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A variant of benign paroxysmal positional vertigo (BPPV) involves the subjective report of vertigo without the coinciding nystagmus. This presentation includes truncal retropulsion when sitting up from the ipsilesional provocative test (ie, Dix-Hallpike), which we term type 2 BPPV. The primary objective of this study is to prospectively determine the prevalence and describe the clinical course of type 2 BPPV. We offer a theoretical explanation for the absence of nystagmus.Prospective, observational study carried out in 2 tertiary hospitals. One hundred eighty patients (134 women, 46 men) met the inclusion criteria and were included between January 10, 2018, and October 30, 2019. Efficacy of physical therapy maneuvers was determined at 1-week follow-up. Three-dimensional reconstructions of the planes of the semicircular canal cupula from histological preparations are offered as evidence for the theoretical explanation.One-third of the patients met the criteria for type 2 BPPV; the remainder had typical posterior or horizontal semicircular canal involvement. Symptoms from type 2 BPPV were longer in duration yet responded favorably to physical therapy maneuvers. Upon repeat testing, 19 patients treated for posterior canalithiasis developed a slight, persistent positional downbeat nystagmus in the Dix-Hallpike position that we propose as evidence the otoconia entered the short arm of the posterior semicircular canal.Our data and 3-dimensional rendering suggest the report of vertigo, yet absent nystagmus in type 2 BPPV is from otoconia aligning with the gravitoinertial vector during provocative testing that precludes cupular stimulation. Type 2 BPPV appears to be a common and treatable form of vertigo.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A372).

OBJECTIVE Compare intraoperative and postoperative outcomes of endoscopic and microscopic stapes surgery to provide objective evidence on whether the former is a better alternative than the latter. METHODS We performed a systematic review and meta-analysis for studies that compared endoscopic stapes surgery with microscopic stapes surgery. Only studies that met predetermined criteria were selected and assessed for bias and quality. Primary outcomes were postoperative air-bone gap (ABG) and chorda tympani nerve injury. Secondary outcomes were average operating time, tympanic membrane (TM) perforation, and postoperative taste disturbance, pain, and dizziness. We calculated pooled odds ratios (ORs) with 95% confidence intervals (CIs) for dichotomous outcomes and weighted mean difference (WMD) with 95% CI for continuous outcomes. A confidence interval starting above 1.0 was considered as statistically significant. I2 and χ2 tests were used to quantify statistical heterogeneity. We used funnel plots to look for publication bias and performed a sensitivity analysis. RESULTS Six nonrandomized cohort studies were eligible. The primary outcomes were ABG 20 dB: OR = 2.51 (95% CI: 0.77 to 8.22), and chorda tympani injury: OR = 3.51 (95% CI: 1.55 to 7.93). Secondary outcomes were taste: OR = 2.36 (95% CI: 1.01 to 5.51), average operation time: WMD = 0.14 (95% CI: -11.69 to 11.98), TM perforation: OR = 1.70 (95% CI: 0.44 to 6.58); pain: OR = 0.84 (95% CI: 0.36 to 1.96), and dizziness: OR = 2.15 (95% CI: 0.94 to 4.89). CONCLUSIONS Endoscopic stapes surgery is a valid alternative to the microscope. LEVEL OF EVIDENCE 2a Laryngoscope, 130: 2019-2027, 2020.

