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Conclusions. After forced prolonged position type one (FPP-one) and the appropriate repositioning maneuvers, or FPP-two, 95.45% of patients with cupulolithiasis of the horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV).were symptom-free. Objectives. To treat patients with cupulolithiasis of the HSC-BPPV. Subjects and methods. This was a prospective study including 22 subjects with HSC-BPPV (cupulolithiasis) based on apogeotropic direction-changing positional nystagmus (apo-DCPN). Patients adopted FPP-one, which means lying down on the side of the weaker nystagmus during nightly rest for 2 weeks. If apo-DCPN persisted, subjects adopted type two FPP (FPP-two), which means lying on the strongest nystagmus side during nightly rest for 2 weeks. Results. No vertigo or nystagmus was observed in 15 subjects after FPP-one. One subject experienced geotropic DCPN (geo-DCPN), two subjects had posterior BPPV, and another had superior BPPV. Three subjects had persistent apo-DCPN and they were subjected to FPP-two. After that, no vertigo or nystagmus was detected in two subjects. Apo-DCPN persisted in the other remaining subject after FPP-two. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the ability of patients with unilateral Ménière's disease (MD) to reach the corresponding limits of stability and to define the existence of directional constraints. PATIENTS: 112 patients with unilateral MD and 30 normal age-matched subjects with no history of equilibrium problems. METHODS: A computerized dynamic posturography system was used to test the ability of subjects to displace their centre of pressure (COP) to the corresponding limits of stability. The eight targets used were separated by 45 degrees to form a circle around the subject who had to displace their COP to the target. Reaction time, velocity, accuracy and an overall evaluation of the intended movement towards and away from the target were analysed. Other characteristics of the patients were also assessed. RESULTS: A small but significant correlation was found between auditory and vestibular deficit and the different variables studied in the limits of stability test. Three factors were derived from variables obtained with short displacements, and the results are significantly different between patients and controls and are correlated with the period since the last vertigo spell, the level of disability, hearing loss and vestibular deficit. CONCLUSIONS: Dynamic balance is moderately impaired in patients with Ménière's disease. [ABSTRACT FROM AUTHOR]

The objective was to assess audiological results after total ossicular reconstruction for stapes fixation. The study is a retrospective evaluation conducted in a tertiary referral centre. The patients were 16 adults with conductive or mixed hearing loss and stapes fixation due to tympanosclerosis or otosclerosis. A total or partial stapedectomy with perichondrium interposition on the oval window and ossicular reconstruction with titanium total prosthesis were done. To assess pre- and post-operative (1 and 4 years) air and bone-conduction thresholds (frequencies 0.5, 1, 2, 3 kHz), pure-tone average air and bone conduction, and air-bone gaps were measured and the number of decibels of closure of the air-bone gap at 1 year and at 4 years were compared. One year after surgery, air conduction thresholds and pure-tone average air conduction were improved for all frequencies, and there were no significant differences in bone conduction thresholds or in pure-tone average bone conduction. There were no differences in air and bone conduction thresholds, pure-tone average air or bone conduction between 1 and 4 years. The air-bone gap was significantly reduced 1 year after surgery and remained so at 4 years. (Preoperative air-bone gap, 34.04 dB; at 1 year, 16.40 dB; at 4 years, 17.3 dB. Decibels of closure of the air-bone gap at 1 year, 17.64 dB; at 4 years, 16.74 dB.) No differences were found between otosclerosis subjects and all other cases combined. Total ossicular reconstruction in stapes fixation due to tympanosclerosis or otosclerosis produces satisfactory short- and long-term auditory results.

