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This retrospective, observer blinded case-control study aims to compare the prevalence of neurovascular conflicts (NVCs) of the vestibulocochlear nerve and the anterior inferior cerebellar artery (AICA) in patients presenting with clinical signs of acute vestibular neuritis with and without subsequent objective vestibular function loss (VFL). 58 acute cases of clinically suspected acute vestibular neuritis were investigated with same day cranial MRI at a tertiary referral centre and compared to 61 asymptomatic controls. The prevalence of NVCs in cases with objective VFL were also compared to cases without VFL. Radiologists described the NVC as "no contact" (Grade 0), "contact < 2 mm" (Grade 1), "contact > 2 mm" (Grade 2) and "vascular loop presence" (Grade 3) without knowledge of neurotological data. Neurotological data was collected without knowledge of MRI findings. Vestibular function was tested by bithermic caloric irrigation. 26 cases (45%) showed caloric VFL (Group A), whereas 32 (55%) exhibited no VFL (Group B). Group A included 13 cases with NVCs (50%), Group B included 26 NVC cases (82%) (p = 0.012) and the control group included 16 individuals (26%) (p < 0.001 for comparison of all 3 groups). Group B had a significantly higher NVC-Grading than Group A (p = 0.009). There was no statistically significant association between NVCs and either SNHL or tinnitus (p > 0.05). Our results suggest that patients presenting with clinical signs of acute vestibular neuritis who show symmetrical caloric vestibular function test results have a significantly higher NVC prevalence in the cerebellopontine angle., (© Copyright by Società Italiana di Otorinolaringologia e Chirurgia Cervico-Facciale, Rome, Italy.)

The efficacy and safety of the fixed combination of cinnarizine 20 mg and dimenhydrinate 40 mg in the treatment of vertigo of various origins have been investigated in a prospective, noninterventional study involving private practices throughout Germany. A total of 1275 patients with an average age of 61.2 years participated in the study. The vertigo symptoms, measured by a validated mean vertigo score (primary efficacy endpoint) improved by 61 % in the course of the observational period (median: 6 weeks). Concomitant symptoms frequently associated with vertigo such as nausea, vomiting and tinnitus were also markedly reduced by 84, 85 and 51 %, respectively. Overall efficacy has been rated by the physicians as 'very much improved' or 'much improved' in 95 % of the patients. A total of 47 patients (3.7 %) reported 51 adverse drug reactions (all nonserious). The results indicate a good tolerability and efficacy of the fixed combination of cinnarizine and dimenhydrinate in the treatment of vertigo in daily medical practice, which is in line with previous findings of numerous interventional, randomised, double-blind, controlled clinical trials.

Vestibular parxoysmia (VP) is a rare vestibular disorder. A neurovascular cross-compression (NVCC) between the vestibulochochlear nerve and an artery seems to be responsible for short attacks of vertigo in this entity. An NVCC can be seen in up to every fourth subject. The significance of these findings is not clear, as not all subjects suffer from symptoms. The aim of the present study was to assess possible structural lesions of the vestibulocochlear nerve by means of high field magnetic resonance imaging (MRI), and whether high field MRI may help to differentiate symptomatic from asymptomatic subjects. 7 Tesla MRI was performed in six patients with VP and confirmed NVCC seen on 1.5 and 3.0 MRI. No structural abnormalities were detected in any of the patients in 7 Tesla MRI. These findings imply that high field MRI does not help to differentiate between symptomatic and asymptomatic NVCC and that the symptoms of VP are not caused by structural nerve lesions. This supports the hypothesis that the nystagmus associated with VP has to be conceived pathophysiologically as an excitatory vestibular phenomenon, being not related to vestibular hypofunction. 7 Tesla MRI outperforms conventional MRI in image resolution and may be useful in vestibular disorders.