Background Endoscopic type I tympanoplasty was originally introduced in the 1990s, and the extensive spread of this practice can be easily observed. The conventional technique performed involves the repair of a tympanic membrane perforation, and is defined as microscopic type I tympanoplasty. Objective of review The aim of this study was the comparison of postoperative outcomes of both the endoscopic and the microscopic type I tympanoplasty. Type of review We conducted a meta-analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Search strategy A systematic literature search was performed in the databases of PubMed, Embase, Cochrane Library, Clarivate Analytics-Web of Science, ClinicalTrials.gov, World Health Organization Library, and Scopus by inserting, 'myringoplasty OR (tympanoplasty AND perforation)' into the search query. We applied only a 'human' filter. We excluded non-English studies. Additional records were identified by checking the references of relevant studies. Evaluation method Comparative studies were included in our analysis. We calculated the pooled odds ratio (OR) with 95% confidence interval (CI) for dichotomous outcomes and weighted mean difference (WMD) with a 95% CI for continuous outcomes. Additionally, we assessed the risk of bias and estimated the quality of evidence for each outcome. Results Our systematic search yielded 16 studies (involving 1179 interventions), eligible for analysis. The pooled graft uptake rate (OR: 1.21, CI: 0.82-1.77; I2 = 0.0%), the postoperative hearing results (WMD = -1.13; 95% CI: -2.72-0.45; I2 = 78.1%) and the operation time (WMD = -21.11; 95% CI: -42.60-0.38; I2 = 99.3%), were all comparable amongst the two techniques. In contrast, the endoscopic type I tympanoplasty outperforms when regarding the pooled canaloplasty rate (OR = 7.96; 95% CI: 4.30-14.76; I2 = 0.0%, P = 1.000) and features an increase in desirable cosmetic results (OR = 19.29; 95% CI: 11.37-32.73; I2 = 0.0%, P = 0.839), when compared with the microscopic approach. Conclusions Based on our meta-analysis, the surgical outcomes of endoscopic type I tympanoplasty in terms of graft uptake rate, postoperative hearing results and operation time were comparable to the microscopic type I tympanoplasty. In regards to cosmetics, an increase in desirable results was achieved in the endoscopic group, particularly the incidence of canaloplasty which proved to be significantly lower.

Abstract: Introduction: The success of cochlear implantation can be evaluated with audiological measurements and quality of life questionnaires. Aim: Our aim was to translate and introduce the Cochlear Implant Function Index (CIFI) test to analyze the physical, psychological and social state of our cochlear implant patients. Method: Between 01. 11. 2016 and 31. 05. 2018, 30 patients filled the questionnaire before and 6 and 12 months after the implantation. Results and conclusion: Results showed a remarkable improvement in the quality of life in several patients even after 6 months. Further improvements could be measured after 12 months. Orv Hetil. 2019; 160(33): 1296–1303.

Abstract: The existence of cervical vertigo is still a question under debate. The basic hypothesis of the disease is that the abnormalities of the neck cause dizziness. The name itself is not accurate, as on the basis of the descriptions we cannot talk about true vertigo. The most common symptoms of cervical vertigo are cervical pain or discomfort, imbalance or dizziness and limitation of cervical movement. The origin of the disease is unclear. Based on the literature, there are four most accepted hypotheses: neurovascular, vascular, proprioceptive theory and migraine-associated cervicogenic vertigo. Of these, the neurovascular theory has already been discredited and its existence is clearly disproved. When diagnosing cervical vertigo, we always face the following difficulties: there is no diagnostic method specific to the disease, pathognomic clinical elements are unavailable, no clear therapeutic recommendation exists. The diagnosis of the disease requires the exclusion of alternatives, but the possibility of the existance of psychogenic vertigo causes further difficulties for the clinicians. Regarding the treatment, the combination of manual therapies and vestibular rehabilitation seems to be the most effective. Orv Hetil. 2019; 160(25): 967–972.

Abstract: Sudden sensorineural hearing loss is defined as a greater than 30 dB deterioration in at least 3 consecutive frequencies occurring within 72 hours. The disease is mostly idiopathic and needs an urgent treatment. Between 01. 01. 2015 and 31. 12. 2016, 149 patients with sudden hearing loss were admitted to the Department of Otorhinolaryngology, University of Pécs. The epidemiological data, the prognostic factors and the outcome of the treatment were retrospectively analyzed. Isolated high frequency (p = 0.012) and less severe hearing loss (p

Purpose: To successfully analyze the surgical and audiological results of cochlear implantation in patients afflicted with inner ear malformations. This study briefly presents our surgical strategi...