Conclusions: Three possible results are commonly seen after ice-water caloric irrigation and to correctly interpret them the function of the corresponding vestibular receptor and of normal endolymphatic flow must be taken into account. Bedside vestibular examination helps to interpret discrepant findings., Objective: To review the findings obtained with the ice-water caloric test in patients with dizziness and to compare the results with those of the bedside test., Patients and Methods: The study was undertaken in a university hospital, tertiary medical center. The indications to perform the ice-water caloric test were: 1) unilateral canal weakness >90%; 2) a maximum slow phase velocity of nystagmus after hot (44 degrees C) and cold (30 degrees C) caloric stimulation in either ear of <9 degrees s(-1); or 3) in both ears <15 degrees s(-1). After irrigating the ear with ice water, nystagmus was recorded in the face-up and face-down positions. The result of the test was classified as a response (nystagmus beats away from the irrigated ear in the supine position and changes when in prone), a gravity-independent response (nystagmus does not change in direction in the prone position) or no response. The spontaneous and post head-shaking nystagmus, as well as the results of the head-impulse test, were also analyzed. When indicated, a rotatory chair test was performed., Results: In the 71 patients that displayed unilateral hypofunction, the ice-water test produced a normal response in 24, a gravity-independent response in 31, and no response in 14. In two of these patients a vertical gravity-independent nystagmus response was observed. Bilateral hypofunction was found in 12 patients and the results in the head-impulse test were in agreement with the results in the ice-water test.

Ocular tilt reaction (OTR) includes skew deviation, eye torsion and head tilt. It is usually accompanied by a tilt in the subjective visual vertical. OTR seems to reflect an otolithic dysfunction. This case report shows an OTR of central origin as a result of simultaneous paramedial thalamic and mesencephalon rostral infarcts.

Objective: Patients satisfaction and side effects assessment after vestibular tests., Materials and Methods: Questionnaires were sent to 150 patients after vestibular testing in 2006. Forty-two questionnaires were sent back to us. On each questionnaire there were 5 questions regarding patient expectations, 4 questions about side effects after vestibular tests and one question was related to follow-up medical attention., Results: Most of the patients think that the delay between clinical consultation and vestibular test was not too long. Information patients received beforehand regarding vestibular tests aim, duration, possible side effects and diagnostic expectations are good enough for most of the patients. However patient's assessment of the informed consent document and location of vestibular tests is diverse. The vast majority of patients feel "very important" to receive information about vestibular tests results on the same day. For most of the subjects caloric test is the most disconfortable tests. In the following days, more than half of the subjects feel vestibular symptoms. The most frequent suggestion we received from patients is to give them a phone calls after vestibular tests., Conclusion: It is worth mentioning the importance of informing the patient about vestibular test results upon completion. Our aim is to make some changes on the informed consent document given to patients and to make a phone call to patients after vestibular tests.

Objectives: To analyse the correlation between vestibular dysfunction and hearing level of patients diagnosed with Menière's disease., Methods: Retrospective study on the correlation between hearing level and unilateral weakness in 100 Menière's disease patients. In order assess the effect of disease severity in such correlation, the study group included 50 patients who subsequently were treated with oral medication and 50 who later received intratympanic gentamicin to control their symptoms. Audiogram and caloric tests were performed before beginning both of the treatments. Patients were classified according to the AAO-HNS guidelines. Handicap was assessed with the Functional Level of the AAO-HNS and the Dizziness Handicap Inventory., Results: No correlation was found between pure tone average and canal paresis neither when patients were analysed as a whole nor when correlation was controlled for the treatment installed afterwards. Nevertheless, when they were grouped by hearing loss AAO-HNS stages, we found a greater canal paresis in those with a higher hearing loss (groups 3 and 4)., Conclusion: No correlation was found between hearing loss and canal paresis of patients diagnosed with Menière's disease. However patients with a higher amount of hearing damage have a tendency to abnormal caloric results.

In the superior canal dehiscence syndrome, patients can have sound- or pressure-induced vertigo and oscillopsia. They may also present conductive hearing loss or higher than normal bone conduction thresholds. Clinical manifestations are due to the effect of a third mobile window in the inner ear created by the dehiscence. Diagnosis is based on clinical manifestations, vertical and rotatory nystagmus induced by sound and pressure reflecting SSC stimulation, reduced threshold and increased amplitude of vestibular evoked myogenic potentials (VEMP) and temporal bone CT scan images showing the SSC dehiscence. Characteristic eye movements can be recorded with the scleral search coil technique.

