DOCSLIB.ORG

Resolution of Persistent Post-Stapedotomy Vertigo with Migraine Prophylactic Medication

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Resolution of Persistent Post-Stapedotomy Vertigo with Migraine Prophylactic Medication Otology & Neurotology 38:1500–1504 ß 2017, Otology & Neurotology, Inc. Resolution of Persistent Post-Stapedotomy Vertigo With Migraine Prophylactic Medication ÃOmid Moshtaghi, ÃHossein Mahboubi, ÃYarah M. Haidar, ÃyRonald Sahyouni, ÃHarrison W. Lin, and ÃyHamid R. Djalilian ÃDivision of Neurotology and Skull Base Surgery, Department of Otolaryngology–Head and Neck Surgery; and yDepartment of Biomedical Engineering, University of California, Irvine, California Objective: To describe persistent post-stapedotomy vertigo indicating an incidence of 0.9% at our institution. The onset (PSV) and its treatment using migraine prophylaxis. of vertigo symptoms was on average 20 days postopera- Patients: A retrospective review of all patients with persis- tively. All five patients had daily vertigo episodes and tent PSV spanning 10 years at a tertiary academic hospital experienced complete resolution with no vertigo episodes was performed. Patients who experienced persistent vertigo after treatment. Symptomatic resolution was achieved over for a minimum of 3 months after surgery were included. an average of 9 weeks after initiating treatments. Those with possible perilymph fistula, long prosthesis, and Conclusions: Persistent PSV beyond 3 months is a rare benign paroxysmal positional vertigo were excluded. occurrence and its treatment can be challenging when there Interventions: All patients received instructions on migraine is no evidence of an underlying pathology. This subset of dietary and lifestyle changes and Vitamin B2 and magne- patients may be suffering from migraine, which was sium. In addition, prophylactic treatment with nortriptyline, triggered postoperatively. Treatment with migraine prophy- verapamil, or a combination thereof was started. laxis in this cohort of patients may result in resolution of Main Outcome Measure: Changes in vertigo frequency was vertigo. Key Words: Migraine—Persistent post- the main outcome variable. The secondary outcome variables stapedotomy vertigo—Stapedectomy—Stapedotomy— included the time period and medications necessary to Vertigo. achieve symptomatic resolution. Results: Four women and one man with an average age of 53 years were identified that met criteria for persistent PSV Otol Neurotol 38:1500–1504, 2017. Complications of stapes surgery are relatively rare and Some patients with persistent PSV may have no appar- include persistent conductive hearing loss, prosthesis ent underlying etiology, making diagnosis and treatment displacement, vertigo, dysgeusia, deafness, and facial challenging. In our practice, we have anecdotally noted nerve injury (1,2). Post-stapedotomy vertigo (PSV) that these patients commonly report a history of affects 8.5 to 45% of patients following stapes surgery. migraine. We concluded that a subset of patients with PSV is typically transient and resolves within 1 week persistent PSV could be suffering from vestibular (3,4). In 0.5 to 2.6% of patients, vertigo may persist migraine and surgical stress may have triggered the beyond 4 weeks (5,6). In these cases, long prosthesis, vertigo. In this study, we aimed to investigate the results perilymph fistula (PLF), benign positional vertigo of treating persistent PSV with a migraine prophylaxis (BPV), and pneumolabyrinth have to be ruled out (7– regimen. 9). A high-resolution CT scan of the temporal bone, Epley maneuver, and autologous blood patch comprise METHODS the work up to evaluate for these conditions (10–14). A retrospective chart review spanning 2006 to 2016 was conducted with permission from our Institutional Review Address correspondence and reprint requests to Hamid R. Djalilian, Board. All post-stapedotomy patients who developed PSV M.D., Division of Neurotology and Skull Base Surgery, Department of persisting beyond 2 months were included. Before initiating Otolaryngology–Head and Neck Surgery, University of California migraine prophylaxis, all patients were evaluated for other Irvine, 19182 Jamboree Road, Otolaryngology-5386, Irvine, CA possible etiologies according to an algorithm outlined in 92697; E-mail: [email protected] Presented at the American Otological Society Annual Spring Meet- Figure 1. As such, all patients with possible PLF, long prosthe- ing; April 26–30, 2017; San Diego, CA. sis, and BPV were