Abstract: Introduction and aim: The reason of gradually developing conductive hearing loss in otosclerotic patients is the ossification of the stapes footplate to the surrounding bony structures and the therapy of stapes fixation is mainly surgical. In stapedotomy the footplate of the stapes is fenestrated with laser and microdrill in a diameter of 0.8 mm, whereas in stapedectomy there is complete removal of the footplate followed by the reconstruction of the ossicular chain. In the early postoperative period, temporary vertigo is frequently recorded which significantly influences the recovery. Method: In the Department of Otorhinolaryngology, University of Pécs both stapedectomy and stapedotomy were performed on a daily basis between 01.02.2010 and 15.03.2012. Our study focused on comparing the degree of postoperative vertigo after the two types of surgery. We hypothesized that the smaller fenestration of the stapes footplate during stapedotomy limits exposure to the inner ear reducing the severity of dizziness. Vertigo was evaluated subjectively with a retrospective questionnaire and objectively with static posturography. Results: On the 1st postoperative day, significantly fewer patients reported vertigo in the stapedotomy group and with significantly lower intensity. Results of the questionnaire regarding the later postoperative period showed no significant differences between the groups. Based on the analysis of the posturography test results, no significant difference was detected between the postoperative stability of the two groups. Results of the questionnaire and the posturography showed no correlation. Posturography test results did not confirm the presence of subjective vertigo. Conclusion: Many factors may play a role in the development of vertigo after stapes surgery, but the type of intervention does not influence it. Orv Hetil. 2017; 158(38): 1503–1511.

Absztrakt

The existence of cervical vertigo is still a question under debate. The basic hypothesis of the disease is that the abnormalities of the neck cause dizziness. The name itself is not accurate, as on the basis of the descriptions we cannot talk about true vertigo. The most common symptoms of cervical vertigo are cervical pain or discomfort, imbalance or dizziness and limitation of cervical movement. The origin of the disease is unclear. Based on the literature, there are four most accepted hypotheses: neurovascular, vascular, proprioceptive theory and migraine-associated cervicogenic vertigo. Of these, the neurovascular theory has already been discredited and its existence is clearly disproved. When diagnosing cervical vertigo, we always face the following difficulties: there is no diagnostic method specific to the disease, pathognomic clinical elements are unavailable, no clear therapeutic recommendation exists. The diagnosis of the disease requires the exclusion of alternatives, but the possibility of the existance of psychogenic vertigo causes further difficulties for the clinicians. Regarding the treatment, the combination of manual therapies and vestibular rehabilitation seems to be the most effective. Orv Hetil. 2019; 160(25): 967-972.Absztrakt: A cervicalis vertigo létezése napjainkban is vita tárgyát képezi. A kórkép alaptézise, hogy a nyak rendellenessége szédülést okoz. Maga az elnevezés nem pontos, hiszen a leírások alapján nem is igazi vertigóról van szó. A cervicalis vertigóra leginkább jellemző tünetek a nyaki fájdalom vagy diszkomfortérzet, az egyensúlyzavar vagy bizonytalanságérzet és a nyaki mozgáskorlátozottság. A kórkép eredete nem tisztázott egyértelműen. A szakirodalom alapján négy, leginkább elfogadott hipotézisről beszélhetünk: neurovascularis, vascularis, proprioceptív elmélet és migrénasszociált cervicalis vertigo. Ezek közül a neurovascularis elmélet már idejétmúlt, létezése egyértelműen megcáfolható. A cervicalis vertigo diagnózisának felállításakor minden esetben az alábbi nehézségekkel szembesülünk: nincs a kórképre specifikus diagnosztikai módszer, cervicalis vertigóra pathognomicus klinikai elemek nem állnak rendelkezésre, egyértelmű terápiás ajánlás nem létezik. A kórkép felállítása kizárásos elven alapul, azonban a pszichogén vertigo lehetősége további nehézségek elé állítja a klinikusokat. Kezelését illetően a manuálterápiás eljárások – vestibularis fejlesztőgyakorlatokkal kombinálva – tűnnek a leginkább célravezetőnek. Orv Hetil. 2019; 160(25): 967–972.