Conclusion: Tympanotomy with sealing of the round window is a promising surgical alternative as a salvage strategy in younger patients with acute idiopathic sensorineural hearing loss (SNHL) and may be considered as an alternative drug delivery method to the round window., Objectives: To analyze the potential benefit of the sealing of the round window with special emphasis on the age of treated patients and the influence of time elapsed between symptom onset and surgery., Methods: This was a retrospective cohort study of 25 patients (13 males,12 females) with an average age of 55 years (range 31-75 years) with sudden SNHL, who underwent an enaural tympanotomy with sealing of the round niche using triamcinolone-soaked fascia. Pre- and postoperative bone conduction thresholds were compared for each frequency and for the pure-tone average (PTA) measured at 500 Hz, 1 kHz, 2 kHz, and 3 kHZ. The time (days) between primary symptom onset and surgery as well as age was scrutinized. Hearing improvement was described as 'no improvement' (0-9 dB), 'moderate recovery' (10-29 dB), or 'marked recovery' (≥30 dB). The difference in age of patients who improved was compared to those who did not., Results: A statistically significant improvement in PTA values (mean change 20.4 dB) was noted (p = 0.0002). In all, 13/25 (52%) patients exhibited improved bone conduction postoperatively regardless of age and time of treatment. A marked recovery (≥30 dB) could be seen in eight patients (median time to surgery, 9 days; average age, 48.5 years); recovery between 10 and 30 dB in five patients (median time to surgery, 10 days; average age, 46.6 years). Twelve significantly older patients showed no improvement (average time to surgery, 19 days; average age, 61.8 years; p = 0.004). No patient over the age of 65 years showed improvement in bone conduction.

Conclusion: Tenotomy is a promising surgical alternative with a high reduction in dizziness handicap in the short and long term., Objectives: To investigate the immediate and the long-term effect of tenotomy of the stapedius and tensor tympani muscles on subjective dizziness as measured by the Dizziness Handicap Inventory (DHI)., Methods: A retrospective follow-up study of 42 patients with definite, unilateral Meniere's disease (19 males, 23 females, average age = 58.1 ± 14.1 years) had undergone tenotomy under general anesthesia through an endaural approach. Pre- and postoperative DHI values were compared for all patients, with postoperative follow-up ranging from 6 months to 9 years. Additionally, results were divided into three postoperative subgroups (A = 0-3 years, B = 3-6 years, C = 6-9 years)., Results: A statistically significant reduction of 48 DHI points, from a median preoperative DHI = 52 to DHI = 4 postoperatively, was noted (p < 0. 001). In all, 40/42 patients reported a reduction of dizziness handicap, while in 33/42 the difference was > 12 points. A statistically significant reduction of DHI scores was noted (A = 60, B = 34, C = 33) in all subgroups. It was also noted that the higher the preoperative DHI score, the greater the subjective success of the surgery.

Conclusions: Because the presented data reveal an immediate and persistent reduction of vertigo and a clear improvement in hearing function and functional scales, we conclude tenotomy to be effective in unilateral, definite Meniere's disease - laying the foundation for future prospective, randomized controlled trials., Objectives: This study compares the unique long-term results of tenotomy of the stapedius and tensor tympani muscles in definite Meniere's disease refractory to medical treatment and presents a hypothesis on why tenotomy seems effective., Methods: This was an interventional cohort study. The study sample comprised 30 patients (15 males, 15 females; average age 57 ± 13.1 years) with definite Meniere's disease (AAO-HNS criteria, 1995). Patients were evaluated pre- and postoperatively using pure tone audiometry, AAO-HNS questionnaires regarding vertigo attacks, functional level scores, and tinnitus, and were followed up for 2-9 years. Postoperative values were calculated for the patient collective as a whole and consequently divided into three equal postoperative terms of 3 years each., Results: A statistically significant improvement of inner ear hearing levels postoperatively (p = 0.041) and a major reduction in vertigo attacks in all groups (p < 0.001) with complete absence of attacks in 26/30 patients was noted. Results remained constant up to 9 years postoperatively. Although tinnitus persisted, the intensity was lower overall (p = 0.013).