systematically identified and excluded from Financial Disclosure: None. the study. Once all potential etiologies were ruled out, patients The authors disclose no conflicts of interest. began a migraine prophylactic treatment regimen (Fig. 2). The DOI: 10.1097/MAO.0000000000001596 first line therapy was commonly nortriptyline, verapamil, or 1500 Copyright © 2017 Otology & Neurotology, Inc. Unauthorized reproduction of this article is prohibited. RESOLUTION OF PERSISTENT POST-STAPEDOTOMY VERTIGO 1501 Present with PSV Diagnostic Dix Hallpike Epley Oral Prednisone maneuver 1mg/kg x 5 days No improvement Improvement IT blood Stop patch treatment No improvement Improvement Determine if change Stop in pressure induces symptoms treatment Yes No CT scan r/o Migraine long prosthesis prophylaxis Yes No Consider changing Migraine prosthesis prophylaxis No improvement Improvement Consider Continue treatment for perilymph 3 months followed by fistula repair taper FIG. 1. Treatment algorithm for PSV and steps taken to rule out other etiologies. PSV indicates post-stapedotomy vertigo. both if there was no symptomatic resolution. Second line describing an episodic true rotatory vertigo (Table 1). treatment was topiramate if resolution was not achieved with All patients had a primary diagnosis of otosclerosis and first line therapy. All medications were given at escalating experienced improved hearing postoperatively. Two doses. Patients were also instructed to improve the consistency patients (40%) had a history of episodic vertigo before of their sleep hygiene and adhere to a strict migraine diet which stapedotomy while two (40%) had a history of migraine avoids foods that can trigger migraine (15,16). After 3 months of symptomatic relief, the drug(s) were tapered off one at a time. headaches, meeting international headache classification Symptom resolution was confirmed with multiple follow-up (IHS) criteria for migraine. None of the patients met appointments for at least 1 year postoperatively. criteria for vestibular migraine. There were no distinguish- ing features between patients with regards to severity of RESULTS otosclerosis, age of onset, and postoperative hearing when compared with the overall otoslecrosis cohort. Between 2006 and 2015, 312 stapedotomies were Postoperatively, all patients developed daily vertigi- performed at our institution. Of these, three patients nous episodes with an average postoperative onset of experienced persistent PSV, resulting in an incidence 20 days (range, 2–60 d). These patients were observed of 0.9%. Additionally, two patients with persistent PSV and treated as outlined in Figure 1 for at least 2 months were referred after being operated at other institutions. following the onset of vertigo and before initiation of The average age was 53 years, with all patients migraine treatment. All patients had CT scans to rule out Otology & Neurotology, Vol. 38, No. 10, 2017 Copyright © 2017 Otology & Neurotology, Inc. Unauthorized reproduction of this article is prohibited. 1502 O. MOSHTAGHI ET AL. Otology & Neurotology, Vol. 38, No. 10, 2017 underwent empirictation and intratympanic elevation autologous changes (Table blood with 1). combination Both therapy. required patients a trial ofpatients a required third drug combinationpatient (topiramate) therapy after responded and failure to oneDose patient escalation single was medicationwas necessary confirmed therapy. at in Two avertigo all minimum upon cases. completion of of 1 Only(range, migraine year one prophylaxis after 3–15 which treatment. achieved wk). over There an wasment average treatment complete was course resolution initiated,seen of in of complete 9 all weeks symptomatic cases.Otosclerotic Once plaques relief the in was migraineings the prophylactic fistula treat- ante withuate fenestrum for were long no prosthesis.possible All superior/posterior canal evidence patients dehiscence had and negative to of find- eval- vertigo. cochlearFIG. otosclerosis. 