Objective: We report a rare case of sudden deafness and benign paroxysmal positional vertigo (BPPV) corresponding to a canalithiasis of the ipsilateral left posterior semicircular canal (PSC)., Case Report: The initial examination showed intact lateral semicircular canal (LSC) function. Cerebral MRI results were normal. However evoked otoacoustics emissions were absent in the left ear. The patient developed, in the course of one week, symptoms and signs of an acute unilateral vestibulopathy in the same ear. However there were no change in hearing loss after it., Conclusion: The association of BPPV acute vestibulopathy and sudden deafness is uncommon but usually the former develops well after the second and third. This case is best explained by a vestibulocochlear labyrinthitis.

Objectives: To determine whether an association exists between the parameters of the caloric and rotatory chair tests in patients with unilateral Ménière's disease., Methods: Patients with unilateral Ménière's disease (n = 100) were subjected to the caloric and the rotatory chair test (sinusoidal harmonic acceleration and impulsive tests) on the same day. Canal paresis and directional preponderance were assessed in the caloric test, and different variables were measured in the rotatory chair test based on the existence of abnormal parameters in the vestibulo-ocular reflex at two or three consecutive frequencies of those tested and on the time constant of the vestibulo-ocular reflex., Study Design and Setting: A prospective study was conducted at a University hospital., Results: An abnormal result in the caloric test was obtained from 73% of the patients. In the rotatory chair test, the most frequent abnormal findings involved increases in the normal phase lead at 2 consecutive frequencies tested (23%). There was a stronger association between an abnormal result in phase, gain, and/or symmetry at three adjacent frequencies and a pathological result in the caloric test., Conclusion: Very few of the criteria used to define the caloric and rotatory chair tests seem to be associated. This confirms previous knowledge that both tests examine vestibulo-ocular reflex by different ways. Only when vestibular dysfunction is severe enough (manifested by the finding of an abnormal result in at least three consecutive frequencies in the rotatory chair test), the caloric test is also found to be abnormal.

Conclusions: When considering benign recurrent vertigo and a similar peripheral vestibular deficiency, the asymmetry of the vestibulo-ocular reflex (VOR) time constant (Tc) is lower in those patients with paretic head-shaking nystagmus (HSN) than in those with reversed HSN or without HSN., Objective: To determine whether the existence of HSN is related to the time constant of the VOR in patients with benign recurrent vertigo (BRV)., Patients and Methods: This was a prospective study conducted at a tertiary care center in which patients were subjected to the head-shaking test, the caloric test and rotatory chair impulsive test on the same day. The clinical features of the disease analyzed were the disease duration, frequency of vertigo spells, time since the last vertigo spell and the existence of migraine. The results of the head-shaking test were considered positive when nystagmus appeared after head-shaking had ended. Two groups of patients were established on the basis of these results and the group that displayed HSN was divided according to the direction of nystagmus. In the impulsive test, the time constant of the VOR after ipsilesional and contralesional acceleration was analyzed, as was the symmetry of the response. The differences in the means were calculated., Results: BRV was diagnosed in 25% of patients suffering recurrent spells of vertigo, of which 33 patients were HSN- and 29 were HSN+. In the latter group, vestibular migraine was frequently observed (83% of the patients), the spells of vertigo were more frequent and the patients were seen closer to the previous spell of vertigo. No differences were observed in the Tc of the VOR between HSN+ and HSN- patients, although the asymmetry of this Tc was higher in HSN- patients than in HSN+ patients. Nevertheless, the differences observed were only significant between paretic and reversed HSN patients and paretic HSN patients and HSN- patients.

Objective: Middle ear salivary gland choristoma are extremly rare. We report a case, describe the clinical management and review the literature., Clinical Case: A 12 year old boy presented with unilateral conductive hearing loss associated with a large inferior retraction pocket on otoscopy. CT scan demonstrated a large mass in the left middle ear cavity. The incus was absent and the stapes was partially eroded. Middle ear exploration demonstrated an 8 mm yellow/red mass in the region of the fallopian canal. This mass was comptly removed and histopathology confirmed salivary gland choristoma., Conclusion: These lesions result from an abnormal development of the second branchial arch. It is important to consider these lesions as part of the differential diagnosis for any unilateral hearing loss associated with a middle ear mass in children.