Background: Chronic sinusitis and nasal polyps with subsequent nasal blocking, anosmia, and relapsing infections are frequent in the rhinological practice. Often, recurrent disease necessitates repetitive conservative therapy and surgical treatment (functional endoscopic sinus surgery). This study was initiated to scrutinize the relationship of wheat and milk allergies to chronic polypoid sinusitis (CPS) and recurrent disease., Methods: Blood samples of 50 healthy controls and 50 patients with clinically and radiologically diagnosed CPS and nasal polyposis were screened for common food allergies including wheat and milk allergy. On inclusion into the study, none of the patients reported a symptomatic food allergy., Results: Fifteen of 100 tested subjects (15%) revealed a previously undiagnosed allergy to inhalant (dust, rye, and pollens) and other food allergens (corn and egg white). Six of 50 patients (12%) with CPS exhibited a wheat allergy, and a milk allergy could be identified in 7 patients (14%). In the control group, seven healthy subjects (14%) showed a wheat allergy and no case of milk allergy could be identified (p = 0.0125)., Conclusion: In contrast to previous studies in other countries presenting a food allergy incidence of ∼75% in patients with nasal polyposis, we could not show such a high incidence. In the group with chronic polyposis 14% of the patients were positive for milk allergy compared with none of the tested healthy subjects, resulting in a strong statistical significance. Therefore, we conclude that cow's milk but not wheat allergy might be a relevant pathogenetic entity in chronic nasal polyps.

PRES is a clinicoradiologic entity, combining seizures, blindness, and coma with MR imaging findings of predominantly vasogenic and occasional cytotoxic edema. In this clinical report, we determined the type of edema by using DWI and FLAIR sequences on MR imaging as well as ADC maps in 28 patients with PRES. The neuradiologic findings were correlated with levels of serum albumin, which is a main contributor to colloid osmotic pressure and vascular integrity. The presence of vasogenic edema was significantly associated with decreased serum albumin levels, which may be a particular risk factor for the development of PRES.

Reports that low-intensity microwave radiation induces heat-shock reporter gene expression in the nematode, Caenorhabditis elegans, have recently been reinterpreted as a subtle thermal effect caused by slight heating. This study used a microwave exposure system (1.0 GHz, 0.5 W power input; SAR 0.9-3 mW kg(-1) for 6-well plates) that minimises temperature differentials between sham and exposed conditions (< or =0.1 degrees C). Parallel measurement and simulation studies of SAR distribution within this exposure system are presented. We compared five Affymetrix gene arrays of pooled triplicate RNA populations from sham-exposed L4/adult worms against five gene arrays of pooled RNA from microwave-exposed worms (taken from the same source population in each run). No genes showed consistent expression changes across all five comparisons, and all expression changes appeared modest after normalisation (< or =40% up- or down-regulated). The number of statistically significant differences in gene expression (846) was less than the false-positive rate expected by chance (1131). We conclude that the pattern of gene expression in L4/adult C. elegans is substantially unaffected by low-intensity microwave radiation; the minor changes observed in this study could well be false positives. As a positive control, we compared RNA samples from N2 worms subjected to a mild heat-shock treatment (30 degrees C) against controls at 26 degrees C (two gene arrays per condition). As expected, heat-shock genes are strongly up-regulated at 30 degrees C, particularly an hsp-70 family member (C12C8.1) and hsp-16.2. Under these heat-shock conditions, we confirmed that an hsp-16.2::GFP transgene was strongly up-regulated, whereas two non-heat-inducible transgenes (daf-16::GFP; cyp-34A9::GFP) showed little change in expression.

Balance is accomplished by the congruent integration of visual, vestibular and somatosensory input and the execution of adequate control movements. With increasing age, nonlinear dynamics of central control systems become more regular. In unilateral vestibular dysfunction, sensory input to central systems is similarly less complex, because of one sided reduction of information influx. This study aimed to increase postural stability in patients with vestibular asymmetry and resulting disequilibrium by implementing a computerized visual training method relying on the principles of stochastic resonance. 24 subjects (average age 64a, 31-78a, 15 women, 9 men), with minimum 3 months of persisting disequilibrium due to vestibular dysfunction, were either treated with computerized optokinetic therapy (COKT), or solely observed. Treated patients were requested to read texts, stochastically moving in a previously defined matrix, during 10 sessions over three weeks. The Sensory Organization Test (SOT) was used for comparative posturographic measurements. COKT patients showed significant improvement in conditions 4, 6 and composite score. A significant post-therapeutic difference was seen between therapy and control groups in conditions 1, 6 and composite score. The results show a clinical benefit and we conclude COKT to be an effective rehabilitation method in patients with chronic disequilibrium.