2. Two patients had pressure induced vertigo, with eruc- Copyright ©2017 Otology&Neurotology,Inc. Unauthorizedreproduction ofthisarticleisprohibited. Nortriptyline Treatment approach to the management of post stapes 25mg No symptomaticimprovement No No symptomaticimprovement Magnesium oxide400mg Migraine lifestyleand and riboflavin200mg hypertensive? Verapamil 120mg diet changes Topiramate On SSRIor Nortriptyline 25mg and AND daily 25mg Verapamil Yes 120mg TABLE 1. Defining features of subjects included in the study Duration and Time Until Days of Treatment Hx of Hx of Medications Air-Bone Frequency of Post-op Until Complete Vertigo Migraine Used to Significant Significant Gap After Vertigo Before Symptom Symptomatic Before Headache Achieve Migraine Vertigo Age Sex Surgery Treatment Development Resolution Surgery Before Surgery Resolution Triggers Triggers 67 F 1.25 1–3 seconds, daily 60 days 15 weeks No No 75 mg nortriptyline and None Eructation, yawning, 240 mg verapamil change in elevation 58 M 3.75 30 minutes, three 2 days 6 weeks No Yes 50 mg nortriptyline Erratic eating schedule Food triggers and when hungry times per week 51 F 13.75 15 minutes, daily 5 days 13 weeks Yes Yes 75 mg nortriptyline and Sleep deprivation None 180 verapamil and stress 53 F 1.25 1–3 seconds,
Load more

Recommended publications
  • CASE REPORT Resolution of Delayed Sudden Sensorineural Hearing Loss After Stapedectomy
    The Mediterranean Journal of Otology CASE REPORT Resolution of Delayed Sudden Sensorineural Hearing Loss After Stapedectomy: A Case Report and Review of the Literature Noam Yehudai, MD, Michal Luntz, MD From the Department of Significant sensorineural hearing loss may develop immediately after suc- Otolaryngology, Head and Neck cessful stapedectomy but sometimes occurs months or even years later. Surgery, Bnai-Zion Medical The rate of recovery from that disorder has not been determined. Several Center, Technion-Israel School of Technology, Haifa, Israel reports in the 1960s described patients with delayed sensorineural hear- ing loss, but that entity has not been mentioned in the English-language Correspondence literature for the last 30 years. We present a review of the literature on this Michal Luntz, MD postsurgical auditory complication and describe a patient with delayed Department of Otolaryngology, Head and Neck Surgery poststapedectomy sensorineural hearing loss that developed 15 months Bnai-Zion Medical Center, after surgery and resolved completely after treatment with an oral steroid. Technion-Israel School of Technology 47 Golomb St, PO Box 4940, Haifa 31048, Israel Phone: 972-4-8359544 Fax: 972-4-8361069 E-mail: [email protected] Submitted: 05 February, 2006 Revised: 07 May, 2006 Accepted: 09 May, 2006 Mediterr J Otol 2006; 3: 156-160 Copyright 2005 © The Mediterranean Society of Otology and Audiology 156 Resolution of Delayed Sudden Sensorineural Hearing Loss After Stapedectomy: A Case Report and Review of the Literature
    [Show full text]
  • Consultation Diagnoses and Procedures Billed Among Recent Graduates Practicing General Otolaryngology – Head & Neck Surger
    Eskander et al. Journal of Otolaryngology - Head and Neck Surgery (2018) 47:47 https://doi.org/10.1186/s40463-018-0293-8 ORIGINALRESEARCHARTICLE Open Access Consultation diagnoses and procedures billed among recent graduates practicing general otolaryngology – head & neck surgery in Ontario, Canada Antoine Eskander1,2,3* , Paolo Campisi4, Ian J. Witterick5 and David D. Pothier6 Abstract Background: An analysis of the scope of practice of recent Otolaryngology – Head and Neck Surgery (OHNS) graduates working as general otolaryngologists has not been previously performed. As Canadian OHNS residency programs implement competency-based training strategies, this data may be used to align residency curricula with the clinical and surgical practice of recent graduates. Methods: Ontario billing data were used to identify the most common diagnostic and procedure codes used by general otolaryngologists issued a billing number between 2006 and 2012. The codes were categorized by OHNS subspecialty. Practitioners with a narrow range of procedure codes or a high rate of complex procedure codes, were deemed subspecialists and therefore excluded. Results: There were 108 recent graduates in a general practice identified. The most common diagnostic codes assigned to consultation billings were categorized as ‘otology’ (42%), ‘general otolaryngology’ (35%), ‘rhinology’ (17%) and ‘head and neck’ (4%). The most common procedure codes were categorized as ‘general otolaryngology’ (45%), ‘otology’ (23%), ‘head and neck’ (13%) and ‘rhinology’ (9%). The top 5 procedures were nasolaryngoscopy, ear microdebridement, myringotomy with insertion of ventilation tube, tonsillectomy, and turbinate reduction. Although otology encompassed a large proportion of procedures billed, tympanoplasty and mastoidectomy were surprisingly uncommon. Conclusion: This is the first study to analyze the nature of the clinical and surgical cases managed by recent OHNS graduates.