Introduction and Objectives: To Evaluate objectively the effect that cochleostomy has in the cochlea as well as the exposition of the estria vascularis, through acoustic otoemissions immediatly after surgery., Material and Methods: Submandibular approach to the guinea pig's middle ear and cochlea. Triming of the timpanic and vestibular first turns and wide exposition of the estria vascularis in the first and second turns. Study of cochlear function through acoustic otoemissions of distortion products., Conclusions: Guinea Pig is a perfect experimentation animal for surgical work when monitoring functional state of the cochlea. Its acoustic response is similar to the one found in other mammals thoug its response is lower than that reported in other papers. The lack of intracochlear manipulation ensures the lower decrease hearing loss deterioration regarding the findings in the different methods of studying the acousting distortion., Results: There is a decrease of amplitud in the audiograms of distortion for specific frequencies (4 and 6 KHz), located tonotopically near the cochleostomies carried out in the first turn (at the level of scala vestigularis and timpanic). Approadring the cochlea without intracochlear manipulation does not modify greathy the results of audiograms of distortion neither the growth slopes of the response. A lateral approach of the estric vascularis minimising the aggression to labrynth did not cause a significant acoustic deterioration.

Introduction and Objectives: To characterize and analyze the "Timed-up-and-go" test in non-fallers patients with peripheral vertigo. To assess if turning to the side of the lesion induces a more intense instability., Material and Methods: The test was performed after carefully explanation to the patient who was allowed to do some attempts. Postural measurements were the angle and angular speed of trunk sway in roll and pitch. It was done with a special device adapted to the trunk with two sensors specially built for that purpose., Conclusions: Dizzy, non-fallers patients perform this test in a period of time considered as normal. Canal paresis influences in roll trunk sway when the patient performs the TUG only when turning to the normal side.

Introduction: We studied the transfection by adenoviral vectors and the antitumoral effect of HSV-tk gene associated with ganciclovir (AdCMVtk/GCV) in KB human oral cavity squamous cell carcinoma, in vitro and in vivo., Materials and Methods: Transfection was assessed by the X-gal stain. It was used in cell cultures and tumoral sections previously exposed to adenoviral vector AdCMVlacZ. In vitro, in order to study the antitumoral effect of AdCMVtk/GCV, survival of cell cultures exposed to AdCMVtk/GCV and to AdCMVlacZ/GCV was compared. In vivo, necrotic volume as a percentage of total tumoral volume, was compared between AdCMVtk/GCV treated group and AdCMVlacZ/GCV exposed group. Hepatic and renal toxicities were assessed., Results: In vitro, survival of cell cultures treated with AdCMVtk/GCV was less than AdCMVlacZ/GCV exposed cells. In vivo, necrotic volume was larger in AdCMVtk/GCV treated group than in AdCMVlacZ/GCV exposed group. No toxicity was found (hepatic, renal)., Conclusions: KB cells are transfected by adenoviral vectors and are killed by AdCMVtk/GCV, both in vitro and in vivo (no toxicity was found in the animal model).

Metastatic involvement of the laryngeal is very rare, with around 150 cases reported to the literature. In eight of these cases, the primary tumor was a colon adenocarcinoma. We report the case of a 80 year-old woman treated of a colloid adenocarcinoma of 7 years earlier, referred to us for chronic and progressive dyspnea. Endoscopic examination showed a subglottic spherical mass, which caused an important compromise of the respiratory airway. Tomographic studies revealed also a thyroid mass. The patient was treated with a tracheostomy, resection of the subglottic mass (with intraoperative diagnosis of "mucin producing tumor"), and total thyroidectomy. The final pathologic diagnosis of the subglottic mass was a metastasis of colloid adenocarcinoma of the colon. In the literature reviewed there are no previous reports of metastatic involvement of the larynx with this type of colon adenocarcinoma. We discuss the clinical and radiological findings, and therapeutic options for metastasis to the larynx, as well as pathological differential diagnosis.