We have previously reported that low intensity microwave exposure (0.75-1.0 GHz CW at 0.5 W; SAR 4-40 mW/kg) can induce an apparently non-thermal heat-shock response in Caenorhabditis elegans worms carrying hsp16-1::reporter genes. Using matched copper TEM cells for both sham and exposed groups, we can detect only modest reporter induction in the latter exposed group (15-20% after 2.5 h at 26 degrees C, rising to approximately 50% after 20 h). Traceable calibration of our copper TEM cell by the National Physical Laboratory (NPL) reveals significant power loss within the cell (8.5% at 1.0 GHz), accompanied by slight heating of exposed samples (approximately 0.3 degrees C at 1.0 W). Thus, exposed samples are in fact slightly warmer (by < or =0.2 degrees C at 0.5 W) than sham controls. Following NPL recommendations, our TEM cell design was modified with the aim of reducing both power loss and consequent heating. In the modified silver-plated cell, power loss is only 1.5% at 1.0 GHz, and sample warming is reduced to approximately 0.15 degrees C at 1.0 W (i.e., < or =0.1 degrees C at 0.5 W). Under sham:sham conditions, there is no difference in reporter expression between the modified silver-plated TEM cell and an unmodified copper cell. However, worms exposed to microwaves (1.0 GHz and 0.5 W) in the silver-plated cell also show no detectable induction of reporter expression relative to sham controls in the copper cell. Thus, the 20% "microwave induction" observed using two copper cells may be caused by a small temperature difference between sham and exposed conditions. In worms incubated for 2.5 h at 26.0, 26.2, and 27.0 degrees C with no microwave field, there is a consistent and significant increase in reporter expression between 26.0 and 26.2 degrees C (by approximately 20% in each of the six independent runs), but paradoxically expression levels at 27.0 degrees C are similar to those seen at 26.0 degrees C. This surprising result is in line with other evidence pointing towards complex regulation of hsp16-1 gene expression across the sub-heat-shock range of 25-27.5 degrees C in C. elegans. We conclude that our original interpretation of a non-thermal effect of microwaves cannot be sustained; at least part of the explanation appears to be thermal.

Background: The use of medical experts in rating the content of health-related sites on the Internet has flourished in recent years. In this research, it has been common practice to use a single medical expert to rate the content of the Web sites. In many cases, the expert has rated the Internet health information as poor, and even potentially dangerous. However, one problem with this approach is that there is no guarantee that other medical experts will rate the sites in a similar manner., Objectives: The aim was to assess the reliability of medical experts' judgments of threads in an Internet newsgroup related to a common disease. A secondary aim was to show the limitations of commonly-used statistics for measuring reliability (eg, kappa)., Methods: The participants in this study were 5 medical doctors, who worked in a specialist unit dedicated to the treatment of the disease. They each rated the information contained in newsgroup threads using a 6-point scale designed by the experts themselves. Their ratings were analyzed for reliability using a number of statistics: Cohen's kappa, gamma, Kendall's W, and Cronbach's alpha., Results: Reliability was absent for ratings of questions, and low for ratings of responses. The various measures of reliability used gave conflicting results. No measure produced high reliability., Conclusions: The medical experts showed a low agreement when rating the postings from the newsgroup. Hence, it is important to test inter-rater reliability in research assessing the accuracy and quality of health-related information on the Internet. A discussion of the different measures of agreement that could be used reveals that the choice of statistic can be problematic. It is therefore important to consider the assumptions underlying a measure of reliability before using it. Often, more than one measure will be needed for "triangulation" purposes.