    [Show full text]
  • OTOLARYNGOLOGY to Request These Clinical Privileges, the Following Threshold Criteria Must Be Met: 1
    DELINEATION OF PRIVILEGES PRACTICE AREA: OTOLARYNGOLOGY To request these clinical privileges, the following threshold criteria must be met: 1. Licensed by the State of Iowa as M.D. or D.O., AND 2a. Board Certification by the American Board of Otolaryngology or the American Osteopathic Board of Ophthalmology and Otolaryngology with certification in otolaryngology, OR 2b. Successful completion of an ACGME or AOA accredited residency program in otolaryngology WITH board certification in 5 years or less of residency completion. AND 3. Maintain admitting otolaryngology privileges at one of the UnityPoint Health-Des Moines Hospitals, one of the Mercy Health Network-Des Moines Hospitals, VA Central Iowa Health Care System or Broadlawns Medical Center. Surgeons with VA privileges only will be limited to schedule adult patients only at the center. OTOLARYNGOLOGY PRIVILEGES - I am requesting otolaryngology surgery privileges for: Requested Granted □ □ Correct or treat various conditions, illnesses, and disorders of the head and neck affecting the ears, facial skeleton, and respiratory and upper alimentary system □ □ Endoscopy of the larynx, tracheobronchial tree, and esophagus to include biopsy, excision, revision and foreign body removal □ □ Exploration / Debridement / Repair /Excision / Biopsy / Aspiration of soft tissue, skin or nodes of the head or neck □ □ Surgery of the frontal, ethmoid, sphenoid and maxillary sinuses and turbinates, including endoscopic sinus surgery, septoplasty □ □ Surgery of the oral cavity and oral pharynx, hypo pharynx,
    [Show full text]
  • Transient and Steady State Auditory Responses with Direct Acoustic Cochlear Stimulation Nicolas Verhaert,1,2 Michael Hofmann,1 and Jan Wouters1
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Lirias Transient and Steady State Auditory Responses With Direct Acoustic Cochlear Stimulation Nicolas Verhaert,1,2 Michael Hofmann,1 and Jan Wouters1 Objectives: Direct acoustic cochlear implants directly stimulate the rehabilitation. Present-day technology does not adequately code cochlear fluid of the inner ear by means of a stapes piston driven by an speech’s fine structure and shows limited F0 information trans- actuator and show encouraging speech understanding in noise results mission (Milczynski et al. 2009; Blamey et al. 2013). Although for patients with severe to profound mixed hearing loss. Auditory evoked rarely encountered in standard cases, cochlear implantation in potentials recorded in such patients would allow for the objective evalu- advanced otosclerosis, a common cause of severe to profound ation of the aided auditory pathway. The aim of this study was (1) to mixed hearing loss, can result in fitting problems such as facial develop a stimulation setup for EEG recordings in subjects with direct acoustic cochlear implants, (2) to show the feasibility of recording audi- nerve stimulation (Toung et al. 2004). Despite the fact that CIs tory brainstem responses (ABRs) and auditory steady state responses are associated with a higher chance of acceptable speech under- (ASSRs), and (3) to analyze the relation between electrophysiological standing in quiet (Merkus et al. 2011), the above mentioned thresholds derived from these responses and behavioral thresholds. possible drawbacks could persuade caretakers to tend stapes surgery before cochlear implantation in advanced otosclerosis. Design: For the three subjects implanted during a phase Ib clinical study Recently, a powerful acoustic hearing implant for direct in the authors’ center, ABRs and 40 and 80 Hz ASSRs were recorded with a straightforward acoustic stimulation setup and a newly developed acoustic cochlear stimulation was developed and showed direct stimulation setup.