Sudden sensorineural hearing loss is defined as a greater than 30 dB deterioration in at least 3 consecutive frequencies occurring within 72 hours. The disease is mostly idiopathic and needs an urgent treatment. Between 01. 01. 2015 and 31. 12. 2016, 149 patients with sudden hearing loss were admitted to the Department of Otorhinolaryngology, University of Pécs. The epidemiological data, the prognostic factors and the outcome of the treatment were retrospectively analyzed. Isolated high frequency (p = 0.012) and less severe hearing loss (p0.001), older age (p = 0.005), comorbodities like cardiovascular disease (p = 0.009) and diabetes (p = 0.029) were found as negative prognostic factors. Time of introduction of the treatment, gender, and side of the affected ear did not influence the outcome. Our finding was mainly congruent to the literature. Orv Hetil. 2019; 160(18): 687-693.Absztrakt: Hirtelen halláscsökkenésnek nevezzük a 72 órán belül kialakuló, 3 egymást követő frekvenciát érintő és 30 dB-t meghaladó sensorineuralis halláscsökkenést. A betegség a leggyakrabban idiopathiás, és mielőbbi kezelést igényel. A Pécsi Tudományegyetem Klinikai Központjának Fül-Orr-Gégészeti és Fej-Nyaksebészeti Klinikáján 2015. 01. 01. és 2016. 12. 31. között 149 beteget kezeltünk hirtelen halláscsökkenéssel. Retrospektív analízisünkben a kezelés eredményességét, valamint az azt befolyásoló tényezőket vizsgáltuk. A hallásjavulás mértékét negatívan befolyásolta a magas frekvenciákat érintő halláskárosodás (p = 0,012), az idősebb életkor (p = 0,005), a cardiovascularis társbetegség (p = 0,009), illetve a cukorbetegség megléte (p = 0,029), valamint a kisebb mértékű kisfokú halláscsökkenés (p0,001). Nem befolyásolta a javulást a kezelés megkezdéséig eltelt idő, a beteg neme és az érintett fül oldalisága. Eredményeink döntőrészt megfelelnek a nemzetközi irodalmi adatoknak. Orv Hetil. 2019; 160(18): 687–693.

The reason of gradually developing conductive hearing loss in otosclerotic patients is the ossification of the stapes footplate to the surrounding bony structures and the therapy of stapes fixation is mainly surgical. In stapedotomy the footplate of the stapes is fenestrated with laser and microdrill in a diameter of 0.8 mm, whereas in stapedectomy there is complete removal of the footplate followed by the reconstruction of the ossicular chain. In the early postoperative period, temporary vertigo is frequently recorded which significantly influences the recovery.In the Department of Otorhinolaryngology, University of Pécs both stapedectomy and stapedotomy were performed on a daily basis between 01.02.2010 and 15.03.2012. Our study focused on comparing the degree of postoperative vertigo after the two types of surgery. We hypothesized that the smaller fenestration of the stapes footplate during stapedotomy limits exposure to the inner ear reducing the severity of dizziness. Vertigo was evaluated subjectively with a retrospective questionnaire and objectively with static posturography.On the 1st postoperative day, significantly fewer patients reported vertigo in the stapedotomy group and with significantly lower intensity. Results of the questionnaire regarding the later postoperative period showed no significant differences between the groups. Based on the analysis of the posturography test results, no significant difference was detected between the postoperative stability of the two groups. Results of the questionnaire and the posturography showed no correlation. Posturography test results did not confirm the presence of subjective vertigo.Many factors may play a role in the development of vertigo after stapes surgery, but the type of intervention does not influence it. Orv Hetil. 2017; 158(38): 1503-1511.

Facial palsy that occurs immediately after middle ear surgery (stapedectomy, stapedotomy, and tympanoplasty) can be a consequence of the local anesthetics and it regresses completely within a few hours. In the case of delayed facial palsy, the alarming symptom occurs several days or even weeks after uneventful surgery. The mechanism of the neural dysfunction is not readily defined. Surgical stress, intraoperative trauma, or laceration of the chorda tympani nerve with a resultant retrograde facial nerve edema can all be provoking etiological factors. A dehiscent bony facial canal or a multiple microporotic fallopian canal (microtrauma or laser effect) can also contribute to the development of this rare phenomenon. The most popular theory related to the explanation of delayed facial palsy at present is the reactivation of dormant viruses. Both the thermal effect of the laser and the elevation of the tympanomeatal flap can reactivate viruses resting inside the ganglion geniculi, facial nerve, or facial nuclei. The authors report the case histories of a 55-year-old female, and a 45-year-old male who presented with a delayed facial palsy following laser stapedotomy. The clinical characteristics, the therapeutic options, and the possibility of prevention are discussed.