ménière's disease. Between July 1995 and April 2002, a total of 379 patients were treated for an initial diagnosis of Ménière's disease at our institution. Among this group, 3 patients were found to have an obstructing lesion of the endolymphatic sac or duct that we felt was causally related to their Ménière's-like symptomatology. We reviewed these cases and noted the similarities in each patient's presentation, including a common pathophysiology. On imaging studies, each patient had a different pathologic lesion that involved the endolymphatic sac or duct: patient 1 had a jugular megabulb, and she was ultimately treated with vestibular nerve section; patient 2 had a cholesterol granuloma, which was treated with surgical excision; patient 3 had an endolymphatic sac tumor that was treated with surgical excision. As has been suggested in previous reports, not all cases of Ménière's disease are idiopathic. We conclude that obstruction of the endolymphatic sac or vestibular aqueduct by a mass lesion or vascular anomaly can lead to vestibulocochlear pathology that mimics Ménière's disease.