    [Show full text]
  • Effectiveness of the Epleys Maneuver for Treatment of Benign Paroxysmal
    Effectiveness of the Epleys Maneuver for Treatment of Benign Paroxysmal Positional Vertigo Salah Uddin Ahmmed1, Md Zakir Hossain2,Mohammad Neser Uddin2, Sarder Mohammad Golam Rabbani2, Arba Md Shaon Mursalin Alman3. Abstract Background: Benign Paroxysmal Positional Vertigo (BPPV) is one of the most frequent vestibular disorder. It is characterized by recurrent spells of vertigo associated with certain head movements such as turning the head to right or left, getting out of bed, looking up and bending down. Objectives: The aim of this study was to compare the efficacy of treatment by the Epley maneuver with medicine and medicine (betahistine) only for benign paroxysmal positional vertigo. Materials and Methods: Fifty six patients with benign paroxysmal positional vertigo were randomly divided in two groups. One group was treated with Epley maneuver wth medicine as case and other group with only medicine (betahistine) as control. Results: At the end of first week who were treated with Epley maneuver with medicine, 24 (85.71%) patients recovered and 27 (96.42%) were recovered at second week and all the 28 (100%) were found recovered at end of third week. Whereas, who treated with betahistine only 7(25.00%) recovered at end of first week 22 (78.58%) recovered at second week, 25 (89.29%) recovered at third week and all the 28 (100%) were at end of fourth week. Who received only medical therapy needed one more extra visit than case patients Conclusion: Treatment of BPPV with the Epleys manouvre with medicine resulted in early better and improvement of symptoms than with medicine alone. Keywords: Benign paroxysmal positional vertigo, Epleys manouvre, betahistine.
    [Show full text]
  • Chronic Conductive Hearing Loss in Adults Effects on the Auditory Brainstem Response and Masking-Level Difference
    ORIGINAL ARTICLE Chronic Conductive Hearing Loss in Adults Effects on the Auditory Brainstem Response and Masking-Level Difference Michael O. Ferguson, MD; Raymond D. Cook, MD; Joseph W. Hall III, PhD; John H. Grose, PhD; Harold C. Pillsbury III, MD Objective: To determine whether chronic conductive Results: When comparing the patients’ diseased ears hearing loss in adults results in changes in the auditory with their healthy ears, significant delays were seen for brainstem response (ABR) similar to those observed in wave V as well as for the I-V and III-V interwave inter- children with histories of otitis media with effusion. vals. For comparison with the control population, sig- nificant prolongations were again seen for wave V and Design: Test of effect of unilateral conductive hearing for the III-V interwave intervals. In addition, reduced loss on adult ABR using age-matched control group and masking-level differences and significant correlations subjects as their own controls. between the masking-level differences and the ABRs, independent of hearing threshold, were noted. Subjects: Twelve adults with a history of unilateral con- ductive ear disease. An age-matched control group of 21 Conclusions: The results suggest that chronic con- adults was also tested. ductive impairment in adults leads to changes in the ABR similar to those observed in children with histo- Methods: The ABR, an electrophysiologic test of audi- ries of otitis media with effusion. As such, these tory brainstem functioning, was used to evaluate pos- changes do not appear to be related to a critical period sible brainstem abnormalities in the impaired listeners.
    [Show full text]
  • Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo
    OTOXXX10.1177/0194599816689667Otolaryngology–Head and Neck SurgeryBhattacharyya et al 6896672017© The Author(s) 2010 Reprints and permission: sagepub.com/journalsPermissions.nav Clinical Practice Guideline Otolaryngology– Head and Neck Surgery Clinical Practice Guideline: Benign 2017, Vol. 156(3S) S1 –S47 © American Academy of Otolaryngology—Head and Neck Paroxysmal Positional Vertigo (Update) Surgery Foundation 2017 Reprints and permission: sagepub.com/journalsPermissions.nav DOI:https://doi.org/10.1177/0194599816689667 10.1177/0194599816689667 http://otojournal.org Neil Bhattacharyya, MD1, Samuel P. Gubbels, MD2, Seth R. Schwartz, MD, MPH3, Jonathan A. Edlow, MD4, Hussam El-Kashlan, MD5, Terry Fife, MD6, Janene M. Holmberg, PT, DPT, NCS7, Kathryn Mahoney8, Deena B. Hollingsworth, MSN, FNP-BC9, Richard Roberts, PhD10, Michael D. Seidman, MD11, Robert W. Prasaad Steiner, MD, PhD12, Betty Tsai Do, MD13, Courtney C. J. Voelker, MD, PhD14, Richard W. Waguespack, MD15, and Maureen D. Corrigan16 Sponsorships or competing interests that may be relevant to content are associated with undiagnosed or untreated BPPV. Other out- disclosed at the end of this article. comes considered include minimizing costs in the diagnosis and treatment of BPPV, minimizing potentially unnecessary re- turn physician visits, and maximizing the health-related quality Abstract of life of individuals afflicted with BPPV. Action Statements. The update group made strong recommenda- Objective. This update of a 2008 guideline from the American tions that clinicians should (1) diagnose posterior semicircular Academy of Otolaryngology—Head and Neck Surgery Foun- canal BPPV when vertigo associated with torsional, upbeating dation provides evidence-based recommendations to benign nystagmus is provoked by the Dix-Hallpike maneuver, per- paroxysmal positional vertigo (BPPV), defined as a disorder of formed by bringing the patient from an upright to supine posi- the inner ear characterized by repeated episodes of position- tion with the head turned 45° to one side and neck extended al vertigo.
