This interesting study from Nijmegen (Artz JC et al, Eur Arch Otorhinolaryngol. 2008 Aug 13 ) is very similar to an earlier study from Hanover by Diensthuber, Lenarz & Stöver  (Skull Base. 2006 Feb;16(1):31-8 ) but utilized Cox proportional hazards regression models to define risk, in place of Clinical growth index (calculated by dividing tumor size by the length of clinical history ) utilized by the earlier study, to predict risk of future growth of conservatively managed VS

Editor’s choice :  CLINICO-RAD PREDICTORS OF VS.?

Self-crp and pc-bppv...?

This is another “myth bursting” paper on the subject of stereotypic instructions some give to patients with BPPV. Earlier myths busted include postural restrictions after CRM and use of vibration with CRM. This current study from USA (Helminski, Jansen & Hain, Otol Neurotol. 2008 Aug 8. ) failed to observe any benefit of self—canal repositioning procedure on time to recurrence and the rate of recurrence of posterior canal-BPPV.

august 16  2008

Vol 8 No 9

Otorhinolaryngology news

In this issue

· Clinico-Rad Predictors of VS…?

· Self-CRP &PC-BPPV…?

· Access & Chlesteatoma Surgery..?

· Case of The week

Journal Watch: Development of surgical skill with singular neurectomy using human cadaveric temporal bones. Feigl G et al, 2008

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 Till Next Week,

 Biodun

Cholesteatoma surgery & limited access...?

Abstract: 

Objective:We present a technique which we have found useful for the management of congenital cholesteatoma extensively involving the middle ear.Case report:A five-year-old boy was presented to our department for management of a white mass on the right tympanic membrane. This congenital cholesteatoma extensively occupied the tympanic cavity. It was removed through an extended tympanotomy approach using our modified sleeve technique. The conventional tympanotomy approach was extended by gently separating the tympanic annulus from its sulcus in a circular manner. The firm attachment of the tympanic membrane at the umbo was not severed, in order to avoid lateralisation of the tympanic membrane.Conclusion:Although various operative techniques can be used, our modified sleeve tympanotomy approach provides a similarly sufficient and direct visualisation of the entire middle ear, with, theoretically, no possibility of lateralisation of the tympanic membrane and subsequent conductive hearing loss.

Abstract:

Management of a sporadic vestibular schwannoma (VS) is still a subject of controversy, mainly due to distinct and unpredictable growth patterns. To embark on an appropriate therapy it is necessary to dispose of a reliable prediction about tumor progression. This study aims to design a risk profile with predictors for VS growth. A total of 234 VS patients who were managed conservatively were included. Data concerning (duration of) symptoms and localization of VS were analyzed with Cox proportional hazards regression models. Predictors for growth are unsteadiness/vertigo, no sudden onset of hearing loss and short duration of hearing loss. High-risk patients have (1) VS with an extrameatal localization, short duration of hearing loss and at least one of the two other predictors (unsteadiness/vertigo or no sudden sensorineural hearing loss) or (2) VS with an intrameatal localization and all three other predictors. Low-risk patients have (1) VS with an extrameatal component and no other predictor or (2) VS with an intrameatal localization and at most one other predictor. High-risk patients have a risk of growth of 36.9% in the first year and 64.6% in the second year. For patients with a low risk this is 2.5 and 12.7%, respectively. Simple data gathered at the moment of diagnosis may provide useful information since they may lead to a risk profile for growth

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Abstract:

OBJECTIVE:: The purpose of this study was to analyze if a daily routine of self-canalith repositioning procedure (CRP) will increase the time to recurrence and reduce the rate of recurrence of benign paroxysmal positional vertigo (BPPV). STUDY DESIGN:: Prospective study, nonrandomized control group. SETTING:: Outpatient clinic. PATIENTS:: Thirty-nine patients diagnosed with posterior canal BPPV successfully treated with the CRP. Based on a convenience sample, 17 (44%) patients were assigned to the treatment group, whereas 22 (56%) were assigned to the no-treatment group. The number of subjects lost at the time of follow-up were 5 (29.4%) of the treatment group and 2 (9%) of the no-treatment group. INTERVENTIONS:: Patients assigned to the treatment group performed the self-CRP daily, whereas those assigned to the no-treatment group performed no exercises. Patients were followed for up to 2 years. MAIN OUTCOME MEASURES:: The main outcome measures were the rate of recurrence of BPPV and the time for BPPV to recur. RESULTS:: Of the 39 subjects, symptoms recurred in 16 (41%) of the total population, 6 (35%) of 17 of the treatment group, and 10 (46%) of 22 of the no-treatment group. There was no difference in the frequency of recurrence (Pearson chi; p = 0.522) or the time to recurrence (survival analysis; log-rank test; p = 0.242). CONCLUSION:: Our results suggest that a daily routine of the self-CRP does not affect the time to recurrence and the rate of recurrence of posterior canal-BPPV.