    [Show full text]
  • A Practical Approach to Assessment and Treatment of Benign Paroxysmal Positional Vertigo Combining Research and Clinical Practice
    A Practical Approach to Assessment and Treatment of Benign Paroxysmal Positional Vertigo Combining research and Clinical Practice Naseem Chatiwala, PT, DPT, MS, NCS Board certified Neuro Clinical Specialist Certified Vestibular Specialist Workshop Objectives • Analyze normal and abnormal anatomy and physiology of the vestibular system • Recognize signs and symptoms of BPPV and confidentially identify variants of BPPV • Explain physiologic rationale of test procedures and results of various test for BPPV • Utilize results of clinical examination to develop treatment plans • Be able to identify treatment procedure Overview • In the USA, 1.7 million people sustain a TBI each year • 30% and 65% of people with TBI suffer from some form of dizziness and/or have balance problems at some point during their recovery • 28% of individuals with head trauma have BPPV • A smaller study, of 69 patients with chronic BPPV, found a history of head or neck trauma in 81% of the cohort Pisani et al, 2015 Iglebekk W, 2017 Definitions • Vertigo • Disequilibrium • Presyncope • Floating or rocking sensation • Light headedness ?? DIZZY?? 4 Anatomy and Physiology • 3 Components – Peripheral sensory Apparatus • Motion sensors – Central processor • Vestibular nuclear complex and Cerebellum – Motor output • To ocular muscles and spinal cord Central Sensory Input Motor Output Processor 5 Peripheral Sensory Apparatus [ Motion Sensors] Three Semicircular Canals Lateral, Anterior (superior) and posterior Two Otolith Organs Utricle Saccule 6 • Lateral Canal: Angled at 30°
    [Show full text]
  • Audiology Staff At
    3rd Edition contributions from and compilation by the VA Audiology staff at Mountain Home, Tennessee with contributions from the VA Audiology staffs at Long Beach, California and Nashville, Tennessee Department of Veterans Affairs Spring, 2009 TABLE OF CONTENTS Preface ...................................................................................................................... iii INTRODUCTION ..............................................................................................................1 TYPES OF HEARING LOSS ...........................................................................................1 DIAGNOSTIC AUDIOLOGY ............................................................................................3 Case History ...............................................................................................................3 Otoscopic Examination ..............................................................................................3 Pure-Tone Audiometry ...............................................................................................3 Masking ......................................................................................................................6 Audiometric Tuning Fork Tests ..................................................................................6 Examples of Pure-Tone Audiograms ........................................................................7 Speech Audiometry ....................................................................................................8
    [Show full text]
  • Epley Manoeuvre for Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo in People with Multiple Sclerosis: Protocol of a Randomised Controlled Trial
    Open access Protocol BMJ Open: first published as 10.1136/bmjopen-2020-046510 on 18 March 2021. Downloaded from Epley manoeuvre for posterior semicircular canal benign paroxysmal positional vertigo in people with multiple sclerosis: protocol of a randomised controlled trial Cristina García- Muñoz ,1 María- Dolores Cortés- Vega ,1 Juan Carlos Hernández- Rodríguez ,2 Rocio Palomo- Carrión,3 Rocío Martín- Valero ,4 María Jesús Casuso- Holgado 1 To cite: García- Muñoz C, ABSTRACT Strengths and limitations of this study Cortés- Vega M- D, Hernández- Introduction Vestibular disorders in multiple sclerosis (MS) Rodríguez JC, et al. Epley could have central or peripheral origin. Although the central ► This randomised controlled trial will be the first to manoeuvre for posterior aetiology is the most expected in MS, peripheral damage is semicircular canal benign address knowledge gap on the effectiveness of the also significant in this disease. The most prevalent effect of paroxysmal positional vertigo in Epley manoeuvre in a multiple sclerosis population. vestibular peripheral damage is benign paroxysmal positional people with multiple sclerosis: ► Double- blind and concealed allocation will reduce vertigo (BPPV). Impairments of the posterior semicircular protocol of a randomised the possibility of bias. controlled trial. canals represent 60%–90% of cases of BPPV. The standard BMJ Open ► Videonystagmography goggles will enable the pri- gold treatment for this syndrome is the Epley manoeuvre (EM), 2021;11:e046510. doi:10.1136/ mary outcome of the research to be measured more bmjopen-2020-046510 the effectiveness of which has been poorly studied in patients objectively. with MS. Only one retrospective research study and a case ► Prepublication history and ► The Epley manoeuvre is an easy and quick vestib- study have reported encouraging results for EM with regard additional material for this ular treatment that results in significant changes in to resolution of posterior semicircular canal BPPV.
    [Show full text]
  • Mastoidectomy/Stapedectomy
    MastoidectoMy/ stapedectoMy/ Myringoplasty/ tyMpanoplasty St. Vincent’s Factsheet What is a mastoidectomy? What will happen on the day of my Surgery? A mastoidectomy is the removal of the mastoid bone. We ask that you shower before you come to hospital, and remove your jewellery, make up and nail polish. What is a stapedectomy? It is advised that you leave valuables such as jewellery A stapedectomy is the removal of the stapes bone and large sums of money at home to decrease the within the middle ear to improve hearing loss. possibility of items being misplaced and theft. What is a myringoplasty? On the day of your surgery, please make your way to the St. Vincent’s Day of Surgery Admission Area, which A myringoplasty is the repair of the tympanic is located on the first floor of the In-patient Services membrane to relieve pressure or infection causing Building, Princes Street, Fitzroy. hearing loss following perforation of the membrane. When you arrive the nursing staff will check your pulse What is a tympanoplasty? and blood pressure. A tympanoplasty is a procedure to reconstruct the For your surgery you will need an anaesthetic. tympanic membrane (ear drum) and / or middle ear The anaesthetist (the doctor who will give you the bone as the result of infection or trauma. anaesthetic) will meet with you before your surgery to talk to you about your health and the best anaesthetic What happens before my operation? for you. A general anaesthetic (anaesthetic that puts Before surgery some patients attend a pre-admission you to sleep) is normally used for this surgery.
    [Show full text]
  • Icd-9-Cm (2010)
    ICD-9-CM (2010) PROCEDURE CODE LONG DESCRIPTION SHORT DESCRIPTION 0001 Therapeutic ultrasound of vessels of head and neck Ther ult head & neck ves 0002 Therapeutic ultrasound of heart Ther ultrasound of heart 0003 Therapeutic ultrasound of peripheral vascular vessels Ther ult peripheral ves 0009 Other therapeutic ultrasound Other therapeutic ultsnd 0010 Implantation of chemotherapeutic agent Implant chemothera agent 0011 Infusion of drotrecogin alfa (activated) Infus drotrecogin alfa 0012 Administration of inhaled nitric oxide Adm inhal nitric oxide 0013 Injection or infusion of nesiritide Inject/infus nesiritide 0014 Injection or infusion of oxazolidinone class of antibiotics Injection oxazolidinone 0015 High-dose infusion interleukin-2 [IL-2] High-dose infusion IL-2 0016 Pressurized treatment of venous bypass graft [conduit] with pharmaceutical substance Pressurized treat graft 0017 Infusion of vasopressor agent Infusion of vasopressor 0018 Infusion of immunosuppressive antibody therapy Infus immunosup antibody 0019 Disruption of blood brain barrier via infusion [BBBD] BBBD via infusion 0021 Intravascular imaging of extracranial cerebral vessels IVUS extracran cereb ves 0022 Intravascular imaging of intrathoracic vessels IVUS intrathoracic ves 0023 Intravascular imaging of peripheral vessels IVUS peripheral vessels 0024 Intravascular imaging of coronary vessels IVUS coronary vessels 0025 Intravascular imaging of renal vessels IVUS renal vessels 0028 Intravascular imaging, other specified vessel(s) Intravascul imaging NEC 0029 Intravascular
    [Show full text]